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This wasn’t something I saw, but something I heard over the telephone about 15 years ago.I had signed up with a service that provided one-on-one coaching. This was to help with personal growth, investing and financial management. It came in the form of a weekly phone conversation with a coach, each call lasting about one hour. The coaching was programmed to last for 12 weeks. (BTW, the company had no financial instruments to sell. They weren’t brokers or salespeople.)My coach was very personable and knowledgeable, and we hit it off right away.Things went smoothly until about the 6th or 7th weekly call, during which he didn’t sound quite like himself. I remember thinking that he sounded really tired, then I began concentrating less on what he was saying and more on how he sounded.He was coughing occasionally, talking like he was out of breath, and then I heard distinct wheezing that wasn’t audible at the beginning of our conversation. I abruptly interrupted him mid sentence and asked how he was feeling. He replied that he “felt tired today” but he was willing to finish our session. I began asking rapid fire questions concerning symptoms and risk factors for coronary artery disease. Being a guy who talked to others for a living, he tended to give long answers to any questions, but I rudely interrupted him several times when the answer to each of my questions came out. No, he had no history of asthma. Yes, he smoked. Yes, he was diabetic. Yes, his father and two uncles had died of heart disease. No, he wasn’t having any pain or nausea, but his left arm felt “a little numb”.When I had enough information, I told him in my best authoritarian voice, “Hang up now and call 911! Tell the 911 operator that you think you are having a heart attack! You need to be in the hospital! DO IT NOW!!” To his credit, he didn’t try to argue or ask why I said what I did. He knew that I was a physician, and took me at my word.For those reading this who might not be medically trained, the wheezing I heard was from “cardiac asthma”. It is not mediated by allergies or exercise like “true” asthma, but is a sign of left ventricular failure. The failure can be the result of blockage of the left anterior descending coronary artery which is normally the major pipeline for blood to the left heart muscle. In other words, he was having a myocardial infarction. When the muscle of the left heart can’t pump effectively, it fails and blood “backs up” in the lung circulation, causing wheezing.After he hung up, I wondered if I would ever hear from him again.A day later I got an email from someone with the company saying that my coach was hospitalized, and therefore wouldn’t be available to continue our sessions for some time. I was given the option of having my unused balance refunded to me. I responded, asking if he planned on returning to work eventually, and the reply was “We don’t know.”. I opted to do nothing but wait and see. A few days after the email, I received a phone call from the same person. She basically told me the same thing that was in the email, except she said that my coach had had “major heart surgery and things are serious”. I again said I would wait and see.Several weeks after the “call 911” conversation, my coach called me and wanted to tell me all about himself. He had called 911, and was transported to the local hospital in his area, and then taken by helicopter to a larger metropolitan hospital. (He was somewhere in Ohio, if I remember right.) He said things moved FAST. AMBULANCE, ER, HELICOPTER, ER, CARDIAC CATH, OR, ICU ALL IN ONE EVENING! He had received triple coronary bypass and aortic valve replacement. Several days in intensive care, more days in a hospital room, several weeks in cardiac rehab unit, and finally home! He was very proud that he had stopped smoking, (like he would be able to smoke during his hospitalization!!!!). I congratulated him on his will power.He said he had thought about me a lot during his hospitalization, and had just gotten in a position to call me. He was very grateful that I had told him to get to the hospital. He repeated several times “I could have died! They told me I might have died if I’d waited any longer!” I replied that I was glad to have done my part, and that it was lucky that we were on the phone at the exact time that he was exhibiting signs of his MI.I never finished the coaching. I got an email from the same woman as before, telling me that my coach had taken retirement