My wife is a physician. In doctor-speak she is in "medicine", which means she isn't a specialist. She works in a practice, caring for adults. As is typical for physicians, her earnings are proportionate to the number of clinical hours -- hours spent with patients. An arrangement that seems totally reasonable. But she spends (in my completely unscientific estimation) about 1-1.5x her patient time filing paperwork, much of which is for insurance purposes. Medical treatment depends on thorough records, so the time investment is understandable and necessary for the patient's care. But, no one pays for the hours of paperwork (besides the doctor of course). Insurance forms are extensive, but bear no cost for the insurance companies - they are only billed for clinical time. Paperwork is the most infamous time drain in medicine. But there is no incentive to reduce the time spent on paperwork because there is no cost - doctor's don't bill for it. It's just a hunch, but I suspect that if doctors billed insurance companies for hours spent on paperwork and other vital, but non-clinical time, we should quickly have a far more efficient medical system.