As the hospital was currentlyon a health foodkick, I was enjoying mypureed soybeans andorganic yogurt in thephysicians' lounge when I saw my oldfriend, Bill Lesser, stick his headthrough the doorway and look aroundthe room. He spotted me and made abeeline for the seat next to me. I couldtell immediately that he had a problemhe wanted to get off his chest. Helooked very, very unhappy.

I'm having a crisis, and Ineed your help. The stress of practice isgetting to me, and I'm thinking of leavingmy group and doing somethingelse. I'm not happy.

Whoa, Bill. That's abig step. Start at the beginning, please.

Well, it seems I'm workingharder and harder just to make thesame salary. I don't think my patientsappreciate me, and I don't find practicingmedicine is a challenge anymore.

Let's take these questionsone at a time. First, you're workingharder and harder to make thesame amount of money. How importantis money to you, and why do youneed to make the same amount ofmoney? Does your family need themoney or are you doing it because youfeel you never ought to take a pay cut?

Sorry Bill, let me finish.I've got a lot more to say. I know you—money has never been the main motivatorfor you. You and your wife should sitdown with your financial advisor andcrunch some numbers. I suspect you andyour family could live quite comfortablywith less income. You should not changejobs just because of the money.

Your next issue is that your patientsdon't appreciate you. Come on. Youknow you're dealing with today's culturehere. Patients are a lot more demanding.They're taught to be that wayby the media, which caters to theirwhims in an attempt to sell them morematerial goods. It would make sensefor you to educate them about theimportance of your services to them.Do a little self-promotion here. If youtell them you're valuable, they're likelyto believe it. It doesn't cost anything,and it will improve your satisfactionand your patients' attitudes.

Third, you don't find your practicechallenging. You've studied all yourlife to be the best. Now you are. Didyou think that when you'd arrived,when you'd attained an almost magicallevel of skill and knowledge, you'dstill be as challenged as you were whenyou were a scared young medical studentand the whole bewildering field ofmedicine was strung out before you?

But, I'd just like to behappy in the workplace.

And you can—there'sa million ways to do that, and youought to think about them before youbail. You might lower your expectations,work a little less, deal with lessmoney, and find satisfaction in adoptinga hobby, spending time with yourfamily, or pursuing volunteer work.You might consult a psychologist tohelp you assess who you are and whatyou want. And one more thing, youneed to practice some relaxation techniquessuch as tai chi or yoga to preventyourself from getting so stressedout about this sort of stuff.

Thanks Lou, I see thatyour advice needs my serious consideration,and I need to apply myself tosolving my unhappiness.

No problem. Now Ican get back to daydreaming about mytrip to Greece. It's currently how I getthrough the day. 

Louis L. Constan, a family practice physicianin Saginaw, Mich, is the editor of theSaginaw County Medical Society Bulletinand Michigan Family Practice. He welcomesquestions or comments at 3350 ShattuckRoad, Saginaw, MI 48603, 989-792-1899, or louisconstan@hotmail.com.

Articles

Saving & Spending

It's Not the Money That Makes You Unhappy

All financial matters have become more complexas the number of options available toconsumers has increased steadily over thepast few years. You have more investment options,more credit card options, more insurance options,and many more home financing options. For example,just 25 years ago, you had less than a dozenchoices when you were financing a home. Today,there are more than 200 alternatives. This creates adouble-edged sword for consumers. You have theability to highly customize your financing to suit yourspecific needs, but the sheer number of choices makesit difficult to make a decision. To zero in on your bestchoice, consider the following three questions:

How long do you intend to own the property?

It often makes sense to align your mortgage withthe length of time you intend to stay in your home.For example, if you're buying a starter home, andyou plan to buy a bigger home in 3 to 5 years, yourbest choice may be a 5-year adjustable-rate mortgage(ARM). These mortgages provide a lower fixed interestrate for 5 years and then convert automatically toan adjustable rate that might be higher or lowerdepending on the level of interest rates at the end ofthe 5-year term. If you plan to stay in your home forever,consider either a 15-or 30-year fixed mortgage.The 30-year loan will have a slightly higher interestrate but lower payments.

Where do I think interest rates are headed?

Making the decision process more confusing is thecurrent flux of interest rates. Over the past 2 yearsthe Federal Reserve has raised interest rates 17 times.Only at one of the past meetings did the Fed halt thesteady increases. Is this the end of rising rates? Willrates move lower over the coming months or years?Many people believe we are near the top of interestrates. If you believe that interest rates will be lower inthe future, you should consider a low closing cost,interest-only mortgage or ARM, and plan to refinanceonce interest rates go back down. If you believethat interest rates will move higher or stay the same,consider a fixed-rate mortgage as discussed above.

Manypeople are attracted to the new interest-only mortgageloan because it will allow them to qualify to purchasea bigger home. However, this is usually not a soundchoice unless you are certain that you will have asteadily rising income that will allow you to beginmaking principal payments in the near future.

One of the biggest mistakes people makeis using home mortgage financing to fund consumerpurchases, such as a car, vacation, or other personalexpenses. Home borrowing should be reserved forbuying a residence or making home improvements.

, AEP, is the founder of the Welch Group,LLC, which specializes in providing fee-only wealth managementservices to affluent retirees and health care professionals throughoutthe United States. He is the coauthor of J.K. Lasser's New Rulesfor Estate and Tax Planning (Wiley; 2005). He welcomes questionsor comments at 800-709-7100 or visit www.welchgroup.com. This article wasreprinted with permission from the Birmingham Post-Herald.

Develop a Home Mortgage Plan to Save Money

With people living longer than everbefore, many adults find themselves takingcare of their parents. An 

article outlines some of theways to ease tax burdens while assistingparents. You can claim elder parents asdependents with a $3300 deduction, butwith a few clauses, so be careful. Thededuction begins to phase out for joint-filingcouples with an adjustable incomeover $225,750 and disappears completelyover $348,450. Single filers have theirdeduction phased out starting at $150,000and disappearing at $273,000. All thedependent's taxable income cannot beover $3300, and the dependent must bean American or Canadian citizen. Furthermore,you must be providing more thanhalf of the dependent's living/supportexpenses (ie, clothing, housing, education,health care, transportation, etc). 

suggests that the dependentswitch their taxable bank account intoa tax-exempt bond fund in order to avoidgoing over their maximum income. Agroup of siblings or direct relatives maysign a Multiple Support Declaration, IRSForm 2120, in order to share financialresponsibility and be able to cover that50% living expenses minimum. If morethan 7.5% of your income goes to the elderdependent's health care, the excess can bean itemized deduction. As always, documentand research your tax options beforeagreeing to be financially responsible.