and disability, and therefore wouldn’t be returning to work. They refunded me my entire fee, also, not just the unused portion, which I thought was nice.The last communication I received was another email, telling me that the company would no longer offer coaching. I suspected that my coach might have been the major income producer for the company.Alternately they may have been the entire company, one guy and one gal, possibly husband and wife. I never found out.ADDENDUM:Thank you to everyone who commented and had nice things to say about what I did. I really don’t feel like I “diagnosed him over the phone”. I had a sense that something was wrong with him. Recall that I had already spent several hours on the phone with him before that day, and I knew what he usually sounded like. The change in his voice was noticeable.I don’t really feel like I “saved his life”. I just helped to get the process rolling. Many more people were much more hands on with this man’s treatment than I was. They were EMT’s, nurses, pilots, technicians, cardiologists and surgeons. They actually saved his life.After rereading what I wrote initially, I might have made it appear that I was 100% sure about the diagnosis. I really wasn’t. I had a feeling, maybe like a strong hunch. When I heard how the man sounded, I had a flashback to a patient I had seen In the ER when I was a senior in med school. That patient sounded just like my coach did over the phone and was also having an MI. The cardiologist that I was following around that day even asked me “Do you know why he is wheezing?”. When I didn’t know, I got sent to the library. My instructions from the cardiologist were to “learn everything you need to know about this patient’s condition, and on tomorrow's rounds, tell us everything there is to know about it.”I didn’t know what the diagnosis was, but took the available hints. The patient was wheezing, was being evaluated by a cardiologist, and was being prepped to go to the cardiac cath lab. Wow, must be something about his heart, huh?Having been dismissed, I went to the library and grabbed the thickest cardiology textbook on the shelf. I turned to the index under “W” and looked for something like “Wheezing, causes of”. There, slightly farther down the list that started with Asthma, was Cardiac asthma. I used the copying machine in the library to copy the page from the book that dealt with the subject matter, took it home and read through it about 4 times. The next morning, I had it folded up and in the pocket of my white jacket.When my student group made rounds that morning, the patient that I had seen the day before had been moved to the ICU following coronary artery bypass surgery. After the usual report was given by the student and resident who were “following” the patient, the cardiologist looked at me and said “Now Doctor Pennington will tell us everything we need to know about how this patient presented yesterday.” So, I spoke for about 3 minutes about the patient’s presenting signs and symptoms, along with what I had found out about cardiac asthma.As I said before, I wasn’t entirely sure that my coach was having an MI, as he wasn’t describing the classical symptoms of chest pain, nausea, or sweating. As it turned out, his MI was atypical in this regard. (Diagnosing anything over the phone is difficult at best and dangerous at worst.) It was just that, in my recollection from years before, I could “see” that patient’s face and “hear” how he sounded. Even if my coach wasn’t having an MI, he sounded like he was ill. A trip to the ER to rule out an MI and diagnose something like bronchitis, pneumonia or other non-cardiac problem was justifiable, especially given his other health problems.So, in reality, my coach’s sudden entry into cardiovascular medicine/surgery began in the 1980’s when I saw that patient with that cardiologist who gave me that assignment to talk about that subject. I hadn’t thought about any of this in years, until it came flooding back to me during that phone conversation. I guess if I hadn’t had that exact experience, I may not have told my coach what I did.Incidentally, after I heard my coach tell me that he received surgery and had made it home, I had another flashback to when I was a student. This time I remembered the face of the cardiologist as he was looking at me after I had made my little presentation. I recalled that he smiled at me and said “Thank you, Dr. Pennington. Now you know everything you need to know about cardiac asthma.”Really.

