Doctor’s Rounds™

*The views expressed by the authors below do not represent the views or opinions of MD Preferred Services.

Does Your 401(k) Have One of These?

Monday, April 11, 2016

Self-directed brokerage accounts have been around for quite some time but don’t be surprised if your company’s human resources department and other plan literature doesn’t offer much information about it.  The reason: the company who hosts your 401(k) plan is often not the company who handles the self-directed brokerage account.  Therefore, when participants opt to allocate assets to the brokerage window, the core plan’s custodian loses out on the fees they earn on those dollars. 
But that should not be a reason not to use it.  Self-directed brokerage accounts are a great way to diversify your retirement account and gain access to stocks, bonds, mutual funds, exchange traded funds, and even add your financial advisor to your account for oversight and personalized service.  The investments available in the core plan are usually limited to a list of 5-20 different mutual funds.  Within the self-directed brokerage account, there are thousands.

Every employer offering a self-directed brokerage account has implemented different rules surrounding the use of the self-directed brokerage account.  To understand the basics, first consider your 401(k) plan as having two separate compartments; the core account and the self-directed account.  These are both within the 401(k) so do not worry that using the self-directed brokerage account is somehow creating a taxable event by taking a withdrawal. 
The core account is the one that you’re probably accustomed to using.  It commonly consists of 5-20 pre-selected mutual funds that are (hopefully) periodically reviewed and occasionally replaced for poor performance.  This lineup will hopefully cover some of the spectrum of investments and include some U.S. large company stocks, U.S. small company stocks, international stocks, corporate bonds and government bonds.  Almost always, these investments are in the form of mutual funds; active and passive (index).  Commonly, 401(k) plans core accounts will offer target-date retirement funds that are supposed to be a single solution that simplifies investing.  By selecting the target retirement date fund near your target year of retirement, you get a pre-made mix of investments.  While these may help you to get a better mix of investments, there are shortcomings to this approach as well.  A primary critique of these solutions are their often high management fees.  READ MORE


5 Things Every New Physician Should Do to Lower Taxes and Protect Assets

Monday, February 01, 2016

When speaking with physicians, whether it is one on one, or in a group setting, two topics of conversation are a virtual constant, taxes and asset protection. Notwithstanding the litigious environment we live in, I can clearly see why physicians want to do whatever possible to protect their assets. Reducing taxes is something everyone wants to do.

Even if someone pays very little in taxes, they still want to pay less, so it only make sense that physicians want to keep more of what they make, especially after paying insurance and education costs. So if you would like protect your assets and pay less in taxes, read on.

Form a Physician Corporation

Establishing a Physician Corporation will allow you to pay various expenses from the corporation. Since these expenses are paid before you take your salary, they are deductible from your overall income, and are not taxed at all. Owning a Physician Corporation will also enable you to take advantage of other options which are only available to corporations. Pay Yourself a Salary – Of course you want to make as much money as possible, but in the end, it is really about how much you get to keep. By paying yourself the lowest possible salary, your overall tax burden will be lower, because you will not have to pay FICA taxes on the dividends you take from your Physician Corporation.

Contribute to Retirement Accounts

Your retirement accounts aid you in both reducing your taxes and protecting your assets. From a tax perspective, retirement plan contributions are not subject to income or FICA taxes, so the more you can contribute, the lower your tax bill. As it pertains to protecting your assets, in most states, retirement accounts are not subject to levy as payment in the event of a civil judgment. Therefore, the more you contribute to these plans, the more assets you have protected. Create a Physician


As the owner of your Physician Corporation, you are able to establish a Physician Pension for yourself. This does two things. First, it allows you to fund a retirement vehicle for yourself as an expense to the business. These funds are not taxed, and do not require you to take a significant salary in order to make the contributions. Second, as a retirement account, these funds are also protected from civil judgment in most states.  READ MORE


What IF you need Long Term Care

Friday, January 29, 2016

Favorable tax treatment helps to reduce the “pain” of paying the premium.  Planning ahead by having a conversation about aging before you age is a gift to your family.  What your preferences are on issues such as housing, caregivers and how you would pay for long term care (LTC).  Your health, age, family history and finances will determine which option(s) you have to pay for care.  
Health insurance does not cover long term care, since it is custodial care.  Medicare will cover somelong term care for a very limited time provided that you meet the requirements.
There are favorable tax advantages for LTC premiums based on how you file taxes:  READ MORE


Can it get any better than this?

