“Skin in the Game”

I've been sitting on this post for quite some time, as I wasn't sure whether I wanted to write it or not.  It's a long story, as I have very mixed feelings on the topic.  However, a recent report published in the Journal of the American Medical Association (JAMA) prompted me to finish this post.  The report ("Changes in nonprofit hospitals' finances, operations, and quality of care after using management consultants") used several different data sources to quantify non-profit hospitals' spending on management consultants over a nearly 12 year period.  They next evaluated whether the use of these management consultants had any significant impact on finances, operations, or the quality of care delivered.

The investigators compared 306 US nonprofit hospitals that used a management consultant for the first time in 2010-2022 with 513 matched hospitals that didn't use a management consultant during 2009-2023.  More than 20% of nonprofit hospitals hired a management consultant during the study period, paying an average of $15.7 million for these services.  All told, the nonprofit hospitals in the study spent $7.8 billion on management consultants between 2009-2023.  Financial performance (e.g., revenue, expenses, margins, cash reserves), operational performance (e.g., inpatient utilization, staffing, executive and worker compensation), and quality of care measures (e.g., 30-day mortality, readmission rates) did not appreciably change after the consulting engagement.  In other words, nonprofit hospitals spend exorbitant amounts on management consulting fees with very little return on their investment!

I've read a lot about the management consulting industry over the past few years.  A few years ago, I posted a reply to someone else's post on LinkedIn about the 2023 book, The Big Con: How the Consulting Industry Weakens Our Businesses, Infantilizes Our Governments, and Warps Our Economies by Mariana Mazzucato and Rosie Collington and an accompanying review that appeared in the Wall Street Journal by Barton Swaim (see "The Big Con Review: The Conquering Consultants").  The main premise of the book is that management consultants are becoming increasingly influential in both business and government, but rather than adding value, they are instead oftentimes weakening the organizations that they are trying to help.  As these organizations outsource strategy and other operational functions to the consultants, they lose in-house expertise, creating a vicious cycle in which the organization becomes even more dependent on the management consultant.  If you read the 2014 book The Firm: The Story of McKinsey and Its Secret Influence on American Business by Duff McDonald, you will learn that this is the exact business model for these consultant firms.  They essentially work to make organizations dependent on the consultants for key business functions.

If you are interested in reading further, there are two additional books that I've found to be worthwhile on this subject.  The first is the 2023 book When McKinsey Comes to Town: The Hidden Influence of the World's Most Powerful Consulting Firm by Walt Bogdanich and Michael Forsythe, and the second book a older (published in 2005), but still worth a look, Martin Kihn's  House of Lies: How Management Consultants Steal Your Watch and Then Tell You the Time.  Kihn's central argument is that management consultants frequently repackage common sense recommendations as high-priced expertise, offering fancy slide presentations instead of practical solutions.  The title is self-explanatory - these consultant firms often "borrow" information from clients, reframe it in polished language, and then sell it back to them as strategic insight.

Last, but not least is an old video clip from a 1992 talk that Steve Jobs gave at the MIT Sloan School of Management.  Jobs said that one of the biggest issues with the recommendations that management consultants make is that they are never around long enough to see their recommendations put into action.  They never get the opportunity to learn from their mistakes if the recommendations are not the right ones.  He said, "I think that without owning something over an extended period of time, like a few years, where someone has a chance to take responsibility for one’s recommendations, where one has to see one’s recommendations through all action stages and accumulate some scar tissue for the mistakes and pick one’s self up off the ground and dust one’s self off, one learns a fraction of what one can."  Jobs suggested that management consultants just don't have enough "skin in the game."

As you are reading this post, I may have led you to believe that I am against the practice of bringing in management consultants in general.  That's not necessarily the right conclusion.  I have had some great engagements with management consultants.  However, as I reflect, the engagements that have been the most successful are the ones with a specific, focused problem to solve (e.g., "Let's improve efficiency of operations within the call center").  The ones that have fallen short (in some cases, far short) of success are the ones that have tried to take on too much (e.g., "Let's transform the organization's culture").  

Back to the JAMA article - if these management consultants were brought in to transform the organization by driving improvements in financial metrics, operational metrics, and quality of care, I can't imagine that they would be successful.  As a matter of fact, there is a well-known statistic provided by McKinsey that 70% of organizational transformations fail.  What's not clear is whether organizational transformations succeed any better when management consultants are involved.  The data published in JAMA would suggest that is not the case.

