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Grow Your Medical Practice Profitably

Let the PROFIT EXPERTS Show You How
You are busy running your practice. You have patients but also employees and costs. Many
physicians find out too late that adding more billing does not always mean more profit. Our clients
have thriving medical practices because they have a profit roadmap. They know how to easily
maximize their profits, so they can focus on their patients.
My name is Fred Parrish, Author of The Profit Mentality, Former Practice Management CFO/COO,
Advisor and current CEO of The Profit Experts. My company can help maximize your profitability:

CONSULT: Real world advice, customized for you. For example, determine how the
Affordable Care Act will affect your business and what you must do now to safeguard your

ANALYZE: Using our model, identify the profit leaks in your practice. Simply, in just a few
minutes, we can show you areas of concern and options to fix.

PREDICT: Using historical data and our forecasting tools, run highly accurate what if
scenarios to determine present and future profit impacts (staff, equipment, facilities, etc.) For
example, whats the financial impact of hiring a PA or adding a new piece of equipment


Q: I already have accounting software.
Great, well need that information into our database. We work hand and glove with your current
software, giving you tools that complement and enhance your current system.
Q: How difficult is the process and how much does it cost?
Its easy. We load your information, conduct the initial consultation, and you see the results
immediately. The cost is a fraction of what youd spend for traditional CFO services, only a few
hundred dollars monthly.
Q: Whats the ongoing process afterwards?
We conduct a joint monthly online consultation with you to do a comparative analysis and review
Q: What benefits should I expect long term?
Increased profitability and cash flow of course. But mostly peace of mind by knowing that your
decisions are strategic, not reactive. Predictive knowledge that is accurate and highly useful really
can maximize your profitability.
Just call us at 214-383-0500 or email to schedule a free 15 minute

Does Your 401(k) Have One of These?

By Daniel Grote, CFP is a partner with Latitude Financial Group
Self-directed brokerage accounts have been around for quite some time but dont be surprised if your
companys human resources department and other plan literature doesnt offer much information
about it. The reason: the company who hosts your 401(k) plan is often not the company who handles
the self-directed brokerage account. Therefore, when participants opt to allocate assets to the
brokerage window, the core plans custodian loses out on the fees they earn on those dollars.
But that should not be a reason not to use it. Self-directed brokerage accounts are a great way to
diversify your retirement account and gain access to stocks, bonds, mutual funds, exchange traded
funds, and even add your financial advisor to your account for oversight and personalized service.
The investments available in the core plan are usually limited to a list of 5-20 different mutual funds.
Within the self-directed brokerage account, there are thousands.
Every employer offering a self-directed brokerage account has implemented different rules
surrounding the use of the self-directed brokerage account. To understand the basics, first consider
your 401(k) plan as having two separate compartments; the core account and the self-directed
account. These are both within the 401(k) so do not worry that using the self-directed brokerage
account is somehow creating a taxable event by taking a withdrawal.
The core account is the one that youre probably accustomed to using. It commonly consists of 5-20
pre-selected mutual funds that are (hopefully) periodically reviewed and occasionally replaced for
poor performance. This lineup will hopefully cover some of the spectrum of investments and include
some U.S. large company stocks, U.S. small company stocks, international stocks, corporate bonds
and government bonds. Almost always, these investments are in the form of mutual funds; active and
passive (index). Commonly, 401(k) plans core accounts will offer target-date retirement funds that
are supposed to be a single solution that simplifies investing. By selecting the target retirement date
fund near your target year of retirement, you get a pre-made mix of investments. While these may
help you to get a better mix of investments, there are shortcomings to this approach as well. A
primary critique of these solutions are their often high management fees.
Most plans that offer self-directed brokerage accounts will require that your contributions be made to
the core account at all times. So, you will still need an allocation for these dollars until you
accumulate enough to meet the minimum transfer requirement, which is also a nuance to every
employer plan. Some plans will allow you to transfer as little as you like to the self-directed account
while others may require your transfer be a more sizeable amount, such as $5,000 or even more.
401(k) plans offering self-directed accounts also restrict how much of your total balance can be
allocated to the self-directed account. Some will allow you to allocate the majority while others will
allow you to only allocate 50% of your total balance to the self-managed account. What makes the
most sense is a personal decision and definitely something that you should discuss with an objective
third party professional. Understand that the 401(k) representative may not be a very big advocate of
you moving funds to the self-managed account because his or her paycheck is directly tied to the
amount of assets in the core account. Thats what we call a conflict of interest. Ask an independent
financial advisor for their help in making this decision.
Regarding fees yes, there are generally fees for using the self-directed account. Using the core
account is not free either. Its a hotly debated matter but understand that the 401(k) is not a freebie.
With the core account likely consisting of 5-20 mutual funds, the fees are embedded in the mutual
funds performance (or lack thereof) and are not entirely transparent. While reading the prospectus
might help you understand certain costs, mutual fund trading fees are difficult (arguably impossible)
to discern because they can vary greatly from time to time and from fund to fund. For instance, if

