In our work with more than 1,000 U.S. physicians, we have observed that the Number 1 financial goal for nearly all physicians is to achieve a financially secure retirement on their terms, including each doctor’s unique timeline and lifestyle goals. It is not surprising that data from national physician surveys confirm this as the top financial objective.

What is surprising is how many physicians attempt to reach this goal using just one of the tools at their disposal – a qualified retirement plan (QRP) – while completely unaware of another tool they could be using– a non-qualified plan (Non-Q Plan).  

Qualified Plan Basics

The designation QRP means that the plan meets the definition of a retirement plan under U.S. Department of Labor and Internal Revenue Service rules created under the Employee Retirement and Income Security Act (ERISA).  A QRP may be in the form of a defined benefit plan, profit sharing plan, money purchase plan, 401(k), or 403(b). Properly structured plans offer a variety of benefits:  You can fully deduct contributions to a traditional QRP, funds within the QRP grow tax-deferred, and (if non-owner employees participate) the QRP funds enjoy superior asset protection. Despite these benefits, QRPs have a host of disadvantages that physicians should understand:

• Mandated maximum annual contributions for defined contribution plans 
• Mandatory participation by employees
• Potential liability for management of employee funds in the plan
• Controlled group and affiliated service group restrictions
• Penalties for withdrawal prior to age 59½
• Required distributions beginning at age 70½
• Full ordinary income taxation of distributions
• Full ordinary income taxation and estate taxation of plan balances upon death (combined tax rates on these balances can be over 70%)

Despite these numerous disadvantages, nearly all U.S. physicians participate in traditional QRPs, largely because of the tax deduction benefits. For many physicians, however, the cost of contributions for employees, potential liability for mismanagement of employee funds, and the ultimate tax costs on distributions may outweigh the current tax savings offered by QRPs. If not giving pause, these drawbacks at least suggest that it would make sense to investigate another type of plan that hedges the QRP as an additional savings vehicle.

This is especially true if you believe that income tax rates, especially the higher marginal rates, will go up over the coming decades.  When you use a traditional QRP, you trade today’s tax rates on your contribution for the tax rates in the future when you withdraw the money from the plan.  If rates rise in the future, the QRP might prove not to be a good deal at all.  Thus, the QRP tax rate bet is one that should be hedged against by using retirement savings alternatives.  

One alternative to consider is a Roth QRP. Many medical practices sponsor 401(k) plans which give participants the option of making salary deferrals into either a traditional 401(k) or a Roth 401(k). Although traditional contributions are a tax deduction today and will be taxed upon distribution at the tax rates in effect at that time, their Roth counterparts are after-tax contributions today. Thus, the participant pays tax at today’s rates, but the funds grow on a tax deferred basis and are tax free upon withdrawal assuming they stay in the Roth account for at least five years. Only the salary deferral portion of a contribution can go into a Roth plan. Any profit sharing or match must go into a traditional account.

SEP-IRAs

Simplified Employee Pension Individual Retirement Accounts (SEP-IRAs) are not officially QRPs. They are custodial accounts that are similar in many ways.  Both SEP-IRAs and QRPs have the same tax restrictions on annual contribution amounts, penalties for early withdrawals, mandatory withdrawal rules, and taxation on distributions and plan balances at death.  One big difference is that a SEP-IRA may not have the same level of asset protection under state law that a QRP enjoys.

Many physicians who use traditional QRPs, Roth QRPs or SEP-IRAs as a substantial part of their retirement planning should understand that such plans alone may not be enough to achieve their retirement goals. Whether because of annual contribution limits or the taxation of distributions as ordinary income, most doctors need another retirement savings vehicle.  This is where Non-Q Plans could play a significant role.

Non-Qualified Plan Basics

Non-Q Plans can be valuable retirement tools for many doctors.  Because these plans are not subject to QRP rules, Non-Q Plans do not have to be offered to any employees.  Further, even among the physician-owners, there is total flexibility. For example, one doctor can contribute a maximum amount, the next partner could contribute much less, and a third physician could opt out completely.

