The vote was 5 -2, finding that there is “nothing in Montana Supreme Court precedent or Montana statutes indicating that physician aid in dying is against public policy.” Justice W. William Leaphart writing for the majority added, “The ‘against public policy’ exception to consent has been interpreted by this court as applicable to violent breaches of the public peace. Physician aid in dying does not satisfy that definition. We also find nothing in the plain language of Montana statutes indicating that physician aid in dying is against public policy.”

The case involved a retired Billings truck driver and his doctors who hesitated to grant their patient’s request that they provide him with lethal medications that he could administer to himself to end his life. And the fact that it would be the patient that self administered the drugs was not lost on the justices. A physicians ‘indirect aid’ was considered not to be contrary to public policy.

Even among the majority, the reading of the law was not consistent. In fact, this was actually a very narrow ruling in that the justices were taking the position that legislators have not crafted clearly worded legislation that doctor assisted suicide is against public policy. The justices were very clear that there was no ‘vindication of constitutional interests’ in their ruling.

So, it would seem that, until the legislature steps up to the plate, passes a law against doctor assisted suicide, that law is challenged, moves up the judicial ladder and ultimately ends up before the same justices, physicians have at least an amber light to assist their patients as they seek not just quality of life but quality of death.

But State Solicitor Anthony Johnstone indicated that he plans to push the legislature for clarification. “The Montana Supreme Court recognized that physician-assisted suicide is a policy question for the people of Montana and their Legislature. As we have argued, that is where the resolution of this important issue belongs.” Stay tuned.

The courage of life is often a less dramatic spectacle than the courage of the final moment. - John F. Kennedy

I’ve always suspected that size really does matter but I never thought to put a tape measure to my Telomeres. Actually, I’d never heard of telomeres. It simply hadn’t come up in date night small talk. So, I went to my trusty computer and Googled telomeres and discovered that they are actually relatively short sections of DNA at the end of our chromosomes. A BBC science writer compared them to the plastic tips of a shoe lace that keep the laces from unraveling. Leave it to the Brits to come up with an imaginative analogy.

It would appear that each time a cell divides, its telomeres get shorter…I can think of several politically incorrect analogies myself…but the point of these ramblings is that the hyper active enzyme that the Ashkenazi Jews seem to be blessed with repairs the telomeres and prevents them from shrinking. The magic enzyme is called Telomerase. And telomeres that don’t shrink seem to retard the aging process.

The pharmaceutical companies are probably already shifting into overdrive to find a drug that stimulates the enzyme in those of us with life styles that tend to discourage longevity. So keep an eye on your spam files. Before long they will be replacing the Viagra promises with a little blue pill promising longer Telomeres. Of course there will probably be warnings of possible side effects…hair loss, tooth loss, drooping eyelids, erratic driving, memory loss and a bankrupt social security system. But those are small prices to pay for the promise of living long enough to see universal healthcare and a Republican president.

A doctor’s chief occupation is helping to cure the sick. Answering this calling, however, does not preclude the desire or the need for a doctor to earn a good living whether she works on staff at a hospital or ultimately owns her own practice. In my financial planning work at my wealth management firm I quickly found that while most doctors, once established, do earn a good salary, as a whole they are usually too busy to sit down and plan for their financial futures. However, they do want to have greater control over their financial health.

Doctors who are new, who work at a hospital or are employed by a practice, also need to look ahead at the fast-approaching future. While planning their professional lives new doctors should not neglect their personal finances. Not having a sound personal financial plan can impact such important milestones as their ability to buy a home, to educate their children and to have a happy retirement. While establishing and following a personal financial plan early is the best prescription for good financial health, the good news is that during a working life it is never too late to begin.

As a doctor in your own practice, which means your own small business, you want to be in a position where the decisions you make about running and growing your business have a direct impact on the lifestyle you create for yourself and your loved ones.

As you have undoubtedly learned, being a small business owner isn’t easy. Most of us start out with great expertise in our professions or industries; we soon learn that we also need to become experts at managing a business’s finances. Without this added skill, your business will never generate maximum returns, and your personal wealth will be limited as a result.

