Physician Income: Adding A Nutriceutical Pharmacy

By Dr. Dean Raffelock D.C., Dipl. Ac., CCN, DIBAK

Many fine physicians I know have been struggling with working longer hours for significantly decreasing revenues.

The dilemma they face is that they want to be able to spend enough time with their patients to provide quality health care but feel pressured and handcuffed by insurance company dictates. This problem has gotten so troubling for some that they question whether all the hard work and investment in medical school has been worth their present frustrations. These frustrations increase stress levels, potentially harming the physician’s own health. Some even question staying in practice.

There are a number of possible solutions to this dilemma. Some with busy practices with motivated patients establish concierge practices. Yearly fees for joining offer patients more quality time with their doctor. Insurance companies are still billed for services rendered but the entry fee often covers basic overhead and sometimes more. This allows patients to receive better health care and guarantees the physician a baseline income that can allow them to practice in a more thorough, less hurried manner while retaining more profit.

Here’s another solution that is becoming increasingly more popular. I have coached many doctors to establish their own ‘in office’ nutriceutical pharmacy. Many physicians have significantly increased their incomes by taking evidence-based seminars on nutritional interventions for common diseases and providing their patients with ‘doctor only’ professional grade nutritional products. This is a win/win for doctors and their patients. Most patients would much prefer to take nutritional products over pharmaceuticals whenever possible and prudent.

Here’s how establishing a nutritional pharmacy can work. Let’s use the example of prescribing Niaspan (niacin) to help lower LDL and raise HDL cholesterol and even more importantly lower Lp(a). If one prescribes Niaspan, the pharmaceutical company and the dispensing pharmacy make all the profit. On the other hand, if you dispense professional grade niacin out of your office, you make $15 on a $30 dollar bottle than provides 120 tablets of 500 milligrams each. In many cases the co-pay for Niaspan is more than 30 dollars.

If the patient’s liver enzymes elevate on the niacin, a standardized extract of milk thistle herb containing 80% silymarin very effectively restores liver enzymes to normal range in most cases. The win/win is that your patient gets to keep taking a highly effective cardiovascular intervention and receive all the hepato-protective effects of the herbal extract and you have just added a continuing monthly profit of $35 for the one patient.

If you choose to provide this same cardiovascular risk patient with high quality fish oil (Lovaza is massively overpriced and every bottle I’ve tested is rancid), ubiquinol (a superior form of CoQ10), and D-ribose to enhance heart muscle endurance; you now have an ongoing monthly profit of over $100 with this one patient. Plus the patient will thank you for how much better they feel.

About: Dr. Dean Raffelock is a nationally known expert in integrative health care and consults for physicians nation-wide at Raffelock and Associates. You may contact him at 303.541.9019. 

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Kathryn Schulz - TED Talk "On Being Wrong"

What happens if we consider being wrong?

I just spent 17 minutes of my day watching Kathryn Schulz give a talk on the meaning of being "wrong". Best 17 minutes I've spent in a while.

Her premise is simple:  open yourself up to the possibility of what "else" is out there.  Challenge yourself to see the world (and reality) through a different person's window ... or at least recognize that there are millions upon millions of different windows out there.  Her message?  Embrace your wrong-ness.  It is an integral part of the human condition.  It drives us and helps us create.  It moves us forward as a species.

Physicians are especially prone to not wanting to be "wrong".  It's true, being wrong can have desperately negative consequences in your line of work.  But for many docs this fear of risk, failure, and error transfers over into other parts of their life... where being wrong is less clear-cut and the consequences are more of a grey area.  They agonize over life changes, career moves, interpersonal challenges with colleagues, to the point of "analysis paralysis" where they are immobilized and unable to do anything.  

But there is freedom in embracing wrong-ness as a possibility.  Kathryn speaks not only of being wrong, but of opening up your awareness of when you are unconsciously wrong, but think you're right.  This is a much more dangerous place to be, and warrants some thought.

Watch the video.  Think about how you feel about being wrong.  Open your window.

Real Estate Is Finally A Buy & Hold Investment

As a real estate investor since the late 80s, I’ve lost count of how many times I’ve been asked, “Is now the time to buy a rental?” 

The specifics of the market are constantly changing my answer.  In the late 1990s, my answer was, “Buy as many houses as you can!” To many, this seemed counterintuitive as the real estate market had fallen in the early 90s and remained flat for years.  Nevertheless, I followed my own advice and bought as many houses as I could, and less than five years later I was able to sell the houses and buy an apartment complex.  It’s the classic strategy in the game Monopoly: you trade four small green houses for one red hotel.

