Toward a Clinical AI License for Independent Initial Diagnosis and Prescribing in Primary Care

Recent medical large language models have been reported to approach physician-level performance in selected diagnostic and prescribing-related tasks, yet regulations continue to restrict clinical authority to licensed human professionals. Without assuming artificial general intelligence (AGI), I propose a Clinical AI License with four requirements, disease-domain performance thresholds, staged evaluation analogous to clinical trials, graduated scope of practice, and ongoing monitoring, together with an allocation of primary legal liability to the licensed operating entity. Responsibility, empathy, and safety are not fixed human monopolies; under an appropriate licensing framework, they can be specified, evaluated, and continuously monitored in AI-based clinical systems, potentially enabling scalable and more equitable healthcare.