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Strange Things in the Precious Metals
Issue #531, July 17, 2018

Buying Years of Retirement
Issue #530, July 09, 2018

Rent-A-Kid for Retirement
Issue #529, July 02, 2018

The Dark Side of Student Loans
Issue #528, June 25, 2018

The Cost of Out-sourcing Convenience
Issue #527, June 18, 2018

Social Security: 66 or 70?
Issue #526, June 11, 2018

Student Loans: There’s (Unfortunately) a Lot More!
Issue #525, June 04, 2018

Co-signing a Note
Issue #524A, May 31, 2018

The Knight Frank Luxury Index and Collectables
Issue #524, May 28, 2018

The Importance of Diversification: The Myth of Diversification
Issue #523, May 21, 2018

How to Save Thousands on Your Food Bill
Issue #522, May 14, 2018

MoviePass and Other Things
Issue #521A, May 10, 2018

Degree Inflation, Long Training Periods, and “Certification”  Part III
Issue #521, May 07, 2018

Degree Inflation, Long Training Periods, and Certification” Part II of III
Issue #520, April 30, 2018

Follow-up on Several Things
Issue #519A, April 25, 2018

Degree Inflation, Long Training Periods, and “Certification”: Part I of II
Issue #519, April 23, 2018

The Kids Birthday Party Hustle
Issue #518A, April 18, 2018

A Pension Question: Part II of II
Issue #518, April 16, 2018

A Physician is an Executive
Issue #517A, April 11, 2018

A Pension Question: Part I of II
Issue #517, April 09, 2018

Is the Correction Over?
Issue #516A, April 05, 2018

Used Car Dealers, Student Loans, the Chinese, and Uncle George’s Rule
Issue #516, April 02, 2018

Starter Homes
Issue #515, March 26, 2018

Redecorating: Beware!
Issue #514, March 19, 2018

NASDAQ Closes at Record High
Issue #513, March 12, 2018

A 40% Chance
Issue #512, March 05, 2018

Several Things
Issue #511, February 27, 2018

Human Capital, Education and Wealth
Issue #510, February 19, 2018

Another Stock Market Update
Issue #509A, February 18, 2018

Some Thoughts on Savings
Issue #509, February 12, 2018

A Stock Market Upfate
Issue #508S, February 10, 2018

Who Can You Trust? Part II of II
Issue #508, February 05, 2018

The Christmas Decoration Pre-worn Jeans Hustle
Issue #Interim Bulletin #507A, February 03, 2018

2018 Outlook for Financial Markets
Issue #507, January 29, 2018

Who Can You Trust? Part I of II
Issue #506, January 22, 2018

Life Insurance Settlements
Issue #505, January 15, 2018

Commodities and Buying the Breakout
Issue #504, January 08, 2018

Buffett Wins His Bet
Issue #503A, January 04, 2018

Practice Real Estate and Free Agency
Issue #503, January 01, 2018

Outlook for 2018: Part III: Stocks and Bonds
Issue #502, December 25, 2017

My Outlook for 2018: Part Ii: Precious Metals
Issue #501A, December 21, 2017

Outlook for 2018: Hard Assets: Part I of III
Issue #501, December 18, 2017

More Thoughts on Bitcoin
Issue #500A, December 14, 2017

Fees and Good Relations with Bankers
Issue #500, December 11, 2017

Salvator Mundi
Issue #499A, December 07, 2017

Should You Rent or Own a Home?
Issue #499, December 04, 2017

A Gift Subscription
Issue #Interim Bulletin #498A, December 02, 2017

Stocks vs Real Estate: Asset Allocation: Part II of II
Issue #498, November 27, 2017

When Good Enough is Fine
Issue #497A, November 22, 2017

Stocks vs Real Estate: Asset Allocation. Part I of II
Issue #497, November 20, 2017

The Saudi Arrests and the Perils of Foreign Investing
Issue #496, November 13, 2017

Gambling and Las Vegas
Issue #495, November 06, 2017

Some Tips on Auto Insurance
Issue #494, October 31, 2017

Bitcoin and the Digital (Crypto) Currencies
Issue #493, October 23, 2017

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

Escheat
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

Contracts
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

THE PHYSICIAN INVESTOR NEWSLETTER

HELPING PHYSICIANS ATTAIN FINANCIAL SECURITY
By Robert M. Doroghazi, M.D., F.A.C.C.

