New doctors need to give up sense of entitlement

There are more doctors than ever before; yet two million Canadians can’t find one.

  image: davegranlund.com

An estimated 30,000 Kamloopsians don’t have a family doctor, although only about one-half of them are looking if national averages apply.

Something doesn’t add up. Why can’t Canadians find a doctor if there is a surplus? It’s complicated.

First, recent graduates of medical schools can’t find the residency they want. Without a residency, they will never become doctors.

This year, 2,980 will graduate from Canada’s 17 medical schools. They will compete for 3,308 residency spots. That would seem like every graduate should get a spot. However, 917 of those spots are in Quebec which means that there is a shortage for English-speaking graduates.

Then there is the arcane process of matching graduates to residencies which leaves some out. Health reporter André Picard says:

“But matching a graduate to a residency spot is a complex process, overseen by the Canadian Resident Matching Service (CaRMS). Medical students apply to CaRMS in one or more specialties; committees select who they wish to interview and rank them; graduates rank the programs and, finally, an algorithm spits out a match, and the student is legally bound to take that residency spot (Globe and Mail, May 1, 2018).”

Graduates have become pickier. They get assigned in residency specialties where they don’t want to work. As a result of preferences and the complexities of CaRMS, 115 graduates are unmatched this year. Jobs are waiting for them -there are 78 unfilled positions, 65 of them in family medicine.

The unmatched graduates have invested a lot. They have accumulated an average debt of $100,000 during four years of training. Taxpayers have invested a lot. We are on the hook for their subsidized education. The cost of training a medical student is $250,000.

Also, some graduates want a regular job where they work only 40 hours a week as in a hospital in a so-called “hospitalist” position. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. Compare that with a doctor in his own private practice. After paying staff and rent, a doctor would have to earn $400,000 a year to take home that much -and they’d work longer hours with less medical equipment and fewer support staff such as nurses. But there are only so many hospitalist positions.

One-half of Canada’s physicians focus on sports medicine or palliative care says Dr. Danielle Martin on CBC’s the Current:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

Doctors need to abandon their sense of entitlement says Picard. We need more general practitioners, especially in small cities and rural Canada. Enrolling in medical school doesn’t entitle graduates to jobs wherever they want, in the speciality of their choice.

“Becoming a doctor is hard,” says Picard, “It’s also a privilege. We need a system that ensures the right doctors are working in the right places, not on where personal desires can trump societal needs.”

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Facebook is a Canadian utility

So many Canadians use Facebook that it should be regulated like any other Canadian utility. No broadcaster or telephone company would operate in Canada without government oversight. We should make it comply with our regulations as with other communications utilities.

      image: Tod Maffin

It’s the most-used Canadian social media. Ninety-four percent of Canadians aged 18 to 44 have a Facebook account. Overall, 84 per cent of us have an account and 80 per cent check the site daily according to The State of Social Media in Canada, 2017.

Now, Facebook is about to become more integrated into our lives with an announcement May 1, 2108, of a dating service. CEO Mark Zuckerberg said: “And if we are committed to building meaningful relationships, then this is perhaps the most meaningful of all.”

Facebook’s phenomenal rise has made it a monopoly. Canadian professors Andrew Clement and David Lyon say:

“In light of Facebook’s overwhelming grip on the social networking industry, the commissioner of competition should investigate the company for its monopolistic behaviour (Globe and Mail, April 23, 2018).”

Facebook’s ascent has left governments behind. Other communications industries have taken decades to mature and regulations have kept pace. Regulators have had time to insure that TV, radio and telephone companies meet Canadian standards of privacy, identity and sovereignty.

“The Canadian Radio-television and Telecommunications Commission (CRTC) should learn to treat social-media enterprises as utilities,” says Clement and Lyon.

There’s a lot of misunderstanding about the nature of Facebook’s grip. It seems so personal that there’s a conspiracy theory claiming Facebook is eavesdropping on people’s conversations through their smartphones and using that insight to serve ads. Tech expert Avery Swartz finds this ironic:

“People find it hard to believe that computers could know so much about them, even though they are voluntarily feeding their information into the machine. For private citizens, Facebook’s targeted advertising is creepy. For advertisers, it’s captivating (Globe and Mail, April 23, 2018).”

Facebook doesn’t sell users’ data to advertisers. It sells access to data, so advertisers can target their ads to specific audiences. No wonder that advertisers like Facebook. They can place an ad for as little as one dollar a day and ad campaigns can be created for $100.

