An interview with Physician on FIRE's Leif Dahleen, MD
Leif Dahleen, MD is a part-time anesthesiologist on the brink of early retirement from medicine at the age of 43. When he realized that work had become optional in his life, he started a website, Physician on FIRE (Financial Independence Retire Early) to help educate and enlighten others on personal finance topics. He can be found via his website, Twitter, Facebook, and Instagram.

Do you think doctors approach money differently than other groups? Why?
Well, money is money and the money we doctors earn is no different than the money that everyone else gets. Nevertheless, there are some unique aspects to our career trajectories that necessitate an approach to money that addresses them. We get a late start, are often saddled with large student loan debt, and are taught next to nothing about money management throughout our education and training.

Do you think physicians have any financial advantages? 
Physicians earn a lot of money. Any published list of the top-earning professions will be dominated by medical specialties. The high salaries are an advantage in that they allow us to potentially save a lot. However, it's not unusual for a doctor and his family to spend the vast majority of that income. Gratification has been delayed for so long that it's hard not to splurge once you finally see a real payday.

We also benefit from relatively good job security. I actually lost my first "permanent" job as an anesthesiologist when a hospital was going bankrupt, but that's relatively rare and I had plenty of opportunities at that time to work elsewhere. Our skills are portable, too. Locum tenens work can be a great way to supplement our incomes without having to learn a "side hustle."

Do you think physicians have any financial disadvantages?
They start earning late, the massive debts, and the lack of financial literacy. That last piece makes us sheep facing a financial services industry with far too many wolves. 

Physicians also too often mistakenly assume that because they've been successful in their careers, they will also be successful in other endeavors. Unfortunately, understanding the complexities of the nephron does not translate well to the business world. I've known physicians to go bankrupt after putting too many eggs in one faulty basket with business and real estate ventures.

How would you recommend that a physician get started learning about managing money and investments? 
Start with a good book or two. My first money book was The Only Investment Guide You'll Ever Need, which I read as a medical student. I read The Millionaire Next Door shortly after finishing residency. Since then, a few good books have been written by physicians, including books from The White Coat Investor and The Physician Philosopher.

With a good foundation from a well-organized book, delve into topics of interest via blogs and podcasts.

What blogs, websites, books or podcasts do you recommend? 
I've written a pretty thorough guide to DIY investing that's chock full of resources. I've also got a two-part series on Investing Basics for busy professionals. But my site is just one little sliver in the personal finance world, and the number of physicians participating has increased more than tenfold since I started in 2016.

I'm a part of the White Coat Investor Network which also includes WCI, Passive Income MD, and The Physician Philosopher. All are excellent.

Helpful podcasts include Dr. Nii Darko's Docs Outside the Box, Dr. David Draghinas' Doctors Unbound, and Dr. Carrie Reynolds' Hippocratic Hustle. These are insightful podcasts with guests doing unusual and extraordinary within and in addition to medicine. 

There are dozens of other great resources out there, and I can't possibly mention them all. I do my best to keep a blogroll that's reasonably up-to-date, but the landscape changes rapidly in the online world.

Do you think there is a magic number in terms of how many hours/week a physician should spend on managing money? 

The number isn't magic, but for the vast majority of physicians, that number should be less than one. I think people ought to spend a few hours a week learning about personal finance, but money management is generally best when it's automated and not tinkered with much at all. Invest in a three fund portfolio or variant and earn the market returns. Most who try to do better fail, including very well-paid investment managers with vast resources in terms of data, connections, and quantitative analysis. 

Simple and effective money management shouldn't take much more than an hour a month once you've set things up the way you want them.

By John Jurica MD
Shortly after finishing my residency, I worked in a small family medicine practice. I held inpatient privileges, and spent many hours in the local community hospital caring for my patients. As a result, I attended many medical staff committee meetings. I balanced work in the office, nursing homes, and the hospital for a long time. I enjoyed working in the hospital environment.
Ten years later, I was hired as Vice President for Medical Affairs, the hospital’s first ever physician executive. I was later promoted to Senior Vice President / Chief Medical Officer (CMO), and I stopped all direct patient care.
In the next few paragraphs, I’m going to explain how to make the transition from practicing clinician to hospital executive, based on my experiences and conversations with CMO colleagues.
Characteristics of an Emerging Hospital CMO
Physicians best suited to this career generally have the following characteristics or backgrounds:

• Enjoy working on teams and attending and running meetings;
• Interested in improving the health of populations of patients;
• Affinity for reading financial reports, working on QI projects, and starting new service lines;
• Trained in a hospital-based specialty such as: hospital medicine, anesthesia, surgery, cardiology, pulmonology/intensive care medicine, or emergency medicine.
  

