The Art of Medicine with Dr. Andrew Wilner

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Show Notes

Many thanks to Larry West III, MBA, EA, a tax planner with Precision Tax Planning, LLC, for joining me on today’s episode of “The Art of Medicine.” Larry was referred by Veena Jetti, an expert in Class B real estate. Veena shared her investment expertise on “The Art of Medicine” a couple of weeks ago. (Episode #46: Veena Jetti)

During this 20-minute episode, Larry explained that tax planning requires a proactive approach. As an “EA,” an “enrolled agent,” he is licensed to represent individuals to the internal revenue service (IRS). Larry has worked as an EA for the last eight years and can serve clients in all 50 states.

According to Larry, tax planning is most important for business owners and investors. Tax strategies can include deductions and employing family members. These family members could also potentially benefit from employer-sponsored retirement plans and other fringe benefits. 

When it comes to mounting an effective defense before an audit, documentation is critical. Employed family members must have a job description, records of hours worked, and an appropriate salary for the type of work.

According to Larry, social security and medicare taxes can be avoided for children under 17 when employed under the proper entity such as an LLC.

For additional tips on building wealth and “legal loopholes,” reach out to Larry at
www.pb-strategies.com.

Thanks for listening!

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#taxplanning #precisiontaxstrategies #Bidentaxplan #certifiedpublicaccountants #EA #CPA #IRS

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Special Announcement: The Locum Life: A Physician's Guide to Locum Tenens is available on sale in the month of November only through this link:

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Veena Jetti

Real Estate Investments for Physicians

Many thanks to Veena Jetti, founder of Vive Funds, for sharing her expertise in real estate investing during this 20-minute interview. Veena’s company has a 1/2 billion dollar portfolio. 

Veena invests in Class B and Multifamily real estate, which includes apartments with 200 units or more. These buildings cost millions of dollars, which are far too expensive for most individual investors. Consequently, after vetting these properties and doing due diligence, Vive Funds harnesses the purchasing power of multiple investors to complete the deal. 

These purchases are typically long-term investments, which may not realize a profit until Veena resells the property several years later. Vive Funds puts their money where their mouth is by co-investing with the Limited Partners on every deal. Investors must balance the potential of high profits with the lack of guaranteed returns.

Veena offers a Masterclass to provide prospective investors a solid understanding of where the money goes and the likelihood of larger amounts returning! Masterclasses are staffed by experts and run for six weeks. 

To register for the next class, check out MFmasterclass.com. You can register with this  link:
 https://mf-masterclass.teachable.com/?affcode=779274_bincyq0u 

For more information on investing, please contact Veena Jetti at: ViveFunds.com

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 #investing #ClassBinvesting #Vivefunds #multifamily #portfolio #FIRE #retirement #masterclass #realestateinvesting #realestate #locums #locumtenens #physicianinvesting

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Show Notes

August 16, 2021

I was honored today to speak with Edward Halperin, MD, a pediatric radiation oncologist, and Chancellor and Chief Executive Officer of New York Medical College, Valhalla, NY. Dr. Halperin is an erudite student of medical history and authored the recent article, ‘“We do not want him because he is a Jew:” The Montreal Interns’ Strike of 1934,’ published in the Annals of Internal Medicine (1). The story resonated with me for several reasons, one of which is because I was a neurology resident and epilepsy fellow in Montreal from 1985-1989. Dr. Halperin’s research puts the current discussion of institutional racism in medicine into relevant historical context.

During this 25-minute interview, Dr. Halperin relates the almost forgotten story of Samuel Rabinovitch, MD, the top medical student at the University of Montreal and Jewish intern (briefly!) at the Montreal Notre-Dame Hospital. To protest the hiring of a Jew, 75 French Canadian Roman Catholic interns from multiple hospitals chose to disregard their patient responsibilities and leave Dr. Rabinovitch as the sole intern on duty. Concerned that the strike deprived so many patients of medical care, Dr. Rabinovitch took the high road and resigned. 

Dr. Halperin also discussed his research regarding quotas that limited Jews and other ethnic groups from entering medical and dental school from the 1920s to the 1960s. Specifically, he investigated why some hospitals defied this policy and integrated their classes. 

