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Southern Orthopaedic Association
The 33rd Annual Meeting of the SOA will beheld at the Naples Grande Beach Resort July27-30, 2016, directly on the beach!!!! MARKYOUR CALENDARS NOW. Nancy and Iwould like to take this opportunity to extendto you and your entire family our personalinvitation to attend this wonderful event atsuch an awesome location. I am truly honoredand quite humbled to have been chosen toserve as this year’s President. I can only prom-ise that I will give the organization everythingI have during my time as your President. I amsurrounded by strong leaders on the board aswell as past presidents, who will surely pro-vide guidance and support throughout theterm. As YOUR President I am always excitedto hear from our membership about ways wecan help, or any concerns you may have.Please feel free to email or call me [email protected] or (859) 351-9631,with any concerns you may have. We, theBoard, had a lively Interim Meeting in Januaryto discuss issues that have come up over thelast year. Our goal is simply to serve you, our
President’s MessageDarren L. Johnson, MD
members, in the best way possible and makenecessary changes to honor that commitment.
Scott Mair, MD, my partner and friend, willserve as this year’s Program Chair. He and theProgram Committee, Lee R. Leddy, MD; RyanM. Nunley, MD; Robert D. Zura, MD and L.Andrew Koman, MD, are off to wonderfulstart in crafting a program of high scientificmerit, that I can promise. I am very confidentthat the program will benefit all orthopedicsurgeons with thought provoking scientificpapers, symposium, and guest lectures. SOAoffers Resident/Fellow Awards for the top tenabstract submissions, as well as three PosterPresentation Awards. I am honored that mygood friend and colleague for the last 20 plusyears, Peter Indelicato, MD, has agreed to be
W i n t e r 2 0 1 6 / V o l u m e 1 5 / N u m b e r 2 / w w w . s o a a s s n . o r g
ear Colleagues and Friends;
First of all, a huge debt of grati-tude and thanks to Langdon andCharlotte for their service and
dedication to our wonderful organization overthe last year as the First Couple. Langdon andCharlotte topped off their outstanding yearwith a first rate Annual Meeting at The GrovePark Inn this past summer. Langdon and hisProgram Chair, Lee Leddy MD, along with theentire Program Committee put together anoutstanding educational event, with 116 ab-stract podium presentations, 6 symposia, and29 poster presentations for a total of 25.75available AMA category 1 CME credits. Char-lotte is to be congratulated for putting togetheran outstanding social program for family,spouses, and friends that was truly enjoyed byall. Our organization is very strong, under theleadership of our Board of Trustees and sup-port from Data Trace; we have establishedourselves as one of the premiere regional or-thopaedic societies.
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I N S I D E
Meet SOA’s New Board Members p. 4
Upcoming SOA Meetings p. 4
Recap of the 32nd Annual Meeting p. 6
2015 Presidential Address p. 6
Thank You Annual MeetingGrantors and Exhibitors p. 7
Money Matters p. 10
Save the Datehe Southern Orthopaedic Association willpresent its next Annual Meeting July 27-
30, 2016 at the Naples Grande Beach Resort inNaples, FL. The Annual Meeting is one of thepremier meetings for orthopaedists practicingin the South. The Scientific Program will bedeveloped to present timely reviews of prac-tice-related techniques and clinical researchfindings in orthopaedic surgery through ac-cepted outstanding abstracts. Nationally recog-nized speakers will be invited to participate.
John Calipari, Head Coach of the KentuckyWildcats Men's Basketball Team will be thePresidential Guest Speaker, and Dr. Peter In-delicato will be honored as the 2016 Distin-
guished Southern Orthopaedist.SOA will also welcome Dr.Kevin Leman as a Special GuestSpeaker – prepare to be enter-tained!
The Preliminary Program will be availableonline in the spring and will include details onthe education sessions, events and activities,and hotel and travel information.
Make your reservations at The Naples GrandeBeach Resort by calling (844) 210-5931 andmentioning Group Code GSOA16. Cutoff forSOA Room Rates is June 27, 2016.
T
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SOA Central Office
110 West Road, Suite 227Towson, MD 21204-2136
Phone: 866-762-0730
Fax: 410-494-0515
E-mail: [email protected]
Web Site: www.soaassn.org
Executive DirectorChuck Freitag
Director of OperationsCynthia Lichtefeld
PRESIDENTDarren L. Johnson, MD
PRESIDENT-ELECTSamuel I. Brown, MD
SECRETARY/VICE PRESIDENTMatthew J. Matava, MD
TREASURERRyan M. Nunley, MD
IMMEDIATE PAST PRESIDENTLangdon A. Hartsock, MD, FACS
BOARD OF TRUSTEESJames A. Browne, MD
James R. Ficke, MDJeffrey A. Guy, MD
Christopher A. Heck, MDAndrew A. Shinar, MD
H. Clayton Thomason III, MD
Historian (Ex-Officio)C. Lowry Barnes, MD
Editor (Ex-Officio)L. Andrew Koman, MD
SOA BOC RepresentativeFrederick C. Flandry, MD, FACS
SOA Board of Trustees
The Southern Orthopaedic Association (SOA) was founded in 1983 for physicians who are engaged in the specialty oforthopaedic and trauma surgery. Its mission is to develop and foster the art and science of medicine in the specialty oforthopaedic and trauma surgery. SOA operates exclusively for charitable, scientific and educational purposes.
The SOA
President’s Message continued…
honored as the 2016 Distinguished SouthernOrthopedic Surgeon. I cannot thank Peterenough for his mentorship, friendship, guid-ance, and support over the last 20 plus years inserving as an academic team physician in theSoutheastern Conference. I am confident youwill thoroughly enjoy and be enlightened byhis address.
The Presidential Guest Speaker will be recentinductee into the hall of fame John Calipari,head basketball coach at the University ofKentucky, “Coach Cal” to all of us in Big BlueNation or BBN. Since his arrival in Kentuckythe level of excitement, energy, passion, of thecommonwealth faithful is second to no fanbase in the country! As Coach Cal likes to say,“you people are crazy.” Guess who made themthis crazy, HA you got it, Coach Cal. I haveasked Coach Cal to address our group afterreading his book entitled “
” My son Bran-don, true story, told me it was the best book heever read. I think we as physicians can learnmany things from Coach Cal. How about “Pa-tients First: Doctoring from the inside out.”All of those in attendance for Coach Cal’saddress will receive a free copy of this out-standing book. I can only promise you thatyou will be entertained and enlightened by hispresentation. My own presidential address en-titled “The House That Builds Us” will havesomething for everyone. I will focus on family,faith, mentors, colleagues, and patients. Ithink you will find my thoughts very in lineand in tune with many of your own.
Naples Grande Beach Resort is one of the mostexciting new resorts in Florida. Set on 23 wa-terfront acres, the resort promises to be a sanc-tuary of beachfront sophisticationcomplemented by spectacular ocean views anda portfolio of world-class amenities, includinga luxurious spa, an 18-hole championship golf
course, 15 tournament grade tennis courts aswell as a beautiful beach and a vibrant swim-ming pool deck. Naples is the crown jewel ofSouthwest Florida, nestled on the sundrenched beaches of the Gulf of Mexico. It isknown for world class shopping, dining and anabundance of challenging golf courses. It is alsoonly steps away from the untamed tropicalwilderness of The Everglades. To further ex-plore the area, sign up for Dolphin Explorer,Kayaking, Backwater Fishing and The Ever-glades excursions.
The meeting will kick off with a casual ener-getic and family fun Welcome ReceptionThursday night, pool side of course. All arewelcome to enjoy an abundance of feast andfellowship as old acquaintances are renewedand new ones formed. New this year, yourspouse may be interested in participating in asocial get together over breakfast every day.Early Friday night we will honor and toast ourvendors with a wine and cheese reception fortheir true educational support of our meeting.We simply could not have such an outstandingmeeting without their support and as Presi-dent; I truly appreciate what they do for ortho-pedic education. On Saturday night Our GalaDinner Dance, with outstanding food, bever-age and entertainment, will be a great way toconclude our final night. Nancy and I are hum-bled and thankful to serve as your Presidentand First Lady this year. We look forward toserving you our membership, our most impor-tant job. Please mark your calendars for ourAnnual Meeting in Naples, July 28-31. Bringthe entire family to the beaches of Naples andenjoy our wonderful educational event.
