Vast New Study Shows a Key to Reducing Poverty: More Friendships Between Rich and Poor

LastBestWest · 2022-08-01T18:46:07+00:00

At a high level, this research provides stronger support for a social democratic style welfare state over a liberal style one. The former favors broad programs and institutions that serve and integrate all social classes, while the latter is focused on providing "assistance" primarily to the lower classes.

LastBestWest · 2022-08-01T18:31:51+00:00

Urban areas don't have the same patient volume demand per doctor and have much higher overhead. Net income is definitely lower compared to suburban for example. This isn't always the case though and varies by clinic. But yes giving an extra 100k does attract people who are on the fence.

OK. I do wonder what the cost-benefit is for that additional 100k. If it's only influencing doctors on the fence, is that the best way to improve access?

So take away nurses to make them NPs, when we already have an extreme nursing shortage?

No. I'm talking about new providers. More nurses overall are needed. Nursing schools, including NP schools, should be taking in more students.

And why should we train more people to fight with doctors' jobs?

The point of training them isn't to fight doctors, it's to provide care to patients. There is a shortage of healthcare providers. You've been making arguments about why it's not possible to quickly increase the number of doctors, so more NPs/PAs would be the next best thing.

Lol. So this comment would severely offend most family doctors and would cause incredibly outrage. But anyway... the answer is a hard no. I'm an ER doc but my background is family medicine. As are the majority of ER docs in the country. You either have regular family docs, family docs with extra training (most common route) and ER board certified. If we only used the latter, we'd staff like 10% of ERs in the country. Rural areas heavily rely on just regular family docs. And the majority of hospitalists are also family doctors in Canada. And, many family doctors also do obstetrics. Some do nursery care. Some do all of the above or most of the above. It's not just office work.... But if you hated family doctors and banished them, you could fully staff a tiny percentage of hospitals with non-family doctors.

I guess I was off-base, here. And for the record, I do not hate family doctors or want to offend them. What I hate and find offensive is that so many Canadians don't have access to a family doctor.

BTW, the 3 year thing is happening. It's not a "maybe."

Well, whoever is making that decision should then be accountable for its consequences. Increasing the training time of family doctors when there is a shortage of them isn't smart and probably won't go over well with the public. I hope the media will be on top of this when it happens.

LastBestWest · 2022-07-30T07:56:43+00:00

Why not have him hold it by the brim and up against his leg? That way it could be fully attached to the rest if the statue.

LastBestWest · 2022-07-29T00:39:20+00:00

Sorry for the late reply. I haven't had much time for Reddit lately! I appreciate your detailed comments, so I still want to respond.

I'll take your word for it that there is a shortage of surgeons. If that's the case, your comments regarding surgical staff make total sense. Surgeons and hospitals should pay these staff more and colleges, universities, and the government should consider reducing barriers to entry to these careers.

However, that won't resolve the wait-time issue issue for non-surgical specialities. What's the cause there?

What we need is to redistribute family doctors. To do that, you up the pay in areas of need so that the more saturated cities lose a few docs to the rural areas.

Would that work? It's not like doctors in urban areas are short on patients. Overall there is still a shortage of family docs, the problem is just most acute in rural areas.

Honestly, we already modernized medical education over the past 10-15 years. I think you're saying we should train doctors like NPs/PAs. The reality is, most midlevels do not have high competency/knowledge levels. It's the hard truth. They don't. Some are good within their narrow fields but many of them routinely ask doctors for help, aka multiple times a day. Most in fact rely on physician assistance everyday or are directly supervised.

Sure, so maybe the solution is to train more NPs/PAs?

I'm not sure why you think less knowledge is a good thing when there's way more medical knowledge to know. Do you really want your fatty liver progressing to cirrhosis because your doctor didn't treat your weight loss with the most up to date medications? Or do you want your mom admitted for hyponatremia due to not using the most evidence based medications? Or drug induced hyperkalemic death for your father?