youre looking at the small company stock fund or the emerging markets stock fund, undisclosed
trading expenses could be much more than what youd think (a whopping 3-5% per year). So, when
someone discourages you from using the self-directed brokerage account because of expenses,
understand that there are always two sides to every argument.
A 2015 study conducted by Empower Retirement and its subsidiary Advised Assets Group suggests
that participants who are using a managed account in their 401(k) retirement account are
outperforming by nearly two percentage points over the five year period ending March 31, 2015.
Managed accounts being available through the self-directed brokerage account.
Finally, understand that your financial advisor may have the ability to help you manage your account
only if it is allocated to the self-managed account. While many financial advisors may offer tips or
advice on which funds to use in your core plan, in all likelihood, their compliance and supervision
departments would prohibit them from doing so. Why? Legal liability. Offering advice without any
official contractual agreement (including a fee) probably voids their errors and omissions coverage
should things go awry. It is an unfortunate aspect of modern living that handshakes and goodwill are
not acceptable methods of doing business. By using the self-directed brokerage account, your advisor
may be able to be added to the account for oversight. Yes, they will be compensated for this but
consider this question. When was the last time you got something for free that was worth having?
Also consider that the average investor underperforms drastically when they invest. Dalbar recently
revealed that the average investor underperformed the stock market by 74% over the 20-year period
ending 2015. Said differently, the stock market produced a return of 8.19% while the average investor
produced a return of 2.11%. Thats more than a 6% difference. Now, the unanswerable question,
unless you have a crystal ball, is whether or not with your advisors help, you will earn more than the
added cost above and beyond what you would get by doing it ALL BY YOURSELF. Think about it.
Daniel Grote, CFP is a partner with Latitude Financial Group, LLC- an independent financial
planning firm located in Denver, Colorado advising clients in CO, CT, FL, GA, IA, ID, IL, MD, MN,
NM, NY, OH, UT, VA, WA, WI, WY. Securities offered through Securities America, Inc., a Registered
Broker/Dealer, Member of FINRA/SIPC. Advisory services offered through Securities America
Advisors, Inc., an SEC Registered Investment Advisory Firm. Daniel Grote and his business partner
Scott Cody are Registered Representatives. Latitude Financial Group and the Securities America
companies are unaffiliated. Securities America and its representatives do not provide tax or legal
advise; therefore it is important to coordinate with your tax or legal advisor regarding your specific

MD Preferred Services
We would like to invite you to join our LinkedIn group
Networking for Healthcare Professionals is all about our members and the healthcare industry
coming together. Share ideas, opinions and industry news. Establish connections with other MDP
members and share your knowledge with the healthcare field. The goal of this group is to establish
business to physician relations as well as physician to physician networking. We also hope that this
will become a resource for physicians and healthcare professionals looking for tools to help them grow
in their career or career search and meet their everyday needs.

