Physician Investing: Vacation Home Rentals - Part 1

A very interesting and often overlooked aspect of real estate investments is vacation home rental.

This unique aspect of the property market offers multiple advantages to the owner/investor.  Whether you are looking to purchase such a property or already have a property that could be utilized in this fashion, it may be something worth looking at.

First, by way of clarification, I am not referring to "classic" investment property rentals. In that scenario, you would typically employ the services of a property manager, and the tenants living in the property are there on a hopefully, long term lease basis.  Vacation home rentals are for short-term rentals only - any where from 2 days to 2 weeks (occasionally up to a few weeks).  There are two ways of handling such rentals - you can work with an on-site or off-site rental manager or you can do it yourself.

I have used a rental manager for many of our properties.  These have been in ski resort areas. The most common rental is for a weekend or a week. The manager handles all the marketing, the reservation booking as well as the cleaning and maintenance. For these services, the rental manager charges 30% to 50% of the net rental proceeds.  As compared to long-term leases, these rentals will provide a much higher nightly rental rate. If your property is in a desirable location and you are able to have good occupancy, you can frequently bring in significantly more income by nightly rentals.  For example, a condo in the ski resort of Mammoth Lakes, CA. could lease for $ 1500 per month. Nightly rentals could bring $ 300 per night! So if you want a steady source of income without having to worry about nightly occupancy, then a long-term lease is for you. If you want to try to reap higher income, then nightly rentals are worth a shot. The primary advantage of using such a rental manager is time and effort - they do all the work. The obvious disadvantage is having to give up a large portion of the proceeds.  

The last scenario is doing vacation home rentals yourself. As an example, let me tell you about our vacation rental.  We have a guest house on the spectacular Mendocino Coast of Northern California. It is part of our large ocean-view DragonMist Estate property we have for our primary residence. When are son went off to college, he in no uncertain terms informed us that he would not be a "failure to launch" candidate and would not be returning home, other than occasional respites (for some home cooking and laundry). So we took a long and hard look at our property, our expenses and most important our life style in this empty nest portion of our lies. It became obvious that there was no reason why the property couldn't start paying for itself.  So we started looking at managing our own vacation home rental. More on that in my next post.

Understanding Your Online Reputation As A Physician

By Jeffrey Segal, M.D., J.D. and Michael J. Sacopulos, J.D.

The observation that social media is experiencing explosive growth is hardly novel. Moreover, social media is significantly influencing the medical profession. 

CNN Money.com reported that Facebook passed the milestone of half a billion signed on users half a year into 2010.  The professional and legal ramifications from the rapid growth of social media touch almost every aspect of physicians practicing today.  One of the most challenging of these ramifications is a physician’s online reputation.

Pew Internet and American Life Project recently released numbers that document just how important the source of information regarding medicine and physicians the internet has become.  Sixty-one percent (61%) of American adults look on-line for health information. Forty-nine percent (49%) of Internet users report researching a specific disease or medical problem on the Internet.  Forty-seven percent (47%) report seeking information about their physician or other healthcare professionals from on-line sources. 

Finally, five percent (5%) of “E-Patients” have posted a review online of a doctor. It is these very reviews from a small subset which form the basis of a physician’s reputation on-line.

Most physicians equate a tainted online reputation with a direct loss of business.  The analysis is simple; the worse the online reputation, the fewer the patients.  There are certainly many examples to support this reasoning. 

Dr. Linda Morrison, a physician practicing in Indiana, experienced first hand the harm that arises from an online reputational attack. In July of 2000, Dr. Morrison noticed that an anonymous individual was posting defamatory statements about her via the internet. Dr. Morrison received e-mails from this individual under a pseudonym “Surfycity45” that, among other things, made threats against her medical license.  The attacks continued into the fall of 2000. Dr. Morrison ultimately learned that “Surfycity45” had been circulating defamatory comments about her while simultaneously encouraging others to do the same. “Surfycity45” worked hard to organize a cyber mob with Dr. Morrison as its target.  

Dr. Morrison, via counsel, attempted to enjoin Defendant American Online, Inc. from the continued posting of the defamatory statements about her by the anonymous subscriber.  For a variety of legal reasons, the United States Northern District Court of Indiana ruled against the injunction.  Although Dr. Morrison alleged that “Surfycity45” statements were false, defamatory, and had resulted in damage to her professional reputation as a physician, she was unable to have these remarks removed from the Internet in a timely fashion. The damage was done.  

The implications of a physician's online reputation now extends beyond patients. At least twenty seven (27) states have a recognized cause of action for negligently credentialing a physician. Given this liability, credentialing committees will likely perform detailed background checks using all available search tools, including social network sites.

