# L2D-Clinical: Learning to Defer for Adaptive Model Selection in Clinical Text Classification

arXiv: https://arxiv.org/abs/2604.13285 · HTML: https://mlsanity.com/paper/2604.13285/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 10 of its 21 references that are in the map.
- First posted on arXiv 14 Apr 2026.

## Builds on (most cited first, 10 of 10)

- [BioBERT: a pre-trained biomedical language representation model for biomedical text mining](https://mlsanity.com/paper/1901.08746/) (2019)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [FrugalGPT: How to Use Large Language Models While Reducing Cost and Improving Performance](https://mlsanity.com/paper/2305.05176/) (2023)
- [Dataset Cartography: Mapping and Diagnosing Datasets with Training Dynamics](https://mlsanity.com/paper/2009.10795/) (2020)
- [Consistent Estimators for Learning to Defer to an Expert](https://mlsanity.com/paper/2006.01862/) (2020)
- [Predict Responsibly: Improving Fairness and Accuracy by Learning to Defer](https://mlsanity.com/paper/1711.06664/) (2017)
- [Large Language Models are Few-Shot Clinical Information Extractors](https://mlsanity.com/paper/2205.12689/) (2022)
- [The Right Tool for the Job: Matching Model and Instance Complexities](https://mlsanity.com/paper/2004.07453/) (2020)
- [The Algorithmic Automation Problem: Prediction, Triage, and Human Effort](https://mlsanity.com/paper/1903.12220/) (2019)
- [Investigating Selective Prediction Approaches Across Several Tasks in IID, OOD, and Adversarial Settings](https://mlsanity.com/paper/2203.00211/) (2022)

## Built on by (most cited first, 1 of 1)

- [Learning to Fuse LLMs with Ontology Rankers for Rare-Disease Diagnosis](https://mlsanity.com/paper/2609.02473/) (2026)

## Abstract (arXiv)

Clinical text classification requires choosing between specialized fine-tuned models (BERT variants) and general-purpose large language models (LLMs), yet neither dominates across all instances. We introduce Learning to Defer for clinical text (L2D-Clinical), a framework that learns when a BERT classifier should defer to an LLM based on uncertainty signals and text characteristics. Unlike prior L2D work that defers to human experts assumed universally superior, our approach enables adaptive deferral-improving accuracy when the LLM complements BERT. We evaluate on two English clinical tasks: (1) ADE detection (ADE Corpus V2), where BioBERT (F1=0.911) outperforms the LLM (F1=0.765), and (2) treatment outcome classification (MIMIC-IV with multi-LLM consensus ground truth), where GPT-5-nano (F1=0.967) outperforms ClinicalBERT (F1=0.887). On ADE, L2D-Clinical achieves F1=0.928 (+1.7 points over BERT) by selectively deferring 7% of instances where the LLM's high recall compensates for BERT's misses. On MIMIC, L2D-Clinical achieves F1=0.980 (+9.3 points over BERT) by deferring only 16.8% of cases to the LLM. The key insight is that L2D-Clinical learns to selectively leverage LLM strengths while minimizing API costs.