Medical Office Location Analysis

By Ernie Anaya, MBA

Location for a medical office is of the utmost importance to the success of the practice it supports.
Due to changes in regulations and the market, healthcare providers are now seeking locations near
where their patients live. This trend has resulted in a retailization of care. Medical office seekers can
learn a lot from the retail industry, which has made site selection a science.
The following are factors that need to be taken into consideration when selecting a location for your
medical office:

First and foremost, what is the demographics profile for your practice? Who are your best
patients? Where do they live? And what education and income levels do they have? What are
their medical expenditures and how many doctor visits do they make a year? What is the
population to physician ratio in that particular location? Is it above 2,000?
As with retail, site selection within the desired demographics area requires visibility and
accessibility (ingress and egress) to be successful. It should be located near mass
transportation and should have an adequate Traffic Count. Is there a medical cluster
requirement that the office be located near a hospital or other complimentary medical offices
and businesses?
What are the space requirements in terms of workflow, number of patients seen daily, number
of exam rooms, consult rooms, waiting rooms, offices, labs, break rooms and computer rooms?
What size and configuration is needed, including Tenant Improvements? What utilities are
required? Is 24 hour access required? Would the landlord have access to computer rooms or
file rooms creating a potential HIPAA infraction? Is there special equipment requiring specific
floor loads? Are you planning on X-RAY or MRI? Then you must also look at shielding and
code and ordinance requirements.
What about disposal of blood-borne pathogens requirements and OSHA compliance? Is this
type of use allowed by the landlord? Do you have storage requirements? Parking needs? What
amenities are needed? What type building is required (Class A or B office or retail?) Do you
need rail access and ADA compliance?
Beware of competition; do you need an Exclusivity Clause?
What are the budget requirements when dealing with a Triple Net lease including property
taxes, maintenance and insurance costs, or the cost of tenant improvements?

With all of these considerations, the process for leasing a medical office can be complex and time
consuming. Choosing the right location requires planning and expertise. A tenant broker can help you
analyze your requirements, find the right location, and negotiate on your behalf. Tenant brokers only
represent you under BRRETA Agency law in Georgia and receive their commission from the landlord.
It is also important to work with a healthcare specialist to help you navigate through the entire
For more information on this subject, or for any commercial real estate related questions or
information, youre invited to email or call Ernie Anaya at 404-876-1640 x

How to get more out of Public Service Loan

By Pastore Financial Group
In our experience, few physicians understand how to take full advantage of the opportunities afforded
them through PSLF (Public Service Loan Forgiveness), which could cost them upwards of $20,000$40,000 per year depending on the amount, type of debt and personal circumstances.
Our average new physician client begins medical residency with a staggering $250,000 of medical
school debt (range of $0-$400,000). This is occurring during a time when how physicians are
employed and the incomes they earn, are in flux2
The first step for a graduating student is to learn how to navigate and understand the government
programs for loan forgiveness. There are several options to choose from but each requires an
understanding of your distinct circumstances. It is not a simple decision as life changes.
Here are some considerations:

How much debt do you have?

What type of debt (Direct Loans or other Federal Loans)?

Do you currently work for and/or have future plans to work for a tax-exempt organization such
as a not for profit hospital or a public benefit corporation?

How much do you currently earn?

How much do you expect to earn in the future?

Marital Status, family size and income of spouse

Are you currently enrolled in an Income Driven repayment plan and when did you first start
making payments?

Are you taking full advantage of tax-deductible benefits?

Once you know the considerations then you need to choose the right program:
IBR (Income Based Repayment), PAYE (Pay As You Earn), REPAYE (Revised Pay As You Earn), ICR
(Income Contingent Repayment), Standard Repayment, Graduated Payment.
For over 45 years, Pastore Financial Group has helped medical professionals learn how to make
informed financial decisions. Our experience has shown us that physicians are excellent problem
solvers in their fields but they are often not educated on how to apply their skills to solve financial
problems. We assemble all of their financial information in a way that it is easy to comprehend and
analyze so they can feel comfortable making these important life decisions and implementing
strategies to reduce debt, build wealth and protect income so plans are self-completing.
Many physicians move from state to state during medical school, residency, fellowship, and during
their careers. Pastore Financial Group currently works with physicians in 28 states, helping them
throughout all stages of their careers. We are constantly expanding our national coverage as our
client-base expands geographically.

