My Home Server software stack
Well, you could say it stops unwanted foreign substances from entering.
I found tteck's Proxmox Helper Scripts great for getting my proxmox experience off the ground. I'm similar to you with just recently getting started while having limited network experience.
I also just set up Twingate for external access following a networkchuck video and love how easy it was. I was just going to do a vpn on my unifi router but this was a more streamlined solution.
As far as services, I've got:
- Plex
- Home Assistant (a huge but fantastic rabbit hole)
- pihole
- A docker LXC running Portainer, a transmission+OpenVPN container, SearXNG, and Twingate
- Trilium (notes app similar to Evernote or OneNote)
- Nextcloud (kind of frustrated with this one, mobile auto-upload doesn't want to ever work properly)
- BlueIris NVR
- Heimdall dashboard
I don't watch enough TV to justify setting up the *arr services and prefer to find my own Linux ISOs if I'm interested in a particular one. Otherwise I'm quite happy with my setup, all running on an old desktop PC.
I think the article falls short in its reasoning. Yes, I agree that Canadian IMGs should have priority over foreign IMGs, but where's the root of the problem? Why do we have so many Canadian international medical graduates in the first place?
The issue here is not so much with how residency programs rank candidates, and I'd very much like to see a source for Pawliuk's claim of IMGs paying for residencies, because CaRMS doesn't work like that, but more because of the lack of Canadian graduates in the first place. Canadian medical schools are extremely exclusive and use outdated evaluation practices to limit their intake to a number that has not increased much at all in the past decade, at least at my local university.
This exclusivity leads to Canadians who want to be doctors to seek medical training elsewhere, as the article mentions. This then makes them an IMG, and the system doesn't often distinguish between a Canadian or foreign IMG. It'd be up to the residency program itself to prioritize Canadians, but then you'd have to convince the ranking committee to select based on nationality rather than aptitude.
The question we should be asking is not, "why are there so many foreigners in Canadian residencies?" but rather, "why don't we have more Canadian graduates to fill our own residencies?"
You need Canadian med students to fill Canadian residencies, so medical schools need the resources to expand their intake, which relies both on convincing many conservative provincial governments to provide more funding to keep the already exorbitant tuition at a similar level, and having more people willing to teach in med school, which often means giving up some of their practice.
In my opinion, there is a vast supply of people who want to become doctors, but the very limited spots that med schools have lead them to create extremely obtrusive barriers to entry to limit their intake to who they think are the best, the succes of which is questionable at best.
It's fairly clear that standardized tests aren't an indicator of success in a profession, even grades at the undergraduate level can arguably be said to be an indication of how well one is at test writing. Intake, at least at the university near me, is also based on an in-person interview with poor scoring metrics, often conducted by later year med students or residents rather than practicing doctors.
I don't think the issue is a multitude of rich foreigners essentially paying for residency spots. The system is so dysfunctional they wouldn't even know where to send the money. Look to where the journey of becoming a doctor starts, and you'll find universities with limited resources using outdated intake practices to artificially limit the ones they accept into medical school, creating a bottleneck right at the very start of the process. There aren't a lot of Canadian graduates going unmatched to residencies, there are a lot of residencies open to foreign grads because we don't produce enough Canadian grads to fill them.
Urban and rural can be quite different. Urban family docs can do mostly clinic, so a fairly regular 8-5 with maybe some evenings, because other people provide the other medical services.
A typical week for a rural family doc in my experience would be clinic about 3 days, maybe 9-3 seeing patients, but actually 8-6 because you have to round on your hospital inpatients first and have paperwork after seeing patients.
Another day would be a 24 hour ER shift, where you're seeing 60 patients because there aren't enough resources for a walk-in, some with a stubbed toe, some trying their best to die. You might get an hour or two to sleep if you're lucky. You'd often take the day after to recover, but it's not uncommon to get phone calls during the day from consults and such, so not really a great sleep.
On top of this, you can be on obstetrics call on your clinic days (or weekends) so if there's a baby to deliver, you're up, either delaying your clinic or keeping you working into the night. There's a fair bit of communication needed even when the doc isn't needed in the hospital, so your sleep is shit again.
Essentially, rural family docs do nearly everything in their service area and only the most serious stuff gets sent out. With an antiquated part of the bylaws of the College of Family Physicians saying family physicians must always be available for their patients, rural physicians get fucked around, while urban docs have the luxury of dedicated 24-7 ER to take care of that.
ER docs on the other hand, at least from the ones I know in Regina, have usually a rotating 8 hour (sometimes 10 or 12) shift over a few days. So you'd work an afternoon, evening, then night shift three days in a row, then have a day or two off. Patients seen can be less because of better family physician and minor ER access, but the main thing is that when you're done your shift, you're done. You aren't going to get a call from a consult, or lab, or a request to do or assist in a procedure like a c-section. You can turn your brain off of work mode and not dread the sound of your phone's ringtone.
It's unfortunate you have to make that distinction, but thank you.
It's definitely a complex issue, but I think a few things could help in my experience as the spouse of a physician in rural SK with an engineering background.
