What do the Fidelity ZERO mutual funds mean for physician investors?

Finance
August 20, 2018

Vanguard, Fidelity, and Schwab have been engaging in a fierce competition to claim the mantle as the leading provider of low-cost index funds. As a result, each has aggressively lowered their fees for their index fund offerings over the past few years and advertised their low-cost offerings to investors.

After the latest round of fee reductions in mid-2017, I wrote a post speculating whether it was inevitable that Vanguard, Fidelity, …

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A strong doctor-patient relationship: why it matters

Physician
August 20, 2018

Writing in Annals of Family Medicine a few years ago, Chicago obstetrician Benjamin P. Brown vividly described his mentor’s interaction with a patient who had just emigrated from Mexico and had no family support. “When he asked earnestly how she was doing, her hard-won defenses seemed to crumple, and all of a sudden she was sitting on the exam table, sobbing,” Brown wrote. “I watched, rapt, as Dr. Gonzales — …

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Why doctors don’t like to retire

Physician
August 19, 2018

The past decade has seen an enormous upheaval in the practice of medicine. The private independent medical practice is in danger of extinction. Management overhead and red tape has skyrocketed due to government regulations and private insurance and pharmaceutical benefit rules. Added to that are multiple electronic medical records that need to be implemented, vary from one hospital to another, and often do not “talk” to one another. Thus, it …

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What is one thing that separates good doctors from great ones?

Education
August 19, 2018

What makes a good doctor or, for that matter, a great one? Most patients want physicians who are excellent clinicians and diagnosticians. But we also want doctors who are caring, empathetic and maybe even telepathic — doctors who seem to know intuitively what we need without any awkward discussion of sensitive issues.

After all, patients may not want or know how to talk about substance abuse, domestic violence, sexually transmitted disease …

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Live like a medical student, invest like a professional

Finance
August 19, 2018

If money is the root of all evil, what does that make debt? Evil’s ugly big brother.

A report by the Association of American Medical Colleges (AAMC) revealed that over 86 percent of medical graduates carry an educational debt principal of over $160,000, with a significant number of graduates reporting debt totaling over $350,000. In addition to massive student debt, personal financial challenges include the loss of nearly a decade of …

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MKSAP: 77-year-old woman with frequently fluctuating INRs

Conditions
August 18, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.

On physical …

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The many ways to describe chest pain

Conditions
August 15, 2018

There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland.

But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 …

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Don’t worry, this psychiatrist won’t analyze you

Physician
August 15, 2018

“Oh, you’re a psychiatrist? I hope you won’t analyze me!”

I never know what people actually mean when they say that upon learning that I work as a psychiatrist.

I think they’re saying, “I hope you’re not going to spend our time together trying to discern my flaws.” Nobody wants people to seek out, highlight, and exploit their vulnerabilities and faults, so I can understand that. Of course, that’s not what psychiatrists do.

Anyway, …

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Structure case conferences as a primary way to teach and learn

Education
August 14, 2018

When we studied ward attending rounds, the thought process represented the top attribute that learners valued.  Learners can learn facts from textbooks, but using those facts requires experience and role modeling.

I have given many lectures on clinical reasoning, and I have attended many lectures on clinical reasoning.  These lectures can entertain, but one lecture does little to help our colleagues and our learners.

We must structure case conferences as a primary …

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4 disturbing trends in health care

Policy
August 13, 2018

It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.

Here are four trends that are changing health care but on the surface are too unsexy for us to care about.

Trend 1: The doctor-patient …

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A private equity primer for physicians

Finance
August 12, 2018

“My group has been approached by a private equity company.  It sounds like a great deal!  Any questions I should ask?”

Whether it be through one on one discussions or through the Physician Side gigs group, I’ve found myself having this conversation with increasing frequency.  Part of the reason for that is because I find it fascinating, albeit also sometimes terrifying.  As the trend towards consolidation …

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Atul Gawande’s prescient 2012 TED talk

Policy
August 12, 2018
YouTube video

Health care is buzzing as Atul Gawande has been selected as CEO of the Berkshire-Hathaway/Amazon/JP Morgan strategic venture. I was thrilled they picked a physician, like myself, in the trenches to run their gig. After hearing the news, I remembered Gawande’s TED Talk from 2012 and decided to catch up on it during my flight to the Healthcare Finance Management Association Annual Meeting and Innovation Lab.

After watching the …

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New interns: Get ready to be fleeced

Education
August 11, 2018

This one’s for the new interns.

You’re excited, you’re about to start residency. You’re a doctor. No more short white coat. You’ve got the long white coat that you’ve been waiting for. You’ve arrived.

But actually, there’s one more thing you need before you really feel like you look like a doctor. It might be a few months. There’s going to be a long process. Someone in your program, maybe the chief …

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How to write a medical school diversity essay

Education
August 10, 2018

Now that you’ve turned in your AMCAS (phew!), you’re probably wondering how to tackle the monster of secondaries coming your way. One of the most common questions asked in one form or another is the diversity essay for medical school. Have you ever wondered why diversity is such an important component of the medical school admission process? I’ve heard a lot of pre-med students eager to write this off …

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How perception can affect your financial situation

Finance
August 10, 2018

An interesting phenomena recurs when I work with physicians to makeover their finances. They almost never believe that overspending is the problem. They believe the reason their credit card balance is growing, and their large monthly income isn’t enough to pay their expenses can’t be due to their own choice to overspend. They always have a reason for the lack money:

They have huge student loans.

They have eight kids.

They are in …

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The best way to fight misinformation in health care

Physician
August 9, 2018

Fake news is a term that’s become notorious over the last couple of years. For notorious reasons perhaps. But there’s actually another serious arena where there is inadvertently an awful lot of “fake news” on a daily basis. And that is, well you guessed it: in health care throughout our nation’s hospitals and offices!

Let me explain, and I suspect anyone who works in health care will be familiar with the scenario. …

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Changing the treatment plan when covering for another doctor

Physician
August 8, 2018

I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that.

I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan …

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Converting your 401(k) to a Roth IRA after residency or fellowship

Finance
August 8, 2018

Many residents and fellows will contribute to a 401(k) or 403(b) over the course of their medical training. They should be commended for saving for retirement on just a resident’s income.

Often, newly-minted attendings wonder what to do with these 401(k)s or 403(b)s from their training hospitals. In particular, they wonder whether they should convert their 401(k) to a Roth IRA.

4 options: some better than others

In general, there are four things …

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Working in the ER on holidays

Physician
August 7, 2018

As I prepare to go into work for another string of night shifts, I become aware that this is just another holiday that I will be working. It’s the Fourth of July, not a major holiday as is designated by any scheduler, so no credit will be given to those of us who work today. Some previous employers have given extra pay for said days, as little as $200 to …

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