By: Ivan Hoffman, CFP®, Valeo Financial Advisors

At last, all of your medical training is about to pay off. Perhaps the 16 hour work days won’t go away completely, but at least your pay check will reflect compensation received for services rendered.  No more fresh student loans to sign, no more embarrassing residency stipends that pale beside the pay checks of your friends with a bachelor’s degree.  Your gross monthly income now approaches your annual resident’s salary, and should pave the way to prosperity.  You must now focus on patient care, track to partnership, Medicare and Medicaid paperwork, continuing medical education, and clinical excellence.  Your financial life is about to become much less complicated and far less demanding of your time and attention.  Buying a house, replacing that high-mileage vehicle and paying down a mountain of student loan debt can be managed when the time permits.  Right?

Wrong!

Our experience suggests otherwise. Although, clinical and business issues are critical to developing your career as a physician, you cannot expect your new found revenue stream to take care of your other financial obligations without your attention. It is more important now than ever to establish a strong financial foundation. This is the period in your life to begin taking a proactive stance to solidifying important financial decisions. Fortunately (and unfortunately) for you, there are numerous financial professionals ready and willing to serve. These financial professionals will come in all shapes and sizes. You have probably already met a few of them, but you should be prepared to begin receiving calls, emails and mailings from various types of insurance agents, mortgage brokers, private bankers, financial advisors, stock brokers, realtors, malpractice attorneys and accountants, to name a few.

School is out, but your homework is far from being done. Find out who these people are and ask the hard questions:

1. What is your company known for?

2. What are your credentials?

3. Have you or your firm ever been disciplined for unethical actions?

4. How much will this cost me?

5. What is your incentive? How do you get paid?

6. How often will we talk?

7. Will I talk with you or someone else?

8. Will you provide references?

9. Can you show me an example of an engagement letter / agreement?

Be keenly aware of conflicts of interest. Don’t be the next physician preyed upon by salespeople looking out for their interests instead of yours. Surround yourself with people whose business model centers upon objectivity.  Begin to build a team of trusted advisors. You have earned the right to financial prosperity. Take it upon yourself to be ready for it.

Ivan Hoffman, CFP® is a financial planner at Valeo Financial Advisors, a fee-only financial planning firm servicing clients throughout the U.S. Ivan is also a NAPFA-Registered Financial Advisor (National Association of Personal Financial Advisors), as well as a member of the MD Preferred Financial Advisor Network. He can be reached at 888-488-2536 or idhoffman@valeofinancial.com.

It is a well documented fact that seniors spend tens of thousands of Medicare dollars in their last six months of life. But trying to save some of those dollars through reform is not going to be easy. It is no secret that Congress plans to find fully one third of the dollars needed to cover the millions of uninsured by squeezing the Medicare and Medicade systems.

Trying to determine when the end is near is rather like telling a bus passenger that they should get off the bus six blocks before Elm Street. Even patients with terminal illnesses surprise their doctors and families with frequency. When do you give up on a patient and withhold expensive care? Who will determine what procedures, tests and care are appropriate?

One of the less discussed reforms in both the House and Senate Healthcare bills talks about a Commissioner of the Health Choices Administration, a new government agency. In addition to establishing federal standards for health insurance programs both private and public, this agency and its administrators would eventually be charged with determining standards of care and who gets what and when and at what cost. If it sounds like rationing it is. The difference is that the decisions will be made by unelected government bureaucrats.  Many doctors, seniors, insurance executives and hospital administrators have a host of unanswered questions about how this new agency will be built, how it will be staffed and how it will work.

Dctors are not helping the situation considering their reluctance to discuss cost issues with patients. A recent survey appearing in Health Affairs magazine shows that physicians almost always take cost into consideration when making treatment recommendations. The survey showed that oncologists treating terminal cancer consider factors such as a patient’s out of pocket costs and Medicare reimbursement when making a treatment recommendation. But only 43% say that they discussed the cost issues affecting their medical advice.

The simple facts of healthcare reform are that there are no simple solutions. Controlling spiraling costs is a prime motivator of the reform process. But when you strip away all the political retoric it comes down to questions like: How much spending on a termanal health condition is too much? How much are tax payers willing to spend to keep the uninsured alive? What is the economic value of one year of life…one month…one day?

And with or without reform, someone will always have to fill the role of final abitor of treatment.

A young professional prepares to buy her first home and presents her mortgage application to the bank. She clearly qualifies for the loan but there is a problem. Her credit report shows over $9,000 in unpaid medical bills! The problem is that they are not her bills. This scenario is playing out more and more frequently as medical identity theft becomes a growing problem.