Bulletin Board

Assisting Parents and Relieving Tax Burdens

Previously, there were only 19 health-relatedexchange-traded funds (ETFs). But,a new set of ETFs has surfaced, allowinginvestors to aim their dollars at a specificdisease category, such as cancer, diabetes,asthma, obesity, etc. According to a recent

article, this new family offunds, HealthShares, was developed byFerghana Wellspring in New York. ETFs aresimilar to index funds, but can be tradedlike stocks. These ETFs allow investors toparticipate in a portion of the market thatfeeds off growth and innovation—with apotential for great returns. As with someinvestments, these ETFs may be too riskyto consider without the help of a professionaladvisor. Because each HealthSharesindex will contain shares of only 20 companies,any sign of a failed clinical trial inone of the companies could affect theentire index.

Pursue ETFs that Target Specific Diseases

It's a situation that many Americans arefinding themselves in today—hitting themilestone of their 50th birthday withoutsufficient retirement savings. According toa recent article in 

magazine, 57%of workers aged 45 to 54 have saved lessthan $50,000. The average baby boomer isonly able to replace 60% of their currentincome in retirement, even with help fromSocial Security and pensions. While thereare many reasons contributing to these statistics(eg, college costs, aging parents,medical insurance, etc), what do you do ifyou find yourself a part of this statistic?

s top recommendation is somethingwe've all heard before: You and yoursignificant other should max out anyemployer-sponsored retirement plans available.At age 50, you and your spouse havelikely reached your peak earning years andare able to feed a higher income percentageinto a retirement plan. Even the governmentis aware of this crunch time—workers aged 50 and older can put moremoney into individual retirement accounts.

also recommends tightening yourpurse strings when it comes to recklessspending and downsizing on your homesooner than later if it is a part of your plan.Tapping into equity now may free up significantsums to invest.

When It's Time to Play Catch-up on Saving

Who would have thought that buyingthe cute colonial house at the end of yourblock wouldn't be a good investment, butpurchasing 400 acres of cornfields inIllinois would? Today, that seems to be thegrowing reality in real estate. According toa recent article in the 

,while the housing market cools, there hasbeen a rush to snag undeveloped propertyanywhere from New England to Montana.Farmland values rose at their highest year-over-year rate since 1981 to 11%, and ruralland in Texas hit a historic high of nearly$1500 an acre on average this past year—up about 75% since 2000. Property useranges from being enjoyed recreationallyfor deer hunters or off-road vehicles, to aninvestment leased to farmers. While undevelopedland is a hot market, the 

warns of many pitfalls. For example, it'simportant to have a survey done of the landyou're interested in because property linesaren't always well defined. You also need topay attention to how you access the land.Some places have makeshift roads thatcross property lines providing illegal accessto your property—resulting in lawsuits.Another consideration to be aware of ismineral rights. Particularly in energy-richTexas and the Rocky Mountain states, sellerscan retain the rights to oil or mineralsburied beneath the land you purchase. Inthat event, they can drill or mine on yourproperty—and you have to allow it.

Hot in Real Estate, Undeveloped Land

newsletter discusses a retirementoption that a number of baby boomersseem to be banking on: their home. Mostpeople plan on using this retirement strategyin a couple of different ways. One exampleis the soon-to-be retiree who bought ahouse in Washington, DC, in the 1960s or1970s for $50,000 and plans to sell it forupwards of $600,000 today. They then moveto a lower cost area and buy a smallerhome, using only a portion of the proceedsfrom the sale of their first home, and theremainder to fund a large portion of theirretirement expenses. Another example issomeone who may own two homes—one avacation home eventually intended to be theretirement home. At retirement, the principalresidence is sold, and the money is dedicatedto retirement expenses. While these twoexamples seem solid and foolproof, the articlewarns of the drawbacks and uncertaintiesthat should be considered. While thehousing market was booming from 2000 to2005, the market at the time of your retirementcan never be certain. Prices could falland homes could remain unsold. What itcomes down to is that a home is not a liquidasset in the way a stock or mutual fund is,and a physician-investor should not put alltheir eggs in that one basket.

Using Your Home as a Retirement Fund

If you're a coupon cutter, you may bemissing out on the virtual blue-light specialsonline. According to a recent article in

magazine, the following are somepopular Web sites that bargain huntersshould keep an eye on:

Price Grabber.com is for the shopper who likes to compareprices and products. The Web site collectsinformation from across the Web andallows consumers to view and contrastprices from a slew of retailers.

eDealinfo.com is theWeb's version of the Sunday newspapercircular, providing information on whatdiscounts are being offered by manufacturersand retailers. You can obtain a specialcode that can be used when you checkout after a purchase is made online.

FatWallet.com givesshoppers the opportunity to receive arebate if they go through their portals ontheir way to shopping at brand nameretailers. They get a commission for referringyou, and in return, send you rebatesvia check or PayPal. Amounts can be asmuch as 7% of an item's purchase price(eg, 3% from Dell Home Systems, 4% fromStaples, and 6% from Brookstone).

Overstock.comprovides the shopper with the same opportunitiesas a regular outlet store, offeringdiscounts on excess inventory, such as closeoutsand overstocked goods. Overstock.comhas the broadest selection and the best dealon shipping.

Bargain Opportunities for Online Shoppers

—Percentage of Americanwomen in 2005 that were engaged inearly entrepreneurial activities.(BusinessWeek, 2006)

—Amount stolen byan Australian Mint employee over 10months, smuggled in his lunch boxand boots. (Time, 2006)

—Percentage of people whobelieve dreams reflect unconsciousdesires. (Newsweek, 2006)

—Percentage of peoplewho don't believe dreams reflectunconscious desires. (Newsweek, 2006)

—Number ofdiscarded cell phones in 2005 in theUnited States. (Entrepreneur, 2006)

—Percentage of Louis Vuittonand Christian Dior items on eBay thatparent company LVMH alleges arefakes. (BusinessWeek, 2006)

—Average net worth ofpeople aged 25 to 34. (Media Counselto the AICPA, 2006)

—Percentage rise on averageof private 4-year college tuition.(Trends in College Pricing Report, 2006)

—AmountAmericans spend on women'sclothing. (Real Simple, 2006)

—AmountAmericans spend on men's clothing.(Real Simple, 2006)

Did you know

DID YOU KNOW ...

This special feature serves as a forum for our physician-readers to share their

stories. We welcome tales from your practice (eg, a unique patient, a staff crisis, etc),

your financial planning (eg, handling a windfall, surviving a scam, etc), your personal

life (eg, family stories, interesting hobbies, etc), and your adventures (eg, an exotic trip,

a personal discovery, etc). Please limit articles to 1000 words and share photos if possible.