About the Author: John V. Jurica, MD, MPH, is a certified physician executive, host of the Physician Nonclinical Careers Podcast and “admin” for the Physician Nonclinical Career Hunters Facebook Group. You can access a free guide to 3 Top Hospital Management Jobs, minicourses, and articles by going to vitalpe.net/nonclinicaldoctors.

Heather Fork, MD, MCC is a master certified coach, blogger, and founder of The Doctor’s Crossing. Over the past 10 years she has helped hundreds of physicians find greater fulfillment both in medicine and in nonclinical careers. In addition to coaching, she also recruits for several nonclinical companies. Dr. Fork ran her own successful dermatology practice for 9 years in Austin, Texas.
In this interview, Dr. Fork shares her insights about the financial aspects of transitioning to a non-clinical job including the anticipated salary and how to approach a contract negotiation.
Dr. Fork explains that many physicians who want to pursue non-clinical jobs are often hesitant due to financial concerns. She says that it is important for physicians to consider their long-term salary expectations and how much they would be willing to accept through a transitional phase.

Many of her clients carry a heavy weight of financial responsibility as the primary breadwinners of the family. Dr. Fork says that some doctors feel trapped, but she wants physicians to be aware that they have more career flexibility than they realize. She says that most doctors are surprised to learn that primary care physicians can expect to earn a starting income in a non-clinical field that ranges between $160,000 and $300,000.
She also explains that specialists— who have a depth of knowledge when it comes to high cost services, such as in orthopedic surgery, neurology, or cardiology—may be offered salaries above $300,000 by pharmaceutical and insurance industry employers. 
Dr. Fork encourages doctors to consider all aspects of an anticipated salary, and explains that stock options, bonuses, and yearly pay increases, as well as eventual promotions are routine in the non-clinical healthcare industry. She tells doctors to calculate hourly compensation in clinical work by including time spent charting and responding to off hours calls to be able to make accurate apples to apples comparisons between jobs. 

She suggests that doctors to do their homework and learn the industry standards when negotiating a first contract. Dr. Fork explains that she had a client who had more experience than a typical entry-level physician. Because Dr. Fork had other clients who worked for the same company, she was familiar with compensation range and her client was able to negotiate an increase in compensation before starting the job. 
She also recommends that physicians consider the long-term career potential of a new position. Sometimes a physician may accept a lower salary than they are used to in order to have better work-life balance. This is not uncommon, especially for the higher earning specialists, such as radiology and oncology. Taking a pay cut in the interim can also be a way to develop expertise in a new area with the goal of rising in the ranks and regaining the salary. 
Dr. Fork says that in her experience, it is realistic for some physicians to continue to see patients a few days a week while working part time in a non-clinical role. This is often specialty dependent. In fact, she says that this arrangement can help prevent burnout and may keep a physician’s skills sharp, helping build skills in both jobs.

With her extensive experience guiding physicians through career transitions, Dr. Fork also reminds doctors that it is important to formulate financial goals and become comfortable with financial issues and investments. She points out that it helps to understand your relationship with money and to try to develop a healthy attitude about money. For example, Dr. Fork says that some doctors have a hard time knowing when they have enough money to take the foot off the gas. In reality, they have piles of money but they still feel compelled to keep working hard. They’re often aware of this compulsion, but still have difficulty slowing down.  It’s also common for some physicians to be so focused on providing for everyone else —helping extended family members, saving up for the kids college, donating to worthy causes, etc. that they neglect their own self-care and well-being. They feel guilty spending money on a gym membership or a massage. 

When making a career change, she advises that physicians get a good handle on their financial goals, their habits around money, have a good understanding of their true income potential in a variety of jobs and careers. 

By Nana Korsah MD

Have you ever felt overwhelmed with the transition from one job to another? The pressures that come with this life change is somewhat unavoidable, but there is something that is sure to ease the process, and that is tail insurance coverage.
 
So, what is tail insurance? According to www.studentdoctor.net, “tail coverage is an extended reporting period endorsement, offered by a physician's current malpractice insurance carrier, which allows an insured physician the option to extend coverage after the cancellation or termination of a claims-made policy.” In this guide, I will get into how you can set up tail coverage with ease, if needed, and how to discover different types of malpractice insurance. This is information that I wish my coaching clients knew sooner, but my hope is that this will prevent the stress of tail malpractice insurance coverage.

In conclusion, when it comes to malpractice insurance, pick a job that has an occurrence-based policy. If you should decide to go for a claims-made policy, make sure you have established one of the following: your employer will cover tail insurance when you leave, you have a tail coverage fund, or your new employer will pay for your tail policy. I encourage you to use these simple, practical solutions at your disposal because no one should be imprisoned at a job because of tail insurance.

About the author: Nana Korsah, MD is a former Nephrologist turned locum Hospitalist. Board certified in Internal Medicine. She has side gigs as a Telemedicine Physician, Neora skincare/wellness company brand partner, a certified life, and financial coach for physicians who want to pay off debt and live wealthy lives quicker. She helps physicians who want to enjoy the lives they sacrificed so much to create, but they don't know where to start. She helps them build wealth and say yes to the lives they want using the magic of personal finance and multiple streams of income.

