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REAL ESTATE ADVISOR

Tips & Tools from the world of todays Realtor
So, you are a physician looking to buy your first house. But like
many young physicians you are still recovering from your medical
education debt and forced poverty during that education process.
Your free cash flow has allowed you to accumulate only about
$18,000 for a down payment. On the plus side you have a
guaranteed employment contract with a base of $170,000 and are
on a fast track to partner.
To buy or not to buyand if the decision is to buy how much
house can you afford and what price range should you be
considering. Those are all good questions. Here are some things
to consider.
1. If you have not yet forged a relationship with a trusted financial advisor with whom you have crafted a detailed
financial plan, you should hold off on your decision until you can incorporate any home purchase with your short
and long term financial goals.
2. If you want to know what you can afford, the best person to talk with is a mortgage broker. He or she will often
have an online calculator that can do the math. Look for someone that works with other doctors and has a lending
product crafted specifically for medical professionals.
3. Determining what you can afford is not the same thing as determining what you need. The tendency in todays
depressed market is to grab for as much house as you can afford. You may well qualify for a mortgage with a small
down payment that will leave you with a $6500 monthly payment. But that is probably not the best route for a
young physician to go.
4. Determine how long you plan to stay in your first house. In all likelihood your compensation and net worth are
going to grow dramatically as your career advances. If you plan to stay in your first home for less than five years
(about average) you can kill two birds with one stone by looking at this first purchase as an investment. Buy smaller
with a 20% minimum down payment and plan on paying off the mortgage in five years.
5. Turn your first home into an investment property and keep moving upscale every five years until you arrive at that
dream home. Until you are certain that you will be staying in your present position and in the present location for
the foreseeable future, view each purchase as an investment.
6. Keep in mind that residential investment property can work for you in more than one way. You dont have to
become a landlord by renting out a property. You can keep moving up the housing ladder by selling your current
property with owner financing and get a very nice return on your capital.
Final thought: Many young physicians are anxious to reward their family with a beautiful home in recognition of the
sacrifices they have made to their medical education. But in the absence of a solid financial plan, that move often
comes too soon. Before anything else, make sure you have built your six month emergency fund. In your case that
should be in the neighborhood of $50,000. And that is the first neighborhood you should be considering come home
buying season.

Case law and frozen pre-embryos

Those of you who follow the paparazzi are probably aware of the
ongoing legal battle between the actress Sofia Vergara and her exfianc Nick Loeb. But their celebrity has little to do with the import of
the fight going on in court. Whats at stake here is the fate of the
couples frozen pre-embryos. For the record, case law now refers to a
fertilized egg that has been frozen as a pre-embryo, pre-gamete or
pre-zygote. The key is the prefix or pre. It does not achieve embryo
status until it has been implanted in a womans womb.
A quick look at case law finds that the determination of disposition of
frozen pre-embryos after a marital or even a non-marital breakup of the progenitors has evolved since Davis v. Davis a
Tennessee Supreme Court ruling in 1992. In Davis, the couple participated in a frozen embryo program and were later
divorced while frozen pre-embryos remained. There was no written agreement between the couple or with the clinic.
The wife wanted to donate the pre-embryos to another couple and the husband wanted the pre-embryos destroyed.
The lower court held that the pre-embryos were essentially children and awarded them to the wife. But the Tennessee
Supreme Court reversed the ruling noting that the frozen pre-embryos were neither children nor property but
something in between. They noted that frozen pre-embryos held the potential for human life which removed them
from the traditional property category. The court first looked to any written agreement that detailed disposition in the
event of divorce. There was none. The court was comfortable with the concept that the progenitors do in fact have the
right to determine disposition but in the absence of an agreement they turned to the constitutional right to privacy.
They ultimately gave more weight to the husbands right not to have children than the wifes right to donate the frozen
pre-embryos. Although the case established some precedent, the fact that the wife wanted to donate the pre-embryos
rather than have them implanted in her probably affected the outcome of the case.
From Davis v. Davis we move to Kass v. Kass, a New York case from 1998. Clinics were urging couples to sign an
agreement in advance of any freezing of fertilized eggs, both between themselves and with the clinic. In this case the
couple did in fact have an agreement in place which stated that in the event of divorce the pre-zygotes could only be
removed from storage with the consent of both parties. The agreement made passing reference that ownership would
be part of a property settlement as directed by order of a court of competent jurisdiction. The court ruled that the
passing reference to a court directive was not intended to transfer the disposition decision out of the hands of both
partners. They ruled in favor of the husband who did not wish to have children and was unwilling to agree to release of
the pre-embryos.
The case law became more ambiguous in 2000 when a Massachusetts court flat out ruled that even with the presence of
an unambiguous agreement to release pre-embryos to the wife in the event of divorce, the court would not, as a matter
of public policy ever enforce an agreement that would compel one donor to become a parent against his or her will. So
Davis v. Davis called for the courts to follow the instructions of a properly drafted written agreement while another
court from another state refused under any circumstances to enforce a properly drafted written agreement that forced
a parent to become an unwilling parent.
If things were not complicated enough a case from New Jersey in 2001 threw another monkey wrench into the case law.
Described only as J.B v. M.B the court had a divorced couple with a written agreement that spelled out disposition of
the frozen pre-embryos in the event of divorce. In the agreement the pre-embryos would revert to the IVF Program

