Ri h dRichard A. FlFeely, DO FAAOFCA...
Transcript of Ri h dRichard A. FlFeely, DO FAAOFCA...
Ri h d A F l DO FAAO FCA FAAMARichard A. Feely, D.O.,FAAO,FCA,FAAMAPresident American Academy of Osteopathy
P i t P ti Chi ILPrivate Practice ‐ Chicago, IL
WARNING The content of this lecture may or may not be Politically CorrectPolitically Correct.
The lecturer has no political, philosophical or religious agenda other than exposing you to his knowledge agenda other than exposing you to his knowledge, experiences and philosophy that has stood him well for 30 years of successful OMM practicefor 30 years of successful OMM practice.
Unless otherwise stated the opinions, views and expressions of the lecturer is not necessary those of expressions of the lecturer is not necessary those of the American Academy of Osteopathy ‐merely one man’s opinion.mans opinion.
Some basics‐ definitions Convocation‐formal assembly: a large formal assembly e g of a college or university community or assembly, e.g. of a college or university community, or the senior members of a church. ‐ Encarta World
bl f k d b ( ) bl a : an assembly of persons convoked b (1) : an assembly of bishops and representative clergy of the Church of England (2) : a consultative assembly of clergy and lay England (2) : a consultative assembly of clergy and lay delegates from one part of an Episcopal diocese; also :a territorial division of an Episcopal diocese c : a a territorial division of an Episcopal diocese c : a ceremonial assembly of members of a college or university. – Merriam Webstery
Definitions ‐ Vocation a summons or strong inclination to a particular state or course of action; especially : a divine call to the state or course of action; especially : a divine call to the religious life –Merriam Webster
urge to follow specific career: a strong feeling of being urge to follow specific career: a strong feeling of being destined or called to undertake a specific type of work, especially a sense of being chosen by God for religious especially a sense of being chosen by God for religious work or a religious life –Encarta World
somebody's job: somebody's work job or profession somebody s job: somebody s work, job, or profession, especially a type of work demanding special commitment – Encarta World
Vocation Physician
Definitions; Profession ‐; the act of taking the vows of a religious community
f l d l i bli l l i i an act of openly declaring or publicly claiming a belief, faith, or opinion
lli i i i li d k l d d f a : a calling requiring specialized knowledge and often long and intensive academic preparation b : a principal calling vocation or employment c : the whole body of calling, vocation, or employment c : the whole body of persons engaged in a calling. – Merriam‐Webster
ti i i t i d ti occupation requiring extensive education: an occupation that requires extensive education or specialized training Encarta Worldspecialized training. ‐ Encarta World
Profession Osteopath – Osteopathic Physician and surgeon
Osteopathyp y Is a Philosophy of medical healthcare original articulated by A T Still June 22 1874A.T. Still, June 22, 1874.
Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and diseaserole of the musculoskeletal system in health and disease.
It’s main tents are;Th b d i i b d i d d i i The body is a unit‐ body, mind and spirit.
The body has homeostatic /self‐regulatory mechanisms’d f ll l d Structure and function are reciprocally interrelated
Rational treatment is based upon understanding of the above.
Osteopathic Physicianp y One who practice osteopathic medicine. A graduate of an American College of Osteopathic A graduate of an American College of Osteopathic Medicine, has a state license to practice and usually has completed a residency and passed a specialty p y p p yboard to become a board certified Osteopathic Physician and surgeon.
A Harvard study found significant differences in the attitudes between MDs and DOs. The study found students and physicians described themselves as students and physicians described themselves as "socioemotionally" oriented DO 63.8% vs. MD 40.1% over "technoscientific" orientation (p < .0001).(p )
State of Life Defined by relationships with others and time
it t t th l ti hi th t h t i commitment to the relationships that characterizes your life.O i di i l ll d i l i d li i One is divinely called to single, married or religious state of life. ‐ Catholic Church
l l d d d d Marital status: single, married, separated, devoiced, widowed.
The alternative is worse, absence of life.