It is not just patients and credentialing committees which are scrutinizing physicians’ online reputations.  In any  medical malpractice action, physicians should assume that the plaintiff’s attorney will checking the doctor’s online reputation. Geoffrey Vance, a thirty eight (38) year old partner at McDermott, Will and Emry, makes use of social networking sites to gather facts about the opposing side for trials.  “I make it a practice to use as many sources as I can to come up with and to find information about the other side” Vance said.  “We used to run Lexus Nexus; we still do that.  We always look at cases, and now we use the internet – Google, and social networking sites.”

Mr. Vance is not alone.  Paul Kiesel, a lawyer in Los Angeles County, admits to using social media not only to investigate the opposing side, but also to help select jurors.  “Last month I had fifty (50) jurors, and as the Court Clerk read out the names, I had two (2) people in the courtroom and the third person back at the office, with all three (3) of them doing research.”

Lawyers are not the only actors in a courtroom who are using social media at trial.  Courts across the country are grappling with the serious problem of “Internet-tainted” jurors.  In case after case, judges and lawyers have discovered that jurors are doing independent research via cell phone during trials.  Last year in Arkansas, a state court judge allowed a 12.6 million dollar verdict to stand even though a juror sent eight (8) messages via Twitter from his cell phone.

Physicians’ online reputations are being examined with increasing frequency at crucial moments in their professional career.  It is no longer  prudent for a physician to fail to monitor his or her online reputation. “Physicians should carefully monitor their online reputation. I have seen examples of ex-spouses, past employees, and competitors all posing as disgruntled patients in an online effort to damage a physician’s reputation. This is a real threat that is not going away,” says Rivera.

Whether physicians work through organizations such as Medical Justice or Search Engine Optimization companies or go it alone, they need to guard their online reputations. In the words of Benjamin Franklin “It takes many good deeds to build a good reputation, and only one bad one to lose it.”

About: Jeffrey Segal, MD, JD, is a neurosurgeon, is the founder and CEO of Medical Justice Services and has been a speaker at the Medical Fusion Conference.

Submit a guest post and be heard.

Toss Your Quarterly Investment Statements

Now that it’s a new year, you're about to receive your fourth quarter 2010 investment reports.

If you have a financial advisor he might send you his own quarterly report detailing your performance for the last 3 months down to the penny---every stock, mutual fund, and account he manages. Along with those reports you’ll probably get some sort of outlook for 2011 and a review of the significant events of the last 3 months of 2010.

The reports will say something like this:

“The last quarter of 2010 saw a surge in US equity markets driven by increased risk appetite by investors as they shrugged off stagnant unemployment reports and rising interest rates.”

“The bond market began to fall as investors feared rising interest rates, making short term debt relatively more attractive at current valuations.”

“Our outlook for 2011 remains cautiously optimistic. After a 20 month run up we think equities are probably overvalued and remain bearish in the near term but cautiously optimistic in the intermediate term. Therefore we recommend a more defensive stance and recommend more exposure to large blue chip stocks with stable growth such as consumer staples and healthcare industries.”

While all of that sounds impressive, what exactly do you or advisor do with that information?

How about this: ignore all of it because it’s a complete 100% waste of your time. Here’s why.

First anytime you read a review of economic events in the past quarter, those events have already happened so it’s too late to adjust your portfolio to those events. Yes, unemployment was 9%. Yes, interest rates rose. Yes, manufacturing was flat. The problem is that none of this predicts what will happen this quarter.  And even if it did, you and your financial advisor are not the only ones who know this information. None of this is a secret. Everyone else already knows. So prices have already adjusted for this information and by the time you know it, it’s too late to adjust your investment portfolio.

Second, you’ll read incredibly vague phrases like “cautiously optimistic.” What exactly does that mean? I have no idea, neither do you, and I can assure your advisor doesn’t either. But it creates the illusion of sophistication. Speaking of that, what does “near term” mean? Is it the next hour of trading, the next day, next week, next month? What about intermediate term? Investing is a LONG TERM process, so why all the talk about last quarter and the near term? But financial advisors purposefully use nebulous terms like this to make themselves look smarter than they really are. Think about it –if you don’t define exactly what these terms mean, then no matter what happens to the market or the economy, the advisor will tell you he’s right. If the market goes down, he’s right because he’s cautious. If the market goes up, he’s right because he’s optimistic.

Third, how can anyone or a group of people understand something as complex as the economy or the stock market and predict where they’re headed? The Fed can’t do it. Mutual fund managers can’t do it. How do you expect you or your financial advisor to do it?

