How To Open A Travel Medicine Franchise?

Here on Freelance MD we often discuss unique business opportunities for the medically inclined or interesting clinical practice models.

One of the interesting opportunities that I've come across is the possibility of opening a travel medicine clinic through a franchise model with the company Passport Health.

Headquartered in Baltimore, Maryland, Passport Health allows owners to buy into their franchise model and "own" a specific geographic region for development.  They currently have over 160 locations and their website mentions opportunities for the entrepreneurially-minded:

If you are a health care professional or entrepreneur with appropriate connections, we can help you achieve your dreams. Passport Health is an excellent business opportunity for the right individual. Passport Health is a simple, low-overhead service company, which provides immunizations to those about to travel to a foreign country. Basically, we are in the immunization business; we offer on-site services such as Flu and Hepatitis clinics. However, we also specialize in safety and security travel information. We are already a household name in many areas across the country, but there are plenty of great territories remaining.

A follow-up email from the company provided more specific information about their franchise opportunity:

We generally sell large territories, including a city and the surrounding counties, with the owner expected to open multiple offices over time.  Our franchise fee is $35,000.00, and it includes training (5 business days), videos, materials and the use of our exclusive software, Passageware.  There is no build-out and very limited start-up expenses. Owners consist of doctors, nurses, and entrepreneurs, with one hospital (Sentara in Norfolk) and one university system (University of Rochester School of Nursing).  Due to the hard work of the individual owners and our marketing team, we are constantly adding corporate accounts and our business model is ever expanding to include all areas of vaccines.

Besides being an interesting field, Travel Medicine is open to healthcare providers from a variety of backgrounds.  While many Travel Medicine providers are trained in Infectious Disease, I know physicians with many different backgrounds involved in Travel Medicine.  

For those interested in Travel Medicine and desiring increased training in this area, our ExpedMed courses are an excellent way to be exposed to this niche.  Two Executive Board members from the International Society of Travel Medicine, Dr. Alan Magill and Dr. David Shlim, will be speaking this year at our Expedition Medicine National Conference that will be held September 16-18, 2011 at the Omni Shoreham hotel in Washington, DC. A prior post here on Freelance MD described other, multi-month programs in Tropical Medicine that are also available for those with increased desire and more time to invest.

Healthcare Reform & Voting With Your Feet As A Physician

How will physicians vote with their feet in response to the changes that have occurred?

When I was a kid-- I'm not exactly sure when-- I remember a teacher in school telling me that to get to the bottom of any current event, you simply need to watch and see how people vote with their feet.

For instance, whenever a dictator in some distant land would wax eloquent about the utopia he had created, the truth was easily found by watching how the citizens in his jurisdiction were "voting."  Were they risking their lives to flee this "paradise" to begin a new life elsewhere? If so, you could guarantee that all rhetoric aside, living under this dictator's rule was anything but pleasant.

How might this idea of "foot voting" apply to modern day American life?

Well, I recently read an article in the Washington Times written by a physician named Dr. Milton Wolf .  Dr. Wolf is a Radiologist who also happens to be a distant cousin of President Obama.  His article details a very interesting footnote to the whole healthcare reform debate and whether the changes made were for the better or worse.

In his article, Dr. Wolf notes that it appears that many friends of the President-- those who supported and pushed for the new healthcare reforms-- have received waivers protecting them from the obvious and dramatic increases in healthcare insurance costs that those who were against the reform package argued would occur if the measure passed.  In other words, recipients of the White House waivers-- over 700 thus far-- helped push a bill onto the American public that they themselves believe is too onerous to live under.  Their rhetoric says they love this new bill, but their feet are voting against it-- or at least voting against paying the price for it.

Another area where I've found individuals voting with their feet is within the realm of clinical medicine.  Physicians, especially primary-care physicians, are fed up with the ridiculousness of modern-day clinical medicine and are leaving it in droves.  The new healthcare regulations seem to add fuel to the fire, with one poll reporting that 40% of clinical physicians will leave clinical medicine or significantly reduce their practice hours over the next three years as the reform mandates are phased in.  This is in spite of the gleeful assurances from the American Medical Association that physicians in America were and are strongly behind these new initiatives.  It appears that the AMA is learning that controlling the behavior of America's physicians is a little more difficult than distorting their voice.

