There are some 8.8 million people working in healthcare in the United States, according to data from the U.S. Bureau of Labor Statistics (BLS). The figure includes physicians and surgeons, dentists, anesthesiologists, nurses, physical therapists, radiologists, and dozens more areas of medical specialties.
What’s more, the U.S. Labor Department has noted that five of the 20 fastest-growing industries over the next decade will be in the healthcare and social assistance sectors.
That’s a lot of high-earners and high-net-worth individuals who already need sound financial advice in a sector with robust growth potential. Riding this healthcare wave is Integrated WealthCare, LLC, based in Durham, North Carolina.
“We have a very focused, physician driven client base,” Shayne Ruffing, founder and managing director of Integrated WealthCare told Advisors Magazine in a recent interview. “We intend to work exclusively with physicians; I can count on one hand the number of non-doctors that we have as clients.”
Ruffing, with CLU, ChFC, and AIF® credentials, added that the practice also serves a more narrow and innovative space in certain medical specialties.
“We’re so heavily involved in this one aspect of the professional world that I have long-term clients who have become long-time friends,” he said. “We’re just really attuned to the culture of medicine.”
Ruffing founded Integrated WealthCare in 2006, following a speaking engagement with a national medical association that made him acutely aware of a developing opportunity, for the right business model. Integrated WealthCare was born as a result.
“Our client philosophy is built around physicians — their culture, their priorities, their language, their fears and concerns, their cash flow model, their debt model and more,” said Ruffing. “And we have deep focus in a few particular specialties and sub-specialties.”
Ruffing noted that the practice will identify financial opportunities in the healthcare world that requires collaboration between multiple professionals and then integrate those partners to develop solutions.
“I think where we’ve done a good job overall is in creating business models out of fact patterns,” Ruffing explained. “For example, the lifecycle of medical training produces a fact pattern, with defined opportunities and pitfalls. This enables us to create specific roadmaps that really communicate our understanding of our client base.
That deep dive into the facts and assessing the common denominators of being a doctor allows Integrated WealthCare to better create finely tuned financial solutions.
“We’re able to identify all the components of a plan, put them in a process, and just make it very clean and easy to understand how to move from point A to point B,” Ruffing said. We also have revenue models in multiple areas such as asset management, insurance brokerage, retainer and planning work, other so whatever the client needs, we can work on a solution.
Most recently, Ruffing says Integrated WealthCare has seen a big push by several physician specialties toward independent contractor structures.
“Doctors are very narrowly focused and faced with multiple demands on their time,” he explained. “They are very good at practicing their particular specialty of medicine, but they don’t often have as much time or experience to run a business.”
He added: “So, we’ve created a process that sets up physicians as independent ‘solo-preneurs.’ We essentially create the business framework, the accounting structure, the employee benefits structure working with their CPA firm, and so on. It’s a one-stop shop for independent contractors to go from clinical physician to business owner, more or less overnight.
Of the nearly 9 million healthcare practitioners in the U.S., about 300,000 are located in North Carolina, according to BLS data. But outside of its home base, Integrated WealthCare counts clients in 46 other states. The practice has seven team members in addition to Ruffing and has offers out to two more.
“We have a couple people in our main office,” he said. “The rest of the folks are based up and down the Eastern Seaboard. So, we’re accustomed to working remotely, which was very helpful in 2020 and 2021.”
He added that the pandemic reinforced the need to keep a sharp focus on the firm’s core offering, but also highlighted the importance of being nimble and flexible.
Like most other financial advisory practices, Integrated WealthCare is big on educating clients. But since the firm is collaborating mostly with doctors, it is educating the already highly educated and does so in a unique, finance-related manner.
“Physicians are students of science” Ruffing explained. “They live and breathe in an educational environment every day.”
He said that after serving the medical space for almost 20 years, Integrated WealthCare has learned to communicate with and educate clients in ways they are most familiar.
“We use physician phrases; we use the same language that they use,” Ruffing said. “I have regular speaking engagements at hospitals and clinics and am kind of surrounded by the medical community and medical terminology.”
In a relaxed environment, Integrated WealthCare will guide their clients toward a financial solution. “It’s essentially four steps—we articulate, then educate, then guide them through informed decision-making, and then finally we execute in every facet that we can take on for them.
In terms of planning for future financial well-being, Ruffing’s approach is not to invest someone’s money.
“We focus on lifetime cash flow as opposed to investment performance or other transactional data,” he said. “Performance is certainly an important consideration; but how relative performance impacts individual success is a more valuable metric. For asset planning, we tend to use conservative returns; 6.5% as a pre-retirement return on investment, and a 4% post-retirement ROI”.
We separate lifetime from scheduled inflow and outflow and apply reasonable rates of inflation in various categories so that the actual cashflow needs are met.
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