Send submissions to Attn: Lisa A. Tomaszewski, Ascend Media Healthcare, 103

College Road East, Princeton, NJ 08540 or ltomaszewski@ascendmedia.com.

	Many recent articles report that treatments for back pain are of little help—an assertion that diminishes hope for many chronic back sufferers. And medical experts say you can have pain and function, but how much discomfort and how much function? It makes you wonder how many of those medical experts experienced it themselves. As a neurologist, I cared for numerous patients with chronic back pain. But being a patient and suffering with my own lumbar pain made me a more empathetic doctor.

	Most back pain gets better in a matter of weeks or months. Mine did not. The pain wore me out emotionally and physically. Seeing my afternoon patients felt like I was running the last mile of a marathon. Eventually the grinding and unrelenting lower spine discomfort I experienced influenced my decision to stop practicing medicine after 25 years.

	Stoicism was an unquestioned virtue in my German-Irish Catholic Midwest family. My mother set the example by never complaining or going to the doctor, so when my discomfort began, I ignored it. There was no preceding accident or instigating event—it wasn't clear to me or anyone else what the cause of my pain was. Eventually, an MRI showed a small, right, lower lumber herniated disc in an area that correlated with my pain. However, MRI abnormalities are common, even in the absence of back problems.

	A bevy of medications, exercises, and epidural steroids didn't offer me relief. This prompted me to seek help at the Mayo Clinic in Rochester, Minnesota. My doctor was grim, and she verbally attacked me as though I voluntarily slipped my own disc. As a physician, she took advantage of her power to make me feel terrible. And I experienced the vulnerability of a patient, seeking the help of a physician for relief. I wondered if I had ever disregarded that vulnerability with any of my patients—and remembered a 40-year-old man who I made strip down to his boxer shorts for the examination. I could see that it embarrassed him terribly, but at the time, I ignored this. In retrospect, I would have taken that extra minute to have him put on a gown.

	Finally, after 6 years of anguish, I had a lower lumbar discectomy, not knowing if it would help. The life I had known was potentially over if the surgery didn't improve my condition. My legs, shriveled from lack of exercise, missed the 4-mile walks I used to take three times a week. I was filled with concern over how I was going to avoid normal activities that caused me pain, like walking up stairs—a wheelchair and home elevator was a possibility in my future. Though my husband and daughter supported me completely, thoughts that death would be a better option than living in my present condition haunted me.

	The operation was, thankfully, an enormous success, and I was overwhelmed with gratitude toward Dr. Peter Hall, my neurosurgeon. Not only did we have a doctor-patient relationship, but we had also been colleagues and acquaintances, having worked together earlier in our careers at Wishard Memorial Hospital in Indianapolis and later on at St. Vincent's Hospital. But soon after my operation, Peter developed lung cancer and passed away, even though he had never smoked. He gave me back my life, but his was taken.

	After surgery, I lived in a fog for weeks. It wasn't that I was on pain medications, but that I was simply struggling to accomplish life's little tasks while my body was repairing itself. And in the middle of what seemed to be an uphill battle, I lost my engagement ring, which held enormous sentimental value. The hill just seemed to get steeper, but I kept fighting to get back the life I knew I could have.

	So, it may be true that the treatment for back pain is of little help. But for those who are among that statistic that improves and heals, they beat the odds—as a doctor I had seen it, and as a patient, I lived it. Suffering is not a good option. Neither is accepting immobilization. Taking action is often life-affirming in itself because it provides hope.

	My backache journey was a rocky one. Now, I have more empathy plus appreciation of vulnerability. In the end, the decision to try one last treatment for my chronic back problem saved my life—the one worth living.

Physician's LifeStyle

The Doctor Becomes the Patient

While Singapore has a reputation forbeing strictly governed, many of thosefamous regulations have helped makeit the most developed country inSoutheast Asia. It is a prime example of Asia's advancementas a powerhouse of the 21st century. Thecountry, an island about 24 by 14 miles, has long beenon the globe as a main sea route, and now, with one ofthe world's best airports and best national airline, thecountry is seeking its share in the world of air travel.

Singapore is an excellent stop for travelers, astourist facilities are modern and extensively available—and English is widely spoken. The SingaporeTourist Board (www.visitsingapore.com/publish/stbportal/en/home.html), has excellent guides fluent inEnglish who know their country well.

As a visitor, the country's reputation should not beignored. Tourists should be aware of Singapore's strictlaws and penalties for actions that might not be illegalor might be considered minor offenses in the UnitedStates. For example, penalties are enforced when itcomes to jaywalking, littering, and spitting—and vandalismis punishable by caning. Although the governingentities are strict, the tourist experience is anything but.Be prepared to enjoy a safe, clean, well-rounded nationwhere the food is fantastic, and the service in shops,restaurants, and hotels is highly commendable.

Singapore's upscale hotels are arguably the best inthe world. The Raffles Hotel (65-6337-1886;www.singapore-raffles.raffles.com) is a historic landmark—named after Sir Stamford Raffles, founder ofmodern Singapore, and declared a National Monumentin 1987 on its 100-year anniversary. The PanPacific Singapore Hotel (800-327-8585; www.singapore.panpacific.com) was perfect for our stay. With its35-story atrium, huge pool, and vast fitness center, thePan Pacific creates the private comfort long-distancetravelers crave. The Pan Pacific is also centrally locatedamidst popular tourist attractions, such as MarinaSquare (www.marinasquare.com.sg), a shoppinghaven, and Suntec Singapore International Conventionand Exhibition Centre (65-6337-2888; www.suntecsingapore.com). Also nearby is the Esplanade,Theatres on the Bay (www.esplanade.com), Singapore'snewest and most exciting performance artscomplex. Its popular 4-level, opera-style, 2000-seattheater and its state-of-the-art 1600-seat concert hallprovide some of the most exciting entertainment venuesin Singapore.

Other attractions include riding the cable car tolittle Sentosa Island (800-736-8673; www.sentosa.com.sg), with its serene beaches at the southern tip ofSingapore, and returning via the Jewel Box on MountFaber (65-6377-9688; www.mountfaber.com.sg),with its panorama of the city. Shopping in TekkaMarket near Little India meets any shopping need, andstore items seem endless.

By riding the MRT (ie, rapid transit train) toChinatown's Chinese Heritage Center, you can learnhow the immigrants came looking for their newworld. And don't miss enjoying the Duck Tour in whatwas once a US Army amphibious half-boat, half-truckvehicle that is now a ride that ends at Merlion Park,home to the original half-lion, half-fish sculpture thatis a national icon. Installed in 1972, the Merlion statueis a favorite among photographers and tourists.