Which brings me to one last example of individuals voting with their feet.

In a recent article in Worth magazine, individuals of high net worth (ie- rich), were being given advice about the pros and cons of moving outside the United States and relinquishing American citizenship.  Here's an excerpt:

It used to be difficult for me to offer advice to people who emigrate from the United States about the tax rules that apply to them. As the son of an immigrant—my father came to this country by ship from Russia in the 1920s—I couldn’t understand why an American would relinquish his benefits and protections as a citizen of the country with the greatest liberty and highest standard of living the world has ever known.

Until recently, anyway. The sad truth is that the business environment in our country was in decline even before the recent economic crisis. Federal and state governments, through encroaching regulation and selective enforcement, appear hostile to both entrepreneurs and big business. Deficits will plague our country for decades, and without the political backbone to tackle entitlements, the only alternative is increasing taxes on the “wealthy.”

Regardless of where you stand politically, this sort of exodus is concerning.  Furthermore, until recently, it was simply unfathomable. 

The facts are very simple:  human beings are not automatons that can be easily controlled by distant bureaucratic rulers.  People respond to incentives, and when they no longer have an incentive to work hard or stay or be productive or take risks, they simply modify their behavior.  

I am reminded of a quote by a physician character in Ayn Rand's novel, Atlas Shrugged.  When asked why he stopped practicing medicine, this fictional physcian replied:

“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it – and still less safe, if he is the sort who doesn’t.”

The fuzzy-headed policy wonks in our federal government need to keep in mind a few simple realities as they attempt to micro-manage our lives and clinical practices in between sips of Starbucks expresso:

• you cannot force someone to become a physician
• you cannot force a physician to practice clinical medicine
• you cannot force a healthcare system to function, when it destroys the healthcare providers necessary to support the system

While the talking heads continue their verbose debates on television and throughout the halls of Congress, my attention will be focused not on what's said over the next few years, but who's moved.  My prediction is that we will soon begin seeing some very obvious "foot voting" that will cut through much of the bluster and posturing.

Over the next few years I'll be watching to see how physicians, small businesses, and other mainstays of American society vote with their feet in response to the changes that have occurred.

I believe these votes will be dramatic and significant.

I'm already hearing footsteps...

2011 Medical Fusion Conference Faculty and Agenda

At every Medical Fusion Conference we attempt to cover the most pertinent topics for clinical physicians who are attempting to branch out from their clinical careers.  

For 2011, we've once again assembled a stellar faculty comprised of leaders in many diverse niches from around the country, and have included many hot topics that physicians should be exposed to in this ever-changing healthcare environment.

Our 2011 faculty list was recently published here on Freelance MD, but we've added a few more names so I've decided to list our entire 2011 Medical Fusion Conference faculty once again.  Many of these faculty members are authors here on Freelance MD so you can read about their backgrounds and perspectives here. I'm also listing our agenda below so you can get an idea of what's going to be discussed at this year's event.  Remember, the 2011 Medical Fusion Conference is November 11-13, 2011 and space is limited.  If you're interested in attending you can register online or call 866-924-7969 .

Our 2011 Medical Fusion Conference faculty:

• Dr. Barry Silbaugh, President of the American College of Physician Executives
• Ashley Wendel, founder of High Agility Healthcare
• Dr. Setu Mazumdar, founder of Lotus Wealth Solutions
• Dr. Steven Knope, author of Concierge Medicine: A New System to Get the Best Healthcare
• Jeff Barson, founder Surface Medical, MedicalSpaMD.com and FreelanceMD.com
• Dr. Gary Taff, real estate investor
• Dr. Julie Silver, Chief Editor of Harvard Health Publications
• Dr. Mike Woo-Ming, internet entrepreneur
• Dr. Kenneth Cohn, independent consultant and founder of HealthcareCollaboration.com
• Dr. Gautam Gulati, Senior VP of Digitas Health
• Dr. Steven Peskin, Executive VP and CMO of MediMedia
• Dr. Alan Neuren, disability review consultant
• Tannus Quatre, Principal at Vantage Clinical Solutions

Our conference topics this year are wide-ranging and cover many niches within and around clinical medicine.  Our 2011 agenda is the following:

