TysonCook

Senior Member
15+ Year Member
Aug 19, 2002
648
16
Salt Lake City, Utah
Status
Attending Physician
Hello,
So its the end of the year and I've got some CME money hanging around...

Wondering if anyone has any suggestions for business journals relating to medicine+finances, books, etc that can help me increase my revenues for my job? Possible coding? or just general medical finances?

I'm EM so that would be a plus as well!

Any books including personal finance would help as well!
Thanks!
 
Sep 5, 2009
112
2
Status
Non-Student
I teach CME on this topic, but don't have enduring materials, so can give you some source info. Or, will come to your institution for the price of plane ticket and present free to your department! (I'm a tax attorney/MD financial specialist married to radiologist) Yes, I will even present to residents, have university and law school and CME teaching credentials.
#1 drain on MD income is taxes, by far, so that is study #1.
# 2 big ticket item is insurance, all kinds, from med mal to life, so study no. 2 needs to be about this. Comparable somewhat to housing costs, maybe a little less.
# 3 investments, a distant 3rd in impact on your bottom line, but lots of interesting material out there mostly bs in popular press and on internet. My local NPR station has a finance professor who gives weekly advice which is TERRIBLE for doctors because she assumes a low tax bracket.
As in medicine, you cannot rely on internet remedies. Use google scholar and read the white papers and university research, also tax law and CPA articles in law reviews and CPA journal, econ journals, closest to peer review you are used to. Med economics isn't great, IMO, but some good stuff, writers are generalists. The most dazzling tool in the tax arsenal today for docs is the captive insurance company. PM me and I will send you some articles I have at work. The most important structural decision for you is to form (best case) your own C corporation, which permits the best corporate benefits that executives give themselves, for example, the IRC Section 79 Plan, like a Roth for the rich. Beware the
CPA who practices law, by recommending the type of corporate you should have. Gray area, but once you commit to S corp going back is hard, and trust me, its not for doctors, except those who lose money in practice. Also in arsenal should be custom defined benefit plan, better as you get older, but important because it makes a certain amount of life insurance premium DEDUCTIBLE, if you need life insurance. Maximal customized 401K plan can be combined with defined benefit. Add Health Savings Account for married, another $5600 deduction, half that for single. Pay your kids to work, and I mean WORK, and they can have IRAs, deductible. Read the FINRA website in detail and look at the Rand article below on fees--a bit overwhelming but you will be forever suspicious and understand how you cannot identify the fees you are paying, so you can relax about that and focus on your really big enemy, taxes. Read Fooled by Randomness by Taleb, Liar's Poker (delightful whistle blower book on wall street), Capital Ideas or anything by Peter Bernstein on investments, and avoid the popular press, the Dave Ramsays, and Suze Ormans, and Rich Dads of the world, they are for masses, (actually out to make money for themselves) not doctors. Read this Rand report to understand the treacherous world of fees and the difference between Series 65 licensed Investment Advisory Representatives (standard of care for you the same as standard of care for their own family) vs. Series 7 broker, "stock broker" no fiduciary duty to YOU. http://www.rand.org/pubs/technical_reports/TR556.html Can download free here. This is tough going but worth it. Gold standard is currently Modern Portfolio Theory, explained in detail in Capital Ideas and other Peter Bernstein books. Hope these help. These are investment reading. PM me for tax. Its much more complicated and CPAs, though quite smart and good at what they do, don't necessarily do primarily tax and don't do tax planning, which is what you need. Think of them as family practice and allopathic, generalists and you're already sick, but you make too much $ to make the cut in triage, so most advice focus will be on those trying, hoping to make a million dollars, which you already will, not keeping more of what you earn, which you will need to do. Great CPAs are kind of historians, this is what you did, this is what you owe. Few are great planners--you will get a few tips, but not big ticket ones, and you need big deductions, and not in fields you don't belong in, like real estate. Oh, yes, there is depreciation, but guess what, there is ordinary income RECAPTURE, so you can never sell it, did they tell you that, without major tax outlay, on top of your already top bracket income. Great to have 1099 income which EMs can have a lot of, gives you trememdous flexibility. Beware of asset protection, "bullet-proof" asset protection, high priced materials, and do-it yourself asset protection, you can't. Get a good estate attorney, many work for flat fees (per trust or per LLC, etc.) Hope this gets you started. Interview coding veterans, beware big companies, McKesson has bought a lot of billing companies, and they only want to collect big items, the insurers will nickle and dime you, so a smaller hungrier firm can be a lot better and willing to go after the extra money you are owed. There are some new software programs out there beyond "scrubbing", don't know if they work, but I think that is where the coding is going to beat the payors. I can find the names of a couple, I think. Most docs have no idea what they are NOT collecting as they are too busy, far to busy to investigate. Love to hear more about this if you learn something...may the sun of good fortune shine brightly on your brilliant head. Dry paper people like me LOVE knowing you are there when we need you.