"Here am I. Send me!"

Today, May 25, 2026 is Memorial Day in the United States of America.  The first national observance of what would become Memorial Day occurred on May 30, 1868, when General John A. Logan, Commander-in-Chief of the Grand Army of the Republic, a fraternal organization composed of veterans who had served in the American Civil War, proclaimed "Decoration Day" to honor all of those Union soldiers and sailors who had died during the American Civil War.  "Decoration Day" as a national observance followed many local observances that had started shortly after the end of the war.  Statewide recognition soon followed, beginning with New York in 1873.  By 1890, every (formerly) union state had adopted the observance.  The two world wars turned the "Decoration Day" into a day of remembrance to honor all those who had died while serving in the U.S. military.  Congress officially changed the official holiday to "Memorial Day" and the date to the last Monday in May in 1968.

Notably, two other days celebrate those who have served or are currently serving in the U.S. military.  We celebrate Armed Forces Day on the third Saturday of May to honor all of those men and women currently serving in the U.S. military.  We celebrate Veterans Day on November 11 to honor all of those men and women who have previously served in the U.S. military.

I have always enjoyed Memorial Day.  I grew up in Indianapolis, and we used to listen to the Indianapolis 500 automobile race on the radio every Memorial Day weekend (the race was always - and I believe still is - blacked out on the local television stations).  There's nothing quite like the Indy 500 in all of sports! We often hosted a Memorial Day barbecue with family and friends at our house.  I can still taste the hot dogs, hamburgers, and cherry pie with homemade ice cream!

As I've grown older, I have come to realize how important it is that our nation honors those who have died in service to their country.  I've frequently posted something about what Memorial Day has meant to me over the years (see last year's post, "The price of freedom..." for the links to a number of these posts over the years).  I recently read a great book (all of his books are great, by the way) by Admiral William McCraven, who retired from the U.S. Navy in 2014 after a distinguished 37 year career.  Admiral McCraven is perhaps best known for his May 19, 2014 commencement speech at the University of Texas (the so-called "Make Your Bed" speech), which I posted about several years ago (see "If you want to change the world, don't ever, ever ring the bell").  His latest book, Duty, Honor, Country, & Life: A Tribute to the American Spirit is a collection of his speeches, essays, and poems that all honor those who serve, both as members of the U.S. military and civilians alike.  The title is adapted from General Douglas Macarthur's farewell speech delivered at the U.S. Military Academy at West Point on May 12, 1962.  

General Macarthur said, "Duty, Honor, Country — those three hallowed words reverently dictate what you ought to be, what you can be, what you will be. They are your rallying point to build courage when courage seems to fail, to regain faith when there seems to be little cause for faith, to create hope when hope becomes forlorn."

Admiral McCraven talks about a verse from the Holy Bible (Isaiah 6:8) in his chapter, "Send Me" (based on a toast that he gave to members of the U.S. military at an annual meeting of the Alfalfa Club):

Then I heard the voice of the Lord saying, "Whom shall I send? And who will go for us?"

And I said, "Here am I. Send me!"

There's a powerful scene from the 2014 film Fury, starring Brad Pitt, Shia Leouf, and Logan Lerman, that includes the same verse.  Admiral McCraven says that this same Bible verse is read by a priest, minister, or rabbi during every "Dignified Transfer" ceremony, as a fallen military member's casket is carried by six pallbearers and loaded onto an airplane for the return of his or her remains back home.  During his toast, Admiral McCraven said:

"The soldiers say 'Send me,' because they believe.  They believe that we are the greatest nation on the face of the Earth.  They believe that we are the good guys - the knights in shining armor, the guardians of liberty.  They believe that we will free the oppressed, protect the innocent, and lift up the downtrodden.  They believe that we are willing to lay down our lives for the good of the country and the world.  They believe because they have seen their parents and grandparents before them fight Nazism and fascism, totalitarianism, communism, and terrorism.  They believe that the men and women in this room are the tellers of truth, the upholders of the law, the defenders of the constitution - and everything we do is right and just and honorable and good...Ladies and Gentlemen, would you please stand and raise a glass.  To those who believe and say 'Send me' - to the troops!"