The Singapore Botanic Gardens (65-6471-7361;www.sbg.org.sg) have a magnificent display of orchidsand in the early morning the locals practice their taichi. Later on in the evening, the Night Safari near theSingapore Zoo (65-6269-3411; www.zoo.com.sg)flaunts the fact that 90% of its animals are nocturnal.The Jurong Bird Park (65-6265-0022; www.birdpark.com.sg) nature shows are also interesting, as areFort Canning Park's spice gardens and the undergroundBattle Box command center where the Britishgarrison surrendered to the Japanese in 1942.

Dining experiences vary from the long-establishedmultiple ethnic booths at Newton Circus to the fairlyrecent, internationally acclaimed, Doc Cheng's(65-6331-1612) at Raffles Hotel, where you can sitin a screened booth and eat Western cuisine with anAsian twist. Also consider My Humble House (65-6423-1881), a hip, avant-garde restaurant at theEsplanade Mall, where the plates of cold dessertscome out smoking on dry ice. 

Singapore: A Splendid Asian Experience

Hedge funds are privateinvestment limited partnershipsthat allow privateinvestors to poolassets to be invested bya fund manager, who is the generalpartner or entity that started and isresponsible for running the fund. Thisgeneral partner handles all of the tradingactivity and day-to-day operationsof running the hedge fund. The limitedpartners (ie, participants) are those thatsupply most of the capital, but do notparticipate in the trading or day-to-dayactivities of running the hedge fund.

The first hedge fund was set up byAlfred W. Jones in 1949. Jones wantedto eliminate a part of the market riskinvolved in holding long stock positionsby short-selling other stocks. Hethereby shifted most of his exposurefrom market timing to stock picking.Jones was the first to use short sales,leverage, and incentive fees in combination.In 1952, he converted his generalpartnership fund into a limited partnership,investing with several independentportfolio managers and creating thefirst multimanager hedge fund. In themid-1950s other funds started usingthe short-selling of shares, although forthe majority of these funds, the hedgingof market risk was not central totheir investment strategy.

By design, hedge funds may investin a wide variety of investmentsranging from your typical equityand fixed-income investments toinvestments in derivative securities,distressed firms, currency speculation,convertible bonds, emerging markets,merger arbitrage, and so forth. Thehedge funds may jump from one assetclass to another as perceived investmentopportunities present themselves.

What hedge funds typically attemptto do is exploit temporary misalignmentsin security valuations. Byway of example, suppose the investmentmanager predicts that DaimlerChrysler (DCX) stock will outperformduring the coming year, whereasFord Motor Company (F) stock isexpected to do just the oppositeâ€”underperform. In such a case, theinvestment manager may exploitwhat they perceive to be an investmentopportunity by taking a longposition in DCX and shorting Ford.By implementing such a strategy, themanager is "hedging" their exposure,while making a bet on the relative valuationbetween the two companies.

Does this mean that taking such aposition is risky? Of course, the answeris "yes" insofar as the fund is speculatingin perceived valuation differencesbetween the two companies. This positioncould obviously be right orwrong, and if the fund utilizes leveragein such a transaction, returns can bequite volatile.

Unlike mutual funds that poolassets to be invested by a fund manager,hedge funds are structured as privatepartnerships and are subject tominimal SEC regulation. Typically,they are open only to wealthy or institutionalinvestors. Many hedge fundsrequire investors to agree to initial"lock-ups" of their money. In otherwords, investors typically agree to lockup their investment for periods as longas several years, during which timefunds may not be accessed or withdrawn.In this way, hedge funds mayinvest in illiquid assets (ie, assets thatare not easily and quickly convertedinto money) without having to worryabout meeting the demands for redemptionof funds.

Hedge funds also differ from mutualfunds in that their compensationstructure is markedly dissimilar. Forinstance, the typical equity mutualfund may assess annual managementfees in the neighborhood of 1% to1.5%, whereas hedge funds charge notonly an annual management fee, but"incentive fees" that are oftentimessubstantial. For instance, it would notbe unusual for the typical annualincentive fee to amount to 20% ofinvestment profits realized during thecourse of the year.

Despite such fees, hedge funds havegrown enormously in the past few yearsfrom as little as $50 billion in 1990 toover $1 trillion by the end of 2005. Oneof the fastest growing sectors has beenin "funds of funds." These types offunds invest in several hedge funds. Inthis way, the risk is spread across severaldifferent funds. Such a strategy is notwithout risks, however, as these fundsoperate with considerable leverage ontop of the leverage of the primary fundsin which they invest. This makesreturns even more volatile.

Hedge funds also are not subjectto the numerous regulationsthat apply to mutual funds for theprotection of investorsâ€”such asrequiring a certain degree of liquidity,insisting that mutual fund sharesbe redeemable anytime, protectingagainst conflicts of interest, the assuringfairness in the pricing of fundshares, disclosing regulations, limitingthe use of leverage, and more. Thisfreedom from regulation allows hedgefunds to engage in leverage and othersophisticated investment techniques toa much greater extent than mutualfunds. Although hedge funds are notsubject to registration and all of theregulations that apply to mutual funds,hedge funds are subject to the anti-fraudprovisions of the federal securitieslaws.

Hedge funds generally rely on Sections3(c)(1) and 3(c)(7) of the InvestmentCompany Act of 1940 to avoidregistration and regulation as investmentcompanies. To avoid having toregister the securities they offer with theSEC, hedge funds often rely on Section4(2) and Rule 506 of Regulation D ofthe Securities Act of 1933.

Because of their growing popularity,hedge funds are attracting the attentionof regulators. And as this industrycontinues to grow, you can be sure thatregulation will increase as well. So doyour homework first and be carefulbefore you decideâ€”if you decideâ€”toinvest in a hedge fund.

Thomas R. Kosky and his partner, Harris L.Kerker, are principals of the Asset Planning,Group, Inc, in Miami, Fla. The companyspecializes in investment, retirement, andestate planning. Mr. Kosky also teaches corporatefinance in the Saturday Executive and Health CareExecutive MBA Programs at the University of Miami in CoralGables, Fla. Mr. Kosky and Mr. Kerker welcome questions orcomments at 800-953-5508, or e-mail Mr. Kosky directly atProfessorKosky@aol.com.

Planning

Hedge & Mutual Funds: What's the Difference?

An equity-indexed annuity(EIA) is a special type offixed-rate annuity. It paysa lower guaranteed ratethan an ordinary fixedannuity. For example, it may pay 1.5%to 3% a year. In return, it pays a higherrate if a stock market index performswell in a particular year. However, if themarket falls during the year, you won'tlose anything; your return will be zerofor that year. And like all annuities, EIAearnings are tax-deferred, so you won'tpay taxes until you withdraw money.