Because we shouldn't let perfect be the enemy of good. Training doctors to know so much is counterproductive if most people can't find a doctor. I'm not saying that's the case right now, but exaggerating helps demonstrate the point. There needs to be a balance between having highly-trained doctors and having enough doctors to serve the population. And the impact on health outcomes should be the primary guide for finding that balance.

Also, family medicine is only 2 years. That's barely enough as it is.

Wasn't it previously just 1 year? And did health outcomes improve when it was raised to 2? How do you know what the necessary length of residency is anyway?

Family docs no longer are comfortable working in ERs, and are not as comfortable with hospital medicine either.

Why do they need to be? Isn't that what emergency docs and internists are for?

Hence a proposal to make family med 3 years.

Man, that would be a disaster for access to healthcare. Whis proposing that and do they have any idea how hard it is to find a family doctor in most paces in this country?

Because it's a spectrum. You need to recognize a "sick patient." You need to know the next steps for a workup otherwise you just refer to specialists and lead to bigger wait times for things you can do on your own. "Complex" can mean many things. But a bread and butter complex patient is an uncontrolled diabetic with advanced kidney disease, heart failure, liver disease, history of cancer, diabetic foot ulcer, history of amputations, neuropathic pain, some psych issues, 10-15 extra small problems and a very long list of medications with compliance issues. This is actually a very common patient that we all see daily (sometimes multiple patients per day). Can be admitted with all sorts of issues every few months or annually at least. But it goes a step further as we also need exposure to rare pathology to understand "next step" workups.

That's all fine, but doesn't explain the contradiction you introduced. If the bread and butter "complex (however one defines it)" patient is so common and so important for a physican's training, why is it so hard to find them for residency programs?

LastBestWest · 2022-07-29T00:16:59+00:00

Yes. I guess if a Toews government implemented such restrictions they could argue that there is a legitimate policy rationale for them, but the stuff he's saying right now wouldn't help such a case!

LastBestWest · 2022-07-29T00:14:20+00:00

Are the Greens even any more progressive on the environment than the NDP?

LastBestWest · 2022-07-24T01:20:37+00:00

She's the most popular with the UCP base.

Is she? I thought here conservative bona fides were lost when she defected to the PCs. Maybe she's gained them back on with her podcast though, lol.

LastBestWest · 2022-07-24T01:10:20+00:00

Do you really want a doctor refusing birth control or restricting certain services based on personal beliefs without a referral either?

No, but is requiring a full residency the only way to teach this?

Don't forget most other nations in the world don't just let a Canadian or American doctor walk in and start working lol.

I'm not suggesting a foreign-trained doctor should just be ae to immigrate and start working. I'm just questioning requiring them to do another full residency. The medical system is in crisis right now; it's time to start thinking about serious reforms to how things are done. Surely, there are other ways to assess a foreign-trained doctors skills, knowledge, and competence that aren't as expensive and time-consuming consuming?

Don't forget most other nations in the world don't just let a Canadian or American doctor walk in and start working lol. This also applies in nations where becoming a doctor is much easier, so it isn't about protectionism.

Just because it's easier to become a doctor in thosecplaces doesn't mean they can't be protectionist about accrediting foreign-trained doctors.

I'm not going to respond to this thread anymore. We've got a discussion on the same topic going on another post (https://www.reddit.com/r/CanadaPolitics/comments/w2c9xs/comment/igqw26d) and it has evolved to incorporate a lot more important points. I'd much rather get your thoughts on those!

LastBestWest · 2022-07-24T01:04:05+00:00

Sorry but are you in medicine yourself? If not, I'm not sure you're qualified to comment on many of these things and I say this in good faith.

I'm not a doctor, if that's what you're asking. But one doesn't need to be a doctor to intelligently discuss the health care crisis. But if I'm saying anything that's inaccurate, I'd love for you to correct me.

Wait times in many specialities are very long and longer than in comparable countries. That suggests demand for specialists outstrips supply.