OUR CHOICES IN LIFELIFE NON LIFE aka DEATH HOPE LOVE
JOY
DESPAIR, DISBELIEF HATE
SADDNESS JOY FAITH CONSTANCY
SADDNESS LACK OF TRUST INSTABILITY CONSTANCY INSTABILITY
STATE OF LIFEVOCATIONVOCATIONPROFESSIONMISSIONMISSIONGOALS
State of Life, Vocation, Mission, Goals STATE OF LIFE ‐ Single, Married, Separated, Devoiced, WidowVOCATION OSTEOPATHIC h i i d VOCATION ‐ OSTEOPATHIC physician and surgeon
MISSION – Life’s WORK, e.g. teacher, clinician, researchGOA S CO S A C A G G GOALS – MULTIPLE CONSTANTLY CHANGING Temporary ‐ Pass test, obtain knowledge, pass boards, get a degree residency house spouse children ideal positiondegree, residency, house, spouse, children, ideal position
Constant and Long term Physical healthPhysical health Financial health Intellectual ‐ Professional development Emotional – psychological ‐Social development Spiritual development
Our Vocation in life as a Single D.O.g FOCUS ON MISSION, GOALS, SELF AND OTHERSB h b DO Be the best DO
Achieve the specialty Go where you want to go Career achievement/opportunities Money‐ less dependants Fame – generally able to advantage of more Fame generally able to advantage of more opportunities
Our vocation in life as Married D.O FOCUS ON FAMILY then MISSION, GOALS, OTHERS AND SELFAND SELF
Devotion to spouse Be the best DOBe the best DO Provide for your spouse’s & children’s temporal needs Define and limit your career advancement based upon Define and limit your career advancement based upon spouse and family’s needs
Child rearing time/stressors/joyChild rearing time/stressors/joy Increased financial costs Increase contentment, harmony and length of lifeIncrease contentment, harmony and length of life
THEY FAIL TO PLANTHEY FAIL TO PLAN
SO LET’S MAKE A PLAN!
At the END of Your Life What will it Look like? Will there be loved ones near a spouse, child +, an ex ? Will you have a life giving spiritual relationship with God? Will you have fulfilled your mission in Life as you saw it? Will you have financial comfort or hardship because your y p ychoices?
Will you have had good physical health because your h i ?choices?
Will you have grown and shared in love, surrounded by l d th h l ?ones you love and those who love you?
Your Life Plan ‐ highlightsg g Identify your State of Life ‐ Live it everyday!A li V i d il ! Actualize your Vocation daily!
Identify your Mission in Life‐Think and do it everyday! Identify your Goals and work on them constantly.
Physical Health Professional/Intellectual Health Financial Health Spiritual Health Psychosocial/emotional Health
Our experiences count, They make you unique and form your out look Transforming Experiences
Birth Life
Significant events that changed you Significant people who changed you Significant places that have effected youSi ifi i d i i d i d h bi h Significant times graduation, marriage, devoice, deaths, births
Death
A TIME AND A PLACE TO GAIN KNOWLEDGE d DEVELOP i t KNOWLEDGE and DEVELOP into a PROFESSIONAL.
IT IS THE ENTRENCE TO THE IT IS THE ENTRENCE TO THE OSTEOPATHIC PROFESSION, NOT THE END RESULTEND RESULT.
1st Year STATE OF LIFE‐If Single, do I have a call to marriage? If so how do I find a partner?
If Married, how do I balance family and school? When is a good time to have a baby?
VOCATION/PROFESSION Should be thinking of and VOCATION/PROFESSION‐Should be thinking of and discussing the type of medicine you like. Procedure, E/M/Diagnostics, Primary or Specialty.M h k l ki ll h i Mentor search – keep looking all the time
Refining study habits ‐ How do you learn best? If you don’t know come up with new ways of studying, study groups, p y y g, y g p ,visual aids, etc.
Not too early to start thinking about boards – start reading review book taking quizzes for funreview book, taking quizzes for fun.
1st Year MISSION‐ Dreaming/trying it out and visualizing it PERSONAL PERSONAL‐
Physical health – nutrition, exercise; disease and dysfunction Financial health – debt, cash flow, income, expense, savings, , , , p , g ,
investing, insurance Intellectual ‐ Professional development – inside and outside COM
activities developing an Osteopathic philosophical outlook on lifeactivities, developing an Osteopathic philosophical outlook on life Emotional – psychosocial development – stressors, living
conditions Spiritual development – Is it going on? Are you practicing your
religion? Are you living up to it’s ideals daily?
Personal FoundationPersonal FoundationProfessional Health
Ph i l H l hPhysical Health
Financial Health
Psychosocial Health
Spiritual Health
19% of all Bankruptcies in 2002pWhere College Students!
Your Financial Plan in COM Save $1000 as emergency fundK D b l Keep Debt low ‘Live on less than you make’
Required Insurance Auto Home owners/renters Life ‐ level 20 yr term Health – PPO WILL
2nd Year STATE OF LIFE‐married/single/separated/devoiced/widow/ g / p / /
VOCATION/PROFESSION‐ greatly increase knowledge and clinical understanding, become accomplished in
OMTaverage OMT. Should be thinking of and discussing the type of medicine you like Procedure E/M/diagnostics Primary or specialtyyou like. Procedure, E/M/diagnostics, Primary or specialty.