Friday, November 11th

8:00-9:00  Leaving the Tribe, Silbaugh

9:00-10:00  Physician Career Transition, Wendel

10:00-10:30  Break

10:30-11:30  Prescriptions for Financial Success, Mazumdar

11:30-12:30  Living and Working Abroad, Bledsoe

12:30-2:00  Lunch

2:00-3:00  Concierge Medicine, Knope

3:00-4:00  Cosmetic Medicine Profits Blueprint, Barson

4:00-5:00  Real Estate Investing, Taff

5:00-6:00  Should You Get Your MBA?, Cohn

6:00-7:30  Accelerator I

Saturday, November 12th

8:00-9:00  Writing & Publishing I, Silver

9:00-10:00  Writing & Publishing II, Silver

10:00-10:30  Break

10:30-11:30  Internet Entrepreneurship I, Woo-Ming

11:30-12:30  Internet Entrepreneurship II,  Woo-Ming

12:30-2:30  Lunch

2:30-3:30  Product Development, Silver

3:30-4:30  How to be a Rockstar Physician, Barson

4:30-5:30  Independent Consulting, Cohn

5:30-7:00  Accelerator II

Sunday, November 13th

8:00-9:00  Believe Me: The Importance of Building an Unforgettable Brand, Gulati

9:00-10:00  Careers for Physicians in Managed Care and Health Insurance, Peskin

10:00-10:30  Break

10:30-11:30  Introduction to Disability Review, Neuren

11:30-12:30  Online Marketing for Physicians: The Essentials, Quatre

I wanted to make sure I highlighted our two Accelerator sessions at the end of each day.  Our Accelerators are some of our most popular times spent at the Medical Fusion Conference since each faculty and mentor has a table, and participants are allowed to wander from faculty member to faculty member and ask any and all questions of the speakers.  No other event allows you this much face-time with nationally known leaders.  Our participants raved about our Accelerator sessions in 2010 and we know that our 2011 participants will also enjoy this time.  

As you can see from our faculty list and our agenda, Medical Fusion participants will be given exposure to a wide array of interesting topics and significant time with our stellar faculty.  There's no event like the Medical Fusion Conference and there's only one Medical Fusion Conference in 2011: November 11-13, at the Aria Resort & Casino in Las Vegas. Register today to ensure your place at the most exciting and invigorating medical conference in the country.

Informed Consent: The U.S. Medical Education System Explained

If you are considering a career in medicine or currently in training, you need to read this book.

Not long ago I posted a short blog entry about Dr. Benjamin Brown and his controversial analysis of physician income.  At the time, Dr. Brown's blog had around 200 comments.  As of today, over 320 comments have been posted and more seem to come by the hour.

Why the incredible interest in this topic?

Well, for one, we're in a recession and the general public still considers physicians "rich."  For someone to have the nerve to insinuate that not all physicians are wealthy and some are actually underpaid is to cut across the grain of conventional thinking at a time when thinking conventionally is very popular.

The other reason is that I have never seen an analysis of physician income like the one Dr. Brown posted on his site.  It is well done and interesting, and physicians should take the time to read through his material.

Based on the comments, it appears that many physicians are reading this information which tells me that no one else has seen an analysis like the one Dr. Brown has produced.  Unfortunately, something as important as a basic analysis of the financial implications of a career in medicine is not coming from our academic medical establishment, but from a surgery resident who compiled the data in his spare time.  

Go figure.

Well, the good news is that Dr. Brown's book, Informed Consent: The U.S. Medical Education System Explained is now available.  If you're interested, you can check out the book's website and either download a copy to your Kindle or iPad, or order the paperback.

I downloaded a copy for the Kindle ap on my iPad, and have really been enjoying it.  While much of the book is tailored for a young person considering a career in medicine, even physicians out of training will enjoy reading the sections on physician income and the high costs of medical education.

Dr. Benjamin Brown, author of Informed ConsentI recommend this book to any young person considering a healthcare career, any medical student or resident, and any physician who is out in practice and having a difficult time explaining to friends and relatives the true financial implications of being a physician.  

Many thanks to Dr. Brown for his timely piece.  We at Freelance MD wish him continued success in his medical education. 

The PGA Golf Tour, Concierge Medicine, & Hitting Your Next Shot As A Physician

Forget about yesterday and refocus your energies on hitting your next shot.

Well, it's good to be back.  

