AI Regulation Tracker  /  Healthcare and medicine

FSMB Tells State Medical Boards How to Govern AI, and Keeps the Physician Accountable

Guidance to the regulators, not a rule on doctors. In April 2024 the Federation of State Medical Boards adopted recommendations on the responsible and ethical use of AI in clinical practice. The through-line is simple: the tool is not licensed, the physician is, and the physician stays accountable for what the AI does.

By Anthony Guerriero  ·  The Leveraged Years Regulatory Research  ·  Published July 21, 2026  ·  Last updated July 21, 2026

The Federation of State Medical Boards is the national body that represents the state boards that actually license and discipline physicians in the United States. In April 2024 its House of Delegates adopted a report called Navigating the Responsible and Ethical Incorporation of Artificial Intelligence into Clinical Practice. Get the posture right before anything else. The FSMB does not regulate doctors. State boards do. So this document is not a rule you can be sanctioned under. It is a recommendation to the regulators about how they should think, and where a state board adopts it, that is where it starts to bite.

That is exactly why physicians should read it now rather than later. When a state board writes AI expectations into its own practice standards, this is the framework it is most likely to reach for. The FSMB built the recommendations around six themes: education, human accountability, informed consent and data privacy, responsibility and liability, collaboration with experts, and grounding the whole thing in medical ethics. The one that matters most to a working physician is accountability, and the FSMB does not hedge on it.

Does the physician stay responsible when AI is involved?

Yes, without qualification. The FSMB frames the point around a basic fact about medical regulation: "State medical boards do not regulate tools or technologies, only the licensed physicians that use those tools." From there it draws the accountability line hard. In its words, "the physician is ultimately responsible for the use of AI and should be held accountable for any harms that occur." The report treats AI as decision support, not decision-maker. Once a physician chooses to use it, they accept responsibility for how they respond to it, and they are expected to be able to give a rationale. The blunt version, again from the report, is that "failure to apply human judgement to any output of AI is a violation of a physician's professional duties."

This cuts both ways, which is the useful part. If you follow an AI recommendation, you should be prepared to explain why it met the standard of care. If you override it, the FSMB says you "should document the rationale behind the deviation and be prepared to defend the course of action." Even with an opaque black-box tool, the physician is expected to offer a reasonable interpretation of how the output fits the standard of care. The documentation burden lands on the doctor either way.

What does the FSMB say about telling patients AI was used?

The report ties AI to the existing duty of informed consent and pushes toward disclosure. It states that "physicians should disclose to patients when and how AI is used in their care and clearly communicate about the capabilities and limitations of their tools to the patient, including how they use and share any patient data." It also says physicians should obtain a patient's consent before applying a tool that inputs data from the encounter. The framing is that informed consent is not a machine-generated list of risks, it is a real dialogue, and "the ultimate responsibility rests with the physician." For a clinician, the practical takeaway is that AI use is now part of the consent conversation, not a silent back-office process.

Does this create a new CME obligation?

Not a mandatory one, but the direction is clear. The FSMB recommends that "medical education, at all levels, should include an emphasis on advanced data analytics and use of AI in a clinical setting," and that physicians "should regularly engage in accredited continuing medical education programs designed to improve competence in understanding the application, benefits, and risks of AI." It also flags over-reliance on AI as its own hazard, one that can erode independent clinical thinking. Competence with the tool, and the discipline not to lean on it blindly, are both treated as professional duties.

What should US physicians and health-care counsel do now?

Watch your own state board. The FSMB report is the national template, but it has legal effect only where a board adopts it, so the real question is what your licensing board does with it. In the meantime, the low-cost moves map straight onto the report. Document your reasoning whenever AI informs a diagnosis or treatment decision, whether you follow it or reject it. Fold AI use into your informed-consent process and be ready to explain what the tool does with patient data. Keep an eye on accredited AI-focused CME. For health-care counsel and risk managers, this document is a preview of the standard of care that plaintiffs and boards will point to, so aligning documentation and consent workflows to it now is cheaper than retrofitting them after a claim.

Browse the full AI Regulation News tracker

Informational analysis for working professionals, not legal or medical advice. Confirm how any recommendation or board rule applies to your practice with qualified counsel and your state medical board.