The Foggy City of San Francisco?

It doesn’t seem like an ideal place to promote solar energy, but foggy San Francisco has come up with an ambitious plan to encourage businesses and homeowners to tap the sun’s power for their energy needs. The program announced Tuesday would offer companies and residents government-funded loans and rebates to offset the costs of installing solar panels, city officials said. Many states, including California, offer tax credits or rebates to encourage solar power, and some small utility companies provide financing incentives. San Francisco’s program may be the most ambitious because it couples refunds and loans.

Under San Francisco’s proposal, which must be approved by voters and legislators, businesses would be eligible for rebates of up to $10,000. Residents would receive $3,000 to $5,000 off the cost of installing solar panels depending on whether they use a local contractor and are working on property in a neighborhood near a power plant. About 660 homes and other buildings in San Francisco already have solar installations. Officials said they hope to bring the number up to 10,000 over the next decade by cutting property owners’ out-of-pocket costs by half, if not more.

Hunter vs. Gatherer: According to research, men and women are as different as Target and Tiffany when they shop.

Men, who have often been accused of being merely replacement shoppers, tend to be more utilitarian when they hit the malls and shopping centers. It’s a mission. Get in. Get what’s needed. Get out. Quickly. Women, on the other hand, generally like to look around, talk to sales associates and experience the shopping. They walk around, smell perfume, touch clothes, dab on cosmetics.

Men are very task oriented while women are very much more about the relationship and the engagement and the interaction with the people at the stores. Women told surveyors that they liked it when associates showed them different styles and new items. This isn’t terribly surprising: Women run into more problems when shopping than men. On the tribulations scale, women’s No. 1 issue was not being able to find help when they needed it. One in three women who were so miffed by the issue that they said they would never go back to the store again. Men’s biggest headache: Parking. One in three said they hated not finding parking close to the store entrance.

Men ditch stores, too, but their biggest reason to do so is when products are out of stock. Men complained they experienced that when shopping 24% of the time compared with it happening to women 21% of the time.

Age made a difference, too, in shopper loyalty. The younger the shopper, the more likely he or she was to pooh-pooh a store for poor service. The pickiest of all groups were men 18 years old to 35 years old.

Women and men both are four times more likely to relay a good-news experience than a bad one. Still, when all is said and done, women are the shopping queens. They spend an eye-popping $4 trillion annually, which accounts for 83% of U.S. consumer spending

Sell Your Soul For $1.5 Million

With the wealth boom creating unprecedented riches and greater opportunities for gold-digging by both genders, price-tag partnerships and checkbook breakups are increasingly making headlines. Even more surprising, according to a new survey, are the going rates for today’s mercenary unions. Yet even among the workaday (or wannabe) wealthy, marrying for money has become a popular pursuit.  In an infamous personal ad posted on Craigslist this summer, a twentysomething New Yorker who described herself as “spectacularly beautiful” wrote that she was looking for a man who made at least $500,000 a year. You can read her ad here.

According to a survey by Prince & Associates, a Connecticut-based wealth-research firm, the average “price” that men and women demand to marry for money these days is $1.5 million. The survey polled 1,134 people nationwide with incomes ranging between $30,000 to $60,000 (squarely in the median range for nationwide incomes). The survey asked: “How willing are you to marry an average-looking person that you liked, if they had money?”

Fully two-thirds of women and half of the men said they were “very” or “extremely” willing to marry for money. The answers varied by age: Women in their 30s were the most likely to say they would marry for money (74%) while men in their 20s were the least likely (41%).  Women aren’t the only ones with the gold-digging impulse. In the Prince & Associates study, 61% of men in their 40s said they would marry for money. As men get older, they become more comfortable with women being the bread-winners.

The Matrimonial Price Tag Varies By Gender and Age

Asked how much a potential spouse would need to have to be money-marriage material, women in their 20s said $2.5 million. The going rate fell to $1.1 million for women in their 30s, and rose again to $2.2 million for women in their 40s. Men are cheaper! Their asking price overall was $1.2 million, with men in their 20s asking $1 million and men in their 40s asking $1.4 million. Why so low? Men’s numbers are lower because they would feel threatened by women worth several million dollars. The men aren’t going to say they want $10 million, because they wouldn’t be comfortable with a woman who’s worth so much more than they are.

