Happy New Year from AAHS President Brian Adams
Brian Adams, MD
As 2019 begins, I look back on my year as your President with fondness for the wonderful people I worked with and pride for the numerous achievements of the past year.
I hope to see you in sunny Palm Desert to launch another great year for the AAHS. We have a spectacular program planned that offers a wide range of educational and social activities. As always, the friendships among our members will create a rewarding and wonderful time.
I wish you a Happy and Bright New Year!
Yours truly, Brian Adams
Jonathan Isaacs, MD
A lot is happening with your Hand Surgery Endowment! Over the past year, the Endowment has continued its previous focus on world outreach, education, and subsidizing AAHS member research. In partnership with the AAHS leadership, we are supporting some exciting new initiatives.
One of the most important goals of the HSE is to further and enhance world hand care. We do this by sending volunteer surgeon and therapy members to underserved communities around the world, and this past year we have sponsored or co-sponsored trips to Rwanda, Ghana, Nicaragua, Guatemala, and Tanzania. A new scholarship opportunity will support a surgeon and a therapist visit to Fiji in 2019. Providing high level medical care to the patients of these communities is an important and rewarding aspect of this strategy but, as with the proverb "give a man a fish and feed him one day; teach a man to fish and feed him for a life time," advancing communal skills and knowledge achieves a much more substantial and longer lasting impact. To that end, the HSE and AAHS started a "reverse" international fellowship last year. Our first recipient, Dr. Boutros Farhat, a surgeon from Ghana, visited several US centers of excellence including the Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, and Mass General Hospital in Boston. Our hope is that he will share his new knowledge and experience with his colleagues in Ghana and expand AAHS' impact to his country. Dr. Thendo Netshiongolwe, our second reverse fellowship recipient, will be traveling from his home in South Africa, and we are looking forward to his upcoming visit to several participating centers in the United States.
Other joint ventures of the HSE and AAHS include the continued sponsorship of seed level research grants exclusively to our members, educational outreach programs utilizing web-based lectureships such as the Kumasi (Ghana) weekly lecture series, and the recognition of humanitarian efforts and conservation efforts of deserving members (the Humanitarian Award and the Lean and Green Award).
With your help, your HSE has accomplished much in our goals for outreach, education, and care of hand patients. In the future, we can accomplish even more, with your help! Many of you know about the tragic injury suffered by our friend and colleague Dr. Jai Ryu. Just a few days after the 2016 AAHS annual meeting, Dr. Ryu suffered a cervical spine injury leaving him quadriplegic. Despite this tragedy, Dr. Ryu continues to share the positive spirit that he demonstrated throughout his career as an innovative and enthusiastic hand surgeon at West Virginia University. Although he had to retired from active hand surgery practice, he continues to be an inspiration to all of us. At the upcoming AAHS annual meeting, you will hear about the new Jai Ryu Lectureship appeal. Once funded, this annual lecture at our Annual Meeting will honor Jai's innovative spirit and focus on pioneering and inventive topics in hand surgery. Coincident with this effort, we will be announcing the AAHS 50th Anniversary Fund Raising Campaign. Through your generosity, the Hand Surgery Endowment can continue to support outreach, education, and the advancement of knowledge—goals essential to the core mission and values of our Association.
Richard J. Tosti, MD
"Give me six hours to chop down a tree and I will spend the first 4 sharpening the axe." Abraham Lincoln
The quotation above is an expression of the importance of planning and preparation. Most young people are not spending the majority of their time thinking about retirement. However, if a secure retirement were likened to chopping down a tree, it would behoove the woodsman to cut it with efficiency rather than taking desperate strokes with a blunt tool as time is running out.
A sharp saw, or a plan to make the financial goal more effortless, comes in the form of planning ahead and starting early. Due to the exponential growth curve of compounding interest, one can much more easily reach financial independence if one starts saving at an earlier age. So if you are saving now, then great! But how much do you need?
This is a personal question that will vary between individuals. But consider the following example as an "average" doctor's needs/wants expenses per year pre and post retirement:
|Budget Item||Pre Retirement Expense
|Post Retirement Expense
|Income from Social Security||$0||Negative $30|
As you can see, the good news about retirement is that your expenses are much lower. A physician making $250 K per year could comfortably live in the same manner for about $62K per year. The reason is that this person is mostly be free of mortgage payments, student debts, child care and work expenses, and does not have a need for life or disability insurance at this stage, and may benefit from social security income.