unless a court specified otherwise. In this case the husband wanted to donate the pre-embryos to another couple and
the wife wanted them destroyed. The court was not amused with the agreements willingness to dump the decision
into the courts lap. They ruled that the agreement was too ambiguous. But then the justices ruled further that
ambiguity was irrelevant because a contract to implant frozen embryos violated New Jersey public policy and the best
rule of law is to enforce agreements entered into at the time in vitro fertilization is begun, subject to the right of either
party to change his or her mind right up to the point of use or destruction.
So far we have case law that generally was willing to follow the instructions of a written agreement; case law that would
not force either party to become an unwilling parent no matter what the agreement said; and case law that said that
even if both parties agreed to specific rules for the disposition of pre-embryos in the event of divorce, either party could
change their mind at any time. How could the case law be any more confusing you ask?
Take the case of Litowitz v. Litowitz, a Washington state case from 2002. Now pay attention because this one gets a bit
complicated.
The parties wanted to have a child.
The wife was unable to produce an egg or give birth to a child.
They acquired eggs from a third party.
They fertilized the eggs with the husbands sperm.
They had the resulting pre-embryos frozen.
One of the pre-embryos was implanted in a surrogate mother (a fourth party) who gave birth to a normal child.
The remaining pre-embryos were still in frozen storage when the couple divorced.
A contract with the egg donor had been signed that prohibited the Litowitz couple from allowing any other party
to use the eggs without the written permission of the egg donor.
A contract with the medical clinic called for the frozen pre-embryos be thawed after five years in storage and
not be allowed to undergo further development.
You got all that? A lower court considered the best interests of the frozen pre-embryos and ordered the father to use
his best efforts to donate the embryos to a married couple. The state Supreme Court reversed and following the
wording of the clinic agreement, five years having passed, ordered that the pre-embryos not be implanted. The court
further ruled that the agreement with the egg donor ceased to apply when the eggs were fertilized and became
embryos. I have no idea what conclusions to draw from this one.
So, it would seem that evolving state case law actually follows the US Supreme Courts established precedents regarding
abortion. The mothers rights overcome any rights possessed by a nonviable fetus. The frozen embryo cases appear to
hold that no one may be forced to procreate and that right overcomes any contrary right possessed by an objecting
parent or by the frozen pre-embryo which the US Supreme Court seems to feel has no rights at all.
Back to Ms Vergara and Mr. Loeb. It would seem that Mr. Loebs stated wish not to become a parent in the case of the
frozen pre-embryos that he and Ms. Vegara created would have the weight of the law on his side. Ms. Vegara on the
other hand has referenced two other cases currently on appeal that would overrule the objections of the husband in the
event that the female partner had undergone chemo therapy that made it impossible for her to have children. In these
cases, the only way the woman could become a genetic parent would be to implant the frozen pre-embryos. The only
problem is that Ms. Vergara does not have that problem. So, as most things in Hollywood are, their case will be
sensational, illogical, and emotional and in the end settled to the financial interests of the warring parties. So much for
case law.

Growing momentum for off label promotion of

medications by drug manufactures
Primary care physicians are having a hard time staying current on
new off label uses of pharmaceuticals that are both safe and
effective but which have not been approved by the FDA. The
problem here is that although a physician can prescribe any safe
treatment regimen including the use of pharmaceuticals not cleared
by FDA regulators for that particular illness or disease,
pharmaceutical reps cannot not recommend or discuss such use.
There is growing pressure from the Congress to expedite the release
of new drugs to market. A bill known as 21st Century Cures is
working its way through the legislative branch and parts of the bill would appear to make it necessary for the FDA to
relax its strictures against off label promotion. And now the Second Circuit Court of Appeals has thrown another
monkey wrench into the FDAs attempt to keep a tight hand on the regulation of medications.
In 2012 the court reversed a lower court conviction of a pharmaceutical rep for talking about off label use of the
narcolepsy drug Xyrem (Alfred Caronia a sales rep for Orphan Medical). The court cited the First Amendment right to
free speech saying that the amendment protected truthful and non-misleading off label speech. Now a coalition of
drug manufacturer heavy hitters including Pfizer, Johnson & Johnson and GlaxoSmithKline calling themselves the
Medical Information Working Group is using the Caronia decision to pressure the FDA to relax its regulations. In the
tradition of government regulators, the FDA opposed to anything that might weaken its regulatory authority. But with
billions of dollars in potential pharmaceutical sales in play, the FDA is being out spent and out lobbied.
In a concession to growing pressure on all fronts, the FDA has announced plans to hold a public meeting later this
summer to hear drug company concerns about the harsh restrictions to off label free speech. Its hard to see any
losers in a compromise that allows the FDA to require uniform rules on the promotion of pharmaceuticals and
pharmaceutical manufactures to promote effective uses of their drugs while the often complex and time consuming
regulatory process inches forward. Stay tuned for developments.

MD PREFERRED PHYSICIAN CONSULTANTS

Dike Drummond MD is a Mayo trained Family Practice Physician with a unique combination
of ground level experience in medicine, coaching and personal and business development.
Dikes expertise in personal change was developed through a combination of 11 years as a
family practice doctor and 10 years as a business coach working with physicians and startup
entrepreneurs; he has also developed his own unique, interactive guided imagery practice.