To join us for a complimentary webinar to learn how best to manage your student loans, click
To schedule a complimentary individual consultation, click here
Or, for more information call 1-800-228-4067, email us or visit our website

Why is long term care insurance important for you?

By Melissa Barnickel
No retirement plan is complete if it has not addressed long term care. We work so hard to accumulate
assets for a secure retirement. Too many of us fail to build a fence around those assets so that health
care events wont needlessly erode our familys lifestyle.
What is long term care?
Think of how you started your day. You bathed, dressed, had breakfast, drove to work or used public
transportation. What if you couldnt do these every-day activities for yourself whether as the result of
an accident, an illness or just the frailty of old age? Who would be there to help and how would you
pay for it? What would the consequences be to you and your family if you were to require care for an
extended period of time?
Some people think they have enough assets to self-insure the risk of requiring care but fail to
understand the extensive costs that can result from the extended need for long term care support.
The best way to address this important financial issue is to ask some basic questions:

What would the tax consequences be from selling assets to pay for care?
What would happen if I was forced to prematurely dispose of assets in a down market?
What would the consequences be for my family if I required care for a long period of time?

If you properly plan ahead and fund your strategy based on your particular financial picture, then you
or your designated person will maintain financial control no matter what happens.
But doesnt my health insurance cover long term care? No.
What about my disability insurance? No.
Your health policy pays for doctors, nurses, hospitals and some rehabilitative care but not for the
ongoing personal care or assistance with every-day activities. Your disability insurance replaces some
of your lost income to pay for your living expenses but not for the high cost of caregiving.
The fact is long term care doesnt happen to you. It happens to those you love, and the earlier you
take steps to address the long term care risk the lower the cost.
Take advantage of your age, your health and possible tax benefits. Doesnt it make sense to find out
more now?
What is my next step?
Contact Melissa Barnickel at 410-557-7907 or email or visit our

The Recruiters Corner - Tips and Tools

So, you are finally completing your Residency or Fellowship and you have secured a job with a first rate
medical practice in a city near where you wanted to be. Or as a skilled practicing physician you have
decided to move for a better opportunity. All of the hard work is
ready to pay off. So why do you need interviewing advice. Well,
believe it or not, the process is not over and some important things
need to be considered.
You have had your employment contract reviewed by a qualified
attorney who specializes in medical contract law (lets hope so). You
have formally accepted the opportunity in writing (not verbally). You
have discussed the relocation process and reimbursement provisions prior to signing the contract (of
course you did). And now its time to complete the last hectic days of your medical training and relocate
yourself, your family and your possessions.
From this point until your first day in the clinic, its all about communication. Just because you have
secured the job and signed the contract doesnt mean that you can drop off the grid and stop
communicating with your new employer. There will be all sorts of issues to resolve and these will require
your active participation.
You will need to keep the practice updated on your application for a state medical license.
You will need to keep the practice updated on your application for credentialing at the hospitals
that you will serve.
You will need to keep the practice updated on your relocation plans
When will you arrive?
Who is handling the process?
What reimbursable expenses have been incurred?
And a whole host of trivia that you will need to address through and between you and the practice
There will be a whole host of issues that will require your active participation on the home front. If your
spouse will be handling the relocation process while you complete your medical training you will be well
advised to stay involved.
If you have school aged children, will you be using public or private schools at the new location?
Will you be listing your current house for sale?
Will you be purchasing a new home at the other end?
Will a professional moving planner be involved?
Are you keeping the kids in the loop? They may be taking the move much harder than you are.
You will need a new insurance agent, a new banking relationship, a new Realtor, a new local
In short you and your significant other need to sit down and put together a detailed relocation plan
and then you need to divide the labor fairly.
So, accepting the job was only a mile post and not the end of the process. And, completing the journey
successfully will be all about good communication, planning and sharing the load.

Healthcare Opportunities Provided by
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); Physiciancentric 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,; fax 770-994-4747; or call 770-9949326, ext. 319. Please visit for more information.
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
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.