An Open Letter to the ME-P from Alfredo Morabia, MD, PhD


Dear Dr. David Marcinko, 

With warm wishes for a joyful holiday, we are please to announce that the layout of AJPH is almost back on schedule, following COVID-19 related impacts to our production team. To keep these monthly highlight emails synched, we are going to highlight articles in two issues of AJPH
The December issue of AJPH features multiple articles focused on surveillance, surveys and COVID-19, along with articles discussing physical and mental health of home health care workers, racial and ethnic disparities in the impact of COVID-19 in the active U.S. military and firearm injury & gun violence.   Here are a few of the many articles in the December 2021 issue:  
Reaffirming the Foundations of Public Health in a Time of Pandemic Impact of the COVID-19 Pandemic on Public Health Surveillance and Survey Data Collections in the United StatesNational Health Interview Survey, COVID-19, and Online Data Collection Platforms: Adaptations, Tradeoffs, and New DirectionsPrevalence and Predictors of Home Health Care Workers’ General, Physical, and Mental Health: Findings From the 2014‒2018 Behavioral Risk Factor Surveillance SystemOral Histories of Civic Action to Address HIV/AIDS

The mission of AJPH is to advance public health research, policy, practice and education. Toward that goal, the journal also produces monthly podcasts available in English and Chinese at The monthly podcasts are also on iTunes and Google Play.
Be on the lookout for more timely research from AJPH, and consider subscribing or becoming an APHA member for full access.
AJPH and the Centers for Disease Control and Prevention are seeking papers for an issue on “Ubiquitous Lead: Risks, Prevention-Mitigation Programs and Emerging Sources of Exposure.” Manuscripts must be submitted to AJPH by Jan. 30. For additional information about the supplement, contact T. LeBlanc.
Happy Holidays!

Alfredo Morabia, MD, PhD
Editor-in-Chief, AJPH


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Personal Financial Planning for Physicians and Medical Colleagues

ME Inc = Going it Alone but with a Team


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The physician, nurse, or other medical professional should easily recognize that there are a vast array of opportunities, obstacles, and pitfalls when it comes to managing one’s finances.  Still, with some modicum of effort, the basic aspects of insurance, investments, taxes, accounting, portfolio management, retirement and estate planning, debt reduction, asset protection and practice management can be largely self-taught. Yet, it is realized that nuances and subtleties can make a well-intentioned financial plan fall short.  The devil truly is in the details.  Moreover, none of these areas can be addressed in isolation. It is common for a solution in one area to cause a new set of problems in another. 

Accordingly, most health care practitioners would be well served to hire [independent, hourly compensated and prn] financial help. Unlike some medical problems, financial issues may not cause any “pain” or other obvious symptoms.  Medical professionals tend to have far more complex financial situations than most lay people. Despite the complexities of the new world of health reform, far too many either do nothing; or give up all control totally, to an external advisor. This either/or mistake can be costly in many ways, and should be avoided. 

In reality, and at various time in their careers, the medical professional needs a team comprised of at least a financial analyst, lawyer, management consultant, risk manager [actuary, mathematician or insurance counselor] and accountant. At various points in time, each member of the team, or significant others, will properly assume a role of more or less importance, but the doctor must usually remain the “quarterback” or leader; in the absence of a truly informed other, or Certified Medical Planner™.

This is necessary because only the doctor has the personal self-mandate with skin in the game, to take a big picture view.  And, rightly or wrongly, investments dominate the information available regarding personal finance and the attention of most physicians.  One is much more likely to need or want to discuss the financial markets with their financial advisor than private letter rulings by the IRS, or with their estate planning attorney or tax accountant. While hiring for expertise is a good idea, there is sinister way advisors goad doctors into using all their retail services; all of the time. That artifice is – the value of time. 

True integrated physician focused and financial planning is at its core a service business, not a product or sales endeavor. And, increasingly money is more likely to be at the top of the list for providers as the healthcare environment is contracting.

So, eschewing the quarterback model of advice, and choosing to self-educate thru this book and elsewhere, may be one of the best efforts a smart physician can make.

ASSESSMENT: Your thoughts are appreciated.

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Physician Retirement Portfolio Real Estate?

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Inefficient and Illiquid … But?

By Rick Kahler MS CFP®

Rick Kahler MS CFPWhat’s the best way to hold real estate in a retirement portfolio? For many investors, the answer seems to be “not at all.” That’s not the right answer. This asset class, appropriately owned, can help support you well in retirement.

Not like Stocks

Unlike stocks, which trade on a highly efficient and liquid exchange, trading real estate is inefficient and illiquid. The ease of buying and selling stocks is one of the major reasons the asset class is over-represented in most portfolios.

Based on the fascination of the financial press with the stock market, it’s easy to get the impression that stocks comprise the largest financial asset class. According to Matthew Yglesias, author of The Rent Is Too Damn High, the total value of commercial real estate in the US as of December 2013 was $20 trillion. This equals the value of publicly traded stock. (The largest asset class is bonds with $37 trillion.)

While one could make a strong argument for owning equal amounts of real estate and stocks in most retirement portfolios, very few hold any real estate at all.

Direct Ownership

Probably the worst way to hold real estate is to own it directly. The only popular retirement plan that allows direct ownership of real estate is the self-directed IRA. Unfortunately, the government discourages holding real estate this way by taxing it unfavorably. As I’ve described in a previous column, it’s not a good idea.


Registered Limited Partnerships [RLPs] were a popular way to own real estate in the 1980’s. While someone must have made money on these investments, I don’t think it was the investors. I don’t know an investor who made a dime, but I do know some distributors and promoters who got very rich with them. The problem wasn’t the real estate but the lack of transparency inherent in a limited partnership. This allowed promoters and distributors to hide high fees and commissions that didn’t give the investors a chance of profiting.


Gradually, the real estate investment trust gained popularity as another investment vehicle for owning real estate. A publicly traded REIT is similar to an ETF (a form of a mutual fund) that trades on the major exchanges and invests directly in real estate. REITs receive beneficial tax breaks, must pass through 90% of their cash flow to investors, have a high degree of transparency, and are highly liquid. They also tend to specialize in certain types of real estate, so rather than hold REITs individually; I prefer to own a mutual fund that owns a diversified assortment.

The fees and commissions associated with REITs are very low, which helps make them a good choice for investment portfolios. It is also another reason they don’t often show up there, since most financial vehicles are sold, not bought. Mutual funds, annuities, and cash value insurance pay much higher commissions than exchange traded REITs.

Wall Street solved that problem by creating the non-traded REIT, which does not trade on a securities exchange and therefore is highly illiquid. The benefits touted by salespeople are the potential for higher dividends, plus lower volatility than publicly traded REITs. Here’s the downside: Their lower volatility is an illusion created by their high illiquidity. They also lack transparency, which gives cover to charging high fees and commissions. The non-traded REIT is scarily like its older cousin of the 1980’s, the registered limited partnership.



Including real estate in a retirement portfolio can be a good idea as long as the ownership is properly structured. A mutual fund that holds a broad diversification of publicly traded REITS is one way to help you build a strong foundation for retirement.

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