I recently retired and I thought carefully about income needs. I think the 4% number is based on out of date assumptions; it was suggested back in the 1990s, and the world has changed since then.A common model for retirement planning used to be:1. Have $1,000,000 in savings, probably in fairly conservative investments – but they need to earn something like 6% a year. The problem: there are few safe investments left that provide that kind of return.2. Assume you will live only 20 to 25 years post-retirement. (Some people now live longer, particularly women).3. If you withdraw 4% per year, and if your rate of return exceeds 4%, in theory, your money could last forever, and you would have $40,000 per year (before income tax) income. Most Americans have some Social Security income in addition to that, on average, something like $16,000 per year. $40,000 + $16,000 = $56,000 per year income. Sounds great, right? It might be, but only in the short run. (Don’t forget you will pay income taxes and Medicare premiums out of that income.)Of course, most people don’t have anything like $1,000,000 in savings or investments; they might use 4% of whatever they do have saved as an estimate of income beyond social security. If a person has $200,000 saved, 4% per year would be $8000 per year income beyond social security; again, take income taxes and Medicare premiums and premiums for Medicare supplement and part D Medicare prescription drug plan (at least) into account when figuring out how much income you actually have left to live on.Here are some of the problems with the $1,000,000/ 4% model.Even with a modest rate of inflation (currently less than 3% per year), the buying power of your income may be cut by about half at the end of 20 years. If you withdraw $40,000 every year, then 20 or 25 years post retirement, it may have the buying power of $20,000. (If the rate of inflation goes higher, and it could, reduction in buying power would get even worse.)CDs and similar ‘safe’ investments currently pay extremely low rates of return; 3% would be exceptionally high; and that interest would be taxable as income, so it might really yield only 2% “actual” return after tax.Financial advisors usually build into their plans a gradual increase in withdrawal percentage across years to compensate for effects of inflation, e.g., take out 4%, then 4.2%, then 4.4%, etc. to give yourself ‘raises’ to compensate for inflation. However, even if your actual annual rate of return on investments is 6%, you’ll run out of money at some point doing this (even though it might not seem like it). You can figure this out in an excel spreadsheet or have a financial advisor do the math.If your income comes from an IRA, payments are taxed as income. Some part of social security is sometimes taxed. You need to pay Medicare premiums - sliding scale, can be on the order of $200/month.If your investments are not in an IRA, you will have to pay tax on dividends or interest income.If your investments have a nominal return rate of 7%, and they are taxable and/or subject to financial advisor or broker fees, your actual rate of return on investments may be closer to 4%. I’m a fan of index funds which do not charge fees and are fairly conservative, Vanguard, for example.. Some will dispute this, but I am persuaded that “managed” funds with fees do not perform better than index funds with little or no fees.If you own your home, its value may or may not appreciate substantially, and you will have maintenance and repair costs. If you rent, apartment prices keep increasing. There is some low income retirement housing, however, you have to have quite a low income to qualify, and there are usually multiple year waiting lists.Costs will arise that blow your budget plans. You may need to replace your car or do home repairs; and pay for dental or vision care (not covered by Medicare). If you need long term nursing home care, note that Medicare pays for only 30 days after a 3-day hospital admission; after that, you pay out of pocket until you are broke enough for Medicaid.My conclusion was that even if a person has $1,000,000, using the 4% rule, the money would probably run out in about 20 years (or less). And people are living longer on average.If you play the stock market to increase rate of return, and a market crash occurs like the one in 2008, the dollar total of your savings could go down a lot, and 4% of half as much money would be much less income than you planned. Most advisors suggest that as people approach retirement they will want to reduce their risk exposure.If you exhaust your resources, you may qualify for other assistance such as Medicaid. Application procedures can be complicated and the rules are different in every state.Retirement was easier for people when interest rates on safe investments were much higher, and when house values appreciated substantially over time.So what can people planning retirement do?Delay retirement as long as possible. Make sure you have at least 35 earning years – the monthly amount of your Social Security benefit is a sort of complicated average based on your top highest 35 earning years (and you don’t want 0’s included in that). If possible, don’t start to collect social security until you are 70; monthly payments are below “full” social security benefit if