Sincerely,
Darren L. Johnson, MDPresident, Southern Orthopaedic Association
Winter 2016 / Volume 15 / Number 2 / www.soaassn.org
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This year the SOA at the SEC Meeting will not take place in Nashville as planned. Congratulations to Dr. Harrison “Buster” Shull, fromVanderbilt University, this year’s SEC Team Physician of the Year award winner by vote of the SEC Head Athletic Trainers. Dr. Schullwill be formally presented the award at the SEC Sports Medicine Meeting in Opelika in May.
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James A. Browne, MDDr. Browne graduatedsumma cum laude fromWashington and Lee Uni-versity before attendingthe Johns Hopkins Schoolof Medicine. During medi-cal school he was inducted
into the Alpha Omega Alpha Honor MedicalSociety. He subsequently completed his ortho-paedic residency training at Duke Universityfollowed by a fellowship in hip and knee ar-throplasty at the Mayo Clinic where he washonored with the Mark B. Coventry Adult
Meet SOA’s New Board Members Upcoming SOA Meetings
34th Annual MeetingJune 28 - July 1, 2017
Westin Hilton Head Island ResortHilton Head Island, SC
Reconstructive Surgery Fellowship Award.His clinical interests and expertise includecomplex primary and revision hip and kneereplacement. Along with his clinical interests,he is actively involved with research encom-passing all aspects of hip and knee replacementand was awarded the John Insall Award by theKnee Society in 2014 for his work on obesityand knee replacement. He is currently an As-sociate Professor at the University of Virginiawhere he serves as Division Head of AdultReconstruction, Medical Director of the Or-thopaedic Clinic, and Director of OrthopaedicQuality.
James R. Ficke, MDDr. James Ficke is the Rob-ert A. Robinson Professorand Chairman of the De-partment of OrthopaedicSurgery at The Johns Hop-kins University School ofMedicine. He currently al-
so serves as a member of the Committee onTrauma, American College of Surgeons; Chair,Leadership Development Committee, Ameri-can Orthopaedic Association; and Chair, Cen-tral Program Committee, American Academyof Orthopaedic Surgeons.
Ficke completed medical education at Uni-formed Services University, and residency inorthopaedic surgery at Tripler Army MedicalCenter in Honolulu. He completed an AOfellowship in trauma in Munich Germany, andfoot and ankle in Dallas, Texas.
Retired after 30 years of service in the UnitedStates Army, his last military assignment wasChairman of the Department of Orthopaedics
and Rehabilitation at San Antonio MilitaryMedical Center at Fort Sam Houston in Texas.He also served the U.S. Army Surgeon Generalas the senior advisor on policy and personnelfor Orthopaedic Surgery and extremity inju-ries for 7 years. During this assignment, hedeployed to Iraq as senior orthopaedic surgeonin country, and Deputy Commander for the228th Combat Support Hospital. He alsoserved as the Chief of Staff for the SurgeonGeneral’s Dismounted Complex Blast InjuryTask Force and the Army Lead for the DoD/VA Extremity Trauma and Amputee Center ofExcellence Development Group. He served asChair or Co-Chair of the Steering Committeefor the DoD Peer Reveiwed Orthopaedic Re-search Program for 6 years.
He has received the Society of Military Ortho-paedic Surgeons’ COL Brian Allgood Memori-al Leadership Award, as well as The SurgeonGeneral's Major General Lewis Aspey Mo-logne Award for excellence in military aca-demics, education and clinical care. He is aLegionaire in the Infantry Order of St Michael
and a Distinguished Member of the ArmyMedical Regiment.
Dr Ficke continues academic surgical practicein the Johns Hopkins Hospital, and research inthe outcomes of lower extremity injury, limbloss and post-traumatic arthritis of the Footand Ankle. He currently serves on the Adviso-ry Board for Team Red, White, Blue, a non-profit organization of over 84,000 membersunited to enrich the lives of America’s veteransby connecting them to their communitythrough physical and social activity. He alsoserves on the Advisory Board for the RobbReport, and the Baltimore Area Boy Scouts ofAmerica. He is an avid runner, and his wifeRoberta is an Internist and they have threeadult children, Heather, Ben and Eric.