Fourth, while last quarter’s performance was probably pretty good, there’s no predictive value for this quarter’s performance or even this year’s performance. What’s more important is figuring out your performance in relationship to meeting your future goals.

So when you receive your quarterly statements skip the economic outlook and summary. Instead focus on more meaningful things such as: do you have the portfolio that’s right for you? I’ll tackle that question soon.

Trust Between Physicians?

Is trust between physicians possible? Is it necessary? (The simple answer: Yes!)

In my coaching work with physicians I hear many anecdotes about the rivalry and distrust that exists between doctors and within healthcare teams. We all know these stories - that physicians have not been trained to trust others or delegate tasks (and in fact were often publicly reprimanded for doing so while in training), that they don’t trust nurses to do things right, that nurses don’t trust doctors to “have their back”, that physicians don’t trust each other’s intentions, credibility or capabilities, that clinical staff don’t trust hospital administration to be on their side or have the best interests of their patients at heart … and the list goes on and on.

Have we ever stopped to think of what this “deficit of trust” that exists in healthcare teams does to the core functioning of the healthcare providers or how it affects the key issues of patient safety, quality and the hospital’s or practice's economic health?

Simply stated, that there is a significant lack of trust in the healthcare environment is not new news. But what is new, is the understanding that trust is a critical component to both personal and organizational success – and that it underlies and affects the quality of every communication, every patient case, and every team effort.

But what is trust exactly? Well, simply put, trust means confidence. When you trust people, you have confidence in them, in their integrity and their abilities. When you distrust people, you are suspicious of them – of their integrity, their agenda, their capabilities or their track record. It is that simple. We have all had experiences that validate the difference between relationships that are built on trust and those that are not. These experiences clearly tell us the difference is not small; it is dramatic.

In a great book written by Stephen M.R. Covey (no, not that Covey, actually the author is the more famous Covey’s son) called “The Speed of Trust: The One Thing That Changes Everything”, these issues are explored and peeled away to their core. And wow, does it all begin to make sense.

The Economics of Trust 

One of the biggest “ah-ha’s” that come from this book is about what trust – or a lack of trust – does to any organization’s bottom-line. It is the most simple concept, and as Covey puts it:

"Here is a simple formula that will enable you to take trust from an intangible and unquantifiable variable to an indispensable factor that is both tangible and quantifiable. This formula is based on this critical insight: Trust always affects two outcomes – speed and cost:

• When trust goes DOWN, speed will also go down, and costs will go up
• When trust goes UP, speed will also go up, and costs will go down

 It’s that simple, that real, that predictable."

Think about healthcare environments, organizations or teams that you’ve worked in that may have had non-existent or low trust – do any of these “typical” workings sound familiar?:

• Militant stakeholders
• Micromanagement and redundant hierarchies
• Punishing systems and structures
• Initiatives that drag
• Many unhappy employees
• Intense politics with clear camps and parties
• Excessive time wasted defending positions and decisions
• Common “CYA” (cover your ass) behaviors

What about the alternative? If any of you have had the luck to be part of healthcare organizations or groups that have a healthy- to high-trust environment, you may have experienced:

• A healthy workplace with good communication
• Aligned systems and structures
• A focus on work (not politics / rumors / grievances!)
• Effective collaboration and execution
• Positive partnering relationships
• Strong creativity and innovation
• Positive, transparent relationships
• Strong engagement, confidence and loyalty

The way Covey puts it, in organizations where trust is high, you see material improvements in things such as communication, collaboration, execution, innovation, engagement, partnering, and relationships between stakeholders.  

You also see the “dividends” of increased speed, collaboration, and improved economics. This translates into improved patient safety, quality, and clinical outcomes - a win-win-win for the healthcare team, the organization,  and most importantly, the patients and their families.

Trust Changes Everything

But it is not just organizations that suffer the results from a lack of trust – you personally can suffer too. Physicians are well-known for generally not trusting each other or members of the healthcare team – if this is true, or even “rings a bell” for you, I want you to think about how this might be affecting your performance and overall happiness on a daily basis.  Let’s make it real – from Covey:

"Think of a person with whom you have a high-trust relationship – could be a spouse, friend, child, sibling, or colleague – and describe this relationship. What’s it like? How does it feel? How well do you communicate? How quickly can you get things done? How much do you enjoy this relationship?

… Now think of a person with whom you have a low-trust relationship – could be a colleague, boss, family member – and describe this relationship. What’s it like? How does it feel? How is the communication? Does it flow freely and quickly … or do you feel like you’re constantly walking on land-mines and being misunderstood? Do you work together to get things done quickly, or does it take a disproportionate amount of time and energy to finally reach agreement and execution? Do you enjoy this relationship… or do you find it tedious, cumbersome and draining?