Targeted advertising is hardly unique to Facebook. It’s been around much longer than the internet. Big businesses target consumers by placing ads on certain TV stations at specific times. They distribute flyers to targeted neighbourhoods.

However, the issue is not targeted advertising. It’s the way that Facebook treats Canadians and whether its practices align with the values and practices imposed on other communications utilities.

There’s been a campaign to #DeleteFacebook but given how integrated the social medium is in the lives of Canadians, it’s not likely to succeed. An Angus Reid survey revealed that only four per cent plan to delete their accounts.

“Given its business model,” add Clement and Lyon, “Facebook on its own cannot meet the objectives of Canadian media regulations – advancing Canada’s identity and sovereignty, its social and economic fabric, universal accessibility, neutrality, affordability, openness, public accountability and rights protection.”

Canadians like Facebook. Now’s the time help Facebook like Canadians by making it truly ours.

Canadians look beyond America

For the first time in decades, Canadians are more likely to hold a negative view of the U.S. than positive. According to a survey by the Environics Institute, it’s the lowest ever with only 44 per cent saying that they hold a positive view of the U.S.

     image: openeurope.org.uk

It happened overnight says Doug Saunders:

“It is not a subtle drift – Canadians were overwhelmingly positive about the United States as recently as 2016, until Donald Trump’s inauguration put a majority into the anti-American column. The proportion of Canadians who see the United States as “a negative force in today’s world” is now almost 6 in 10, a 12-per-cent rise over 2008, making America by far the most negative country in the eyes of Canadians (Globe and Mail, April 16).”

Canadians see the U.S. even more negatively than even North Korea which is second at 46 per cent.

The U.S. and Britain used to be viewed as “standing out as a positive force in today’s world.” Now Germany is number one, Britain has fallen to second place, and Sweden has risen to third.

While we don’t share languages, we do see similar values in Germany and Sweden.  Those two countries took in two-thirds of Europe’s refugees during the crisis of 2016 at a time when President Trump was denouncing them. And they have avoided far-right governments, which make them look more like Canada.

Canadians look globally in terms of trade. Almost three-quarters of Canadians have a “very favourable” view on international trade. Even NAFTA is more popular than ever. Two-thirds of us say that it “helped rather than hurt” Canada -the highest level since the agreement took effect in 1994.

It may seem as though whatever Trump is against we favour, but it’s not just anti-Trumpism.

Peace defines Canada as much as war. Much has been made of the battle of Vimy Ridge as a defining moment for our country. However, peace played a significant role in shaping Canadian values. Pollster for Environics Institute, Michael Adams, says:

“In recent decades, Canadians have consistently named peacekeeping as their country’s most notable contribution to world affairs since Pearson’s Nobel Prize. This sentiment has held through both Canada’s World surveys that the Environics Institute has carried out, first in 2008 and in 2018 (Globe and Mail, April 16).”

Canadians are more connected than Americans. Anatoliy Gruzd, one of the authors of a recent report The State of Social Media in Canada, told CBC Radio’s Spark:

“Canada is one of the most connected countries in the world. There are twice as many Twitter users than the U.S. per capita. We are very outside-looking. We want to know world events (Mar. 11, 2018)”

Facebook is the most popular social medium with 84 per cent of Canadians having an account. YouTube is second at 59 per cent.

Canada is a nation of immigrants and, unlike the current U.S. president, we value them as an asset not a liability. Canadians look to the world, not only because trade is vital to our economy and to keep in touch with families in home countries, but because we see ourselves as part of a global community.

 

Indigenous labour is an untapped resource

Canadians opened their hearts and homes to Syrian refugees last year. It was a warm humanitarian gesture as well as an economic imperative: Canada relies on immigrants to sustain our work force.

    image: Government of Canada

Treatment of our Indigenous people is puzzling in both regards. Refugees from Indian Reserves do not receive a warm welcome. Communities don’t sponsor Indigenous families and put them up in homes. They are not being bombed but they are fleeing abominable conditions: mouldy housing, undrinkable water, poor education, appalling health care and little hope for employment. Instead of being helped, First Nations refugees often end up on city streets with few options for integration into society.

Not only are Indigenous Canadians uninvited in cities but the labour resource they represent is wasted.

The Centre for the Study of Living Standards released a report earlier this month entitled “The Contribution of Aboriginal People to Future Labour Force Growth in Canada.” The 36 page report outlines the wasted labour resource of Indigenous Canadians.