You can contact Nana Korsah, MD through her website www.mdworklifebalance.com or via email at Doctorkorsah@gmail.com

by Robert Priddy
I’m always meeting with clients who are quick to say, just call me Jane or John…., and I always say to them, don’t give up “doctor.” There is a simple reason for that, it’s called credibility. Regardless of how you may feel today when it comes to the respect you receive from staff, colleagues or even patients, Physician is still the top or nearly at the top of any list of the most respected professions in America.
 
So, if you have the ability to walk into nearly any meeting with the expectation of “trust me” already on your side, why would you not? 
 
Presenting and selling ideas in business is challenging for everyone. Establishing credibility is a tough job. Becoming a physician is also a tough job, so you’ve earned everything you have. Don’t be afraid or too timid or wishing to just be a part of the gang, to use the trust and the power you’ve earned. In time, once the boundaries have been established, you can drop the “doctor,” if you wish. But initially, use the respect you’ve earned.

If you’d like to learn more, don’t hesitate to contact me for an initial Hallway Consult... Call or Text 720-339-3585 or email rfp@thirdevo.com.
More advice by Robert Priddy-The Resume Recruiters and HR People Hate, Physician Career Change, Never Overestimate the Knowledge of Your Audience, and Self Protection Is Self Defeating

 by Andrew Wilner, MD, FACP, FAAN
 
Have you heard about locum tenens? Locums physicians act as "placeholders" in clinics and hospitals that need temporary help. Doctors may work locum tenens in addition to a regular job (moonlighting) or move from one assignment to another, traveling to different destinations and experiencing a variety of practice environments. If you've considered joining the approximately 50,000 locum tenens physicians in the US, here are five tips to get you started.
 
1. Why?
Why work locum tenens? This decision depends on your stage of career. For example, newly graduated residents may travel to a part of the country they have never seen or experiment with different types of practices. Mid-career docs often need extra income or want to test the waters for a practice change. Pre-retirement physicians may wish to cut back a little, but their full-time job won't permit a part-time option. As a locum tenens physician, how often you work is up to you.

2. Find a good staffing agent.  
A staffing agent can offer invaluable assistance, particularly if this is your first foray into the world of locum tenens. When you chat with an agent, ask questions and communicate your needs. Agents focus on certain medical specialties, and it's their job to know the market. Agents work on commission, so there's no cost to you.
 
Select a staffing agency that belongs to the National Association of Locum Tenens Organization (NALTO), which sets standards and sound business practices for locum tenens companies. Two NALTO members that I have contracted with are CompHealth and Staffcare. See the NALTO website for an updated list of NALTO staffing agencies.
 
3. Where and when?
Decide where you want to travel and your timeframe. Once your agent knows where and when you wish to work, he or she will search for an appropriate opportunity that fits your schedule and offers the best compensation.

About the author: Andrew Wilner, MD, FACP, FAAN is the author of The Locum Life: A Physician's Guide to Locum Tenens Dr. Wilner can be reached at www.andrewwilner.com

By Maiysha Clairborne MD

It was 2004 straight out of residency that I started my first business.  I didn’t know a thing about business, much less running a practice. However, I jumped in headfirst without a life vest.  The journey that began in August of 2004  became one the scariest and most exhilarating journeys of my career.  Now, almost 15 years later, I share the knowledge, expertise, and learnings that I’ve acquired about stepping into physician entrepreneurship and what it takes to start, grow, and successfully maintain a business without pulling your hair out with other doctors wanting to do the same. I speak with women physicians and other moms in medicine daily who are thinking about quitting medicine, but aren’t sure they have what it takes to start their own business.  They have this grand view that starting a business is this impossible mountain.  Here are some of the top 5 myths I hear about becoming a physician entrepreneur and starting a business.
 
You have to have an MBA or have a business background
 
I have known many physicians (and non-physicians) who have had MBA’s who are either not utilizing the degree (meaning they have not started their own business), or who are failing at starting, growing, or maintaining a successful business. On the contrary, I know even more physicians (and non-physicians) who have no such degree and have started and grown multiple businesses.  The point is, while having an MBA or business background is not a bad thing, it’s certainly not an indicator of whether or not you can start or be successful as a business or practice owner.

You have to have business experience to start a business
 
This is like saying to a newly graduated college student that they have to have experience in a position before they can get a job.  While, the former helps, it doesn’t predict one’s success in the field.  Having prior exposure to running a business (through family or other ties) is an added benefit, but not a necessity to be able to successfully run a business. What is required is the willingness to educate oneself, learn from mentors or coaches, and grow into the expertise. I grew up in an entrepreneurial household.  However, when I first started my practice, it failed because I knew nothing about business. I knew I wasn’t going to spend $40K and 2 years on a business degree, but what I did know is that I could attend workshops, conferences, and seminars. I bought programs, hired coaches, and participated in masterminds. This willingness to learn is what has made me successful in my businesses.

