The Doctor is in...the Cage?

Family Physician and Professional Mixed Martial Artist, Dr. Seth Kleinbeck.

Okay, so you're frustrated with your medical practice.  You need a hobby to blow off some steam and maybe make a few bucks on the side.  You're considering moonlighting in another career just to see how it would go.  Not sure what you want to do exactly but open to ideas?  

How about cage fighting?

Dr. Seth Kleinbeck is a Family Medicine physician in Arkansas who also is a professional mixed martial artist.

Interestingly, as a native Arkansan and a student of Brazilian Jiu Jitsu (BJJ), I heard about Dr. Kleinbeck a few years ago when I visited a Little Rock BJJ school and heard stories about a local doctor who "punched as hard as anyone we've ever seen."  

From what I can tell, Dr. Kleinbeck fought in a variety of smaller shows before being signed by the now defunct EliteXC to a six fight professional contract.  According to fight reports on mixed martial arts (MMA) websites, Dr. Kleinbeck has an 8-4 professional record and last fought in late 2007.

No word as to whether the good doctor has retired from fighting or just looking for another venue.  If we hear anything, we'll let you know.  

One thing's for sure: the guy's no joke. Here's a highlight video of some of his fights.

Why Does Leadership Appear?

Leaders emerge for three reasons.

Carl Larson, Professor Emeritus of Communications Studies at the University of Denver, has spent his professional life trying to understand leadership. organizational behavior and team performance. In his book "Teamwork", co-authored by Frank LaFasto, they describe the characteristics of efffective teams:

• A clear, elevating goal
• A results-driven structure
• Competent team members
• Unified commitment
• A collaborative climate
• Standards of excellence
• External support and recognition
• Principled leadership

Not surprisingly, it almost always comes down to leadership.

I recently had the opportunity to hear Prof. Larson talk about the origins of leadership. As he pointed out, most scholars look at the performance characteristics and personalities of leaders at a given point in time, usually during a crisis or at a time of great challenge, for example, Roosevelt and Churchill during the war, Guiliani during 9/11 or Jack Welsh during the haydays of GE. Prof Larson's approach, however, was to try to identify the sources of leadership and how it evolves. He concluded, after studying 30 highly successful leaders in the not-for-profit world, that there were three patterns that emerge at a very early age.

The first was a critical inciting event. One social entrepreneur witnessed the shooting death of both his parents and went on to create a foundation for orphans. Another saw homeless children in India while a pre-teen and created a charity to feed hungry children. A third was left fatherless as a result of a war and originated a organization supporting the children of veterans.

The second pattern was evidenced by those leader entrepreneurs who felt such passion and empathy for a cause, that they literally could not do anything else other than help. Think Tom's shoes.

Finally, some leaders had the good fortune to have models or examples of leadership at home, school or community and were able to replicate it.

Research on predictive entrepreneurial success factors indicates that the one best test is how young someone was when they created their first company. Likewise, Larson's research reminds us that leadership traits appear at a very young age.

Dr. Thomas Fogarty: Surgeon, Inventor, Entrepreneur

I wanted to write a quick blog about a medical hero of mine: Dr. Thomas Fogarty.

I have never met Dr. Fogarty, but one day I'd like to have the opportunity.  Dr. Fogarty is a former Professor of Surgery in the Stanford University Medical Center.  He has published over 170 scientific articles but is most famous for his medical inventions.  He currently holds 63 surgical instrumentation patents, has founded or co-founded over 30 startup companies, helped begin a venture capital firm, has won numerous awards, and is the founder of the Fogarty Institute for Innovation .

His other claim to fame is his vineyard.  The Thomas Fogarty Winery and Vineyard is located in the San Francisco region and produces an array of fine wines.

Dr. Fogarty is an example of a physician who began as a clinician, branched out into an alternative area of medicine, and then went on into a non-medical venture.  The purpose of the Medical Fusion conference is to teach physicians how to make these career transitions, and there are few better examples of this progression than Dr. Fogarty.

2011 Tax Law Changes Every Physician Needs To Know

The tax laws are changing in 2011. Here's how that will apply to you as a physician.

Recently I sent the following information to my clients regarding the 2011 tax law changes which are almost a done deal. Hope this helps you

You may have heard that a deal for 2011 tax laws is almost a done deal. I'd like to point out several things which will apply to you.

1. Federal income tax rates

Will remain the same as they are now for 2011 and 2012. However, we don't know what the cutoffs for the tax brackets are yet. It's unclear whether phaseouts for deductions on Schedule A of your income tax return will remain as is or will get worse next year. It looks like they will remain the same as now for the next 2 years. Obviously this is good news for high income taxpayers such as all of you.

