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Physician Sense

Student Loan Repayment Options for Doctors

Maybe you weren’t lucky enough to attend medical school at NYU for free. If that’s the case, you’re likely one of the doctors who graduated medical school with a median loan debt north of $200K. In case you missed our recent post on how to avoid being a broke doctor, step three is to deal with your student loan debt load. With that in mind, we put together this quick reference guide for various student loan repayment options. In the coming weeks, we’ll review the ins and outs of each option.

The first two options are for doctors who have the money to pay their loans, but would like to streamline their finances a bit, and maybe save a little money in the process.

Consolidation vs. Refinancing

Think of consolidation as a way of keeping things simple. Instead of paying off multiple federal loans, you combine them. That means you only have one monthly payment to worry about. Consolidating might also make you eligible for other repayment options or forgiveness. More on that later. Only federal loans are eligible for direct loan consolidation.

Refinancing also simplifies things. Your loans — public and private, all or some — get combined into a single private loan, hopefully (if you’ve done your homework and your credit is good) with a lower interest rate.

Next up, let’s say you didn’t land your dream job, or you overestimated what being a pediatrician in Buford, Wyoming would pay. You may qualify for a repayment plan that scales based on your take-home pay, through income-driven repayment.

Income-Driven Repayment

Income-driven repayment options offer the loan holder the ability to scale their required monthly payments according to their income level. Only federal loans are eligible for these plans. There are four income-driven repayment options:

  • Revised Pay-As-You-Earn Repayment Plan (REPAYE): Payments are 10 percent of your discretionary income, divided by 12.
  • Pay As You Earn (PAYE): This plan is the same as the previous plan, but to qualify, you must be a new borrower as of Oct. 1, 2007 and have received a loan disbursement on or after the same date. This also only applies to Direct Loans.
  • Income-based Repayment (IBR): You’ll find the same formula here: 15 percent of discretionary income (or 10 percent for new borrowers) divided by 12 months gets you your monthly payment. This covers FFEL Program and Direct Loans. Caveat: Consolidation loans that include at least one Parent PLUS Loans and Parent PLUS Loans themselves do not qualify.
  • Income-contingent Repayment Plan (ICR): With this plan, your monthly payment will be the lesser of either your payment under an income-adjusted, monthly payment plan over 12 years, or, 20 percent of discretionary income, divided by 12 months. This plan also has some caveats. It’s the only option available for Parent PLUS loans. Parent borrowers can consolidate Direct PLUS or Federal PLUS loans to form a Direct Consolidation Loan, then repay the new loan using Income-contingent Repayment.

But what if you just don’t feel like paying  your whole loan? Can’t say I blame you. You didn’t hear this from us, but you may not have to.

Forgiveness and Public Service Loan Forgiveness (PSLF)

Forgiveness

If you’re in an income-driven repayment plan and you’ve made 240-300 qualifying payments, then you may qualify for having your balance forgiven. Income-driven plans are available to all, regardless of your employer. The primary benefit is lower monthly payments while your income is low. The major drawback of this option is that you will owe income tax on the amount forgiven. It’s essential to compare the amount that you’ll owe in taxes with your loan balance to determine if it’s worth it.

PSLF

To obtain PSLF, you must:

  • Be participating in an income-driven plan
  • Be working for an eligible non-profit
  • Complete annual employment certification, proving that you work for an eligible non-profit

PSLF applicants must make 120 qualifying payments while meeting all three of the aforementioned criteria. The primary benefits are fewer payments (compared to 240-300 under regular forgiveness), and you won’t have to pay taxes on the amount forgiven. The drawback: You may be limiting your career prospects by only working for qualifying non-profits. But be forewarned, you need to make 10 years’ of qualifying payments while working for a non-profit to obtain PSLF, so make sure it’s a job you enjoy.

Now, let’s say you’ve experienced a major financial hardship, like a disabling medical condition or suffer a long stretch of unemployment. You may qualify for loan deferment or forbearance.

