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The Coming Bear Market: Part II How to Prepare
Issue #492, October 16, 2017

Some Observations on Cemeteries
Issue #Interim Bulletin #491A, October 12, 2017

The Coming Bear Market: Part I: The Myth of Buy and Hold Forever
Issue #491, October 09, 2017

The Market makes New Highs
Issue #490, October 02, 2017

The Importance of a New High
Issue #489, September 25, 2017

A Little Insurance: Wealth, War and Wisdom
Issue #488, September 18, 2017

Some Observations
Issue #487, September 11, 2017

How to be Successful in Your Career
Issue #486A, September 07, 2017

How NOT to Buy a Home
Issue #486, September 04, 2017

This Week in the Market
Issue #485, August 28, 2017

Is the “Trump Bump” Running Out of Gas?
Issue #484, August 21, 2017

Gold is on the Move
Issue #483, August 14, 2017

The Importance of Estimation
Issue #482, August 07, 2017

Buying Art and Collecting: Part II of II
Issue #481, July 31, 2017

Buying Art and Collecting in General, Part I of II
Issue #480, July 24, 2017

Physicians need to be More Forceful: Follow-up
Issue #479, July 17, 2017

Physicians need to be More Forceful
Issue #478, July 10, 2017

Your First “Real” Investment
Issue #477, July 03, 2017

Leasing a Watch: Don’t
Issue #476, June 26, 2017

The Importance of Your Children having a Job
Issue #475, June 16, 2017

The Problem with Medical Student Debt is—the Med Schools
Issue #474, June 12, 2017

Critters and Varmints in your Home and Yard
Issue #473A, June 07, 2017

Leveraged ETFs
Issue #472, May 29, 2017

Leasing a Vehicle: Don’t!
Issue #471, May 22, 2017

Issue #470, May 15, 2017

More on Buying Jewelry
Issue #469, May 08, 2017

Buying Jewelry: Gold, Diamonds and Pearls
Issue #468, April 30, 2017

Thomas Sowell: Part III of III
Issue #467, April 24, 2017

Thomas Sowell: Pat II of III
Issue #466, April 17, 2017

Live Close to Where You Work
Issue #465, April 10, 2017

Medtronic in Hospital Management
Issue #Interim Bulletin #464A, April 07, 2017

Thomas Sowell: Part I of II
Issue #464, April 03, 2017

A Political Contribution a an Investment: Part II of II
Issue #463, March 27, 2017

A Political Contribution as an Investment: Part I of II
Issue #462, March 20, 2017

Buffett Selling Vacation Home
Issue #461, March 13, 2017

Advanced Placement (AP) ourses
Issue #460, March 06, 2017

The Importance of a Credit History
Issue #459A, March 02, 2017

A Credit Card Scam
Issue #459, February 27, 2017

The Electronic Health Reord
Issue #458, February 20, 2017

Issue #457, February 13, 2017

Platinum and Palladium
Issue #456, February 06, 2017

Economic Outlook for 2017: Part II of II
Issue #455A, February 02, 2017

Economic Outlook for 2017: Part I of II
Issue #455, January 30, 2017

A Story From Vegas
Issue #454A, January 25, 2017

Land Donation Deals and the IRS
Issue #454, January 23, 2017

The Theory of Gambler’s Ruin
Issue #453, January 16, 2017

Student Loans: But Wait, There’s More!
Issue #452, January 13, 2017

A Second Home
Issue #Interim Bulletin #451A, January 04, 2017

The Consumer Confidence Index
Issue #451, January 02, 2017

Social Security
Issue #450, December 26, 2016

My Outlook for 2017: Part II of II
Issue #449, December 19, 2016

My Outlook for 2017: The Market
Issue #448, December 12, 2016

Medicine in 20 Years
Issue #447, December 05, 2016

Higher Interest Rates
Issue #446, November 28, 2016

Trump and the Markets: The Bad and Ugly
Issue #445A, November 23, 2016

Trump and the Markets: The Good
Issue #445, November 21, 2016

Negative Trends: The Suits aren’t Makin’ Steel
Issue #444, November 16, 2016

The New DOJ Fiduciary Rule
Issue #443, November 07, 2016

Barron’s Conference, Part IV of IV
Issue #442, October 31, 2016

Barron’s Conference, Part III of IV
Issue #Interim Bulletin #441A, October 26, 2016