33rd Annual MeetingJuly 27-30, 2016
Naples Grande Beach ResortNaples, FL
Winter 2016 / Volume 15 / Number 2 / www.soaassn.org
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Recap of the 32nd Annual MeetingThe 32nd Annual Meeting was a great success,with an outstanding scientific program. Pro-gram Chair Dr. Lee R. Leddy along with theSOA Program Committee did an exceptionaljob of putting together the 2015 Scientific Pro-gram. Program highlights included a touchingDistinguished Southern Orthopaedist tributeto Dr Lamar L. Fleming. The PresidentialGuest Speaker Andrew R. Burgess, MD gave anintriguing presentation “
”and Dr. Langdon A. Hartsock gave an out-standing Presidential Address, “
?” As requested by meeting at-tendees, the complete address is included inthis Newsletter. Also, new this year, Rapid Firepresentations were added to the program tostimulate more audience involvement.
The meeting kicked off with the WelcomeReception on the Mountain View Terrace,which had a breathtaking view of the moun-tains, highlighted by a fantastic bluegrass band.Everyone had a wonderful time and had achance to visit with old friends as well as dance
a little. The following evening began with theExhibitor Reception before everyone went outon their own to explore the town of Ashevilleor just relaxed at the Grove Park Inn. Themeeting was brought to a close with the ele-gant Gala Dinner Dance.
It was a memorable meeting and we thank allwho attended. If you missed it, view the 2015Asheville pictures on the SOA website atwww.soaassn.org and see what a great timewas had by all.
We look forward to seeing you this summer atthe July 27-30, 2016,
the Naples Grande Beach Resortin Naples, Florida.
32nd Annual Meeting Presidential Address
Thank you to friends, family,members of SOA, the SOA BoardMembers and all of our friends atData Trace who work so hard tomake the SOA a successful orga-nization.
Congratulations to the new President of theSouthern Orthopaedic Association, Dr. DarrenJohnson!
It is hard to believe the year has gone by soquickly! It has been an honor to serve as Pres-ident of the Southern Orthopaedic Associationthis past year. I have enjoyed representing theSOA and I am confident that SOA will contin-ue to provide a great meeting for learning andprofessional development. SOA has a wellknown history of hospitality and a familyfriendly atmosphere that makes this groupspecial.
I want to recognize my wife and my family.You inspire me and support me. To my wifeCharlotte, my one true love, you have createda life for me so I can do what I do best. To mychildren, Langdon, Thomas, and Charles, Ilove each of you dearly and I love being your
Dad and seeing you grow up into fine youngmen.
I have been thinking about what I could saytoday. For an orthopaedic surgeon I am notmuch of a wordsmith so, with apologies toTom Douglas, country music hall of famesongwriter, and close friend of my sister andher husband in Nashville, TN, here it goes –
Recently I received a personal letter from ayoung orthopaedic surgeon and it went some-thing like this: “Why the hell am I here?"
And I realized that what I wanted to say to himin response to his letter is what I want to say toyou. So, if you will indulge me –
Dear colleague:
You ask, “Why the hell am I here?"
Well, truly heaven only knows, but we camealong a common path. We followed a dream.We dreamed of being a doctor, and not justany doctor but an orthopedic surgeon.
So we go to college, medical school, and startresidency. It's all good, but we are swimmingin the waters of confusion. But then it all startsto make sense like finally finding dry land.
It all starts to come together like early creationand you get a rhythm out of the jumble ofideas and concepts and anatomy, biomechan-ics, injuries, illnesses, and treatments. What isall this about after all?
Oh, yeah, this is medicine, this is surgery. Thisis what we have dreamed about for all theseyears. And voila, after 5 years of orthopedicsurgery residency, you are pushed out into theworld for office, clinic, call, emergency roompatients, surgery, consults, staff meetings, andyour new partners. And this is called the prac-tice of orthopedic surgery. Busy? Yes! Andhopefully professionally rewarding and com-pensated appropriately.
And you join a hospital staff, get evaluated byyour peers, admire the senior staff for theirclinical prowess and their full surgical sched-ules. Somehow you take some secret pride infinally having your own clinic schedule, anurse to help you, and the great feeling of
continued on p. 8
Winter 2016 / Volume 15 / Number 2 / www.soaassn.org
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Thank You Annual Meeting ExhibitorsThe Southern Orthopaedic Association would like to thank the grantors and exhibitors of the
Southern Orthopaedic Association’s 32nd Annual Meeting. Without the unrestricted educationalsupport of the companies listed below, we would not have been able to provide this conference.