Deferment

Deferment temporarily suspends student loan payments. The loan balance remains the same, you’re just delaying future payments rather than defaulting on the loan. Generally, the loan holder needs to show some kind of hardship or inability to pay. Read the qualifications carefully. With some types of loans, you don’t have to pay accruing interest while in deferment.

Forbearance

Like deferment, forbearance is a temporary suspension of student loan payments due to hardship or inability to pay. Unlike deferment, the loan holder must pay accruing interest, but gets a break from paying the principal. Accrued interest gets added to the principal. Again, read the qualifications carefully.

TL;DR

Are you able to make your loan payments, but want to simplify things a bit and/or possibly get a lower interest rate? Then consolidation or refinancing may be your best bets. Not bringing in as much money as you thought you would? You could look into Income-Based Repayment. Hit some financial hardship? You may qualify for forbearance or deferment. Maybe you have a government job and a have made a number of payments already? Look into loan forgiveness.

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Are Millennials Fueling Physician Burnout?

Not another “those damn Millennials!” post. ‘Fraid so. But here’s the thing: Work hour restrictions may have some unintended consequences. They include millennial doctors who are a) less prepared to join a workforce of baby boomer colleagues and b) physician burnout.

In a recent post, Dr. Drummond, who is CEO of The Happy MD and author of Stop Physician Burnout, delved into the causes of and possible solutions for burnout. This week, he explains how the changing work culture brought on by new physicians is exacerbating the issue.

Drummond says it was once common for doctors to work 36-hour shifts every third day for a month or more. He can remember working 126 hours in a week on an inpatient pediatric rotation his internship year.

“That has consequences,” he says. They include suicide, poor patient outcomes, and mistakes due to physician overload. “We are completely exhausted, yet we keep showing up no matter what. It’s a piece of the never-show-weakness programming” that also leads to burnout.

While overwork certainly leads to physician burnout, it seems that so can underworking doctors in their residency.

“What ends up happening is the current generation of doctors, trained in an environment of work hour restrictions, are not pushed as hard as the boomers. As a result, they aren’t as thoroughly conditioned as we were” he says. “The screws were put to our generation and before. The screws were intentionally unscrewed for them.”

Less Prepared

Fewer hours spent working during residency also means less knowledge acquired. That leads to a more prolonged onboarding process for new physicians in their first clinical jobs. Drummond says this also leads to, “an early flush of burnout in recent residency graduates as they try to keep up with boomer colleagues and are suddenly asked to work harder than they have ever worked before.”

Work hour restrictions have also played a role in worsening the physician shortage.  

Drummond explains that millennial physicians often won’t accept the baby boomer’s definition of “full time,” which can be in excess of 60 hours weekly. It is common for a Millennial new hire to request 0.8 FTE instead. Historically, CMOs may have not offered a less-than-full-time option. Now that multiple qualified candidates are turning down 1.0 FTE positions, CMOs are offering less than full time to new hires in order to meet patient volume demands. This steady drop in the workload of group members only exacerbates an existing physician shortage.

Older physicians, who are still working on the old FTE definition, will often follow suit, requesting the same 0.8 FTE option. With younger and older physicians working less, the pressure increases on those remaining physicians working full time and full speed. It is not uncommon, Drummond says, to hear these Baby Boomer physicians say things like, “These new doctors don’t know how to work hard and they just don’t care.”

Drummond says in actuality, “The new generation of doctors works differently and cares differently and have better boundaries than doctors my age. They are redefining the meaning of full time for all doctors.

“It remains to be seen how healthcare will address the worsening doctor shortages in the years ahead as the gladiator style work hardening of the good old days comes to an end.”

TL;DR

Millennial doctors, shielded from longer residency hours, may not be as prepared for the stress of actual life as a doctor. This could be contributing to physician burnout. Their desire to work shorter hours is also contributing to the doctor shortage, and perhaps indirectly leading to secondhand burnout, as well.