So today especially, we honor and cherish the memories of those brave men and women who gave their last full measure of devotion to what it means to be an American.  As you sit down with family and friends, enjoying the beautiful summer weather, sitting by the pool, grilling, or whatever you are doing, please take a moment to pause and remember that those whose day we are celebrating made a clear, deliberate choice to serve, and if necessary, die for their country.  "There is no greater love than to lay down one's life for one's friends."  Today we honor those who stood up and said, "Send me."  They believed that ours is a cause worth dying for.  And it is still a cause worth dying for.

There is no better way to honor and cherish their memory than to continue their cause.  "It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced.  It is rather for us to be here dedicated to the greatest task remaining before us - that from these honored dead we take increased devotion to that cause for which they here gave the last full measure of devotion - that we here highly resolve that these dead shall not have died in vain - that this nation, under God, shall have a new birth of freedom, and that government of the people, by the people, for the people, shall not perish from the earth." [from The Gettysburg Address by Abraham Lincoln]

Our work has only just begun.  Our toughest days lie ahead, but we are up to the test.  Here are we.  Send us.  "Rest easy shipmates.  We have the watch."

Magic Power

When I was growing up, I used to love going to rock-n-roll concerts.  One of my favorite bands was the group Triumph, a rock and roll power trio from Toronto, Canada.  Guitarist Rik Emmet (who has to be one of the most underrated guitar players of all time) and drummer Gil Moore shared lead vocalist duties, with bassist Mike Levine often providing back-up vocals.  At a time when most rock-n-roll bands were writing songs about "sex, drugs, and rock-n-roll", Triumph's music stood out for positive and motivational themes, with hit song titles such as "Magic Power", "Lay It On The Line", "Fight the Good Fight", "Never Surrender", and "Follow Your Heart".  They were known for their melodic vocals, technical musicianship, and elaborate live shows.  While I had heard them on the radio, I first saw them play on a live television broadcast of the 1983 Us Festival in San Bernardino, California.  I was blown away!  "There's only three musicians playing THAT?!???"  I ended up seeing them play live multiple times over the years.

My favorite Triumph song had to be "Magic Power", a single from their 1981 album Allied Forces.  The lyrics speak to the power of music to give all of us clarity, inspiration, and emotional healing.  Just check out the first few lines of the song:

Something's at the edge of your mind

You don't know what it is

Something you were hoping to find

But you're not sure what it is

Then you hear the music

And it all comes crystal clear

The music does the talking

Says the things you want to hear

Music is magic.  Music is emotion.  And music has the power to heal.  

I was thinking of Triumph's "Magic Power" while I was reading a section of the latest book by Arthur C. Brooks, The Meaning of Your Life.  I've posted about Brooks and his research on happiness a number of times in the past (see "The mathematics of happiness", "Are you happy?", "All shall be well", and "Real friends are useless" for just a few examples).  In a wonderful chapter of the book called "Surround Yourself with Beauty", Brooks talks about research by Rollin McCraty that studies the effects of different forms of music on mood and stress (see "The effects of different types of music on mood, tension, and mental clarity").  A total of 144 study subjects completed a psychological profile before and after listening for 15 minutes to four different types of music (grunge rock, classical, New Age, and designer).  Subjects listening to grunge rock showed significant increases in hostility, sadness, tension, and fatigue, with concomitant reductions in caring, relaxation, mental clarity, and vigor.  The results for New Age and classical music were mixed, while designer music (music designed to have specific effects on the listener) produced significant increases in caring, relaxation, mental clarity, and vigor with concomitant decreases in hostility, fatigue, sadness, and tension.  

All of that is well and good, but does music have the "magic power" to make you happy too?  As it turns out, listening to a song that you love triggers your brain's limbic system to release dopamine.  Think of the limbic system as your pleasure and reward centers of your brain and dopamine as the neuromediator that regulates your happiness.  Music has all kinds of positive effects on our mood and well-being (see Adam Croom's review article, "Music, Neuroscience, and the Psychology of Well-being: A Précis" in the journal, Frontiers in Psychology).