Personal Finance

Tips & Tools from the world of financial planning

You have completed your medical training and
have moved into the world of medicine. You
are justifiably proud of your new six figure
salary and guaranteed contract. The future is
bright and the mountain of medical education
debt though imposing is manageable with a
little bit of planning. And as a young physician
starting out you are one of the wise ones who
has partnered with an experienced financial
plannerno rookie mistakes for you.
So, its time to push the beater that has served as the family car off the nearest cliff and put yourself and perhaps your
spouse behind the wheels of two suitably luxurious vehicles in keeping with your new status. To buy or to leasethat is
the question. Well, perhaps not the only question.
The case for buying a car is all about equity. At the end of your finance contract or when you are ready to trade for a
newer model you have something to show for your monthly car payments. On the other hand the leased vehicle
generally comes with little or no down payment, a lower monthly tab and a new vehicle every three years. And
maintenance costs are often included.
There are a number of economic factors that drive the purchase/lease decision and in todays economy the odds are
stacked very heavily on the lease side. These factors revolve around the used car market and the real verses projected
depreciation of a leased vehicle. Because space is limited for this column Ill keep it simple. Although there are some
signs of a pulse, since 2008 the auto industry has been in a coma. For many years sales of new cars were deeply
depressed. The result is a shortage of late model used vehicles. And this shortage is expected to extend well into the
future. So, come the end of your lease in three years there is a very good chance that you will beat the lease. You
might even have some equity in the vehicle!
And as a physician looking at a luxury vehicle the numbers are even more in favor of the lease route. A luxury vehicles
value is going to dramatically depreciate in the first two years. If you look to trade in three years after a purchase you
may actually be underwater. So much for the pride of ownership! And of course there is always the consideration of
business use of your vehicle and the resulting write off. But the rules are not as generous as they once were and unless
you are a country doctor making house calls in your company car you may find it hard to dip in the tax mans pocket.
For the time being, the numbers favor a leased vehicle for both the doctors vehicle and the family car.

Fun in the Sun

Spring is sprungthe grass is riz
I wonder where the sunscreen is
The Center for Disease Control and Prevention (CDC) is out with its
annual report on sunscreen use. Not surprisingly they report that a
very low percentage of citizens protect themselves from the
potentially harmful rays of the sun. According to their research only
14.3% of men and 29.9% of women use sunscreen regularly. And 33%
of those who use sunscreen havent a clue if their brand provides
broad-spectrum protection against both UVA and UVVB rays.
As a motorcycle enthusiast, your author spends a good amount of the time in the summer sun and I must admit, I wasnt
even aware that there were two flavors of rays I needed to worry about. It would seem that UVB are high energy rays
that cause sunburn. While UVA are lower energy rays that are actually more dangerous because they are present year
round, can go through clouds and glass and are the linked to melanoma, the most deadly form of skin cancer.
Although skin cancer is the third most common cancer in adolescents and young adults, protecting oneself is relatively
easy. The CDC recommends that you stay out of the sun during the hottest times of the day, wear protective clothing
such as a wide-brimmed hat and sunglasses and apply a protective amount of sunscreen every two hours. Although this
may be a practical proscription for most, it doesnt help an active biker. So I of course zeroed in on their advice
regarding sunscreen.
Consumer Reports is always a good place to search for product recommendations and they didnt disappoint. They
tested 34 brands of sunscreen and published their 2015's best and worst picks. It was interesting to note that 15 of the
brands they tested did not deliver the sun protection factor (APF) that they advertised. Part of the problem seems to be
that spray on sunscreens, although convenient, may not be used in great enough quantity to deliver the SPF claimed.
One final note. ..the FDA limits the level of chemical ingredient in sunscreen that produces the SPF and that limit maxes
out at around 20 SPF. In fact the FDA is thinking of limiting sunscreen labeling to claims of no higher than SPF 50. Any
sunscreen with an SPF of more than 50 is probably a waste of money because it simply isnt delivering a correspondingly
higher level of protection. So, enjoy the summer. Use common sense. And check out the old tube of sunscreen left
over from last summer. You may not be getting all of the protection you think.

MD PREFERRED PHYSICIAN CONSULTANTS

Drawing on personal experiences on all sides of health care as a patient, a physician, a
family caregiver, a business owner and an entrepreneur Dr. Vicki Rackner helps health care
professionals thrive in the era of ObamaCare.
This former surgeon and nationally noted authority in the doctor-patient relationship helps
clients achieve the personal, professional and financial goals that drew them to a career in
medicine. She offers a bridge between the world of medicine and the world of business.