So the next question becomes, how large does the nest egg need to be in order to generate $62 K in income per year without running out? A highly cited study by Trinity University in 1998 calculated that the average portfolio comprised of 50% stocks and 50% bonds will not run of money over 30 years if the yearly withdrawal is 4% of the portfolio. Withdrawal rates at 5% and above ran a high risk of running out of money.
So for the above sample physician, if he/she plans on withdrawing 4% per year the total portfolio should grow to $62,000 / 0.04 = $1,550,000.
The last part of the lesson factors in the amount of time you have to grow to this number. Obviously a larger portion of your yearly income would have to be saved if you start saving later. Here is a way to estimate your annual savings rate:
EXAMPLE: a 35 yr old doc with no savings plans to retire at age 65 yrs. In order to figure out how much he/she needs to save to get to 1.55 million by 65 yrs you can use a feature on Microsoft Excel called “PMT” or (payment calculation). In one of the cells type in =PMT and a guide will pop up asking for the following variables:
PMT = payment (how much you need to periodically invest)
Rate = interest rate (positive number)
NPER = period (how many years you’ll be investing, positive number)
PV = present value (how much you have already)
FV = future value (how much you will have later)
Type = whether you invest in the beginning of the period (1) or end (0)
So for our physician assume:
Rate = 5% (average market growth)
NPER = 30 yrs
PV = 0
FV = 1550000
Type = 0
=PMT (5%,30,0,1550000,0) = $23,329.72 per year
Now let's play with the period variable to see why starting earlier is truly having a sharper axe.
If the same physician starts at age:
40: =PMT (5%,25,0,1550000,0) = $32,476 per year
45: =PMT (5%,20,0,1550000,0) = $46,876 per year
50: =PMT (5%,15,0,1550000,0) = $71,830 per year
55: =PMT (5%,10,0,1550000,0) = $123,232 per year
Obviously saving from a younger age will reduce your yearly payment to your portfolio and allow growth through compounding interest. The best ways to save are in tax protected retirement accounts such as 401K, IRA, and Roth IRA (see previous article on Backdoor Roth IRA).
Sure you can pay a financial advisor to calculate this for you. You could also learn the basics yourself of creating your own financial plan from the course offered by White Coat Investor.
Dr. Tosti is a practicing hand and microvascular surgeon and a paid consultant of the White Coat Investor, LLC.
He is not a licensed financial advisor and has not completed any formal financial training.
Please be aware the advice written herein should be considered personal advice for the purposes of informal discussion and diffusion of ideas.
All information given should be verified with a professional advisor
Sandra Salinas, OT, CHT
3D printing technology is gradually making its way into therapy clinics. Some hospitals are using this technology for creating a physical model of patient anatomy for pre-surgical planning. These devices create 3D models using computer assisted design and special slicing software programs that convert the information so the printer, using filament, to "build" the design. The result is a Lego-like solid object that is durable, and inexpensive to make. In our rehabilitation clinic we are creating orthotics for hand and finger diagnoses such as trigger finger, swan neck deformities, and also create medical models for patient teaching, and for adaptive equipment to help clients perform self-care.
Perhaps one of the greatest benefits is the cost of the 3D print. We are able to pass substantial savings on to our clients. Prefabricated finger orthoses cost the client about minimally, and much more for custom metal silver rings. As a hospital-based clinic, we can measure for the orthotics, but the clients are asked to order them from the manufacturer and request reimbursement from their insurance company. A 3D printed finger orthosis costs about 10 to 20 cents each. The savings are passed onto our community hospital clients, many who do not have insurance and are limited financially.
Therapists are also using 3D printing to create upper extremity anatomical models. Robin Janson, OTD, CHT at IUPUI in Indiana is using 3D printing to create models for her therapy students to learn the anatomy in a meaningful way, and is using materials to simulate ligaments. The cost of the model shown in the picture costs about $5. Her students take them out on loan. Ms. Janson makes her design available for other therapists to replicate for use in their clinics.
A small print such as the swan neck orthosis take about an hour to create. Larger prints can take much longer, depending upon the size of the model and settings. This prevents us from using 3D printing for larger orthotics, and the traditional way of making orthotics is preferable at this time. Therapists are learning to create their own designs, parts for larger orthotics, or adaptations of smaller orthotics. Indeed, the future is here.