Doctor’s Rounds™

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

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. 

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. 

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. 

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? 

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. 

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. 

What Do You Really Want Out of Life?

Friday, September 11, 2015

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

Few questions are more provocative than asking someone, “What do you really want out of life?” Warren Buffett, jokingly said, when asked the question, that now that he is the world’s richest man, he wants to also be the world’s oldest man!
His lighthearted response underscores the sense that most of us are uncomfortable answering questions that could profoundly affect not just our outlook on life, but how we live our lives going forward. I was updating a client’s financial plan this week and in the process was taken aback by how little they spend to maintain their lifestyle. They expected to retire years from now, but based on my calculations, they could walk away from work right now without any financial repercussions.
I’m sure it will be an interesting meeting when I present them with my findings, because they will then be confronted with the question. They no longer need to work support their lifestyle. No need to save any further. They are financially secure. No need to really do anything they are not interested in doing. Think about it for a moment: how would you answer the question if you were in their shoes?
One of the tough things about answering this question is that life typically presents us with conflicting choices and tradeoffs. These choices have consequences that need to be carefully weighed. Typically there are no clear cut choices. Buffett’s answer may be representative of the opinions of most people – they are more interested in extending their longevity, than finding meaningful ways to spend their remaining time.
Money can be like a drug. The more you have, the more you want. The pursuit of wealth has tradeoffs. Most people view those tradeoffs as rewards. The seduction of wealth accumulation is that you do things for money, not necessarily for you. So when you try to answer this question, be sure that you are doing the talking, not your money.   

Keep Calm and Buy Stocks

Thursday, August 27, 2015

By ACap Asset Management

News of recent market volatility alarmed some investors, sending them scrambling to manage loses. But it’s time to take a breath and avoid panic. Those with a solid financial plan and a diversified portfolio needn’t have worried. 

So what is going on? The Dow Jones Industrial Average (Dow) is officially in a correction, which is defined as a 10 percent decline from its peak. The truth is that markets do not always go up, so it is perfectly natural and expected for markets to decline occasionally. In developing and maintaining investment portfolios for our physician clients, we at ACap Asset Management plan for down-markets as well. Not only do we protect against downturns through strategic portfolio design and diversification, but we also capitalize on down days as buying opportunities.  Because we at ACap have been expecting this correction for some months now, we have been intentionally accumulating cash in our clients’ accounts. We use the cash as an opportunity to buy in a down market. It’s like buying stock on sale. Who doesn’t like a good sale? 

But why did the market take a downturn? While there’s really no clear answer to that question, the likely cause is simply consumer panic.  As the market slowly declines, many investors panic and sell too, which fuels the fire. Selling your investments in a panic is a bad idea.  Those who sell their holdings in an acute down market are often times left in a worse position than they would otherwise have been in if they had held their investments through the market decline and waited for the markets to recover. Markets do recover. And while down markets are never pleasant for investors in the short-term, they are good buying opportunities for the long-term term investor with at least a 5-year holding period. Investing with a shorter time-frame does not always allow for the markets to react and recover to the current world headlines.

So what can you do? 

Insurance Protection for Physicians – pt 2

Thursday, August 13, 2015

By David I. Katz, AAMS®
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Insurance Protection for Physicians pt 1

"One of the best ways to reduce the risk of a malpractice lawsuit is to treat every patient with courtesy and respect."
-Kenneth Fox, a partner with McAloon & Friedman, P.C. in New York City

Medical malpractice insurance protects against the financial risks faced by doctors and dentists. Some types of practices - cardiovascular surgery, and obstetrics-gynecology, for example - carry a higher risk of a malpractice lawsuit, and premiums reflect that difference. For example, a new obstetrician in New York might pay an annual premium of $100,000 to $200,000 for $1.3 million in primary insurance coverage.

State laws vary widely in terms of malpractice insurance requirements. In some states, purchasing a policy is mandatory. In other states, a medical professional can post a bond as surety in the event of a malpractice lawsuit, or even drop coverage altogether. In addition, some state legislatures have set caps on damage awards in malpractice cases, reducing the potential financial risk to a practicing physician.

New physicians and doctors who are changing affiliations should also have a clear understanding with the practice or hospital about how a malpractice lawsuit would be handled.

Malpractice liability and insurance coverage may also be affected by the structuring or a group practice or collaborative arrangement, such as an accountable care organization (ACO). In a partnership, one physician or dentist may be considered liable for the actions of another partner, said Fox. However, the shareholders in a professional corporation or limited liability company would generally not be liable for another shareholder’s medical malpractice. Instead, a malpractice lawsuit might also be filed against the company as well as the practitioner.