arXiv:2609.10221v1 Announce Type: new Abstract: Reinforcement learning over a frozen reasoner has become a common recipe for teaching a policy which external tools to invoke. We show that this recipe becomes structurally mismatched in specialist scientific settings where the complete tool-subset space is enumerable. There, a small set of recurring computational capabilities covers the domain, so the space of tool subsets is combinatorial yet small enough to enumerate, and GRPO still estimates an action expectation from a handful of sampled rollouts. Worse, the approximation degrades as training succeeds: as the policy concentrates on preferred subsets it resamples them, sampled rewards collide, and the group-normalized advantage vanishes. On genomic reasoning the fraction of questions yielding no reward signal rises from 0.2% under a uniform reference policy to 20.8% after GRPO training. As a remedy, we introduce FGPO (Full-Group Policy Optimization), which (1) scores every tool subset and optimizes the exact action expectation, so each update sees the complete action space, and (2) precomputes the reward of each question--subset pair into an exhaustive table, removing frozen-reasoner calls from the training loop entirely. Across five frozen reasoners and three genomic benchmarks, FGPO outperforms GRPO in all 15 settings by 6.75 points on average and up to 14.20, while a standard on-demand GRPO schedule would require 2.4 times as many frozen-reasoner reward evaluations and, on GenomeQA, FGPO cuts invoked tools per question from 2.36 to 1.40.

Background: Telemedicine has expanded rapidly in recent years, with particularly pronounced growth following the COVID-19 pandemic. By improving access to care and offering greater flexibility in service delivery, it has become an important component of health care. Although the benefits of telemedicine for patients are well documented, its effects on physician job satisfaction remain insufficiently understood. Given the importance of job satisfaction for workforce stability, physician well-being, and quality of care, further examination of how telemedicine affects physician job satisfaction is warranted. Objective: This study aims to examine the association between telemedicine adoption and physician job satisfaction and to assess whether the physician-patient relationship mediates this association. Methods: A cross-sectional survey was conducted among health care professionals in Xi’an, China. Data were collected between November 7 and December 8, 2023, via an online questionnaire administered using the REDCap (Research Electronic Data Capture; Vanderbilt University) platform. A total of 12,052 physicians were included in the analysis. Physician job satisfaction was measured using a validated 6-point Likert scale. Telemedicine adoption was assessed through self-report. A partial proportional odds model was used to examine the association between telemedicine adoption and job satisfaction, adjusting for a comprehensive set of potential confounders. Additionally, the Karlson-Holm-Breen (KHB) decomposition method was used to explore the mediating role of physician-patient relationship quality in this association. Results: Among 12,052 surveyed physicians, 1642 (13.62%) reported adopting telemedicine, whereas 10,410 (86.38%) did not. After adjusting for demographic characteristics, work-related factors, psychological factors, and physician-patient relationship, telemedicine adoption was significantly associated with higher job satisfaction (odds ratio [OR] 1.17, 95% CI 1.05‐1.30). Findings were robust across multiple sensitivity analyses. Subgroup analyses indicated that the association did not vary across physician subgroups, and no significant interaction effects were observed. Mediation analysis revealed a total effect of telemedicine on job satisfaction of 0.33 (95% CI 0.17‐0.50), with an indirect effect of 0.10 (95% CI 0.07‐0.13) through improved physician-patient relationships, accounting for 30.30% of the total effect. Conclusions: These findings suggest that telemedicine adoption is positively associated with physician job satisfaction, partially mediated by the physician-patient relationship. Policies should promote telemedicine adoption while prioritizing platform designs that support effective physician-patient interactions to enhance provider well-being and care outcomes.