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These Finance-Savvy Doctors Made These Big Mistakes so You Don’t Have To

Whether you’re just coming out of residency and that first big paycheck is burning a hole through your pocket, or you’ve been practicing for years and have your fair share of financial-investments-gone-wrong stories, it’s always interesting to see what those with an established financial online presence have to say. Take a deep breath, and maybe a cold shower. Don’t end up a broke doctor and listen to some pearls of financial wisdom from these six leading physician financial bloggers.

White Coat Investor: Wait a While to Buy a House

Jim Dahle is an emergency physician and the White Coat Investor. Dahle made his foray into personal finance and investing after he got tired of being ripped off by financial professionals. His mission is to teach financial literacy to doctors. His hard-learned lesson involves a house:

“I wish I had waited to buy a house until I was in a place I knew I’d be for at least five years. At least I’m not alone in making this common mistake. Other common mistakes I made were mistaking a commissioned salesman for a financial advisor and buying a whole life insurance policy that was completely inappropriate.”

Ben White, MD: Use Discretionary Time Wisely

Ben White is a Texas-based physician and all-around fascinating guy. In addition to being a prolific, insightful blogger, he also has written several books for doctors and curates Nanoism, an online publication for Twitter fiction. Dr. White offered the following:

“The ‘correct’ answer is usually to spend less on a car, not buy a house, put more away for retirement, and get disability insurance. But looking back, my biggest real regret is not being more purposeful with my discretionary time. Time outside of work obligations has both a monetary and nonmonetary value, and I was very free with spending too much of it to ‘maximize’ my income at rates that are trivial to me now. I was worth more on a per-hour basis back then, even if I didn’t realize it.”

Physician on FIRE: Start with a Starter Home

Physician on FIRE is a practicing anesthesiologist with a secret identity who writes about strategies for Financial Independence and Retiring Early (FIRE, get it?). Think of him as Mr. Money Mustache for Doctors. Here’s what POF had to say:

“I did a few things right. I worked locums exclusively for a couple years, practiced in different settings, and saved much of my income those first two years.

“When it was time to settle down in one place, we decided to build our dream house on the water without knowing enough about the hospital’s financial situation. Four years later, the hospital would go bankrupt, and I be left with one of the nicest homes in town and few viable buyers. When it eventually sold, I lost nearly a quarter million dollars on that house. I should have taken the advice to start with a starter home.”

Wealthy Doc: Beating the Market is a Myth

Wealthy Doc is another established physician financial blogger who writes about creating financial freedom. He also happens to hold a finance MBA from a top-20 business school. He’s completely debt-free and gets returns in the top 15 percent of all investors. He advises the following:

“I wish I didn’t waste so much time trying to ‘beat the market.’ I thought a smart analytical mind like mine could study and discern the patterns that predict outstanding performance. I didn’t want to just settle for ‘average.’ As a result, I wasted a lot of time and money reading useless information and increasing my transaction costs and taxes.”

A Good Life MD: Rent Out of Residency for a Year

A Good Life MD is a radiation oncologist and father of two who writes about finance, as well as some big-picture topics, including morality, charity, compassion, mindfulness, meaning and purpose. Some of his recent blogs posts include defining happiness, investing in your wellbeing and real estate wisdom. He offers the following:

“I would not have bought an expensive house out of training. I would have rented a modest home to get a lay of the city, schools, churches, food, etc. and most importantly see if I like the job! Rent out of training for at least a year.”

Wall Street Physician: Index Funds are Your Friends

Before becoming a doctor, Wall Street Physician was a trader at an investment bank on, you guessed it, Wall Street. He brings real-world experience as a physician and financial professional to his frequently updated blog. He gave this advice:

“I spent far too many years trying to find a magic trading strategy that would help me beat the market. I strongly recommend all new investors to understand the basics of index fund investing, and realize that your market returns are not correlated with the time you spend analyzing the financial markets.”

