Doctors Burnout from Spending Less Time with Patients and More Time Arguing with Insurance Firms

Government policies have increased the paperwork that physicians must process and the time they must spend arguing with insurance companies on behalf of their patients. The policies have increased the need for back-office staff to handle the regulations, and so increased the overhead of private practice. So more and more physicians have given up private practice and become employees. They find their work less fulfilling and face burnout. Patients suffer when more of their physicians are bitter and burned-out.

(p. A1) There’s a question dividing the medical practice right now: Is being a doctor a job, or a calling?

. . .

(p. A2) Physicians work an average of 59 hours a week, according to the American Medical Association, and while the profession is well-compensated—the average physician makes $350,000, a recent National Bureau of Economic Research analysis found—it comes with high pressure and emotional strain.

. . .

Among physicians under age 45, only 32% own practices, down from 44% in 2012. By comparison, 51% of those ages 45 to 55 are owners.

Owners have more autonomy, but also increasing overhead costs. Vaughan, who sold his private practice in 2011, saw his malpractice insurance premiums increase to $65,000 a year.

Dr. Joseph Comfort, 80, sold his anesthesiology practice in 2003, frustrated by rising billing tussles with insurance companies. He now works part time as an internal medicine doctor at a small concierge clinic in Sanford, Fla.

“We’ve been ripped down off our pedestals,” he says.

For generations, Comfort says, doctors accepted being at the mercy of their pager and working long hours as the cost of doing business. “We took it because we considered ourselves to be masters of our own fate,” he says. “Now, everything’s changed. Doctors are like any other employee, and that’s how the new generation is behaving.”

They also spend far more time doing administrative tasks. One 2022 study found residents spent just 13% of their time in patient rooms, a factor many correlate with burnout.

. . .

In San Francisco, Dr. Christopher Domanski—a first-year resident who had his first child earlier this year—says he’s interested in pursuing a four-day workweek once he’s completed his training.

“I’m very happy to provide exceptional care for my patients and be there for them, but medicine has become more corporatized,” says Domanski, 29. Though he’s early in his medical career, he’s heard plenty of physicians complain about needing to argue with insurance companies to get their patients the treatments they need.

“It’s disheartening,” he says.

For the full story see:

Te-Ping Chen. “Younger Doctors Balk at Medicine’s Workaholic Culture.” The Wall Street Journal (Monday, Nov 04, 2024 [sic]): A1-A2.

(Note: ellipses added.)

(Note: the online version of the story has the date November 3, 2024 [sic], and has the title “Young Doctors Want Work-Life Balance. Older Doctors Say That’s Not the Job.”)

Early Illegal Migrants’ Resentment of “the Venezuelans” Led Them to Support Trump

I often disagree with the commentaries in The New York Times, but recently I read one that taught me something important that I did not know.

For the commentary, Megan Stack interviewed two Mexican immigrants in Chicago, one legal and one illegal.

(p. A20) They are both fans of Donald Trump. Mr. Mata voted for Trump, and though Jose can’t vote, he tells me that Mr. Trump “has courage.

They blame “the Venezuelans,” which is their shorthand for the roughly 50,000 migrants who came to Chicago in buses in the last three years. Because of how they were processed at the border during the Biden years, “the Venezuelans” are allowed to receive work permits, which gives them an unfair advantage over earlier illegal migrants such as Jose. And some of them are criminals.

Chicago has spent about $640 million in housing, feeding, and otherwise supporting “the Venezuelans” which has caused resentment both among long-term Chicago citizens and among the earlier illegal migrants, who were not so well-housed, fed, or supported.

Stack’s commentary taught me that many illegal migrants support and admire Donald Trump, and it taught me why.

For Stack’s full commentary see:

Megan K. Stack. “Why Immigrants Fear Trump Even if They Voted for Him.” The New York Times (Sat., March 15, 2025): A20-A21.

(Note: the online version of the commentary has the date March 10, 2025, and has the same title as the print version.)

Vindication is Sweet, Even 60 Years Too Late

When I was a child my mother would stick an oral thermometer in my mouth. When she returned she would always be annoyed with me, saying that I didn’t have it in right, because my temperature was too low. She would say with irritation: ‘Now this time do it right!’ So I would feel discouraged and would give the thermometer a hard jab into my mouth until it hurt. But my temperature would still be too low.