Skip a meal and you just might gain weight

Dont you just love how some common sense approaches to some of
lifes little problems prove to be counter intuitive. As the old saying
goes, the best laid plans of mice and men often go awry. And speaking
of mice another batch of little furry creatures have been called upon to
aid human researchers in better understanding how fellow humans lose
and gain weight as they sit atop the food chain.
I dont know about those of you who follow my blog, but this author is
resigned to the fact that Ill never fit in those jeans that I used to wear
in college. To be completely honest, I never really had six pack abs. But at least I was able to see my toes and when
necessary touch them. Today it is a constant battle to just hold the line. And now I find that my favorite dietary strategy
may be causing more harm than good.
Whenever I get bored I like to pick up some lively reading like the Journal of Nutritional Biochemistry. And as I was
absorbing all kinds of useful knowledge I found the results of a new study published by researchers from The Ohio State
University and Yale. And it would appear that these knowledgeable gals and guys are bent on debunking one of my
trusted common sense approaches to fighting the battle of the bulge. Namely, skip meals, shed pounds and inches.
Enter our trusted white mice partners. After counting off by twos, group one was put on a steady diet of small meals all
day. They were allowed to nibble their way to health and happiness. And they did reasonably well. Group two on the
other hand were put on the fast & feast diet that I have used repeatedly with such spectacular absence of results.
Group twos rodents were fed just once a day(apparently the same amount that the nibblers got over the course of the
same day) and, no big surprise they literally inhaled their chow. Sound familiar?
Group two participants became what Martha Belury, the senior author of the study, likes to call gorgers. And even
after they were released from the diet they continued to behave as gorgers. But what really captured my attention was
the fact that not only did the little fellows gain back all of the weight they lost, but they actually began to increase the
amount of fat around their bellies.
A vastly simplified summary of the researchers findings show that the gorgers livers developed insulin resistance. The
livers stopped listening to insulin signals telling them to stop producing glucose (evil sugar). And that overdose of
sugar traveling through the blood stream headed straight for the waist line and parked there as adipose tissue (belly
fat). Next time someone tells you that you are becoming a bit chubby tell them it is just an excess of adipose tissue and
you are working on the problem. In short, the mice were consuming the same number of calories but they were now
storing the calories differently.
And what is the lesson to be learned? Snacking all day long on nuts, berries and twigs is a better strategy for controlling
your weight than skipping breakfast, lunch and dinner and consuming a bed time snack of a two pound porterhouse
steak. And if you find the prospect of munching on celery and carrot sticks unappealing you can join 108 million of your
fellow citizens who spend over $20 billion on weight loss products every year. By the way, did you know that 85% of
U.S. customers who consume weight loss products and services are women? But that is a story for another day.

2,147,483,647
On Tuesday, June 4, 1996 the first flight of the Ariane 5 rocket,
designed and funded by the European Space Agency was launched. It
was a relatively brief flight. It lasted exactly 39 seconds at which point
it exploded and transformed four very expensive satellites it was
carrying into $370 million worth of confetti. Fortunately it was not a
manned flight.
On Thursday, April 28, 2015 the American FAA reported that the Boeing
787 aircraft may have a potentially catastrophic problem where the control unit managing the delivery of power to the
jets engines might automatically shut down the engines if it has been left on for over 248 days. This is more than just a
potential problem on a scale of Canadian white mice contracting stomach ulcers from drinking six gallons of green tea
each day for a month of Sundays. You see the control units are not normally shut down in between flights or even in
between scheduled maintenance.
What, you may ask, do these two events share in common? It would seem that they share the number 2,147,483,647.
Without going completely off the deep end with IT minutia, the above stated number is the maximum positive value
that can be stored by a 32-bit signed register. In laymans terms, many modern computer systems commonly use 32bit signed registers. Now 2 billion would seem to be a pretty big number. But for modern computers it is on a level of
2+2=4.
Here is the problem in an oversimplified analog nut shell. If the odometer on your car can only handle a number as large
as 99,999 and you travel beyond 102,000 miles, the odometer simply rolls over and starts over. It cannot recognize a
larger number, becomes confused and reboots. In the digital world of computers the register controlling the computer
that controls the gadget can become overwhelmed, confused and generally schizoid. The point at which it blows a fuse
is determined by the size of the register.
Take the Ariane 5 event. The rocket actually had a much older 16 bit register left over from the previous generation of
rockets. No one gave it a thought. A 16 bit register goes gaga at only 32,767. When the rocket censed lateral velocity in
the newer and faster rocket that exceeded its limited ability to comprehend, it went to fail safe and blew itself up.
Oops!
The Boeing 787 issue did not come to light until a number of amateur geeks pointed out that if you count time in 100ths
of a second (as apparently computers do) 2,147,483,647 100ths of a second works out to beyou guessed it248 days.
As if I didnt have enough flight worries with terrorists, deranged pilots and global warming.
So, why should doctors and hospitals and patients worry about this seemingly esoteric digital dilemma? Well, how many
of your hospitals cutting edge technology diagnostic, surgical, imaging, and monitoring devices are managed by micro
chips? And how many of them have a signed register tucked away in some corner of its brain? And what size is the
register. And what units of time does it spend its days counting? Do the devices ever get turned off? And what will
happen if it reaches fail safe and shuts itself off in the middle of a procedure? I may be tilting at windmills here but it is
certainly something worth worrying about. I know that it will be one of the last conscious thoughts Ill have as my next
surgery is set to begin and the cute CRNA puts the gas mask over my face and instructs me to start counting backwards
from2,147,483,647.