According to a study by music psychologist Michael Bonshor, the happiest-sounding songs have certain tempos, chords, and musical keys.  Dr. Bonshor developed a formula to determine the "Happiest Song of All Time".  Apparently, "Good Vibrations" by the Beach Boys scored the highest and was ranked by Dr. Bonshor as the happiest song in history.  The top ten scientifically happy songs according to his formula are:

1. "Good Vibrations" by the Beach Boys

2. "I Got You (I Feel Good)" by James Brown

3. "House of Fun" by Madness

4. "Get The Party Started" by P!nk

5. "Uptown Girl" by Billy Joel

6. "Sun is Shining" by Bob Marley

7. "I Get Around" by the Beach Boys

8. "YMCA" by Village People

9. "Waterloo" by ABBA

10. "September" by Earth, Wind & Fire

So, next time you are feeling down, check out the "magic power" in any of the songs in the list above.  Listening to music may not help you solve all of your problems, but it will certainly make you feel a little better.  Here's another lyric from Triumph's song "Magic Power" that sums it all up:

She climbs into bed

She pulls the covers overhead

And she turns her little radio on

She's had a rotten day

So she hopes the DJ's

Gonna play her favorite song

Makes her feel much better

Brings her closer to her dreams

A little magic power

Makes it better that it seems

Music is magic.  Music is emotion.  And music has the power to heal.

Oenophiles strike back!

According to Google AI, an oenophile (pronounced ee-nuh-file) is a connoisseur or lover of wine, derived from the Greek roots oinos (wine) and philos (loving).  While I am certainly not a wine connoisseur (at least not yet), I am a wine enthusiast and someone with a deep appreciation for wine.  As I have discussed a number of times in previous posts (see "Raitis tammikuu", "The world is changed...", and "The bullwhip effect (again)"), the wine industry has been struggling the past few years, as alcohol consumption in general has dramatically decreased.  As I mentioned most recently in my post, "Eat your ice cream", red wine consumption is no longer considered healthy!  The Office of the U.S. Surgeon General released a new advisory last year declaring that there is no safe level of alcohol consumption.  The advisory called out in particular the risks associated with several types of cancer, especially breast cancer in women and cancers of the digestive tract in both men and women.  The advisory states, "The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day."

As I mentioned in the same post ("Eat your ice cream"), part of the problem with all of these observational studies on physical health and wellbeing are that they at times can provide conflicting information.  For example, the so-called French Paradox which was popularized in the 1980's and 1990's was based on the observation that people living in France have comparatively lower rates of coronary heart disease, including deaths, despite a higher intake of dietary cholesterol and saturated fat.  The suggested explanation for the French Paradox was that people living in France also consumed higher amounts of red wine.  The anti-oxidant properties of compounds found in red wine negated the negative effects of the higher intake of cholesterol and saturated fats.  Unfortunately for oenophiles everywhere, the purported benefits of these anti-oxidants are negated by the amount of alcohol consumed when drinking red wine.

I suggested that sooner or later, there would be yet another study that suggested that red wine can indeed provide health benefits.  I was therefore not surprised to see another report come out suggesting that individuals who consume even moderate amounts of red wine live longer!  Of course, the study was first reported in the magazine Wine Spectator, who may be a little biased.  However, the report came from a 2026 study of 340,000 British adults, which found that moderate wine drinkers had a lower risk of early death and heart-related diseases compared to those consuming other alcohols, with benefits most pronounced in red wine drinkers.  The study results were presented at the Annual Scientific Session of the American College of Cardiology in New Orleans in March.  The study investigators noted that people who, on average, drank up to 10 (for women) or 20 (for men) 5-ounce glasses of wine per week were 8% less likely to die of any cause and up to 21% less likely to die from cardiovascular causes during a 13 year follow-up period compared to both non-drinkers or occasional drinkers.  Importantly, people who consumed the same average weekly amounts of other kinds of alcoholic beverages (beer, cider, spirits) were 9% more likely to die of cardiovascular disease and had a slightly higher risk of dying from non-cardiac diseases, such as cancer.

