Calculate Your Financial APGAR Score
BY: Andrew Schwartz, CPA
The term “APGAR Score” will already be familiar to anyone who has experienced the birth of a child — and to those in the medical community. Immediately after being born, every baby is evaluated by a doctor, to determine its medical condition. The evaluation consists of the following five signs: Appearance, Pulse, Grimace, Activity, and Respiration. The APGAR score ranges from zero to ten, and serves as an initial indication of the baby’s health.
Anyone looking to gain control of their financial affairs must first get a sense of where they stand. Below is a variation of the APGAR test designed to help you make an initial self-evaluation of your financial condition. The five attributes of your financial APGAR test are as follows:
1. Automobile Habits
2. Payment of Credit Card and Consumer Debt
3. Got Life and Disability Insurance?
4. Accumulated Wealth
5. Residential Equity
| ATTRIBUTE | POINTS | ||
|---|---|---|---|
| 0 | 1 | 2 | |
| Automobile Habits | |||
| Payment of Credit Card and Consumer Debt | |||
| Got Life and Disability Insurance? | |||
| Accumulated Wealth | |||
| Residential Equity |
AUTOMOBILE HABITS
Besides one’s home, automobiles are generally a person’s largest purchase. The car you drive is also perceived as a status symbol — consequently, even the most frugal person might consider being extravagant when buying a car. How long do you generally hold on to your car(s)?
• Give yourself 2 points if you keep your car(s) for more than five years, are provided with a company car from your employer, or don’t own a car and spend less than $250 per month on rentals and cabs.
• Give yourself 1 point if you generally hold on to your cars for less than five but more than three and a half years; or, if you don’t own a car, you spend more than $250 but less than $400 per month on car rentals and taxis.
• Give yourself 0 points if you generally keep your car(s) for less than three and a half years; or, if you don’t own a car, you spend more than $400 per month on car rentals and taxis.
PAYMENT OF CREDIT CARD AND CONSUMER DEBT
In this step, you will take a look at your credit card habits. Maintaining a balance on credit cards can cause your financial position to erode significantly.
• Give yourself 2 points if you generally pay off your credit cards each month.
• Give yourself 1 point if you owe money on your credit cards, but will have all balances paid off within six months.
• Give yourself 0 points if there is no way that you will be out of credit card debt within six months.
GOT LIFE AND DISABILITY INSURANCE?
Life insurance and disability insurance are keys to a successful financial plan. Generally, a person will obtain life insurance and disability insurance as part of the benefits provided by their employer, or on their own through an insurance salesperson.
• Give yourself 2 points if you have purchased life insurance or disability insurance on your own.
• Give yourself 1 point if you have life and/or disability insurance through your employer’s benefits package.
• Give yourself 0 points if you have no life or disability insurance at all.
ACCUMULATED WEALTH
In this step, you compare your net investments, your age, and your income. You first need to calculate the total fair market value of all of your investment assets, excluding your principal residence and your cars. Make sure to include non-retirement savings, retirement savings, and any other investments you may own. You should then calculate the total of all of your debts, excluding any loans on your principal residence and your cars. Don’t forget to include your student loans and your credit card debts.
You should then subtract your total debts (excluding loans on your principal residence and your cars) from your total assets (excluding your principal residence and your cars) and:
• Give yourself 2 points if your net assets divided by your annual household income exceed the sum of the following formula: [(your age - 30) x 0.2] +1. (If you are married, use the average of your two ages.)
• Give yourself 1 point if your net assets are greater than $0 but not enough to qualify you for 2 points.
• Give yourself 0 points if your net assets are less than $0.
RESIDENTIAL EQUITY
Owning a home is an essential ingredient to most financial plans. Home ownership provides a hedge against inflation and a tax-free means of accumulating wealth. For this step, you will need to know the fair market value of your home and the current balance of any mortgages and equity loans on that property.
If you own a home, you must calculate the value of your home’s equity by subtracting the current balance of your mortgage and equity loans from the current fair market value of the home.
• Give yourself 2 points if the equity of your home divided by the home’s fair market value exceeds the sum of the following formula: [(your age - 30) x .025] + 25%.