The story below suggests, decades too late for me, that maybe it wasn’t my fault. Maybe the official mandated “normal” temperature of 98.6 was wrong!

(p. D6) We seem to be getting cooler. Since 1851, when the standard was set at 37 degrees centigrade, or 98.6 Fahrenheit, the average human body temperature has steadily declined.

. . . . The analysis is in eLife.

. . .

. . . improvements in sanitation and improved dental and medical care have reduced chronic inflammation, and the constant temperatures maintained by modern heating and air conditioning have helped lower resting metabolic rates. Today, a temperature of 97.5 may be closer to “normal” than the traditional 98.6.

For the full story see:

Nicholas Bakalar. “Is 98.6 No Longer ‘Normal’?” The New York Times (Tuesday, January 21, 2020): D6.

(Note: ellipsis, and bracketed date, added.)

(Note: the online version of the story was updated Jan. 21, 2020 [sic], and has the title “Body Temperature 2.0: Do We Need to Rethink What’s Normal?”)

The academic paper in eLife, mentioned above, is:

Protsiv, Myroslava, Catherine Ley, Joanna Lankester, Trevor Hastie, and Julie Parsonnet. “Decreasing Human Body Temperature in the United States since the Industrial Revolution.” eLife 9 (2020): e49555.

See also:

Dana G. Smith. “We Are Running Cooler, on Average.” The New York Times (Tues., October 17, 2023): D7.

Ed Leamer Doubted the Robustness of Many Econometric Studies

Ed Leamer showed that a lot of econometric studies in economics amounted to economists searching among the plethora of plausible specifications of variables and functional forms, until they found one that yielded the sign and statistical significance of the variable they cared about. So, for example, an economist who thought capital punishment deterred murder, could produce that result, and an economist who thought capital punishment did strong>not deter murder, could also produce that result.

Leamer suggested that economists should show whether their results varied under a variety of specifications, in order to show the robustness of the claimed main result.

(p. C6) One day in elementary school, Edward Leamer noticed that his teacher had written the wrong answer to a math problem on the blackboard, so he stood up and told her so. His teacher took another look and assured him that it was correct. Again he protested, so she asked him to take his seat.

“He refused to sit down,” his brother, the author Laurence Leamer, said in a gathering on Zoom to celebrate his brother last month. “His whole life, he’s refused to sit down.”

Leamer, an economist who died Feb. 25 at the age of 80 from complications stemming from ALS (or Lou Gehrig’s disease), was best known for standing up and telling economists that they were doing it wrong. In influential papers like 1983’s “Let’s Take the Con Out of Econometrics” and his seminal book, “Specification Searches” (1978), Leamer warned economists that the methods they were using to analyze data produced weak findings that couldn’t hold up to scrutiny. He said economists often had a bias toward the results they wanted or that were the kinds of firm conclusions that led to press coverage, funding and policy positions they supported.

What’s more, Leamer warned economists that they weren’t being honest about the strength of their conclusions or transparent about the fact that they had run other tests that showed different results.

For the full obituary, see:

Chris Kornelis. “The Economist Who Called Out Other Economists.” The Wall Street Journal (Saturday, March 15, 2025): C6.

(Note: the online version of the obituary has the date March 14, 2025, and has the title “Edward Leamer, Economist Who Said Economists Were Doing It Wrong, Dies at 80 [sic].” Where the wording is different between the versions, the last three sentences quoted above follow the online version.)

Leamer’s wonderful paper, mentioned above, is:

Leamer, Edward E. “Let’s Take the Con Out of Econometrics.” American Economic Review 73, no. 1 (March 1983): 31-43.

Leamer’s book, mentioned above, is:

Leamer, Edward E. Specification Searches: Ad Hoc Inference with Nonexperimental Data, Wiley Series in Probability and Mathematical Statistics. New York: John Wiley & Sons, Inc., 1978.

“Practice-Changing” Cancer Advance Adds Only 10 Months of Life

The subheadline of this article gushed that this drug “tripled life expectancy,” the article quoted one expert gushing that it was “a light after a long time,” and another expert gushing that it “will be practice-changing.”

Then you read more carefully and see that the average recipient of the drug has a gain in life expectancy from about four and a half months without the drug to 14 months with the drug–in other words a gain of only roughly 10 months, and with the major side effect of cytokine syndrome.