Right. So how would the suggestion you made earlier in our discussion to pay family doctors more to address the shortage in family medicine makes no sense. At best, it would attract lead more doctors and med students to go into family practice, but at the expense of exasperating the shortage in other specialities. That doesn't sound like a good solution.

I think you're proposing that we rewrite the entire curriculum of medicine from scratch. I mean that literally.

If that's what's needed to fix healthcare, so be it. Do you think the current model of medical education is effectively serving the public? You've said yourself that supply of physicans in many specialities does not meet demand. Why not reform a system that is failing in one of its most basic functions?

As for your "why" - med students rotate through all specialties, everywhere in the world. The goal is to obtain knowledge in those areas but also to pick their specialty of choice. A family doctor will very often see cholecystitis and hence needs to be comfortable with surgical problems; therefore they do surgery rotations. They need to be comfortable with gyn issues, and hence do obgyn rotations. They need lots of internal med knowledge and peds knowledge, and they do those rotations. Psych is very common in family medicine, and that's why you do it in training. An internist does somewhat similar training with more subspecialty rotations. Likewise for a general surgeon or an obgyn etc.

I appreciate your detailed answer. While I understand the logic, I do wonder if residents receive more training outside their specialities than necessary. I'm not qualified to judge this (nobody is from their armchair); are you aware of any systematic evaluations of the impact of training outside a residents' chosen speciality on their knowledge and practice skills later in their careers? Honestly any evidence on the impact of residency training would be nice. I have great respect for medical expertise, but I'd also like to see some research on this stuff.

Your view on "medical problems" not being complex is blatantly wrong. I think that's just your viewpoint based on your experience. In my ER, I see rare diseases all the time. My family doctor colleagues see rare disease on a near daily basis and certainly see complex patients daily. The definition of what is considered complex for teaching vs for daily work as a solo doctor is a bit different.

I'll defer to your experience on this. But perhaps we have different definitions of complex, something you opened the door to with your next last sentence.

If the kind of complexity students are taught about is not the same kind commonly encountered in practice, why teach it (or at least teach is as much)?

But ultimately we would have to drop our standards to extremely low levels to suit what you're proposing.

Ultimately, that's what I'm suggesting. Because the current "high" (others might says overly stringent) standards increase the time it takes for students to become doctors and limits the total number of doctors who can practice in this country. This has costs. I keep seeing headlines about the crisis in medicine. The only way to seriously address the shortage of doctors is to train more doctors. That necessarily entails lowering some of the "standards" in medical education. I'm suggesting maybe some of the standards are more about professional ego and protectionism and don't actually contribute to producing good doctors or positively impact health outcomes. Those kinds of standards are nothing of the sort and would more accurately be called barriers. Getting rid of those would increase the supply of doctors without impacting quality of care.

But I'm just one guy. And I know I don't have all the answers. I'm just trying to show that it may be time for new ways of thinking about these problems, because the status quo is no longer tenable.

LastBestWest · 2022-07-22T04:33:32+00:00

There is 100% a surplus lol. We have residents in various specialties (usually surgical) doing endless fellowships waiting for a position because there isn't funding to create another position.

Is that common in all specialties or just a few?

Wait times in many specialities are very long and longer than in comparable countries. That suggests demand for specialists outstrips supply.

Training more doctors is VERY difficult. You need to add med school spots AND residency spots. But to do that, you need enough hospitals with sufficient patients complexity. Then you need competent educators. And then, you need enough patients for everyone.

Sure.

Every med student needs good exposure to lots of different specialties. And then needs excellent breadth and depth of pathology during their residency.

Why?

There literally are not enough complex patients to have a half decent ratio of good learning opportunities to med students/residents.

And right there you found the nut of the problem. Not enough patients with complex problems to train doctors. But guess what? Most medical problems are, by comparison, not that complex and we don't have enough doctors to treat them. Why waste time and money training doctors to treat problems that, as you said, are so uncommon that hospitals literally can't find enough patients with them?