Thursday, January 21, 2016

BY: Terry J. Kelly, President 


Home ownership is again at all time lows. Some folks are still recovering from the 2008 crisis, others don’t have the down payment or acceptable credit to qualify, and some want to wait until the time is right. There are also those who have a good job, good credit plus a huge earning potential like the medical profession, but still lacking the required down payment. The answer for years has been rent or rent to own. It’s an attractive option for those who want to own their home now and want to fix the value at today’s prices, and gain on future appreciation. Typically on the rent to own programs, the prices and rents are a little higher and the option fee for the right to purchase usually runs from 3% to 5% of the purchase price depending on a number of factors like credit, employment, length of time before purchase, etc.  That’s all changed now.

What’s new for 2016? A new program, where our clients now can pick their rental payment, pick their home in the area they want to live, , pick their price and close in 30 days. So what’s the catch? You need a FICO score of 525 or higher and a gross income of $50,000.

The costs and fees are zero, there are no loans, no banks, and easy qualifying.  There are no option deposit fees.  We even handle the closing costs.  Your responsibility is to agree to a 1 year lease and pay the rental deposit. If you change your mind and decide to relocate after 1 year, no problem.  You can walk away with no liability and you get your rental deposit back.  However, if you decide to stay, you can complete your purchase at any time up to 5 years. Their would be a slight increase in rent and price in the 2nd  through the 5th year.

As I said in my opening statement, it doesn’t get any better than this.  
If you have any questions about this program, please email or call us at or call Terry at 951-200-4130.  READ MORE


The Hidden Treasure

Monday, January 11, 2016

By: Anthony J. Ogorek, Ed.D., CFP
Ogorek Wealth Management LLC

We recently accepted a new client who could have used an advisor years ago, but waited until a near crisis struck before reaching out for help. Over the course of working with our client and their extended family, I came upon a truth that I never fully appreciated in working with clients over a couple of decades.

This client had a somewhat disjointed financial situation that was complicated by his significant health concerns, as well as those of his wife. They needed answers now, but it was difficult to advise them because of the difficulty in assembling pertinent financial documents and data. Before we could provide them with the answers they wanted, we had to devise a multi-pronged approach that would expedite the signing of updated estate documents, review all credit card expenses over the past year, and track down cost basis information for their taxable portfolios.

What struck me was how often we take the benefit of continually updated client information for granted. This is perhaps one of the most significant benefits that we provide to our clients, yet is perhaps unappreciated at best. Although we strive to obtain as much of this information as we can without involving our clients, sometimes they must get involved; and we realize that can be an inconvenience.

Having up to date information allows us to offer counsel, often times on the spot. In the event that more analysis is required, we can frequently come up with a recommendation quickly. Clients who resist updating their information are doing themselves a disservice. After as short a period as a couple of years, financial information can be obsolete, and can require extensive data gathering. We would much rather spend limited meeting time on your concerns, rather than on housekeeping items. Up to date records is the hallmark of a financial planning relationship that works. If you are still making New Year’s resolutions, try to ensure that all of your financial records are current. It will pay big dividends down the road.  READ MORE


Physician Burnout Rates Top 50% in latest Mayo Study

Monday, December 14, 2015

By Dike Drummond MD, CEO

- Over 50% of US Physicians now suffering at least one symptom of burnout
- Depression and suicidal ideation rates even more concerning

In our work with thousands of over stressed and burned out doctors, it has been clear that burnout rates in the USA have been rising in the last several years. There is just too much political chaos, marketplace M&A activity and documentation overload for it to be otherwise. 

Finally the research has caught up with our suspicions in the latest version of Mayo's landmark 2011 physician burnout study. Here is our smoking gun at last. 

Sure, burnout rates are up an additional 20% but that is not the most concerning finding.