2. Dividend and capital gains tax rates

Before this deal dividends in taxable accounts were going to be taxed at your highest rate, which was going to be 39.6% as of next month. However even the current dividend tax rate of 15% will stay on for 2 more year. This is also true for capital gains taxes, which were supposed to go up to 20% and instead will remain at 15% for 2 more years. If you have a taxable investment account, this will make it easier for me to rebalance portfolios since the cap gains rate will remain low.

3. Roth IRA conversions

I've already discussed and converted several of your traditional IRAs to Roth IRAs already this year. If you have not converted your traditional IRA to a Roth yet but are considering it, you may be OK doing it next year in order to defer paying taxes on the conversion. However, realize that by converting this year there is an option to spread out the income over 2011 and 2012 and that option is good ONLY for converting in 2010.

The other issue is that for those of you whom we've converted in 2010 already, it is probably more advantageous for you to spread out the income over 2011 and 2012 since tax rates will remain the same. Please discuss this option with your CPA when tax time comes. In other words instead of reporting the income on the conversion for 2010 only (this would be more advantageous if tax rates are going up next year) you may be better off reporting it in 2011 and 2012 in order to defer taxes to those years.

That brings up another issue—estimated tax payments. If your CPA plans on reporting this all in 2010, then adjust your 2010 Q4 estimated tax payment. However, if the plan is to split the income from the conversion in 2011 and 2012, then there may not be a need to adjust your Q4 estimated tax. Instead, you will have to adjust estimated taxes for 2011 and 2012.

And finally if you have nondeductible IRA contributions, remember that portion is not taxed on the conversion.

4. Estate tax

It looks like the estate tax exemption will be $5 million for 2011 and 2012. This changes things like whether to set up life insurance trusts. However, realize that this is once again a temporary rule and eventually this will change again in 2 years. So it may still be better to proactively address these issues rather than to address them later. But at least this might buy some more time.

5. Medicare investment tax is coming

For taxable investment accounts starting in 2013 there will be an additional Medicare investment tax on investments sold for a gain in addition to capital gains tax. This tax will be 3.8% on "high income" earners and will apply to both capital gains and dividends. This was part of the health care law passed earlier this year. Of course the details on this still have to be worked out.

Hope that helps put some of this in perspective. If you have any questions about this, please ask them as a comment and I'll do my best to answer them.

Physician Wealth Protection: The First Component of Wealth Management

As physicians we are fiduciaries to our patients—we put the patient’s interests first before our own.

Part of that fiduciary duty involves determining the risk-benefit ratio of any treatment, whether it’s prescribing a drug or performing a procedure. We generally won’t use a particular treatment if the risks involved are far higher than the potential benefits.

A great example of this is the use of thrombolytics in acute ischemic stroke. Giving thrombolytics to patients more than a few hours after the onset of stroke symptoms tends to tilt the risk-benefit equation more toward risk (higher rates of hemorrhage) so we generally avoid it altogether. It’s still even debatable whether we should use them at all.

This is the same approach you should use in your comprehensive financial plan.

While most physicians think of financial planning as investing, the reality is that investing is only one component of a comprehensive financial plan. It’s actually down on the list of priorities and should not be addressed at all until you’ve protected what you already have.

Your financial plan should address three broad areas of your financial life: wealth protection, wealth enhancement, and wealth transfer.

After determining your financial goals, wealth protection comes first. This involves two parts: protecting your assets, and buying appropriate insurance to transfer potentially catastrophic risks.

Proper wealth protection involves addressing and answering all of the following questions:

1.   Do I have enough liquidity (cash) to meet potentially unexpected cash requirements?

2.   What activities in my personal and professional lives expose me to risk?

3.   What risks can I eliminate altogether?

4.   What types and amount of risk am I willing to accept?

5.   What types and amount of risks am I not willing to accept?

6.   What types and amount of risks must I accept but which I can tranfer to someone else?

7.   What will happen to myself, my family, and my retirement if I become disabled?

8.   How much disability insurance do I need and what type of policy is appropriate for me?

9.   What will happen to my family if I die suddenly?

10. How much life insurance do I need and what type of policy do I need?

11. Will my family be able to take care of me if I require long term medical care?

12. Do I need long term care insurance and if so what type of policy do I need?

13. How much dwelling coverage do I need in my homeowners policy?

14. Do I have adequate personal liability protection from my homeowners and auto insurance policies?

15. Do I need umbrella insurance and if so how much and what type of policy?

16. Am I adequately shielded from potential creditors?

17. What types of investment accounts and trusts can provide asset protection?

While this is only a partial list, you’ve got to have appropriate wealth protection techniques in place first before thinking about enhancing your wealth.

Bottom Line: First do no harm.

The Physician Entrepreneurs Five Minute Business Plan

The executive summary is the Cliff’s Notes of your business

One of my favorite Saturday Night Live sketches was Father Guido Sarducci’s Five Minute University. The idea was that a 16 week college course could be reduced to one thought in five minutes, like economics is basically the law of supply and demand. To pass the test all you had to do was attend the right class for five minutes.