Whatever the case, the prices for both men and women seem surprisingly low, given the new landscape of wealth. While $1 million or $2 million may sound like a lot to people making $30,000, it’s hardly enough to transform someone’s life or make them “rich” by contemporary billionaire standards. No one in the survey quoted a price of more than $3 million. Of course, when the mercenary marriage proves disappointing, there’s always divorce. Among the women in their twenties who said they would marry for money, 71% said they expected to get divorced — the highest of any demographic. Only 27% of men in their 40s expected to divorce.

Everyone plays up the notion that we are in huge amounts of debt. This is simply not true.

With Treasury Secretary Henry Paulson in China this week to discuss a range of issues related to U.S.-Sino commerce, we thought it would be an opportune time to separate fact from fiction and highlight some key issues that presently define the economic ties between the United States and China:

1. U.S. Foreign Investment in China — Not As Much as You Think     Rarely does a day pass without the media reporting yet another American firm de-camping the United States for China. Reality is quite different. U.S. foreign direct investment (FDI) to China has climbed over the past decade, but a little perspective is in order. The $15.5 billion the U.S. has sunk in China this decade equates to only 1.6% of the global total. U.S. FDI in Ireland and Germany was roughly triple the level of investment in China over the same period.

2. The U.S. Enjoys a Huge Lead over China in FDI     It is no secret that Chinese investors are quite interested in increasing their direct investment position in corporate America. Equally, it’s no secret that any planned purchase of a U.S. company by Chinese investors is subject to a great deal of scrutiny in Washington. Next to America’s massive trade deficit with the mainland, China’s foreign investment in the U.S. has emerged as a key tension point between the two parties. That said, it’s interesting to note that when it comes to foreign direct investment — or the corporate presence of the U.S. in China versus China’s presence in the U.S. — the U.S. enjoys an overwhelming advantage over the mainland. In 2006, for instance, U.S. foreign investment in China on a historic cost basis totaled $22.2 billion, a figure well in excess of China’s investment stakes in the U.S. In other words, U.S. firms have far better access to the Chinese market than their Chinese counterparts in the United States. This investment gap represents a strategic competitive advantage to corporate America.

3. What really attracts U.S. firms to China? Consumers     Contrary to popular opinion, access to the Chinese consumer remains the key motivation of U.S. firms entering China. Keep in mind that China is not a unified market of 1.2 billion people but a collection of markets with different dialects, varying levels of development, and disparate per capita incomes. These variables, along with many others (the brand-sensitivity of Chinese consumers coupled with intense foreign and local competition) dictate that American firms adapt to local tastes and operate on the ground. Customer proximity, in other words, is key in China.

4. “Made in China” — What It Really Means     The mainland has emerged as an exporting powerhouse, with “Made in China” the most ubiquitous signature in the world. Yet lost on many folks is this: A great deal of what China exports to the United States and the world are goods from so-called foreign-invested enterprises, or foreign subsidiaries of various global multinationals. “Made in China” is not what most people think. Thousands of low-cost Chinese firms are not flooding the U.S. market with goods, displacing U.S. workers in the process. Rather, foreign firms are increasingly leveraging low-cost China to their competitive advantage.

5. The U.S. Trade Deficit with China: A Dangerous Scorecard     Much has been made of China’s merchandise trade surplus with the United States, which topped $230 billion in 2006. That’s a large figure, to be sure, although the figure does not accurately reflect the true nature of bilateral commerce between the United States and China. Missing from this equation are local sales of goods and services of U.S. foreign affiliates operating in China. The latter totaled some $86.5 billion in 2005 (the latest available data. Missing from the trade debate is the following: The primary means by which U.S. firms deliver goods and services to China is via foreign affiliate sales, not exports. At the end of the day, China does sell more to the United States, but not by the lopsided margin some might suppose.

6. Capital — China’s Top export to the U.S.     China’s most important export to the United States is capital — or U.S. dollars to be more exact. Lost on many legislators in Washington that want to punish China for running such a large U.S. trade surplus is this simple yet critical fact: China not only provides U.S. consumers with cheap, high-quality goods, it also provides the capital to purchase such goods by recycling greenbacks earned from trade back into U.S. treasuries and other dollar-denominated assets.