The main drawback to Non-Q Plans is that contributions are never tax deductible. However, they can be structured for tax-free growth and tax-free access in retirement, like a Roth IRA.  How much would you put in a Roth IRA if there were not funding limitations? If you think you would fund such a vehicle, then a Non-Q Plan could be very attractive to you.

In fact, a Non-Q Plan can be an ideal long-term tax hedge against a QRP.  Beyond these general ground rules, there is tremendous flexibility and variation with Non-Q Plan designs, with the following common attributes:

• No limitations on contributions as with QRPs
• Can be implemented in addition to any QRP, such as a 401(k) or profit-sharing plan
• Owners/partners can vary in how much or whether they participate
• Employee participation is not required
• No tax deduction on contributions, but funds can grow tax-free and be accessed tax-free upon withdrawal
• Top asset protection in many states

Conclusion

As noted at the outset, the Number 1 financial goal of nearly every physician is retirement on his or her own terms, and both QRPs and Non-Q Plans can play important roles in achieving this goal.  If building your retirement wealth is an important goal for you, we recommend you work with an experienced advisor to investigate both types of plans for your practice.  

About the Author

David B. Mandell, JD, MBA

David B. Mandell, JD, MBA, is an attorney and author of more than a dozen books for physicians, including For Doctors Only. He is a partner in the wealth management firm OJM Group (www.ojmgroup.com), where Carole C. Foos, CPA  is also a partner and lead tax consultant. They can be reached at 877-656-4362 or mandell@ojmgroup.com

Disclosure:
OJM Group, LLC. (“OJM”) is an SEC registered investment adviser with its principal place of business in the State of Ohio. SEC registration does not constitute an endorsement of OJM by the SEC nor does it indicate that OJM has attained a particular level of skill or ability.  OJM and its representatives are in compliance with the current notice filing and registration requirements imposed upon registered investment advisers by those states in which OJM maintains clients.  OJM may only transact business in those states in which it is registered or qualifies for an exemption or exclusion from registration requirements.  For information pertaining to the registration status of OJM, please contact OJM or refer to the Investment Adviser Public Disclosure web site www.adviserinfo.sec.gov.

For additional information about OJM, including fees and services, send for our disclosure brochure as set forth on Form ADV using the contact information herein. Please read the disclosure statement carefully before you invest or send money.

This article contains general information that is not suitable for everyone. The information contained herein should not be construed as personalized legal or tax advice. There is no guarantee that the views and opinions expressed in this article will be appropriate for your particular circumstances. Tax law changes frequently, accordingly information presented herein is subject to change without notice. You should seek professional tax and legal advice before implementing any strategy discussed herein.

While aging is an unavoidable biological process with many influencing factors that results in visible changes to the hair, there is limited literature examining the characteristics of hair aging across the races. Now a new study describes the unique characteristics of hair aging among different ethnicities that the authors hope will aid in a culturally sensitive approach when making recommendations to prevent hair damage during one's life-time.

Among the findings: hair-graying onset varies with race, with the average age for Caucasians being mid-30s, that for Asians being late 30s, and that for Africans being mid-40s. Caucasians and Asians typically experience damage to the distal hair shaft, while African-Americans see damage occurring closer to the hair root. Postmenopausal changes include decreased anagen (active or growing) hairs in the frontal scalp, lower growth rates and smaller hair diameters.

Similar to skin, hair aging comprises both intrinsic aging, which includes the natural physiological changes that occur with time, and extrinsic aging, or changes associated with environmental exposures and physical stress caused by daily grooming.

"Despite a similar chemical composition, the structural properties of hair vary between different ethnicities and, consequently, the aging of hair differs as well. As the population ages and becomes more diverse, it is of greater necessity to understand the hair aging process in different types of hair," says corresponding author Neelam Vashi, MD, associate professor of dermatology at Boston University School of Medicine and director of the Boston University Cosmetic and Laser Center at Boston Medical Center.

Read more here.

Source:

EurekAlert!

