Physician Income?

By Mehul Sheth DO

When giving talks on personal finance to medical students and residents I see that 'look' in the eyes of my audience.

It’s a look that says “you can make it sound easy, but that’s because you’ve written articles and given talks about it.”  This is despite my introduction specifically mentioning that I was naive about money and investing prior to starting medical school.  I was incredibly fortunate to grow up in a family that followed the tradition of supporting kids in their education, allowing me to focus on my academics.  I did have a number of jobs growing up, including working three part time jobs in college at once, but no one except me relied on that income-unlike now, when my wife and three kids depend on my job to pay off our bills.  I was naïve enough about money that I believed the prevailing thought during medical school to not worry about the hundreds of thousands of dollars of debt we were accumulating-we were going to be doctors after all!

This laissez faire attitude gave way to anger.  During medical school and residency I couldn’t help but look around at those treating us so nicely with some distrust.  Why is a financial advisor so excited to buy me lunch?  Why are physician recruiters so interested in helping me find the right job?  Why are banks willing to give me a 100% loan based on an employment contract and not actual pay as most of America now has to?  The answers to these questions were what made me so mad-that physicians are easy to take advantage of.  I have a number of friends in the world of finance and when I talked to them they told me what I already suspected-docs are easy targets.  We have that rare combination of high-end, steady income and low interest or knowledge on matters of money.  Because of this there are a lot of folks who would like to help make our lives easier by taking a slice of our income.  A great parallel is the band TLC from the 90's.  Despite being quite succesful, they filed for bankruptcy, partly based on the fact that there were too many people taking too many pieces of that pie.

So I decided to see if personal finance was really that difficult to figure out.  The financial advisors had come in talking about 401(k)’s and Roth IRA’s and tax implications, making it sound daunting enough that I didn’t even want to look into it.  What I learned was incredibly surprising-with a little bit of interest and about 1 hour a month you can learn everything you need to know about personal finance.  I was lucky enough to start during residency and with that little bit of time commitment I have handled all my personal finances without the help of an accountant, financial advisor, or tax-man.

The key is that when you are in residency you don’t have much money coming in.  Which also means that there’s not much to do-setting up a Roth IRA is about it.  I used those years to learn about the Roth and filing my own taxes-much easier than you think.  As my family expanded and my investments diversified, I spent about 2 hours a month on average keeping up with all of it.  I now manage our daily finances, 4 retirement accounts, 2 investment properties, 3 kids college funds, a full time job and a number of consulting jobs with income-all without outside help.  And the beauty is that you can also.

Where I started is more and more surprising as I get more into personal finance-Suze Orman!  As a relatively more sophisticated investor now, I find some of her advice appalling, but she was the perfect fit as I was getting my feet wet.  I used her book-Suze Orman’s Financial Guidebook-to walk me through some of the basics of personal finance. It was incredibly simple and with those small pieces of success my confidence built.  There are hundreds of great authors on finance-Robert Kiyosaki, Benjamin Graham come to mind-but Suze does an amazing job of giving black and white answers when you are just starting out.

If you find that there are too many cooks in the kitchen, then pick up Suze Orman’s Workbook and take back some of that control.

About: Mehul Sheth DO is a physician executive with Allscripts and career coach. His expertise is at the intersection of medicine, technology and social media, having used Twitter, Facebook, and LinkedIn to effectively engage with a wide variety of nonclinical jobs and opportunities. Dr. Sheth is accessable via his LinkedIn profile and his blog at http://techpedsdoc.wordpress.com

Submit a guest post and be heard

Adding A Nutriceutical Pharmacy To A Medical Practice: Part 2

Part 1 of this article briefly discussed the concept of adding a nutriceutical pharmacy to a medical practice.

Besides helping the health of your patients, it is not unusual for a physician with a moderate size practice to be able to increase yearly profits by $100,000-$200,000 by adding an efficiently run nutriceutical pharmacy.

Here are questions I typically receive from physicians about nutriceutical pharmacies along with my answers:

Q-“I was taught that taking vitamins and minerals just give you expensive urine. Can’t we get all the nutrients we need from food?”

A-Every nerve, muscle, bone, organ, gland, cell and all bodily fluids in the human body are entirely formed from nutrients. Every metabolic pathway (i.e. citric acid cycle, urea cycle, Phase I and 2 liver detoxification, etc.) is formed from nutrients and dependent upon nutrient co-factors to keep functioning. All tissues need a continual supply of high quality nutrients to function because many nutrients are used up and are not recycled. Mitochondria require a constant supply of thiamin, riboflavin, niacin, pantothenic acid, pyridoxal-5-phosphate, alpha lipoic acid, and coenzyme Q10 in order to convert a one molecule of acetyl CoA into 38 units of ATP.

The Standard American Diet (SAD!) is junk food laden and horribly deficient in the nutrients that help our bodies function optimally. In fact these junk foods actually increase the need for specific nutritional supplements like chromium, vanadium and certain B vitamins.  Because of poor farming practices many fruits and vegetables contain only half the nutrients they contained in the 1950s.

