Hundreds of wounded arrived in Bishkek hospitals following violent confrontations between armed forces and protesters in the streets of Kyrgyzstan's capital on April 7. The Doctors Without Borders/Médecins Sans Frontières (MSF) team in Kyrgyzstan immediately responded by providing the National Hospital and the main ambulance station with emergency medical supplies and drugs, including bandages and other sterile material, intravenous injection sets, antibiotics and painkillers. More material and drugs are to be donated today by MSF to three health structures in the capital city.

In coordination with the International Committee of the Red Cross (ICRC), MSF staff in Bishkek are visiting hospitals and meeting health authorities to further assess needs in terms of medical material and human resources. "In the NationalHospital, injured people are still arriving today. We have to ensure the hundreds of victims have access to proper medical care. Most of them have been beaten or shot, and some suffered heavy traumas to their heads or chests," said Alexandre Baillat, MSF's Head of Mission in Kyrgyzstan.

Additional shipments of more surgical material and special medical kits that contain enough supplies to take care of 300 wounded people, are currently being sent from MSF's supply center in Bordeaux, France, to Kyrgyzstan.

Médecins Sans Frontières has been running a tuberculosis program in Kyrgyzstan's penitentiary system since 2006.

Whether making medical decisions or financial decisions, both are influenced by emotions. The role of emotions when making financial decisions has transferable application in the world of medical decisions as well. 
 
Financial advisors know that one of the most important components of providing financial advice is discussing the client's goals. Inherently your goals are tied to how you see yourself and in what ways you see your money and net worth as a reflection of yourself. This aspect of your financial life is usually tied to emotions based on perceived positive or negative experiences in your life. Financial advisors find that they expend considerable time and energy addressing emotions and negative reactions to events in clients' lives. The goal is to move the focus toward positive steps in reaching the client's goals.
 
As with other aspects in your life, emotional reactions can distract you from well reasoned actions that benefit you in the long run. This is the reason it is beneficial to engage a financial professional to guide you through your financial life circumstances with advice driven by goals rather than emotional negative reactions.
 
The use of Emotional Intelligence is a learned skill set. Financial Advisors who are skilled in understanding the four basic emotions that guide them and their clients will find they are more successful in their chosen work! The four emotions are: Glad, Sad, Mad and Scared. These four basic emotions are neither good nor bad - they just "are"! It is one or more of these emotions that help determine just how "risk adverse" a client will be. It is absolutely necessary for a financial advisor to be aware of the client's emotional state, whether the client is aware or not.
 
People react emotionally to market downturns. They are probably scared first, but also mad and sad as the market changes. They may get caught up in the market's emotional swings and lose sight of their own goals and strategy. They think it will always stay that way. Or in an upturn, they believe the market will always stay up. They get caught up in the euphoria of "glad" and again lose sight of their goals and strategy. Many people get caught up in the high market frenzy and end up buying shares that are overpriced.
 
Pulling out of the market to protect temporary downside losses in value also means not participating in the upside, which eventually occurs. From the major downturn in the spring of 2009 to the fall of 2009, the market recovered better than 35%. Those who pulled out of the market and stayed out missed out on that portion of their own portfolio's recovery. Due to reacting emotionally, people buy in up market and sell in a down market - the opposite of what garners them a good return.
 
Another difficulty is that people lose sight of the fact that a fund investment is in actual companies - some of which survive and some don't. The nature of the investment market is that there are no guarantees on return of investment. A certain amount of volatility is normal. It is the price you pay for the opportunity of garnering a higher return than with "safe" investments.
 
And how safe are "safe" investments? If your "safe" investments are earning 1% while inflation is running at 3%, you are losing purchasing power. If the bucket is leaking slowly, it can still end up empty!
So when you feel "glad" about a safe investment, what may be a good feeling may turn out to be a bad investment.
How does an advisor help to keep their clients' focus on the positive steps that can be taken to meet goals instead of reacting solely to current market conditions? How does advisor keep from getting involved in the client's negative and unproductive emotional reactions?
 