you start collecting at 62, and are increased above “full” social security benefit if you can wait until 70.Consider part time work to supplement your income, particularly early in retirement.Become very frugal. Shop at Goodwill, Salvation Army, Dollar Store and similar.With very low income, you might qualify for benefits such as food stamps.Consider moving to a location with a lower cost of living (although the benefit of living close to friends and family should not be underestimated!)Keep your percentage rate of withdrawal from savings, investments, or IRA as low as possible. For most people, I believe 4% withdrawal per year will be too high.Weigh the risks: a higher rate of return on investments requires you to accept greater risk. Be careful not to fall for scams… con artists often prey on elders.If you can find a source of ‘passive’ income such as renting an apartment attached to your house, or getting guests through AirBNB, it’s worth considering; but realize that there can be a lot of physical work involved (for example, cleaning between guests). This may not be something you can manage for many years after retirement.Make friends and cultivate good relationships with family! Older people need social support even if they have a lot of money. If you can live with family, that may cut living costs, but not all families can do that.Having said all that: I do understand that most people don’t have $1,000,000 saved; most do not collect the maximum social security benefit; many people ‘retire’ because they are downsized or because of health problems, and so forth. With these additional problems, the problems with 4% withdrawal per year as a plan look even worse.Here are a few articles that discuss why the 4% rule is not a good idea.https://money.usnews.com/investing/investing-101/articles/2018-06-06/why-the-4-percent-withdrawal-rate-is-obsoletehttps://www.fool.com/retirement/2018/01/16/3-serious-problems-with-the-4-retirement-rule.aspxhttps://www.cnbc.com/2014/11/03/the-4-retirement-rule-is-broken-and-heres-why.htmlSorry, I know this is all very depressing. Somehow, even people who live on a below average social security income and nothing else seem to manage… sometimes. But they often face painful choices between buying food, medicine, and paying rent and utilities.The point of all this is: Think carefully about potential income before you retire. Realize that the income you estimate from simple formulas like “4%” will probably be reduced by income taxes, and that inflation gradually eats away at the buying power of a fixed income.

There are 31 answers already and I have not read them all. I do feel that my perspective my be helpful though so here are a few thoughts and opinions:You deserve the BEST retirement that your efforts and sacrifices can buy. You are the one working to earn the money, and you are the one making the sacrifice of saving some of it, so you don’t deserve to get anything less than the best.Before addressing how to get the best retirement plan/adviser let’s define best based on the Five Lives of Retirement. If you have a:Long Life-Best would be the highest monthly income that lasts the longest (running out of income represents a failed financial plan)Short Life-Best would be the highest continuing income for your spouse or partner if you pass away before life expectancy.Rough Life-Best would be that your emergency fund IN-Case money is earning a nice, high rate of return and not just sitting in a bank account.Sick Life-Best would be the plan that creates the highest amount of Long Term Care and Medical expenses PAID BY SOMEONE ELSE rather than you paying out of pocket.The Next Life-Best would be the plan that leaves the AMOUNT of inheritance that you want to leave to loved ones and charities in the WAY that you want it to be left to them.In other words the BEST retirement plan would have the highest lifetime income while you are alive, leave the highest income to your loved ones if you suddenly pass away, have an emergency fund making the highest interest, have a ton of money provided by outside companies to pay for medical expenses and nursing homes AND leave the largest amount possible to loved ones…..in a way that does not make them lazy, trust fund babies.In an effort to help you find the adviser that can offer the BEST retirement plan possible let’s start eliminating some huge groups of people who are either NOT ALLOWED to do what’s BEST for you or or are INCAPABLE of doing what’s best for you.Group Number One (to eliminate): Stock Brokers and Mutual Fund Salesman. If I were to ask you to name some large financial planning firms you would no double spout off the big names we have all heard of. There are three really big ones…one of which has over one TRILLION dollars of client money. If you knew how to ask the right questions, and read their Revenue Sharing Agreements (which they hide on their websites so that they are hard to find and are written to be hard to understand) you would understand that they are not allowed to do what’s best for you. Any “adviser” you choose from these brand name companies ultimately has to sell you what his boss and his company wants him to sell you. They are literally not allowed to offer you what is best for you and must sell you mutual funds, variable annuities etc. They are not