EIAs have various crediting methods.For instance, a contract may call forcrediting 50% of the market's profits.So, if the S&P 500 is up 15% for theyear, you'll be credited with a 7.5%rate. Many EIAs have rate caps, whichmean that you won't earn more than acertain amount—say, 9%—even if theindex is up 30%. While EIAs soundappealing, the following are some of thedownsides of EIAs:

Every EIA has a differentcrediting method, and those finedetails can make a big difference inyour return. Even the simplest EIA iscomplex, but some are so complicatedthey make your head spin. It's challengingto understand how EIAs workand even harder to compare them.How can you tell if an EIA you're consideringis one of the best ones? It'salmost impossible to know.

The big"if" with EIAs is that the minimumreturn is guaranteed only if you holdthe EIA to maturity. If you don't, allbets are off and withdrawal penaltiescan last up to 10 years. If you needyour money before the surrender periodis up, you'll have to pay a stiff withdrawalfee, and you may not get theguaranteed minimum rate.

Whether you invest a littleor a lot in an EIA, the agent earns thesame commission—up to 15% is typical.You don't pay a sales charge, andit's ultimately deducted from yourreturn. The same is true of the insurer'shefty management fees and profits.While EIAs do provide some advantages,physicians planning for retirementcan pursue other options. You canaccomplish the same things as an EIA,but much more cost-effectively andwithout tying up your money by pursuingthe following three EIA alternatives:

Considerputting 50% of your nest egg intreasuries and 50% in conservativestock mutual funds. You'll have a guaranteedreturn on half of your moneyand growth potential with the otherhalf—and it's all 100% liquid. Anotheradvantage is that a portion of mutualfund dividends (ie, the portion generatedby qualified stock dividends) aretaxed at a maximum 15% rate, as arelong-term capital gains distributions.

Most variableannuities now offer guaranteed lifetimeincome options or withdrawal optionsthat help cushion against market risk.And while a variable annuity can producea negative return during any givenyear, you get the full benefit when themarket is up, instead of just a portion.The best variable annuities have reasonablemanagement fees. Some that aresold by financial advisors have no mortalityand expense fees—just an asset-managementfee, making them as cost-effectiveas mutual funds.

Fixed annuitiesprovide a guaranteed tax-deferredyield without gimmicks. Ifyou want to guarantee some of yourprincipal, you can, of course, put partof your money in variable annuitiesand part in fixed annuities.Before you put your money into anEIA, consider the alternatives carefully.The more you look under the hood, theless attractive EIAs will be.

Frank Congemi is a financial advisor whoworks with many physicians in severalstates. He lives in Deerfield Beach, Fla, andhas an office in Queens, NY. He welcomesquestions or comments at 800-228-2309 orfrank@frankcongemi.com.

Pitfalls Inherent in Equity-indexed Annuities

If you're aged 40 to 60 years old, the next 5 to 20years will be critical. In retirement you'll need 80%of your preretirement income—more if you want totravel—but that's just the first year. In each of the followingyears you'll need even more to compensate forthe rate of inflation. Many doctors would like to retireearly, but the longer the retirement, the more they riskhaving insufficient retirement income.

The major advantages of real estate are in rentalproperties. They offer stable income, which increaseswith inflation, and real estate always has residualvalue—prices will never fall to zero. Also real estate isa hybrid asset, having the capital appreciation of astock but the income-producing capacity of a bond.This makes a real estate investment the ultimate protectionfrom inflation because in this situation, inflationworks for you, not against you, pushing the value ofyour asset upwards as well as your rental income.

However, doctors share common roadblocks as towhy they don't invest—insufficient time and lack ofknowledge. The following are some issues to considerwhen looking into real estate investments:

Carefully analyzed real estateinvestments will usually increase in value over time. Bybuying property in the right location, the investor canrest assured that the value of their investment willalways increase over the long run.

By applying the concept of leverage(ie, borrowing most of the funds necessary as a loanagainst real estate to buy other real estate or businessassets), an investor will have greater purchasing power,which gives them the ability to acquire a number ofinvestments, resulting in larger returns.

Renting real estate creates cash flow.The tenants pay the rent, which you can apply to themortgage. They can literally buy all or most of theproperty for the investor.

The investor can deduct, as anexpense, all of the interest, property taxes, insurance,repairs, and depreciation of their property. The rules ofdepreciation bear no relationship to the market valueof the real estate; the property can be appreciating invalue while the investor is depreciating the real estateasset on their tax return. This noncash expense canreduce current taxable income without reducing actualincome. Real estate is the only investment that theIRS allows you to show a depreciable loss when youhave, in fact, made a profit.

This allows aninvestor in real estate to sell and purchase other investmentproperty without current tax liability and createfor the investor substantial additional wealth.

By applying the above concepts, a doctor can investin real estate and get the cash flow of bonds, the appreciationthey could see in a successful year in stocks,along with the ability to have someone else pay for themajority of the investment. Additionally, you candeclare a loss on your taxes even though the real estateis making money. This makes real estate the most prudentinvestment today for doctors. 

Paul Hanks, president of Portfolio Development Services, startedhis professional career as an orthodontist. He became a Californiareal estate broker and started a company tailored to the needs ofclinicians that offers a trustworthy and safe way to invest in realestate. His company caters to people who are simply too busy toinvest and strives to create future financial security and wealth for his clients andtheir families.

Look to Real Estate for Retirement Funding

For physicians who have foundthat qualified and nonqualifiedplans insufficiently meet theirretirement planning expectations andasset protection needs, they may wantto look off the beaten path and considernontraditional plans. While nontraditionalplans may provide you theright pieces to fulfill those financialneeds, it is important to be knowledgeableabout the specifics of each plan orconsult a financial advisor.

Split dollar plans have been the primarytype of nontraditional plans in thecorporate workplace for the past 40years. Although it is not an insurancepolicy, it is an arrangement between anemployer and a chosen employee thatsplits the premiums, death benefits,and proceeds of permanent life insurance.But over the past 3 years, the IRShas changed the rules significantlyregarding them. Unfortunately, manyadvisors who do not practice in thisarena on a daily basis operate underthe misconception that split dollarplans are now dead. Nothing could befurther from the truth.

Under these new rules, it is certainlymore difficult to implement a splitdollar plan for public companies.However, for private businesses likemedical practices, it can still be aviable option. In fact, given the lowinterest rate environment that we currentlyenjoy, now may be a perfecttime to implement a split dollar planfor your medical practice. Physicianscan take advantage of this low interestrate and enjoy significant retirementwealth accumulation without offeringit to any employees. These types ofplans can be structured to handlemany of the buy-out and buy-in issuesbetween the younger and older partnersin a practice. If you want topotentially have more income inretirement and explore tax-efficientways to transition ownership of apractice, consider the advantages anddisadvantages of a compliant split dollarnontraditional plan to determine ifit's right for you.