Advisors have seen these situations before, but clients may not be aware that financial markets tend to return to the norm and provide a positive return in the long run. By helping provide a perspective on how the market normally behaves; the focus can be shifted from how the market currently stands, a temporary fluid condition, to the longer range behavior of markets. This provides a sense of stable emotions that allows the client and the advisor to make better financial decisions.
An advisor can also help you realize that financial planning is more than investments and that some goals are not solely monetary. It is less stressful and far more productive for people to keep their eyes on their goals, not on the dollar value of their portfolio. In the end, your net worth is not the same as your self-worth.
 
Because emotions play a significant role in all decisions we make, a major part of an advisor's job is to help the client keep their focus on the positive steps that can be taken to meet those goals instead of reacting based solely on emotions!

The lack of honesty on both sides of the health care debate almost assured that any final legislation would be fatally flawed.  The first thing any college debate coach teaches his or her students is that you cannot prepare to debate if you are going to ignore any of the pertinent issues.  And yet our elected officials who spend most of their time debating one thing or another are masters at ignoring the inconvenient.

The burden of defensive medicine and malpractice insurance is a major factor in the steady rise in healthcare costs.  And yet the issue was off the table from day one.  There were no fiery statements for or against tort reform.  It was simply quietly ignored.  The legal lobby gets a well done on this one.

This country was built on the principle of hard work and personal responsibility.  If a pioneer needed protection he built a sturdy house and kept his powder dry.  If he needed the services of a physician, he found a way to pay for those services...even if it was with a chicken or a bag of grain.  Exercise and a sensible diet was a part of every day life.  No one considered themselves a victim.  Today it would seem that everyone is a victim to one degree or another.  A victim of greedy insurance companies, of greedy physicians, of greedy employers.  We have become a country of over weight, passive, irresponsible citizens that demand cradle to grave care from their government.  

In a capitalist economy one ignores supply and demand at their own peril.  Right now there are too many patients demanding too much care from too few providers.  The government wants to change the reality without addressing the forces at play.  One cannot simply mandate lower costs and universal coverage.  You can't stuff 10 lbs of s... in a 5 lbs bag.

This is truly a third rail.  To even suggest that the natural result of a fixed supply of health resources means that someone will be denied something that they believe they need and someone else believes that they can do without.  Rationing goes on right now.  Health insurance companies deny coverage every day.  Poor people do without every day.  Doctors refuse new Medicaid patients everyday.  How can we possibly strive for universal coverage without acknowledging the fact that there must be a process by which our limited resources are distributed equitably?

Technology is a marvelous thing.  One only needs to consider the computer on which you are reading this message and the internet that makes it possible.  Medical technology is a voracious creature.  Each new machine is bigger, faster, more complex, more capable and more expensive.  Every new pill has been developed through the expenditure of thousands of man hours and countless amounts of dollars using the most sophisticated laboratories and equipment available.  And each new pill is more effective and more expensive than the last.  And with an insurance system that separates the consumer from the bill, there is no incentive to drive costs down.  Who can blame physicians, hospitals and patients from demanding the best of the best.  But at what point will technology overwhelm the system?

Every creature lives and dies.  The human intellect has struggled with the meaning of life and the finality of death.  Our machines and our doctors have expanded our life expectancies.  But death still waits for each and every one of us.  But with each new medical break through has come an expectation of the next.  If we can live to be 85 why not 90...why not 100?  But where is the point of diminishing returns?  Who should decide how our medical resources are distributed?  Is the life of a ten year old more worthy of care than that of a 90 year old?  What percentage of resources should go to the oldest and what to the youngest?  What percentage to the sickest and what to the healthy?  And is it not reasonable that it is incumbent upon each of us to prepare for the end of life with grace and dignity and honesty?  

There are those who would argue that government is never the answer.  But even those who believe that government must play a constructive roll in a complex society are uneasy with the convoluted programs flowing from Washington and the intellectual dishonesty that produces them.  Until we have an open and honest discussion of the facts that have brought us to this place, we will never find solutions that will take us where we wish to go.