In addition to the antioxidants found in red wine, the study investigators suggested that people who drink wine (i.e., oenophiles like me!) live healthier lifestyles than people who consume other kinds of alcoholic drinks.  As Zhanglin Chen, the study's senior author, suggested, "People who drink wine in light to moderate amounts tend to have healthier overall lifestyles.  For example, they may eat more fruits and vegetables, exercise more or be less likely to smoke, and these habits can also contribute to lower risk."  Another recent study showed that regular exercise may actually offset at least some of the health risks associated with alcohol consumption (the study was recently published in the journal Sports Medicine).  It's tempting to speculate that red wine consumption, especially in moderation, could maximize the benefits of the antioxidants found in red wine, while the regular exercise could minimize the risks of the alcohol.

Ezekiel Emanuel, an American oncologist, bioethicist, and health policy researcher, suggested another possible benefit to wine consumption in his book, Eat Your Ice Cream.  Drinking wine is often a highly social activity, and there are definitely health benefits to spending time with friends and family!  As Dr, Emanuel reported, "It's important to cultivate family, friends, and other social relationships for a long, healthy, and happy life."  I've posted a lot about the so-called "Loneliness Epidemic" several times in the last year (see, in particular, my posts, "The Loneliness Epidemic", "To be of importance to others is to be alive...", and "We all need the human touch...").  There are now a countless number of studies that provide convincing evidence that fostering and maintaining close personal relationships through marriage, family, and friendships is one of the most important drivers of happiness and vitality. 

The Harvard Study of Adult Development provides important evidence on this point.  Robert Waldinger, who has led the study for over two decades, states, "The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health.  Taking  care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation."  Spending time with others, particularly fellow oenophiles, could therefore be one of the secret ingredients to living a long and happy life!

I suspect that there will be other studies providing conflicting evidence.  For now though, I will stick with Dr. Emanuel's recommendation to have the occasional indulgence of things that may or may not be healthy for me (depending on which study you read), including red wine.  But never alone and always with friends and family, of course!

Roddie's Medal of Honor

I see a lot of stories posted on the Internet that appear interesting at first, but after researching further and doing some fact-checking, turn out to be exaggerated or even false.  Not so with a story I saw late last week.  It's worth repeating here.

Roderick W. Edmonds, known to all as his friends as "Roddie" was a soldier in the U.S. Army during World War II.  He fought at the Battle of the Bulge and was captured in December 1944, and he spent the remainder of the war in a German Prisoner of War (POW) camp, Stalag IX-A.  Master Sergeant Edmonds was the highest ranking American non-commissioned officer at the camp, and he was therefore responsible for 1,275 American POWs.  

On their first day at Stalag IX-A, the German commandant told Master Sergeant Edmonds that the next morning, all the Jewish soldiers should assemble outside their barracks.  He had heard rumors that European Jews were being sent to death camps, and he was determined to protect the Jewish servicemen under his command. Instead of following the Nazi’s orders, Master Sergeant Edmonds issued his own: All 1,275 American POWs would assemble outside the barracks in the morning.

The next day, when the Nazi officer saw that all the soldiers were outside, he angrily demanded that Master Sergeant Edmonds identify the Jews.  Instead, Master Sergeant Edmonds told his men that they would not obey the order. Then he turned to the commander and said, "We are all Jews here."

Furious, the Nazi officer took out his pistol and threatened to shoot him. "They cannot all be Jews!" he said, insisting again that Master Sergeant Edmonds identify the Jewish soldiers.

Even with a gun to his head, Master Sergeant Edmonds did not back down.  "WE ARE ALL JEWS,” he repeated. "If you shoot me, you’ll have to shoot all of us and after the war, you’ll be tried for war crimes."

The Nazi officer backed down, and 200 Jewish-American soldiers were saved.  Stalag IX-A was eventually liberated, and Master Sergeant Edmonds and his fellow POWs returned home to the United States.  He never told anyone about his experiences there.

Master Sergeant Edmonds died in 1985.  Shortly after, his children began to read the diary that he had kept during his time as a POW.  Most of the diary just listed the names and addresses for his fellow POWs.  When his son Chris contacted one of those individuals in order to learn more about his father's time as a POW, he learned what had really happened.  Chris contacted several others who confirmed the story.  