If you fail, you are obviously a bad business person
 
I am the poster child for not letting failure define me as a business person. Not only did my first practice fail, I’ve probably had more failures in business than successes. However, it’s the failures that have led me to those major successes, and it’s the mindset that failure is feedback that keeps me in the game.  If you are going to be a physician entrepreneur and be in business, you have to get that failure is just part of the game. If you are not willing to fail, then you are really not willing to succeed. 
 
14 years after my first business adventure, I continue to step into new territory.  It is the life of an entrepreneur… always “leveling up”.  I take the lessons I learned over the last more than decade, and not only re-apply them in new ventures, but also teach my physician entrepreneur mentees and students everything I’m learning along the way. The most important thing for physicians who want to embark upon starting a business to know is that it’s not so much a destination but a journey. When you choose business ownership you choose the mountain with no top. It can be a scary journey, but the biggest failure in business is to not try at all.
 
Maiysha Clairborne MD is an integrative medicine physician and coach, who blogs at Stress Free Mom MD is the founder of the  Next Level Physicians Entrepreneurs Institute. She is also the creator of Next Level Physicians Doctors in Business Facebook Groups

By Eric Brown
USMLE Course Consultant
After spending two years in the classroom, now it’s time to begin your third-year with clinical rotations. During clinical rotations, you get to immerse yourself in patient care, know more about the different specialties and put your bookish knowledge to good use.
Although clinical rotation is exciting, this transition can be a stressful time. It may fill you with tons of anxiety. Therefore, it is important that you enter into clinical rotations with a growth mindset. They may seem daunting, but you get only one shot at it. So, make it count.
With that said, here are 5 tips to succeed in clinical rotations.
1. Choose your rotations wisely
Clinical rotations help medical students in figuring out what medical residencies are best for them. During the rotations, the students shadow physicians in variety of medical disciplines. This helps them in making an educated decision about what specialty they want to join and later practice. To choose the right clinical rotations that is aligned with your future plans is not easy.
Some tips to choose the right clinical rotations:

• Explore as many rotations as you can to help you identify the specialty you are truly passionate about.
• Ask yourself these questions: What are your needs and special interests? In what areas would you like gain more experience? What kinds of experiences in clinical rotations would you like to go through before you choose a residency program? Are there any clinical rotation experiences that will help you shortlist your specialty choices or discover your passion?
• Spend time researching possible opportunities and options. Find information about opportunities in clinical electives of your interest from sources such as the clinical department, past medical students, and faculty members.

4. Be attentive to what your patients are saying
Listen carefully. It is one important clinical skill that will help you be a better doctor. Each patient encounter will give you an opportunity to learn something new, if you pay close attention to what your patients are saying.    
5. Be friends with your fourth-year peers
A friend who is in the fourth year can be an excellent mentor to you. You’ll get invaluable advice from students who have been through what you are going through now. Talking with them will keep you informed and updated about the forthcoming challenge.
6. Ask questions
You have got into the third year without much hands-on experience of examining real patients and dealing in logistics of the hospital. Now you are in the real world, seeing real patients; you’ve got a lot to learn. The only way you can learn better is by asking questions. Let no doubts remain in your mind; ask questions, however silly they may seem.
While it may be perfectly alright to ask genuine questions, do not ask questions that could reflect poorly on you. Don’t ask questions that you can easily look up.

About the author:
Eric Brown is a standardized patient (SP) who lives in New York and advises NYCSPREP with their Clinical Skills course. He has a BA from a liberal arts college in the Northeast, where he majored in the theatrical arts and business (he credits the first for his ability to simulate real patients). He’s amassed years of experience as an SP and keeps up to date with CS exam expectations, trends and developments. When the Phillies are in town, Eric considers it his duty to support his home team. He won’t be seen without his trusty catcher’s mitt on these occasions, and prides himself on having caught more than one foul ball with it. If you have any questions about standardized CS exams or courses at NYCSPREP, email Eric at eric.brown@nycsprep.com or visit http://www.nycsprep.com.
More advice from Eric Brown:
How International Medical  School Graduates Can Obtain US Clinical Experience

By Robert F. Priddy
Loss of license is a devastating event for a physician. It's not just the absence of a license and a mechanism for making a living, but the act or issues that led to the revocation of the license. Whether it's malpractice, substance abuse, some alleged egregious administrative act or other, it's a challenge to your professionalism, to your identity and to who and what you've worked your entire life to be.
It may seem like the end, but it's not. One of the unfortunate realities of medical practice and the medical profession is that everyone you've encountered, from your first day of medical school to you last day of residency or fellowship, and even on into the "doctors lounge," has expected you to practice medicine until you can no longer work.