To learn what happened to Dr. Rabinovitch and gain more insight into discrimination in medicine, please take time out of your day to listen to Dr. Halperin!

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Also available on your favorite podcast player.

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References

1.     Halperin E. “We do not want him because he is a Jew”: The Montreal Interns Strike of 1934. Ann Intern Med 2021;174:852-857.

#discrimination #institutionalracism #bigotry #internsstrike #Rabinovitch #Montrealhospitals #antisemitism #NewYorkMedicalCollege #segretation #quota

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Show Notes

Recent space adventures by Richard Branson on Virgin Galactic and Jeff Bezos’ flight on his rocket ship, “New Shepard,” have lowered the bar for travel beyond earth’s atmosphere.

One consequence of humans entering space is the burgeoning and exciting field of space medicine. William Tarver, MD, MPH, discussed astronaut selection and the challenges of space flight with me in Episode #35: https://www.youtube.com/watch?v=eCGqeSkqVx8&t=39s

Today, I’m joined by Karina Marshall-Goebel, Ph.D., to discuss health issues related to long-duration spaceflight. Dr. Goebel is a human physiologist with special training and ten years of experience in space medicine. As human beings venture further into space, health concerns related to long-duration space flight will inevitably increase. A round trip to Mars will be a 3-year journey, and some health issues like bone and muscle loss and exposure to radiation are foreseeable. But no one can yet predict all hazards to human health that must be addressed along the way.

One recently described health issue that affects approximately 2/3 of the International Space Station crew is spaceflight-associated neuro-ocular syndrome (SANS). Astronauts may experience visual blurring as their eyeballs become distorted over time. Other, more subtle ocular effects such as retinal and optic nerve changes occur. The underlying cause seems to be an excessive amount of fluid that has shifted to the head that would normally be held lower in the body due to gravity. To learn more about this syndrome and devise preventive measures and treatments, astronauts currently study themselves while in space with ultrasound and eye examinations.

Dr. Marshall-Goebel discussed countermeasures under development that astronauts could employ to counteract health problems associated with microgravity fluid shifts. Artificial gravity is one solution but tough to implement. A novel solution might be “vacuum pants,” which redistributes excess fluids from the upper body back to where they belong.

Please join us for this 15-minute discussion to learn more about the challenges of space medicine.

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#astronaut #vacuumpants #Mars #missiontomars #artificialgravity

#spaceflight #longdurationspaceflight #SANS #microgravity #NASA #outerspace

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Show Notes

July 9, 2021

Many thanks to Rhonda Finnie, DNP, APRN (and a lot of other acronyms due to her many certifications!) for joining me today to examine the role of nurse practitioners and other nonphysician providers in the health care team.

We discussed the recent article published in JAMA Neurology by Calli Cook, DNP, and Heidi Schwarz, MD, that called attention to the role of advanced practice clinicians (APCs) in neurology (1). Rhonda’s clinical focus for more than 15 years has been neurology and neurosurgery. Currently, she works as a nurse with a 5-member neurosurgical group where she evaluates and cares for patients in the emergency room and intensive care unit. Her clinical activities allow the neurosurgeons to spend more time in the operating room employing their unique skills

Advanced practice clinicians are a growing part of the healthcare workforce. For example, of the 36,000 members of the American Academy of Neurology, more than 1,600 are APCs. How these providers integrate into patient care with respect to autonomy and scope of practice is very much a work in progress. The inclusion of “midlevels” has not been without its growing pains. Rhonda clarified how the addition of APCs to the healthcare team can benefit patients.

 Rhonda explained that postgraduate education such as specialty boards can help APCs prepare for roles in neurology. Mastering the neurologic clinical examination is another key to success. 

Physicians and organizations that employ APCs need to have appropriate expectations. Rhonda emphasized that APCs are “not there to replace the physician.” Physicians shouldn’t feel threatened by the integration of APCs into the healthcare team.

Please enjoy this 20-minute interview. Your feedback is always welcome.

