The Federation of State Medical Boards just argued that a license isn’t a certificate of correctness — it’s a name to attach when something goes wrong. This is the federal database of those names.
The FSMB’s president and board chair published their answer on August 3 to whether generative AI should be licensed to practice medicine. The answer is no, and the reason isn’t accuracy. Their argument: a license is a grant of authority tied to a human being who can be disciplined, sued, and named.
Nobody disciplines a checkpoint.
So look at where the naming actually happens. The National Practitioner Data Bank holds 1,911,185 disclosable reports covering 985,019 distinct practitioners. Every one is a person. Not one is a product.
Below is the paid-malpractice half of it, cut two ways at once: what was alleged (11 allegation groups) × what happened to the patient (10 injury-severity codes). Every one of the 110 cells is a dot.
One dot = one (allegation group × injury severity) cell. Radius scales with claim count. Payments are the midpoints of coded ranges, not exact dollars — the NPDB public file does not release actual amounts.
Clinical AI does not have its own category here. Whatever it touches, the claim files under one of these eleven headings, under a person’s name.
| Allegation group | Paid claims | Share | Mean payment | % death |
|---|
Rows in red are the four groups a diagnostic or decision-support tool most plausibly touches. Together: 63.8% of paid claims and 60.5% of dollars, 2004–2021.
Paid malpractice claims are the money machine. Adverse licensure actions are the license machine. Over the same twenty years, one got quieter and the other got busier.
Paid claims by incident year (left axis) vs. adverse licensure actions by action year (right axis). Incident years 2020–2021 are shaded: NPDB reports arrive years after the incident, so the most recent incident years are structurally incomplete. Do not read the tail as a trend.
PAYMENT holds the midpoint of a coded band. Every sum here understates high-value claims, and the largest band swallows everything above it.Two state legislatures — Idaho and Iowa — introduced bills this year to license “autonomous service providers” outside the medical board. Both failed. FSMB has now told boards to go re-read how their state defines the practice of medicine.
That definition is the API contract every clinical AI tool is written against, and 69 boards are about to start editing it independently. Meanwhile the accountability record stays what it has always been: a name, a date, an allegation group, and a number.
Your real users aren’t the people who need the answer. They’re the people who have to sign it.