Degree Inflation, Long Training Periods, and Certification” Part II of III

Issue #520, April 30, 2018

    I received a great deal of feedback, and have much more to discuss, that I’m going to make this a 3-part series.
    The situation discussed in the last Newsletter about more education and “certification” for nurses has also occurred in Medicine. Rather than requiring more letters behind the MDs name, the same result has occurred by extending training periods and requiring more Board Certification and Maintenance of Certification requirements. 
    My year (1979), the third year of Internal Medicine training became mandatory rather than optional. Also in my time, a Cardiology Fellowship was 2 years. Now it’s 3, and if you want to be Board eligible to be an Interventional Cardiologist, or Electrophysiologist, or an expert in Congestive Heart Failure, that’s another year or more.
    Why has this trend of more degrees and more training to do basically the same job occurred in Nursing and Medicine, and according to The Wall Street Journal Op/Ed, business in general?
    Always cited is the increase in knowledge and complexity of the modern world. This is the big hammer, but one doesn’t need to examine it too closely to see it is mostly hollow and specious, a canard, and applies only occasionally. This is from my Commentary “Negative Secular Trends in Medicine: Prolonged Training Periods” in the May, 2016 issue of The American Journal of Medicine (129(4):352-353). “Several arguments are routinely made to rationalize the need for more training. First is the explosion of knowledge, which is estimated to double every 7 years. This argument was made 10 years ago, 20 years ago, 40 years ago. To take this to its illogical conclusion, if training periods increase pari passu (means to proceed at the same rate) with the increase in knowledge, within a generation physicians won’t live long enough to complete their training (RMD comment: I noted “I make that tongue-in-cheek point with trepidation, that someone will take it seriously”)…In the end, some knowledge…never changes…some…is no longer clinically relevant, some…makes little difference to the practicing physician. No matter the total amount of medical knowledge, the knowledge base one needs to be an excellent physician stays about the same”.
    One more point: with few (or no) exceptions, the decisions to prolong training periods or add more requirements, were arbitrary, backed by no data, a sorry situation for a profession that (supposedly) prides itself on the scientific method. This comment applies in general to the entire discussion.
    In the next Newsletter, I’ll discuss what ties this all together: the continued push for more training and more degrees. Why require an RN to have a Degree when those with a Diploma did just fine, require more years of training for physicians with no evidence to back it up, require Board Certification when none was required before, or require a college degree to perform a job currently performed quite well by one without a college degree?
    I’ll also make recommendations for what degree I think is the best investment for the smartest kids in the class (Hint: MBA), and what are the best options if you do with to pursue a career in health care (unfortunately, it’s not an MD). 
   
                                                                RMD

    A Diploma RN was the first CRNA at a large hospital in the 70s. As time went on, a Bachelor’s Degree, then a Master’s Degree, was required. “For the most part, the degrees are shallow and neither added to my anesthesia skills”.
    RMD comment: That’s the entire issue: does more training, with the time and expense and debt, improve job performance? In many cases, the results are marginal at best.
    She notes they are now pushing for CRNAs to have a PhD. “That was it. I retired.”
    RMD comment: She had her “Popeye” moment: “This is all I can stands, I can’t stands no more”. The Op/Ed from the WSJ (4/3/18) was “Degree Inflation and Discrimination”. I believe her story, and the one of the Diploma RN from the last Newsletter, could be considered discrimination against Diploma nurses, and as it applies to industry in general, age discrimination. People who have performed a job quite well for years (by definition, they are older) are no longer qualified because they don’t have the extra letters behind their name. 
    When we looked to buy a place at the Lake of the Ozarks in 1996, I was amazed at all the money in the real estate and the boats, which can easily be as expensive as a condo or home, like $100K, $150K or more. I quickly realized: how much do they own, and how much does the bank own? It’s easy to “own” a lot when it’s borrowed money. I mentioned this to someone recently, who reminded me there are 30-year boat loans.
    RMD comment: Think about that: depending on the interest rate, after 30 years you have paid at least 3x the original cost of the boat, which is now worth zero, zilch, “semmi” (“SHEM-me”, nothing in Hungarian). A 30-year old boat is comparable to the SS Minnow (The boat that sunk on “Gilligan’s Island”). Purchasing a depreciating asset, esp. on credit, is NOT how you accumulate wealth. If you purchase a boat (which I hope you don’t), it should be cash.
    Actually, let your friend purchase the boat and drive you around. If you treat for supper and even some gas, you’ll end up far ahead. By the way, boat stands for Break Out Another Thousand. How do you make a million dollars in the boating industry? Start with $10M. See Issue #33, 2/4/08.   
    Received an ad from a furniture company. “6 years, no interest, no money down. *Minimum purchase of $999 or more and monthly payments required. Purchase of protection plan required”
    RMD comment: Over the years I’ve heard “A nickel down, a nickel a month”, and “A dollar now, the rest when you catch me”. This is NOT how you accumulate wealth. If you purchase things like this, it should be cash.


   
    Amazon (AMZN) reported blowout results, and was up 3.6% on Friday. Its market cap is now $735B, 2nd only to Apple (AAPL). Profits were $1.6B, giving a P/E of 114. Sales were $51B, giving a price to sales ratio of 3.6. AMZN reinvests most of its profits back into the business, and pays no dividend.
    RMD comment: AMZN is revolutionizing the consumer industry, just as the department store did 150 years ago with flat pricing, Sears Roebuck did for rural America120 years ago, and Piggly Wiggly (people used a cart to fetch the items they wanted) did 100 years ago. 
    Patrick Westhoff is a professor here at the U. of Missouri. He is consulted by or testifies frequently before Congress on agricultural policy. Last year he presented before our Rotary, and noted that farm debt was 15%, compared to 25% before the agricultural bust of the early 80s. I ran into Patrick recently and asked where things stood now.
    The estimate of farm debt for 2017 was 12.7%, mostly because land values increased over the nation as a whole, although there were declines in many areas. Land values didn’t fall further because there continue to be buyers in a thin market. They project debt will increase to 14% by 2024. If there are larger-than-anticipated increases in interest rates, land values will fall, and it will become more difficult to service debt.
    This is in response to last week’s Newsletter which ended with the vignette of Abe Lincoln interviewing for a job. “I like your use of humor to articulate how needlessly complicated and bizarre life has become. Like you, I have always felt hands-on experience invaluable. I had a poster of Einstein in my office with the quote “Imagination is more important than knowledge”
                                                      Canada Mike
     
     
                   
 
       
 

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