PLATINUMPacira Pharmaceuticals, Inc.
GOLDEthicon
Mallinckrodt Pharmaceuticals
BronzeCeramTec Medical Products
THINK SurgicalZimmer - Grantor
COPPER
Arthrex, Inc.CAE HealthcareDePuy Synthes
DJO GlobalExactech, Inc.
Medtronic Advanced Surgical
Pikeville Medical Center, Inc.Shukla Medical
Smith & Nephew, Inc. – Endo./Recon.Smith & Nephew, Inc. - Trauma
Stryker OrthopaedicsStryker Performance Solutions
EXHIBITOR
ACIGI RelaxationBBL Medical Facilities
BiocompositesConforMIS
Ferring PharmaceuticalsHCA Physician Recruitment
Harvest TechnologiesInnomed, Inc.
Innovative Medical ProductsLifeNet Health
MicroPort OrthopedicsNutramax Laboratories, Inc.
OREFOrtho-Preferred
ProScan Reading Services
8
walking into the operating room for the firsttime and it is your case.
And you look at the hospital website to see ifyour picture and bio are there and ask yourfriends and family to Google your name. Wehope that checkout girl at the hospital cafete-ria will greet us with a cheery “Good morningDoctor.” One of life’s little pleasures.
And we carry the torch of our heart and theknowledge that burns inside and we can't waitto show what we know.
We keep going to our CME events like thisone, the Southern Orthopaedic Association,and we get through our oral boards and followour mentor’s advice and the advice of oursenior partners, read the Journals, go to theLearning Center, refine our skills, add newtechniques to our skill set and still we arefollowing our dream.
And we realize it takes an army of people to dowhat we do–clerks, nurses, medical assistants,technologists, trainers, therapists, dietitians,social workers, chaplains, nurses, scrub techs,anesthesiologists, radiologists, hospitalists, in-tensivists, housekeeping staff, administrators,accountants, and yes, even lawyers.
And on any given day we stand next to astretcher with our next patient for surgery,saying hello, holding a hand, giving a smile,and saying, “yes, we will take good care of you.”
In your letter you asked about me. Well, I’m achild of the Carolinas, born in Charlotte, livingin Charleston, born of a mother from NewEngland and a Dad from Virginia. Attended aprep school trying to be athletic and trying myhand at photography, summer jobs at textilemills, and a new machine called at home com-puter. I grew up knowing about racial divi-sions in our community, experienced busingand playground fights, Vietnam, landing onthe moon, the Cold War, Watergate, Iran hos-tages, and the space shuttle.
Summer Beach vacations spent on Sullivan'sIsland, South Carolina and the siren song of
Myrtle Beach…the Pavilion, girls in bikinisand beach music.
Off to college at Vanderbilt, Navy ROTC, newfriends, country music and fraternity parties.The hard realization after freshman year and amonth on a nuclear submarine that engineer-ing and the Navy were probably not for me,and a frightening search for what would comenext.
Friends like Robert McIntyre from New Or-leans who worked hard and played even hard-er and hometown mentors like Dr. AngusMcBryde lead me to a new career path – med-icine. Moving on to Davidson College andstudying even harder, two full summers ofsummer school and the dream of all dreams –acceptance to Duke School of Medicine. Theblitz of first-year lectures in the auditorium,clinical clerkships in the second year, then theDuke Orthopedic Research lab and Jim Urban-iak and Tony Seaber setting me on a trajectorybeyond anything I ever dreamed.
Four years of medical school later, standing atthe front of Duke Hospital with a new IDbadge, short white coat and white pants – theuniform of the Duke surgical resident. Onethat I then felt was incredibly awkward at thetime, but came to know as a badge of courageand the recognizable symbol of the Spartanbrotherhood of the Duke surgical house staff ofthose days. Every other night in house call,endless pages, reams of paper, rounds on thefloors, rounds in ICU, rounds in the cardiacACU, Monday afternoon conference with “theMan,” Dr. Sabiston. Going to the OR afterbeing up all night, the feeling of relief to seeyour co-intern show up for morning rounds.We grew up fast and became doctors.
