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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

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


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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