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With a growing physician shortage, with healthcare reform swelling the ranks of patients, with rising malpractice premiums, shrinking revenues and growing government regulation, it has never been more important that a physician or nursing professional make the right choice when considering a career change.

MD Preferred understands that a job search involves far more than resumes and interviews. That is why MD Preferred has selected the nation's leading service professionals and recognized them with the MD Preferred Service Medallion. As you will discover, MD Preferred offers access to award winning professionals in: Real Estate/Relocation, Mortgage Services, Private Banking Services, Legal Services, Accounting Services and Financial Planning.

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Will You Have Enough Money in Retirement?

Articles abound with the claim that - if you save $100 a month, earning 10 percent per year, you will have a given sum of money in 30 years. These simplistic future-value exercises (also known as deterministic calculations) are helpful in explaining the potent effect of compound interest and encouraging investors to start saving early; after all, it was Einstein who once said, "the most powerful force in the universe is compound interest." The problem with such deterministic calculations is that they assume the average annual earnings will remain constant throughout the investment period - in other words, investments will always have positive returns. If we have learned anything these past few years, it is that stock markets do not always earn positive returns each year, and that returns can be volatile. Until recently, most financial advisors used deterministic calculations to forecast future portfolio values; however, such calculations fail to answer the most crucial questions on an investor's mind: Will I have enough money to retire? In recent years, financial advisors have shifted away from using deterministic calculations and toward Monte Carlo simulations to be able to answer the aforementioned  questions with a greater level of confidence.

Monte Carlo simulation is a robust algorithm used by financial advisors to estimate an investor's probability of meeting his/her financial goals. Instead of using a single future value based on deterministic calculations, Monte Carlo simulation calculates your portfolio value under thousands of random scenarios that may affect portfolio value, and then takes the average of those scenarios to determine a probability of success. It provides information about the range of possible outcomes and the likelihood that each outcome will occur. For many years, financial advisors were limited to deterministic calculations mainly because the computing power was not available in most commercial investment software. Now with more advanced planning software available, more advisors are using Monte Carlo simulation methods to make better informed investment decisions. Monte Carlo simulations are widely used and relied upon across many industries beyond finance. In fact, it was used to develop the hydrogen bomb; it was used by NASA to determine how the Ares I rocket launch vehicle would behave in flight; and is used in nearly every analysis involving risk management. Because of its reasonably reliable outcomes, financial advisors who accurately use and interpret Monte Carlo results can add tremendous value to their clients.     

All financial models, no matter how robust, are subject to limitations, including Monte Carlo simulation. The biggest limitation of Monte Carlo models is the use of historical data to predict future portfolio values. While we can never accurately and consistently predict future investment returns, using historical returns and patterns allow us to gain some understanding of investment returns. Users of Monte Carlo simulation models must fully understand its application, know how to accurately enter data, and most importantly, appropriately interpret results. Despite its limitations, we cannot underestimate the powerful capabilities of using Monte Carlo simulation. Do not rely on simple future value calculations to predict your financial success; seek a trusted financial advisor who uses and understands Monte Carlo simulation techniques to prepare your comprehensive financial plan to increase your chances of reaching your financial goals.  You should never have to wonder, "Will I run out of money?"

Ara Oghoorian, CFA is the president and founder of ACap Asset Management, Inc., a "Fee-Only" financial advisory and investment management firm specializing in working with medical professionals. Ara can be reached at aoghoorian@acapam.com or on the web at www.acapam.com

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More unfunded government mandates.

On April 12^th Health and Human Services Secretary Kathleen Sebelius announced a program projected to save 63,000 lives and up to $35 billion in health care costs over the next three years by preventing hospital related injuries and illnesses.

"Americans go the hospital to get well, but millions of patients are injured because of preventable complications," Sebelius said. "Working closely with hospitals, doctors, nurses, patients, families and employers, we will support efforts to help keep patients safe, improve care, and reduce costs. Working together, we can help eliminate preventable harm to patients."

Like so many other government mandated programs the devil is in the details.  I spoke recently with a hospital administrator in Maryland and asked him what his hospital was doing to combat hospital acquired infections and was it saving the hospital and patients money.  I was surprised with his answer.

Hospital bugs are very clever, aggressive and durable adversaries.  And he wasn't talking about the government administers that dream up new unfunded mandates.  He agreed that hospital acquired infections cost money to cure.  But he pointed out that preventing infections might just be costing more than the cure.