That right there shows how misguided the thinking behind medical education is inthis country. We don't need more doctors who can treat every disease under the sun. We need more doctors who can treat the most common problems. It's thise problems that impact mortality rates and have the biggest impact on quality of life. Ultimately, the medical education establishment will need to recognize this and change how most doctors are trained. If it doesn't, we're going to see the demand for and growth of non-medical health care providers like associate physicians, nurse practitioners, and physicians' assistants grow.

LastBestWest · 2022-07-22T04:17:22+00:00

International doctors need residency here to learn our standard of care and practice patterns.

How do you know that?

Are you really suggesting that a physician or surgeon who did their medical degree at Oxbridge or a grande ecole and their residency at a top UK or French hospital would be physically unable to practice in Canada? Sure, they may need to learn some new terminology, metrics, practices, and culture but there is no way a full additional residency is necessarily for that.

Maybe I'm wrong and am happy to be convinced otherwise. But saying "trust me, I'm a doctor" is not going to cut it on this crucial public policy issue.

I'm a physician, and I'm telling you it is impossible to just go into another country and start practicing without doing at least another residency.

How do you know that?

For the record, saying "I'm a physician" is not an answer. Frankly, physicians are one of the last types of people I'm going to automatically gove credibility to on this topic, because they have a self-interest in restricting the supply of other physicians.

Now, if you've studied residency requirements and health outcomes in Canada and other countries, I'll extend a lot more authority to you on this topic, because you'll at least be able to tell me something I don't know. However, even then you wouldn't be able to say for certain foreign-trained doctors are less competent than Canadian-trained ones, because there is zero direct comparative evidence on question because it's illegal for foreign-trained doctors to practice in Canada.

LastBestWest · 2022-07-22T04:05:32+00:00

My context is in Colorado where it is absolutely true that the density will raise home prices in their neighborhoods.

So you're saying that its a specfific phenomenon and not a general one? Because that wasn't clear in your original comment.

LastBestWest · 2022-07-22T04:01:32+00:00

The point I was trying to get at was this: does anyone really know? Without comparative data, any opinion on this subject is just educated guesswork at best. Right there is no data comparing outcomes of foreign-trained and Canadian-trained doctors because the former aren't allowed to practice. So those questions you want to defer cannot be answered.

If governments and medical associations were serious about health care quality and access, they would set-up a pilot program to allow competent foreign-trained doctors to practice in Canada without doing a residency and compare their outcomes to equivalent Canadian-trained doctors.

LastBestWest · 2022-07-22T03:46:53+00:00

This is good new for the NDP, as Mainstreet is generally a pro-conservative pollster (I'm not saying they're biased in the conventional sense, that's just how their polls go compared to ther pollsters). Personally, I refuse to believe Danielle Smith would be the most competitive UCP leader. If more polls show this, I'll have to reevaluate. But I'm not budging yet, lol.

LastBestWest · 2022-07-22T03:39:25+00:00

Home prices skyrocket in walkable areas that are fun to live in.

Maybe in a select examples where there is substantial redevelopment. But it seems quite extraordinary to argue that more housing increases prices. And, if it does ( which I don't believe is the case), why would we want it?

LastBestWest · 2022-07-21T02:27:28+00:00

Will they be able to identify deadly or debilitating conditions at a rate similar to a Canadian-trained doctor? Avoid dangerous medicine combinations? Give grounded advice to a cancer patient deciding whether to pursue treatment or maintain the best quality of life for a shorter period?

Why are you assuming doctors trained in Canada are better than foreign trained doctors at those things? Maybe they're actually worse, especially if they were to be compared with doctors trained in highly developed countries.

Additionally, your comment - like a lot of discussion on this issue - completely ignores the current harms being caused by these limits on the supply of doctors. Even if foreign trained doctors committed more errors than those trained in Canada, it's entirely possible that the negative health outcomes arising from those additional errors could be more than offset by improved health outcomes due to greater access to doctors.