Inflammatory reactions to dermal fillers have been linked to the COVID-19 vaccines. While this news is alarming, doctors have come to the consensus that this incidence is extremely rare. (According to Wayne, NJ facial plastic surgeon Jeffrey B. Wise, MD, the probability of this type of facial swelling occurring is two two hundredths of one percent of the patients who have had the vaccine.) Further, experts assert that the risk of being infected with COVID-19 outweighs the risk from a reaction to one of the vaccines if the patient has a history of using dermal fillers. While nerve-calming information has risen to the surface, so has a new question: Can this type of inflammatory reaction happen with breast implants, too?

When speaking to La Jolla, CA plastic surgeon Robert Singer, MD and Eugene, OR plastic surgeon Mark Jewell, MD, it became clear that this has become a common question among their patients. “I’ve had a couple patients with breast implants who have called wondering if there is any problem with getting the vaccination while having implants,” says Dr. Singer. “At this point, there are no reported incidences of any kind. In fact, there are numerous plastic surgeons across the country who have implants and have received their COVID vaccinations. They have had no problem in regard to the implants.”

“Historically, patients have had vaccines for flus, shingles, pneumonia, and more, and there has been no recorded responses in people who have implants,” adds Dr. Singer. “If there is any data that comes out, we will let the public know. However, at this point, there is absolutely nothing to be afraid of if you have implants or are considering them and are planning to get the vaccine. I would encourage everybody to get their COVID vaccination.”

Read more here.

Source:

NewBeauty

A plastic surgeon in Beverly Hills has died from COVID-19 ... and it appears to be entirely because he was able to keep working on patients during a pandemic.

Dr. Payman Simoni -- who's been featured on "The Doctors" show -- passed away while hospitalized in L.A. -- this after he contracted the virus while performing a cosmetic procedure on a patient who turned out to be COVID positive ... so say family sources.

We're told Dr. Simoni was doing a lip injection on a woman last month ... obviously an elective procedure. She was temperature checked and filled out a COVID questionnaire. She was not tested.

While the doc was hovering over the maskless woman, our sources say she coughed in his face. He had his mask on, but still ... she sprayed on him. She contacted the office a few days later to inform them she had tested positive for COVID.

Dr. Simoni then went into quarantine and began experiencing symptoms -- shortness of breath, etc -- and in short order, he was on a ventilator at Cedars-Sinai Medical Center. We're told Dr. Simoni was eventually placed in a medically induced coma as his lungs started failing. He died Friday from a brain hemorrhage.

Read more here.

Source:

TMZ

What should we do about the financial burden of health care? This question has vexed our political class for decades. Not even the passage of Obamacare in 2010 has managed to settle the issue. Now President-elect Biden will get a turn to address our nation’s most intractable long-run challenge. To succeed where others have failed, Biden should focus on a solution that improves health outcomes while reducing the cost of care—treating biological aging.

The fundamental problem with health care in the U.S. is that it is expensive. In 2018, the latest year for which data is available, national health expenditures stood at 17.7% of GDP—$3.6 trillion. Politicians vigorously debate whether and to what extent consumers, employers, or the government should pay for care, but victory by any side only papers over rising costs. The reality is that we all pay $3.6 trillion a year one way or another—through higher taxes if the government pays, through lower wages if employers pay, or directly with our own money in out-of-pocket scenarios. To solve the problem, we need to slash the $3.6 trillion cost of care.

Not all methods of reducing costs are equal. The few times politicians have tried to control health costs, they have done it through rationing. This is inevitably unpopular and politically unsustainable. Obamacare’s Independent Payment Advisory Board—remember “death panels”?—was repealed in 2018. Unlike rationing, which generates lower costs through a reduced supply of care that almost invariably leads to worse health outcomes, we need solutions that keep people out of hospitals and doctors’ offices in the first place, by making them so healthy that they don’t need as much care.

The most exciting opportunity for such an improvement in health productivity is to understand and address the biology of aging. Our population is getting older—by the mid-2030s, there will be more Americans over 65 than Americans under 18. Age is the biggest risk factor for cancer, cardiovascular disease, and neurodegeneration. Without treatments to slow or reverse aspects of biological aging, an aging population means we are in for a health care cost tsunami. With such treatments, Americans would experience more healthy, productive years of life. Chronic diseases would be delayed, a phenomenon public health experts call “compressed morbidity.” This translates into lower medical bills.