This illustrates the discouraging side of many ballyhooed cancer advances, they amount to only months of added life, and the added life comes at the cost of major side effects.

(p. D4) The Food and Drug Administration on Thursday [May 16, 2024] approved an innovative new treatment for patients with a form of lung cancer. It is to be used only by patients who have exhausted all other options to treat small cell lung cancer, and have a life expectancy of four to five months.

The drug tarlatamab, or Imdelltra, made by the company Amgen, tripled patients’ life expectancy, giving them a median survival of 14 months after they took the drug. Forty percent of those who got the drug responded.

After decades with no real advances in treatments for small cell lung cancer, tarlatamab offers the first real hope, said Dr. Anish Thomas, a lung cancer specialist at the federal National Cancer Institute who was not involved in the trial.

“I feel it’s a light after a long time,” he added.

Dr. Timothy Burns, a lung cancer specialist at the University of Pittsburgh, said that the drug “will be practice-changing.”

(Dr. Burns was not an investigator in the study but has served on an Amgen advisory committee for a different drug.)

The drug, though, has a side effect that can be serious — cytokine release syndrome. It’s an overreaction of the immune system that can result in symptoms like a rash, a rapid heartbeat and low blood pressure.

For the full story see:

Kolata, Gina. “Drug Approved for a Stubbornly Deadly Cancer.” The New York Times (Tuesday, May 21, 2024 [sic]): D4.

(Note: bracketed date added.)

(Note: the online version of the story has the date May 16, 2024 [sic], and has the title “F.D.A. Approves Drug for Persistently Deadly Form of Lung Cancer.”)

The New York Times Discovers Diverse Americans Support the Right to Bear Arms

In a surprising front page article The New York Times presents several diverse new gun owners who differ in gender, race, ethnicity, education, and in some cases who previously opposed gun ownership. But in each case they want to avail themselves of the right to protect themselves.

Sometimes they also see other, secondary, advantages.

(p. A1) Ken Green’s tipping point came as he watched an angry mob storm the U.S. Capitol on Jan. 6, 2021.

John Alvarado’s came during the pandemic, as he evolved from a self-described “bleeding-heart liberal” to a deeply religious conservative.

A spike in anti-Asian violence in that same period is what motivated John Tsien.

For Victoria Alston, it was living on her own again after separating from her husband.

And for Anna Kolanowski, the tipping point came as she walked to a bar one night to meet friends.

. . .

(p. A11) With her parents — Polish immigrants, and longtime gun owners, who were not completely comfortable with her gender transition — Ms. Kolanowski’s new hobby has provided a bonding opportunity.

“It’s kind of cute, like, ‘We have something in common!’” she said.

Ms. Kolanowski and the other new owners said they had expected to feel more confident and self-reliant after buying guns. Less expected, they said, were the new friends they made, and the uplifting sense of having bridged a societal divide.

Several described a profound enjoyment of a pastime they never dreamed would be so satisfying.

Though he dislikes the macho energy that he sees pervading gun culture, Mr. Tsien says he has found shooting to be a deeply meditative, calming pursuit.

He likens the hobby to others he has embraced in the past, like photography and scuba diving, where part of the appeal is mastering a complicated tool and understanding how it works.

For Ms. Alston, the connection with other Black women at her shooting range felt energizing and empowering: “We’re finally becoming less afraid,” she said.

Likewise, Dr. Green sees his gun ownership as a way of defending his Jewish identity.

“One of the reasons the Holocaust happened is because people allowed it to happen,” he said. “Not on my watch.”

Several said they looked for opportunities to talk about their decisions, even with those who were skeptical, in hopes of promoting dialogue and understanding.

In Mr. Alvarado’s church in Maine last summer, he sat by a door in the back, keeping watch. His role on the security team is “where I fit in,” he said. “It feels purposeful, and it feels good to have a purpose.”

For the full story see:

Jenna Russell, Emily Rhyne and Noah Throop. “Moment They Knew It Was Time to Own a Gun.” The New York Times (Thurs., Feb. 20, 2025): A1 & A10-A11.

(Note: ellipsis added.)

(Note: the online version of the story has the date Feb. 16, 2025, and has the title “The Tipping Point.”)

