Wealth Matters: Putting Your Doctor, or a Whole Team of Them, on Retainer

With that he entered the world of concierge medicine, a growing subset of medicine where patients pay doctors anywhere from $1,500 to $25,000 a year to receive personalized attention and care. (Dr. Glazer said he was paid toward the top of this range.) In most cases, patients presume that in an emergency their concierge doctor will push them to the front of the line to see a top specialist.

Even as more people are struggling to pay medical bills and being rushed through office visits with their doctors, an elite group with money has another option: exclusive medical care, around the clock and anywhere in the world, including on a yacht or private plane.

One of Dr. Glazer’s clients, for instance, has had his yacht outfitted with a system from Guardian 24/7, a company in Leesburg, Va., founded by former White House doctors that advertises itself as offering “medical protection previously available only to the president of the United States.” The company’s “ready room” will allow a doctor trained in the system to perform basic medical care remotely if something should go wrong while the patient is on the high seas.

“There is very little that we can’t do with the triage room on their yacht,” he said.

The cost of Guardian 24/7’s services ranges from $6,000 to $12,000 a month, plus an additional $700,000 for one of the company’s top-of-the-line “ready rooms” installed in a client’s home, yacht or airplane, said Jonathan Frye, chief executive.

While it is difficult to determine how many people are served by this more personalized care, the number of doctors who have moved to this new model has risen fivefold in the last five years. And that raises questions about medical care in America. For those who can afford it, what do they get for their money? Is it worth it? And for the rest of us, who cannot afford this level of care, is it fair and ethical for doctors to be doing this? Or is concierge care contributing to the growing gulf between the wealthy and everyone else?

COSTS AND BENEFITS Concierge medical care is nothing new. In places like Florida, with a high concentration of Medicare patients, some upper-middle-class retirees pay extra fees so they can see a doctor when they need to.

MDVIP, which has 450 concierge doctors in 34 states, charges patients $1,500 to $1,800 a year. Their doctors are each limited to 600 patients, whereas, the company says, most primary care physicians serve at least 2,000 patients. It says appointments with doctors “start on time and last as long as necessary” and can usually be made the same day or the next one. The company’s fee is for the extended care and comprehensive annual physical and wellness plan, but its doctors still bill the patient’s insurance company for procedures.

The international, around-the-clock programs take concierge medicine to a different level. Their primary goal is to offer an extra level of oversight to make sure that participants are getting the proper level of care whenever they need it.

Dr. Miles J. Varn, chief medical officer at PinnacleCare Private Health Advisory, which charges annual fees of $1,500 to $25,000, said the starting point for all patients was a complete review of all health records with an emphasis on finding gaps in care.

“We have physicians who look for omissions of care or deviations from standard care,” Dr. Varn said. “That record travels with them around the world.”

In promoting themselves, the plans say their doctors know each patient’s health conditions intimately and are able to discuss it with another doctor anywhere in the world.

Dr. Daniel Carlin, founder and chief executive of World Clinic, which charges $20,000 to $75,000 a year on average, said he recently had to intervene and stop a patient from getting the wrong procedure. The client was at a hospital in Florida where the doctors wanted to do bypass surgery for a blocked vessel. Dr. Carlin said the proper care was putting in a stent, and the difference was months of pain and recovery for the patient and tens of thousands of dollars for the hospital.

“You’re holding up a shield and saying, ‘We’ll weigh everything before we move forward,’?” Dr. Carlin said. “With the primary care guy gone, the average patient isn’t being treated.”

IS IT WORTH IT? Despite reports about the decline in the number of family physicians and the increase in the hours the remaining ones work, many wealthy people are reluctant to pay extra for health care.

 

In Scotland, the Only Match That Really Matters May Matter Too Much

But if the popular name for their clashes sounds benign, it has become a cruel euphemism over the years, conveying nothing of the hatreds and lurking violence that characterize what may be the oldest, and the most dangerous, crosstown rivalry in all of sports. If sports are a metaphor for life, the Rangers-Celtic story is one of age-old Protestant and Catholic enmities that are one of the ugliest strains in Scotland’s history.

Late last week, those tensions seemed to reach a new extreme with the disclosure that four crude bombs were sent through the mail to Celtic’s manager and two of the club’s most prominent supporters over the last six weeks. All were intercepted or reported to the police before they could explode, but spokesmen for the police said their components were capable of inflicting serious harm. British news media reports suggested they contained flammable liquids and nails.