Indigenous citizens are the youngest, fastest growing demographic in Canada.

To start with, all Indigenous people are underemployed. More critically, participation of the 15-24 age group is 12 per cent lower than average. Only one-half of Indigenous youth are employed. That untapped resource could contribute to future labour force growth. It’s worse in the North where participation in the labour force is one-fifth the average.

If Canada’s Indigenous work force were developed, they would contribute to one-fifth of the future national labour growth. That contribution could be in the North, where they are most needed. As the global climate change warms and the climate of the North warms disproportionately, opportunities will open for jobs in resource extraction, infrastructure, housing and tourism. The expansion of the Indigenous work force In the North could comprise 83 per cent of total northern growth.

What would it take? The report states rather dryly:

“Indigenous people also face deficiencies in hours worked, employment, income by level of education and health among others. Progress must be based on Indigenous autonomy and this in turn will require strengthening administrative and managerial capacities, most likely under new institutional arrangements.”

In more vital words, it will take a reversal of our colonial past which was designed to dominate and assimilate Indigenous peoples. The Trudeau government made a good start when it divided the Indigenous portfolio in two with Jane Philpott becoming minister of Indigenous services and Carolyn Bennett becoming minister of Crown-Indigenous relations and Northern Affairs.

Some criticise the move as increased bureaucracy but the split was recommended in 1996 by the Royal Commission on Aboriginal Peoples. Both ministers are capable I can only hope they will succeed in ending the anachronistic Indian Act.

National Chief Perry Bellegarde of the Assembly of First Nations is optimistic:

“First Nations are working to move beyond the Indian Act and re-asserting our jurisdiction and sovereignty over our own lands, title and rights.”

Let’s bring our Indigenous brothers and sisters in from the cold. And if compassion doesn’t motivate Canadians, maybe a bleak economic future without them will.

Continental divide with U.S. widens

We used to think we were becoming more like our American cousins. In 2002 58 per cent of Canadians thought we were; now it’s only 27 per cent.

    “Weirdo” image: CBC

There’s more to the shift than the election of President Trump. We are maturing and are more confident. And it has to do with the realization that we are fundamentally different.

Those differences are revealed in response to a relatively simple statement: “The father of the family must be master in his own house.”

Because values are clustered together, response to that statement reveals other values says pollster Michael Adams: “Patriarchy is only one of more than 50 values we track, but it is clearly among the most meaningful. It is also a value that is highly correlated with other values such as religiosity, parochialism and xenophobia, and views on issues such as abortion, guns and the death penalty.”

American response to the statement cycles up and down. When asked in 1992, 42 per cent agreed. Support for patriarchy went up during the Bush presidencies and back down to 1992 levels during the Obama years. The election of President Trump has restored patriarchy to record highs.

Canadian response has been relatively constant for decades -in the low twenties.

It’s a versatile analysis. It also reveals the degree that immigrants adopt Canadian values. Thirty-five per cent of Canadian immigrants agreed with statement; not surprising when most immigrants come from male-dominated countries. In the U.S., substantially more immigrants agree with patriarchy at 56 per cent, even though they are from the same countries as in Canada.

I’m impressed with the way that Adams has of cutting through the clutter of public opinion. I wrote about his research in 2004 in my column for the Kamloops Daily News . Back then he was examining the connection between patriarchy and religiosity. “Canadians have more confidence in their ability to make moral decisions without deferring to religious authority,” said Adams.  As a percentage, twice as many Americans go to church weekly as Canadians, twice as many believe the Bible is literally true, and twice as many say religion is important to them.

In the same column, I argued that the continental divide is marked by something other than just the U.S./Canada border. Progressives on both sides of the border share the same “country.” I find that when I talk to people in the U.S. states of the Pacific Rim, they sound remarkably Canadian. Adams recent research confirms that progressive/populist divide in the U.S. Support for patriarchy is less strong in the coastal states than the Deep South.

Swings in U.S. support for patriarchy reveal a national insecurity. Psychoanalyst Robert Young has studied the psychology of populist movements. “When people feel under threat,” says Young, “they simplify; in a reduced state people cannot bear uncertainty.”

This siege mentality that currently grips the U.S. under Trump indicates just how insecure some Americans feel. Before 9/11, fundamentalist saw modernity and pop culture as a threat to core values. After September 11, the threat became global with the loss of jobs overseas.

The reasons why Canadians don’t want to become more like Americans is becoming ever clearer, as are the reasons why some Americans appreciate Canadian values.