Hackman Was the Inspiring Hero of The Poseidon Adventure

I was surprised to see a commentary on Gene Hackman by Ben Stiller, so I started reading. He wrote that one Hackman film had mattered to him a lot.
I doubted that we liked the same film, but I read on, feeling a bit of hope and suspense. I admit I felt a tingle of triumph when I read that we both liked the same film–The Poseidon Adventure.

Stiller said that at age 7 he watched it in the theatre about 10 times. I don’t remember if I ever saw it in the theatre, but I have watched it more than once and I think about it fairly often. What I think about is what the passengers do when the ship is flipped over by a mammoth wave. Almost all of the surviving passengers start hobbling toward the top deck of the ship, hoping for rescue. But the small band of misfits who had been sitting at Reverend Gene Hackman’s table, plus the cruise singer, are convinced by Hackman that the only hope for rescue is to go in the opposite direction, because the hull is now the highest point of the ship.

He convinces them and he leads them in the right direction. At a key moment he acts to save them. The movie had hope in the face of disaster, perseverance paying off, courage when almost everyone else is going in the wrong direction.

Stiller says that the movie, and Hackman’s character in it, inspired him to want to be an actor. When Stiller acted as Hackman’s son in The Royal Tenenbaums, he finally worked up the courage to tell Hackman how much Hackman’s performance in The Poseidon Adventure had meant to him. Hackman smiled at him and simply said “money job.” Then Hackman got up when they called for them to shoot their last scene together. Stiller stayed sitting for several seconds, seeming stunned. In their scene Stiller tells Hackman that he has gone through a lot recently. Hackman looks at him with great empathy, puts a hand reassuringly on his neck and says “I know.” He says it was the same sincerity that he saw in Hackman’s performance in The Poseidon Adventure, and he doesn’t think it was a money job.

Just now I watched a YouTube interview of Hackman by Johnny Carson on the filming of The Poseidon Adventure. Hackman has a modesty to him, and a sense of humor. He talks about the filming being fun, but also talks of being disappointed that they cut a scene in which he did a difficult stunt. He could have just let the stuntman do it, but he chose to do it. When he was doing the movie he took it seriously.
My take is that as a modest man, when he said “money job” he might have been deflating the awkward intensity of what Stiller had told him, and it might not have been the whole truth.

For Stiller’s full commentary see:

Ben Stiller. “Gene Hackman’s Simple Truth.” The New York Times (Sat., March 1, 2025): A19.

(Note: the online version of the commentary has the date Feb. 28, 2025, and has the title “Ben Stiller on Gene Hackman’s Simple Truth.”)

Public Health “Experts” Rebuffed Renegades Who Saw Covid Spread in Aerosols

Steven Johnson’s The Ghost Map shows how rigid adherence to the miasma theory of disease shut out alternatives. And an alternative was indeed needed to explain the spread of cholera. But the defeat of the miasma theory for cholera may have been too complete, prejudicing scientists to oppose theories of disease-spread through the air, which turn out to be important for some diseases, such as Covid-19.

(p. C9) In early 2020, as word spread of a frightening new respiratory outbreak in China, the World Health Organization and the Centers for Disease Control and Prevention were pressed for advice. Both initially counseled social distancing, guided by the assumption that the disease was spread by large, boggy droplets that fell rapidly to the ground after being expelled by coughing or sneezing.

By avoiding such projectiles and keeping surfaces clean, the reasoning went, infection could be avoided. Yet this advice ignored—with tragic consequences—nearly a century of science suggesting that many respiratory diseases can spread via microdrops that are exhaled during normal breathing and can remain suspended in the air for hours.

In “Air-Borne,” the New York Times science writer Carl Zimmer seeks to explain how public-health officials could have overlooked such an important mechanism of the Covid-19 contagion. He begins his meticulous history with the ancient Greek physician Hippocrates, who taught that illness could be caused by “an invisible corruption of the air,” which he termed a “miasma.”

. . .

While the field of aerobiology may have entered the new millennium stuck on a “stagnant plateau,” as one journal article lamented, hope was starting to emerge. Advances in technology led to a more complete characterization of the aerobiome. A range of scientists from around the world, meanwhile, re-examined the possibility of airborne transmission and discovered the evidence against it wanting.