• Give yourself 1 point if the home’s value exceeds the current balance of the mortgage and equity loans, but you don’t have enough equity to qualify for 2 points.
• Give yourself 0 points if you do not own a home, or if the amount that is owed on your home exceeds its fair market value.
INTERPRETING YOUR SCORE
Add up your total points.
If your score is 8 or higher, you appear to be on the right track with your finances. Take a look at any attribute that didn’t score a 2, and see if you should make any changes.
If your score is between 5 and 7, you have a pretty big job ahead of you. Invest some time to try and determine which of these financial attributes need work, and put together a plan to make improvements in those areas.
If your score is 4 or less, you have lots of work to do. Take a deep breath and make a commitment to getting your finances on track. Keep in mind that the challenge you face may be daunting; but it is not insurmountable.
Andrew Schwartz, CPA, partners with his brother, Rick, in the Woburn, Massachusetts accounting firm Schwartz & Schwartz, PC, which specializes in services for health-care professionals and their practices. He is also the founder and editor of The MDTAXES Network, www.mdtaxes.com, a site providing tax and basic financial planning information for young health-care professionals.
USMLE Step 2- Clinical Skills
USMLE Step II – Clinical Skills
The USMLE Step II Clinical Skills (CS) exam was originally administered as the Clinical Skills Assessment (CSA) exam, to international medical graduates (IMGs). IMGs had to pass both this and an English proficiency test in the process of applying to residency programs in the U.S. In 2004, the CSA was made a requirement for U.S. medical school seniors as well; so all individuals who are seeking licensure in the U.S. now must pass the Step II CS exam.
The CS exam is administered at five locations in the continental U.S.: Atlanta, Chicago, Houston, Los Angeles, and Philadelphia.
When you register for the CS exam, you will be mailed a scheduling permit. You will have twelve months from the time of registration to schedule a testing date; this is your eligibility period. The specific testing date can be chosen online. You will need to bring the scheduling permit and a form of government-issued ID to the testing site. You may bring a stethoscope, but no other materials are allowed. (The examination rooms will provide all necessary equipment). Before the exam, you will sit through a short, on-site orientation.
The CS exam lasts approximately eight hours, including two breaks (30 minutes and fifteen minutes). The exam consists of twelve standardized patient encounters, each lasting fifteen minutes, followed by a ten-minute documentation session. At some stations, instead of a patient encounter, you will be required to have a telephone encounter (You will talk to a mock patient on the telephone), a caregiver encounter (as there are no young children in the exam), or a model encounter (Some procedures, like the breast exam, may only be performed on a model, not a live patient).
Before entering the room, you will be given a clipboard, paper, and pen. An announcement will be made informing you that it is time to begin the exam, after which you will have a chance to review the chief complaint/reason for visit and demographic and vital-sign information posted on the door. After reading this information, you will enter the room. Inside, you will find a standardized patient. You will have to obtain a history and perform a focused physical exam (you cannot perform rectal, pelvic, breast, or corneal-reflex exams on the live patients). Furthermore, you will need to answer any questions and address any concerns the patient may have. You should comport yourself as if you were seeing a real patient. You will receive a five-minute warning before your time is up. You may finish the encounter in less than the allotted fifteen minutes. If this happens, you may leave the room, but reentry is not permitted.
After each encounter, you will have an additional ten minutes (more if you finish the patient encounter early) to draft a patient note, either on paper or on a computer. The note will include pertinent history, physical-exam findings, initial differential diagnosis, and diagnostic studies you feel are indicated for the patient’s workup.
The Step II CS is pass/fail and scored on the basis of three components:
- Integrated Clinical Encounter: In this section, you will be graded on your patient note, history, and the physical performed during your encounter.
- Communication and Interpersonal Skills: This section is based on your professionalism, style, and the quality of your interactions.
- Spoken English Proficiency: This section rates how well you communicate in English.
You have to pass all three parts in order to pass the USMLE Step II CS exam. The test costs about $1,000. If you must travel to the test site, additional costs will be incurred. Over 95 percent of U.S. students pass the USMLE Step II CS exam, so don’t fret. Just remember to smile, articulate your words, wash your hands, and answer all of the patient’s questions.