Q-“I’m considering this but are their really any good studies about the efficacy of nutritional therapies?”

A-Yes. There is now a very large body of well-designed studies showing the efficacy of specific nutrients for specific health problems. In fact, these studies are much less biased than the ‘junk science’ that many pharmaceutical pay for to sell their products.

Q-“Isn’t selling nutrients out of my own office a ‘conflict of interest’?”

A-That is your individual choice but consider this: Pharmaceutical companies pay for their own studies and will often suppress findings that show ineffectiveness and even dangers of their drugs. That is a major conflict of interest!

So is providing your patients with professional grade, much needed Vitamin D3 and you making a profit instead of the health food store a conflict of interest for you? Especially when you can provide them with a more absorbable form with certificates of analysis proving the product actually contains the dosage claimed and is free from toxicity?

Q-“ I’m not sure my state board will allow me to dispense and sell nutrients out of my own office.”

A-Often their is no specific published ruling about this so many physicians just choose to do what’s best for their patients. If your board specifically prohibits you from selling nutrients from your office, form a coalition of like-minded physicians and keep bringing your board research to establish you are providing your patients scientifically researched nutritional therapy.

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 dr.dean.raffelock@gmail.com

Submit a guest post and be heard.

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. 

Submit a guest post and be heard.

Transitioning From Residency To Clinical Practice

By Dr. Thuc Huynh

In 74 days, thousands of residents will be graduating residency; I being one of them.

For me, it’s been 13 years since beginning college and finishing as a family practice physician. For others in surgical residencies or other fellowships, their road has been much longer. As our days of leaning on our attendings come to an end, it’s now time for us to transition to our new role and acquire a greater deal of responsibility. Now, it’s time for us to be the attendings that others rely on. Are you ready?

Take a break

Before you dive into this newfound responsibility. Take a break. We’ve been at it for years; this grind of education. If you think about it, there are very few times in our life that we will be able to take a long break. It’s a trend that with every major task completed, there has always been a nice break for me. I took 2 months off after high school before college, 2 months off before medical school, and 2 months before residency. So it’s only natural that I take 2 months off before starting my next adventure. With every break, I’ve used the time to recuperate from the toils of the recently completed task and re-energize for the future. It works. Take a break after residency. Do what you’ve always wanted to do but couldn’t because of all those 30 hour calls. You’ll enter your next job with a brighter outlook and well rested.

Get into the groove

Let’s face it. We’re going to be slow with productivity at the start. It’s okay. Our bosses know that we have no clue about their system, paperwork, and sometimes not even their geographical area. As we get used to our new surroundings, we’ll get faster. In addition, most jobs will start you off with fewer patients because they anticipate we’ll be slower. Eventually, they’ll add more patients to your schedule. Become familiar with the available resources at your disposal. Look online, ask your nurses, ask your colleagues.

Don’t be afraid to ask

We’re not expected to know everything. Just because we’ve graduated residency, it doesn’t mean we’re now know-it-alls. Don’t be afraid to ask your partners for their opinions on cases. They have years of experience and are a valuable resource. I’ve already let my current attendings know that I’ll be calling them from time to time over my career.

Don’t stop learning

This one goes with the topic right above. If you don’t know something, improve yourself. A career in medicine essentially means you’ll be learning for life. New guidelines and breakthroughs in medicine require us to stay updated in order to practice the best standards of care for our patients. Get involved with CME classes, conferences, or credits online.

Finally, don’t burn yourself out We’ll be in this business for years, whether it’s practicing medicine or moving into nonclinical roles. To avoid burnout, remember to take a break. Not a 2 month break like we talked about before; but a mini-break. Use up those vacation days. Engage yourself in hobbies like joining a book club or work on your garden. For me, I enjoy working on my websites and actively engaging in social media. Do anything that will take your mind off of medicine for a while so you can rest and re-energize.

Keep in mind these simple principles as you transition from residency to clinical practice. I wish all of us a rewarding and successful career. Congratulations Class of 2011!

About: Dr. Thuc Huynh is a family practice physician and physician technologist. Her main interest lies around how medicine can play a role with web 2.0 and social media. Dr. Huynh is currently Chief Resident at her Family Medicine Residency in Rapid City, SD and CEO of ScrubdIN, a startup company that aims to help health professionals and e-patients choose their next medical app. She blogs at http://thuchuynh.com

Submit a guest post and be heard.

The Nocebo Effect

There is an everyday  occurrence in modern clinical  psychiatry that is seldom discussed, poorly understood and constantly overlooked in daily practice.

