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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

The War on Cash
Issue #408, March 07, 2016

Precious Metals: Don’t Jump in Yet
Issue #407, February 29, 2016

The Bear is Growling
Issue #406, February 22, 2016

The Importance of Showing Respect
Issue #405, February 15, 2016

The 80-20 Rule of Thumb Pareto Principle
Issue #404, February 08, 2016


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

Physicians need to be More Forceful: Follow-up

Issue #479, July 17, 2017

    My Commentary “A Military Commitment to Fund Your Medical Education” has been accepted by The American Journal of Medicine. It will be my 7th Commentary in the “Green Journal” in the last 2 years. I am on the Editorial Board. The general topic of “Trends in Medicine” would make a great Grand Rounds or presentation to your Hospital Staff or organization.
    Immediately following the discussion of the main topic are some important points about commodities in general, and specifically the precious metals. Please take a look.
    Last weekend’s newsletter “Physicians need to be More Forceful” clearly struck some raw nerves. My email lit up like the switchboard at the home shopping channel offering beer for 10 cents (see below).
    One subscriber said “A few comments on physicians “rolling over”. In hospitals today, if you offend an RN with talk they consider “aggressive” or “demeaning” (I am NOT talking about sexual harassment, vulgarity, or violent behavior), you will be in big trouble if they write you up. In the eyes of the administration, you are wrong and they are right, especially if you’re a male physician. You will be told about the policy of zero tolerance”.
    RMD comment: I talked to an “old-time” RN (Real Nurse), a diploma school grad, whose advice I seek on these issues. “Dr. Doroghazi, it’s really changed since you retired. I used to call people “honey” and “sweetie”. No more: some consider that inappropriate. I’m even afraid to tap people on the shoulder and say “good job”. The independent physicians have a little more leverage, but if you are a hospital-employed physician and a nurse says you “demeaned” them, you’re gone. I just keep my mouth shut”.
    Another subscriber wrote “Wimp physicians. It is not only physicians. Docility has been purposefully inculcated throughout our educational system”.
    RMD comment: I am still hesitant to use the word “docile”, but likewise, few of the recent generation of physicians could be called “rugged individualists”.
    This is from a sophisticated investor, non-physician, subscriber. “Physicians as employees compromises their ethics and integrity. I recently changed primary care providers from an employed physician, who I thought was a zombie, to an independent practitioner. The difference is unmistakable”.
    RMD comment: When the public notices these things, it’s pretty obvious. The point about employed physicians compromising their integrity is profound. I hadn’t considered that before, and need to think about it some more. The most significant negative trend in Medicine is physicians becoming hospital employees. You may have an MD behind your name, but you are just a cost center to be controlled, no different than an X-ray tech or the cost of paving the parking lot. You have no leverage. Don’t believe me? Try to get on the schedule of the hospital CEO. Good luck!
    One point I forgot to mention last week is that the “Suits”, the businessmen and woman who run the hospitals, insurance companies and government agencies, now refer to physicians as “providers”. They no longer show you the respect and deference that a person who trains for many years and always puts your patient first deserves. Rather, you are lumped with the psychologists, PAs, NPs and many others. If the hospital CEO calls you by your first name (if they even know your first name) rather than “Doctor”, you already know exactly where you stand. 
    Last week I noted that “The AMA and the various societies and colleges are NOT the answer. They have their own interests to protect”. A subscriber related a story I cannot refer to even obtusely. Just take my word that organized Medicine puts their own interests before that of their physician members.
    “I was on the Board of the ABIM (American Board of Internal Medicine) and thought it was pretty nasty that they had so much money in the bank and we had our meetings at very high-end places. The ABIM needs major, major reform’.
    Last week I recommended that physicians need to be represented by an organization with clout, and maybe even should unionize. One subscriber pointed out that unions can have their own problems. They can be corrupt (think of Jimmy Hoffa, wherever he is now), or often turn to the Left, such as Walter Reuther and the United Auto Workers. The best type of person to head this organization would be a physician of immense personal stature, such as Michael DeBakey or Paul Dudley White, respected by Academia, the physicians, the public, and the politicians.
    The entire process of training physicians in the US needs to be overhauled, starting with shortening training periods. We need another Flexner report. But nothing of significance will happen without the support of the Deans of the med schools, who I have come to appreciate hold the vast majority of the power in the Medical Establishment.
    Last week I noted the COT (Commitment of Trader’s) Report suggested we were at or near a bottom in gold. The latest COT report is even better, showing a multi-year low in the long positions of the Large Speculators (the “dumb money”), and a multi-year low in the short positions of the miners and big bullion houses (the “smart money”).
    RMD comment: Currencies drive prices. Since commodities are priced in dollars, and the dollar weakened—again—last week, the stage appears to be set for a big rally in hard assets. There is never a bad time to buy physical gold and silver. More later, if gold breaks through the recent resistance level of $1,290. 
    Everything has an intrinsic value, a table, your socks, a piece of machinery. So does money. Loaned to a borrower who will repay in an environment of stable prices, money generates a “real’ return of 3-4% per year. Last week, Univ. Prof. and agricultural economist Patrick Westhoff spoke at our Rotary. He showed a graph of cash rent to farm land prices. Year in and year out, farmland prices and nominal return fluctuate, but the “real” return remains about 4-4 ½%. Subtract taxes, insurance, etc., and you have a 3-4% return for the owner who cash rents his land.
    In Issue #222 (8/13/12) I discussed investing in farmland. Prices at the time were very strong, and in retrospect, this was the top of the market. I asked my source if we were going to see a bust similar to the early to mid-80s. He said he didn’t think so, because the farmers, and especially the lenders, had gotten religion, and were avoiding asset-based lending, with farmers more often making purchases with cash. Westhoff showed a graph of farmer’s debt vs. assets. It peaked at about 25% in 1985. It dropped to the low-teens in 2012, but over the last 4 years it had inched up to about 15%. He noted some farmers were starting to hurt, but nothing like the early 80s. 
    The reference to beer for 10 cents comes from the most infamous baseball game of my lifetime. On June 6, 1974, Cleveland had 10 cent beer night. By the 5th inning, fans were so hammered that they ran the help off the beer concession, guzzling all they could drink, sometimes straight out of the tap. Going into the 9th inning, the score was tied 5-5. The Cleveland fans then attacked the visiting Texas Rangers players. The Cleveland players, wielding bats, helped protect the Rangers. The umpires were also attacked. There was not enough security to keep control, so the umps, led by 20 year vet Nestor Chylak, forfeited the game, 9-0, to the Rangers.
    RMD comment: This was a kind of bad time for Cleveland. In 1969, the Cuyahoga River was so polluted it caught on fire.
    There are 30,000 gun related deaths in the US every year.
    65% are suicide.
    15% are by law enforcement in the line of duty.
    17% are criminal activity
    3% are accidental discharge.
    So technically, 5,100 are “gun violence”. 25% of those occurred in Chicago, Baltimore, Detroit and Washington, DC, cities with the strictest gun control laws.
    The next 2 Newsletters are about buying art and collecting in general. You’ll love them. 

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