About the author: I provide my clients with what I call a CareerDiagnosis™. It's two days focused on learning about desirable and appropriate career paths to follow. I follow a SOAP note to collect that information. So, you can see, transitioning is a process, but it should be a structured and orderly process that takes you to a positive and rewarding career. 
If you'd like to learn more, don't hesitate to contact me for an initial, no-charge, no-obligation Hallway Consult... call/text 720-339-3585or email rfp@thirdevo.com. 

More advice by Robert Priddy-The Resume Recruiters and HR People Hate, Physician Career Change, Never Overestimate the Knowledge of Your Audience, and Self Protection Is Self Defeating

Always Act Like You've Been There Before
by Robert Priddy
I try to refrain from sports analogies, but this is one of my favorites. I'm from Ohio, so, yes, I'm a buckeye at heart, and one from the Woody Hayes era of The Ohio State University football. So, the legend goes, a young Ohio State player scored his first touchdown for the Scarlet and Gray. He then performed some celebration in the end-zone before returning to the sidelines, whereupon Coach Hayes reportedly grabbed him by the front of the jersey and pulling him in close growled, "Son, when you play for THE Ohio State University, you act like you've been there before."

by Robert Priddy

Put another way, most markets have plenty of room for expansion and growth, and that includes you as a new entrant.
 

Physician "Sell" Thyself
by Robert Priddy

If you’d like to learn more, don’t hesitate to contact me for an initial Hallway Consult... Call or Text 720-339-3585 or email rfp@thirdevo.com.
More advice by Robert Priddy-The Resume Recruiters and HR People Hate, Physician Career Change,
and Self Protection Is Self Defeating

DANGER WILL ROBINSON! Is a Recession about to strike?
By Mark J. McCandless, CPA, CFP®, MTax
President, Pathfinder Wealth Advisors LLC

In the 1960s television series Lost In Space, my favorite character was the Robot. Whenever the Robot sensed a meteor storm or an unknown presence, he would shout “Danger Will Robinson!” Here is a short clip.   An impressionable nine year old, I would play Lost in Space with my friends. I would run through my yard waving my arms and holding my hands in the “hook ‘m horns” position (You know, University of Texas) and yelling “Danger!” like the Robot with his claw hands would.  I believe my Mom wondered if she had dropped me on my head as a baby.

Today, some investment firms have started to yell “Danger” that a recession will descend upon us within the next two years. Should we change strategy? What should we do? Rather than run around the halls of our office like the Robot, I thought something else might be more useful for our clients. With some research help from our partners at Dimensional Fund Advisors, we created our Pathfinder report “Pursuing a Better Investment Experience – Ten Recommendations For Dealing with the Noise of Volatile Markets.” One of the most important recommendations is to “Focus on What You Can Control.” This means you can control creating a portfolio that is geared to your risk tolerance, globally diversified, uses funds or other investments with lower expenses than most funds, has lower turnover and is sensitive to the impact of income taxes. You can do this yourself or with the help of an investment advisor.

We tell our clients that the purpose of this is to remind all of us what we should and should not do in order to have an opportunity for success in investing. Will we have a recession? Of course. When will we have a recession? No one knows. Not even the Robot. The key is to be patient, avoid loud promoters that promise unrealistic results, communicate with us, and let us do the necessary rebalancing that will adjust the portfolio due to market changes. The worst investment returns were incurred by those that sold out during the last significant downturn. Investors that rebalanced to their target allocation and were patient achieved outstanding returns.
 
In the heat of a market downturn that feels like a meteor storm, when even the Robot can only yell “Danger” but can’t tell you what to do, remember the recommendations for Pursuing a Better Investment Experience. If you would like a copy of all of the recommendations, please send an e mail to me at mark@pathfinderwealthadvisors.com and include “Ten Recommendations” in the subject line.
More advice from Mark McCandless: Generating Tax Savings and Retirement Savings With SEP-IRA

The author:
Mark J. McCandless, CPA, CFP®, MTax, President
Pathfinder Wealth Advisors, LLC
6100 Oak Tree Blvd. Suite 200, Independence, Ohio 44131
mark@pathfinderwealthadvisors.com
www.pathfinderwealthadvisors.com
"Dedicated to our clients and their success"
Investment advisory services are offered by Pathfinder Wealth Advisors, LLC a registered investment advisor firm. We cannot accept orders for trades or any other transactions via e mail or voice mail. This e-mail message is sent to the intended recipient for their confidential use. If you received this message in error, or are not the intended recipient, please reply immediately to the sender and delete immediately from your system. 

