Grab Bag


I am sticking with my prediction that gold is the next bubble. True, I said that when it was at $1,200 an ounce and it has ballooned up to $1,800, thanks to the feckless louts in Washington. But it will fall like a rock when interest rates go up.

Remember the "Greater Fool" theory, which is a fancy way of saying gold investors are playing musical chairs, and when the music stops, the slowest to sell is going to get a rude comeuppance. After all, holding gold produces no interest, no dividends, nothing except a psychological game of chicken. I was reminded of all of this when one of the doctors in my Kitchen Cabinet told me he had invested heavily in gold. You know what they say about an investment: when the doctors and dentists get in, it's time to get out.


Some interesting stuff from Harvard in the largest study in 20 years. Only one in five suits lead to a settlement or payout; one in 14 doctors face a claim each year; neurosurgeons and cardiac surgeons had the most with one in five yearly; and pediatricians surprisingly have the highest average payout of $520,000.

Two other notes; a) "A lawyer would have to be an idiot to take a frivolous case to court," because the up-front costs of hiring experts, etc., is so high, and b) the primary cost for doctors who are sued is not financial, it is emotional. We are self-critical people, and we just hate to be criticized.

Work hours

The Archives of Internal Medicine just published a study revealing that the fewer number of hours worked by doctors is directly related to increased job satisfaction. I can only hope that they didn't spend a lot of money on this research. The average turns out to be 48.5 hours per week, not including being on call. Vascular surgeons and critical care internists worked the most and occupational med, pediatric ER doctors and dermatologists worked the least.

No wonder dermatologist residencies are so hard to get.

Physician group mergers

The American Medical Association reports that group mergers are up 78% in the last year. By the end of the year, it is estimated that 950 deals worth almost $250 billion — with a "B" — will have occurred this year alone. (Does anyone out there want to acquire me?) And that info just fuels my earlier prediction that economic pressure will eventually push us all into salaried groups. Fee for service is just too much of a cost driver to remain the predominant system in the long run.

Helpful websites — let the pharmacies bid the lowest price for your business. — charges you by the rental, not by the month, like Netflix, for you occasional users. — aggregates electronic deals from 2,000 dealers.

Hulu or — $7.99 per month for TV on your computer instead of very expensive cable. — prescription glasses for as little as $7
. — a good alternative to Stubhub for discounts on concerts and sporting events


The authors of Decide and Deliver did a study that showed that seven is the ideal decision-making group size. You lose 10% of effectiveness for each member added above that. So if you sit in a group of 17 or more, nothing useful is going to happen.


No-shows are a major headache for every practice. A study in the American Journal of Medicine showed an average drop of 6% in no shows when a reminder call is made. A little more than three-fourths of respondents said a call from a person was helpful, while even 72% benefitted from an automated reminder.

What is not clear is whether all this effort is cost effective, although it must be because every dentist I have ever gone to has done it and I've noticed that they tend to be more business aware than many doctors seem to be.

The stock market

A column in The Wall Street Journal recently pointed out, again, that investors who have sold out their holdings upon a large decline in the market have invariably been proven wrong in the long-term. That's one reason why the average investor always underperforms market averages.

Remember that no one has ever become rich by being a long-term bear on the fortunes of the United States. And no, I am not on the payroll of the NYSE.