The blessed transition to orthopedics after twoyears of general surgery – we can finally wearscrubs outside of the OR! Fractures, scopes,sports medicine, total joints, spine surgery,pediatrics, grand rounds, making slides with acamera and x-ray film and then getting to usea new computer program called PowerPoint.
My first cell phone was in a bag.
Incredible friends like John Weiner who invit-ed me to a Duke vs. UVA football tailgate partyin the fall of my year as a senior resident.There was a girl there in blue jeans and a whitesweater and a ponytail. The first Gulf War hadstarted and I was assigned to the WomackArmy Hospital at Fort Bragg. My dad nearlydied that previous summer from leaking tripleA, and thankfully survived.
A phone call from John to his friend LyleBeatty, and then a phone number for the girlwith a ponytail. A date for Chicago style pizzain Chapel Hill and a movie. Love blossomed.Trips to Maryland and to Charlotte to see thehometowns and the parents. Weekends drivenhome from Asheville, VA to see Charlotte andthen the obligatory family gathering the nextsummer at Sullivan's Island. Who knew thenthat the stage was being set for us to live ourlife together in Charleston?
A June wedding, chief residency, graduation,off to Baltimore to be a trauma fellow at ShockTrauma – the hardest I have ever worked butthe most fun I ever had. Andy Burgess who ishere with us this week at SOA was my fellow-ship director. To have a mentor and friend likeAndy is to have a combination in one personof great humor, incredible fortitude against theforces of academic institutional chicanery, sci-entific excellence and loyalty to friends andformer Fellows that is renowned and unparal-leled. The orthopedic trauma giants of the time– Harold Tscherne, Emile Letournel, ChipRoutt, Joel Matta – all were friends of Andy'sand Andy sent me to see them all in person.Scrubbed in elbow to elbow, I saw them oper-ate, and had their experience revealed to mefirst-hand.
Job interviews, what to do? How did I end upin Mobile, Alabama? One person – AngusMcBryde. Angus cajoled, coerced, or fooled me– not sure which, to come to University ofSouth Alabama. When I got there, they hardlyhad any equipment in the operating room. Imade the day for the local orthopedic sales repwhen we went to the catalog and ordered atleast one of everything in the surgical implantsand instrument section. Despite being so far
32nd Annual Meeting Presidential Address continued
continued on p. 9
Winter 2016 / Volume 15 / Number 2 / www.soaassn.org
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32nd Annual Meeting Presidential Address continued
from home and friends, South Alabama wasgreat for me. As a brand-new trauma attendingin the South Alabama operating room, all myShock Trauma friends hundreds of miles away,it was up to me to figure it out. I realizedtraining only gets you so far. You have to see,to learn, and to do many things never beforeseen in training. There was no senior traumamentor there. But there was a great chance tohone skills, focus on the fundamentals of or-thopaedics, and humbly learn from my pa-tients.
I developed a bad habit of following Angus,from Charlotte to Mobile, Mobile to Charles-ton, and Charleston to Columbia. Well, no, notto Columbia.
I stayed in Charleston and Angus gave me mynext big chance. I became a DepartmentChairman at the young age of 39. We had onlyfour full-time faculty in 2000 including myself,Dick Gross, Del Schutte, and Carl Stanitski.Fifteen years later, 20 faculty recruits later, 45residents, and one new Chairman later, here Iam, just a guy 15 years down the road andhonored to be President of this great organiza-tion – the SOA.
To my friend and young colleague – our pro-fession is a noble calling. Despite electronicmedical records, Medicare requirements, end-less rules, regulations, hold backs, clawbacks,
SGR fixes, denials of service, EOBs, DOJs IRSs,DEAs, ICD 9s, 10s, and 11s, IPABs and anyother combination of the letters of the alpha-bet, it still comes down to a surgeon and apatient.
Mark Twain said it best: “The two most impor-tant days in your life are the the day thatyou’re born, and the day you find out why”.
Well…we know why. We take care of peoplewho need our knowledge and skills to livebetter and more functional lives. Because afrightened set of parents at a Children’s Hospi-tal needs reassurance from their doctor thatthe scoliosis surgery was successful. Because asoldier at the Army Hospital in Landstuhl,Germany needs your help to repair his shat-tered legs, and because a middle-aged execu-tive just wants the pain in his arthritic hip togo away so he can enjoy golf with his buddiesagain.