By Mark J. McCandless, CPA, CFP®, MTax
President, Pathfinder Wealth Advisors LLC
 
In an era when many individuals are either full time self-employed consultants or doing some type of consulting in addition to being employed full time by an organization, a question often arises regarding how to “capture” some of those earnings for retirement. One solution that is easy to establish and has great flexibility is a SEP-IRA. A SEP-IRA is a written employer plan that permits an employer to make deductible contributions into an IRA for the employee. The SEP – IRA is controlled by the employee or the self-employed individual. If you are the one doing the consulting, you could make a contribution to your SEP-IRA out of your net earnings from consulting (also known as “self-employment income”).

The amount you can contribute is based upon a percentage up to 25% of your “net” earnings from self-employment. The “net” is important because it is defined as:
 Your consulting revenue
 Less your business expenses
 Less one half of the self-employment tax you pay
Less your SEP-IRA contribution
= Net Earnings from Self - Employment
You may be thinking “How can I know what I can deduct if I have to base my contribution on what I’m going to contribute?” Fortunately, the IRS provides helpful tables to determine the exact percentage to contribute assuming various contribution rates. The maximum contribution to a SEP-IRA for 2018 is $55,000. However you can contribute a smaller amount based upon your cash flow.

The plan is also easy to set up. You complete the IRS form 5305-SEP and maintain it in your files to show you adopted the plan. If you have employees, you must provide a copy of this form and additional information indicated in the instructions regarding the accounts. If you have employees, you must contribute to their IRAs in the same percentage as your own contribution.
I have helped many individuals over the years supplement their retirement contributions and save taxes through the use of plans like SEP-IRAs. Every situation is unique and every solution does not fit all situations. If you would like guidance on retirement, investment or other tax planning ideas, please feel free to contact me at Mark@PathfinderWealthAdvisors.com
More advice from Mark McCandless: Dealing With Volatile Markets
The author:
Mark J. McCandless, CPA, CFP®, MTax, President
Pathfinder Wealth Advisors, LLC
6100 Oak Tree Blvd. Suite 200, Independence, Ohio 44131
mark@pathfinderwealthadvisors.com
www.pathfinderwealthadvisors.com
"Dedicated to our clients and their success"
Investment advisory services are offered by Pathfinder Wealth Advisors, LLC a registered investment advisor firm. We cannot accept orders for trades or any other transactions via e mail or voice mail. This e-mail message is sent to the intended recipient for their confidential use. If you received this message in error, or are not the intended recipient, please reply immediately to the sender and delete immediately from your system. 

Most physicians come from a culture high on self-reliance. You may have belonged to a group practice, but you didn’t treat patients or perform surgery in a “group.” Medical practice is one patient at a by one physician at a time. It’s a pretty simple calculation. And anytime another physician is brought into a patient care situation it’s usually because that patient is being handed off… or taken away from you. Now you’re being asked to bring in another physician. Does this mean your job is being handed off… taken away from you? No, not if paragraph one accurately describes your work environment.
What this means is it is time to grow, to expand your span of influence and control. It’s time to offload some of your lesser tasks to someone else, and time to possibly acquire a slightly different skill set to open new opportunities – opportunities that will involve you if you allow them.

Shutting the door to staff expansion may appear to be self-protective, but you’re actually closing the door to growth, both intellectual and career. One of my adages when I was in the corporate world was that I could never have too many staff, have too much office space or too large a budget. In most corporate or organizational environments, the more your control, people, space and money, the more powerful you are and, and get this…, the more you have to give away if things get tight. Think about it, if you have a department of two and the corporate mantra becomes, we’re cutting back, you may soon be a department of one. Growth equals control, power, influence and viability. Don't shy away from adding that next physician, then the next and the next. There is safety in numbers.
More advice by Robert Priddy-The Resume Recruiters and HR People Hate, and Physician Career Change

If you’d like to strategize the new nonclinical job you have, one you hope to have or you’re just starting to test the nonclinical waters, call me, Robert F. Priddy, for a no charge, no hassle, hallway consult. Contact me at 720-339-3585 for voice or text or email rfp@thirdevo.com. You can also visit me anytime at http://www.thirdevo.com.

By Eric Brown
USMLE Course Consultant

Every year a large number of physicians apply to pursue their residency in the United States of America. Each physician who plans to pursue residency in America has to learn about the intricacies of the American system in order to make a seamless transition from a foreign medical graduate to a successful practicing physician.
If you are planning to pursue your residency in America, there are various aspects an International Medical Graduate has to consider while applying for clinical experience and residency programs in the U.S.

Which Students Are Considered as International Medical Graduates?
 
If you graduate from a medical school outside America, irrespective of whether you are a U.S citizen, you will be considered as an International Medical Graduate (IMG) when applying for residency programs.  This will require you to take the USMLE and apply for clinical experience.
 