In 2015, Master Sergeant Roderick "Roddie" Edmonds was honored by the Israeli Holocaust Memorial Yad Vashem as Righteous Among the Nations. 26,000 non-Jews who saved Jews during the Holocaust have been so honored, but Master Sergeant Edmonds is the only U.S. serviceman on that list.  And after a decade of advocacy from his family, community, and legislators, Master Sergeant Edmonds’s bravery was recognized with the nation’s highest military decoration, the Congressional Medal of Honor, which President Trump awarded posthumously to Edmonds on March 2, 2026.  His citation ends:

Without regard for his own life Master Sergeant Edmonds gallantly led these prisoners in a relentless pursuit of opposition and resistance, forcing the Germans to abandon the camp leaving the 1,200 American prisoners behind. The full extent of his bravery, unbending will, and courageous leadership would be realized when soldiers from 3d U.S. Army liberated the camp on March 30, 1945. Master Sergeant Edmonds’ conspicuous gallantry and intrepidity at the risk of his life, above and beyond the call of duty, are in keeping with the highest traditions of military service and reflect great credit upon himself, his unit, and the United States Army.

Master Sergeant Edmonds' bravery reminds me of one of my favorite poems, "First They Came" by Martin Niemöller, a German theologian and Lutheran minister (I posted about Niemöller's story in my post, "First They Came").  As I wrote in a post from August, 2017 ("A life of privilege - Part I"), "It doesn't matter whether you are white, black, brown, yellow, or red.  It doesn't matter whether you are gay or straight.  It doesn't matter whether you are male, female, or transgender.  It doesn't matter whether you are Catholic, Jewish, Protestant, Hindu, Buddhist, or Muslim.  It doesn't matter whether you first learned to speak English or another language.  It doesn't matter whether you were born here or whether you moved here later.  We are all Americans.  That is what this country stands for - and we need to stand up.  Or some day there will be no one left to stand up for us."

As Master Sergeant Edmonds said, "We are all Jews here."  

We've lost our third places...

Last October (see my post "Connections"), I mentioned a great online article ("How '6 points of connection' can repair our shared trust") by the social entrepreneur Aaron Hurst, who recently co-founded the U.S. Chamber of Connection.  The U.S. Chamber of Connection is a movement to reverse the decline in connection and trust in society today, something that they call the connection gap.  They have called this connection gap the greatest challenge of our time, stating that "We are divided and disconnected.  It is destroying lives, communities, and our country."  In the article, Hurst talked about how the six points of connection can help restore trust in society.  Notably, Hurst's fourth point of connection is what are known as third places.  

Sociologist Ray Oldenburg first coined the term third place in his 1989 book Great Good Place.  If the first place is your home and the second place is your place of work, then the third place describes the places you go to spend time with friends and family, such as church, cafes, bars, clubs, gyms, parks, etc.  Oldenburg argued that these third places are important not only for a sense of place and belonging, but also for civic engagement and, more generally, democracy.  Oldenburg co-authored the 2023 edition of the book with Karen Christensen.  Christensen makes the argument that third places are the answer to our current epidemic of loneliness, political polarization, and even climate resilience. 

Howard Schultz, founder and former CEO of Starbucks, famously wanted to turn his coffee shops into a third place (see my post "It's not about the coffee...").  He once described his vision, saying, "The idea was to create a chain of coffeehouses that would become America's third place.  At the time, most Americans had two places in their lives - home and work.  But I believed that people needed another place, a place where they could go to relax and enjoy others, or just be by themselves.  I envisioned a place that would be separate from home or work, a place that would mean different things to different people."  

Unfortunately, third spaces are disappearing across the United States.  As recently as 2019, nearly two-thirds of all Americans could name a regular, local third place.  However, that number has dropped to just over half in 2022.  An American Social Capital Survey from 2024 indicated that 63% of adults rarely or never visit a library.  Half rarely or never visit a park.  More than 1 in 5 Americans live in communities with no access to third spaces like parks, libraries, or community centers.  And, as I mentioned in a recent post ("The fox, the hound, and the body..."), a Dutch study on changes in personal relationships strongly suggests that the loss of third places is an important reason why many personal relationships fade with time. 

There are several reasons that can potentially explain the loss of third spaces in society today.  Certainly, suburban sprawl has pushed individuals further away from commercial and social hubs that are often located in the downtown areas of cities.  Americans are also spending more time at home in general, and frequently that time is spent alone.   I've also posted a lot about the role that television (see "Amusing Ourselves to Death"), technology (see "The Walkman Effect", "The Quiet Commute", and "Take a Break...") and social media (see "Familiarity breeds contempt...",  "Liberation", and "The truth about connection") have played with the growing trend to spend time alone.  I think we can easily make the argument that the more time we spend on technology (e.g. smart phone, Internet) or social media, the less time we are connecting with others (friends, family, etc).  