This past week I had the pleasure of taking a trip out to Arizona where I took in the PGA event at the Ritz-Carlton Golf Club and caught up with my friend Dr. Steven Knope, author of Concierge Medicine: A New System to Get the Best Healthcare .

It was a whirlwind tour, but one that left me with some time to think about the state of clinical medicine and our place as physicians within it.

During the flight to Arizona, I whipped out my new iPad and finished reading Steve's book using the iPad Kindle application.  It's a great read, and for those of you who have questions about Concierge Medicine, I would certainly recommend it.  Be forewarned, the book is not a "how to" book that tells you how to set up your clinical practice in a concierge or retainer style; it's basically a narrative of how Steve ended up in his current form of medicine and some of the arguments for and against the model.  I found it fascinating and after reading it I was even more eager to meet with Steve and bounce some questions off of him.

However, before I met with Steve, I had the opportunity to attend the World Golf Championship-Accenture Match Play Championship on Wednesday.  If you're not a golf fan, basically this tournament includes the top 64 golfers in the world who compete head to head in a single-elimination format until the champion is crowned five days later.

I'm not a golfer, but walking around the course during this PGA event, watching the top 64 players in the world compete, I was really amazed.  Even a non-player like myself could appreciate the talent and dedication it takes to be able to consistently hit shot after shot, all the while battling strong gusts of wind, fairways lined with crowds, and television cameras on every corner.  

What I found most inspiring, though, was not the incredibly placed shots that seemed to occur on a regular basis, but the imperfect ones that took a wrong bounce or caught an errant gust of wind and were pushed into the rough (or worse).  More precisely, it wasn't the bad shots themselves that were all that inspiring as were the responses of the pros who hit those shots.

Yes, there were a few fits of frustration when shots went awry, but to a man, every one of those pros recentered themselves when they went to follow up.  Often enough, when a pro hit a bad shot, he followed it up with an incredible adjustment shot and ended up close to where he would have been in the first place.  I observed multiple shots from bunkers, the rough, and out of bounds, that ended on the green near the hole.  It was as if the player wiped his mind clean as he approached his botched shot and made the best of the situation.  The memory of his "failure" was seemingly forgotten, and his focus was turned towards his current challenge with renewed intensity.

It was a great character lesson, to be sure, and provided me with much to think about as I headed to my meeting with Steve towards the end of the week.

For those of you who do not know Dr. Steven Knope, he was one of the first Concierge Medicine physicians in the country and wrote one of the most popular books on the subject.  He's been interviewed by multiple media outlets and was a speaker at our 2010 Medical Fusion Conference.  Steve is intelligent and candid, and I thoroughly enjoyed talking with him about Concierge Medicine, his practice, writing his book, and his views of the changing face of clinical medicine.

During our talk, one of the things that came up was a recent article that appeared in The Wall Street Journal .  Steve had forwarded me a link to the article prior to our meeting, and we took some time to dissect its meaning for Concierge Medicine and clinical medicine in general. 

In this article, the author points out that the recently passed healthcare legislation has already significantly changed the healthcare landscape.

Here's a excerpt:

The most significant change is a wave of frantic consolidation in the health industry. Because the law mandates that insurers accept all patients regardless of pre-existing conditions, insurers will not make money with their current premium and provider-payment structures. As a result, they have already started to raise premiums and cut payments to doctors and hospitals. Smaller and weaker insurers are being forced to sell themselves to larger entities.

Doctors and hospitals, meanwhile, have decided that they cannot survive unless they achieve massive size—and fast. Six years ago, doctors owned more than two-thirds of U.S. medical practices, according to the Medical Group Management Association. By next year, nearly two-thirds will be salaried employees of larger institutions.

Very interesting stuff.

It seems that many physicians have seen the proverbial "writing on the wall" and are selling out in an attempt to protect themselves from what's coming.

Look, I'm not saying that every physician job in a large institution is a bad one and I'm also not saying that every physician has a desire to run his or her own practice.  However, when the percentage of doctor-owned practices goes from more that two-thirds to approximately one-third in such a short time, something is amiss.

The simple fact is that today, more than any time previously, physicians are under attack.  A clinical physician today was already being squeezed by an out-of-control malpractice environment, falling reimbursements, huge student loan debt, and increasing paperwork and regulation.  With the added pressures of the new healthcare laws, many are simply saying "enough is enough" and throwing in the towel.  Conformity and subservience is preferred to bankruptcy, or so the thinking most likely goes, and at a time when we desperately need physician-leaders, many seem to be simply checking out.