But first, in order to take the USMLE and pursue your residency in U.S.A, being an IMG, you will first have to confirm that the medical school you graduate from is listed in the World Directory of Medical Schools. This is because medical schools listed in this directory meet the eligibility requirements set by the Educational Commission for Foreign Medical Graduates (ECFMG). Thereby, allowing you the register for the USMLE Step 1, Step 2 CK and Step 2 CS as an IMG.

Once you have cleared your USMLE exams, you then have to work on building your portfolio in order to secure admissions in a U.S. residency program. This will require you to obtain U.S clinical experience. Your clinical experience will be a part of your CV and other documents you will be required to submit when applying for a residency programs. The most common forms of clinical experience for IMGs are observerships, clinical rotations, clerkships or research positions. However, finding a clinical position in the US is not an easy feat, and being an IMG, your chances of securing a spot in a U.S residency program is much lower than that of a typical U.S. graduate. This generally happens due to the difference of medical laws and practicing patterns in various countries.

How Can IMGs Apply for U.S. Clinical Experience?
Being an IMG, finding the right type of clinical experience may be tough, but with the right methods, persistence and ingenuity, there are several ways to find the right type of opportunity, such as:
1. Use Renowned Online Resources
The most trusted online resource when it comes to an all-encompassing database of medical schools, hospitals and clinics is a website sponsored by the Association of American Medical Colleges known as Extramural Electives Compendium. It is a free database lets you search institutions based on their geographic location. It also offers useful information about medical school campuses, application procedures, elective time, and fee structures of such institutions.

2. Go to Direct Placement Clinics
Since IMGs face such difficulties finding clinical experience, some clinics even offer clinical experience programs that you can attend by paying to participate. Such clinics even provide letters of recommendation in case of well-performing students.  However, such direct placement clinics operate independently, be sure to ascertain whether they are certified by the American Medical Association, among other qualifications.
Why is U.S. Clinical Experience Important for IMGs?
Considering the highly competitive nature of this field, it has been observed that IMGs who participate in observer-ship programs to gain clinical experience are more likely to match. Many hospitals, research institutes, and private practices provide valuable opportunities to foreign graduates for internship, externship, volunteer-ship, and research assistance.

• it boosts your resume for the residency match
• it allows you to gain first-hand experience of the healthcare practices and environment in U.S.A
• it helps you increase your network in terms of peers, experienced doctors and mentors
• it helps you in getting recommendations and references once your clinical experience is complete

About the author:
Eric Brown is a standardized patient (SP) who lives in New York and advises NYCSPREP with their Clinical Skills course. He has a BA from a liberal arts college in the Northeast, where he majored in the theatrical arts and business (he credits the first for his ability to simulate real patients). He’s amassed years of experience as an SP and keeps up to date with CS exam expectations, trends and developments. When the Phillies are in town, Eric considers it his duty to support his home team. He won’t be seen without his trusty catcher’s mitt on these occasions, and prides himself on having caught more than one foul ball with it. If you have any questions about standardized CS exams or courses at NYCSPREP, email Eric at eric.brown@nycsprep.com or visit http://www.nycsprep.com/

As a healthcare provider, your reputation matters. Traditionally, patients have depended on word of mouth when it comes to which doctor to go to. Everyone would tell family and friends which doctors they liked or didn't like, while referring physicians would refer to the specialists whom they trusted as good doctors to take care of their patients. 
 
Online rating sites are starting to change things. The truth is that the vast majority of people don't bother to rate their physician at all- so there are very few ratings out there. But, terrible ratings and comments from irate patients is a real cause of distress for doctors. 

Unfair negative comments 
Many doctors want to know what to do about unfair, potentially damaging comments. Unfair negative comments can happen when a patient doesn't understand the bill (the doctor doesn't personally send the bill, but medical bills reflect poorly on the doctor) Negative ratings can happen when a patient doesn't receive disability or other benefits. And unfair negative ratings can happen when a patient doesn't receive certain substances he may have demanded from the physician. The medical community is aware of these biases, but most patients aren't aware of these factors when they look up a physician online. 
 
And, doctors are often frustrated because the negative comments are not usually directly related to the particular dispute, but are often falsified. Nevertheless, they are out there for everyone to see. 
 
Bad comments that are true
No one is perfect, and unfortunately, people are more likely to post bad comments on rating sites when they are unhappy with the outcome than they are to post good comments when things turn out well. Many of us achieve a sense of satisfaction and feel more 'in control' of life after posting a negative review. 
This tips the factual comments in favor of the negative.
 
What should you do?
*Often, doctors try to redirect practice away from medical conditions that are commonly associated with patients who are more likely to be 'toxic.' This can be unfair to patients because even angry or vindictive people have real medical problems and need medical care. 

*Some doctors have been able to contact administrators of physician rating sites, as negative ratings can have a harmful impact on referrals and on the livelihood of good physicians who are treated unfairly online. 

*Because of patient privacy concerns, physicians, unlike other business owners, cannot rebut a complaint by explaining in a comment on the website, 'this patient asked for ...'  