Finding mentors – learn from the very best and one or two from the very worse!y
Start thinking about residency‐type, location, fall back plan.
2ND YEAR MISSION‐ thinking, trying it out and visualizing it PERSONAL PERSONAL‐
Physical health – nutrition, exercise; disease and dysfunction
Financial health – debt, cash flow, income, expense, savings, investing, insurance
Intellectual ‐ Professional development – inside and outside Intellectual Professional development inside and outside COM activities, developing an Osteopathic Professionalism , ATTITUDE AND PERSONAEmotional ps chosocial de elopment sophomoric Emotional – psychosocial development – sophomoric learning/acting, stressors, living conditions
Spiritual development – Is it going on? Are you practicing l l ’ d l d lyour religion? Are you living up to it’s ideals daily?
90% of AmericansBuy things they cannot afford.y g y
3rd Year STATE OF LIFE‐married/single/separated/devoiced/widow VOCATION/PROFESSION‐ greatly increase knowledge and g y g
clinical understanding in real life situations. Finish trying on each specialty as you rotate.
Research residency programs.y p g What do our allopathic counterparts think of us, how do we
work together when our training is so different. MD vs DO residency why other DO’s advise against MD vs. DO residency……why other DOs advise against
osteopathic residencies? Why do DOs advise fore osteopathic residencies?
Start networking! Go to conferences See and be seen Start networking! Go to conferences. See and be seen. Thinking about the financial impact of undergraduate and
graduate loans. G t fi i l d ti l f Go to financial educational conferences.
3rd Year MISSION‐ thinking, trying it out and visualizing it –
Much clearer vision teaching research clinical practice Much clearer vision teaching, research, clinical practice, administration, practice setting ideal.
PERSONAL‐ Physical health – nutrition, exercise; disease and dysfunction Financial health – debt, cash flow, income, expense, savings,
investing, insurance, FINANCIAL PLANNING Intellectual ‐ Professional development – inside and outside COM
activities, REFINING Osteopathic Professionalism , attitude and persona growing with experiences.
Emotional – psychosocial development – HOSPITAL, CLINIC stress, patient interactions, staff interactions, living conditions
Spiritual development – Is it going on? Are you practicing your p p g g y p g yreligion? Are you living up to it’s ideals daily?
Chance of winning the lotteryg y1 in 15 million5Chance of being struck by g ylightening 1 in 1.5 million
4th Year STATE OF LIFE‐married/single/separated/devoiced/widow‐
preparing for a change in Life situation.p p g g VOCATION/PROFESSION‐ greatly increase knowledge and
clinical understanding in real life situations. Deciding on a specialty as you rotatespecialty as you rotate.
Start thinking of a strategy to pay off your debt, consult financial advisor.
Thinking about what you want when you get out of residency, how will you get there…..corporations vs. private practice.
Finding resources to accomplish your professional goals Finding resources to accomplish your professional goals. Do external rotations, great way to network, especially in the
field you want to go in to and/or the area you want to live in.
4th Year MISSION‐ thinking, deciding, and visualizing it –
Much clearer vision regarding teaching research clinical Much clearer vision regarding teaching, research, clinical practice, administration, practice setting ideal.
PERSONAL‐ Physical health – nutrition, exercise; disease and dysfunction Financial health – debt, cash flow, income, expense, savings,
investing, insurance, FINANCIAL PLANNING Intellectual ‐ Professional development – inside and outside COM
activities, REFINING Osteopathic Professionalism , attitude and understanding fairly developed.
Emotional – psychosocial development – HOSPITAL, CLINIC stress, patient interactions, staff interactions, living conditions.
Spiritual development – Is it going on? Are you practicing your p p g g y p g yreligion? Are you living up to it’s ideals daily?
Personal FoundationPersonal FoundationProfessional Health
Ph i l H l hPhysical Health
Financial Health
Psychosocial Health
Spiritual Health
“average car payment $378”g p y $Invested for retirement @25 years old
6 ld l i @65 years old value is now $4,000,000.
