Underwriting is Noisy

An example a brief essay “Bias Is a Big Problem. But So Is ‘Noise.” about noise and decision-making in the NYT by Daniel Kahneman and his co-authors in support of their new book Noise: A Flaw in Human Judgement:

Consider another noisy system, this time in the private sector. In 2015, we conducted a study of underwriters in a large insurance company. Forty-eight underwriters were shown realistic summaries of risks to which they assigned premiums, just as they did in their jobs.

How much of a difference would you expect to find between the premium values that two competent underwriters assigned to the same risk? Executives in the insurance company said they expected about a 10 percent difference. But the typical difference we found between two underwriters was an astonishing 55 percent of their average premium — more than five times as large as the executives had expected.

This is why you don’t buy an insurance policy from a captive agent; you purchase through an independent agent who can get quotes from multiple companies. Every decision is subject to bias and noise, and they are separate and independent problems (i.e. both inaccurate and imprecise).

The easiest way to push both in your favor is through multiple independent attempts.

Student loan debt predicts burnout

From “Predictors Between the Subcomponents of Burnout Among Radiology Trainees” by Le et al. in JACR.



In summary:

Debt level < $200,000 was associated with lower [emotional exhaustion] scores among upper-level trainees and was the only predictor of burnout that significantly affected multiple years of training.

I suspect there is a dose-response above that debt level as well.

Uncertainty breeds despair. Make sure you develop a student loan action plan.

Regulatory controls and not-so-free markets

Not just doctors but all sorts of students and professionals scrambled to figure out how to deal with their high-stakes exam during the pandemic. Lawyers were no exception. Some states had new lawyers take the bar remotely. But a few states just got rid of it altogether and allowed diplomas from accredited schools to stand on their own.

NPR’s Planet Money, “Most People Can’t Afford Legal Help. 1 Reformer Wants To Change That” is an interesting quick discussion of slowly changing legal regulations that has plenty of parallels with medicine:

The National Conference of Bar Examiners, which helps states administer the bar, argues that the bar remains important in protecting the public. “Every high-stakes profession, including engineering, medicine, aviation, and others, relies on licensure to ensure that practitioners meet minimum standards of fundamental competency, and the practice of law is no exception,” the organization said in a statement.

But Gillian Hadfield, a law professor and economist at the University of Toronto, argues there’s no evidence that the bar actually protects the public. She thinks not only it is time we reevaluate use of the bar exam — it’s time to completely revamp how we regulate the practice of law in the United States.

The bar exam, she says, is one part of a broader system that raises the cost of legal services and contributes to an “access to justice crisis” in the United States. “My estimate is well over 80% of Americans who need legal help can’t get it because it’s too expensive,” Hadfield says. “And the main reason for that is a crazy regulatory system. The bar exam is part of that.”

It’s kinda like cafe baristas getting control of the coffee market by using the regulatory system to prevent restaurants, Keurig machines, and gas stations from providing you coffee. They’re like, “It’s for your safety! You could get burned or poisoned! The coffee will be worse!” Meanwhile, a cup of coffee costs $20.

Leverage & Growth 2021

Last year, Peter Kim (Passive Income MD) put on a free virtual summit comprised of interviews with physicians doing interesting/entrepreneurial things outside of medicine. There were some pretty neat sessions.

I always enjoy talking shop, so Peter and I did an interview for this year’s conference about writing/blogging/self-publishing.

The Leverage and Growth Summit is free and runs from March 22-28 with videos available on Facebook. My interview will be released on Day 2, March 23.

You can register for free by dropping your email here.

There will be an option to upgrade to a “VIP All-Acess Pass” if you so choose in the future. That includes lifetime access to the recordings (normally each only available for 48 hours), invites to speaker Q&As, and additional networking. That VIP pass is $97 before the conference, $147 during the event, and $247 afterward. If you decide to upgrade, that link is an affiliate link and I will earn some money. (If you decide to just enjoy the free conference like I did last year, then no one earns anything except warm fuzzies).


The Support Page

It’s one of those things I probably should have done around a decade ago, but last week I put up a “support” page. As I don’t run any ads and the vast majority of my writing is unmonetized, this site is largely a labor of love (and I’m happy with that).


I also talk to enough folks who want to support my efforts that it’s silly for me to make that challenging.

So while the page does include a way to directly send me money, it’s mostly a collection of the active affiliate arrangements I have, which are easy ways to get someone else (Amazon, educational products, physician survey companies, etc) to provide me with financial support at no cost to you if/when such things meet your needs (and usually with a reader discount).

Also, please feel free to ignore it entirely.

Regardless, I will continue to accept virtual high fives, which remain my primary currency.