*Some doctors have tried litigation, which is a costly and lengthy process. But, as with all legal issues, precedents may change things over time.

*Some physician rating sites are starting to charge a fee for services such as 'enhanced search engine optimization' and 'high rating profiles.' This is still a very new concept and it may turn out to benefit doctors who jump on the idea early, or it may not make a difference.

*One way to control your professional online presence is by presenting yourself online as yourself. When old-fashioned word of mouth was the way things were done, a doctor's personality could shine through. Now, doctors can show who they really are through writing patient-centered articles that demonstrate to patients how a doctor may interact in person. Consider writing an article for nonclinicaldoctors.com or for another website as a way to control your own online reputation.

By Dave Denniston CFA
The world is changing.
The concept of retirement is changing.
Is an early retirement even possible? Heck, is retirement by 60 or 65 even possible?
As a matter of fact, I’m seeing many folks work longer and longer- some even well into their 70’s. Truly, it’s not full time for the most part, but part time to scrape some extra dough for some of the extras that make retirement enjoyable- the hobbies, the travel, and the grandkiddos.

In a previous post, I made a big leap and even suggested that Retirement is Dead.
For newly minted attending physicians with student debt burdens over $300,000 and rising, a traditional retirement is getting further and further out of reach. My feeling is that we will be seeing more and more physicians experience what I am coining “The New Retirement.”
Yes, I know that we currently have a physician shortage, but with more “cheaper” PAs and NPs gradually taking over the work for physicians in certain areas- we could see the landscape for physicians changing more and more.
In this post, discover the three components of the New Retirement and how that may fit into your future plans.

Component#1: House Debt Forces You To Work Longer
What are we taught about buying our first place? What matters more than anything else?
Location, location, and of course… location
When it comes to the new retirement, location is everything and I’ll change those 3 words to:
Home price, home price, and home price
For many of us that are labeled gen x, gen y, and millennials- I see time and time again the impact of the price of your home on retirement.
Consider a client in Southern California- they bought a fairly modest home for $900k.
In comparison, here in the good ol’ Midwest, our place of similar size was worth around $250k around the same time.
Can you imagine how much more quickly we’ll be out of mortgage debt and able to save more? Our friends on the coast are being FORCED to work much longer.
Ironically, not only are costs higher- particularly homes…. but the salaries are also lower!!!
This means that our physician friends on the coasts are likely to experience the new retirement- unless they do some creative investing or instead, force themselves to live like a resident for a big chunk of their careers.
And it’s awfully hard to live like a resident and when you’re paying a resident’s salary for your home…

Component#3: Creating (or Acquiring) A Business
Can’t find that passion for medicine again? Are you eager to try something else?
For some of us… maybe you don’t want to start from scratch and you don’t want to work ‘for the man’. Wouldn’t it be great to have a business that you can get cash from immediately?
Check out what I did by buying an existing business.
I’m not going to lie. It’s not all rainbows and sunshine, BUT if you structure the acquisition right- you can protect yourself and your future while creating multiple streams of income.
As a matter of fact, I like it so much- I am planning on acquiring or starting 1 new business every year the next 2 to 3 years.
This should allow us to generate a few thousand extra dollars a month. As we develop more systems and automation, each business should be on autopilot with some course correction from time-to-time.

Final Thoughts
Doctors like you are the best and brightest that our country has to offer.
As you may explore the “New Retirement”, keep an open mind.
You have the capacity and ability to contribute so much to the world- whether you are treating patients or starting a new business.
Keep trying, keep testing, and above all else, keep pursuing the financial freedom you so richly deserve.
More Advice by Dave Denniston- Does Stuff Own You? and Finances of Business vs. Hobby

About the Author
Dave Denniston, Chartered Financial Analyst (CFA), is an author and authority for physicians providing a voice and an advocate for all of the financial issues that doctors deal with. He also has 1 wife, 2 kids, and a bunny named Black Snow (which is a lot better of a name than Yellow Snow).
If you’ve enjoyed this guest post, you can learn more about his adventures in financial planning, liquid investments, illiquid investments, & much more nonsense by finding his latest blog post and videos
*Several of the links in this article have listed 3rd party firm/individual are not affiliated with or employees of United Planners Financial Services. United Planners does not supervise this firm/individual and take no responsibility to monitor the information/services they provide to you.
The opinions expressed are those of Dave Denniston and The Capital Advisory Group and are subject to change based on market, tax, and other conditions. The information provided is general in nature. Consult your investment professional regarding your unique situation. Securities offered through United Planners Financial Services 800-966-8737, Member FINRA, SIPC. Advisory Services offered through Capital Advisory Group Advisory Services, LLC. 5270 W. 84th Street, Suite 310, Bloomington, MN 55437, 952-831-8243, United Planners and Capital Advisory Group Advisory Services LLC are not affiliated.