The FTC estimates that imposters using forged or stolen identity documents to secure medical care account for as much as 3% of identity theft in the U.S. – nearly 250,000 cases each year. And of course this problem affects all the victims of the crime including the doctors, hospitals, insurance companies and the individual.

The FTC has taken action to address the problem. And the impact on doctors can be substantial. A new regulation called the “Red Flags Rule” took effect this past August. Within the medical community, the new rule will require doctor’s offices and hospitals to establish protocols to identify the “red flags” of identity theft. Not only must doctors implement procedures, such as checking photo ID’s, checking for medical record inconsistencies and monitoring fraud alerts from consumer agencies, but they must also detail what they will do if they spot a potential problem.

This unfunded mandate requires “creditors” to implement these new protocols. In the language of the statute creditors are defined as businesses that regularly extend or renew credit. This would include any physician’s office or hospital that accepts insurance or offers a payment plan for services rendered. The AMA and numerous doctors groups argue that grouping physicians with auto dealers and utility companies are misguided and that doctors are not “creditors.”

Despite these protests, doctors can add another layer of paper work to an already overburdened process. As the healthcare debate moves forward, it becomes increasingly difficult to understand how the government can get its arms around a complex problem that hundreds of government agencies make more complex by the day.

Guest Contributor, Harry Salzman

The prospect of relocating to a new city is overwhelming to most medical personnel. Unfortunately, many of the various tasks involved in the relocation process must be accomplished while you are either still working full-time at your present location, or are about to graduate from your medical training. To make matters worse, you must now deal ‘long-distance’ with individuals and service providers that you have never even met. The “to do” list of tasks includes such things as:
• Selling your present home, if necessary
• Finding a new home, or whatever type of housing you might need
• Making arrangements for temporary housing in your new location, if necessary
• Selecting schools for your children (Perhaps including Special Education facilities)
• Shipping your pet and boarding him until you arrive
• Renting a car
• Finding employment for your spouse
• Hiring a Moving company (Better have a certified check ready when your furniture arrives, or they won’t unload the van)
• Selecting a new bank
• Finding reliable sources for services in your new location, including: Mortgage lenders, Home Inspectors, Plumbers, Electricians, Pet Care facilities, Landscape companies, Decorators, etc.

The Bad News is that if neither you nor your new employer have established a relationship with all of these local service suppliers, you could end up living in a motel until all of the loose ends are tied up.

The Good News is that there are full service relocation specialists out there who already have these working relationships in place. They can help you resolve all of these problems as quickly and as painlessly as possible.

Relocation Specialists are Realtors who are trained and experienced in taking charge of all of the various tasks involved in moving individuals and families from one city to another. They act as your agent during the relocation process. They have established close working relationships with honest, reliable, local service providers in your new neighborhood and can even coordinate the sale of your present home with the acquisition of your new home. These Relocation Specialists can coordinate all aspects of your move either directly with you or with your Residency Program Director or Coordinator, depending upon the administrative structure of your new employer.

Relocation Specialists are usually in the top 2% of all of the Realtors in their market. When looking for a Relocation Specialist, be sure to look for a “Certified Relocation Professional” (awarded by Worldwide ERC, the International Trade Association for the Relocation industry). Your relocation specialist should work with a firm that is a member of the Relocation Directors Council, the organization for Relocation Directors and Broker/Owners of Real Estate Companies committed to Corporate Relocation.

One exceptional resource for any physician contemplating relocation would be Leading Real Estate Companies of the World, the largest, Independent group of Real Estate companies (approaching 150,000 members, worldwide). Their members are committed to providing the highest level of professionalism in Real Estate sales and relocation services in all metropolitan markets.

Harry Salzman has been a leader in the Colorado Springs and Pikes Peak Area Real Estate market since 1972. In the course of these 37 years, Harry has built a huge network of mortgage lenders, banks, relocation specialists and satisfied clients by offering professional, ethical, thorough representation of buyers, sellers and relocation clients. He recently was named the exclusive MD Preferred Real Estate firm for the Colorado Springs area. No matter where you are moving from or moving to, we are committed to The Power of Relocation Innovation. Contact Salzman Real Estate Services, Ltd at 800-677-MOVE or by Email at Harry@salzmangroup.com.

Ever been to South Bend Indiana? Lovely Midwest town… Notre Dame University…the Studebaker National Museum. In the summer when the college kids go home, there are no lines at the local Jewel food store or at the downtown stop lights for that matter.