When you started your own business you probably drafted a business plan that stated what specialty you would be practicing, and how you planned to attract and serve your patients. Most likely, your plan also included a review of your start-up expenses and estimated operating costs for the first year or so. Having a feasible business plan gives the new small business owner — especially one who has never been in business before — credibility in the eyes of banks, vendors and customers.

But, when you drew up your business plan, were you also writing down how your business would help you achieve your personal financial goals? Did you establish some guidelines as to how you would manage your practice’s cash flow? For that matter, did you take the time and effort to determine just how much money you actually need to accumulate in order to achieve your personal wealth goals? If you answered no to these questions, you are not alone. All too many small business owners launch their businesses without paying attention to these important issues, they are simply too busy already, which impact their future financial well-being.

It is not too late to take charge of your financial destiny — both through the financial management of your practice and of your personal wealth building. To do this you first need to draw up a personal financial plan, and then refine your business plan so it looks to the future and shows how it will support the goals in your personal financial plan.

You’ll Never Walk Alone
To help you construct your plans, there are three basic questions you must ask yourself. Writing the answers down will help focus your thinking and you will have a tangible guide for your planning. Here are the questions:
• How much wealth do I need to accumulate for my personal financial goals?
• How much profit does my business need to generate in order for me to create the cash flow that I need to achieve these goals in a specific time period?
• What financial management actions can I take at this stage in the life of my business to hold on to more of the cash coming in and to minimize my operational expenses?

Think of your two plans as being most successful when they run in tandem. The financial achievement of your business and your own personal financial satisfaction are as closely linked as two people bound together in a three-legged race. Unless you draw up and implement two financial plans — one for your personal finances and the other for your practice —you may have trouble crossing the finish line, let alone winning the race. As you attend to your all-important financial goals, you should reach out to a financial planner who is also a CPA who can help you run the numbers and structure your business and personal financial plans.

I cannot over stress the importance of sound legal advice for any professional embarking on a new career. Good advice is available from any number of quarters including the family attorney and other family members and friends who are older and wiser. But there are those whose job is dispensing financial advice. They are called, not surprisingly, Financial Advisors. And, of course, as in other professions, there are advisors and then there are advisors.

An excellent source for financial advisors who are “fiduciaries” (Financial Advisors who work on a fee only basis placing the interests of the client first) is the National Association of Personal Financial Advisors, NAPFA. All of their members are experienced fiduciaries. Within the association is a group of Financial Advisors who display the MD Preferred Financial Advisor Medallion. They specialize in serving the very special needs of physicians.

Here is an example of the sort of advice that one might expect from an MD Preferred Financial Advisor.

Let’s say you are graduating from Fellowship and have accepted an opportunity in another city. You plan to get married and buy a home. You and your spouse select a suitable residence and find yourself at the closing. As your eyes begin to glaze over after reams and reams of paper pass in front of you for your review and signature, the closing office asks, “How will you be structuring the title?”

You look at each other and ask, “How do most buyers structure it?” You are already in trouble. If you have not thoroughly investigated every aspect of the home purchase process, YOU ARE GOING TO MAKE MISTAKES.
• Does the house fit your current economic situation?
• Is it in the right location?
• Does it fit your financial plan?
• Is it in the right location?
• And how should you structure the title?

Going back to our example, the title officer replies, “Most couples place it in Joint Tenancy.” Not wanting to appear uninformed, you reply “That will be fine.” But will it really? Prefacing my comments with the statement that I am not an attorney or a financial advisor and I am probably the last person to turn to for advice, there is a structure that a high income, high net worth professional should consider…Tenancy By The Entirety.

Both joint tenancy and tenancy by the entirety have a right of survivorship. If one joint tenant dies, the surviving joint tenant automatically owns the entire property. No probate…no new deed. But Tenancy by the entirety has two unique features which distinguish it from joint tenancy.
• Only married couples who are living in the property as their primary residence may own property as tenants by the entirety.
• Property held in tenancy by the entirety is shielded from the creditors of one spouse.
It is this second feature that makes it attractive to physicians. Let’s face it, a physician is more prone to being sued and to having their personal assets attacked. A creditor who has a judgment against one (but not both) of the owners of property that is held in tenancy by the entirety cannot force the sale of the property to pay the judgment.