We are overcompensated and rapidly becom-ing underpaid. Do we do it for the money? No,we would pay them to let us operate – Well,no, that’s not really true, that’s hyperbole.
But, we do have great advocates who will helpus and I urge you to support them: the Ameri-can Academy of Orthopaedic Surgery and yourState Medical Society. If our work is compel-ling, and it is, we will get paid.
We have the gift of being orthopedic surgeons,and with that gift, comes an immense respon-sibility. We are responsible to not become avictim of the catastrophe of failure where webelieve everything is against us and we aredoomed. Or, become the victim of the catas-trophe of success, where we remove ourselvesfrom the struggle of creation and with thatconflict removed, we are nothing but a swordcutting daisies.
The end result of both of these catastrophes isthat we worship the creation, and not theCreator. And false idols ultimately require ev-erything from you including your dreams andyour sense of purpose in life.
In closing, my dear colleague, God, the Cre-ator, allows us to participate in this endeavorof caring for our fellow man. And through ourefforts as orthopaedic surgeons, we impact onefellow human being at a time and through thiswe can change the world.
So today all is well but tomorrow is anotherday. So prepare, read, listen, learn, and prac-tice, because sooner later I’ll be the patient andI will need you. I’ll be under your knife andthat is why you are here.
All my best,
Langdon Hartsock, MD
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In Part 1 of this article, you learned why thefollowing strategies may not make sense formost physicians.
1. Not using a corporation (or using the wrongtype of corporation).2. Owning assets your name, spouse’s name, orjointly with spouse.3. Making a questionable bet on traditionalqualified retirement plans.
Part 1 of this article was included the Springissue of the .
Part 2 focuses on tax, investment and insur-ance mistakes doctors make when followingadvice that is designed for tens of millions ofaverage Americans. When professionals withsignificant tax, asset protection and retirementchallenges use tools designed for people whopay little or no tax and will never be sued,problems are bound to arise. More important-ly, this segment of the article offers you somehelpful hints to avoid these pitfalls.
Mistake #4 – Paying Full Price Whenthe Government Offers to Pay Half.Technically, the government (Internal Reve-nue Service) is not paying half of anything.However, if they offer you a tax deduction andyour combined state, federal and local margin-al tax rate is close to 50%, you can think of atax-deductible purchase as being half as expen-sive for you because the government will allowyou to deduct this purchase. You must realizethat nearly 50% of Americans do not pay anyfederal income tax (Source: IRS). You can ei-ther look to advisors who can help you legallyreduce any unnecessary taxes or you can letthe system work for everyone else but you.Let’s look at an example of one simple way touse tax laws to your benefit.
Suggestion – Deduct Long Term Care insur-ance (LTCi) through your Practice.
Over 60% of American households will re-quire some sort of Long Term Care assistance.Doctors, more than any other segment of thepopulation, realize that longer life expectan-cies and skyrocketing medical costs signifi-cantly increase the probability of a familyfacing an illness with devastating financialconsequences. Without a shifting of riskthrough a long term care insurance policy, youwill have to pay for this assistance from yoursavings. You can cover your spouse throughthe practice even if you are not both physi-cians or employees. If you are a C corporation,you may receive a tax deduction for 100% ofthe premiums. Unlike traditional retirementplans where contributions that are tax-deduct-ible and benefits are taxable, Long Term Careinsurance premiums can be tax-deductible andthe benefits are 100% tax-free.
There are also non-traditional benefit plansthat also allow physicians to make contribu-tions of $100,000 or more per year, discrimi-nate to only include the doctors or keyemployees, and access the funds before age59-and-a-half without penalty. These planscan be set up to be very important pieces of afamily’s estate plan without sacrificing tax de-ductions or control of the assets by the doctor.For further information on these plans that arebeyond the scope of this article, please contactthe authors at (877) 656-4362 [email protected].
Mistake #5 – Using only Term Insur-ance Premiums.Some well-known advisors tout, “Buy terminsurance and invest the difference.” This isexcellent advice for the “Average American”family who earns $49,000 per year, pays 12%in federal income taxes, and has no potentialliability or estate tax risk whatsoever. This is aperfect example of good advice for most peoplebeing terrible advice for high-income special-ists.