1^st of all you only have to cure someone who gets an infection.  But to prevent those same infections you have to protect everyone...patients, doctors, staff, visitors.  Every time a patient is diagnosed with a drug resistant infection, everything that comes in contact with that patient must be discarded...everything!  That means bed linens, gowns, gloves, in some cases privacy screens, porous fabric on furnishings. 

Special measures must be taken in the handling, disposal and cleaning of anything that has any thing to do with that room.  It affects culinary personnel, aids, janitorial staff as well as clinical staff.  And of course all visitors must wear disposable gloves and gowns when visiting the room.

And of course, no other patients can share the room!  Semi private rooms instantly become private rooms.  And insurance doesn't cover private room fees just because the hospital is meeting a government mandate.  End result.  Many older hospitals and almost all new facilities are going to an all private room structure. 

These draconian steps are the end result of attempts by non-healthcare administrators trying to solve healthcare problems.  I applaud Ms. Sebelius' intentions with her new program.  But do I expect her mandates to save up to $35 billion?  I would be amazed if she broke even.  Throw in the paper work and further cut backs in Medicare and Medicaid reimbursements and all you are doing is shifting the costs of her mandates to the hospitals and they have no where else left to shift them but to you and me.

Good News on the Dietary Front

A recent study headed by Dr. Lance Price of the Arizona-based Translational Genomics Research Institute (TGRI) examined 136 meat samples from 26 grocery stores in Illinois, Florida, California, Arizona and Washington D.C.  The researchers found "high levels" of Staphylococcus aureus (S.Aureus) bacteria in the meat.

According to Price, "Staph causes hundreds of thousands of infections in the United States every year and causes a whole slew of infections ranging from skin infections to really bad respiratory infections like pneumonia.  Staph infections kill more people in the U.S. than HIV."

Of course the FDA is on top of the situation.  They are aware of the findings and are working to discover the causes and effects of the bacteria.  That is reassuring; especially considering that Dr. Price also found that the bugs in the butt steak are also antibiotic resistant.  Seems the farmers are pumping so many antibiotics into their cattle that we are getting bacteria on steroids.

So far we can nuke the critters by thoroughly cooking the meat and of course completely decontaminating our kitchen and appliances and hands and clothing every time we toss something simple together for dinner.

One might consider going vegan if it were not for the salmonella that has been popping up in the spinach.  Stay tuned.  

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With a growing physician shortage, with healthcare reform swelling the ranks of patients, with rising malpractice premiums, shrinking revenues and growing government regulation, it has never been more important that a physician or nursing professional make the right choice when considering a career change.

MD Preferred offers the only medical job board with top tier job listings and access to award winning, doctor friendly professionals in: Real Estate/Relocation, Mortgage Services, Private Banking Services, Legal Services, Accounting Services and Financial Planning.

Medical professionals requiring discrete professional representation during their job search can call 800-260-8366 to speak with a personal search associate. 

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Another symptom of defensive medicine...or worse.

It seems that our personal physicians are treating themselves with a different set of standards than they are treating their patients.  And morality seems to have nothing to do with it.  If anything, it has more to do with mortality.

In a study published in the April 11 issue of the Archives of Internal Medicine, the author, Peter A Ubel, M.D. for  Duke University, reports that primary care physicians are recommending low mortality risk treatment with more adverse effects for their patients but opting for higher mortality risk treatment with less adverse effects for themselves in a similar scenario.

What is afoot?  Although the study was limited in scope and dealt with hypothetical survey questions it would seem that doctors have become so risk averse in their treatment decisions that even when the patient has a fatal illness, the doctors are avoiding treatment options that offer the patient greater relief but might statistically increase the mortality rate.

But when asked if they would chose the same regimen for themselves more doctors opted to avoid adverse side effects even if the mortality risk was greater.  Remember, the scenario presented to the participants in the study involved fatal diagnoses.

So should you find yourself facing the grim reaper and your doctor suggests that a twice daily dose of some vial tasting medication with ghastly side effects is the best course of treatment, ask the doc if he would swallow the "@#%*!" if he was in your pajamas.

Keeping Your Doc in the Dark 

A recent survey shows that most Americans may not be having this conversation with their health care providers. The survey, conducted by the American Association of Retired People and the National Center for Complementary and Alternative Medicine, found that 53% of people say they have used complementary and alternative medicine at some point -- including dietary supplements -- but just 58% discussed it with a health care provider.