Mind controlled bionic limbs

Ossur, an Island based global leader in non-invasive orthopaedics, is
focused on improving peoples mobility through the delivery of
innovative technologies within the fields of Prosthetic,
Osteoarthritis and Injury Solutions. They recently announced
positive results in two tests of their mind-controlled bionic
prosthetic lower limbs.
According to the company, two amputees equipped with their new
technology are now able to control their bionic prosthetic legs with their thoughts, thanks to tiny implanted myoelectric
sensors (IMES) that have been surgically placed in their residual muscle tissue. The IMES instantaneously triggers the
desired movement, via a receiver located inside the prosthesis. This process occurs subconsciously, continuously and in
real-time. Mind-controlled Bionic prosthetic legs are a remarkable clinical breakthrough in next-generation Bionic
technology, said Jon Sigurdsson, President & CEO of ssur. By adapting not only to the individuals intentional
movements but to intuitive actions, we are closer than ever to creating prosthetics that are truly integrated with their
user.
According to Dr. Thorvaldur Ingvarsson, MD, PhD, the orthopaedic surgeon who leads ssurs research and
development efforts and spearheaded the mind-controlled prosthetics project, movement in able-bodied individuals
generally begins subconsciously, which triggers electrical impulses inside the body that catalyze the appropriate muscles
into action. ssurs new technology replicates that process in an amputee: that electronic impulse from the brain is
received by an IMES that was surgically placed into muscles in the amputees residual limb.
The technology allows the users experience with their prosthesis to become more intuitive and integrative, Dr.
Ingvarsson said. The result is the instantaneous physical movement of the prosthesis however the amputee intended.
They no longer need to think about their movements because their unconscious reflexes are automatically converted
into myoelectric impulses that control their Bionic prosthesis.
The implant surgery is relatively simple and is done under a local anesthetic. The implanted IMES are very small and
because the brain is signaling residual muscle tissue using the bodys own neural pathways, no brain electrodes or
surgery are required! Ossur hopes to move into aggressive clinical trials with the new technology and bring products to
market in three to five years. Science marches onliterally!

MD Preferred Services is the only comprehensive online resource center for doctors. Each year MD Preferred
identifies and promotes uniquely qualified, doctor friendly, community based, preferred professionals from a wide
range of disciplines including: Accountants, Attorneys, Bankers & Mortgage Lenders, Financial Advisors, Insurance
Agents and Realtors. Visit us at www.MDPreferredServices.com

Apples growing investment in healthcare

In the poorest parts of Africa one of the most common health problems is blood parasites. And as is the case with many
health issues in 3rd world countries, accurate diagnosis is often more of a road block to cure than are available medicines
and treatment regimens. Seeing a hematologist can entail long trips and expenses that the average citizen can simply
not afford.
Enter a team of IT and healthcare researchers at UC Berkeley. They have produced software and hardware that can
identify blood parasites in the field in less than three minutes. The projects name, CellScope Loa, uses a 3D-printed box
(very low manufacturing cost) on which a smart phone (Apple only thus far) can sit. The device takes five-second videos
of blood samples which are analyzed by a companion app. When movement of microscopic worms is detected, a
diagnosis for river blindness and elephantiasis among other diseases caused by blood parasites can be made. And the
drugs needed to treat these parasites are readily available.
But there are challenges that remain. One of the challenges are the potentially devastating side effects that the drugs
can have. If a patient is also suffering from African eye worm, or Loa Loa, the drug that can successfully treat other
blood parasites can cause death or traumatic brain damage. Thus the name of the project, CellScope Loa. At present,
health campaigns in African countries have halted by the fact that a cure can sometimes do more harm than good.
With the low cost of the programs components and their ability to screen out Loa Loa patients, it is hoped that
aggressive public health initiatives will once again be possible. A planned trial in Cameroon will further test the efficacy
of the system. Increasingly the I Phone and other smart phones are becoming sophisticated tools that dedicated
physicians can use to bring cutting edge healthcare to remote, third world communities.

The Mouse That Roared

Well here is another interesting research study that any Renaissance man will find fascinatinghow about a Renaissance
mouse. It would seem that scientists with an excess of time on their hands have found a way to increase the size of a
mouse brain by injecting a strand of human DNA (called HARE5) into a mouse embryo. And as they postulated, it
resulted in larger brain sizes. And you will be happy to know that the increase in brain size was greater than when a
similar strand of Chimpanzee DNA was used. Another validation of the theory that we are smarter than monkeys.
There isnt all that much difference between our genetic makeup and that of a Chimp. Our DNA is actually about 95%
identical. But its that other 5% that keeps us at the top of the food chain. And our bigger brain seems to be the
benefactor of that differential. I am told that the average human brain weighs in at 1,352 grams and that of a chimp a
mere 384. That would explain why chimps are such lousy poker players. By the way, did you hear that a super
computer recently out played the top human poker players? Perhaps we should stick some micro chips in a mouses
brain and see how that plays out.
Debra Silver, an assistant professor at Duke University Medical School, and a member of the research team believes we
have just scratched the surface in what we can gain from this line of study. Hmmm. I assume she is referencing
advances that will accrue to the benefit of humans and not just smarter mice. Actually, this research can be seen as a
small step toward finding ways to repair, replace or grow human brain cells. And such advances could benefit patients
with Alzheimers and other diseases affecting the brain. And that is the piece of cheese at the end of the maze that
makes it all worth.