TL;DR

Note well, doctor: Four out of the six doctors we spoke with mentioned mistakes concerning the purchase of a house. Don’t make a permanent move until you know your employer’s financial standing. Don’t buy a house unless you’re sure you want to be in that location for five years. Rent for a while in a city that you’re inclined to settle into so that you get the lay of the land. And when it comes to investing, trying to beat the market is futile. The best thing you can do is financially educate yourself.

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Opinion: Time for an ABIM Board Review on Maintenance of Certification

Why won’t the American Board of Internal Medicine (ABIM), a tax-exempt 501c3 organization, and its shadow organization, the ABIM Foundation, answer questions regarding their $2.3 million condominium purchase, Cayman Island investments, political lobbying efforts, spousal travel fees, and tax form discrepancies for this piece about Maintenance of Certification, published on Physician Sense? This is unusual behavior for a 501c3 non-profit organization.

When first conceived in 1936, ABMS board certification was little more than a medical accolade. From the ‘70s to the ‘80s, board certification was allowed — by working physicians too busy doing the real work of patient care — to morph into a multi-billion-dollar business for the American Board of Medical Specialties (ABMS) and its 24-member boards (including the ABIM), subspecialty societies, and the other member organizations of the Accreditation Council for Graduate Medical Education (ACGME).

Not only have fees mushroomed 276 percent in the last 18 years, but our personal and certification data, updated daily, is being sold for profit to third parties for their benefit, not the benefit of patients or the physicians. Maintenance of Certification (MOC), then, is not about keeping up with the expanding medical knowledge, but rather it’s a clever business arrangement that sells physicians’ personal and practice data to control the healthcare marketplace through group purchase organizations like Premier, Inc, which serves more than 3,900 of the nation’s hospitals and supports payment denials from insurers.

No data exists regarding improved patient outcomes from physicians with lifetime certification compared to time-limited certification. To the best of our knowledge and belief, it has become increasingly evident that ABIM has engaged in fraud and consumer fraud activities for its own political and financial benefit. Some working physicians lost their jobs, had to relocate, or were forced into retirement after refusing to recertify. Patients lose when this happens.

It is time for the deception to end. Please consider donating to Practicing Physicians of America to help fund a pre-litigation investigation of the ABIM and the ABIM Foundation concerning MOC and to draft a complaint against the ABIM and its collaborators. From now until our campaign ends, an anonymous physician donor has offered to match contributions dollar-for-dollar. Together, we can restore the integrity of the U.S. physician board certification system to its rightful place without the threat of losing our ability to work.

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What the Proposed CMS Changes Actually Mean for You

Some news that might have fallen through the cracks heading into the recent holiday weekend: 170 physician groups from multiple specialties sent a letter to the Centers for Medicare and Medicaid (CMS) asking them to reconsider the proposed changes to billing for evaluation and management (E&M).

The doctors behind the letter, which was distributed by the American Medical Association, struck a help-us-help-you tone, acknowledging that the administration’s proposal, called Patients Over Paperwork, though well-intentioned, “could hurt physicians and other healthcare professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care.”

The changes might also hurt specialists’ wallets. In what appears to be a similar version of the AMA letter, the American College of Rheumatology put it more bluntly:

“We urge CMS to reconsider this proposal to cut and consolidate evaluation and management services, which would severely reduce Medicare patients’ access to care by cutting payments for complex office visits.”

Despite a potential pay cut, the doctors behind the AMA letter write that they like a few things, specifically:

  • Altering required documentation to focus on the patient’s duration since last visit
  • Eliminating the physician requirement to re-document information already provided by office staff or by the patient
  • Striking the need to justify a home visit in lieu of an office visit

Looking over the CMS proposal and the letters, there’s a mixed bag of winners and losers among stakeholders.

Specialists: Mostly Losers

Specialists would have less paperwork to do, but ultimately their bottom lines would take a hit. The proposed changes condense eight former payment rates down to two. The second of the proposed new rates — which generally applies to sicker patients with more complex cases — nets a lower reimbursement than the older codes. While in theory this means less time spent on “note bloat,” specialists may bulk up their caseloads to compensate for the pay cut.