- Pay parity - rural family physicians provide many of the same services as urban ER docs would, but are paid considerably less, while having worse work-life balance. Family docs can also do just one year of ER residency add-on and work solely in emergency medicine. This makes family practice much less attractive and incentivizes many family docs to pursue subspecialties. One of Regina's hospitals' ERs are staffed fully by family doctors, and we've had 2 of our 14 doctors leave recently to work in non-primary care specialties, with another also pondering leaving, effectively saying, "I can make more money, see less patients in a day, and have better work-life balance just an hour down the road, why should I stay here?" With this, family physicians have considerably higher overhead compared to really any other specialty. Clinic rent, clinic staff, clinic equipment, an EMR subscription, IT equipment all adds up. Work in a hospital and you have none of that. We also just had a health authority administrator ask the doctors here, who practice privately, to pay for scheduling software for the hospital. It's insulting, really.
- Support and scrutinize education - there is med student and residency education opportunities throughout many rural sites in our province, but there's become a lack of supports around those positions. Lack of housing for electives, stagnant med school intake and family residency spots. If you want more doctors, you need to educate more doctors and provide the adequate support in order to do so. Less on the government side and more towards education, but there are also some residency programs and/or preceptors whose residents are consistently behind standards, yet there seems to be no oversight or corrective measures taken. This is more on substandard self-governance and entitlement of certain individuals, though.
If I had to boil it down, I'd say those who make decisions in government have a complete lack of understanding of the day to day operations and expenses of rural physicians. A government rep was flabbergasted when she heard that family physicians often have several hours of non-patient facing time in a day when she asked why clinics can't be open 8-5 in a recent meeting. A 6-hour clinic day would often produce 2 hours of paperwork, or you'd need to leave 1 weekday for paperwork if you worked the other 4 seeing patients. Yet, given this lack of understanding, they still refuse to pay doctors for their time to meet to discuss these issues.
This is a symptom of a twofold problem. First, additional staffing and resources for ERs would help to reduce wait times, but I think the more important issue is lack of primary care, which would help patients avoid needing to go to the ER in the first place.
I'm not much of a fan of the way the article is written. Of course there are going to be some cases where a LWBS has serious complications, but locally (and anecdotally), our ER seems to operate more as a walk in clinic at times, and doctors will often see more patients there than they would in a typical clinic day. I feel like the non-emergent visits are likely a considerable part of the 6.8% LWBS rate, and could be offset by a better supply of family physicians. Unfortunately, at least in Saskatchewan, that would require a government willing to do anything whatsoever to help the healthcare system.
Again, they are not trying to talk them into anything, they are saying it's an available option.
That's precisely the job of a physician or health professional though. Ensure the patient is aware of the options they have available for care. They saw that he would likely meet the criteria and suggested it as an option. Them explaining the reasons of why they elected to suggest that option of care is not coersion in any sense.
While I agree that assistance in dying should not be used to offset a lack of other necessary care, like mental health, addictions (which I believe are disqualifiers for MAID), or disability, the article provided only examples of health care professionals offering the service to people who had severly diminished quality of life as an option of part of their care. I think it's a stretch to say these were examples of coersion. The decision is left solely to the patient, and I think their family's account can often cloud any reporting of what the patient's wishes actually are.
Anecdotally, the health professionals I know say there are far too many families, and ocassionally doctors who think they're superheros, who wish to prolong their relative's/patient's life for the sole purpose of delaying death. People, like Mr. Nichols' family, will say he's got a great quality of life, but picture yourself in his shoes. Deaf for most of your life, now vision loss, seizures, your body essentially withering away. He was suffering, and clearly, he wanted to end it. Several inquiries noted he fully qualified for and received MAID as he wished, even though it may not have been the wish of his family.
I do think it would be useful to have a review panel for more complex cases, like Dr Marmoreo suggests. But, I think the majority of cases where the family might raise concerns are cases where they are prioretizing their wishes above those of the patient actually seeking the care, rather than a professional wantonly pushing MAID for no particular reason.
You seem to have missed the part where I asked for an example. That means providing evidence for one's claims.
Can you provide an example of MAID being abused?
I was actually quite interested in something like this in high school in the late 2000s. There were a few DIY EVs that existed that were just ICE vehicles with anything ICE taken out, an electric motor put in the engine's place, and several 12v batteries connected in series.
Of course, they're pretty crude compared to those we have today, but it's very possible.
Engineering and architecture are different. It's our job to make sure the things we design bring no harm to people and we have specialized training allowing us to take that responsibility on.
Site supervisors are often tradespeople, and may not even have the authority to direct health and safety measures on their site if corporate sees otherwise. I agree, they have a responsibility to do so, but it must be started from the top with some coercion by strong regulation. Putting liability personally on supervisors just removes it from the company who likely made the decision to forego supplying water because of cost savings.
Ah yes, the conservative doctrine.
I quite enjoy this one.
The sausage might not make it terribly cheap though.
I've got two 820As and tried getting them to work with frigate with no success. I am a bit of a Linux noob, so I'm sure I could have tweaked some more, but I instead tried out Blue Iris and they worked without issue. I've now got AI detection and motion alerts going to my phone through home assistant and they were fairly straightforward to set up.
Re: VPN and Wireguard, I was looking into doing the same on my unifi router, but came across Twingate (through a networkchuck video) and decided to try that instead, being a bit of a networking noob. It's almost too easy...you can share individual resources or whole networks with user and device control over each. I think you get 5 users and 10 resources in the free plan. I'd recommend looking into it.
I had been pondering Nabucasa for external Home Assistant access but am very happy I found this. Now my wife can have remote access to HA and Plex and I can access the whole network remotely.