Government Speak
Doctors and hospitals are reimbursed by Medicare and Medicaid for their services to elderly and poor patients. The
reimbursement is regulated by the CMS. This is the lead agency in the governments daily battle to control the ruinous
rise in healthcare costs. Their primary regulatory weapons in this war are the formulas and principles that they set to
determine how much government money flows to healthcare providers. Because these regulations, once in place,
become the law of the land, annual proposed changes are closely watched and analyzed by the healthcare industry.
Government speak has raised the use of clever acronyms to an art form. The names of agencies, programs and
initiatives are often determined by how cute their acronym will be. Here is just a sampling of the alphabet soup that
permeates medical journals and government entities:

HHS - United States Department of Health and Human Services the cabinet level department of the U.S.
government that is charged with protecting the health of Americans and providing essential human services.

HCFA Health Care Financing Administration the former name of the government agency within HHS that
manages Medicare and Medicaid now known as CMS

CMS The Centers for Medicare & Medicaid Services the federal agency with HHS that administers the
Medicare program and works with state governments to manage Medicaid which provides subsidized
healthcare services for the poor and also administers SCHIP and HIPAA

HQSRR Hospital Quality and Safety Reporting Requirements part of Medicares reimbursement formula that
is designed to move physician and hospital reimbursement toward a payment model that rewards quality over
quantity

PQRS Physician Quality Reporting System - a CMS program initiated in 2006 described as a pay-for-reporting
incentive that pays physicians a bonus for reporting quality data

EPIP Electronic Prescribing Incentive Program another CMS initiative designed to move doctors toward
electronic prescription technology and devices that minimize miscommunications and adverse drug interactions

SCHIP State Childrens Health Insurance Program a program that provides matching funds to states for
health insurance for uninsured children in families of modest incomes that are too high to qualify for
Medicaidnow more commonly known as CHIP.

HIPAA Health Insurance Portability and Accountability Act of 1996 The Act has two primary partsTitle I of
the act lays out regulations that protect the health insurance coverage for workers and their families who have
lost their jobs or are changing jobs. Title II of the act establishes national standards for electronic health care
transactions and governs very strict privacy rules for the handling of personal healthcare records and
information.

EHRs Electronic Health Records government mandated digital records that will replace paper records of our
health history including doctor visits, test results, medications, diseases and disabilities. There are still many
issues to address including privacy concerns and hardware and software standards that allow the transfer and
sharing of records from one healthcare entity to another.

NCHIT National Coordinator for Health Information Technology The government Czar charged with making
EHRs happen.

APIs application programming interfaces pieces of software code that give patients access to their medical
information on their smart phones and other mobile devices

Common sense trumps religious freedom

One of the founding principles of this country was religious freedom. Congress shall make no law respecting an
establishment of religion, or prohibiting the free exercise thereof... And along with other guaranteed freedoms, it has
weathered the test of time. But in the healthcare arena, religion and medical research and technology have increasingly
been at odds.
When one considers that many of the founding texts of the major religions date back thousands of years it should not be
surprising that literal adherence to religious dogma can lead to undesirable consequences. And immunization for
childhood diseases is one of the most hotly contested examples. Religious fundamentalists (not just Christian, Jewish or
Muslim) often turn their backs on modern science (with the obvious exception of bullets and bombs). Their version of
the creator is all powerful and if their lord wants a child to be healthy and to live a long life, then who is man to stand in
the way of divine guidance. If illness threatens, they turn to prayer rather than medicine; faith healing rather than
pharmaceuticals, divine intervention rather than preventive medicine.
And it is in the area of childhood immunizations that even diehard conservatives and liberals alike are having some
problems defending the rights of some parents. Personally I am willing to stand aside when a parent genuinely believes
that they know what is best for their own children. I cringe when I read stories of young children who ultimately perish
after their parents withhold potentially lifesaving modern medical care. And shake my head when they staunchly say
their loss was Gods will.
But I do have a problem and am prepared to push back when their decisions threaten the health and well being of my
children. If a fundamentalist is prepared to stand by and watch a loved one suffer and die, well, that is their choice and I
cant change the world. But if their decision leads to suffering and possible death to my own, that is a line that they
cannot cross. And such is the case with a refusal to have their children immunized against highly contagious childhood
diseases like measles and polio.
If a parent, citing religious beliefs refuses to have their children immunized, than it is this authors studied opinion that
they forfeit the right to have their children mingle with the general population. And that includes public places such as
schools, shopping malls and other places where card carrying members of the 21st century gather. But even enforced
isolation is not a practical solution. It is simply not possible to enforce such restrictions and sooner or later their kids will
slip into Disney World and sicken their fellow citizens.
Thus I find myself doing something I would have thought impossible. I am agreeing with legislation put forward by two
California liberals, Democratic Sen. Richard Pan, of Sacramento and Ben Allen, of Santa Monica, dubbed Senate Bill 277.
The legislation which passed the state Senate on Friday would not allow personal or religious exemptions to infant
immunization. It would require every child to be vaccinated for such diseases as measles and polio, before entering
kindergarten. If it makes it through the state assembly and if Governor Jerry Brown signs it into law, as he has signaled
he will, California would join Mississippi and West Virginia as the only states in the union where common sense has
finally trumped religious myopia.

Trust in the Lord with all your heart, and do not lean on your own understanding
Words to live by22 centuries ago.