The purpose of this post is not to dispense real estate or legal advice. But it is my purpose to stress that a physician, young or old, should seek out sound advice before making any important decision. In the arenas of Legal Services, Real Estate, Insurance and Financial Planning one good place to find sound advise is an online resource center for physicians found at MD Preferred Services. And of course keep reading Rounds On Line for other bright ideas that yours truly brings to the table each day.

So I gave a friend of mine who recently completed her masters in math a call. She is serving hamburgers at a Red Robin restaurant near here and I caught her between shifts. After I asked how her career was going and she inquired about my literary ambitions, she informed me that after a trillion comes a quadrillion. So I started to worry. Is it possible in my life time to see our country’s debt grow to a quadrillion dollars? It certainly didn’t take very long to go from the billions to the trillions after all.

Well if a trillion is a thousand billion. Then a quadrillion must be a thousand trillion. If our national debt continues to rise at just over a half a trillion dollars per year (and I have little confidence that the politicians will be able to hold the line at annual deficits of $511,000,000,000), you could use that number to see when we will hit a quadrillion dollars. So, I subtracted 9.13 trillion from 1000 trillion and got 990.87 trillion dollars to go before we top out at a quadrillion. Then I divided 990.87 trillion by .511 trillion and got 1,939 years.

And that really made me feel a whole lot better. Not only will I not live to see the debt reach $1 quadrillion bucks but neither will my kids or grand kids. As long as one keeps things in perspective, life is so much less stressful. And because we are empty nesters, my wife and I are only responsible for $60,000 of the current national debt. My two kids can figure out a way to cover their own $30,000 each. Life is good.

“A man in debt is so far a slave.” - Ralph Waldo Emerson

Well, the day is fast approaching when you will be to afford to have your genome mapped out and delivered into your hands in a nice neat report. Why would anyone not be interested in such a valuable database of information? There are actually a number of very valid reasons.

First of all, the report is going to basically be nothing but bad news. After all, there is no link to genetics that will predict wealth, happiness, talent or success. What it can do is list all of the genes that have the potential to make you sick. And in most cases, there is probably little that you can do to change the future with that knowledge.

Secondly, most people would probably not be willing to make a meaningful commitment to make radical lifestyle changes to prevent a “statistically possible” future health event. Let’s face it, we all know that those who have a good diet, exercise regularly and make intelligent lifestyle choices generally live longer. I would hardly describe our younger generation as healthy, wealthy and wise.

The hidden costs of using genetic information are also a consideration. An article appearing in the Lancet notes that even if a complete DNA screening were affordable, the real cost of such information lies in its analysis and the counseling that would be required to use the information intelligently. And at present the counseling resources simply are not in place at any cost.

And finally, there is the principle of unintended consequences. With the increasing incursion of the government into all aspects of health care, what is to prevent insurance bureaucrats from using genetic information to set insurance rates and provide services?

Without question, mapping the human genome is one of the greatest achievements in the history of mankind. But we are a long way from putting this potential treasure trove of information to practical use.

When most people think of life insurance, they think of it as something they need in their personal lives. But the benefits of life insurance extend way beyond the family unit into protection for businesses and key employees.

Of course, life insurance is a valuable personal tool for income replacement to provide money for loved ones in case you die and cannot earn an income, for income creation to provide cash needed for final expenses at death, and for asset preservation to pay for estate taxes or to equalize the amount of an estate for multiple dependents.

However, as a physician, life insurance has many business-related practical uses and beneficial impacts for you. You must consider not only your personal financial needs, but also the needs of your practice. After all, you are both a physician and a businessperson.

The number one use of life insurance for business is to fund buy-sell agreements. A buy-sell agreement lays out what happens if/when one of the practice owners dies. It establishes the price of the practice, identifies who the buyer will be, and mandates that the estate of the deceased must sell. While buy-sells may be funded with retained earnings, a long-term payout, or borrowed money, many practice owners find life insurance to be a much better source of financing.

Life insurance can also ensure that the beneficiary of the deceased owner gets paid in full and in cash immediately. Many times, without life insurance, the income derived from the business declines because one of the individuals who performed a good portion of the work is no longer there, or because additional staff must now be hired to replace that person. Either way, the beneficiary may not get paid — either in full or on time — if future earnings will be needed to fund the buyout. Life insurance can prevent that from happening.