Following the emergence of Covid-19, many of these researchers were appalled by the seemingly reflexive—“mind-boggling,” in the words of one scientist—rejection of airborne transmission by public-health agencies. At first, these renegades individually struggled to have their work published but were largely rebuffed.

After an early Covid-19 outbreak among a choir in Washington state was initially attributed to large-droplet spread, a more detailed analysis by a unified group of skeptical researchers suggested that airborne transmission was far more likely. On Dec. 23, 2021—nearly 21 months after tweeting “FACT: #COVID19 is NOT airborne”—the WHO “finally issued a clear public statement that the virus was airborne,” Mr. Zimmer writes. A triumph for persistent scientists, perhaps, but also a pointed reminder of the complexity, fragility and deeply human dependencies of evolving science.

For the full review see:

David A. Shaywitz. “Microbes in the Mist.” The Wall Street Journal (Saturday, March 15, 2025): C9.

(Note: ellipsis added.)

(Note: the online version of the review has the date March 14, 2025, and has the title “‘Air-Borne’: The Microbes in the Mist.”)

The book under review is:

Zimmer, Carl. Air-Borne: The Hidden History of the Life We Breathe. New York: Dutton, 2025.

DNA Analysis Refutes Some Anthropologists’ Pompei Stories

When we visited Pompei many years ago, the plaster castes of of the skeletons of victims created powerful memories. Anthropologists created stories about who they were and what they were doing when disaster struck. Now DNA can be analyzed from the bones, to learn the gender and relatedness of the victims.
What has been learned often refutes the stories. For instance, one group of four was viewed as a mother with her three children. DNA analysis shows that the adult in the group was a male, and none of the four victims was related to each other. The moral of this story seems to be to take anthropological stories based on slender evidence, with an especially large grain of salt.

The DNA analysis is discussed in:

Franz Lidz. “Pompeii Narratives Take a Twist With DNA.” The New York Times (Tues., November 12, 2024): D4.

(Note: the online version of the article has the date Nov. 7, 2024, and has the title “With DNA, Pompeii Narratives Take a Twist.”)

The academic paper reporting the DNA analysis is:

Pilli, Elena, Stefania Vai, Victoria C. Moses, Stefania Morelli, Martina Lari, Alessandra Modi, Maria Angela Diroma, Valeria Amoretti, Gabriel Zuchtriegel, Massimo Osanna, Douglas J. Kennett, Richard J. George, John Krigbaum, Nadin Rohland, Swapan Mallick, David Caramelli, David Reich, and Alissa Mittnik. “Ancient DNA Challenges Prevailing Interpretations of the Pompeii Plaster Casts.” Current Biology 34, no. 22 (2024): 5307-18.e7.

Global Warming Allows German Wine Entrepreneurs to Grow a “Superb” Chardonnay

In my Openness book, I argue that the costs of global warming have been exaggerated, partly because environmentalists forget that entrepreneurs can adapt, either lessening the costs, or sometimes even creating benefits. A case of creating benefits is apparently now the growing of “superb” chardonnay wine in Germany:

(p. D4) What accounts for the arrival of . . . German chardonnays? Certain wine regions like Rheinhessen, the Pfalz and the Obermosel have limestone soils, which chardonnay has a special affinity for, but the warming climate has made it possible to ripen chardonnay sufficiently to make superb wines.

Climate change influenced decisions to plant chardonnay in other ways as well.

“Climate change for us does not just mean it’s getting warmer and warmer, it means everything is getting more extreme — frost risk, weeks without rain, hailstorms,” said Klaus Peter Keller, . . . . “Therefore, we must spread the risk a bit more than we would 30 or 40 years ago. Rather than 100 percent riesling we have now 70 percent riesling, 15 percent pinot noir, 10 percent chardonnay and 4 percent others, and we think that will be the structure for the coming 30 or 40 years.”

Mr. Keller said he had wanted to plant pinot blanc rather than chardonnay but that their son Felix had pushed for chardonnay.

“Felix was right,” he said. “Chardonnay is much better adapted to climate change, with thicker skins, and it transmits the soil much better than pinot blanc.”

Felix Keller said by email that his grandfather had tried planting chardonnay in 1988, but that the timing had been wrong.

“Back then, it didn’t ripen every year,” he said. “It took us until 2018 to try again. We believe chardonnay has a bright future in Germany because we now have the climate that used to be in Burgundy in the early ’90s.”