The police say they will deploy unprecedented numbers of officers at the Rangers-Celtic match on Sunday, a game that could go a long way toward determining the winner of the Scottish Premier League, which Rangers lead by a point over Celtic. Police spokesmen said they would arrest anybody at Rangers’ Ibrox Stadium whom they catch giving voice to sectarian slogans or songs that have been the motif for the teams’ games for as long as anybody can remember.

So far, there have been no arrests for the intended bombings, and the police have not disclosed whatever information they may have on suspects or possible motives. But a police official, who did not want to be identified discussing a developing investigation, said inquiries were focused on the sectarian hatred between the clubs. The police raided homes in Glasgow on Saturday morning and arrested two men, 23 and 27, for posting “sectarian and hate-filled” comments on unspecified Web sites. More raids are expected as part of an continuing campaign focusing on online soccer forums.

According to statements by the police and the intended victims, the bombs were sent to the Celtic manager, Neil Lennon; to Paul McBride, a lawyer who has represented him; and to Trish Godman, ?a former politician in Scotland and a prominent Celtic fan. In interviews since the case went public Thursday, Lennon, 39, a Catholic from Northern Ireland who had a successful career as a player in England and in Scotland, said he had received bullets through the mail before the two bombs that were mailed to him.

In an interview that was quoted in most of Britain’s major newspapers Saturday, he described the bombs as "a tipping point."

He added: “Hopefully, all this rubbish can stop. It has nothing to do with football, and we’re all fed up with it. We’re all fed up with the singing, fed up with the abuse, and we just want to do our jobs.”

Suggesting the turnaround could begin with Sunday’s game at Ibrox, he added: “There might be a few sympathetic voices in the ground, which would be nice. But I am not looking for sympathy. I am looking to go there and win a football match.”

His counterpart at Rangers, Walter Smith, a former manager of Scotland’s national team and of Everton in the English Premier League, was less sanguine. In interviews, he told reporters that the Old Firm environment was too toxic to enjoy, and that if he had not already announced his retirement from Rangers at the end of this season, the mailing of the bombs would have prompted him to question his staying on anyway.

“After the happenings of the last week, I’ll be delighted that it’s my last one,” he said, referring to Sunday’s game.

The enmities between the two clubs have their roots in the 19th century, when waves of Irish migrants fleeing famine and the seizure of their land by British authorities crossed the Irish Sea and settled in western Scotland, many around Glasgow. About three-quarters were Catholics, a quarter Protestants, and they brought with them the sectarian hatreds that had festered in Ireland.

“They decanted their historic tensions and hatreds to western Scotland and Glasgow,” Tom Devine, a professor of Scottish history at the University of Edinburgh, said in telephone interview.

In time, the animosities found expression in the two soccer teams, and in the so-called “90-minute bigots” who pack the stands. Celtic, which plays in green-and-white stripes, was founded in 1888 by a Catholic priest, partly to counter religious persecution. Rangers, whose colors are the blue, white and red of Britain’s Union flag, drew mostly Protestant support. From the start, the underlying loyalties — Protestant and Catholic, British and Irish — lent strong passion to their encounters. Yet these seem to have intensified even as their original causes have eased. Religion has declined in an increasingly secular Scottish society, and 13 years have passed since Catholics and Protestants in Northern Ireland concluded the Good Friday agreement that has brought at least a fragile peace.

That has led Devine and others who have studied the issue to say that the enmities now are more tribal than religious, and fueled by poverty and social breakdown. Glasgow, Scotland’s largest city, has pockets of poverty that are among the most extreme in the developed world. The Catholic minority, particularly men from 18 to 35, has traditionally been among the poorest, and has suffered “a bigoted anti-Catholicism in certain sections of society,” Devine said. ?

In the most deprived areas, encompassing crumbling public housing towers ravaged by joblessness, and alcohol and drug abuse, male life expectancy is 54 — four years lower than in war-torn Sudan — according to World Health Organization figures.