Now that we know that health care reform is going to cost around a trillion bucks.  I got to wondering just how much money that is. 
 
If I owned a building that was a bit larger than the size of a football field (let's say 96,768 square feet, about 2.2 acres), and the government came to me and said, "Healthcare reform is going to cost about a trillion dollars and we would like to store that amount of money in your building so that when the bill comes due we will be able to pay it
 
Setting aside for the moment that any government official with that sort of attitude lives with Santa Clause at the North Pole, I would have to consider just how I would go about storing that amount of cash. Since the largest bill currently in circulation is the $100 dollar bill I would have to get the cash together in bundles of $100 dollar bills, pack them on pallets and move them into my building. 
 
First I suppose I should band the bills in stacks. Let's say 100 bills to a stack. Now how many stacks will I need to store? Well, if I put ten stacks in a square and then make ten layers high I get a square of 100 packs of 100 bills worth a million bucks. And my stack is only about 12" wide by 12.5" deep by 4.3" high. This isn't going to be too bad at all!
 
To make storage easier I think I'll use commercial pallets to make stacking and transfer easier. To cover the pallet with one layer of my 100 bill bundles I need to lay out 7 packets ($10,000 per packet) wide by 16 packets deep. This single layer covering my pallet is worth $1,120,000. Because stacked paper is very dense, I can only put about 90 layers on my pallet.  And 90 layers will be worth $100,800,000. But for the sake of simplicity I'll just count it as an even one hundred million dollars. The government likes to round things off anyway.
 
Now I'll move that pallet to the back corner of the building and fill another pallet. After a couple of hours work I have ten pallets filled with $100 million bucks each and have them neatly parked in the back representing a cool $1 billion. And I have a ton of space left. I bring in some day laborers (forgive me if I don't check ID's) and we really get an assembly line going. I decide that we may as well stack the pallets two high and by day's end we have one complete row of 50 double stacked pallets worth ten billion dollars. This is taking a bit longer than I thought.
 
Next morning, bright and early I bring my crew in (now double the size) and we really get to work. And, by the end of the work week, we are finished. And to my amazement we have filled the entire building with double stacked pallets (one hundred rows of 100 pallets). That's 10,000 pallets each containing 90 layers of 112 bundles of $100 dollar bills, 100 bills to a bundle. That's 1,008,000 bills per pallet x 10,000 pallets...my calculator doesn't have enough columns to compute.
 
If someone had told me when I was born (I suppose they would have had to tell my mother and she could fill me in when I was older) that I would live to be 75 years old and I was to be given $1 trillion dollars to spend during my lifetime, I would need to spend $36.5 MILLION per day. Now that is a life time occupation

California Gov. Arnold Schwarzenegger recently signed a bill allowing the construction of an $800 million. 75,000-seat stadium that developers hope will lure an NFL team to the Los Angeles area.  The stadium would be built in the City of Industry, approximately 15 miles east of Los Angeles.  The developer has targeted seven teams about possibly relocating to the area.
 
One of the most exciting amenities will include cutting edge medical and training facilities, which will attract physicians, medical staff and sports related professionals from across the country to the community. Top athletes require top medical treatment and the preliminary plans include an orthopedic medical facility, with the latest equipment and highly trained doctors and staff. This facility is targeted to be opened to the public as well.
 
This new project will be a huge boom to the community. In addition to the stadium and its new medical facilities, the regional entertainment venue is slated to include office and industrial space, retail, restaurants, movie and live theater and museums
 
Working closely with the developers, Winkelmann Realty, the exclusive MD Preferred Real Estate firm for OrangeCounty, plans to help new physicians and their families relocate to the area. "Our knowledge of the area and full service relocation services will help make the process as smooth as possible," said Linda Hawkins, President of Winkelmann Realty. 
 
For further information, contact Linda Hawkins, Winkelmann Realty at 1-800-397-3562 or www.winkrealty.com.