I have a swell idea. Why don’t we turn the healthcare debate over to the citizens of South Bend. Whatever they decide will be binding on the 308,487,535 US citizens who don’t call South Bend their home. Think of how much more streamlined the process would be. There probably aren’t more than a couple of dozen lobbyists who live there. No filibusters, no parliamentary maneuvering, no party lines…just a simple up or down vote. If the yeas have it we get healthcare reform but without all the pork. If the Nays have it we go on with our current system, warts and all.

Absurd you say. Nonsense, undemocratic, heresy! The thought of letting 109,425 citizens decide for the rest of us is simply ludicrous. Well, if the entire population of South Bend actually voted (work with me here) they would equal the total margin of victory that Scott Brown enjoyed in the Massachusetts Senate race that rocked the political world. And the election of a Republican Senator from Massachusetts gives the Grand Old Party the 41st vote they need to block any healthcare reform changes coming out of the conference committee charged with the task of reconciling the Senate and House bills.

That means that if even one sentence, one word, one punctuation mark is changed, the Democrats would need 60 votes again in the Senate. And Republicans are daring them to try it. So, it looks like just shy of 110,000 folks in a smallish East Coast state are going to determine the future of healthcare reform in America. Our democracy is becoming as fragile as a china tea cup (no reference to the Tea Party Coalition intended).

While democracy in the long run is the most stable form of government, in the short run, it is among the most fragile.
Madeleine Albright

If I owned a building that was a bit larger than the size of a football field (let’s say 96,768 square feet, about 2.2 acres), and the government came to me and said, “Healthcare reform is going to cost about a trillion dollars and we would like to store that amount of money in your building so that when the bill comes due we will be able to pay it.”  Setting aside for the moment that any government official with that sort of attitude lives with Santa Clause at the North Pole, I would have to consider just I would go about storing that amount of cash.

Since the largest bill currently in circulation is the $100 dollar bill I would have to get the cash together in bundles of $100 dollar bills, pack them on pallets and move them into my building.  OK, let’s get started.

First I suppose I should band the bills in stacks.  Let’s say 100 bills to a stack.  Now how many stacks will I need to store?  Well, if I put ten stacks in a square and then make ten layers high I get a square of 100 packs of 100 bills worth a million bucks.  And my stack is only about 12” wide by 12.5” deep by 4.3” high.  This isn’t going to be too bad at all!

To make storage easier I think I’ll use commercial pallets to make stacking and transfer easier.  To cover the pallet with one layer of my 100 bill bundles I need to lay out 7 packets ($10,000 per packet) wide by 16 packets deep.  This single layer covering my pallet is worth $1,120,000.  Because stacked paper is very dense, I can only put about 90 layers on my pallet.  And 90 layers will be worth $100,800,000.  But for the sake of simplicity I’ll just count it as an even one hundred million dollars.  The government likes to round things off anyway.  Not bad.

Now I’ll move that pallet to the back corner of the building and fill another pallet.  After a couple of hours work I have ten pallets filled with $100 million bucks each and have them neatly parked in the back representing a cool $1 billion smackers.  And I have a ton of space left.  I bring in some day laborers (forgive me if I don’t check ID’s) and we really get an assembly line going.  I decide that we may as well stack the pallets two high and by day’s end we have one complete row of 50 double stacked pallets worth ten billion dollars.  This is taking a bit longer than I thought.

Next morning, bright and early I bring my crew in (now double the size) and we really get to work.  And by the end of the work week we are finished.  And to my amazement we have filled the entire building with double stacked pallets (one hundred rows of 100 pallets).  That’s 10,000 pallets each containing 90 layers of 112 bundles of $100 dollar bills, 100 bills to a bundle.  That’s 1,008,000 bills per pallet x 10,000 pallets…my calculator doesn’t have enough columns to compute that but just how in the hell are we supposed to pay for all this?

If someone had told me when I was born (I suppose they would have had to tell my mother and she could fill me in when I was older) that I would live to be 75 years old and I was to be given $1 trillion dollars to spend during my lifetime, I would need to spend $36.5 MILLION per day.  Now that is a life time occupation.