When you need money for your business, investors will initially want to see an executive summary of your business plan. Nothing elaborate or fancy, pruned of jargon and business buzz-speak, the executive summary is like a Cliff’s notes of your business, quickly identifying the highlights to help them determine whether, in five minutes, your idea is worth a further look.

Here’s an example of what is should look like in PDF form so it can be sent to your favorite smart money source.

OVERVIEW

Our Awesome Company (OAC) is a medical device company with a revolutionary patent pending technology to treat bad breadth.. Our goal is to be the market leader in providing minimally invasive treatments that address the root cause of bad breadth. In 2010, OAC successfully completed its initial human proof of concept study outside the US. OAC is seeking a $500,000 bridge fund right now and  $3 million in funding to perform a Pilot clinical study at a US site beginning in early 2011. An additional $10 million will be required for a Pivotal study in Q4 2011. FDA approval is expected in late 2012. The Company anticipates financial exit via acquisition.

BAD BREATH

Bad breath has multiple causes including gastroesophageal reflux disease, sinus infections and chronic infections of the tonsils and adenoids. The most common cause is gingivitis and bacterial impregnation at the base of the tongue. Treatments to date, including turning your head to the side, oral breath mints and putting your hand over your mouth have proved ineffective over the long term.

MARKET

The current market for bad breath/halitosis products is $6+ billion worldwide. Market growth rate is estimated at 20% per year due to demographic factors , growing awareness of the condition and increasing intolerance of members of the opposite sex. The current standard of treatment for patients are insults, denigraton and criticism.. The current treatment  consists of an air pump and mask that the patient wears while in contact with humans.. The compliance rate for this treatment is less than 50%. The National Institutes of Health has stated that bad breath is a major public health problem and is associated with other chronic diseases like excessive nerdiness, depression and withdrawal..

TECHNOLOGY

Our product, BetterBreath,  is an implanted device inserted into the tongue by a single needle injection under local anesthesia. Once implanted, the device emits a remotely controlled plume of breath freshener into the mouth.  The entire procedure takes 2 to 5 minutes and can be performed in a doctor’s office. The device can be easily adjusted or totally removed in 1 minute without the need for anesthesia. Extensive preclinical and initial human studies show efficacy with excellent safety and patient comfort.

INTELLECTUAL PROPERTY

OAC/BetterBreath’s initial patent application has been filed in the United States, the European Union, Japan, and other important markets. Two other patent applications are also pending.

FDA PATHWAY

Intraoral devices for treatment of halitosis are considered  predicate devices with a 510(k) regulatory approval process.

FINANCIALS

Management is seeking $500,000 in bridge financing to prepare for pilot clinical studies in the US;  $3 million to fund Pilot study clinical trials beginning in early 2010, and an additional $10 million is budgeted for Pivotal study trials leading to FDA approval in late 2012.

TEAM

Bob Dragonbreath is the Chief Executive Officer of OAC. He has 20+ years of product development experience focused in minimally invasive implantable medical devices at Johnson and Johnson, Cordis, and C.R. Bard. He has 10 issued patents and several more submitted. He has lead small and large teams in the areas of concept development, product design, clinically relevant testing, and product commercialization.

I.M. Lookingforanotherjob, M.D.DDS, is founder and currently Chief Medical Officer. Dr. Lookingforantoherjob is a leading authority on the anatomy of the human upper airway as well as a board certified Otolaryngologist and Dentist with 20 years experience in treating patients with really bad breath. He was a faculty member in the Departments of Otolaryngology at Harvard, Cambridge and Oxford for 17 years. During that time he was Principal Investigator on 5 NIH grants researching unique aspects of the human upper airway. He has published over 50 articles in medical journals and received 15 major research awards.

INVESTORS

Big Deal Ventures LLC, a New York-based venture fund, invested $3.5 million in early 2007 to fund product development and the first-in-man trial.

In the words of Father Sarducci, ''There were actually more than ten, but Moses was old and grumpy, and after he broke the tablets he could only remember the negative ones. "Don't do this. Don't do that." The truth is, most of them were more like advice. The Twelfth Commandment, for example, was "Whistle while you work." (People think its from Disney, but Disney stole it from God.)" Even Moses needed to keep it short.

Begin a Career in Wilderness Medicine: Dr. Eric Johnson

I sat down with Dr. Eric Johnson at our Expedition Medicine National Conference to ask him about his career in Wilderness Medicine.  

Dr. Johnson is a past president of the Wilderness Medical Society and has twice served as a physician at the Everest Base Camp Clinic.  In this interview, Dr. Johnson discusses his involvement in Wilderness Medicine, how individuals can get involved in Wilderness Medicine, and then gives his thoughts on our Medical Fusion Conference.