In the soccer rivalry, the resentments have often found expression in violence, but soccer authorities have been slow to act. Rangers were fined $12,000 last week by UEFA, soccer’s governing body in Europe, after its fans continued singing sectarian songs at high-profile matches, including one that urges those of Irish origin to “go home,” and another, “The Billy Boys,” that includes the refrain “We’re up to our ears in Fenian blood,” Fenian being a derogatory term for Irish republicans. Celtic supporters have refrains of their own, including “The Fields of Athenry,” an old Irish republican ballad.

Magnus Linklater, a Scottish journalist writing in Saturday’s Times of London, said the tribalism appeared to have crossed Scotland’s class divide.

“Among the baying fans are lawyers and accountants, whose language is often as extreme as the thugs they stand alongside,” he wrote.

Like many others, he called for the police to crack down hard, beginning with Sunday’s match.

Ally McCoist, the assistant manager of Rangers and previously a longtime player for the club and for Scotland’s national team, agreed.

“I honestly don’t know what more the clubs can do,” he said.

Scotland’s first minister, Alex Salmond, who is facing a difficult election next month, blamed the violence narrowly on what he called a “lunatic element,” but Devine, the historian, sees a more sinister threat.

“I think it’s ironic that in a post-Christian, secular society, the problem seems to be intensifying,” he said, adding: “What’s happened over the last few days is unprecedented. There have been riots, but sectarianism in Scotland has never had this violence and criminality.”

 

Wealth Matters: Taking the Time to Pick the Right Financial Adviser

在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。
在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。

In the past, there have been few people to consult about whom to pick. Accountants and lawyers have played this role, warily. But they would typically present two or three advisers and leave the final decision up to the investor.

Now Douglas Black, a 30-year brokerage industry veteran, has started a firm called SpringReef Partners that will screen and select financial advisers for wealthy families. While the amount of wealth needed to receive his advice is high — from $5 million to $50 million — his approach can help those intent on evaluating an adviser to fit their needs. His advice may be aimed at the wealthy, but anyone with money to invest can adopt his practices.

“Firms don’t do a very good job of matching adviser capability with client complexity,” Mr. Black said. “They haven’t taken the focus away from the advisers in determining who is going to end up with whom.”

Mr. Black, who started his career as a financial adviser and stepped down as the chief operating officer of UBS Wealth Management in 2010, is entering this business at an opportune time. Investors are particularly insecure about making the wrong choice.

Charlotte B. Beyer, founder and chief executive of the Institute for Private Investors, said her members were now screening eight to 10 advisers when they used to meet with two or three.

“That’s an enormous difference and an enormous time commitment,” Ms. Beyer said.

While wealthy investors may have made a lot of money and surely understand how complex the world is, they are just as afraid as anyone else of getting this choice wrong. So how do you pick the right adviser without being overwhelmed by the process?

TYPICAL MISTAKES Regardless of wealth, people make the same mistakes in selecting advisers.

Listening to family and friends for suggestions on money management — or, worse, picking family and friends to do it — can be a bad idea. First, there is no correlation between your sense about a person and that person’s ability to do a good job. Remember all the people who felt such affection for Bernard L. Madoff? And second, hiring a friend or relative makes firing that person tough.

Rushing the process is another mistake. Picking a financial adviser can be as serious as selecting a doctor, and it certainly should require more time than picking a paint color. But for many investors, even those who had to make tough decisions in business, it is about as interesting as watching that paint dry.

“People don’t interview enough people on the front end,” said Jim Grubman, owner of FamilyWealth Consulting, which works with advisers. “They’ll take someone else’s recommendations. What works for your friend or your colleague may not be the best fit for you.”

Relying on a name brand firm can be just as bad as going with someone you know. But selecting a boutique firm in the belief that smaller size means more attention for clients can be equally problematic.

“Our belief is there are exceptional advisers spread across all different types of platforms, but there are no great firms,” Mr. Black said.

QUESTIONS TO ASK Picking an adviser is an awful lot like choosing a spouse: you really want the relationship to last forever, to be rewarding and fulfilling, but if it happens to fall apart, you don’t want that to destroy you.

Mr. Black, whose firm is paid either a fixed fee or a percentage of assets for continuing monitoring, said he asked 18 questions of all firms and 17 of advisers. For firms, some of the major questions involve how the organization functions, its experience and risk-management practices and how it handles problems that arise.

For advisers, the criteria are a mix of set standards and questions. He will not work with any adviser who has fewer than seven years’ experience. One thing he found when he worked at UBS was that it generally took at least seven years for any financial malfeasance to surface. He said he also wanted to make sure that the adviser’s firm had broad experience with clients whose wealth levels were similar to his own client’s.