It has a myriad of clinical, social and psychological consequences. It facilitates the bashing  of the pharmaceutical industry and modern psychiatry, it promotes the so prevalent negative stigma towards mental illness. The treatment for it is usually meaningful psychotherapy, but most therapists don’t know much about it, and many have never even heard of the concept. The phenomenon is present in just about every specialty in medicine, with the exception of maybe pathology or diagnostic radiology. Ironically it drives up the cost of health care, increases the practice of defensive, if not paranoid medicine, and sends us into a quandary when trying to help our patients. It leads us on quests and safaris to find a treatment, any treatment that will be beneficial, and somewhere along the lines we end up working a lot harder than the patient, to try to help and improve the patient’s well-being. Working and trying harder than the patient, is a political powder-keg and a taboo and unacceptable thing for doctors to admit on the internet or anywhere else. Yet at least in psychiatry it can be quite diagnostic of the phenomenon.

Click to read more ...

Adherence Challenges For Physicians & Patients

One of the great challenges physicians face is getting patients to take their medications properly and on a regular, continuing basis.  

All too often, patients skip doses, take drug holidays, discontinue treatment early, or even fail to initiate a recommended course of treatment.  These issues are particularly problematic in the treatment of chronic diseases, leading to treatment failure and to frustration for both patients and their doctors.

Oddly, Nobel prize-winning work on microlending may provide a window on how to enhance patients’ adherence to treatment (http://www.tocatchadollar.com).  Microlending—giving poor people tiny loans to start small businesses—has been extremely effective at helping poor women achieve a greater degree of self-sufficiency.  Compliance with loan repayment has been extraordinarily high.  In theory, these programs are supposed to work because people need money in order to make money.  Perhaps far more important to the success of these programs, however, is the support system that complements the loan.

Successful microlending programs have borrowers organized into small teams that meet once a week, reporting what was purchased with the loan and what is being done to sell product in the business.  Each week, borrowers are expected to make a small re-payment toward the loan and to set aside a small amount in their savings account.  If borrowers miss meetings or are otherwise unable to meet the requirements of their borrowing contract, they suffer the social pressure of their team.

These weekly visits are powerful motivators that drive loan repayment compliance.  The visits foster the discipline and provide the social support needed for spending and selling behaviors that result in business success.  Without this discipline and support, it is unlikely that just giving the borrowers a bolus of money would result in a high level of successful business outcomes.

Too often in medical practice, prescriptions of medication are handed to patients without the support needed to get patients to use their medications regularly.  While research studies may have weekly visits to record changes in disease severity—visits that drive patients’ adherence behavior—in clinical practice, medications may be given with no follow up scheduled for months, perhaps without any planned follow up.  Expecting patients to use their medications successfully under those conditions would be like expecting borrowers to use the loan wisely without timely follow up.

Like the weekly visits in the microlending program, office visits with physicians are a powerful social motivator for patients to adhere to their doctors’ recommendations.  I’m not entirely sure why, but the phenomenon is powerful and ubiquitous, explaining why people floss their teeth right before visits to the dentist, why they practice piano just before the lessons, why medications work better in drug studies than they do in real life practice, and why so, so many patients report, “Doctor, you always catch it on a good day.”

Weekly visits to a physician may not be practical or efficient.  But one follow up visit or phone call contact shortly after initiating treatment may be enough to encourage more patients to fill and start their prescriptions.  If patients do use their medication well at first, they may develop the habit of using medication, resulting in a long-term pattern of regular use.  That would be a huge help in our management of patients with chronic illnesses.  Other approaches that solicit regular feedback from patients on the effectiveness, safety and tolerability of their treatment—particularly approaches that give patients a sense of watchful caring from their physician—would add to the support (and perhaps pressure) needed for patients to successfully adhere to the recommended treatment regimen.

About: Steve Feldman, MD, PhD, is founder of the www.DrScore.com physician rating website and author of the book Compartments. He is Professor of Dermatology at the Wake Forest University School of Medicine in Winston-Salem, North Carolina.

McKinsey Consulting Gigs For Physicians

McKinsey & Company, a management consulting firm with nearly 9,000 consultants in 90 offices across 50 countries, is hosting two exciting summer programs for students working towards advanced professional degrees: Insight Healthcare and Insight Engineering & Science.  

These programs will give non-MBA advanced degree students an insider's look into management consulting.  Each of the comprehensive seminars will cover a range of topics important to those who are exploring alternative career possibilities.  Program agendas include an overview of management consulting, an introduction to the type of work we do, a management consulting case study, and an opportunity to network with colleagues and participate in social activities. 

Insight Healthcare
Philadelphia, Pennsylvania
June 23 – 26, 2011 Application deadline: April 20, 2011  

http://www.mckinsey.com/careers/apd/Opportunities.aspx >

Qualified Applicants for Insight Healthcare should be:

• Completing an MD, a medical internship, residency or fellowship in 2012 or 2013
• Completing a PhD or post-doc in healthcare related disciplines including biology, biomedical engineering, chemistry or immunology in 2012
• Currently residing in the United States or Canada
• Available to attend the entire event starting at 5:30 p.m. on the evening of Thursday, June 23rd and ending at 1:30 p.m. on the afternoon of Sunday, June 26th

No business experience required. All expenses will be paid by McKinsey & Company.

There are more nonclinical jobs