{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/neurologists/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Neurologists",
    "soc_code": "29-1217",
    "category": "Healthcare",
    "us_employment": 10590,
    "median_annual_wage": 248560
  },
  "verdict": "SAFE",
  "risk_resistance": 80,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 12,
    "embodiment": 14,
    "liability_shield": 19,
    "trust_premium": 17,
    "judgment_accountability": 18
  },
  "reasoning": {
    "task_resistance": "A 12 reflects that a real share of the neurologist's day — dictating H&Ps, generating differentials from a symptom list, first-pass reads of MRI for white-matter lesions, screening 24-hour EEG for spikes, titrating antiepileptics by protocol — is already being absorbed by ambient scribes and FDA-cleared triage software, while localizing a lesion from an inconsistent exam or distinguishing psychogenic nonepileptic seizures from frontal-lobe events at the bedside stays out of reach.",
    "embodiment": "A 14 rather than 18 recognizes that the hands are essential but the environment is mostly controlled: percussing reflexes, testing tone and pronator drift, needle EMG through muscle, LP into the L3-L4 space, EMG-guided botulinum into cervical dystonia — all in clinic or on the ward, not roadside or in a patient's kitchen, and a meaningful fraction of stroke-call decisions now happen over telestroke video.",
    "liability_shield": "A 19 is set by the fact that tPA and thrombectomy decisions, DEA-scheduled prescribing of antiepileptics and stimulants, and EMG interpretation are signed under an individual state medical license backed by board certification in neurology, and a door-to-needle miss or a missed cord compression names the neurologist personally in the malpractice complaint, not the hospital's algorithm vendor.",
    "trust_premium": "A 17 comes from the disease timelines: epilepsy, MS, Parkinson's and ALS patients stay with the same neurologist for a decade, and the willingness to accept a DMT change, a driving restriction, a PEG tube conversation, or hospice referral rests on that specific accumulated relationship rather than the recommendation's content.",
    "judgment_accountability": "An 18 tracks the calls with no clean rule: thrombolysis in a 79-year-old on apixaban with an unclear last-known-well, immunosuppression escalation in seronegative autoimmune encephalitis that is deteriorating, brain-death determination and apnea testing, and whether an atypical MRI is MS, NMOSD, or sarcoid — each made on incomplete data with irreversible consequences."
  },
  "rationale": "Neurology's diagnostic core rests on the hands-on neurological exam — reflexes, gait, tone, cranial nerves, subtle asymmetries — which no current system can perform, plus procedures like EMG/nerve conduction, lumbar puncture, botulinum injections, and EEG supervision. AI is genuinely strong on the pattern layer: MRI lesion detection, EEG spike flagging, differential generation, and note drafting, so documentation and first-pass image reads will compress. What persists is owning ambiguous calls — is this MS or an atypical mimic, do we thrombolyse, do we escalate immunotherapy in a deteriorating encephalitis patient — under personal license and liability, and delivering diagnoses like ALS or dementia to families over years of care.",
  "outlook": "By 2035 AI handles most neurology documentation and first-pass imaging/EEG screening, letting neurologists see more patients — the exam, procedures, and acute decision-making stay firmly human, and the persistent US shortage keeps demand well above supply.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "task_resistance",
        "change": "As AI absorbs first-pass MRI reads, EEG spike flagging, and note drafting, the residual day concentrates on the ambiguous tier: atypical demyelinating vs mimic, immunotherapy escalation in autoimmune encephalitis, thrombolysis/thrombectomy calls under time pressure, and multi-year disease-modifying therapy sequencing. This is a genuine two-tier occupation and the judgment tier is not currently automatable.",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "task_resistance",
        "change": "Growth in procedure-anchored subspecialty work — EMG/NCS, botulinum chemodenervation for dystonia/spasticity, DBS programming, intrathecal nusinersen, epilepsy surgery mapping — shifts the case mix toward tasks requiring hands and real-time interpretation. Watch RVU mix and fellowship match data in neuromuscular and epilepsy.",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "liability_shield",
        "change": "FDA moving toward requiring autonomous-mode neuro imaging/EEG triage devices (e.g. Viz.ai LVO, Persyst) to be labeled adjunctive-only with a named physician-of-record interpretation, plus CMS conditioning the AI add-on payment (NTAP-style) on documented physician concurrence, would harden the countersignature requirement.",
        "plausibility": "plausible",
        "would_add": 1
      },
      {
        "dimension": "trust_premium",
        "change": "Payer and health-system telestroke contracts that specify a board-certified vascular neurologist must be on the video call for thrombolysis decisions, plus Joint Commission Comprehensive Stroke Center certification standards naming neurologist availability, convert trust into a purchased requirement rather than a preference.",
        "plausibility": "already happening",
        "would_add": 2
      },
      {
        "dimension": "judgment_accountability",
        "change": "State board and malpractice-carrier positions that AI output does not transfer the standard of care — mirroring recent AMA policy on 'augmented intelligence' physician oversight — plus court rulings holding the interpreting neurologist liable for a missed AI-flagged lesion, keep the consequential call personally owned.",
        "plausibility": "plausible",
        "would_add": 1
      }
    ],
    "ceiling_note": "Already 80/100; the institutional dimensions are near saturation, so realistic headroom is a few points, mostly from task-mix concentration in the judgment and procedural tier. The downward pressure on routine imaging/EEG reads is real and may offset."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2021,
        "emp": 7120,
        "wage": 239200
      },
      {
        "y": 2022,
        "emp": 11340,
        "wage": 224260
      },
      {
        "y": 2023,
        "emp": 9350,
        "wage": 239200
      },
      {
        "y": 2024,
        "emp": 7700,
        "wage": 239200
      },
      {
        "y": 2025,
        "emp": 10590,
        "wage": 248560
      }
    ],
    "from": 2021,
    "to": 2025,
    "change_pct": 48.7,
    "comparable_from": 2021,
    "spans_soc_revision": false
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}