How the Doctor Got Buried

Nobody decided to take doctors away from their patients. There was no meeting. No memo. It happened slowly, one small thing at a time, until the doctor could barely see the patient through the pile.

The JAMA authors give this a name: fraction by fraction. Each new task looked small on its own. A new form. A new screen. A new box to click. The kind of thing nobody would fight about. But small things added together get big. The authors put it in one line:

The transformation happened fraction by fraction… but fractions compound.

That is from the same JAMA paper (Martinelli et al., 2026). To compound here means small things piling up until the pile is enormous.

The numbers, in plain words

A 2016 study in the Annals of Internal Medicine followed real doctors through real office days (Sinsky et al., 2016). The numbers are uncomfortable.

About half of an office day goes to the computer. Filling in records, clicking through forms, doing the desk work that has to be done.

About a quarter of the day goes to the patient. The actual sit-with-the-person part. The reason most doctors say they wanted to be doctors in the first place.

Read those two lines next to each other. The screen got more time than the human. That is what we have built.

What got piled on

It is worth naming the pieces, because none of them sound bad on their own:

Paperwork. Records of every visit, every note, every plan.

Billing and coding. Every visit has to be turned into the right numbers so the insurance pays. Get the numbers wrong and the visit is unpaid.

Insurance approvals. For many treatments, the doctor has to ask permission from an insurance company before giving the treatment. This is called prior authorization — getting permission ahead of time. It can take hours per patient.

Performance scores. Did the doctor check the right boxes? Was the visit fast enough? Did the patient fill out the survey?

Inbox messages. Patient questions, lab results, refill requests — all flowing in all day, even after the office closes.

Each one is reasonable. The first three even make care safer. The pile is the problem, not any single piece of it.

What the pile does to people

There is a word for what happens when you do work you love, surrounded by work that is not the work. The word is burnout — being so tired from work that you stop feeling like yourself.

A 2025 study in Mayo Clinic Proceedings tracked doctor burnout from 2011 through 2023 (Shanafelt et al., 2025). The numbers swing, but the pattern is clear. About 6 in 10 doctors were burned out at the worst point of the COVID years. By 2023 the number had come down to about 4 in 10. That is better. It is not okay.

Now hold that next to the empathy study. Of course readers picked the warmer reply. Half of the doctors writing the other replies were running on empty.

Why this matters for the headline

The story online is that AI is more empathetic than doctors. The story underneath the story is different. The doctor was buried. The chatbot was not.

If you bury anyone — a teacher, a chef, a coach, a friend — under enough paperwork, they will be less warm too. That is not because they stopped caring. That is because warmth needs a person who is actually there.

The next chapter is about a single sentence in the JAMA paper that has stayed with me. It is about what AI is actually for.

References

Martinelli, C., Carnevale, V., Ercoli, A., et al. (2026). Artificial Intelligence Is Not the End of the Physician. JAMA. doi:10.1001/jama.2026.4356

Sinsky, C., Colligan, L., Li, L., et al. (2016). Allocation of physician time in ambulatory practice. Annals of Internal Medicine, 165(11), 753–760. doi:10.7326/M16-0961

Shanafelt, T. D., West, C. P., Sinsky, C., et al. (2025). Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2023. Mayo Clinic Proceedings, 100(7), 1142–1158. doi:10.1016/j.mayocp.2024.11.031