Ask a physician if malpractice premiums affect the cost of health care and you will not only get an affirmative answer but probably an impassioned lecture.  Many doctors place the cost of malpractice coverage and defensive medicine at 10%.
 
But, based on more recent empirical data, the costs involved may be far less. And tort reform, as the holy grail of health care reform, may be vastly overstated.  "Jackpot justice" as it is often referred to when discussing large jury awards and frivolous law suits, may actually be contributing less than 1% to the rising cost of health care.
 
First of all, a very small percentage of malpractice suits result in any payment at all. And in states that actually report such statistics, the average jury award in malpractice cases has actually been going down. In Missouri, in 2005, the average malpractice award was $253,888. In 2008 the average was $202,612 a decline of over 20%! Yet in Missouri health care insurance premiums and per capita health care spending have continued to rise.
 
It is likely that other factors such as an increasing cost of medical technology and a precipitous drop in investment income for insurance companies may be playing much larger roles. In fact, malpractice costs probably represent less than 2% of the $2.2 trillion in health care costs in this country. The Congressional Budget Office (CBO) recently estimated that "even a reduction of 25 percent to 30 percent in malpractice costs would lower health-care costs by only about 0.4 percent to 0.5 percent."
 
States are beginning to understand that tort reform does affect the cost and availability of health care in their states...even if the impact is not as great as once believed. And many are implementing caps on medical malpractice awards. But as in so many aspects of the health care reform debate, over-simplification and extrapolation are two statistical tools that can bend the facts to suit the user. 
 
The CBO in the same study cited above found no significant difference in per-capita health-care spending between states with and without limits on tort liability, even when they took into account the larger costs of defensive medicine. 
 
Mark Twain once pointed out that "there are lies, damned lies and statistics." Something along those lines may be at work here. 

All's right in the world.  That perfect job offer has come in.  Euphoria rules the day.  Unfortunately many a physician will let their guard down at this happy time and ignore the critical issues and restrictions concerning their rights should it become necessary to terminate the employment relationship.  Even the best laid plans can turn sour for any number of reasons, and that's the wrong time to realize for the first time that your employment agreement unreasonably prohibits you from plying your trade.  While non-competition, non-solicitation and similar restrictive covenants are largely creatures of state law - and hence the rules governing such covenants tend to vary from state to state - there are a few general principles to consider and evaluate regarding non-competition provisions before signing on the dotted line.
 
While physician non-competition restrictions are usually difficult to enforce (and in some states entirely unenforceable), this does not mean you should accept whatever language your new employer proposes in your employment agreement. Defending claims initiated by former employers is expensive and time-consuming, as you'll need a good (a/k/a/ expensive) litigator to push back. Bear in mind that even if you ultimately prevail in dismissing the claim, it's entirely possible that your new employer will have revoked your employment offer to avoid undue expense, risk or headache on their end. In such a case, the non-competition provision will have succeeded in restricting your activities even though it was ultimately either not enforceable or not applicable to your new position.
 
One approach might be to suggest a non-solicit of patients in lieu of the non-compete, as that's often the risk of greatest concern to a practice. If you lose this battle, your focus should shift towards making sure that the provision is reasonable in terms of geographic scope and timing. A non-compete which runs for 4 years following termination of employment is, in all likelihood, far too long. Shoot for 6 months or maybe a year. If your practice is located in a dense metro area, the non-compete should ideally be restricted to other practices within a specified radius of such practice. In a smaller suburban or rural community the restriction might be the city limits.
 
Next, you should ensure that any restrictions are limited to your specific position at the practice. In other words, a pediatrician should not be restricted in any way from joining other types of practices. Finally, and possibly most importantly, the non-compete should become null and void in the event your employer terminates your employment without "Cause" (which should be defined, preferably narrowly, in your employment agreement). It would be rather unfortunate to be out on the street 1 month after accepting employment due to budgetary constraints at your new practice with no ability to work in your hometown

Interested in reading more articles like the ones found in the Advisor?  Visit the rapidly growing Rounds Online. 

A blog maintained by the MD Preferred team.

 

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