Four things you need to know about long term care

Monday, December 07, 2015

By Melissa Barnickel- Baygroup Insurance

Chances are, you are going to need it.
70% of today’s 65-year-olds will need long term care at some point.

That means… Only 3 of 10 persons over age 65 will not need assistance with bathing, dressing, eating, transferring,* toileting, continence or cognitive impairment. 

Feeling Lucky? Or do you think it might be time to learn more about how issues related to long term care can impact your future? ….just in case, that is.  READ MORE


The Great California ShakeOut. Are you ready for an emergency?

Thursday, November 19, 2015

On Thursday, October 15, 2015, schools, universities, government agencies, and businesses across California participated in The Great California ShakeOut.  We all know how important it is to be ready with a plan in case of an emergency like an earthquake. Not only did our children participate in this earthquake drill at school, but here at ACap we also participated in the #ShakeOut. Drills and emergency kits (we update ours yearly with medicines, nonperishable foods, clothes, batteries, etc…) are vital for the moments during and immediately following an emergency. But what happens after the ground stops shaking? Equally important to practicing procedures and preparing a physical emergency kit is establishing and maintaining a financial emergency preparedness kit. What is a financial preparedness kit?  READ MORE


Beware of What You Ask For

Thursday, November 12, 2015

By: Anthony J. Ogorek, Ed.D., CFP
Ogorek Wealth Management LLC

This week I attended a meeting of the local estate analyst community. This group is comprised of some very high-end accountants, attorneys, and advisors, among others, who were being briefed on some of the intricacies of stretching out required minimum distributions from retirement accounts. Toward the end of the presentation it occurred to me that the advice they were giving, although technical in nature, could conflict with why any of us save money in the first place.
The thrust of the presentation was a reaffirmation of what all of us have been trained to advise our clients: in order to save taxes, defer payments from retirement accounts for as long as possible. “Success” is viewed as keeping the greatest amount of money from Uncle Sam’s hands. The only drawback with keeping it out of our Uncle’s hands is that it also keeps it from our hands! To better frame this conflict, how would you answer this question: ‘Who is wealthier, someone with a $1 million account who refuses to spend it, or someone with $100,000 who intends to spend it on activities that give him or her enjoyment?’ Obviously this is a very skewed example, but you can appreciate the point: does money really matter if you have no intention of deriving any economic value from it?
I am sure that none of the professionals at the meeting would advocate that a client sacrifice their lifestyle in order to save on taxes. However, if saving taxes is your sole gauge of success, perhaps you need to reassess what having money is all about. No one, including yours truly, wants to pay more tax than is required by law. However, there are situations when denying you just to spite the tax man makes little sense.
In our line of work, everything comes with a price. There are no silver bullets that produce remarkable results without creating tradeoffs in other areas of your life. Before you engage any financial professional, be sure that you carefully weigh what you are looking to accomplish, with the tradeoffs that are sure to accompany any strategies you decide to employ.  READ MORE


The potentially devastating impact of ICD-10 on small private medical practices

Monday, October 19, 2015

After years of delay, the U.S. Department of Health and Human Services (HHS) has finally adopted and implemented the International Classification of Disease – 10th Revision (ICD-10) effective October 1st.  A recent survey by the Professional Association of Health Care Office Management estimates that most small medical practices have invested approximately $2,500 per provider to implement the conversion to ICD-10.  They are advising their members to prepare for a potential sharp rise in claim denials and a corresponding drop in revenue. 

The dimensions of the potential train wreck here cannot be understated.  Many industry experts are predicting a 30 percent or greater drop in cash flow over the first 90 days of implementation.   Some trade associations are going so far as to advise their members to set aside cash reserves and apply for a bank line of credit to cover a 50% drop in revenue!  

The heart of the problem is that there is no way to accurately predict how the insurance industry is going to handle the new demands of ICD-10.  Without going into mind numbing technical detail, payers are having to literally rebuild their bundled reimbursement models for everything from an upper respiratory infection to a heart transplant and every medical event in between.  And until they sort these issues out and provide guidance to the billing and coding contractors no one is quite sure how to proceed.  READ MORE