In any event, Steve had some great insights into how Concierge Medicine fits into the big picture of American healthcare these days (more on this in a later post) and when I began thinking about things after our chat, my mind began drifting back to those golf pros from the PGA and how they handle their difficulties on the links.

When I watched those athletes, it became very clear that the line separating their talent was very thin.  On any given day, the winner-- more often than not-- is simply the guy who can refocus himself after a tough go of it and remain mentally tough in spite of trying circumstances.  

As physicians today, it's obvious that we've received more than our share of frustrating circumstances and difficulties. The key, though, is in how we approach these circumstances.  We can check out, certainly, or obsess about the past and "what might have been."  We can stew in our frustration and bask in the collective pity-party in the doctor's lounge, or we can begin looking for ways to move forward.

What if we took a tip from the pros in the PGA and stopped looking backwards and began to look forward once again?  Why not wipe the past away, focus on what we can change,  and begin to move forward?  What if we all stopped worrying about the ultimate outcome and... just hit the next shot.

The purpose of Freelance MD and our Medical Fusion Conference is to provide resources to help all of us do this.  We've assembled an incredible team of career coaches, entrepreneurs, non-clinical job experts, and many other talented individuals to help physicians focus our energies on hitting the next shot well, and begin looking forward with hope instead of backwards with regret.

How do you take the first step?

Well, begin by registering for Freelance MD and joining our community.  We're going to be sending out special information to our members and discounts from our various Select Partners.  

Next, become active in the Freelance MD community.  Don't just read the blog, write a comment or two, let us know your opinion, engage.  We need to hear from you and you'll profit from the lively interaction.

Last, consider attending our Medical Fusion Conference.  The dates are November 11-13, 2011 and we're already getting registrations.  There's limited space so please register early-- we don't want anyone to be left out!  Remember, this year we'll be staying at the incredible Aria Resort & Casino, a Five-Diamond property on the Las Vegas Strip-- a fun place to rejuvenate while connecting with interesting and motivated peers from around the country.

Over the next few weeks we're going to be going deeper into a variety of topics, Concierge Medicine included, and we're glad you've stopped by the blog to check us out.  Thanks for your interest. If you like what we're up to, or even if you don't, please leave us a comment to let us know how we're doing. 

Physician Income And The Curious Case Of Dr. Benjamin Brown

Physician income analyzed.

I stumbled upon a very interesting blog post the other day.  It's entitled, The Deceptive Income of Physicians, and was written by Dr. Benjamin Brown, a plastic surgery resident who is also the author of the upcoming book, Informed Consent: The US Medical Education System Explained.  Here's how it begins:

Physicians spend about 40,000 hours training and over $300,000 on their education, yet the amount of money they earn per hour is only a few dollars more than a high school teacher.  Physicians spend over a decade of potential earning, saving and investing time training and taking on more debt, debt that isn’t tax deductible.  When they finish training and finally have an income – they are taxed heavily and must repay their debt with what remains.   The cost of tuition, the length of training and the U.S. tax code places physicians into a deceptive financial situation.

The post is an interesting read and has generated a lot of discussion.  As of today, there have been 203 comments.

What I find most "curious" about this post-- aside from the passionate comments-- is the fact that I have never seen physician incomes analyzed like this before.  It is an unfortunate fact that most medical students remain completely naive to the financial implications of their choice of profession, and their potential specialty choices.

I wrote a recent blog post about this very issue where I quoted Dr. Robert Doroghazi, author of the book, The Physician's Guide to Investing: A Practical Guide to Building Wealth , as saying: 

"I believe the position of the academic medical establishment to deny medical students financial instruction is naive, hypocritical, and indefensible.  They should acknowledge that money is important.  It is never as important as your patient.  It is never as important as your family, your health, your freedom, or your integrity.  But is is important."

I couldn't agree more.

The medical establishment in this country should be ashamed of themselves.  Instead of having very frank and necessary discussions with medical students about the financial implications of becoming a physician, our medical leaders turn a blind eye to this very real need, and medical students are cast out into a harsh economic world with little financial knowledge to protect themselves and their families from potential financial ruin.