To be wealthy enough to:To giveRetire with dignityRetire with dignityLeave an inheritanceTo have fun
THE Financial Plan‐ Dave Ramseyy1. $1,000 emergency cash in house2 Debit ‘snowball’ unproductive debit free2. Debit snowball unproductive debit free3. Financial emergency fund 3‐6 months of living
expensesexpenses4. Investment 15% of income into retirement fund5 Start a College Fund5. Start a College Fund6. Pay off House7 Wealth building7. Wealth building
Pinnacle point‐ live off your money @8% income per year‘THE TOTAL MONEY MAKEOVER’‐DAVE RAMSEY
78% of us will have a Major unexpected event in the j pnext 10 years!
Residencyy State of Life, Vocation/Profession, Mission, Goals, Personal foundationPersonal foundation
General or Specialty Allopathic or OsteopathicAllopathic or Osteopathic Location Program pluses and minuses Program pluses and minuses Fellowship yes/no Employment or self employment Employment or self employment Hospital system, specialty group, multi specialty group, partnership, junior associategroup, partnership, junior associate
Your Financial Plan Residencyy Save $1000 as emergency fund Keep Debt low Keep Debt low
‘Live on less than you make’ Start the debt relief Snowball
Required Insurance Auto Home owners/renters Disability Ins. Private policy specialty specific Life level 20 yr term Life ‐ level 20 yr term Health – HSA PPO WILL
Patient Safetyy ID PatientEff i C i i Effective Communication
Physician Disruptive Behavior – KEY Conflict resolution Refuse to answer questions Condescending voice Impatient with questions Nurse witnesses you, discuss with others present and supervisor present
Physician Disruptive behaviory p ShoutingTh i i Throwing instruments
Behavior in condescending voice Not answering questions Not returning calls Refusal to perform assigned task Out bursts in meetingsOut bursts in meetings Physical threat
Patient Safety 2y 3. Monitor patient Medications
t t t k d X % % h f 50 steps to take a med X 99% accuracy=39% chance of error
Top 5 Meds 1 Insulin 2 Morphine 3 Hepairin 4 KCl 5 Top 5 Meds 1. Insulin 2. Morphine 3.Hepairin 4.KCl 5. Warfaren
4 Eliminate wrong‐site wrong Patient wrong‐Procedure4. Eliminate wrong site, wrong Patient, wrong ProcedureTimeout for correct Pt./Correct site/correct procedure
5 Iv pump safety5. Iv pump safety6. Decrease Infection‐WASH HANDS7 Accurate reconciliation of medications7. Accurate reconciliation of medications
DOs by the numbersy Colleges of Osteopathic Medicine‐ 26/ 32 campusesS d 8 d Students ‐ 2010 over 18,000 5,300 to graduate 2015
Residences – Practicing in USA
Identify your strengths, personality, talents, weaknesses and look for the best fit.
d f h l h d f lWord of mouth, relationships and professional reputationLicensure issuesContract issues Contract issues
termslengthgexpenseswork definedpay
Life is different when you are THE responsible party for this patient’s Lifepatient s Life
Osteopathic keys to successp y “Despite correlations between MCAT and Step 1 licensing exams correlations between the latter and licensing exams, correlations between the latter and clinical performance are weak. Performance as a physician correlates better with proficiency in the physician correlates better with proficiency in the humanities and with personal characteristics such as motivation, conscientiousness, integrity, empathy, and , , g y, p y,a robust psychological constitution."
KNOW WHO YOU ARE YOUR TALENTS
P h l i l Psychological MentalPh i l Physical
EmotionalS i i l Spiritual
O OO OC O /SKNOW YOOUR VOCATION/STATE OF LIFEOF LIFE Married Single Religious Religious
KNOW YOUR PREFERRED WAY OFKNOW YOUR PREFERRED WAY OF MAKING MONEY Business owner, manager, employerE l Employee
Business owner, manager, g Need to have/develop business management skills Employee management Employee management Deal with CPA,, Lawyers, Government regulations on employment and insurance regulationsemployment and insurance regulations
Strong organizational strengths Business Planning Business Planning Advertizing, marketing, communications Medical health care rules and regulations Medical health care rules and regulations Identify who your customer is and meet their needs Your financial health depends on you Your financial health depends on you
Employee of whomp y Hospital corp. – clinical, administrationCOM hi d i i i li i l COM‐ teaching, administration, clinical
Group‐ single specialty/multi specialty; clinical, admin Government‐ clinical. Administration
Bottom ID your role and file it to best of your ability Your Financial health depends on the employer Your Financial health depends on the employer
Early Practice Lifey Personal Foundation – work itS f Lif State of Life
Mission Goals
Financial planner CPA Lawyer Insurance agent Develop a financial plan, and a life plan
Your financial Plan in Practice1. $1,000 emergency cash in house
D bi ‘ b ll’ d i d bi f2. Debit ‘snowball’ unproductive debit free3. Financial emergency fund 3‐6 months of living
expenses4. Investment 15% of income into retirement fund5. Start a College Fund
Debit Relief – ‘Snowball’ It isn’t complicated, but it is difficult8 % b h i % h d k l d 80% behavior 20% head knowledge
Pay off the smallest amount 1st, then the highest i k i idinterest rate, make a payment every time you get paid
Goal‐ No credit card, or short term debit After that pay off 2nd mortgage, business loan and then house
List all debits, total payoff, minimum payment,% interest, new payment, total payments remainingp y p y g
Your financial Plan in Practice Required Insurance
Malpractice Malpractice Auto Home owners/renters/umbrella Home owners/renters/umbrella Long term Disability‐ 50‐70% income Personal policy specialty specificy
Life ‐ level 20 yr term, all debts, enough for spouse and children needs till 25 years.