Yet, he said, the value his firm will bring to the selection process may be in the questions that do not have simple yes or no answers. The 17 criteria for advisers are listed on the firm’s Web site.

One simple statistic he looks at is how much additional money an adviser’s existing clients are asking him or her to manage. Mr. Black said most very wealthy people had several advisers from various stages in their lives. But the one who is doing the best job — as opposed to the friend from high school — is the one who gets the new money they are making.

Yet even lawyers and accountants who take the typical approach of making introductions to wealth advisers are aware that the complexity of both individual investments and the global economy requires more voices, not fewer.

View the original article here

Wealth Matters: Taking the Time to Pick the Right Financial Adviser

在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。
在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。

In the past, there have been few people to consult about whom to pick. Accountants and lawyers have played this role, warily. But they would typically present two or three advisers and leave the final decision up to the investor.

Now Douglas Black, a 30-year brokerage industry veteran, has started a firm called SpringReef Partners that will screen and select financial advisers for wealthy families. While the amount of wealth needed to receive his advice is high — from $5 million to $50 million — his approach can help those intent on evaluating an adviser to fit their needs. His advice may be aimed at the wealthy, but anyone with money to invest can adopt his practices.

“Firms don’t do a very good job of matching adviser capability with client complexity,” Mr. Black said. “They haven’t taken the focus away from the advisers in determining who is going to end up with whom.”

Mr. Black, who started his career as a financial adviser and stepped down as the chief operating officer of UBS Wealth Management in 2010, is entering this business at an opportune time. Investors are particularly insecure about making the wrong choice.

Charlotte B. Beyer, founder and chief executive of the Institute for Private Investors, said her members were now screening eight to 10 advisers when they used to meet with two or three.

“That’s an enormous difference and an enormous time commitment,” Ms. Beyer said.

While wealthy investors may have made a lot of money and surely understand how complex the world is, they are just as afraid as anyone else of getting this choice wrong. So how do you pick the right adviser without being overwhelmed by the process?

TYPICAL MISTAKES Regardless of wealth, people make the same mistakes in selecting advisers.

Listening to family and friends for suggestions on money management — or, worse, picking family and friends to do it — can be a bad idea. First, there is no correlation between your sense about a person and that person’s ability to do a good job. Remember all the people who felt such affection for Bernard L. Madoff? And second, hiring a friend or relative makes firing that person tough.

Rushing the process is another mistake. Picking a financial adviser can be as serious as selecting a doctor, and it certainly should require more time than picking a paint color. But for many investors, even those who had to make tough decisions in business, it is about as interesting as watching that paint dry.

“People don’t interview enough people on the front end,” said Jim Grubman, owner of FamilyWealth Consulting, which works with advisers. “They’ll take someone else’s recommendations. What works for your friend or your colleague may not be the best fit for you.”

Relying on a name brand firm can be just as bad as going with someone you know. But selecting a boutique firm in the belief that smaller size means more attention for clients can be equally problematic.

“Our belief is there are exceptional advisers spread across all different types of platforms, but there are no great firms,” Mr. Black said.

QUESTIONS TO ASK Picking an adviser is an awful lot like choosing a spouse: you really want the relationship to last forever, to be rewarding and fulfilling, but if it happens to fall apart, you don’t want that to destroy you.

Mr. Black, whose firm is paid either a fixed fee or a percentage of assets for continuing monitoring, said he asked 18 questions of all firms and 17 of advisers. For firms, some of the major questions involve how the organization functions, its experience and risk-management practices and how it handles problems that arise.

For advisers, the criteria are a mix of set standards and questions. He will not work with any adviser who has fewer than seven years’ experience. One thing he found when he worked at UBS was that it generally took at least seven years for any financial malfeasance to surface. He said he also wanted to make sure that the adviser’s firm had broad experience with clients whose wealth levels were similar to his own client’s.

Yet, he said, the value his firm will bring to the selection process may be in the questions that do not have simple yes or no answers. The 17 criteria for advisers are listed on the firm’s Web site.

One simple statistic he looks at is how much additional money an adviser’s existing clients are asking him or her to manage. Mr. Black said most very wealthy people had several advisers from various stages in their lives. But the one who is doing the best job — as opposed to the friend from high school — is the one who gets the new money they are making.