Doctors Without Borders/Médecins Sans Frontières (MSF) Releases 12th Annual ListRepublished with permission - New York, December 21, 2009 - Civilians attacked, bombed, and cut off from aid in Pakistan, Somalia, Yemen, Sri Lanka, Afghanistan, and the Democratic Republic of Congo (DRC), along with stagnant funding for treating HIV/AIDS and ongoing neglect of other diseases, were among the worst emergencies in 2009, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) reported today in its annual list of the “Top Ten” humanitarian crises.Sudan, along with the failure of the international community to finally combat childhood malnutrition were also included on this year’s list.  The list is drawn from MSF’s operational activities in close to 70 countries, where the organization’s medical teams witnessed some of the worst humanitarian conditions.Sri Lanka, tens of thousands of civilians were trapped with no aid and limited medical care as government forces battled Tamil Tiger rebels in the spring.  Aid groups, including MSF, were banned from entering the conflict zone. In Somalia, civilians continued to bear the brunt of a vicious civil war.  More than 200,000 people fled the capital, Mogadishu, in just the first few months of 2009 and aid workers were increasingly targeted – at least 42 relief workers have been killed since 2008, including three MSF staff.Yemen, civilians and hospitals were heavily affected by fighting in the Saada region in the north of the country as government forces fought rebels.  The fighting forced tens of thousands of people from their homes and compelled MSF to close the only hospital serving an entire district after it was shelled. And in a glaring case of abuse of humanitarian action for military gain, civilians gathered with their children at MSF vaccination sites in North Kivu, DRC in October, came under attack by government forces.  The attack threatened to severely undermine the trust necessary to carry out independent medical humanitarian work in conflict settings.Pakistan, where tens of thousands fled fighting, hospitals were struck by mortar fire and two MSF workers were killed in Swat Valley, where the organization ultimately suspended its operations due to the violence there.US President’s Emergency Plan for AIDS Relief (PEPFAR) announced plans to reduce or limit funding.Rome in 2009 failed to commit to combating the disease, which groups like MSF have shown can be prevented and treated by providing growing children with proper foods that meet their nutritional requirements.

Continuing crises in north and south

Three distinct patterns dominated in 2009: governments blocked lifesaving assistance to trapped populations, including in Sri Lanka, Pakistan, and Sudan, where aid groups—including some MSF teams—were expelled from Darfur; respect for civilian safety and neutral humanitarian action further eroded, such as in Yemen, Afghanistan, Pakistan, DRC, and Somalia, where people—and in some cases aid workers—were either indiscriminately or directly attacked; people suffering from a host of largely ignored diseases were again neglected by the international community, and those living with HIV/AIDS saw their chances of receiving life extending therapy further diminished.

“There is no question that civilians are increasingly victimized in conflicts and further cut off from lifesaving assistance, often deliberately,” said MSF International Council President Dr. Christophe Fournier.  “In places like Sri Lanka and Yemen, where armed conflicts raged in 2009, aid groups were either blocked from accessing those in need or forced out because they too came under fire.  This unacceptable dynamic is becoming the norm.  Our teams on the ground are witnessing the very tangible human consequences of these crises directly, either in war zones or in the AIDS and nutrition clinics in which they work,” he said.  We’re therefore compelled and obligated to speak out.” Read the rest of this entry »

As the human tragedy unfolds in the aftermath of the earthquake in Haiti, MD Preferred Services, the Internet based physician resource center, is calling on their entire network of physicians and professionals to assist Doctors Without Borders in their relief efforts. 
 
“The work that Doctors Without Borders does around the world is truly amazing and their assistance in Haiti is needed now more than ever,” said Michael O’Malley, CEO of MD Preferred Services.  “We are hopeful that the thousands of professionals within the MD Preferred Service network and the thousands of medical professionals using the network will make it a priority to support, in any way that they can, Doctors Without Borders and the people affected in Haiti.”
 
MD Preferred Services, which maintains online physician service directories in Legal Services, Financial Advisory Services, Relocation & Real Estate Services, Insurance Services, Physician Job Services and Travel Services, is asking their service partners to forward their request for aid to their staff and clients and that Residency & Fellowship Directors that read their monthly E-Newsletter, The Advisor, forward a special edition detailing the relief effort being mounted by Doctors Without Borders to their physicians.  All forms of assistance both medical and financial are going to be needed in the coming days, weeks and months.   All travel and allied travel services booked through the MD Preferred Travel Site will generate an immediate donation to Doctors Without Borders.
 

Please read the release from Doctors Without Borders below.
A special site has been set up to handle offers of assistance and financial contributions.
You will find links at the end of the article.

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MSF Teams Set up Clinics to Treat Injured After Facilities Are Damaged

The first reports are now emerging from Doctors Without Borders/Médecins Sans Frontières (MSF) teams who were already working on medical projects Haiti. They are treating hundreds of people injured in the quake and have been setting up clinics in tents to replace their own damaged medical facilities.