With all of this in mind, Aaron Hurst makes an important point in his article on the six points of connection.  Hurst writes, "Third places matter because they invite spontaneous connection - between generations, across cultures, and beyond our usual social circles.  They're where we bump into each other, strike up conversations, and build trust without needing an invitation."

He goes on to suggest, "The simplest and most powerful action is to show up. Visit your local third places regularly. Stay a little longer. Learn the names of the baristas or librarians. Say yes to the community event. When we consistently support these spaces, we keep them alive — and signal that connection matters."

For those so-called civic deserts, communities that lack third places, Hurst suggests that we should become advocates by "asking for benches, plazas, or gathering spots."  A lot of this is under our direct control, if we work together to spend time together.  Together, we can restore our third places, and as a direct result, improve the quality of our own lives and of those around us.  

Is "burnout" burning out?

I don't know how I missed this, but Dr. Tait Shanafelt and his research team published their most recent nationwide survey of physician burnout in the Mayo Clinic Proceedings this past July ("Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2023").  I've mentioned the burnout issue a few times in the past (see "Don't ask me to to take resilience training!"), and most studies still suggesting that approximately half of the physicians in the U.S. meet at least one of the three criteria for burnout in the Maslach Burnout Inventory (more on this point below).  Dr. Shanafelt has published extensively in this area, and his team has longitudinally measured the prevalence of burnout at 3-year intervals since 2011.  In addition, they conducted an off-cycle survey (about 15 months after the 2020 survey) to assess the impact of the COVID-19 pandemic on professional burnout.

Importantly, according to the MBI, which is the most commonly used scale to measure burnout today, an individual meets criteria for burnout when he or she meets threshold criteria in each of the three categories - emotional exhaustion, depersonalization, and a sense of a loss of personal accomplishment.  The media has erroneously reported in the past that "nearly half of physicians in the U.S. are burned out."  Unfortunately, this statement is technically not correct, and it would be more accurate to state that "nearly half of the physicians in the U.S. meet at least one criteria for burnout."

Using both online and mailed surveys, Dr. Shanafelt and his team surveyed a diverse and representative sample of U.S. physicians.  The response rate was low (less than 10%, or just over 7,600 physicians), but they were able to measure burnout using two of the three metrics included in the MBI - they substituted a previously used survey of personal accomplishment that was more specific to physicians.  They found that burnout in US physicians peaked during the middle of the COVID-19 pandemic with the 2021 survey.  However, relative to 2021 and 2014 (the previous high water mark), burnout at the end of 2023 had decreased and was similar to levels reported in the 2017 survey.  Overall, 45% of physicians reported at least 1 symptom of burnout, compared to 62.8% in the 2021 survey.  When compared physicians to the general U.S. workforce, physicians remained at higher levels of burnout.

Dr. Shanafelt and his team also reported updated survey results of burnout in U.S. residents and fellows (physicians who have graduated from medical school and are training in a particular specialty).  Those survey results were published in the journal, Academic Medicine (see "Changes in Burnout and Satisfaction With Work-Life Integration Among U.S. Residents and Fellows and the General U.S. Working Population Between 2012 and 2023") in December 2025.  Again, burnout among U.S. trainees was lower in 2023 compared to results found in a survey conducted in 2012. Despite this improvement, trainees remain at higher risk for burnout than workers in other fields.

If these results hold up to further scrutiny and follow-up studies, then that is an encouraging development.  Burnout is a major issue that needs to be addressed, and many health care organizations have invested heavily in programs that have tried to address burnout in the entire health care workforce, not just physicians.  However, two results are important to acknowledge.  First, close to half of all physicians still report at least one symptom of burnout, and that is still too high of a percentage.  Second, burnout continues to be higher amongst physicians compared to the general workforce.  We have to do better.

So, back to my question.  Is "burnout" burning out?  Probably not, but perhaps we have reached (and hopefully passed) the peak - and that is progress.  As Winston Churchill once said, "Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning."