In this conversation, it’s important to distinguish science itself (which, along with facts, are already under attack in our politics) from failings of the research industry.
Couple of points: The 21st Century Cures Act has recently expanded rules for information portability, which will make it much easier to get access to your data in the future. The challenge here has nothing to do with radiologists hoarding your data. The lack of interoperability typically stems from limitations of electronic health information systems. Most radiologists would love to be able to look at your scans from multiple previous hospitals where you were imaged previously, but technical barriers currently make that difficult.
I don't blame the practicing radiologist, but I also don't buy this is purely a technical issue. The hospital is quite literally incentivized to have you repeat tests. I highly doubt they care to make data accessibility/portability a priority. Hopefully these new rules will force their hand.
You are right, to an extent. Health systems and EHR vendors both have historically had an economic disincentive to share data. Think “ecosystem lock-in”. My impression is that things are gradually changing for the better.
The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamental problem.
I have seen comments talking about "physician cartels" purposely encouraging a labor shortage to drive up physician pay. There is no physician cartel. Only about 15% of physicians even belong to the AMA, and only a subset of those have any political involvement at all. It just doesn't exist.
One of the things that I think contributes to the general dissatisfaction of physicians in 2017 is the increasingly negative public opinion of the medical profession and the imputation that there is some sort of evil conspiracy at work. A lot of the negative opinion is misdirected. It should be aimed at the for-profit health care system itself. Most physicians I know have very little control over the things people complain about, including cost.
The AMA caters to a base that is not happy with the influx of IMGs and DOs. The AMA inflates their numbers by auto-enrolling every allopathic medical student. The AMA is equally unhappy that the government using large scale funding levers at the residency level to overwhelm their efforts to tighten supply. By using money and their exclusive access to legislate, the government creates such a Venturi effect that they suck up all the available MDs, and all the available graduates from two other pipelines: the DO programs and the IMGs.
In 2017, the dissatisfaction of the 85% of physicians who don't belong to the AMA is ultimately driven by too much work.
Source: am physician. Have worked primary care, seeing 40+ patients a day, now completing a specialist residency. My work as an underpaid primary care doc was enough to keep 3-5 people fully employed (reception, x-ray certified assistant (sometimes 2), office manager, owner) from 8 am to 10 pm 7 days a week, while sending overflow to others.
Every one of the 85% of physicians who aren't in the AMA declined to renew their membership at some point. Many align with other orgs: almost invariably their specialty's organization, which aligns with the AMA but they are more professionally beholden to (for CME, board certification, etc). Many try to offset the ill effects of the AMA by aligning with other orgs like PSR or MSF or their local public clinics.
But the AMA has a bunch of offices in DC, and has had people in those offices, paying mortgages in McLean or Chantilly, or Silver Spring, <insert DC suburb here> for a century. Those people are motivated to continue their mission of lobbying in support of the legal grip of allopathic medicine, long past their original call to arms (licensure laws to cleanse the field of snake oil salesmen).
I'm also a physician. I am generally satisfied with my work, but I do feel distressed by what feels to me like erosion of the social contract between doctors and society that flourished during the second half of the twentieth century. It sounds like we agree that some of that erosion has occurred because of nakedly self-serving political action by medical professional societies.
When I made the decision to become a physician twenty years ago, I thought medicine was my calling. I believed that the personal sacrifices one makes to be a physician--and there are many--would be rewarded with professional pride, the respect of my community, the gratitude of my patients, and a secure and well-paid living. I have gotten a little wiser, I think. I make a good living, my work is interesting, and I still think medicine is a great career. But times have changed, and I no longer consider medicine a calling for which one should be willing to sacrifice one's personal well-being. I find myself defending my profession on the internet a little more than I'd anticipated :)
Those who control the business of medicine take economic advantage of the patient-first mindset of our medical tradition, and it cheapens what we do, both literally and figuratively. It is for that reason that, despite its many flaws, I do think organized medicine does have redeeming qualities. It gives physicians at least some voice in politics, where they would otherwise have none at all. Maybe one day health care reform will right the ship.
Don't get me wrong, we have a great gig. A fellowship director once expressed shock that I would advice my kids to go into medicine. I asked him "Have you looked for another job? I had a job before this, and had to look for another before I got an acceptance letter, married with two kids. Have you looked at the job market? What other job pays half as much, is half as satisfying, or gives you half as many further opportunities?" His reply: "Yeah, I mean, when you put it that way..."
Well, what other way are you going to put it?!
I'm all for organized medicine. But I favor PSR and MSF. They represent the ideals of the modern liberal social order. The AMA needs to be starved off the face of the earth.
The issue of positive predictive value versus specificity comes up almost every day in my work as a pathologist. There is widespread misunderstanding, and in my own anecdotal experience, it very frequently results in unnecessary lab testing and misinterpretation of test results by clinicians.
When I was a pre-med student, for some reason the prerequisites required a year of calculus. That succeeded in weeding out people who can't make an A in freshman calculus, but I'm not sure what else it accomplished. Calculus has little to do with the daily practice of medicine, unless you're a radiation oncologist or doing some hardcore research.
A year of statistics would have served me and my patients much better. That goes double, given the current firehose of data that is part and parcel of the personalized medicine revolution.
heh, pathologist here as well. See my other comment in this thread (1). I did physics, so I don't know what the general pre-med curriculum is like, but I'm not so sure a stats class would necessarily help more than two semesters of calculus when you're up against big data. Understanding integration and continuity are more valuable in the big picture.
My experience has been that big data is more about linear algebra, which is usually several classes beyond entry level calc or stats. You have to be able to reason about arbitrarily large collections of partial differential equations (albeit reduced to difference equations).
For example, if you want to talk about genomics, Durbin's Biologic Sequence Analysis is probably the most foundational text available. It introduces Bayes's theorem on page 8, has stuff that looks suspiciously like calculus on page 40, and is into Markov chains by page 48. They hold off on a formal treatment of entropy until about half-way through the book.
And for phylogenetics, the equivalent books is Felsenstein's Inferring Phylogenies. He introduces linear algebra before integration.
My favorite quote from Felsenstein, particularly germaine for pathologists (surely the taxonomists of medicine):
"Knowing exactly how many tree topologies ... is not particularly important. The point is that there are very large numbers of them. ... one use for the numbers was "to frighten taxonomists."
I am doing the same thing without the HDMI audio extractor. The Chromecast is plugged directly into an HDMI port on the receiver. It works fine. Maybe whether the extractor is necessary depends on the receiver.
Whether it will work seamlessly may depend on the receiver, but I have a Chromecast plugged into an HDMI port on my Yamaha unit. (Note, there is nothing plugged into the HDMI out port on the receiver.) This setup works flawlessly for streaming audio throughout my house.
Some people say they had to use an HDMI audio extractor to achieve this, but that was not necessary in my case.
Yeah, similar setup here - I've plugged mine into the first HDMI port on my Onkyo receiver (http://amzn.com/B0077V88V8), and everything works fine. Audio through the reciever, no TV on - plus I get the automatic input switching thing that Chromecast does (seems to just go to the first HDMI port on the receiver, not the actual one it was plugged into). Pretty nice.
'So much'? You honestly think an artist/label getting $0.003 per play is 'so much'? What world do you live on. At least with iTunes if say 1000 fans your track, you'll get at least $500 from the sales. But if those same 1000 just streamed the track from Spotify, they'd each have to play the track 166 times to get the same royalties.
You honestly think an artist/label getting $0.003 per play is 'so much'?
Yes. And this sense of entitlement is getting on my nerves.
The cost of music distribution has gone from infinite to ZERO in just about 130 years. This is a great achievement for us as a species and we should adapt accordingly instead of bemourning expired business models.
The music industry was constructed around the bottleneck of physical media distribution. This bottleneck does not exist anymore.
Sorry, that's not what I meant. I meant that the record companies ask for enough money that the company can stay in business but so much that they make a big profit.
Personally I think the amount artists get paid by streaming services is wrong. $0.003 and even less per stream is what I've seen but we also must remember that artists signed to the major labels get paid a much higher cut due to deals they make with the streaming services. I think the services would work best if artists/labels could opt-in and the price per stream was fixed for all artists ($0.02 per play seems fair to me).
It varies by month, by country, and by record label. So it's hard to give an exact figure for every artist. $0.003 is on the top end of the scale though.
I can tell you why I use the NY times mobile site instead of the Android app on my Galaxy Nexus: the ads. The ad on the mobile app stays on the screen when you scroll the content. It's frequently an obnoxious color that distracts from the article. In the browser, the ads are similar but as you scroll down they leave the screen.
Simple, but it's enough to make me abandon their Android app.
I am really starting to like Google docs as a possible Evernote replacement, as soon as they improve their offline editing support. One thing I can't figure out is how to change the default font for new documents. I try saving the "Normal Text" style with Ubuntu as my font, but new documents always revert back to Arial.