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References

Cook CL, Schwarz HB. Advanced Practice Clinicians-Neurology’s Underused Resource, JAMA Neurology, May 24, 2021, doi:10.1001/jamaneurol.2021.1416.

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#advancedpracticeclinicians, #midlevels, #AAN, #nursepractitioner, #APCs, #RN, #providers,

#locums #locumphysicians

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Show Notes
July 9, 2021

Many thanks to Brian Bradley, Esq., for discussing the topic of asset protection during this 20-miunute podcast. Brian is an asset protection attorney with Bradley Legal Corp.

The more assets one has, the more critical asset protection becomes. However, asset protection plans may be advisable even for those without private jets and multiple residences. Brian advised that anyone who invests in something beyond their personal residence should consider asset protection. For example, owning a single rental property may warrant a Limited Liability Company (LLC) or other strategies. According to Brian, real estate is a “very risky asset” because you become a landlord with tenants. Other assets, including “anything that needs a key that has a motor,” such as an airplane, boat, or recreational vehicle, requires inclusion in an asset protection plan.

Brian explained that “asset protection” goes beyond insurance policies and estate planning. Asset protection is crucial because it places an additional legal barrier between assets and a potential creditor. As the stakes get higher, security can be layered. An asset protection trust may be advisable for high-net-worth individuals.

Brian also explored whether malpractice insurance provides sufficient protection for most physicians. This depends upon the type of medical practice as well as personal risk tolerance.

To learn more about malpractice, check out Chapters 11 and 12 of my book, “The Locum Life: A Physician’s Guide to Locum Tenens,” available on Amazon and through my website: www.andrewwilner.com

If you have assets to protect, it’s important to develop a continuing relationship with an attorney specializing in asset protection. A directory of asset protection attorneys is available at www.assetprotectioncouncil.com.

Brian Bradley can be contacted at: www.btblegal.com

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#risktolerance #malpractice #assetprotection #assetprotectionattorney #liability #LLC #realestate #realestateinvestment

SHOW LESS

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Show Notes
July 9, 2021

Many thanks to Leighann Landy, FNP-C, for sharing her experience as a co-owner of a Medspa with her husband, Stephen Landy, MD. If you listen to “The Art of Medicine” regularly, you will remember that Dr. Landy and I had a great talk about migraines in Episode #32.

Leighann explained the difference between a Medspa and Dayspa.  Botox, fillers, and lasers are popular Medspa treatments that require medical training to limit complications. Dark spots, telangiectasias, and wrinkles are all susceptible to amelioration. Leighann observed that the type of treatments available varies depending upon the individual Medspa.

Leighann emphasized that prospective patients should check the staff’s medical credentials when selecting a Medspa. They must also have realistic expectations regarding the expected results. 

Before treatment begins, Leighann consults with each patient and discusses possible interventions and costs. Clients need to know that some procedures, like eliminating dark spots, may require more than one visit. Other treatments, like removing wrinkles with Botox, can be completed in one visit but wear off and need to be performed periodically. In some instances, Medspa techniques offer an alternative to more definitive surgery.

To reach Leighann for a consultation, visit Landy Headache and Esthetics, 311 S. Gloster Street, Tupelo, MS: https://landyhe.com/

Thanks for listening!

#Medspa #Dayspa #esthetics #laser #filler #migraine #Botox #bodyimage

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Show Notes

July 7, 2021

Many thanks to Ripal Patel, MD, founder and lead for Mercision Emergency Medicine, for joining me to discuss locum tenens and ER medicine. Dr. Patel received his MD at UT Southwestern Medical Center and his MPH at Kings College, London. He started in general surgery but quickly found his home in ER medicine. After an ER residency at Thomas Jefferson University Hospitals, Philadelphia, PA, he moved to Houston, TX, where he is an Assistant Professor at the Baylor College of Medicine. 

As a locum tenens ER physician, Dr. Patel has traveled to as many as 30 different ERs in a half-dozen states. He works with staffing agencies and also has his own group of ER physicians who contract directly with hospitals. During this 20-minute interview, Rip shares his experiences, both good and bad, with the world of locums.

