The problem is doctor distribution, not shortage

The number of doctors in Canada is increasing faster than population growth says Dr. Michael Rachlis on CBC Radio’s The Current:

  photo: Nancy Bepple

“We’ve been increasing the number of physicians at about three per cent per year for the last 10 years and the population is only going up at one per cent per year.”

Another of the panellists on the program, Dr. Danielle Martin, author and VP at Women’s College Hospital, warns of a surplus of doctors:

“In fact you know in some parts of the healthcare system, people are worried about a glut and you hear stories of people coming out [of medical schools] and being unable to find a job.”

That’s certainly not the view from the streets of Kamloops. NDP candidate Nancy Bepple regularly visited lines of people lined up at a clinic to see a doctor. An estimated 30,000 Kamloopsians don’t have a family doctor (one-third of the population). In B.C. overall, it’s 15 per cent.

Why can’t people find doctors if there’s so many of them? Are they hiding?

Well, some of them have chosen to work for a salary rather than billing for each patient. They work exclusively in hospitals says Dr. Chris Pengilly of Victoria, another of the panellists. He calls them “hospitalists.”

They prefer to work only 40 hours a week. Who can blame them? And they are paid better. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. After paying staff and rent, a family doctor would have to earn $400,000 a year, to take home that much; and work longer hours with less support.

The choice is obvious says Dr. Pengilly:

“So anybody coming out of medical school with a big student loan, which do you think they’re going to go for? A family physician [with] no time in hours a week or a hospitalist 40 hours a week and $300,000 with minimal expenses?”

Furthermore, hospitalists don’t want to work alone says Dr. Rachlis “Well, I say good for them that they’re looking to work in teams with other groups, with other physicians.”

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

“. . .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].”

The current model is not working because doctors no longer want to work in the silos of a fee-for-service practice.

It’s ironic that the provincial government has created a hospital environment which doctors prefer to work but one that removes them from the general public.

The solution is obvious but the BC Liberals have been slow to implement it: Build walk-in clinics and hire doctors on a salary basis. Everyone, doctors and patients alike, will be happier.

It’s going to cost more because the government will own the clinics. But the alternative, privately-built clinics, is a failure. The reason that two walk-in clinics in North Kamloops closed their doors is because doctors don’t want to work for less in an environment where they don’t have the same support that hospitalists enjoy.

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The future of smart radios

I imagine that the future of radio will combine traditional fm with the technology of smart phones.

I’m not talking about the distant future: the fm broadcast protocols already exist and most cell phones already have an fm radio chip, although you’d never know it. Chris Burns wonders why. In his article for SlashGear.com and he explains how you can find out if your phone has the chip:

“A whole bunch of smartphones out on the market today have FM radio capabilities – but their owners don’t know it. There’s no real good reason for this lack of knowledge save the lack of advertising on the part of phone makers. . . Today we’re listing the whole lot of phone devices that can run FM Radio right out the box.”

I first heard about the fm chip in cell phones last year on CBC Radio’s Spark. Barry Rooke explained how useful they could be. They could be used where no cell service exists and in an emergency when cell towers are down as in the wildfires of Fort McMurray in 2015.

Rooke is the executive director of the National Campus and Community Radio Association and he’s formed a consortium of broadcasters, including CBC, and radio listeners who would like to see the FM radio chip activated.

It doesn’t even have to be a smartphone to receive fm. A friend bought a simple cell phone in Mexico with the fm chip activated for $22 dollars, and that included free calls for eight days -no contract (it galls me how much more Canadians pay for cell phones, but that’s another column). You can hardly buy an fm radio alone for that amount.

The innovation that I imagine would be the use of graphics in smartphones. Some of the fm audio spectrum would be partitioned off for text and lo-res graphics. The text could include lyrics of the song being played and a picture of the artist, news, weather, sports, traffic, stock reports. In poor countries where the phone is more common than radios, it could include voting information, crop and commodity reports. Text and graphics could be saved for future reference.

The graphics would be stacked on the original signal with a subcarrier much in the way that left and right channels are now carried on regular fm as described in Wikipedia. The protocol already exists for car radios and would need to be adjusted for smartphones.

The best system would be a digital overhaul of the fm modulation signal. But that won’t happen because radio stations must be received by regular receivers as well as the new smart radios.

Broadcasters would never transmit a signal that can only be received by relatively few. That’s what happened when stereo radio was introduced. The new stereo signal had to be received by old mono radios as well as the new until the new technology was adopted.

The push for smart radios won’t come from cell phone service providers –they would prefer that you pay for data. It must come from broadcasters and listeners.

Facebook knows you best

Does Facebook know you better than your friends do, or even better than you know yourself? Lily Ames conducted an experiment to find out and reported the results to CBC Radio’s technology program Spark.

like

The personality program she tried is called Apply Magic Sauce, developed by The University of Cambridge Psychometrics Centre. It takes your Facebook “likes” and gives you a score based on a database of six million social media profiles.