In many circumstances, the centralgoal of a nontraditional plan may beasset protection for your practiceassets. The employee's ownership canbe organized in an irrevocable trust orother similar legal arrangements,which can be used in a number ofestate planning and asset protectionplans. Many physicians are concernedthat one of their partner's or employee'smistakes could result in a lawsuitthat decimates all of their practice realestate, equipment, and accounts receivable.They are delighted to hear that asolution to their concern can also offerretirement and tax benefits.

Most popular in this arena forphysicians are those that asset-protecta practice's accounts receivable. However,in this type of nontraditionalplan, it is crucial that both asset protectionand tax issues be properlynegotiated. In most of the plans thereare common pitfalls lurking. If thistype of plan is of interest to you,work with a financial advisor wellversed with this method of planning.

Financed nontraditional plans, when properly structured, can providethe greatest after-tax investmentreturn to participating physicians.Because an outside lender supplies theinitial capital to fund the plan inexchange for a fixed return, the physiciansgain the use of other people'smoney compounded on a tax-deferredbasis. Furthermore, the plansare typically structured for substantialasset protection against the creditorsof both the medical practice and theindividual physicians.

Based on their personal experience,every successful physician should considera nontraditional plan or a nonqualifieddeferred compensation(NQDC) plan, which includes anyplan, agreement, or arrangement thatprovides for the deferral of compensation.Qualified plans are burdened witha host of restrictions, costs, and tax limitations.This often makes them expensivefor physicians, and they may notallow for significant retirement wealthaccumulation. NQDC plans have muchfewer restrictions and, therefore, canbe relatively inexpensive to implement.Nontraditional plans are more flexible,provide asset protection, and can likelyprovide the best return for physicianparticipants. If building your retirementwealth is an important goal for yourfinancial plan, investigate NQDC andnontraditional plans to see if they maybe right for you. 

David B. Mandell, JD, MBA, is an attorney,lecturer, and author of Wealth Protection,MD (Guardian Publishing; 2004). He is also acofounder of The Wealth Protection Alliance(WPA), a nationwide network of elite independentfinancial advisory firms whose goal it is to helpclients build and preserve their wealth. Robert Davenport,MSFS, CFBS, is president of Partners Financial Group, andprovides sophisticated business planning to physiciansaround the country. Partners Financial Group is a chartermember of the WPA, and can be reached at 800-554-7233.For a 40% discount on Jarvis and Mandell's new book,Wealth Protection, MD, or for an audio CD on asset protection,call 800-554-7233 or e-mail info@wealthprotectionalliance.com. The information contained in this article isgeneral in nature and should not be construed as comprehensiveadvice. Please consult a qualified tax, legal, orfinancial advisor before taking any action.

Retirement Options You Haven't Heard Of

There is a widely held beliefthat companies that havegood investment opportunities,and hence growth,can and should reinvest allof their income in the business to growthe company and its share price. Onlycompanies that do not have such opportunitiespay out any money they cannotprofitably reinvest to shareholders asdividends. Under this theory, dividend-payingstocks do not have good growthopportunities—they are mostly inmature industries—and over time theywill produce lower total returns thanstocks that do not pay dividends.Therefore, most investors should avoiddividend-paying stocks. Both theory andempirical evidence show that the conventionalwisdom is wrong.

Financial theory holds that in a perfectworld, whether a company pays dividendsdoes not matter. This would betrue in a world without taxes, but itshould still be nearly true in the realworld with taxes.

This is a puzzling statement andneeds some explanation. Briefly, the "ifeverything else is the same" part impliesthat if there are two companies that areidentical in every other respect, thenover time, they will produce the sametotal return even if they pay very differentdividends. Because if the companythat pays higher dividends needs moneyfor investing, it can always borrow thenecessary money. "In a perfect world" essentially requires that both investorsand business managers behave rationally.So in theory, there is no reason to takedividends into consideration whenselecting stocks for investment.

Empirical evidence shows that stockspaying good dividends over time significantlyoutperform stocks paying little orno dividends. As a matter of fact, amajority of the total return of moststocks over the long run comes fromreinvestment of dividends. Therefore,stocks that do not pay dividends arelikely to provide lower total return thandividend-paying stocks in the long run.

The empirical evidence contradictsthe conventional wisdom, but does itcontradict the theory as well? Not necessarily.Recall that the theory assumesthat business managers behave rationallyand would reinvest earnings in thebusiness only if they can do so profitably.It seems that a lot of businessmanagers are not rational. They reinvesta lot of a company's income in businessesthat do not earn an adequate returnon investment. In other words, theywaste a lot of the shareholders' money,and the shareholders of such companieswould have been better off if the managersdistributed a good part of the company'sincome as dividends. Paying dividendsremoves money from the hands ofthe managers that they would haveinvested poorly.

There are two major investmentimplications from the empirical findings.First, no matter what your age, youshould hold a number of dividend-payingstocks. If your current portfolioemphasizes value stocks, as it should,then you probably already have a goodsize investment in dividend-payingstocks because many value stocks payhigh dividends. Otherwise, add somemutual funds or exchange-traded fundsthat focus on dividend-paying stocks.

Second, unless you need the incomefrom your portfolio to live on, reinvestall dividends instead of spending them.While doing so, also reinvest all capitalgains distributions from your mutualfunds by choosing reinvestment ofboth dividends and capital gains—anoption that almost all mutual fundsoffer. The long-term compoundingeffect of doing so is enormous. In taxableaccounts, you will owe currenttaxes on all dividend and capital gainsdistributions. Try to pay the taxes fromnew savings to impose an additionalsaving discipline on yourself.

Chandan Sengupta, author of The OnlyProven Road to Investment Success (JohnWiley; 2001) and Financial Modeling UsingExcel and VBA (Wiley; 2004), currentlyteaches finance at the Fordham UniversityGraduate School of Business and consults with individualson financial planning and investment management. He welcomesquestions or comments at chandansen@aol.com.

Pursue Dividend-paying Stocks at Any Age

There is little question that the US economy isslowing down, with the significant increasesin short-term interest rates by the FederalReserve over the past 2 years, and the current downturnin the domestic housing market. The big debatenow, however, is whether the country will experiencea "hard" landing—a recession—or come in with a"soft" landing, by slowing and posting a modestgrowth rate.

To understand the origins of this debate, we needto take a look at recent history to help us see wherewe are and how we got here. Over the past 5 years,the economy has fluctuated between two extremes.First, the economy was weak from 2001 to 2003with output declining or rising slowly. From there,the economy rebounded to robust, above-averagegrowth from 2004 through early 2006.