Health – HSA PPO, specialized insurances Long term health careLi i Will C i I i l Living trust, pour over Will, Corporation, International trusts
Are you in the Top 40% of Americansy pThey pay OFF their credit cards y p yevery month!
49% of AmericansCan not cover less than one months expenses if they lost their income/job.
Usually second or third employer5 years out in practice – confident, can get the job done, knows what 5 y p , g j ,to do.Involved in hospital committee and low level medical association politicspoliticsBegins to start make some decent moneyHigh malpractice incidences – know it all/too busy/missing things/ g p / y/ g g /stressed out‐ fail to Dx/fail to Tx45‐55 years old high productive years as far a work volume and incomeM it l it ti ll ttl d if i d h hild Marital situation usually settled, if married house, children, expenses high You wake up one day and decide in your soul that you made IT or not.p y y yMid life crisis
Mid Career Financial Plan1. $1,000 emergency cash in house
D bi ‘ b ll’ d i d bi f2. Debit ‘snowball’ unproductive debit free3. Financial emergency fund 3‐6 months of living
expenses4. Investment 15% of income into retirement fund5. Continue the College Fund6. Pay off Housey7. Wealth buildingPLUS required insurances previously listedPLUS required insurances previously listed
Personal FoundationPersonal FoundationProfessional Health
Ph i l H l hPhysical Health
Financial Health
Psychosocial Health
Spiritual Health
3% of 65 year oldsyAre financially secure!
Own your own business bring in partners or notHigh levels of hospital, government, administration or medical g p , g ,corporation positionIncome is usually fairly high until 60‐65 years oldAfter 60 years old work level slows down, can’t turn and burn as muchNo longer in practice or just consulting
Late Career Financial Plan1. $1,000 emergency cash in house‐ DONE
D bi ‘ b ll’ d i d bi f DONE2. Debit ‘snowball’ unproductive debit free‐ DONE3. Financial emergency fund 6 months of living
DONEexpenses‐ DONE4. Investment 15% of income into retirement fund‐
ONGOING OR LIVING OFF ITONGOING OR LIVING OFF IT5. College Fund‐ FINISHED OFF6. Pay off House‐ DONE7. Wealth building‐ONGOING AND LIVE OFF IT7 g
The paradox of wealthp It makes more of what you really are!
J k Jerk GenerousKi d Kind
GuiltyF f l Fearful
Loving
DID YOU REALY LIVE LIFE DID IT JUST HAPPEN?or DID IT JUST HAPPEN?
loved onesfinancially securel tilocationdignityg yin touch with Godhealthy to the endhealthy to the end
Your Life Plan ‐ highlightsg g Identify your State of Life ‐ Live it everyday!A li V i d il ! Actualize your Vocation daily!
Identify your Mission in Life‐Think and do it everyday! Identify your Goals and work on them constantly.
Physical Health Professional/Intellectual Health Financial Health Spiritual Health Psychosocial/emotional Health
THE Financial Plan‐ Dave Ramseyy1. $1,000 emergency cash in house2 Debit ‘snowball’ unproductive debit free2. Debit snowball unproductive debit free3. Financial emergency fund 3‐6 months of living
expensesexpenses4. Investment 15% of income into retirement fund5 Start a College Fund5. Start a College Fund6. Pay off House7 Wealth building7. Wealth building
Pinnacle point‐ live off your money @8% income per year‘THE TOTAL MONEY MAKEOVER’‐DAVE RAMSEY
CONSUMED.
DALLAS WILLARDDALLAS WILLARD
C idCannot provide.
DALLAS WILLARD
ill d ill t b dwill and will not be used.
DALLAS WILLARD