How to assemble the right financial team to assist your practice

November 10, 2017
Keith Loria
Keith Loria

Keith Loria is a contributing writer to Medical Economics.

Why physicians need financial advisers, attorneys and bankers

Many busy physicians find they don’t have the time and energy to develop a savvy financial plan for their practice or their own personal needs. That’s why they need the support and guidance of a strong financial team. 

Many physicians never learned how to run a business or handle personal finances while in medical school, says Kyle O’Dell, investment advisory representative  and  managing partner at O’Dell, Winkfield, Roseman & Shipp, a financial advisory firm in Denver, Colorado.

“Because their professional lives are so busy, it’s essential they find someone they can turn to for financial advice and guidance so that they can continue to maintain their focus on patient care,” he says of his physician clients. “By working with an adviser, they can create a financial plan that can reap the rewards of their hard work.”

Finding the right financial adviser

O’Dell says the most important attribute to look for in any financial relationship is trust. “I would look for a fiduciary adviser who has experience working with doctors and understands the world they live and work in,” he says. “Finding a firm well-rounded enough-with the resources and experience to effectively manage your portfolio-can be a daunting task, but the decision can have a major impact on a doctor’s bottom line.”

Most advisers may claim they can handle all aspects of the financial portfolio, but O’Dell says before hiring someone, physicians should ask: Do they truly have those resources? Is it something they do every day? 

Most experts agree that physicians should work with a fee-only financial adviser, because they do not receive commissions or financial incentives based on the advice they give. 

Eiman Jahangir, MD, MPH, a cardiologist at the Permanente Medical Group, Santa Rosa, California, works with people he knows and has trusted for some time, although he reviews his policies every two years to ensure there aren’t any unexpected developments.

“Fee-only becomes important because then you can be comfortable that the financial adviser (or insurer) is not selling you a product just to make a profit,” Jahangir says. 

Jahangir notes that physicians can use an investment calculator, such as the one on the website Physician on Fire, to see just how much it costs over time.

“A physician should start off by asking friends or colleagues for an introduction or referral to their adviser, and begin interviewing advisers until they find the right fit for their goals,” he says. “The adviser you would want to look for is someone that is both a fiduciary (charging a flat fee or receiving a cut of typically 1%) and insurance licensed. Many advisers only carry a securities license or a life insurance license.”

Other useful places to start looking for fee-only advisers, according to several physicians, are the Financial Planning Association, the National Association of Professional
 Financial Advisors and XY Planning Network.

 

When searching for financial advice, a doctor might ask for assistance in just one area, but the right adviser should also be able to quarterback a team that includes lenders, CPAs and real estate agents, if necessary. He or she can also help physicians find the rest of their financial team members.

“If you have a financial adviser already, he or she should be able to refer people,” says Zachary A. Abrams, CFP,  a wealth manager for Capital Advisors Ltd. in Shaker Heights, Ohio. “I have a list of accountants, attorneys, investment banks and lenders that I refer my clients to depending on their situation.”

 

Choosing a CPA

Another important member of the financial team is the certified public accountant (CPA). 

Stephen N. Klein, CPA, a partner with the New Jersey-based accounting and advisory firm Klatzkin & Company LLP, says the best way to choose a CPA is through referrals from other physicians and performing due diligence on those they recommend. 

“Interview several [CPAs] before making a decision,” he says. “While cost is always a factor, it should not be the determining factor, as it is difficult to put a price on good advice. During the interview process, you will notice differences in style, experience, the questions they ask you, their answers to your questions and the chemistry between the two of you.”

Once hired, the CPA will be responsible for helping the physician with the type of corporate entity to set up for their practice, tax planning and tax preparation, as well as consulting on decisions about savings.

“They can also help by setting up an annual budget for the physician’s personal spending,” Klein says. “The physician needs to understand the importance of saving money from the day he or she first starts to earn a living. They will need to save for a down payment for a home, and other major life events, including college for their children and their own retirement.”

Finding the right attorney

Attorneys are also a vital part of the financial team, as they can help a physician keep his or her practice out of legal trouble. 

Glenn H. Truitt, JD, partner with iDeal Business Partners in Las Vegas, Nevada, says a relationship with an attorney involves a great deal of confidential and sensitive information, so performing due diligence on an attorney is an important part of complementing the overall financial team.

“Physicians, by nature, are usually quite skilled as lie detectors,” he says. “These skills should similarly be applied to their conversations with prospective attorneys. They should ask the potentially awkward questions up front, including the attorney’s background and experience in healthcare, references from other physicians and how they bill.”

 

Since it can be difficult to gain the necessary insight just with a traditional interview, Truitt suggests giving a candidate a small project to do, with minimal guidance.

“This will provide you essential insight into how they organize, accomplish and bill for work, as well as the quality of their work product and their communication skills, that you simply can’t get any other way,” he says. “Also, physicians work extreme hours, so an attorney that is only available on weekdays from nine to five is likely going to be challenging for them to work with.”  

Harry Nelson, JD, founder and managing partner of the Los Angeles-based healthcare law firm Nelson Hardiman LLP, says having a relationship with an attorney knowledgeable about regulatory compliance is essential, as is working with one who regularly deals with healthcare issues.

Nelson says that asking other physicians for attorney recommendations is a smart way to find one, but that researching articles written by attorneys also can identify lawyers who are knowledgeable about any specific concerns a physician may have. 

 

Finding the right banker

A banker is an important part of the financial team because he or she can offer services to simplify a physician’s busy life, such as dealing with student loan debt and obtaining consolidation loans.

James G. Edwards, III, managing director of SunTrust Private Wealth Management Medical Specialty Group, Atlanta, Georgia, says it’s nearly impossible for a physician, both personally and professionally, to self-finance all that they desire for their practice or personal needs. 

“On the practice side, we recommend that physicians set up a working capital line of credit,” he says. “Many times, practices are going to have cash flow timing disruptions, like a delay in insurance payments, so having access to a line of credit can help bridge the timing difference.”

For capital-intensive medical practices that want to finance equipment, having access to funding is important as well, Edwards notes. “Even if they have the cash to pay for the equipment outright, interest rates have been good and terms are attractive, so it may make sense for physicians and practices to use a (bank) instead of writing a check,” he says. 

On the personal side, many physicians work with banks on home mortgages and many bankers recommend that physicians have a personal line of credit for cash flow disruptions that could come based on a delay in income or a significant expense. 

“Physicians should look for advisers who understand how a medical practice works corporately as well as the professional life cycle of a physician personally,” Edwards says. “For example, when making loans to a practice, having advisers that understand the unique financial characteristics of the practice can help ensure a well-structured loan and a timely approval and closing.”