As the economy picked up steam in mid-2004, theFed gradually raised interest rates to encourage moderategrowth and temper the potential for inflation.The 17 successive quarter-point interest-rate hikeshelped drain excess liquidity from the economy,while allowing borrowers time to adjust to tightercredit conditions. Keep in mind, the full effects of Fedtightening are usually felt about a year and a halfafter it takes place, so the impact of the most recentcycle that ended in June 2006 may not be fully realizeduntil mid-2007.

In addition to the rate hikes, several other factorshave emerged over the last year that have also helpedslow economic growth and increase the likelihood ofa soft landing. Energy prices dropped sharply duringthe second half of the year, enabling consumers tostretch their incomes a little further. In addition, theFed's interest rate hikes helped cool the overly inflatedhousing market. Once the weakness in the housingsector became pronounced, the Fed stopped raisinginterest rates, at least for the time being.

In the meantime, lending credence to the soft landingscenario is the fact that corporate profits havecontinued to grow, giving companies sufficient fundsto expand payrolls and increase capital spending.This will help sustain economic growth, albeit at amore modest and manageable pace.

It's important to remember, however, that geopoliticalevents are always a factor when looking at theprospects for the economy. With the current challengesfacing our country—the conflict in Iraq, the resurgenceof the Taliban in Afghanistan, and the nuclear ambitionsof Iran and North Korea—the probability of anadverse geopolitical event that could jolt the economyand bring about a hard landing has increased.

However, all things considered, absent a majorgeopolitical event, we expect a soft landing for theeconomy in the year ahead with economic growthslowing—not stalling.

Joseph F. Lagowski is vice president, investments, and a financialconsultant with AG Edwards in Hillsborough, NJ. He welcomesquestions or comments at 800-288-0901, or visit www.agedwards.com. This article was provided by AG Edwards & Sons, Inc,member SIPC.

Investing

The Economy: Coming in for a Landing

It's common financial advice to hearthat the younger you are, the moreadventurous you should be in yourinvestments by taking on more risk. Thefurther you are from retirement, themore time you have to bounce backfrom an initial investment blow. Butthat is hard advice to swallow for ayoung doctor with a pile of studentloans and credit card debt, strugglingfrom paycheck to paycheck. Althoughyou may be younger and in a betterposition to take risk, you may not haveas much money to gamble with, whichcan make holding steadfast to a volatileinvestment a difficult task, according toa recent article in 

Being aggressive means putting yourmoney into investments such as smallcap funds (ie, a mutual fund that holdsthe stocks of small capitalized companieswith a potential for growth), realestate, and international funds, ratherthan into lower risk assets like bondsand money market funds. But investingaggressively is an emotional ride.

Small cap funds are a perfect example.Though they have averaged 13% ayear over the past 2 decades, accordingto 

, keep in mind that in 9months in 2000 when large caps lost5%, small caps were down 28%—apainful drop for a young physician in atight financial situation.

During the housing boom, peoplelooked to real estate as an alternativeinvestment. But today, this tried andtrue method to a large return is now aburden to those with unsold propertiesor drowning in high interest rates fromtheir adjustable rate mortgage. Accordingto CNNMoney.com, a CommerceDepartment report showed the homeownervacancy rate rose to 2.7% in thefourth quarter of 2006, well above the2% the previous year.

And while international investingshould occupy a portion of your portfolio—taking advantage of the potentialfor growth in some foreign economies,particularly in emerging markets, is agreat way to diversify—wars, changesin currency exchange rates, and socialevents create unanticipated fluctuationsin your investment.

Before jumping into an aggressiveinvestment, review your current situationand what you anticipate for thenear future. If you presently have a largeamount of debt or are anticipating alarge expense, like purchasing a newhouse or starting a family, those circumstanceswill help you determine yourability to ride out the volatility of a riskyinvestment without panicking.

Your youth should not be the onlyfactor determining whether or not youshould pursue a roller-coaster investment—every person handles this investingstrategy differently and youmust find a balance both emotionallyand financially.

Once You Start, Can You Stay Aggressive?

Our nation's finances arein serious trouble, and ifit feels like you're notgetting the whole storyfrom those in charge,you just may be right. But which investmentswill keep you afloat as the dollarsinks? Why, commodities, of course.

Imagine there's a company you'vebeen following, and a few months ago itannounced a dismal $318-million loss.The CEO promised a company turnaround.However the company was hidingan ugly truth from the public—theywere actually keeping two different setsof books. The first set held the numbersannounced to shareholders and lenders,while the second set had the real numbers,showing that the company hasbeen bankrupt for years. The companywas only able to survive because lenderskept loaning money. The real numbersshowed that the company hadn't lostjust $318 million, but closer to $760million. It is unlikely that you'd invest inthis company. The problem is, you'realready invested.

This company is the United States.And the numbers are far worse than theexample. The United States is "officially" $318 billion in debt, with the realnumber closer to $760 billion. And thatfigure doesn't include the future obligationsof Social Security and Medicare,which pushed the actual national deficitin 2005 to $3.5 trillion.

In fact, the US government is dependenton new lending to stay afloat, to thetune of $2 billion per day. Often, thatcomes from foreign countries thatwould like nothing more than to help usdig a bigger hole, such as Middle Easterncountries, Argentina, and Russia.

This debt exerts downward pressureon the US dollar. As more of the babyboomers retire, and more of thosefuture obligations become due, the governmentwill have to issue more dollars.This will lead to inflation and a severedevaluation of the dollar. Worse, currentgovernment bond owners maystart selling off their debt, driving thedollar down further and scaring awaynew lenders.

How do you short the United States?By taking your current dollars andinvesting them in commodities, specificallygold and other precious metals,which can rise despite other externalforces. As a tangible asset with intrinsicvalue, commodities represent a saferefuge when other investments plungeor when geopolitical trouble erupts.

In the past this may not have beenenough to drive up commodity prices,as commodity producers generally producedas much as possible. Whenevercommodity prices moved up, theywould increase production, leading to aglutted market, and prices would againcome back down.

This is no longer the case. New managementteams are in place at manycommodity producers—executives withbackgrounds in investment banking.Only some of that money is going backinto increasing production. The rest isbeing used to buy back shares, pay offdebt, pay dividends, or acquire othermining companies.

All of these activities drive up thecompany's stock price, increasing shareholdervalue—but none of them increasethe world's supply of gold orother commodities (eg, Rio Tinto hasn'tdeveloped a new copper mine in over adecade, even though the price of copperhas quadrupled in the last 5 years).