Patients: Short-Term Winners, Long-Term Losers

In theory, patients would get more face-to-face time with doctors since doctors wouldn’t be as bogged down by paperwork. But will lower reimbursement rates deter medical students from pursuing specialties? Fewer specialists would mean less time for patient interaction in the years ahead. Existing specialists also might rush to fill their schedules to compensate for the revenue decrease, cutting time with patients. With physician shortage already an issue in the U.S., it’s hard to see a way for this to be beneficial for patients in the long term.

Employed Physicians: Mostly Winners

Internists of America, rejoice. You might only have to bring half of your documentation work home with you. And patients will appreciate the extra eye contact, since you won’t be buried behind your laptops. Keep in mind, though, your pay increase would only apply to outpatients.

Physicians in Private Practice: Winners

Under the consolidated E&M rates, PCPs and doctors in private practice would see a pay bump for routine visits. This post from ICD10monitor provides a fantastic comparison of what physicians would bring in under the new and old rates for two specific scenarios.

TL;DR

The AMA issued a letter signed by more than 100 physician organizations saying that proposed CMS changes would limit patient access to care. The AMA said that although the changes are intended to give doctors more face-to-face time with patients, they will have the opposite effect and may even cost specialists money.

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Social Media Marketing: Discover if it’s Right for You and Best Practices

Don’t believe the social media hype. Despite the prevailing belief that all doctors — especially those in private practice — need to be on social, in actuality, it’s more nuanced than that.

Tim Sawyer, president of Crystal Clear Digital Marketing, a firm that caters exclusively to healthcare providers, says that only certain types of doctors need to be on social. But if doctors decide to use it, they need to do social right.

First, here’s who is off the social media hook: neighborhood doctors in private practice who generally make their money by accepting insurance for common procedures. Here’s why:

“With any social media initiative, you have to ask yourself, ‘Why am I doing this?’ Social media for a private practice should really be transactional in nature,” Sawyer says.

That means if you’re not trying to sell a specific elective procedure, you’re probably wasting your time and money. Insurance companies will continue to send patients your way if you keep doing everything right and providing a pleasant office experience.

But if you’re offering something elective and special — anti-aging treatments, testosterone replacement therapy, or niche dermatological treatments, for example — then it’s time to get into the social media game.

“Eighty percent of people looking for an elective medical treatment or procedure will start their search on the internet,” Sawyer says. “With procedures that are unique and not generally known in the public, it’s absolutely critical that you do social media.”

Social Media Done Right

If you want to have success marketing your practice and/or a specific procedure, here’s what Sawyer says you should do:

  • Choose the right platform: Different social media platforms have different demographics. Facebook attracts an older crowd. Instagram skews slightly younger. Snapchat is where you’ll find the youngest cohorts. “Social should start with, what are your business goals?” Sawyer says. If you’re a plastic surgeon looking to sell face lifts, then Facebook is where you want to be. But if you’re a dermatologist looking to help millennials with stubborn acne, then you want to be showcasing your work on Instagram.
  • Put out quality, unique content and do it consistently: Sawyer says you want to aim for two posts daily on each of your platforms. Free applications, such as Hootsuite, can do this for you. Your content should be unique and it should drive patients toward purchasing your services. “Tie your social media to your website. If you have three pages for your top-three procedures, social should be promoting topics related to those pages and backlinking to those landing pages.”
  • Be clear on who will handle social and how success will be measured: Once you know the platforms you’ll be using and you have developed quality content, the next step is to put someone in charge of your social media accounts. Use somebody you can trust as this person will be representing your practice to a potentially global audience. This employee should focus exclusively on social (contracting this role out is always an option). Success should be measured based on how social is driving revenue in the practice. “You can’t manage what you can’t measure,” Sawyer says. “If you can’t follow that formula, “I’d recommend that you stay away from all marketing.”