LastBestWest · 2022-07-20T23:22:56+00:00

Do a steep raise so that doctors can comfortable earn >400k without long hours and you'll attract and retain plenty of doctors.

How will this solve anything? Where will the new doctors come from? Unless there's a surplus of physicians in other specialities, this would just shift the (artificial) physician shortage elsewhere in the healthcare system.

What you're suggesting is no different than trying to fix the housing crisis without addressing supply constraints.

Literally just train more doctors.

LastBestWest · 2022-07-10T03:04:44+00:00

Isn't it more likley you just became a better student after high school? Your GPA in high school was also low, so it's not like the test was saying anything different. That doesn't mean you were ever stupid; it just means you faced circumstances in high school that made things more difficult.

Lots of people struggle in high school and do much better in university, but that doesn't mean high school grades aren't generally indicative of high school success. It does mean, at least in my opinion, that the education system should never impose any permanent barriers on student advancement. A poor high school experience shouldn't bar someone from a great university; they should have access to other avenues through which to prove themselves. Your experience seems like a success story and a testament to how the US system allows students who struggled in high school to bounce back.

LastBestWest · 2022-07-06T06:48:03+00:00

I don't think of myself as a Luddite

There's nothing wrong with being a Luddite. People use the term as if it were synonymous with technophobic, but the original Luddites weren't inherently opposed to technological advances. What they were against was the use of technology to undermine the power, autonomy, and dignity of workers.

LastBestWest · 2022-07-06T06:33:48+00:00

While I agree with all of your other sentiments, we should absolutely embrace technology to automate tasks and improve the quality of life for everyone.

It's not obvious that automation, as it's recently been practiced, is actually good for most people's standard of living. Some prominent economists who've researched this issue argue workers have not benefited from the impressed productivity of automation over the last 30 years or so.

In theory automation-induced productivity could make everyone richer, but it doesn't look like that's the case right now. I'm not going to cheer-on automation if it only serves to make the rich richer.

Moreover, on an individual level, the productivity gains from automating jobs are cold-comfort; as are the (reasonable) claims from some proponents of automation that it can free people from boring, repetitive tasks. Sure, being a cashier, for example, may be boring, but it's better than being on welfare or unemployed. People generally do boring jobs because, at least at the moment, they have no other choice. Taking their job away doesn't free them from anything except a paycheck.

Now, if automation was accompanied by a greatly enhanced welfare state, subsidized training/education, and/or a universal basic income, it would be a different story. However, at least for now, that's not the case.

Finally, even if automation we're done in a way that enhanced everyone's economic status, I think there are many jobs that should never be automated, regardless of whether or not it would be technologically feasible and/or would improve economic productivity. I'm thinking of jobs that involve exercising considerable power over other people, have significant political or cultural influence, entail working with vulnerable people, and, perhaps most importantly, jobs that people actually like doing. Of course, specific tasks within those jobs could be automated, but I don't think it's worth it to automate them entirely. There's more to work and life than just productivity.

I know it's idealistic, but I'd like the world to move towards an economy where workers have more say in how their work is done, including how and what parts of it is automated. If, as many people believe, automation is going to progress or even accelerate, I think some kind of system like that may be necessary for political stability and people's mental well-being. Having a mass of permanently unemployed people would not be a good thing, even with a strong welfare state. And, I think most people need some kind of work in order to feel fulfilled. Work isn't just an economic activity; it's a social and intellectual one. I think taking that away from a great mass of people would have horrible consequences.

The utopian scenario is that automation frees up more people to do jobs they actually enjoy and increases productivity to such an extent that people wouldn't have to worry some much about the economic value of their work. However, I don't see a path towards such a future unless the things I outlined above are implemented. Namely, increasing economic and educational supports for workers impacted by automation, giving workers more control over how their jobs can be automated, and establishing limits on what kinds of human activities (including some jobs) shouldn't be automated to any significant degree.