There is one fly in the ointment to this seemingly simple strategy: timing.  By the early 2000s, my answer to the big question was, “Hold onto what you have for a couple of years, but don’t buy anything new.”  By 2004 my answer changed to, “Are you crazy?  Why would you want to buy a house for $450,000 that will rent for $1,500 per month?”  Too many people got caught up in the bubble mentality, and the aftermath is now well known.

In 2009 the question started arising once again.  By now, real estate prices had fallen to as low as 75% from the peak (yes, in some neighborhoods they did!) and the rents would actually produce a handsome positive cash flow.  While it would be fine to buy rental property in that climate (especially for a one to two year hold), my answer was still, “Not yet.” Why?  If you followed the market indicators closely, you could see the making of a double-dip far off in the horizon.  The market was at bottom but there were still too many non-performing loans that would later result in foreclosure.  This meant that the market was bound to give you a second chance to buy the same house at the same (or even lower) price in two years or so.  Why hold through that period when you can just buy and flip?  Let your money grow by flipping— investors in buy and flip funds can tell you how good this is—then once the market enters the second correction, jump into the new strategy: four small green houses, one red hotel.

The second market correction is here!  Foreclosures are mounting, prices are falling (about 7% in 2010 and will probably fall another 7% in the first half of 2011), displaced former homeowners are looking for a home to rent, and other segments of the economy are beginning to stabilize.  Builders are barely adding to the supply of homes because homes can be purchased below the cost to build them.

This time single-family home prices will find their natural bottom, become an excellent cash-flow investment, and asset values will be able to climb naturally.  All of this adds up to a good time to accumulate single-family homes and rent them to tenants, and then sell them after the real estate market has fully recovered.

While the economy at large is starting to charge forward, the real estate market has been moving in the opposite direction.  Compare this to pulling back on a slingshot; eventually you have to let go, and you know what happens then!  The slingshot will let go when all of the bad loans have been foreclosed.  The demand for housing will still continue.  Real estate prices must rise due to the increasing demand until the prices exceed the cost to build, allowing builders to once again add to supply.  No one knows exactly when this will happen, but when it does you want to have an interest in as much property as you can to take maximum advantage of the market.

I have mentioned Praxis Capital in previous posts.  They are a limited partnership syndication group that specializes in buy and flip foreclosure properties. In addition to that flipping strategy, they are now launching two new funds to give their investor clients an opportunity to put their money to work in this age-old strategy of wealth accumulation without having to deal with tenants, toilets, and trash.  To find out how, call Sherri, their investor relations manager.  She will tell you about their brand-new buy and hold opportunities for single-family and multi-family properties.  In addition to making good returns on buy and flip properties, you may want to consider also getting involved with some buy and hold properties for cash flow and future appreciation.  Remember, it’s all about timing!

For more information on this investment opportunity, contact Sherri Haskell at (415) 322-2665 or sherri@praxcap.com.

Dr. Michael Callahan and the Medical Fusion Conference

Not long ago I caught up with my friend, Dr. Michael Callahan, and got his thoughts on our new Medical Fusion Conference.

Michael is an Infectious Disease specialist from Harvard who works with DARPA and the U.S. Defense Department in various niche areas.  He's an expert on reptile envenomations, high altitude acclimitization, and international search and rescue.  Each year we have the privilege of learning from Michael at our Expedition Medicine National Conference in Washington, DC. 

As an individual who has broadened his career to include many interesting and unique areas, I was curious what Michael thought of our Medical Fusion Conference .  Check out the video below to get his insights...

Physicians and The Richest Man in Babylon

If you're a physician looking to transition into some form of business, do yourself a favor and read some of the business classics.

Like every career area, business has a collection of classic texts that many in the field have read and to which they often refer.

After seeing it listed in multiple business books recently, I finally sat down and read the famous finance book, The Richest Man in Babylon by George S. Clason.

Originally published n the 1920's, The Richest Man in Babylon explains how to build wealth and handle money through a series of parables.  While the language is sometimes stilted due to a less-than-modern style and wording, the principles ring true and are fundamental to basic financial health.  It has been a popular text for many years-- cited by multiple sources-- and has reportedly sold over 2 million copies since its original publication.