Dr. Patel explained that locums physicians work on their own schedule, receive excellent compensation, and avoid hospital politics. Assignments are time-limited. If they don’t work out, there’s no obligation to return. On the other hand, if it’s a good experience, recurring assignments offer many advantages.

If you are a physician unhappy with your current employment, need supplemental income, or just ready to try something new, this interview will interest you. Dr. Patel advises that physicians disillusioned with clinical medicine consider locums before switching to a nonclinical career. 

Dr. Patel can be contacted through his website: www.mercisionem.com

For more fascinating interviews, please subscribe to “The Art of Medicine with Dr. Andrew Wilner.”

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If you have questions about locums, don't hesitate to get in touch with me: www.andrewwilner.com

#ER #ermedicine #locums #locumtenens #travel #locumsphysician #roadwarrior #1099 #sidegig #nonclinicalcareers

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Show Notes

July 7, 2021

Please join me for this 20-minute program with Pamela Finnie, RN, Trauma Program Manager at Regional One Health, Memphis, TN. We discussed the role of a regional trauma center and an important public health program, "Stop the Bleed."

Pamela explains what trauma is and the need for immediate specialized care. As a Level 1 Trauma Center, Regional One Health accepts patients from a 150-mile radius. These include motor vehicle accidents, gunshot wounds, falls, burns, and other bodily injuries. Ground and air ambulances arrive at the hospital regularly. The trauma team treats as many as 40 patients each day, every day of the year.

Pamela is a local ambassador for the "Stop the Bleed" campaign, which teaches first aid for gunshot wounds and other injuries that result in bleeding. She explained that the American College of Surgeons spearheaded "Stop the Bleed" after studies of mass shootings revealed that bystanders could have saved lives if only they knew how. For example, law enforcement officers prioritize neutralizing the threat in a mass shooting rather than assisting injured victims. An uninjured bystander's simple application of pressure or tourniquet could decrease bleeding sufficiently until emergency medical services arrive.

The "Stop the Bleed" program recommends three steps:

1.     Before helping others, first make sure you are safe.

2.     Call 911, 

3.     Apply pressure to the wound or a tourniquet 

"Stop the Bleed" educational programs are free of charge. To locate one in your area, contact stopthebleed.org.

For local programs, don't hesitate to get in touch with Pamela at [email protected].  

Many thanks to Pamela Finnie for her work at the trauma center and for explaining "Stop the Bleed!"

Thanks for watching! Feedback is always welcome.

For more fascinating programs, please subscribe: www.youtube.com/c/andrewwilnermdauthor

#stopthebleed #trauma #polytrauma #gunshotwound #opencarry #nopermit #firearms #hemorrhage

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 Show Notes

July 6, 2021

Many thanks to Maheen Mausoof Adamson, Ph.D., for joining me to discuss gender differences in traumatic brain injury. Dr. Adamson is Clinical Research Director for Rehabilitation Services at the Veterans Administration Palo Alto, CA, and Clinical Associate Professor of Neurosurgery at Stanford School of Medicine, Stanford, CA. I’ve interviewed Dr. Adamson before on ReachMD.com, and I’m grateful for this additional opportunity to discuss her research.

As the number of women in active military service and extreme sports increases, so does their risk of traumatic brain injury. Dr. Adamson speculated that anatomical variations between men and women, such as skull size, neck size, and hormonal differences, may play a role in both injury severity and healing. Her team’s research has revealed that traumatic brain injury symptoms can vary depending upon gender. For example, similar injuries resulted in more complaints of anxiety, cognitive dysfunction, depression, PTSD, and vertigo from women than men. Gender differences in traumatic brain injury may have critical implications when individualizing treatment with medication, neuromodulation, and rehabilitation.

Please join us for this 20-minute discussion on gender differences in traumatic brain injury.

Additional information on Dr. Adamson’s research here: 

https://profiles.stanford.edu/maheen-adamson

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Links to prior episodes are available at: www.andrewwilner.com/videos

 #traumaticbraininjury #genderdifferences #menstrualmigraine #menstrualseizures #catamenialepilepsy #blastinjury #artofmedicine #TBI

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