It is really an embarrassment to the medical community that this information isn't coming from the academic medical establishment, but a surgery resident who did the work in his spare time.

Thanks to Dr. Brown for making this information available to all of us.  I look forward to reading his upcoming  book.

Crossing International Borders As A Physician

If you’ve never had the pleasure of crossing a border into a remote part of a developing country, you’re in for a real treat.  Some of the best travel stories-- both good and bad-- occur at border crossings.

While most crossings involve little more than a little eye contact and a perfunctory paperwork inspection, things can turn bad in a hurry for those who are unprepared.  Stories abound on the international travel circuit of travelers being detained—or worse—when attempting to cross a border in a less-than-appropriate fashion.  If you’re going to be traveling in remote, undeveloped regions, it’s best to have a plan for handling the crossing of national borders.

For many Westeners—especially the inexperienced physician traveler—the idea that someone in a country that they’re “trying to help” might not believe their good intentions seems preposterous.  Regardless of your intentions, however, you can run into problems.

You might be the nicest, most altruistic person in the world but look at it from the perspective of a border guard:  you’re foreign, you probably don’t speak the native language, you might appear rude due to your dress or mannerisms, and if you’re a medical officer you’re probably carrying lots of suspicious-looking pills, tablets, instruments, and other doo-dads. 

In the first chapter of our Expedition & Wilderness Medicine textbook, Dr. Howard Donner has some helpful tips for dealing with border crossings.  I’m quoting Howard here at length: 

Don’t carry white powder in zip lock bags.  As obvious as this may sound, it is amazing how tablets of all sorts tend to break down with humidity and then slowly disintegrate in zip lock bags. A poorly identified zip lock bag, with pulverized white medicine inside, presents a rather suspect impression to a customs official.  Try to be meticulous with your drugs.  Place your medicines in clearly labeled zip lock bags or medicine vials. If you choose to use zip locks, protect them from physical damage inside of a sturdy kit or case.   The more organized the kit looks, the less dubious the custom’s officials seem to look. 

Carry a copy of your medical license.  Showing a customs official a photocopy of your medical license carries a bit more credibility than stating, “but I’m a doctor, really." 

Present a letter of introduction.  Customs officials seem to love embossed stationery or letters embellished with gold seals. These blank forms can be easily purchased through most office supply stores.  Even if you’re not traveling with the National Geographic Society, you can print up your own letter on embossed stationary. Introduce yourself as the expedition doctor for the “2008 blank blank expedition”.  As long as your name is on the letter, along with a signature from the sponsoring foundation, (such as a friend of yours), custom officials seem to relax.

-Dr. Howard Donner, Chapter One: The Expedition Physician in Expedition & Wilderness Medicine

In addition to medical kit issues, another big problem with border crossing revolves around trying to exit a country with interesting items of question.  Remember that really cool “antique” the local hustler sold you outside the tourist area?  Turns out it’s a stolen artifact from the local museum.  Be wary of buying local valuables that are sold in a surreptitious manner.  At a border it will be you, not the local “entrepreneur,” who will be charged with theft and attempts to export a national heirloom. 

Also, remember that many animal products such as furs or trophies (especially of endangered species) cannot be taken home as well as most alcohol, plants, food items, and some forms of tobacco.  If there’s any question, it’s best not to attempt to transport it.  Just leave it alone and tell stories about “the one that got away” to your friends when you’re home safe and sound.

Even with all the proper documentation and appropriate behavior, frustrating things can still happen when attempting to cross a border.  Some seasoned travelers recommend having a few small "give away" items such as cigarettes, t-shirts of your favorite ball club, small candies, or other light-hearted gift items in your luggage to help sooth escalating tempers.  It's amazing what a small gift accompanied by a smile and a calm demeanor can do to improve a difficult situation.  

If things still go from bad to worse, the best advice is always be respectful, keep your eyes open and your mouth shut, and do not attempt to bluff your way through with threats or angry gestures.  Remember, this is not your home turf, you are not in charge, and you are very much at the mercy of the nearest supervisor in the area.  All your impressive credentials and academic publications won't matter at all to your cellmate in the local jail, and in this situation, Miranda rights certainly do not apply.

Border crossings are a normal part of international travel.  By keeping a few principles in mind, these events can become routine and fun rather than frustrating and frightening.