The book is not a long or difficult read.  Here are some of the basic principles and meaningful quotes:

• "I found the road to wealth when I decided that a part of all I earned was mine to keep. And so will you."  (ie- pay yourself first and save your money)
• "Opportunity is a haughty goddess who wastes no time with those who are unprepared."
• "Which desirest thou the most? Is it the gratification of thy desires of each day, a jewel, a bit of finery, better rainment, more food; things quickly gone and forgotten?  Or is it  substantial belongings, gold, lands, herds, merchandise, income bringing investments?  The coins thou takest from thy purse bring the first.  The coins thou leavest within it will bring the latter."
• "Good luck can be enticed by accepting opportunity"
• "If thou desire to help thy friend, do so in a way that will not bring thy friend's burdens upon thyself."
• "Better a little caution than a great regret."

If you're going to be getting into entrepreneurial pursuits, jumping into a business endeavor, or simply interested in better managing your finances, you really need to begin learning the principles contained in the business canon.  The Richest Man in Babylon is a business classic and contains timeless principles.  It's not a bad place to start your financial education.

Physicians & Autonomics Anonymous

Dealing with a disabling addiction: A challenge for physician leaders

What would you think if I sang out of tune,

Would you stand up and walk out on me?

Lend me your ears and I'll sing you a song<

And I'll try not to sing out of key.

Somewhere in the near future we look through a one way mirror into a doctor's lounge. Scanning the the room we see a group of anxious individuals sitting in a circle.  They seem uncomfortable being here. Most look downward, trying at all costs to avoid eye contact. The one empty chair is soon filled by an energetic younger man with a clipboard.

"OK, who wants to start?"

No response. 

"Anyone?...No?...OK let's begin with Dr. Dave. Dave, start us off"

"My name is Dave and I'm an autonomic. I haven't demanded autonomy for three weeks now. It's very hard. I still have the urge to interrupt people and help them understand how their thinking process is flawed. I still find it hard to listen to people who are not as smart as I."

"Thanks, Dave. It is hard, but you're doing it. You're doing the hard work and we're proud of you.  Jim?"

"My name is Jim. I haven't demanded autonomy for three months now. The other day, I actually asked a Pharmacist for help!"

Jim is interrupted by applause and shouts of "Right on!, Great job, Jim, You da man!, Dude!"

"My name is Jack. I haven't demanded autonomy for six weeks." Yesterday, I attended a meeting with my team and complemented a nurse who came up with an idea to further reduce wound infections on our surgical floor."

The group again erupts with accolades. "Great work Jack! Way to go! Sweet!"

"My name is Kevin. This has been a very tough week. I came so close to behaving autonomously that I had to call Carl for an intervention....." Kevin begins to sob as others in the group approach and give him a group hug.

OK, not a likely scenario in the near future. But if we define addiction as a compulsive pattern of behavior that is obtained through repetition and persists despite evidence that it is harmful, then is it really a stretch to view our demand for autonomy as an addiction?

When we counsel patients with an addiction to tobacco, alcohol, or drugs, what do we recommend as the first step? We urge the patient to accept the fact that the addiction exists. Isn't it time for us to take that first step and at least recognize that as a profession we are addicted to autonomy? 

I'm not sure the number of steps involved in the Autonomics Anonymous program, but I think I know the first one.

Physician leaders need to confront their own demons with autonomy. Far too often physician leaders, because of their medical training indoctrination, are reluctant to ask for help with the skills they need to be more effective. A good coach or mentor is critical in developing effective leadership skills.

Take it from someone who has wrestled with the autonomy addiction. Ask for help. It is very uncomfortable the first time, but with practice it keeps getting easier. 

Yes I get by with a little help from my friends.

Do You Listen When You Write?

Every time you write a blog, speech, article, pitch or anything else, do you listen to your audience? 

What I mean by this is: Do you put yourself in the position of being the listener, rather than the writer?  This is one "trick" that helps tremendously when you want people to read something.  Here's why.

Many people turn to writing as a form of communication, because they have a message that they want to convey.  So, they say it in written form.  If this was done orally, it would translate into "speaking" rather than "listening", of course.  But, as a writer, you want to be thinking about your listeners (or readers).  If you were speaking, then you'd guage their response by watching attentive facial expressions (or signs of boredom). 

As a writer, you don't get this kind of feedback, so before you finish writing your piece, it's a really good idea to "listen" to it the way that a reader would.  Does it sound the way that you intend?  Does it hold your attention?  Is it the right length, the proper tone, and so on?

Some writers write and some both write and listen.  The ones that do the latter, tend to reach their intended audience better.