Barron’s Conference, Part II of IV
Issue #441, October 24, 2016

Barron’s Conference, Part I of IV
Issue #440, October 20, 2016

This Newsletter
Issue #439A, October 12, 2016

Memoirs of US Grant: Vol II
Issue #439, October 10, 2016

More Points on Collecting, Investing and the Economy
Issue #Interim Bulletin #438A, October 05, 2016

Personal Memoirs of US Grant
Issue #438, October 03, 2016

Ideas for a High School Part-Time Job
Issue #Interim Bulletin #437A, September 29, 2016

Collecting, Investing, and the Economy
Issue #437, September 26, 2016

Free College
Issue #436A, September 22, 2016

A Military Commitment to Pay for Med School
Issue #436, September 19, 2016

When a CD isn’t a CD
Issue #435, September 12, 2016

I Made a Mistake
Issue #Interim Bulletin #434A, September 07, 2016

What is Your Spare Time Worth?
Issue #434, September 05, 2016

Credit Cards and Bonus/Loyalty Points
Issue #433, August 29, 2016

The Write-off of Student Loans
Issue #Interim Bulletin #432A, August 25, 2016

412 Retirement Plans
Issue #432, August 22, 2016

Join the Club
Issue #Interim Bulletin #431A, August 18, 2016

The Case for Precious Metals and Hard Assets
Issue #431, August 15, 2016

When the US went off the Silver Standard
Issue #430, August 08, 2016

Why NOT to Open a Restaurant
Issue #429, August 01, 2016

Some Tips on Life Insurance
Issue #428, July 25, 2016

More Observations on Negative Interest Rates
Issue #427, July 18, 2016

Issue #426, July 11, 2016

Is a PhD Worth It? Part II of II
Issue #425, July 04, 2016

Is a PhD Worth It? Part I of II
Issue #424, June 27, 2016

Avoid Part-time real Estate Agents
Issue #423, June 20, 2016

Issue #422, June 13, 2016

The Problem with Auction Reserves
Issue #421, June 06, 2016

Make Full Use of Your Capital Investments
Issue #420, May 30, 2016

The Fed’s Announcement
Issue #419, May 23, 2016

Quit While You’re Ahead: A True Story
Issue #418, May 16, 2016

The Precious Metals
Issue #417, May 09, 2016

Negative Secular Trends: Part Ii of II
Issue #416, May 02, 2016

Negative Secular Trends: Part I of II
Issue #415, April 25, 2016

Not Winning is not the same as not Losing
Issue #414, April 19, 2016

Behavioral Economics: Part II: Weaknesses
Issue #413, April 11, 2016

Behavioral Economics: Part I: Valid Points
Issue #412, April 04, 2016

The Most Important Books I’ve Read
Issue #411, March 28, 2016

Secret to Success: Take Risks and do Things Differently
Issue #410, March 21, 2016

The Over-Priced Food Presentation Hustle
Issue #409, March 14, 2016


By Robert M. Doroghazi, M.D., F.A.C.C.