Read more here.

Source:

Fortune.com

Ajinomoto Bio-Pharma Services ("Aji Bio-Pharma"), a leading provider of biopharmaceutical contract development and manufacturing services, and Revance Therapeutics, Inc. (Nasdaq: RVNC), a biotechnology company focused on innovative aesthetic and therapeutic offerings, are pleased to announce a strategic commercial manufacturing agreement for the supply of DaxibotulinumtoxinA for Injection.

DaxibotulinumtoxinA for Injection is currently under Biologics License Application (BLA) review. Aji Bio-Pharma will serve as a dual supply source and provide drug product manufacturing services for Revance at the company's aseptic manufacturing facility in San Diego, California.

"We are excited to partner with Revance and their efforts to establish a new standard in aesthetic and therapeutic neuromodulator offerings," said Jean-Baptiste Agnus, VP of Sales at Ajinomoto Bio-Pharma Services. "This partnership underscores our commitment to be a leading, trusted, innovative partner to our clients and reinforces our company mission to improve the health of humankind."

"We are delighted to be partnering with Aji Bio-Pharma for the production of our innovative product and bolstering our supply chain resiliency," said Brian Blagg, Vice President, Engineering & Supply Chain at Revance. "Aji Bio-Pharma's manufacturing infrastructure, long-standing experience and customer-centric service, were important to this collaboration." 

Read more here.

Source:

Revance Therapeutics, Inc.

Revance Therapeutics, Inc. (Nasdaq: RVNC), a biotechnology company focused on innovative aesthetic and therapeutic offerings, today announced positive topline efficacy and safety results from its Phase 2 multicenter, open-label study of investigational drug candidate DaxibotulinumtoxinA for Injection for the combined treatment of upper facial lines, which are comprised of glabellar (frown) lines (GL), dynamic forehead lines (FHL) and lateral canthal lines (LCL), commonly known as crow’s feet lines.

In the Phase 2 study, 48 subjects were enrolled to receive a single treatment of DaxibotulinumtoxinA for Injection with a total study duration of 36 weeks. Subjects received 40, 32, and 48 units of DaxibotulinumtoxinA for Injection respectively in the glabellar complex, forehead and lateral canthal areas.

Treatment Effect

The key endpoints for efficacy were the proportion of subjects achieving a score of none or mild wrinkle severity at maximum contraction (maximum frown, eyebrow elevation, and smile effort) at Week 4, as assessed on the Investigator Global Assessment Frown Wrinkle Severity (IGA-FWS), Investigator Global Assessment Forehead Wrinkle Severity (IGA-FHWS), and Investigator Global Assessment Lateral Canthal Wrinkle Severity (IGA-LCWS), respectively.

Read more here.

Source:

Revance Therapeutics, Inc.

According to recent news, the FDA has approved the Moderna COVID-19 vaccine. With Pfizer’s drug already in world-wide circulation and anticipation for Moderna to enter the rounds this week, there have been some whispers about whether or not the vaccines will have side effects similar to the anaphylaxis allergy situations that have occurred in some Pfizer vaccine patients last week.

According to Statnews, “Rachel Zhang, an FDA medical officer who is presenting the agency’s analysis of the Moderna data, reported that two people developed facial swelling after vaccination; both had a prior history of getting cosmetic injections of dermal fillers in their cheeks.” It was also reported that a third person had a possbile post-vaccine reaction to dermal fillers in her lip area.

“One person had undergone the procedure two weeks before being vaccinated; the second had most recently had dermal fillers injected about six months before being vaccinated…A third person in the vaccine arm of the Moderna trial developed lip swelling about two days after vaccination. This person had received prior dermal filler injections in the lip,” said Zhang.

Healthcare and vaccine writer for Politico, Sarah Owermohle posted a tweet that shows the written data with caption, “This vaccine news may hit Instagram models hard: Two cases of facial swelling in Moderna vaccine volunteers who had dermal fillers injected recently.” But, this common aesthetic procedure is not just restricted to models.

Read more here.

Source:

New Beauty