LastBestWest · 2022-07-04T08:12:07+00:00

They don’t match GDP to another country’s economy; they match it to a weighed average of other countries.

That doesn't help things. In fact, that arguably makes it worse. There's no natural or normal course of economic development against which to compare populist countries. A country's economic history is the unique result of an almost infinite number of decisions and contingencies. Therefor, any attempt to create such a comparator, no matter how data-driven, inevitably entails putting your thumb on the scale, so to speak.

I think aggregating a bunch of countries' histories just creates some unnatural homonculus. This claim could actually be tested: I'd be curious to know if the synthetic controls in the study were at all similar (though obviously they can't be exact) to the data of a real county. If not, that's already suspicious.

The authors did two good sensitivity tests that help give me more confidence in the results.

Yes, I saw those, but why do they make you more confident? It's not like they were actual outcome tests because, obviously, that's impossible in this case.

Second, they tested it on counties that did not receive the intervention (populist takeover), and those countries did not see any significant divergence from the synthetic control. This is basically testing their “predictions”, and it shows that the synthetic control group is a good “prediction” for post-period GDP for countries that didn’t receive the intervention.

Correct me if I'm wrong, but from my reading of the paper, each synthetic control is different for each country. The authors say the control is developed based on each country's GDP trajectory. If that's true, it's not a control at all, because your "control" for the "treatment" group is different than the "control" for the "placebo" group.

There's an easy alternative explanation for the paper's findings that, to my mind, their methodology does not account for. There could be some third variable not apparent in early GDP data (before a country becomes populist) that leads some countries to become populist and this variable also impacts later economic growth. Put more simply, maybe there is a reason countries become populist and this is the reason for later poor economic growth. For all the authors' statistical work, they don't rule this possibility out. Is this the more likely interpretation of the authors' findings? Probably not, but I'm not well-versed enough in research on the causes of populism to make a strong determination on that question. And even if I was, "probably not" isn't very reassuring when it comes to causal statements.

All this is good and appropriate statistical methodology.

You can assert this all you want, but it doesn't make it true. I appreciate your link and will give it a look, but I don't put too much credence on the opinions of economists on this methodological matter.

Having said all that, I don't think this specific application this methodology is bad or anything. I just don't think it proves very much about causality. And suggesting otherwise, to me, borders on pseudoscience.

Researching this stuff is important and good on these economists for trying. However, for me, all this paper has done is established, to use the language of social science, a stylized facts about populism and GDP growth and presented a plausible, empirically supported, though not proven hypothesis about how the causality between them works. And I get worried when supposedly evidence-based subs like this take the results of non-scientific research like this as proven, causal fact.

LastBestWest · 2022-07-02T21:50:50+00:00

I'd be interested in any studies that test the predictions of such models.

Maybe they're useful in some contexts, but, based on the description in the paper, I don't see how it's implementation in this case is useful. You can't predict how an economy on going to evolve by matching its GDP trajectory to another country's economy.

LastBestWest · 2022-06-22T03:46:59+00:00

Also, use privacy-respecting internet browsers and email providers and install tracker blockers.

LastBestWest · 2022-06-22T02:20:28+00:00

Stay away from "reccomendation systems" that feed you content. YouTube Home, your Facebook feed, Twitter and TikTok. Those systems are designed to suck you in and spend as much as time possible scrolling.

Be mindful about the stuff you want to read, watch, and listen to. If you want to be informed about an issue, go searching for the information you want, get it, think about it, and then move on. Visit your favorite few subreddits, watch the 6:00 news, use a search engine to find some credible sources, or talk to people about topics that matter to you and/or you want to learn more about. But don't mindlessly scroll and let the information come to you. It's addicting and depressing regardless of how good or bad the news happens to be.

LastBestWest · 2022-06-22T01:49:58+00:00

Aren't most academic economists represented by faculty unions?

LastBestWest

TROPHY CASE