TL;DR

Unless you’re a private practice owner offering services that are unique to your market, you probably don’t need to be on social media. If you fall into this category and want to venture into the social game, choose social media platforms where your target patients are active, put out quality content consistently that promotes your services, and be clear about who will handle your social media and how success will be measured.

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How Doctors Have Been Conditioned to Burn Out

What’s causing physician burnout? There’s no shortage of clickbaity listicles on the topic. This is not one of them.

With the rate of physician suicides standing at double that of the general population, the issue deserves more attention than that. The key to understanding physician burnout is understanding why it happens, so we can determine how to stop it.

That’s where Dike Drummond, MD, comes in. He’s a physician coach and consultant, helping doctors navigate their way through — and hopefully around — burnout. He’s the CEO of The Happy MD, author of Stop Physician Burnout and a burnout survivor himself, having walked away from a group practice in 2011 to start his company and help doctors.

There is no simple solution to diagnosing and treating physician burnout, Drummond says. He does see distinct patterns in the stresses that cause burnout, however. The first is the practice of medicine itself, and the depletion of what he calls “the energetic bank account.”

‘Super Hero, Workaholic, Lone Ranger, Perfectionists’

“It’s very, very rare for a physician to walk out of their practice at the end of the day with the same energy as when they walked in,” he says. “The practice of medicine is stressful all by itself.”

Job-specific stresses have to be considered as well. These include: EMRs, schedules, leadership quality and support staff caliber.

Next — and most often overlooked — are personal lives. “People can burn out at work and absolutely nothing has changed about the work itself,” he says. “You think you’re stressed as a doctor, let’s give your wife breast cancer and see how that works.” He recommends one of the questions all leaders ask a burned out colleague early and often is, “How is it going at home?”

Poor leadership is also often a factor. “People don’t quit the company, they quit their boss,” Drummond says.

The final pattern Drummond sees is the conditioning created by healthcare education itself. “We’re conditioned to be super hero, workaholic, Lone Ranger, perfectionists,” Drummond says. “Nobody teaches the off switch on doctor. A workaholic only has one coping mechanism and that’s to work harder.”

What Do We Do About It?

Drummond says that organizations that employ physicians, chiefly hospitals, need to “complete the doctors’ medical education.” He explains:

“Teach them everything about stress, stress management, burnout and burnout prevention so they can protect themselves against the number-one threat to their career: burnout. These topics are not in curriculum of med school or residency. Most doctors only learn how to take good care of themselves when they are recovering from their first episode of burnout.”

“If a hospital employs physicians and other providers, it is the hospital/employer’s responsibility to complete their medical education, or sit back and just deal with the massive negative consequences of burnout in a bunch of doctors who don’t understand it or know how to protect themselves,” Drummond says.

“It is very important to rebuild the social ties and human connections between doctors. We are much healthier when we have person to person connections with our colleagues. Some non-work-related ties. Most organizations don’t do a very good job of that,” Drummond says. “One of the things I insist is that if I am delivering a training to a group of doctors, the organization has to make it a full on social event with food, beverages and invite all significant others too.”

If the organization takes these steps it can build the physician’s trust.

“We’re in this together. You understand me. You have my back. I can trust you. That’s a huge piece that’s missing for most employee physicians.”

We’re just getting started on the topic of physician burnout. Check back for more insights from Drummond on how millennials are holding up in the medical workforce, the unintended consequences of employed physicians, and spotting burnout in colleagues.

TL;DR

The five universal causes of physician burnout are: The practice of medicine, your specific job, your personal life, poor leadership and the conditioning of medical education. If medical professionals want to get serious about the issue, organizations that employ doctors need to complete physicians’ education to include stress management and burnout prevention, and employers need to build camaraderie in the medical ranks.

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Maintenance of Certification: Inside Medicine’s ‘Civil War’

Maintenance of Certification has cut a rift through medicine on par with the Yanny or Laurel debate. On one side, you have practicing physicians, fed up with shelling out for tests to remain in good standing with the American Board of Internal Medicine (ABIM). On the other, the ABIM, intent on keeping physicians up to date on the ever-evolving nature of their craft.

