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Primary Care & Financial Advising

I think a lot of people could reach older ages with plenty of health to spare if they were to find a competent Primary Care Physician who wasn’t dead set on treating only lab values.

At the same time, I think a lot of individuals would fare better financially if they had a financial adviser who could see them through to their retirement. Ideally someone who wasn’t dead set on just selling them financial products.


The Primary Care Battle

No offense to my specialist colleagues, but it’s a frequent enough problem that’s worth mentioning. When a patient sees a specialist first, they run the risk of getting a very narrow approach to their healthcare.

Going to the orthopedist for knee pain isn’t cost-effective, isn’t a good way for the orthopedist to spend their time, and may lead to excess intervention. Again, not true all the time but our medical system is designed around a Primary Care Physician handling the first set of complaint which allows room for some intervention into other lifestyle problems and proper screenings.

However, since the majority of Primary Care has turned into an acute care clinic, very little preventative work is done for the patient. This is rarely of any fault of the Internist or Family Medicine physician. If I tell someone that they should do XYZ in order to have less back pain, more bony density, or a lower cholesterol 30 years down the road, well, they’re probably gonna chuckle.

In medicine we have medications and surgeries to handle damn near any lifestyle problem, including stress, substance abuse. And we have surgeries to fix surgeries and medications to combat medication abuse and medication side effects.

No Primary Care Physician will openly admit this (at least not to me) but there is an opportune cycle in patients’ poor lifestyle choices which cause disease which then need to be treated by PCP’s. We get paid very little by the insurance companies to screen patients and offer preventative advice. The majority of patients don’t take such advice and return to us once the preventable disease has set in and then we are paid handsomely by the insurance companies to treat the disease.

Who Benefits From Less Disease Burden In The Population

From a broad perspective, the entire economy would actually improve if people missed fewer days from work due to illness, enjoyed better health in their later years and were able to be productive more days of their lives.

Physicians wouldn’t benefit. PCP’s definitely make more money when patients are sicker. Medicare pays us based on disease burden of a patient. Insurance companies reimburse us far more for a complicated patient than a healthy one.

Patients would highly benefit because they could avoid costly visits with physicians. They would be empowered to take more active roles in maintaining and improving their health. They might even become wise to the shady games the pharmaceutical companies play.

Finding A Great Primary Care Doctor

If you are overall healthy, a good Primary Care doctor can keep you healthy. Real medicine is less about screenings and more about building a relationship with the patient and getting to know them. When I was doing Primary Care in the past, I would know right away when one of my regulars was depressed, or when one of them wasn’t using his compression stockings for edema.

There are still Family Doctors left who spend adequate time with their patients during each visit. They will have a holistic approach to your health and discuss your diet, your lifestyle, your habits and foresee problems. When you start going through depression and you have easy access to them, you don’t wait until your life goes to shit – you address it early and talk it through.

Even more importantly, they will stay up to date on pertinent scientific knowledge. You can bounce ideas off of them and discuss how to avoid injuries with new sports and what the latest information is regarding supplements, diet, etc.

The common complaint is that it’s impossible to get into one’s PCP’s office because they are so busy. However, there are plenty of doctors now who have alternative practices such as the DPC model. And with telemedicine gaining traction it should be easier to see your doctor. Our job is to seek out those PCP’s even if we are physicians ourselves.


The Financial Adviser Battle

I can only comment on what financial advisers based on what I have read, what I have observed and the information shared with me through my own advisers over the years. In short, they don’t have it much easier than PCP’s.

Their biggest hurdle is that they haven’t yet been able to bring a 3rd party between them and their customers in the same fashion that insurance companies essentially guarantee physician jobs. So for now, they are on their own to drum up business and convince customers of their value.

Delaying savings, getting into excess debt, not protecting oneself against catastrophe and exposing the financial household to too much risk are all common diseases of the financial lives of US households.

Most of this is adequately preventable. Intervention should ideally start when kids learn about money, which usually is at the checkout counter when the dad barks back that the toy is too expensive.

Who Benefits From Having Early And Ongoing Access To A Financial Adviser?

Again, the society as a whole would benefit a lot. Sure, we are used to thinking of banks and lending institutions as evil little fuckers. However, if we were savvier consumers and less likely to default on our debt, all of a sudden, both the banks and the customer would profit.

Financial advisers would benefit a ton because they are just as underutilized as Primary Care Physicians. They wouldn’t have to spend so much time with elaborate financial planning to perform damage control or account for irresponsible financial behaviors. They can focus on a higher number of clients and bring higher value to their clients.

Individuals would benefit as well. Imagine avoiding common financial mistakes because someone warned you about them and demonstrated to you why that decision will end up costing thousands of dollars. Would a good financial adviser have let their client buy a home with a variable mortgage back in 2005 just because the bank approved them for the loan? Would a good financial adviser let their client sell out of their investment holdings at the bottom of the 2008 crash and lock in hundreds of thousands of dollars in losses?

Finding A Great Financial Adviser

The best financial advisers are the best listeners. They spend a lot of time doing fact-finding in order to come up with a financial plan that’s customized for you. They anticipate problems and can help navigate you around them. They are experts to offer expert opinion – they don’t handhold and instead act to empower you.

And guess what, just like our health, our finances go through ups and downs. There are divorce, job loss, windfalls, marriage, kids, bankruptcy, sale of a business, loss of a business, and lawsuits.

The financial adviser would sit down with us at every financial turn of our lives and advise us through it. Plans will change and economic trends change just as much.

It can be hard finding a good financial adviser. I would recommend the word-of-mouth technique. Alternatively, you can research what it takes to be a great financial adviser and seek out those characteristics in your own adviser. Just like a PCP, you’ll have to interview many and probably fire as many FA’s as PCP’s to find the right fit for you.


In Summary

A good friend once said that everyone should have a private dentist, mechanic, doctor and lawyer – I will add financial adviser to that list of professionals. We think that having such experts on retainer is only for rich people… but we physicians are those rich people so we should do as rich people do.

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