When Lily ran her Facebook likes through the program, she was surprised at how well it scored on most of 20 things. It nailed her age within two years, religion, gender, education in journalism.

Then she compared those results with a standard test from Cambridge. It categorized her personality in five areas: openness, conscientiousness, extraversion, agreeableness, and neuroticism. She agreed with the test results with the exception of extraversion which she thought was low, especially when she considered extraversion as one of her defining traits.

Then five of Lily’s friends filled out a questionnaire on her personality. Surprisingly, the Facebook likes corresponded more closely to the standard test than either her own opinion or those generated by her friends.

Not so surprising says David Stillwell, a researcher at the Psychometrics Centre. Who we are is a philosophical question. Then, maybe we are not just one but different personalities; our self-impressions, the digital projection of ourselves online, and our personality as perceived by friends.

I was curious about what my Facebook likes would reveal about me so I tried the Apply Magic Sauce algorithm only to find that I didn’t have enough likes on Facebook to make an assessment. “Sorry, we are unable to generate a prediction.” was the reply “An insufficient number of your Likes match with those in our database, and we don’t believe in guesswork. Please take our full personality test, if you would still like to receive scientific feedback on your traits. Thanks!”

So I did. I took the full personality test and here’s the results. I scored highest on openness,73%, which reflects intellectual curiosity. Next was agreeableness, 69%, which suggests that I’m easy to get along with. Then conscientiousness, 66%, a measure of how organized I am. Extraversion, 54%, a gauge of social interaction. Finally neuroticism, 24%, my response to life’s demands. “Based on your responses, you come across as someone who is rarely bothered by things, and when they do get you down the feeling does not persist for very long,” the assessment elaborated.

It seemed fairly accurate, but then, why wouldn’t it when I’m the one who answered the questions?

Social media such as Facebook contain a wealth of data about ourselves that we may not intentionally reveal. Lily couldn’t even remember liking the Saskatchewan Roughriders. And a she was only being ironic when she “liked” new fashion trend.

No problem, says Stillwell. “From a prediction perspective, it doesn’t matter, as long as there is a link between people liking something and their personality. If everyone likes it because they are being ironic, then maybe it would be related to low agreeableness. But it doesn’t matter because the prediction still works.”

Get the message out call your kid “Bud Light”

I naively thought that my FaceBook posts appeared in the order sent. Not so. Look closely and you’ll notice that some posts hang around forever and others you don’t see at all.

It’s because an algorithm controls them, tailored to you; your “likes” and postings you respond to.

algorithm

When you think about it, it’s bizarre communication system. “It seems like a science fiction dystopia,” in which Big Brother controls our perception warns Christian Sandvig on CBC radio’s Spark.

Yet many FaceBook users aren’t even aware of the algorithms. They wonder why some friends never post anything, oblivious of the machinations.

Others know how to “game” the system by using key words that boost their postings; words such as “congratulations” even when it’s inappropriate. For example: “Congratulations, Canada is at war in Iraq.”

Or they use brand names to punch through the happy filter says Sandvig. “Isn’t my baby, Bud Light, cute,” jokes the professor of Communications at the University of Michigan.

Zeynep Tufekci has a similar concerns. While Twitter lit up with postings over the racial tension in Ferguson, Missouri, when a young black man was shot by a white police officer, FaceBook was strangely silent. It wasn’t lack of interest.  Tufekci found out that FaceBook friends were very active with postings about the explosive atmosphere.

Tufekci realized that FaceBook was deciding what should be of interest to her. “There was this disquieting moment because I really don’t want a world in which FaceBook decides which of my friends’ postings I am going to see.”

Algorithms are not necessarily bad. But in the happy FaceBook world of congratulations, wedding announcements, and baby pictures, algorithms are crafted with a certain motive in mind. After all, FaceBook is a commercial enterprise. They are selling your eyeballs to advertisers. While their algorithms are not transparent, their motives are. ”I wouldn’t be surprised if FaceBook algorithms are designed around likes and purchase behaviour.”

Social media have a moral obligation to users, not just  commercial obligations to advertisers. “They are not just selling shoes. We made them successful through use of our friends.”

We need to know things that may not be delightful. “What if a friend is contemplating suicide, and FaceBook decides I don’t want gloomy thoughts.”

Not only does FaceBook have a moral obligation to users as a clear channel of communication, it risks financial decline by being boring. In comparison, the drama of the unfiltered world of Twitter makes interesting.

However, even Twitter is thinking of tweaking their chronological stream though algorithms to stem the torrent.

Well designed algorithms are a useful thing. Google does a good job of anticipating what I’m looking for. Apparently, so does Netflix. My braking algorithm does a better job of stopping my car than I could under difficult conditions.

FaceBook should give us more access to our algorithm so that we can customize it. The tweaking allowed now is laughable. You can adjust the news feed from “top stories” to “most recent” but as my niece tells me, FaceBook switched her back three times in the last few weeks. Choice is a temporary option, it seems.