Physicians writing on KevinMD about running a practice: staffing and overhead, the payer paperwork that arrives with every patient, ownership and consolidation, the administrators and executives who now employ most physicians, and the models physicians have built to get out from under all of it. Four maintained records draw on this archive: Primary care: what physicians say, in their own words, Direct primary care: what physicians say, in their own words, Physicians and administrators: what physicians say about who runs medicine, in their own words, and Private equity and corporate medicine: what physicians say, in their own words.
One common question that doctors face in estate planning is whether to establish a trust. This topic gets brought up in the doctors’ lounges, especially after someone gets a pitch from their financial planner. Most doctors who bring up the topic are quite enthusiastic, and cite that doctors need a trust because “we make a lot of money.”
Fair enough.
Medical students and residents probably do not need a trust
I’ll get this …
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What physicians need to know about living trusts
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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What do the Fidelity ZERO mutual funds mean for physician investors?
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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Why doctors don’t like to retire
“I love what I do. I hate what I have to do.”
It’s a quote that doctors attribute to their profession behind closed doors. As patients, we are so overwhelmed with our own problems. We fail to notice that our doctor may be battling her own problems with a complicated system.
But what do we care? Our meeting with the doctor is a paid transaction. We are owed our money’s due. Empathy …
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Remember that your doctor is also human
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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Live like a medical student, invest like a professional
Three years ago, I left the only path I had ever known to pursue uncertainty on the other side of the world. But let me back up. In July of 2011, five years into my career as an academic hospitalist, the residency work hours changed. Although the intent was obviously to benefit the well-being of the residents and the safety of patients, it took a tremendous toll on attending physicians …
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Fight burnout by following your fear
The most common hurdle that doctors have is overspending. The notion that good income guarantees great buying power not only delays building financial worth but also confines doctors to lengthier careers than needed. The solution, in a nutshell, is to make sure that we make prudent financial and career choices to complement our financial velocity. Easy, right?
The reality is not so simple. Psychology is fascinating. Human behavior can function, at …
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The biggest financial weakness of physicians
Although I would never describe the business of primary care medicine as cutting edge, there are a number of innovations that have come and gone during my short tenure running a medical practice. The business of medicine is fascinating and leaves much room for personalization and creativity. I have been lucky to operate at the forefront of practice management and learned quickly how to leverage two bleeding edge philosophies to multiply profits. …
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Do you run a financially independent business?
Doctor: (from Latin docere “teach” Greek phusikḗ epistḗmē “knowledge of nature”) a specially trained and skilled person who holds an advanced medical degree and is licensed to practice the healing arts.
My definition of doctor keeps evolving. As a child, I was cared for by FPs who helped set bones, suture skin and fight infections like measles, chicken pox, and strep. Though I didn’t like going, I usually experienced healing on …
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The evolving definition of doctor
“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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A private equity primer for physicians
By now, everyone has heard that the Centers for Medicare and Medicaid Services (CMS) has proposed to dramatically change how physicians get paid for evaluation and management (E&M) services in the office as part of the proposed 2019 Physician Fee Schedule Rule. In fact, as of the end of July, CMS has received over 600 comments on the proposed rule, with virtually all of them criticizing the proposal. I suspect …
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Don’t throw the E&M baby out with the bath water: the proposed CMS changes
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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How perception can affect your financial situation
“Yes, you are like that,” said my husband one night as I was lamenting criticism I had heard about myself that day. “I am?” I asked, shocked, a little hurt, and angry. “You are, “ he replied. “Everyone who knows you knows this.”
Gulp.
No one likes to hear criticism. Our lives are so busy, so over-extended, that stopping to hear that something we said or did upset or annoyed someone is …
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Embrace the gift of criticism
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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Converting your 401(k) to a Roth IRA after residency or fellowship
As more doctor pay is being tied to patient satisfaction and “outcomes,” a recent Forbes article argues that “It’s only a matter of time before physicians will see the bulk of their compensation tied to quality measures.” To prepare for this pay-for-performance apocalypse, the article cites Medical Group Management Association (MGMA) CEO Haylee Fischer-Wright, MD, who urges physicians to “build data analyses” and take …
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Stop treating doctors like school children
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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Working in the ER on holidays
When I first began writing about the “doctor” title, I led with my personal beliefs. But as my research expanded, I realized there were so many variables and so many experiences that have shaped other women’s views on being called “doctor.”
Call me “doctor,” please
A few years ago, I was at a charity event for underprivileged kids in Detroit. One of the board members was a well-spoken nurse with a PhD. …
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Gender bias and the word, “doctor”
With burnout on the rise, many physicians are choosing to leave clinical medicine for alternative careers. Other physicians are wondering if it’s worth it to stay in a workforce that does not pull for the well being of their frontline workers.
Gone are the days where physicians stay stuck suffering in a practice or career that is no longer fulfilling or worse, causing burnout. Those physicians are considered old-school and are …
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9 non-medical careers for doctors