Seems pretty straightforward, right? Well, things just got a bit murkier. Enter Dr. Westby G. Fisher, an internist, cardiologist, and cardiac electrophysiologist. You might say that Fisher also moonlights as a private investigator these days as he looks into what he says are the unscrupulous tactics of the ABIM.

“It’s become a civil war among the rank and file in medicine and the bureaucratic elite,” Fisher says. “You’re looking at waste, fraud and abuse, as far as I’m concerned, because we don’t get anything more for that money. We get a time-limited Board certificate now instead of a lifetime one. I started wondering, ‘What is going on?’”

Fisher, who blogs about this issue, began investigating the ABIM’s finances, and partnered with forensic accountant, Charles P. Kroll. What Fisher says they discovered in the ABIM’s tax records is sure to raise some eyebrows.

  •  $2.3 million two-bedroom condo complete with a chauffeured Mercedes town car purchased by the ABIM Foundation for unclear reasons
  • $6.5 million in testing fees transferred to accounts in the Cayman Islands
  • Inaccurate information in ABIM Foundation tax documents about the origins of the organization
  • $78 million in testing fees transferred to the Foundation between 1989-2007 so the foundation could work out a definition for “medical professionalism”

Fisher also says that the ABIM is selling physician data garnered from the testing to corporations, insurance companies and hospitals.

The ABIM didn’t respond to attempts to obtain comment for this post.

Taking Action

“These are people in a bureaucratic ivory tower who have the pomposity to state that these computer tests are going to help patients when they’re really helping themselves,” Fisher says.

Fisher’s group, the Practicing Physicians of America, recently launched a GoFundMe page to support a legal investigation. The page has already raised $120,000 of its $150,000 goal.

The MOC process requires internists to complete ABIM-sponsored activities and assessments at fixed intervals to maintain their standing with the organization. Physicians must complete an MOC activity every two years, earn 100 certification points every five years, and pass either the MOC exam every 10 years or take a Knowledge Check-In every two years.

That can add up. MOC program fees range from $124-$175, depending on when the physician pays. The traditional MOC exam costs $650, with each sub-specialty setting doctors back $1,200, while the Knowledge Check-Ins cost $130, with subspecialties costing $240.

TL;DR

A group of physicians have teamed up to raise more than $100,000 to investigate the ABIM MOC process. The physician spearheading that effort, Westby G. Fisher, MD, with the help of a freelance forensic accountant, Charles P. Kroll, says that the ABIM is corrupt and misuses fees generated from the MOC process.

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How to Avoid Being a Broke Doctor

Be honest. A big paycheck makes becoming a doctor awfully attractive. W. Ben Utley, a professional provider of financial advice for doctors, has some simple guidance: Don’t blow it.

He’s seen it all. New doctors who bought houses that were too big too soon. First-year physicians, fresh out of residency, who got blindsided with surprise tax bills. And ill-advised investments, like cryptocurrency.

Utley, a Certified Financial Planner (CFP) and President of Physician Family Financial Advisors, says when the cash starts coming in, put the plans for that new car on hold and instead take these 5 steps in the following order:

Determine Your Budget and Cash Flow

The cornerstone of any financial advice for doctors is budgeting, Utley says. Budgeting determines how much you can afford to save, and how much you can pay when servicing your student loan debts. It’s also a cold shower when you start lusting after the latest Tesla. Here are some budgeting apps to help get you started.

Build an Emergency Fund of One Month’s Pay

“Typically the first year of practice doesn’t work out the way they think it will,” Utley says of new doctors. It may involve a move. If they’re partnering with a doctor in private practice, the partnership might fall through. Maybe they’re faced with a costly auto repair, or some other unforeseen expense. “There’s room for problems to crop up, and those problems need to be addressed in cash.”

Deal with Your Student Loan Debt Load

Remember the thousands of dollars you borrowed to go to med school? So does the bank. Your debt didn’t just disappear.

