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Pearls and Nuggets


Call them what you will, I've built up a collection over the years of certain gems of practice and financial wisdom that can really be helpful. I have spared no expense in sifting through the clutter, I mean, valuable files that I have assembled over time to bring this precious collection to you.

Call them what you will, I've built up a collection over the years of certain gems of practice and financial information and/or wisdom that can really be helpful. I have spared no expense in sifting through the clutter, I mean, valuable files that I have assembled over time to bring this precious collection to you.

And there is a money back guarantee attached, just like an infomercial or back page of the comic book ad (remember those?). A fair few to follow...

Only 50% of referrals to specialists actually are seen

That includes 70% making the appointment and 20% canceling or no-showing. And we know that 9 times out of 10 if you do not see the patient, you cannot help the patient. Is this a stat that we can and should modify with attention being paid at both ends to better communication? Or follow up with the patient? The patients' well-being aside, time is money.

In 2005, 2/3 of medical practices were privately owned. By 2008, that number had dropped below 1/2.

We are in the middle of an under-the-radar, sociological, medical economic shift that has great implications for the delivery of medical care, aside from what those folks in D.C. think and intend.

Each year, 10-25% of docs die, move, or retire

The numbers range by specialty from dermatology at 10%, internal medicine/FP at 15% to geriatrics at 25%. Maybe the latter is because most geriatricians weren't trained as such, but their patient population aged as they did. That's what I see in my area.

Closing unused credit card accounts will lower your credit rating

Sounds nonsensical, but in lowering the amount that you are approved to borrow, you reduce your "utilization ratio" which is what the credit bureaus look at.

To wit; the amount you have taken compared to the amount that you are authorized to take should remain below 50% to keep your score up. So even if you do not borrow one more dollar, if the amount of available credit drops by dropping an account, therefore the percentage drops and you look badly. So don't tear up those unused cards, just throw them in the drawer to die a slow death.

You cannot be required to either exceed some arbitrary minimum purchase, or give your phone number, address etc.

The bank cards' regulations forbid those and if reported, fines and even cancellation of their membership can be imposed. On the other hand, the poor clerk is just doing what they are told and the manager/owner obviously has their own issues, so a righteous protest may be just a blood pressure raising Pyrrhic victory. Still, it's annoying.

What do you charge for remote consultations?

Increasingly, there is pressure, and opportunity, to do telephone and on-line medical consultation. There are codes to cover them; 99441 for 5-10 minutes, 99442 for 11-20 minutes and 99443 for 21-30 minutes. The $64 question is what you can charge and what your patients and their insurance companies may deem acceptable, if anything.

Theoretically, convenience for both parties would be improved, and costs controlled, but malpractice questions and cannibaIization of higher revenue office visits are unverified risks. It certainly seems inevitable that these contacts will increase in the age of the internet, especially in underserved areas. I tried to start charging for phone consultations some years ago, with a reasonable rationale, but the pushback was strong and people weren't ready.

Maybe they are now.

Owning all or part of a vacation home

Experts say that if you want the place to pay for itself, you have to hit the "Magic 17." 12 peak rental weeks should pay the mortgage and if you can get 5 off-peak rental weeks, that will pay your utilities, cable, HOA etc. That way, you get to use the vacation home for 35 weeks for "free." Hah!

Give away $24,000 for free!

Those who want to help cash-strapped parents can give them $24,000 a year, gift-tax free. The other thing that you can do, savvy tax-wise, is simply to buy something from them that you will inherit, anyway. You don't even have to take possession. It could be a house, a car or even a ring. Just pay something like market value. It will reduce any potential estate tax and you get any appreciation. Simple.

Investment inertia

Reasons for the failure to act, and the resultant failure to gain net worth, are several:

  1. No deadlines. So try getting off the dime by using tax dates, fiscal years, paycheck dates, or the best in many pro's opinion, Now.
  2. A perceived lack of knowledge holds a lot of docs back, not knowing how to proceed. But we hold special knowledge in high repute, so refer yourself to the best fee-based advisor that you can find. Act now.
  3. The financial markets only go up in spurts and those are impossible to predict, so you have to be permanently involved in some way to benefit. Or, as I tell my golfing friends, it's hard to win the Masters if you are not entered. Again, act Now.

Join the secret club

Trust me on this one, if you can get access to a Private Bank, do so. They can give you advice on estate planning, IPOs, philanthropy and suchlike at a higher level than you will easily find elsewhere. The trick is getting entree.

If you have a rich relative, ask for an introduction. These banks like to work with families. If you don't have a rich relative, do your homework, and plan how to approach your choice. They are not cheap, but like all top advisors, certainly worth it in the end. Happy hunting.

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice