Sickcare spending continues to spiral out of control. Patients are becoming impatient voters. Hospitals are folding or consolidating and rural hospitals are disappearing. bringing the number of rural hospital closures up to 98 since 2010. Hundreds more are likely to follow. Currently, 46% of rural hospitals operate at a loss, compared to 44% in 2018 and 40% in 2017. Due to financial strains, nearly 700 rural hospitals are financially vulnerable and at high risk of closure.

Politicians and policy makers see the answer as insuring more patients by spending more taxpayer and employee dollars increasing the present national debt of $23.25 trillion. You cannot possibly get your head around that much money. If you spent one dollar per second, in a day you would spend $86,400. Over the course of a year, your spending would come to more than $31.5 million. At that rate of spending, it would take you over 32,000 years to spend one trillion dollars. (A trillion = 1000 billion.)

Some think that there will be little, if any, substantive change in the US Sickcare system of systems in the near future. But, maybe, instead, we are in the midst of a medapocalypse.

US Sickcare Inc (USI on Nasdaq). a system of systems, including many others around the world, is simply unsustainable. There is an increasing likelihood that we will face the medical meltdown, the Medapocalype, much like the retail apocalypse has devoured retailed businesses and malls. Digital health won’t save us and big box medicine, income inequality and Marie Kondo are three of the culprits impacting USI as well .

Now is the time to prepare for the “de-growth” of USI. Start doing these things today:

1. Prepare for the medical school bubble
2. Become data literate to transform sick care to healthcare
3. Learn how to practice retail medicine
4. Don’t let your babies grow up to be primary care doctors
5. Create and deploy new business models
6. Change the coverage and reimbursement rules
7. Save more, spend less
8. Care about the planet
9. Raise your health and insurance IQ
10. Invest in closing hospitals and make them into condos, senior living facilities, medical department stores or specialized mini-care facilities
11. Create medical devices and drugs that actually work for most patients at less cost and that do not have planned obsolescence built into them. Have the guts to take on the biomedical industrial complex and all the rest who refuse to say no because they feed at a $3.6T trough. That includes doctors who are both part of the problem and the solution.
12. Create substitute technologies, not supplemental technologies, that create a Moore’s law for medical technology, not drive up the cost of care
13. Get rid of single use items and rethink medical packaging and sterilization techniques
14. Don’t allow medical students to take out more loans to get MBAs Will graduate school really teach you how to be a physician entrepreneur or just a way to get your manager ticket punched so you can go to meetings all day long?
15. Separate the sickcare system of systems from the healthcare system system of systems
16. Eliminate the 30% of medical services that are unnecessary

17. Focus on the 5% who account for 50% of spending

18. Get rid of wasteful admininistrivia

19. Replace expensive, ineffective EMR systems.

20. Work with social determinant partners and stop cost shifting the costs to the sickcare system.

Surviving the Medapocalypse will take more than hiding under your desk. Just do these things even if you don’t have $31M dollars to spend each day.

Arlen Meyers, MD, MBA is the President and CEO of the Sociaety of Physician Entrepreneurs on Twitter@SoPEOfficial and Facebook.

A New York Times reader asked:

I’m a 55-year-old male. I recently sold my business, which was very profitable. Financially, I am pretty well set. But while the idea of an early retirement was always appealing, I’m finding that I am bored out of my mind. I miss the activity and satisfaction that came from building and running a company.

I don’t feel I can talk to any of my friends about this, as they are hard at work and can’t really identify with my boredom. I feel I am too old to go back into the work force, which seems so focused on millennials. Moreover, I have enjoyed 25-plus years plus of calling my own shots, so I wonder about reporting to someone else.

Is this just something I need to get over and enjoy the fruits of my labor? Or should I try to re-enter the work force in some limited capacity?

One of the consequences of the emergence of physician entrepreneurs is that some will find themselves in a similar circumstance. Most would find this an enviable place to be. Many of you reading this will relate.

Traditionally, workers have spent most of their adult lives employed, and either building up pensions or, in more recent decades, stashing money away in retirement accounts. Then at some point in their 60s, they leave their jobs and spend the rest of their years retired.

Today’s workers, though, have a different idea of what their retirements will look like. A whopping 92% of workers currently in their 40s say they plan to keep working part-time in retirement, according to a survey by TD Ameritrade and The Harris Poll. Even among those in their 70s, 52% say they plan to continue working an average of 10 hours a week.

Additionally, many workers say they don’t plan to ever fully retire. Among those in their 40s, 61% of respondents said they’d prefer to take year-long “mini-retirement breaks” while they’re younger, and then work until a later age, rather than work continuously for four decades or more and then retire completely.

So, what to do?

1. Monetize your network
2. Get a side gig
3. Be a mentor, coach, sponsor or advisor
4. Start another company
5. Volunteer to solve a wicked problem

1. Take care of the uninsured
2. Start your own non-profit
3. Start an medically unrelated encore career
4. Write
5. Teach biomedical and clinical entrepreneurship
6. All of the above
7. Get a hobby and do it with someone
8. Be a philanthropreneur
9. Be a digital nomad
10. Become a Fulbright Scholar

Here is how to navigate the 4 career crises .

For many at this stage, mission is more important than money, although your innerpreneur knows there is nothing wrong with doing well by doing good. Do it by rewiring, not retiring.

Good luck with your next chapter.

 on Twitter@SOPEOfficial and Facebook

The US Armed Forces has a problem with soldier suicide and depression.

In early 2013, the official website of the United States Department of Defense announced the startling statistic that the number of military suicides in 2012 had far exceeded the total of those killed in battle—an average of nearly one a day. A month later came an even more sobering statistic from the U.S. Department of Veterans Affairs: veteran suicide was running at 22 a day—about 8000 a year.

The situation became so dire that the U.S. Secretary of Defense called suicide in the military an “epidemic.”

Medicine has it’s problems too. It’s estimated that at least 400 U.S. doctors kill themselves every year. Many are struggling with depression, anxiety, or addiction.

Now, add to the list entrepreneurs. Depressed serial entrepreneurs are coming out of the closet and advocating for awareness and change.

Contrary to popular belief, poor self esteem is a component of some entrepreneurs that drives compensatory behaviors that are misinterpreted as egotistical, self-centered or narcissistic. The results are isolation, depression and loneliness or a feeling that they are imposters.

The commonality of these groups seems to be a “warrior mentality” that encourages soldiers, doctors and entrepreneurs to suck up and repress feelings of anxiety, inadequacy or depression, to “fake it till you make it” or to hide things for fear of retribution or adverse consequences. The military,medical and entrepreneurial cultures see those with self doubt as weak or cowardly.

In addition, at least for successful serial entrepreneurs who thrive on success, like to drive fast, take chances , make money and learn something along the way, their innate make up might make them susceptible to breakdowns. Few want to talk about the loneliness of success, but it is pervasive and the head count seems to be rising.

However, there are at least four personality types of entrepreneurs, and we all have a fall back pattern.

On the other hand, hypomanic, ADHD entrepreneurs are also coming out and turning their behavior into the ADHD Advantage. You can also be more creative is you stop paying attention so much. Research is finding that greater distractibility and a reduced ability to focus—what scientists call decreased cognitive control—is often associated with greater creativity in problem solving. But, being married to an ADHD entrepreneur can kill a marriage, so here are some coping tips for you both.

Here is how one CEO with dyslexia and ADHD runs his company. Here’s another.

If you think you have ADHD, here are some tips on how to deal with it.

If you have Asperger’s Syndrome, Peter Thiel wants to hire you. In her book, The Autistic Brain, Temple Grandin explains the positive side of autism and those with austistic spectrum disorders (ASD) or high function autistics (HFAs): 1) attention or an obsession to detail, 2) being able to see the forest from the trees and patterns others don’t see and 3) creativity that disregards and frequently challenges the convention wisdom or status quo.

In her new book, Andy Warhol was a Hoarder: Inside the Minds of History’s Great Personalities, medical and science journalist Claudia Kalb looks at twelve famous figures and weighs the evidence suggesting that each suffered from a different kind of mental health condition. The table of contents could be mistaken for the diagnostic and statistical manual of mental disorders.

One common way of assessing the presence of psychopathic traits in people is to use an assessment known as the Hare Psychopathy Checklist. Here’s a look at some of the traits it lists to see whether they can cause destruction or promotion in a work environment.

Or, maybe you are suffering from Childhood Emotional Neglect (CEN).

Do You…

1. Sometimes feel like you don’t belong when with your family or friends ?

2. Pride yourself on not relying upon others ?

3. Have difficulty asking for help ?

4. Have friends or family who complain that you are aloof or distant ?

5. Feel you have not met your potential in life ?

6. Often just want to be left alone ?

7. Secretly feel that you may be a fraud ?

8. Tend to feel uncomfortable in social situations ?

9. Often feel disappointed with, or angry at, yourself ?

10. Judge yourself more harshly than you judge others ?

11. Compare yourself to others and often find yourself sadly lacking?

12. Find it easier to love animals than people ?

13. Often feel irritable or unhappy for no apparent reason?

14. Have trouble knowing what you’re feeling ?

15. Have trouble identifying your strengths and weaknesses?

16. Sometimes feel like you’re on the outside looking in ?

17. Believe you’re one of those people who could easily live as a hermit ?

18. Have trouble calming yourself ?

19. Feel there’s something holding you back from being present in the moment?

20. At times feel empty inside ?

21. Secretly feel there’s something wrong with you ?

22. Struggle with self-discipline ?

And then there is loneliness and workaholism. A workaholic is a work-obsessed individual who gradually becomes emotionally crippled and addicted to power and control in a compulsive drive to gain approval and public recognition of success. These driven men and women live a Gerbil-wheel, adrenalin-pumping existence rushing from plan A to B, narrowly-fixated on some ambitious goal or accomplishment. Eventually, nothing or no one else really matters.

In addition, there are other other unsung heros. One of the most critical (and most unsung) roles in an entrepreneurial company is not the founder or owner—it’s the role of that person’s significant other or spouse. This has always been true, but the challenges (and importance) of these individuals is even greater and more crucial in the challenging business climate we currently face.

“If an entrepreneurial company fails, it can often take the family’s finances down with it, which can lead to marital troubles or even trigger divorce.”

While not necessarily pathologic, bad habits can torpedo your efforts to build high performance teams or, worse, lead to career suicide. Here are some typical ones.

Everyone pays the price for their choices, whether they accept it or not. But, our infatuation with successful entrepreneurs comes at a price we would rather not see, let alone accept and the results are soldiers fighting the business wars and medical students coming home in body bags.

“The medium is the message” is a phrase coined by the Canadian philosopher Marshall McLuhan and introduced in McLuhan’s book Understanding Media: The Extensions of Man, published in 1964. McLuhan proposes that a medium itself, not the content it carries, should be the focus of study. He said that a medium affects the society in which it plays a role not only by the content delivered over the medium, but also by the characteristics of the medium itself. 45 years later, all of us streaming customers and WhatsApp users are getting the message and lots of them.

Likewise, when it comes to what message you want to send to your customers or stakeholders, getting the message content and how you deliver it is key.

In his book, Traversing the Traction Gap, Bruce Cleveland makes the case for creating a minimal viable category (MVC) as a key initial value inflection point on your way to closing the traction gap and developing brand credibility. That means you need to create a simple to understand value proposition by creating an elevator pitch, preferably about a new product category.

He goes on to state that it should capture the way in which the CEO wants everyone in the company, to explain:

• What the company does
• How the products fit in and stand out
• How your product are different and are a better solution than the competition or status quo
• The approved mission statement
• Competitive positioning

Everyone should stick to the script.

Another way to do marketing messaging is to use the messsage house model or create a messaging matrix. You can either do this yourself or hire someone to do it as you grow. The key, however you do it, is to deliver an easy to understand, consistent message at a 5th or 6th grade reading level that your grandmother can understand. Using short videos on your website helps a lot.

What’s more, at least in sick care and digital health, high trust in your brand has replaced high tech and high touch.

There is a lot entrepreneurs, and physician medical practice entrepreneurs in particular, who don’t sales and marketing. They just don’t get the message.

Arlen Meyers, MD, MBA is the