Instead, they would be compensated in proportion to the relative value units (RVUs) of the care they dispensed. RVUs are a measure of productivity used to determine medical billing.

Generalists like Dr. W. are assigned RVUs primarily according to the complexity of their exams and treatment plans, which are coded on a scale of levels 1 to 5. A simple level 2 visit may yield $60;  level 3, $120; level 4, $210; and so on. “What started to happen is lots of pinkeye was billed at a level 4,” he explained. There was a financial incentive: colleagues who were coding expansively could make twice as much – over $300,000 instead of $170,000.

Oncologists prospered buying chemotherapy drugs from manufacturers and infusing them in the office, generally with a hefty markup, a practice known as “buy and bill.”

As the wholesale price of the new drugs jumped again and again, doctors had little motivation to complain, because they were allowed a markup that was often a set percentage above cost. Doctors who used more expensive drugs earned far more. The practice of buy and bill increased dramatically in the late 1990s and into the new century.

With it, the median compensation for oncologists nearly doubled from 1995 to 2004, to $350,000. One study in 2013 attributed 65% of the revenue in a typical oncology practice to such payments. “Drugs and biologicals make up approximately 80% of all medical oncology charges submitted to Medicare each year.”

Action, Not Warm Thoughts

In a well-intentioned effort to increase tranquility, happiness, and fulfillment, the modern world is littered with exhortations to feel gratitude. Just think about how lucky you are. Just think about how much you have to be thankful for. Just think about the billions, literally billions, suffering through incredibly stressful existences.

As evidenced by a society seemingly no better than previous iterations at reaching an enlightened state, the exhortations aren’t doing much good. To be sure, if one is able to remember that things can always be worse, that moment takes on a different, possibly superior tenor, but that experience is stubbornly impermanent.

I posit that this conundrum is solved through determined action, since it is terribly unlikely to replace negative thoughts through thought alone. Thoughts lead to action and action defines character and on and on – I’m not saying anything original. Yet, I kept thinking about these concepts while watching you in xxxxxxxxx, thinking how people were going to take away the wrong lesson.


Anti Balance

Please allow me to counter myself: fuck balance. There is nothing more important than purpose, and it comes with a steep price. But it’s a price that anyone should want to pay because, as I just declared, there is nothing more important than purpose. All the things we say we want – love, money, health, etc. – are inhabitants in the kingdom of purpose.

There’s a major difference between doing things and doing things. People living in the non-italicized state may think they comprehend some truth that the overweight mogul has missed; they are wrong. The mogul knew the rules – there is a steep price to pay – and decided to play anyway. Some on the path to doing things may pretend the rules don’t apply. They are also wrong. These are the people, specifically women in our current “The Future is Female” moment, who “want it all.” I want to be CEO AND a great mother AND healthy AND well-read AND a great spouse. Naw, it doesn’t work like that, because operating at the highest levels requires a form of singular purpose that blocks out other endeavors – maintaining concentrated purpose is hard enough that spreading it across disciplines is damn near impossible.


“Man himself is in control,” was Bezdomny’s quick and angry reply to what was, admittedly, a not very clear question.

“I’m sorry,” replied the stranger in a soft voice, “but in order to be in control, you have to have a definite plan for at least a reasonable period of time. So how, may I ask, can man be in control if he can’t even draw up a plan for a ridiculously short period of time, say, a thousand years, and is, moreover, unable to ensure his own safety for the next day? And, indeed,” here the stranger turned to Berlioz, “suppose you were to start controlling others and yourself, and just as you developed a taste for it, so to speak, you suddenly went and…well…got lung cancer…”- at which point the foreigner chuckled merrily, as if the thought of lung cancer brought him pleasure. “Yes, cancer,” he repeated, narrowing his eyes like a cat as he savored the sonorous word, “and there goes your control! No one’s fate is of any interest to you except your own. Your relatives start lying to you. You, sensing that something is wrong, run to learned physicians, then to quack, and maybe even to fortune-tellers in the end. And going to any of them is pointless, as you well know. And it all ends tragically: that same fellow who not so long ago supposed that he was in control of something ends up lying stiff in a wooden box, and those present, realizing that he is no longer good for anything, cremate him in an oven. Why even worse things can happen: a fellow will have just decided to make a trip to Kislovodsk,” – here the foreigner narrowed his eyes at Berlioz, “a trivial matter, it would seem, but he can’t even accomplish that because for some unknown reason he goes and slips and falls under a streetcar! Would you really say that that’s an example of his total control over himself? Wouldn’t it be more correct to say that someone other himself is in control?” – and at this point the stranger laughed a strange sort of laugh.

“You haven’t by any chance spent some time in a mental hospital, have you?”

“Ivan!” softly exclaimed Mikhail Alexandrovich.

But the foreigner was not the least bit insulted and he burst out with a hearty laugh.

“I have indeed, I have indeed, and more than once!”


The ultimate form of intrinsic motivation is when a habit becomes part of your identity. It’s one thing to say I’m the type of person who wants this. It’s something very different to say I’m the type of person who is this.

When situation X arises, I will perform response Y.

The punch line is clear: people who make a specific plan for when and where they will perform a new habit are more likely to follow through.

When your dreams are vague, it’s easy to rationalize little exceptions all day long and never get around to the specific things you need to do to succeed.

After [current habit], I will [new habit].


Austin in Udnie

2019: Things


  • Anna
  • Spiderman: Far From Home
  • To All the Boys I’ve Loved Before
  • The Accountant
  • Irrational Man


  • The Count of Monte Cristo 
  • The Smartest Guys in the Room
  • Talking to Strangers
  • Can’t Hurt Me
  • Sum
  • The Right Stuff
  • Wittgenstein’s Mistress


Oculus in Hunter

572 in Mononoke