7. The Mainland — An unlikely Source of U.S. Profits     The lopsided nature of U.S.-China trade gives the impression that all the benefits go to the Chinese. That is simply not true. One of the best kept secrets on Wall Street is this: U.S. firms are making tidy sums of money in the Middle Kingdom.

Data on foreign affiliate income from the government’s Bureau of Economic Analysis corroborate these findings, with U.S. foreign affiliate income in China rising from $1.2 billion in 2000 to $4.7 billion last year. The bottom line: At a time when the U.S. is threatening to impose greater trade sanctions against China, U.S. firms with operations in China are posting record profits.

Here’s the rest of the list.

Consider Bermuda As An Alternative? 

Bermuda’s main commercial district is home to thousands of the world’s top hedge funds. But the British colony has been struggling to catch up to its Caribbean cousins, the Caymans and British Virgin Islands, in the race for the $2 trillion hedge fund industry’s fast-growing offshore business. That could soon change.

In the next 12 months, the 22-square-mile land of pink beaches and rolling golf courses expects to raise the number of registered funds by 50% to 3,000. While Bermuda dominates the offshore insurance industry, the Cayman Islands is the epicenter for hedge funds, with about 9,000 of these loosely regulated investments registered in the British territory. But Bermuda is competing hard, having recently made registration quicker, easier and cheaper. It also touts its proximity to the United States. It is only a two-hour flight from New York, while a trip to Caymans is much longer and often involves a stopover in Florida.  

Managers who invest for foreigners or tax-exempt U.S. clients, such as pension funds and colleges, are attracted to offshore centers because costs are lower and regulatory requirements less stringent than in the United States. In return, hedge funds bring lucrative business to the offshore centers at a time when many islands are trying to diversify revenue away from tourism. To reach the ambitious goal of registering roughly 1,000 new hedge funds in the next year, Bermudans are jetting to international conferences. The primary targets are in Europe, the Middle East and Asia. For years, U.S. lawyers have urged hedge funds to set up in the Caymans. The Caymans occasionally suffer from a reputation of relaxed oversight, thanks to several recent hedge fund collapses. And the 1993 Hollywood movie “The Firm” is about a law firm whose nefarious activities include money-laundering in the Caymans.

Those Europeans!

1. Luxembourg
2. France
3. Ireland
4. Hungary
5. Czech Republic
6. Spain
7. Denmark
8. Portugal
9. Switzerland
10. Austria
11. Germany
12. United Kingdom
13. Belgium
14. Netherlands
15. Australia

When Marriage Is A Risk 

In this Web-friendly age, billionaires, politicians, and others who live in the public eye have a hard time keeping information about their lives private. Yes, the rich really are different from you and me. For most people, a wedding is a simple, joyous occasion. Family and friends gather to celebrate the ceremonial joining of you and your true love. For billionaires it’s more complicated, with stresses and strains that others don’t bear. They don’t just have to choose a florist and a band; they usually need a good lawyer, too. Attorneys familiar with billionaire marriages urge their clients to proceed with care and caution. A billionaire has to treat an upcoming marriage as a merger. But it’s a merger with a potential enemy. Prenuptial agreements are important, but they’re no guarantee of a satisfactory split if things go south.

Another issue that comes with prenups is privacy. Agreements can include confidentiality clauses to prevent one of the parties involved from giving out information about a marriage in case of divorce. That can mean barring anything from TV interviews about the ex to writing a book.

Consider the divorce of Steven Spielberg, now at DreamWorks Animation, and his first wife Amy Irving. She claimed their prenup was invalid because it had been written on a napkin and she hadn’t had legal representation. A judge tossed it out; Irving got $100 million. The prenup of Bob Johnson, the founder of Black Entertainment Television, held up, but it still cost him plenty. He agreed to a deal with his wife, Sheila Johnson, in which she would receive half of their assets if they split up. By the time they did get divorced in 2002, his media empire was worth billions — and she got her half.

Dyslexia Forces People To Master Verbal Communication 

It has long been known that dyslexics are drawn to running their own businesses, where they can get around their weaknesses in reading and writing and play on their strengths. A new study of entrepreneurs in the United States suggests that dyslexia is much more common among small-business owners than even the experts had thought. Julie Logan, a professor of entrepreneurship at the Cass Business School in London, found that more than a third of the entrepreneurs she had surveyed — 35%— identified themselves as dyslexic. The study also concluded that dyslexics were more likely than nondyslexics to delegate authority, to excel in oral communication and problem solving and were twice as likely to own two or more businesses.