All of this combined means that thiscommodity boom promises to be evenmore pronounced than past bull markets.I continue to believe that $1000per ounce of gold is not far away, andthat this is just a consolidation phasebefore its next blast upwards. 

James DiGeorgia is editor and publisher ofthe Gold and Energy Advisor Newsletter(www.goldandenergyadvisor.com) and theauthor of the popular books The New BullMarket in Gold and The Global War for Oil.

Why the US Debt Is a Boon to Commodities

Health care and pharmaceutical companystocks are poised for a rebound, according toreports by 

and Morningstar.Major pharma companies could have big breakthroughsthis year, while also offering alternative treatmentsto serious disease states, 

Sanofi-Aventis' (SNY) weight-loss drug Acomplia,already for sale in Europe, is still awaiting FDAapproval. Acomplia is reported to not only helppatients lose weight, but improve cholesterol and bloodsugar levels. The agency could approve it by April,making way for possible sales of an estimated $300million this year. Other reported uses for Acomplia, inthe treatment of diabetes, for example, could boostsales to $2.8 billion by 2010, according to 

Novartis' (NVS) drug, Galvus, for type 2 diabetesis another potential blockbuster. It is slated forapproval within the first quarter of 2007. Taken oncea day, it is reported to enhance the body's ability tolower elevated blood sugar, without causing hypoglycemiaor weight gain.

In Europe, Novartis will introduce Lucentis, whichis reported to be a treatment for macular degeneration;it has anticipated sales of $1 billion by the end of 2008,according to The Motley Fool (www.fool.com).

Novartis' other eventual big seller could beTekturna, a member of the first new class of highblood pressure medication launched in almost 10years, according to Barron's. Due for FDA approvalin March, Novartis believes Tekturna can reducehypertension's damage to the heart, brain, and kidneys.Sales estimates for 2007 are lean at only $65million to $80 million, but some analysts project peakannual sales of $3 billion.

Another potential groundbreaking drug is Glaxo-SmithKline's (GSK) Tykerb. It has been submitted tothe FDA as treating an aggressive form of breast cancercalled HER2-positive and may be the first cancer drugto fight the disease on two fronts, targeting two proteinsthat promote cancer cell growth, says 

Tykerb could get FDA approval in March for thetreatment of advanced breast cancer, with 2007 salesprojected at $200 million. GSK is also testing the drugon the early stages of the disease, and in 5 years, annualsales could hit $1.2 billion, according to the article.

Experts are split on whether the new antidepressant,Pristiq, from Wyeth (WYE) is a significantadvance, says 

However, in April, Pristiq could be approved as thefirst nonhormonal treatment for menopausal hot flashesand night sweats. With aging baby boomers seekingalternatives to hormone replacement therapy, therecould be a huge market for the drug, according to

. Analysts are predicting annual sales anywherefrom $500 million to $2 billion by 2011.

Morningstar Equity Research calls the health caresector one of the most attractively valued for 2007.In addition to GSK and Novartis, Morningstar picksinclude Johnson & Johnson (JNJ) and Eli Lilly &Company (LLY).

Biotech company, Amgen (AMGN) is rated highly,with annual sales and earnings growth expected in thehigh single digits, according to Morningstar.

In the medical equipment sector, Medtronic (MDT)also makes the cut. Implantable cardioverter defibrillatorsales will increase to low double digits through thenext year, as physicians regain confidence in the devices,Morningstar says.

Health Care and Drug Stocks Poised for Growth

A term used to describe a patient's medicalrecord in a digital format.

While much of the controversy surrounding electronicmedical records (EMRs) has centered onthe issue of patient confidentiality, the cost ofimplementation to the medical community and potentialsavings to that same environment is a major issue.

Recent studies have shed some lightâ€”albeit in ballparktermsâ€”on the costs of setting up EMR systems. Onestudy, published in the journal 

(September/October 2005), revealed that initial EMR setup costs at 14small physician practices averaged $44,000 per full-timeprovider, with an additional $8500 in annual costs tomaintain the system.

While the most comprehensive study was published in

(Vol. 114, April 1,2003), the following are recent figures for the averagebreakdown of costs, estimated by EMR Experts (www.emrexperts.com):

At present, physicians and physician practices bear thecosts of implementing an EMR system, but that couldchange. Several pieces of legislation are pending thatwould provide financial assistance to doctors who startusing EMRsâ€”including legislation proposed by SenatorsBill Frist and Hillary Clinton authorizing up to a $15,000reimbursement. Passage of this and related legislation is,of course, still up in the air.

The same study of 14 small physician practices in

revealed that, on average, the practicesrecouped the cost of EMR system implementation in 2

years. That meant a savings thereafter of approximately$23,000 per provider per year based largely on improvedefficiencies.

cost-benefit studyanalyzed the financial effects of EMR systems in ambulatoryprimary care settings using the traditional paper-basedmedical record for comparison purposes. The studyrevealed an "estimated net benefit from using an EMR fora 5-year period" of $86,400 per provider, not far off of theresults of the study of 14 small physician practices.

Legislation proposing a standardization of EMR systemsis being bandied about, and other obstaclesâ€”including high initial implementation costs and the disruptiveeffects on physician practices during implementationâ€”need to be addressed. But initial studies demonstratethat the implementation of an EMR system in aprimary care setting can result in a positive return oninvestment.

March 2007

It's Not the Money That Makes You Unhappy

Develop a Home Mortgage Plan to Save Money

Assisting Parents and Relieving Tax Burdens

Pursue ETFs that Target Specific Diseases

When It's Time to Play Catch-up on Saving

Hot in Real Estate, Undeveloped Land

Using Your Home as a Retirement Fund

Bargain Opportunities for Online Shoppers

DID YOU KNOW ...

The Doctor Becomes the Patient

Singapore: A Splendid Asian Experience

Hedge & Mutual Funds: What's the Difference?

Pitfalls Inherent in Equity-indexed Annuities

Look to Real Estate for Retirement Funding

Retirement Options You Haven't Heard Of

Pursue Dividend-paying Stocks at Any Age

The Economy: Coming in for a Landing

Once You Start, Can You Stay Aggressive?

Why the US Debt Is a Boon to Commodities

Health Care and Drug Stocks Poised for Growth

Close-up: Electronic Medical Records

Malpractice Survival Kit: Protecting Your Life and Livelihood

Remember to Make an Investment in Yourself

One Practice's Prescription for EMR Success

The Possibilities Are Endless

Competitive and Successful with EMR

Reduce Security and Privacy Risks of EMR

Statin Side Effects Documented Online

Drug Development Backed by Nonprofits

Look into the Future with Database Updates

The Return of the Phone Booth for Cell Phones

Battling Burnout: Stretch & Energize Your Body