The rise of the medical autonomist: How Agentic AI is rewiring healthcare

By Dr Rajendra Pratap Gupta

For decades, “AI in healthcare” meant sophisticated pattern recognition: a computer flagging a suspicious shadow on a lung X-ray or a chatbot answering “What are the symptoms of the flu?” But in 2026, we have moved beyond the era of passive assistants. We are entering the era of Agentic AI; autonomous, goal-oriented systems that do not just suggest; they act. That is why , in my functional pyramid AI Model, I call them ‘doers’.

Unlike traditional AI, which requires a human to prompt every step, agentic systems are capable of reasoning, planning, and executing multi-step workflows. They are the “medical autonomists” of the modern clinic, and their arrival is the most significant disruption to healthcare delivery since the electronic health record (EHR).

From “Chat” to “Do”: The Agentic Shift
The fundamental difference lies in agency. Traditional AI is reactive; Agentic AI is proactive. If a traditional AI identifies a patient’s rising blood pressure in a dataset, it puts a red flag on a dashboard. An AI Agent, however, understands the goal is “stabilize the patient.”

It will independently look up the patient’s medication history, cross-reference it with the latest clinical guidelines, draft a revised prescription for the doctor’s approval, and message the patient to schedule a follow-up—all before the physician has even sat down at their desk.

1. The End of “Administrative Debt”
The most immediate disruption is occurring in the “back office,” where administrative bloat has long been the primary driver of clinician burnout. Agentic AI is now being used to manage Revenue Cycle Management (RCM) and prior authorizations autonomously.

Real-World Disruption: In 2025, several major U.S. health systems began deploying “Authorization Agents.” Historically, getting an insurer to approve a specialty medication required a nurse to spend hours on portals and phones. Today, agentic systems autonomously navigate these payer portals, extract the necessary clinical evidence from the EHR, and submit the request. If denied, the agent analyzes the “Reason for Denial,” finds the missing data point, and submits an appeal automatically. Early pilots have shown a 60–80% reduction in manual administrative labor.

2. The Rise of “Ambient Clinical Intelligence”
We have progressed from “scribes” that simply transcribe notes to Agentic Scribes that manage the encounter. These agents don’t just listen; they coordinate.

Real-World Disruption: During a patient visit, an agentic system now monitors the conversation in real-time. If the doctor mentions a referral to cardiology, the agent doesn’t just write it down—it queries the local cardiology network for the earliest availability, checks the patient’s insurance for coverage, and has a “referral package” ready for the doctor to sign by the end of the 15-minute session. This has slashed “pajama time”—the hours doctors spend charting at night—by nearly 35%.

The 2028 Vision: The 50/50 Workforce
I look toward the near future, where the organizational chart of a healthcare provider is undergoing a radical transformation. By 2028, it predict that a matured healthcare organization will operate with a workforce split: 50% digital employees and 50% human employees.

These “digital employees” are not just software programs; they are agentic entities with defined roles, responsibilities, and performance metrics. While human clinicians focus on complex diagnostics, surgical procedures, and empathetic patient care, their digital counterparts handle the relentless demands of data entry, triaging, lab monitoring, and post-operative follow-ups.

Digital Empowerment and Profitability
This shift toward Digital Empowerment is not merely an operational upgrade, it is a financial necessity. Healthcare organizations are seeing a dramatic increase in profits driven by agentic AI.

Zero-Latency Billing: Digital employees process claims the moment a procedure is finished, virtually eliminating the “days in accounts receivable” that haunt hospital balance sheets.

Resource Optimization: Agents predict patient surges and adjust staffing and supply chains in real-time, preventing the costly waste of over-scheduling or the emergency premiums of under-staffing.

Leaking Revenue Recovery: By autonomously tracking every billable interaction and ensuring no follow-up care falls through the cracks, agentic systems capture revenue that previously evaporated due to human oversight.

The Guardrails: Trust and Transparency
The disruption is not without friction. As AI moves from “suggesting” to “doing,” the stakes for error skyrocket. The healthcare industry is currently grappling with the “Black Box” problem, the difficulty of retracing an agent’s logic during a complex, multi-step task.

To address this, 2026 has seen the standardization of “Human-in-the-loop” (HITL) frameworks. Agents are designed to operate within “latitudes of autonomy.” For high-risk tasks like medication changes, the agent acts as a “co-pilot,” preparing the logic and the action but requiring a final sign-off from a licensed human professional.

The New Bottom Line
Agentic AI is not replacing doctors; it is redefining the healthcare workforce. By delegating the process to a massive fleet of digital employees, we are finally allowing clinicians to return to the patient. For the healthcare organization of 2028, profit and patient outcomes are no longer at odds, they are both powered by the same autonomous engine.

* Dr Rajendra Pratap Gupta is the creator of the ‘Functional AI Pyramid model’ and chairman of the Academy of Digital Health Sciences