For the full commentary see:

Eric Asimov. “The Pour; A Surprise From Germany: Chardonnay.” The New York Times (Weds., March 5, 2025): D1 & D4.

(Note: ellipses added.)

(Note: the online version of the commentary was updated March 4, 2025, and has the same title as the print version.)

My book mentioned in my initial comments is:

Diamond, Arthur M., Jr. Openness to Creative Destruction: Sustaining Innovative Dynamism. New York: Oxford University Press, 2019.

Hamas Seeks “Genocidal” International Jihad

Israel is a tiny democracy, and a hotbed of innovative entrepreneurship. See Gilder’s The Israel Test and Senor and Singer’s Start-up Nation.

I wish I had posted this entry a year ago–maybe ‘better late than never’. Tiny Israel just wants to be left alone to flourish and innovate; Hamas wants to destroy Israel.

(p. A11) Unfortunately, the tendency of sophisticated observers is to play down what terrorists say they believe. In a phone interview from Washington, Steve Stalinsky, Memri’s executive director, points out that in all the coverage of the war, “we have heard almost nothing about the Hamas ideology. Yeah, sure, sometimes you hear about the Hamas Covenant”—the group’s charter, which spells out its genocidal intentions—“but that’s it, and no one even prints it.”

Memri prints it, and publishes video compilations of Hamas leaders stating their movement’s goal: to build an Islamic caliphate stretching from Palestine across the region and the world. That sounds more like international jihad than Palestinian nationalism.

Headquartered in Washington, Memri monitors and translates TV broadcasts, newspapers, sermons, social-media posts, textbooks and official statements in Arabic, Farsi and several other languages. The work may be drudgery, but it yields a steady stream of articles and viral video clips that condemn the region’s tyrants, terrorists and two-faced intellectuals with their own words.

Memri also documents Gazans’ indoctrination from childhood into a religious ideology that puts them on a war footing. “Their textbooks are our life,” Mr. Carmon says, “but no one paid attention.” Instead, Israeli leaders were convinced that Qatari money and past beatings would deter Hamas.

Mr. Carmon directs me to a recent article in which he writes, “Any Arab who hears American officials say that Qatar is America’s ally would burst into laughter—those clueless Americans, who don’t even know that Qatar is spitting in their face with wild anti-U.S. incitement 24/7 . . . because they only watch the deceptive Al-Jazeera TV in English.” On the Arabic-language channel, he says, Qatari-owned Al Jazeera “is the megaphone of Hamas like it was the megaphone of al Qaeda. Every speech, every statement—everything is aired several times until everybody gets it.”

The article faults the Biden administration for “pleading with Qatar” instead of threatening it: “Just one comment by the U.S. administration that it is considering relocating Al Udeid Air Base from Qatar (without which Qatar will cease to exist within a week) to the UAE will set the Qataris running to bring all the American hostages back home.” Instead, while hostage negotiations stall, the U.S. has quietly agreed to extend its presence at the Qatari base for another decade, according to a Jan. 2 CNN report. Mr. Carmon seems mystified by U.S. weakness. “Since when do experienced American officials conduct negotiations without power pressure on the side?”

. . .

One of Memri’s earliest successes came with Yasser Arafat. By 2002 the Palestinian terrorist leader was used to being feted as a statesman. In a “60 Minutes” interview, however, Arafat was flummoxed when Mike Wallace quoted Memri’s translations of his Arabic speeches: “ ‘Millions of holy warriors are on their way to Jerusalem. Jihad! Jihad! Jihad!’ . . . What does that mean?”

For the full interview see:

Elliot Kaufman, interviewer. “The Weekend Interview; When Terrorists Talk, They Listen.” The Wall Street Journal (Sat., Jan. 13, 2024): A11.

(Note: ellipsis between paragraphs, added; ellipsis internal to paragraph, in original.)

(Note: the online version of the interview has the date January 12, 2024 [sic], and has the same title as the print version.)

Gilder’s book mentioned above is:

Gilder, George. The Israel Test. Minneapolis, MN: Richard Vigilante Books, 2009.

Senor and Singer’s book mentioned above is:

Senor, Dan, and Saul Singer. Start-up Nation: The Story of Israel’s Economic Miracle. revised pb edition ed. New York: Twelve, 2011.