allowed to choose the best from these categories either as they have to choose the ones that the company wants them to push so that they get their revenue sharing (kickbacks) from the mutual fund companies. Long story short the job of these brand name “advisers” is to push and sell the mutual funds that their companies sell just as someone working for Pizza Hut is expected to sell you pizza and bread sticks. If anyone reading this works for one of these firms I’d like to offer to debate you publicly….very publicly… and have you bring the last five financial plans you created. Give me 2–5 minutes with each plan and I will not only prove that it is not a financial plan but that you hurt people for profit. Try me, it will be fun.Group Number Two (to eliminate): Money Managers. Though independently licensed money managers (Registered Investment Advisers for example) may be allowed to do the right thing (if they have a fiduciary requirement and an insurance license) they don’t do what’s best for clients. Whether by ignorance or immorality money managers in this country put their clients in portfolios that under perform ALL of the other options. I’ve reviewed over 1,000 financial plans and can tell you that almost every person who comes into my life has money in stock, bonds and mutual funds (through some group they are paying for this “investment advice”) and has not been shown the alternatives. Here’s the reason you cannot work with a money manager and get the best retirement plan:They make less money than if you didn’t use them. If you must have “risk with a side of fees” in your life (the stock market) then just buy the S&P 500 Index on your own. Do a simple search online for “do money managers beat the market” or listen to this podcast episode: RR-Episode 092-Four Google Searches You Must Do and you will quickly see that those fees you pay are just going to waste. It is VERY RARE to find a manager who beats the market long term and if you do find them most people will not have enough money to meet their minimum requirement.They make less than investments with no risk of losing money and no fees at all (Growth Annuities). See this picture for a very simple example of owning the S&P 500 vs. a 50% Participation (in the S&P 500) Annuity. The annuity would have given you 38% more growth BEFORE the stock market adjustment/crash that we are all waiting for. Instagram post by Charlie Jewett • Sep 8, 2017 at 11:55pm UTC This type of tool is most appropriate for IRA/TSP/401k type money that has not been taxed yet. If you have after tax money the next tool will do even better in my opinion.They make less than strategies with no risk of losses, low fees and no taxes due on the earnings (Cash Value Life Insurance Built for Maximum Cash Accumulation). Since the 80s we’ve known (Thanks to EF Hutton) that money inside of life insurance policies grows tax-free like a Roth IRA. There are no limits on contributions like in a Roth and many other benefits. Some of the best contracts today have averaged over 8% in every 20 year period (252 periods). Lowering the expenses is an art and science and anyone you see bashing life insurance online is simply screaming “I suck at my job and don’t have the skills to know how to do what’s best for my clients!”. The fact of the matter is that making 5–7% (net of all fees) tax-free will beat basically every money manager in the country that’s available to the every day retiree. If you’re not familiar with this strategy you can learn more by listening to this free podcast episode: RR-Episode 027-The Rich Man's Roth IRA-With No Contribution LimitsGroup Number Three (To Eliminate): Captive Insurance Agents. Some insurance agents are brokers and can offer any product available from any insurance company. Other insurance agents (called Captive Agents) work for one insurance company peddling their wares. If you choose an “adviser” who’s really a captive agent you will have the same issue as choosing a mutual fund salesman….they are not allowed to do what’s best for you and will always put you into what they sell. In my estimation this will cost you 20–30% of your retirement income and eliminate a lot of long term care benefits you could have at no extra expense…it’s a big deal.I speak to groups of hundreds of advisers at a time and have met thousands. I’m part of the largest, most successful, insurance marketing organization in the country and I can tell you there is only two or three advisers I would trust with my family’s money if I passed away.Whatever you decide (who you interview etc.) I’ll make this offer to you: bring me any financial plan, from any adviser in the country and I’ll evaluate it with and for you at no cost. I’ve never met a plan I can’t beat because literally almost 100% of the advisers are there are selling “risk with a side of fees” and calling it a financial plan. If you are fortunate enough to find someone who also offer annuities and life insurance they will set them up improperly or use the wrong products, not use laddering, do one huge contract rather than multiple small ones……etc.You can have the best financial plan in the world….with my help. Until that’s not true I’ll keep saying it. Again, anyone wants to debate/challenge me on public television….please do. It will be good for the [email protected]