Yet even lawyers and accountants who take the typical approach of making introductions to wealth advisers are aware that the complexity of both individual investments and the global economy requires more voices, not fewer.

View the original article here

Wealth Matters: Taking the Time to Pick the Right Financial Adviser

在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。
在 ServiceModel 客户端配置部分中，找不到引用协定“TranslatorService.LanguageService”的默认终结点元素。这可能是因为未找到应用程序的配置文件，或者是因为客户端元素中找不到与此协定匹配的终结点元素。

In the past, there have been few people to consult about whom to pick. Accountants and lawyers have played this role, warily. But they would typically present two or three advisers and leave the final decision up to the investor.

Now Douglas Black, a 30-year brokerage industry veteran, has started a firm called SpringReef Partners that will screen and select financial advisers for wealthy families. While the amount of wealth needed to receive his advice is high — from $5 million to $50 million — his approach can help those intent on evaluating an adviser to fit their needs. His advice may be aimed at the wealthy, but anyone with money to invest can adopt his practices.

“Firms don’t do a very good job of matching adviser capability with client complexity,” Mr. Black said. “They haven’t taken the focus away from the advisers in determining who is going to end up with whom.”

Mr. Black, who started his career as a financial adviser and stepped down as the chief operating officer of UBS Wealth Management in 2010, is entering this business at an opportune time. Investors are particularly insecure about making the wrong choice.

Charlotte B. Beyer, founder and chief executive of the Institute for Private Investors, said her members were now screening eight to 10 advisers when they used to meet with two or three.

“That’s an enormous difference and an enormous time commitment,” Ms. Beyer said.

While wealthy investors may have made a lot of money and surely understand how complex the world is, they are just as afraid as anyone else of getting this choice wrong. So how do you pick the right adviser without being overwhelmed by the process?

TYPICAL MISTAKES Regardless of wealth, people make the same mistakes in selecting advisers.

Listening to family and friends for suggestions on money management — or, worse, picking family and friends to do it — can be a bad idea. First, there is no correlation between your sense about a person and that person’s ability to do a good job. Remember all the people who felt such affection for Bernard L. Madoff? And second, hiring a friend or relative makes firing that person tough.

Rushing the process is another mistake. Picking a financial adviser can be as serious as selecting a doctor, and it certainly should require more time than picking a paint color. But for many investors, even those who had to make tough decisions in business, it is about as interesting as watching that paint dry.

“People don’t interview enough people on the front end,” said Jim Grubman, owner of FamilyWealth Consulting, which works with advisers. “They’ll take someone else’s recommendations. What works for your friend or your colleague may not be the best fit for you.”

Relying on a name brand firm can be just as bad as going with someone you know. But selecting a boutique firm in the belief that smaller size means more attention for clients can be equally problematic.

“Our belief is there are exceptional advisers spread across all different types of platforms, but there are no great firms,” Mr. Black said.

QUESTIONS TO ASK Picking an adviser is an awful lot like choosing a spouse: you really want the relationship to last forever, to be rewarding and fulfilling, but if it happens to fall apart, you don’t want that to destroy you.

Mr. Black, whose firm is paid either a fixed fee or a percentage of assets for continuing monitoring, said he asked 18 questions of all firms and 17 of advisers. For firms, some of the major questions involve how the organization functions, its experience and risk-management practices and how it handles problems that arise.

For advisers, the criteria are a mix of set standards and questions. He will not work with any adviser who has fewer than seven years’ experience. One thing he found when he worked at UBS was that it generally took at least seven years for any financial malfeasance to surface. He said he also wanted to make sure that the adviser’s firm had broad experience with clients whose wealth levels were similar to his own client’s.

Yet, he said, the value his firm will bring to the selection process may be in the questions that do not have simple yes or no answers. The 17 criteria for advisers are listed on the firm’s Web site.

One simple statistic he looks at is how much additional money an adviser’s existing clients are asking him or her to manage. Mr. Black said most very wealthy people had several advisers from various stages in their lives. But the one who is doing the best job — as opposed to the friend from high school — is the one who gets the new money they are making.

Yet even lawyers and accountants who take the typical approach of making introductions to wealth advisers are aware that the complexity of both individual investments and the global economy requires more voices, not fewer.

View the original article here