The second major use of life insurance in business is key person. Practices insure tangible things like the building from fire and destruction, the equipment, and liability losses, yet many do not insure the most valuable asset and, really, the only one that brings in income: the key employees.
Key person life insurance works like this: The practice buys coverage on the key employee. The business owns the policy, pays the premiums, and is the beneficiary. If the key employee dies, the practice receives the death benefit proceeds to help replace either the income that key employee was generating or the key employee him/herself.

Beyond buy-sell and key employees, as practices become more successful and move past just surviving, the owners tend to look for additional benefits or rewards for themselves and the employees. This is where salary continuation comes into play.

Salary continuation (sometimes referred to as “Golden Handcuffs”) says basically this: “IF you continue to work until age 60 or 62 or 65, the practice will continue some set salary starting after retirement. And IF you should die before retirement, the practice will pay that same salary continuation to your beneficiary starting at time of death.”

And finally, some businesses purchase life insurance for certain employees and let the employees name the beneficiary. This can be done as a straight bonus plan or as a split dollar plan, in which the practice and the employee share the premium expenses.

In summary, life insurance can be used to protect your practice from dying when one of the owners does. It is a proven method both for ensuring the business absorbs the death of a key employee and for rewarding select employees.

PhysicianInsure is a national provider of insurance designed exclusively for physicians. For more information or for a confidential quote, please contact us at: info@physicianinsure.com or 877.962.8737.

His 18 year old daughter received two kidney transplants and owes her life to the donors. I am happy for his family. As an Illinois resident, I have noted on my driver’s license that I wish to be an organ donor in the event of my untimely death. I have also made my wishes known to my family. But I also recognize that not everyone takes these simple steps and the wait for an organ can run to years.

But the legislation that Assemblyman Brodsky is proposing gives me pause. He wants New York to become the first state in the nation to enact a “presumed consent” law. Under this controversial concept, a hospital would require no prior authorization to harvest organs from a deceased patient. Family members would no longer be able to override their loved ones affirmative prior consent to organ donation. But more importantly, a hospital would presume the deceased’s consent to donate their organs unless they have left specific written instructions to the contrary. You die…they harvest…no appeal…no delay.

Now, I understand the spirit of this approach. Many people would not object to saving another life through the donation of an organ after their death. But they never take the steps to enable the procedure. But this Big Brother approach to harvesting body parts has some troubling implications.

Presumed consent if taken to its logical conclusion could force individuals to become donors against their will. And a truly frightening extrapolation would have hospitals withholding aggressive life saving treatment if harvesting organs could serve a “greater good.” Would the next step be a government panel established to mandate the harvesting of a needed organ or portion of an organ from a living patient? After all, we can live with only one kidney and part of our liver. Could the value of a potential organ donation eventually enter into the health care rationing formula?

I was brought up to believe that charity comes from the heart. That’s assuming of course that the government allows me to keep mine.

“All, all is theft, all is unceasing and rigorous competition in nature; the desire to make off with the substance of others is the foremost - the most legitimate - passion nature has bred into us and, without doubt, the most agreeable one.” - Marquis de Sade

Most companies are allowed to ply their trade without much fan fair or government interference. Unless of course one considers the enormous taxes most have to pay to a wide array of government entities. But the more successful a business becomes, the larger it grows. Until you have massive corporations like General Motors, General Electric, Boeing and Citi Group.

The nation’s insurance companies have become very large, very powerful and very profitable. If you set aside for the moment the issue of profit in a capitalist society, one is left with the question of how these companies became so large and how they run their businesses and remain profitable.

Many people in this country do not understand that the insurance companies do not make their profits from the premiums that their customers pay to them. The national average of payout to premium for health insurance is 99% or premiums collected. Insurance companies make their money by investing cash reserves. So, how do insurance companies make sure that they do not actually pay out more in claims than they receive in premiums?

Enter the actuary. These are the guys with green eye shades, pop bottle eye glasses and elbow pads. They spend their days staring at computer screens compiling mountains of statistics about everything from house fires to chickenpox. Their job is to determine in advance how much a policy holder is going to cost on average so that the insurance company knows how much to charge on average in premiums. If he guesses wrong the insurance company is going to eventually have trouble staying in business.