The difference between a high- and low-trust relationship is palpable!

Can you imagine the difference it would make if you were able to increase the amount of trust in the most important personal and professional relationships in your life?"

Said another way, what would developing your “trust quotient” do for you, for your patients, for your team, for your career growth, and for your overall happiness?

There are excellent tools in Covey’s book for improving your own personal “trust competency” and enhancing the working relationships that affect your overall professional fulfillment.  Next time I will share what some of those tools are, and how some of my physician clients have embraced them to improve their success in both the clinical and non-clinical environments.

Until then, I highly recommend you go and pick up the book - it's a great read!

As A Physician, Can You Work For Someone Else?

How important is our autonomy as physicians?

Have you ever wondered how difficult it might be to work for someone else, when we're wired and trained to value our autonomy as one of the perks of being a physician?  Many physicians making a transition from clinical practice struggle with the impact of losing autonomy in their decisions and actions.  Here are some observations from my experiences that might help you as you contemplate making some changes in your life and career.

First, recognize that your biggest challenge as a physician in moving to working for Wall Street, a pharmaceutical firm, a start up company, an insurer, or just about any job that doesn't require you to be in direct patient care, will be adapting to your role in a heirarchy. Most physicians at ACPE cite this transition as their most difficult. After some awkward moments in making the transition, we all learn what we were never taught in our medical training!

To give up absolute autonomy doesn't mean that your input isn't important.  It's just one piece of input among many others. Good group process and good decisions requires multiple viewpoints, disagreement, and vigorous discussion. Physicians trained in the military, who are familiar with leadership principles, say the first step to good leadership is to understand "good followership".  Sometimes we're members of a team, other times we're asked to lead a team.  You've got to understand both roles.

Second, recognize that a good boss doesn't necessarily have anything to do with being a physician.  One of my top two bosses over the past twenty years was an insurance executive.  Chain smoker, equally comfortable in a plaid sports coat or a pin stripe suit, he was one of the most ethical, honest, and exciting people I've ever worked with. 

We disagreed frequently on issues, but I supported him when his actions made physicians upset because he never crossed an ethical boundary, and his intentions were good.  For example, one day he said he wanted to notify all physicians on our networks that their physician-owned malpractice company was going broke.  I told him the physician leaders of the company, who were also key figures in the medical society, would be furious.  As an insurance executive he felt obligated to notify the malpractice carrier's insureds that they could be left high and dry.  He asked for my support when the physician leaders reacted.  I gave him my support, and was there when they had that contentious face to face conversation in his office.  And the malpractice carrier did become insolvement about 9 months later.

In contrast, some of the worst bosses I've ever had were physicians. Maybe they turned out that way because they were so focused on themselves, and their autonomy? Conversely, maybe I didn't understand good followership? Whichever it was, it wasn't good for any of us.  

Third, keep your "physicianhood" in perspective. Though we're all very proud and honored to be part of our profession, other people and professionals are also proud of their hard work and commitment to their occupation or calling. Think of your training as a physician as the foundation for whatever else you want to do in life. If, because you're a physician, you think and act superior to others in business, art, publishing, or at the machine shop, you'll have a hard time working for someone else. 

Our "tribe" - physicians - makes it hard for us to venture in different directions from our clinical care training. We have to be aware of that, but be determined to listen to the pull of other non-clinical interests that are attracting us to new ventures. By exploring the issue of autonomy, and seeking to behave differently from our training, the path will become much clearer.

How Truthful Does Your Memoir Have to Be?

The thin line between fact and fiction.

When James Frey published his memoir, A Million Little Pieces, he was all the rage. Oprah chose this for her book club, and it sold nearly 2 million copies in 2005.  Then, Frey was "outed." His book became known as A Million Little Lies. What happened?

Frey made the critical mistake of writing things that weren't true AND could be documented as lies.  Don't all memoirs contain some "untruths"?  Probably.  A memoir is a snapshot of someone's life.  A period of time that they document from memory.  Since we all have imperfect memories, it stands to reason that any book written purely from memory would contain some erroneous information. 

That's expected and appropriate, if it's not intentional and documentable.  If you say you've been in the military, but the military has no record of this and no one recalls your having been a soldier, then you're in trouble. If you say that your family drove across the United States in a blue car, but it was really tan, well, that's a reasonable mistake. It would be pretty hard to "forget" that you weren't in the military and fairly easy to document this  On the other hand, it's much easier to forget the color of a car that you took a trip in many years ago, and that would be harder to document.  Readers would expect and forgive an inaccuracy such as the latter one. 