Most Americans pay very little tax on invest-ment income and don’t care about asset pro-tection, so the advice to disregard the tax-freeaccumulation and creditor protection benefitsof cash value life insurance to maximize tax-able investment accounts is fine…for thosepeople. Beyond temporary income protectionagainst the premature death of the breadwin-ner, the Average American has little need forcash value life insurance. If you have the fol-lowing characteristics:
• I have no concern over lawsuits against me,my partners, my employees or my family.
• I am not worried about 23% to 47% of myinvestment income going to taxes.
• I don’t mind 40%-70% of certain assets inmy estate going to taxes when I die.
Does this sound like the typical physician situ-ation? Of course not. These completely differ-ent characteristics clearly illustrate how “offthe rack” planning that is widely accepted bythe media and the general population may notadequately help doctors address their uniquechallenges.
Suggestion – Buy Cash Value Life Insurancefor Tax-Savings and Asset Protection. If youare skeptical of this advice, ask yourselfwhether you are skeptical because you did thecalculations yourself (or reviewed a carefulanalysis by an expert) or because you haveheard, “Buy term insurance and invest thedifference” so many times that you have justaccepted it as fact. To spare you the pain of along mathematical proof, let us offer the fol-lowing analysis.
1. Mutual funds growing at 7% (taxable) areworth 4%-5% (after taxes) to high incometaxpayers like you versus 6% or more to Aver-age Americans.
Doctors Betrayed By Traditional Financial StrategiesPart 2 of 2David B. Mandell, JD, MBA & H. Michael Lewellen, CFP®
Statements and opinions expressed in the advertisements and information regarding products or services herein are those of the author(s) and do not necessarily reflect thoseof the Publisher or the Association. The Publisher and the Association do not assume any responsibility or liability for such material and do not endorse, guarantee or warrantany product or service advertised in this newsletter.
continued on p. 11
Winter 2016 / Volume 15 / Number 2 / www.soaassn.org
11
2. Investment gains within cash value life in-surance policies are tax deferred, and can beaccessed tax-free.3. For relatively healthy insureds, the annual-ized cost of all internal expenses within a lifeinsurance policy range from 1% to 1.5%.4. For families in high marginal tax brackets,the cost of the insurance policy is less than thecost of taxes on the same investment gainswithin mutual funds.
Without even factoring in the cost of the terminsurance (which would reduce the totalamount in the mutual fund portfolio), the cashvalue insurance investment outperforms buy-ing term insurance and investing the differ-ence. Yet another benefit is that life insuranceis protected from creditors, and even frombankruptcy creditors, in many states. This is abenefit that may interest a physician’s family,but be seen worthless to Average Americanfamily who has very little risk of a lawsuit.
: Consider a 45-year-old healthymale who wants to invest $25,000 per year for15 years before retirement and then withdrawfunds from ages 61 to 90. Assume this individ-ual’s tax rate on investments is 31% (50% fromlong term gains and dividends, 50% from shortterm gains, plus 6% state tax). Assume thegross pretax return of both taxable mutualfund investments and cash value life insuranceare 7% per year.
• The individual who invests in mutualfunds on a taxable basis will be able to
withdraw $29,871 per year after taxes(without factoring in the costs of purchas-ing ANY term life insurance or the cost ofcreating legal structures for asset protec-tion – which a doctor may need to do toprotect assets from lawsuits).
• The individual who invests in cash valuelife insurance withdraws $38,699 per year(no taxes on policy withdrawals of basisand loans) and has $ of life insur-ance protection.
In the example above, it is obvious that buyingterm and investing the difference in taxableinvestments WAS NOT BETTER than invest-ing in tax-efficient life insurance for a highlycompensated physician in a high tax bracket.The authors welcome your questions. You cancontact them at (877) 656-4362 or throughtheir website www.ojmgroup.com.
is an attorney, author often books for doctors, including
, and princi-pal of the financial planning firm OJM Group(www.ojmgroup.com), where
serves as Director of Financial Planning. Theycan be reached at (877) 656-4362 [email protected].
Disclosure:
Money Matters continued
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