One key piece of financial advice for doctors: You have options.

You may qualify for federal loan forgiveness. Consolidating or refinancing student loans is also an option. Utley says doctors must know the difference between the two. In a consolidation, all loans are combined, with the loan holder retaining most of their rights a debtor.

When refinancing, all loans are paid off by a single loan with a lower interest rate. “The question is, how much loan can you afford?” says Utley. Knowing your budget will answer this question, helping you select the duration of your new loan. A word of caution, refinancing comes with its own risks:  

“The new loan has its own covenants and responsibility,” Utley says. “Typically, in that process, you lose the benefits that you might have under the federal direct loan program.”

Obtain Disability Insurance

Maybe it’s time to reconsider your passion for street luge. If you can’t work due to a disabling injury, then you have no income. “This is the fuel for your economic future,” Utley says. Generally, the more manually intensive the medicine a physician practices, the more expensive their insurance. You are not invincible. Safeguard your future, Utley says. Weigh your policy options carefully and be sure that it matches your specialty — whether you’re a surgeon with golden hands, or a psychiatrist with energetic patients.

Save for Retirement and Set Goals

Unless you’re into the idea of working till the day you die, it’s time to start thinking about investing and setting financial priorities. Investment strategies will vary, Utley says. A cardiologist making $400K will want to max out any available match on their 401k or 403b. A pediatrician working for a non-profit might want to skip their first year.

Utley breaks goal setting into three categories: saving for retirement, a house, or college for children. He’ll ask young physicians what their priority is.

“If you’re going to have a large income, you can have all three of these. But not all doctors have a large income.”

TL;DR

Take these steps in the following order: Create a budget. Build an emergency fund. Pay down your student loans. Get disability insurance. Plan for retirement and set financial goals (retirement, a house, paying your children’s college tuition).

The Latest from Physician Sense

What Associate Doctors Must Do Before Signing a Contract

  • Aspiring associate doctors should have legal help when navigating the contract process.

  • Establish a window to opt out of the contract.

  • Spend as much time as you can in the practice.

Aspiring associate doctors fresh out of residency don’t know what they don’t know. The business landscape can be difficult to navigate, says Dough Graham, a senior management consultant at Doctors Management. It pays to study up.

Young physicians are stepping into a setting where they’re trying to understand complex legal language in associate doctor contracts, Graham says. To further complicate things, they’re typically doing this a year prior to completing residency. They need advice and guidance.

“They don’t get the right advice form the attendings that they are working with because they’ve been in academia,” Graham says. “If they are seriously considering going to work for somebody, and it’s going to be on a partnership track, they really should look for some type of adviser, whether it’s an attorney or some sort of consulting firm like ours — and none of them do that.”

RELATED: Signs that You Need an Associate Doctor

Graham adds that this is a time-consuming process that should begin a year prior to the end of residency. Having a lawyer or consultant to guide young physicians through the process ensures that the hiring physician’s timeline is upheld.

Aspiring Partners and Owners

If the young physician’s goal is to ultimately become a partner or owner of the practice, it’s critical that they have a rough understanding of the practice’s value. Graham says that aspiring partners or owners should keep in mind that practice value is a moving target. “When a new doctor comes on, they’re helping to grow the business,” he says. While consultants can project growth and consequently practice values, young doctors should keep in mind that these are just estimates, not guarantees.

There are also no guarantees that a young physician will ultimately enjoy private practice. While it’s common for hiring doctors to include a contractual clause under which they can terminate the contract without cause with a specified amount of notice, associate doctors don’t always ask for the same.

“After a certain period of time, it’s really in the best interest of both parties to walk away without cause, provided that they give a certain amount of notice,” Graham says.

The best way to avoid this situation outright, Graham says, is for the associate doctor to do their due diligence. Spend two or three days in the practice seeing for yourself.

“Come shadow the provider and working the office for a few days. That way you can see the staff, see the general operations and try to understand the EHR technology they’re going to be using.”