However, as Frey and many others have found out, they don't forgive it when authors lie.  The Smoking Gun investigated and found many documentable inaccuracies in Frey's book--related to police reports, court records and interviews with law enforcement officials.  Frey lied.  He lied to his readers--among them, Oprah.  Oprah never forgave Frey. 

Perhaps unsurprisingly, Frey now writes fiction. 

So, how truthful does your memoir have to be? As truthful as you can make it when you write from memory.  But, keep in mind one thing: if a reporter can check something out and document it, you'd better do that yourself before you ever commit it to paper and call it nonfiction. 

Harvard Writers: March 31 - April 2, 2011

For physicians wanting to learn to write and publish, the Harvard Writers course is the best place to begin.

For physicians wanting challenging and fun new career opportunities, there is no better way than to write and publish--from blogs to books, the opportunities are endless.  There is no better way to jump-start or advance your publishing objectives than the CME course offered by Harvard Medical School titled "Publishing Books Memoirs and Other Creative Nonfiction."

I've been directing national medical conferences for the past five years. Because of my involvement in the medical conference industry, I have reviewed many, many courses and spoken to numerous people about the ones that they've found the most helpful and enjoyable.  The Harvard publishing course is at the top of the list for both criteria.

The truth about medical conferences is that most are, at best, mediocre and some are simply a waste of time. There's really no reason to travel to another city, pay hundreds of dollars, and review the same, mundane material you could easily obtain online.

Because I'm a physician who designs medical conferences and not simply a business person marketing a product to physicians, I look at the medical conference industry with the eyes of a consumer. I like learning about excellent courses, because I want to know where the best teaching is taking place--not only as a conference organizer but also as a potential participant.

A couple of years ago a colleague brought to my attention the Harvard publishing course. I was skeptical at first, but as I learned more about the event I became more and more excited about it. Here was an event that allowed physicians to meet other physicians who had authored books, submit manuscripts to editors, and connect with literary agents.

I was impressed.

When my team and I were organizing the first Medical Fusion Conference in 2009, one of the first people I recruited for the course was Dr. Julie Silver, director of the Harvard publishing course and Chief Editor of Books at Harvard Health Publications. Dr. Silver is a very inspiring person-- a faculty member at Harvard Medical School and an award-winning author. As a physiatrist, her clinical and research work focuses on healing from serious injuries and illnesses (www.JulieSilverMD.com).  Dr. Silver is also a cancer survivor who is creating a "best practices" model for hospitals and cancer centers to implement survivorship services that include cancer rehab (www.OncRehab.com).

My hope for our Medical Fusion Conference was that Dr. Silver could give some basic tips on writing to our audience and maybe a few pointers about opportunities in the publishing world.

What took place at that first Medical Fusion Conference, however, totally blew me away.

Dr. Silver gave two lectures that year, both of which were two of the most highly rated talks ever at our Medical Fusion Conferences. Her speaking style was very easy to follow and she communicated a tremendous amount of quality information in her two hours at the podium. Many in our audience commented on their evaluation forms that she was their favorite faculty member that year and felt that she was one of the best presenters they had ever heard at a medical conference.

Dr. Silver is still one of our most requested faculty members at our Medical Fusion events (and we're excited to say that she's coming back for our 2011 Medical Fusion Event this November).

If you browse through our Freelance MD archives, you'll find blogs by many of the successful physican-authors who attended the Harvard publishing course:

 -Dr. Richard C. Senelick attended the course and is now blogging on The Huffington Post

 -Dr. Jon Wolston credits the course as a catalyst for helping further his writing as a poet

 -Dr. Victoria McEvoy partnered with a professional writer through the course and published The 24/7 Baby Doctor

 -Dr. Yvonne Thornton attended the course and is now a best-selling author of multiple books

If you're a physician who's been interested in writing on any level, the Harvard publishing course is a great place to start, and as this list demonstrates, they've had more than a few success stories.  In fact, Dr. Silver highlights Success Stories every year at the course, and these range from past attendees who have published op-ed pieces in major newspapers, now blog on heavily trafficked websites, published books, been interviewed by Oprah, received a job promotion, landed an unexpected consulting opportunity, become a highly requested speaker, and many other exciting new opportunities--made possible by the content and connections from the course.

So go ahead...

Check out the Harvard Writers website. Read through the list of former attendees who are now published authors. Allow yourself to dream a little, but put feet to those dreams and attend the course in March.

There are few courses that will provide you as much quality information in as short a time, and with a little nudge like this, exciting new career opportunities will become a reality.