If a potential customer with a potentially costly medical condition seeks coverage, the actuary computes how much that individual is likely to cost to insure. The number will be higher than for a healthy person. If a sixty year old man wants coverage it will cost on average more to insure him than it will to insure a 20 year old. And in most cases it costs more to insure a man than a woman all else being equal. Throw into the mix life style issues like smoking and sky diving and the job of an actuary is complex and demanding.

But what would happen if the insurance companies were compelled to ignore the work of their actuaries? What if they had to ignore a persons health when they came seeking coverage? What if they were not allowed to charge more to one class of people than another based on the work of their actuaries? What if they had to ask for permission from their policy holders each time their actuaries determined that premiums had to go up to match payouts? Welcome to the world of government regulation.

The insurance industry is already one of the most tightly regulated industries in the nation. States regulate them, tell them how much they can charge for their services and who they can cover. And now the federal government is going to get in the game big time. Panels of elected politicians with no actuarial experience, who’s jobs depend on the blessing of the electorate, are going to begin telling the insurance companies to ignore the statistics compiled by their actuaries and begin setting rates and policy based upon what the politicians believe is in the “best interests of the country.”

The government has been doing that for decades in Russia. I am guessing that we will have the same long term success with socialism that they had. So, if your son or daughter comes to you one day and says, “Dad, I have decided that I want to become an actuary.” You may want to counsel them that they have a better chance of becoming an NFL wide receiver.

Be thankful we’re not getting all the government we’re paying for. Will Rogers

While donating money to worthy causes is something we think is great; gifting to charities can be greater still when you donate appreciated stock instead of cash. The tax advantages can be worth it. That’s because as long as you have held the shares for twelve months, you can take a deduction worth their current market value. Let’s explain how this works.

Writing a Check to Your Favorite Charity

Consider this, you bought 1,000 shares of stock ten years ago with a cost basis of just about nil. If you sell the stock for $200,000 and give the proceeds to charity after paying the capital-gains taxes (15%), the charity gets only about $170,000, and you get a $170,000 tax deduction. Not bad, but we can do even better.

Gifting the Stock Outright to Your Favorite Charity

If you give the stock to the charity, which is tax-exempt, it can sell the shares and keep the whole $200,000. And you get a $200,000 deduction. This is what we call a win-win situation.

Typically, selling an appreciated stock triggers a tax on the realized gain, the difference between what you paid to purchase the stock and its current value. When you make a gift of appreciated stock directly to your favorite charity and the charity sells the stock, the taxable event and the fees are avoided because the charity is tax-exempt. Plus, you can take a sizeable charitable deduction on your taxes.

How It’s Done

To donate stock, you just have to transfer ownership of the shares. That may be easier said than done, but don’t become discouraged. We at Francis Financial, Inc., can do this for you, making everything as effortless as possible.

You might also consider using a Charitable Trust. These gift trusts allow you to transfer the stock to the trust and take the appropriate deduction for the appreciated value of the shares. The trust then writes a check to the charity for the donation amount that you would like to make.

Using a gift trust is especially helpful when you are donating a significant amount of stock or if you have a number of charities to which you want to make a charitable contribution.

Gifts of Stock Are Popular for Donors of All Ages
• The young donor saves through both the charitable deduction and the hard cash he or she is freeing up.
• The middle-aged donor can create a charitable remainder trust (CRT) with donated stock and with the income received from such a CRT is able to fund his or her child’s or grandchild’s education.

Which Stocks to Give?

If you’re planning to donate stock, choose carefully which shares you give. First, make sure that you have held the shares for at least one year. Next, review how much the shares increased in value. If the stock actually dropped below the price at which it was initially purchased, it is better to sell the stock. Once you sell the shares you can take a capital loss on your tax return and donate the proceeds directly to your favorite charity.

We believe that charitable giving is just another part of a rich life. Give to your favorite charity, feel good about yourself, and save tax dollars at the same time.

Stacy Francis, Francis Financial, Inc.
111 John Street, Suite 240, New York, NY 10038
Phone: 212-374-9008 Fax: 646-219-6799
Stacy@FrancisFinancial.com