Issue #426, July 11, 2016

    When I was an Intern at the Massachusetts General Hospital, Drs. Eve Slater and Roman DeSanctis asked if I would help update their experience on aortic dissection. What an opportunity: they didn’t have to ask twice. As I was preparing a presentation for the fall meeting of the American Heart Association, Roman said “Bob, never give the same talk twice”. This newsletter is 10 years old. Considering Interim Bulletins, there have been about 530 Issues. I have always had new information in every issue.
    I also once read that the best way to study a changing topic such as Medicine, or finance and investing, is to spend two-thirds of your time on new material, but to spend one-third in review. For information to be useful, you must have primary recall. How many times when you review do you say “I knew that, but had forgotten it?”
    Although I still have some of my original subscribers, many have been added since the early years. Thus there is a good chance a discussion of embezzlement (Issue #40, 5/19/08) is new to you. For you old-timers, I know you’ll find the review useful.
    At least one-third, and probably one-half, of physician’s offices are the victims of embezzlement. I’m not talking about paper clips and rubber bands, but 5 or 6-figure stuff, really big money.
    Point #1: embezzlement happens, and there’s a 50/50 chance it’s happening to you right now. You’re not only losing money, but you’ll run into problems with your patients, insurance payers, and the big gorilla—Medicare. It’s not their problem if someone stole from you. All they care about is that they paid you, and hold you responsible when they get re-billed for bills already paid.
    A real story. A forensic accountant was asked to evaluate the books at a physician’s office. Off the bat on Monday, he noted there were no cash entries on the bank deposit slips. He asked if anyone paid in cash. The doctor said “no”. He said “I don’t think so. Some people always pay in cash, and many use cash for the co-pay”. On Thursday, the pleasant, universally-liked front-desk receptionist, implicitly trusted for many years, suddenly resigned.
    Guess where she went? To another doctor’s office!! I’m told there is almost a network of these folks who stay a while, take their cut, start to feel the heat, and move on.
    This is the tough part: it is your most trusted employee that is stealing, because they have the opportunity and know the routine. It’s not the marginal worker, it is the one you trusted to write the checks, to have access to your signature stamp, order supplies and conduct business. Physicians are honest, and presume others are honest. Unfortunately, that’s just not how it is in the real world.
    Pay attention to casual comments and observations. Where did your secretary get the money to purchase a vacation home? A spouse noted that her husband and his group were working hard but weren’t bringing home as much as the other OB/GYNs in town. An audit of the office showed embezzlement.
    If you find embezzlement, should you prosecute? Ideally, yes, but do not confront your employee until you contact the authorities. Let them investigate. If there is a criminal conviction, you may receive restitution (don’t expect much: these people aren’t exactly careful with the money). A criminal conviction also makes subsequent civil cases a slam dunk and can prevent the person from plying their trade elsewhere. The problem here is that it might be tough to get the cops interested. They want to catch real crooks, like a meth-head who sticks up a convenience store for $20, not a white-collar criminal stealing $50,000 from a (rich) doctor.
    Contact your accountant: if they do not have experience with a forensic audit (likely the case), they should be able to provide a referral. Whoever performs the audit must recommend procedures to minimize the potential of future embezzlement. 49% of embezzlement is due to inadequate controls. Don’t give people the opportunity.
    This is just one more thing they don’t teach you in medical school.   
    Some of you have had trouble contacting me: my personal email has changed to
.(JavaScript must be enabled to view this email address)
    Next week I’m going to write about low interest rates. The rate on our 10-year Note is at an all-time low. The rate on more than $10T of sovereign debt world-wide is negative. In Switzerland, everything is negative. I have no idea of the implications, and where this will end. In the interim, if you have a variable rate note, lock in the rate now. Even if you have recently re-financed your mortgage, it’s possible that rates have fallen enough to make another re-finance profitable.
    Since I believe a bull market has started in the precious metals, I’ll also discuss when you might jump in. 
    My Editorial “Negative Secular Trends in Medicine: High Hospital Profits” has been accepted, and will appear in the November issue of The American Journal of Medicine.
    I highly recommend Code Warriors: NSA’s Codebreakers and their Secret Intelligence War against the Soviet Union (Budiansky, Knopf). The book starts before WW II, and of course discusses our breaking the Japanese Purple Code and the British breaking the German Enigma. It then goes all the way through the Cold War to the downfall of the Soviet Union. I read a lot of history, and I learned many new things. The discussion of the mathematics and the logic behind code breaking was at just the right level to be enlightening but nor overwhelming.
    I am despondent about the current political situation. The presumed Republican nominee is a huckster (Webster’s: to promote by showmanship). The Clintons are more dangerous that Aaron Burr and Richard Nixon, because they get away with it.
    RMD comment: it makes you miss decent people like Truman, Eisenhower and Ford.
    From William Tecumseh Sherman (McDonough, Norton). Several times there were movements to draft Sherman as a presidential candidate. He had no interest at all. “He probably would have been no worse, and well might have been better, than a large number of the men who have occupied the Oval Office. Honesty, intelligence, popularity, and a genuine concern for the best interests of the nation, as opposed to party loyalty, personal monetary gain and fame, would all have been in his favor”. 
    We had a couple of high school buddies over for supper on July 4th. One told the story of when he was in a study hall. Two guys started to argue but couldn’t finish it there, so agreed to meet behind Bellmore Village shopping center across the street after school to settle it. Gary instantly threw the other guy down and annihilated him with non-stop kicking to the head, neck and chest.
    Both were absent the next day. The following day Gary made it to class. When the teacher took role, he said “Gary, you were absent yesterday. Do you have an excuse”? Gary responded “I had a sore foot”.

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