Riding Lifes Arc

By: Anthony J. Ogorek, Ed.D., CFP, Ogorek Wealth Management LLC,
www.ogorek.com
Most physicians would like to view their lives, or at least their life expectancy, as a
continuum projecting out to infinity. The unfortunate truth is that our lives can more
practically be viewed as being on an arc comprised of a beginning, middle and an end.
For some odd reason, perhaps self preservation, we tend to park ourselves
comfortably in the middle of the arc, regardless of our age.
This creates the impression that our lives are static, rather than continuously moving forward. Understanding this fact
can radically change not only long held habits, but how we perceive our place in the world.
For example, many of our consumption habits may have been developed when we had little or no money. As we
accumulate money over time, we can definitely afford to change our spending habits but dont because we do not see
our lives moving on the arc; we see ourselves stuck in a moment of time. Therefore, a successful physician may still take
the Super Shuttle from the airport instead of a cab or limo not because he or she cannot afford the other choices, but
because they dont realize their life has changed and they can afford more convenience. How about bothering a relative
to do drop off or pick up duty at the airport in order to save the cost of long term parking?
One can look at the cost of driving instead of flying, settling for the cheapest concert or play tickets rather than ones
that may offer a better vantage point as signs that we have stopped evolving. How about philanthropy? Do our giving
habits reflect our station in life, or are they based on where we were financially during medical school, residency or
fellowship?
An awareness of where we are in the circle of life is not something to be feared. Reassessing our position on the arc
can help us to appreciate each phase of life as well as reduce anxiety. This awareness can also give us an interest as well
as the courage to embrace different experiences, with different people as we ride lifes arc. Heres wishing you the ride
of a lifetime.

THE RECRUITERS CORNER

Tips and Tools from Todays Physician Recruiter
Submitting a CV to a potential employer without a cover letter is
rather like omitting the opening chapter of a novel when submitting it
to an editor. I have spoken with practice managers who regularly
discard unsolicited CVs that arrive without a cover letter with little or
no review. The cover letter is quite simply an introduction. It is the
first important step in forging a relationship.
While its true that credentials win jobs, the cover letter is often the
means by which a candidate secures an interview. No interviewno
job offer. There are rules of etiquette and strategy that guide the
construction of an effective cover letter. Lets take a look at a few.

1. If you want to lose the race before the opening gun is fired, send a form cover letter.
It never fails to amaze when a physician, a technically skilled, highly educated professional submits a resume with a form
cover letter beginning with something like, Dear Sirs. If you are not going to take the time to find out who the
interviewer is, and cannot take the time to create an original cover letter that speaks directly to the recipient, dont
bother applying.
2. Never lose sight of the purpose of the cover letter.
It is designed to gain you an interview. Practice managers and hospital interviewers will reference your CV to search for
key skill sets. They will review your cover letter to determine why you are interested in their opportunity. In fact, one
could accurately say that the cover letter and the CV serve no other purpose than to secure the interview.
3. Little things matter.
If you are applying for a career opportunity that is likely to change your life and the lives of your family forever, invest a
few bucks in first class stationary paper upon which to print both your cover letter and your CV. Dont print your CV on
high-end cotton paper and send it with a cover letter printed on 20 # copy paper that you use in your laser printer.
4. Address your strengths in your cover letter and your weaknesses in the interview.
This one could go either way. You dont want to waste your time and the time of an employer by applying for a position
for which you are clearly unqualified. At the same time if you meet the vast majority of the job requirements listed, and
believe that you can acquire the skill sets you are lacking, address what you bring to the table and state that you are
always improving your clinical skills.
5. Addressing your current employment
Dont be afraid to state clearly in your cover letter that you are currently successfully employed but believe that both
the opportunity and location would be a positive career step that is not available with your current practice. And by all
means, clearly state the confidential nature of your inquiry.
6. Dont forget to whom you are writing.
A dissertation on your sterling qualities and accomplishments without a reference to the practice group or hospital to
which you are applying is both arrogant and foolish. You might just as well print out a couple dozen form letters like
those described in our first point and send them off with your CV. You are applying for a very specific opportunity at a
very specific facility. Bring their needs and your potential contributions into the message.
7. How long should the cover letter be?
Ideally one pagetwo pages at the most. Remember your goal. You want to introduce yourself, establish report, stress
the relevance of your candidacy and get an interview!
8. In conclusion
Once you have accomplished your objectives and have edited your draft (this is a critically important document that
deserves an investment of time and brain cells) wrap it up with a thank you and a call to action. Thank you for your
time and consideration. I would welcome the opportunity to address any questions you may have and to discuss further
the contribution that I can make to your practice group.
It always helps to put things into perspective. You spent four years in college, three years in medical school, three years
in residency and three years in fellowship. How much time are you willing to invest in a killer cover letter?

