Abstract: Foundation models are becoming valuable tools in medicine. Yet despite their promise, the best way to leverage Large Language Models (LLMs) in complex medical tasks remains an open question. We introduce a novel multi-agent framework, named **M**edical **D**ecision-making **Agents** (**MDAgents**) that helps to address this gap by automatically assigning a collaboration structure to a team of LLMs. The assigned solo or group collaboration structure is tailored to the medical task at hand, a simple emulation inspired by the way real-world medical decision-making processes are adapted to tasks of different complexities. We evaluate our framework and baseline methods using state-of-the-art LLMs across a suite of real-world medical knowledge and clinical diagnosis benchmarks, including a comparison ofLLMs’ medical complexity classification against human physicians. MDAgents achieved the **best performance in seven out of ten** benchmarks on tasks requiring an understanding of medical knowledge and multi-modal reasoning, showing a significant **improvement of up to 4.2\%** ($p$ < 0.05) compared to previous methods' best performances. Ablation studies reveal that MDAgents effectively determines medical complexity to optimize for efficiency and accuracy across diverse medical tasks. Notably, the combination of moderator review and external medical knowledge in group collaboration resulted in an average accuracy **improvement of 11.8\%**. Our code can be found at https://github.com/mitmedialab/MDAgents.