The Martissant health center in a poor area of Port-au-Prince had to be evacuated after the earthquake because it was damaged and unstable. The patients are now in tents in the grounds and the medical staff have been dealing with a flow of casualties from the town. They have already treated between 300 and 350 people, mainly for trauma injuries and fractures. Among them are 50 people suffering from burns-some of them severe-many of them caused by domestic gas containers exploding in collapsing buidings. At the Pachot rehabilitation center another 300 to 400 people have been treated. In one of MSF’s adminstrative offices in Petionville, another part of Port-au-Prince, a tent clinic there has seen at least 200 injured people. More are getting assistance at what was the Solidarite maternity hospital, which was seriously damaged.

One of MSF’s  coordinator’s there, Hans van Dillen, confirmed that Port-au-Prince was quite unable to cope with the scale of the disaster. “There are hunderds of thousands of people who are sleeping in the streets because they are homeless,” said van Dillen. “We see open fractures, head injuries. The problem is that we can not forward people to proper surgery at this stage.”

So many of the city’s medical facilities have been damaged, healthcare is severely disrupted at precisely the moment when medical needs are high.

Please help support MSF’s relief efforts in Haiti. 
You can donate here
and keep updated on their efforts at
www.doctorswithoutborders.org.

Although you don’t see it in the headlines, and you don’t hear it from the “talking heads” on the evening news, and there doesn’t appear to be a great deal of time being spent by politicians searching for solutions,

WE DON’T HAVE ENOUGH PRIMARY CARE DOCTORS IN THIS COUNTRY!

And healthcare reform plans to put 46 million new patients into the system.

Here is a primer for our leaders in Washington:
• The American Academy of Family Physicians predicts that, if current trends continue, the shortage of family doctors will reach 40,000 in a little more than 10 years.
• The average wait to see a primary care physician can run up to 30 days in many cities.
• 50 years ago half of our physicians were primary care providers.
• By 2000 14 percent of U.S. medical school graduates were entering family medicine.
• By 2005 the figure was 8 percent.
• A recent survey of students interested in internal medicine showed that 98 percent wanted to become specialists.
• When Massachusetts added 340,000 citizens to their universal healthcare program the wait to see a primary care physician in Boston jumped to 61 days.
• The four categories of primary care, Family Medicine, Internal Medicine, OBGYN and Pediatrics are the lowest paid averaging about $175,000 while medical specialties such as cardiology demand salaries over $400,000.
• Medical education debt can run up to $200,000.
• Politically correct or not, within a few years over 50% of our medical students will be women and they are far more affected by lifestyle issues than their male colleagues.
• It takes from 8 to 10 years to build a doctor from scratch so there are no quick fixes.
• To the same degree that our general population is aging, our supply of practicing doctors is aging and approaching retirement. In fact the physician shortage would be far more severe if thousands of physicians had not delayed their retirement do to the recent economic calamity.

Here is a primer for American citizens:
• Don’t get sick.
• Don’t change doctors (you might not be able to find a new one).
• Don’t lose your job (same reason).
• Don’t relocate (same reason).
• Schedule a doctor visit for three months from now…you can always cancel it if you aren’t sick or injured by then.
• If you plan to have an accident or heart attack in the immediate future, get in line at the emergency room now.
• If you have health insurance now, plan to pay more.
• If you don’t have health insurance now, plan to pay more.
• If the government doesn’t come up with a solution…plan to pay more.

Fact: Heart disease is the world’s number one killer. And as third world countries become more affluent heart disease becomes more prevalent. And sociologists and scientists are quick to point to fast food, cigarettes and a soft lifestyle. Western decadence, they would have us believe, is clogging the arteries of simple cultures around the globe.

But now a new study has called into question those critics of all things American…like Big Macs, Wide Screen TV’s and escalators. Researchers in Cairo have found evidence of atherosclerosis in 22 mummies from the Egyptian national Museum of Antiquities. A team of cardiologists with too much time on their hands, flew to Cairo and conducted CT scans of the mummies looking for signs of heart disease.

According to their report they were actually able to find the hearts in only 16 of the 22 mummies…hmmm. It would seem that the stereotype of the heartless Pharaohs may be more accurate than thought. But I digress. When they could find the heart or arteries they found definite signs of heart disease. A couple of the old guys were as young as 45 and had signs of heart problems.

So, it would seem that one of two conclusions can be drawn. First and most likely, heart disease is part of the human condition, Or, the Pharaohs spent a good deal of time sitting around on their butts, chewing on two all beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun, puffing away at some form of weed and generally stressing out on the business of running an empire.

Just what we need…one more healthcare issue to ponder.