NEW HEALTHCARE OPPORTUNITIES

Provided by MedicalMatch.org
Emergency Medicine - Atlanta, GA - EmergiNet
You may know Atlanta as the unofficial capital of the South, but theres more to this city than its southern
location. If you make your home in the Peach City, youll find an undeniable mix of Southern charm,
sophistication and traditions. Atlanta continues its reputation as a transportation hub with the worlds largest
airport and easy access to I-75 & I-85. When it comes to Atlantas reputation for growth and innovation, health
care tops the list as the citys facilities expand and improve services across the metro area. Serving some of the
fastest growing hospitals is EmergiNet.
EmergiNet has positions available for BC/BP, EM residency trained physicians for work in hospitals
surrounding the Atlanta metropolitan area. We work as a team emphasizing quality emergency care, dedicated
customer service, professional and personal growth. Highlights include: Fee-for-service model having most
MDs starting at around $350k with no ceiling; Profit sharing plan after first year including tax-deferred
compensation to supplement 401k(100% vested immediately); Physician-centric practice owned and run by
physicians; All facilities located within 30 minute drive from downtown Atlanta.
EmergiNet provides a full range of clinical and administrative professional services to the facilities we serve.
Our mission is to maximize patient care and facility resources, as well as educate, facilitate and integrate the
delivery of health care within the community. We continually seek ways to enhance the level of excellence and
quality in the services we provide to our clients. To review this and other opportunities E-mail CV to Neil
Trabel, ntrabel@emerginet.com; fax 770-994-4747; or call 770-994-9326, ext. 319. Please
visit www.emerginet.com for more information.
Staff Physician Needed Toledo, OH The Pediatric Center
Staff Physician needed immediately to join an established Pediatric practice. You will be joining a medical
staff that includes 3 physicians, 6 mid-level providers, supported by 12 nurses. The practice is affiliated with 5
hospitals. Our physicians round on newborns only. We do not attend c-sections. We utilize pediatric
hospitalists and/or specialists for patient admissions. Mid-level providers are on call for parents/patients.
Diagnostic or Interventional Radiologist Providence, RI
A great opportunity for Diagnostic or Interventional Radiologists to join a well-established Imaging Network in
Providence, Rhode Island. The group is open to a Diagnostic; Interventional or any other subspecialty you
possess. Excellent compensation offered along with generous benefits. In addition, there would be an
opportunity to teach and or do research, if desired. One year to partnership for an experienced Radiologist and
Two years for a new grad. There is no buy-in! 1:6 call. Providence has a lot to offer and is just under 45
minutes to Boston.

OBGYN Indiana
Exceptional opportunity to join a busy, vibrant team Call 1:6. State of the art Medical Center. Very
competitive compensation and comprehensive benefits including Educational Loan Assistance, Signing Bonus,
Paid Malpractice, Paid CME, Relocation, and much more. This city offers excellent public and private schools,
University/Colleges and airport. Enjoy an abundance of cultural and recreational activities including water
sports, low tax base, safe neighborhoods, low cost of living, and more. Enjoy an exceptional quality of life.
Indiana is among the top 3 places in the nation in which to practice medicine due to its favorable malpractice
climate. (Medical Economics)
Family Practice Greenville, IL
Greenville Regional Hospital, a 42-bed full-service hospital located in Greenville, Illinois, is seeking a BC/BE
Family Medicine Physician to join their team. The ideal candidate will be interested in performing the full range
of Family Medicine, have the ability and desire to build long-lasting relationships with patients and be a part of
the community.
Greenville Regional Hospital is hospital employed, outpatient only; competitive salary with productivity
bonuses; relocation reimbursement and sign-on bonus offered; student loan repayment options; full benefits
package including malpractice and tail coverage; rural background or preference for rural medicine is a plus.
Greenville, Illinois is located approximately 45 minutes east of St. Louis, Missouri. The home
of Greenville College, Greenville is a modern small town that offers solid, Midwestern values and an
intellectual feel. The community is close to a major metropolitan area and access to cultural events, shopping,
sports and other amenities, yet its residents are able to embrace the advantages of a rural setting with a lack of
congestion, pollution and crime.
Family Practice Illinois
Excellent opportunity to join a very busy practice adding to their team due to continued growth. State of the art,
award winning health system. Very competitive compensation and comprehensive benefits including flexible
insurance plan, generous vacation, flexible retirement plan, relocation, Academic appointment available, and
much more. Located in a vibrant city with excellent public and private schools and numerous cultural and
recreational activities. Easy access to Chicago.
Primary Care Cincinnati, OH
Primary Care Cincinnati, Ohio One of the top integrated health systems in Greater Cincinnati is seeking
physicians trained in Family Practice, Internal Medicine, Emergency Medicine, Internal Medicine/Pediatrics or
Occupational Medicine to practice in one or more of their facilities. These physicians will staff a Priority Care
facility for internal primary care patients, as well as community urgent care illnesses. Employed opportunities
located in Cincinnati, Ohio Full-time and part-time positions are available No inpatient or call responsibilities
Flexible 2015 start dates New state of the art facilities with fully equipped lab and x-ray services Complete
benefit package with malpractice, long term disability, medical/dental coverage, relocation, retirement plan with
matching employer funding. Competitive guaranteed base with bonus incentives Weekend and holiday pay
differential. To learn more, contact Arleen Richardson arleen.richardson@rmmedicalsearch.com
Job #21463
Dermatology Quincy, Illinois
Blessing Hospital is seeking a Dermatologist for a full-time employed position with Blessing Physician Services
in Quincy, IL. Must be Board Certified or Board Eligible in Dermatology. The candidate must have a solid
work ethic and dedication to providing comprehensive healthcare to patients and their families. The ideal
candidate will strive to become an active member of the community, as well as uphold the core values of the
hospital.