“We found that dyslexics who succeed had overcome an awful lot in their lives by developing compensatory skills,” Professor Logan said. One reason that dyslexics are drawn to entrepreneurship, Professor Logan said, is that strategies they have used since childhood to offset their weaknesses in written communication and organizational ability — identifying trustworthy people and handing over major responsibilities to them — can be applied to businesses. Entrepreneurs are hands-on people who push a minimum of paper, do lots of stuff orally instead of reading and writing, and delegate authority, all of which suggests a high verbal facility. Compare that with corporate managers who read, read, read. Only 1% of corporate managers in the United States have dyslexia.

Individuals who have difficulty reading and writing tend to deploy other strengths. They rely on mentors, and as a result, become very good at reading other people and delegating duties to them. They become adept at using visual strengths to solve problems.

Parallel Lessons

• Let Them Cry   Sometimes, no matter how hard it may be, you need to let them cry it out. Whether it’s an employee who wants more of something but hasn’t quite earned it yet or a baby who is overtired and needs to sleep, you can’t always get what you want. As a parent and a CEO, you can’t always give them what they ask for.
• Count to 10   Losing your temper is not a good way to show that you are in charge and worthy of respect. It’s also not a good way to help your staff/child improve. Count to 10 before you react, and think about how a measured response will get you much better results. I’ve found that in most cases when I’m really angry, it’s a very temporary thing.
• Let Them Fail   There are many times when you just need to sit back and watch people fail for their own good. Employees need to botch a sale, sometimes, in order to learn how to do it correctly. Kids have to fall down when trying to stand, walk or ride a bike. If you save either from the mistakes before they happen, you’ll deprive them of the chance to learn important lessons firsthand.
• Carrots, Not Sticks   This is a wonderful lesson that really works with kids. Rewarding good behavior creates a desire to behave well without all the trauma of avoiding pain.
• Be the Boss/Parent   There is a desire among bosses to be friendly with your staff. When push comes to shove, you have to be able to separate as a friend and be the boss. There is a huge difference between being friendly and being friends. Parents are in the same boat — you can love your kids, but you are not their friend. You need to have that separation for times when you need to use your authority.

Watch out for a growing number of trust fund babies in Asia

The opportunities for private banks in Asia Pacific are big, and still growing. The region is home to more than a quarter of the world’s high net worth individuals (HNWIs) - the industry jargon for people with $1m of investable assets. Their wealth is growing by 8.5% a year. By 2011, their combined riches will total $12,700bn.

The difference between North America and Europe? The wealth management business in Asia is a lot more diverse than in Europe or north America - in terms of providers, legal jurisdictions and customers. Potential clients might be a Japanese aristocrat whose family has been rich for generations, or a Malaysian entrepreneur who grew up in a kampong (village) and now wants to invest the proceeds of an IPO according to Islamic shariah principles.

China continues to boom - there are estimated to be at least 300,000 Chinese HNWIs. Foreign private banks are setting up branches as quickly as they can. They are starting to move inland from the wealthy cities along the coast to service the growing number of entrepreneurs in China’s West. India is also showing enormous promise too. Asian HNWIs tend to be more mobile than their counterparts in Europe or north America. That diversity may mean opportunities in providing specialist tax services, for example.

Asian clients may have very different ideas about what private bankers should do for them. A western approach based solely on analysing risk tolerance in accordance with modern portfolio theory, and recommending appropriate products, may not sit well with a customer who is just looking for share tips. It takes time to build trust with such clients, and help them to understand that wealth preservation and growth is more complicated than betting on shares on China’s overheated stock market.

The need for private banking is likely to intensify as a big wave of wealth starts to flow down the generations. “In Asia people may not be as open with me as western clients about all of their investments, so I can’t always make appropriate recommendations,” says one private banker.  The “rags-to-riches” ethnic Chinese entrepreneurs of south-east Asia are beginning to die off. Many left home to seek their fortunes as manual workers in the tin mines of Malaya, or fled China when the communists took over, to start small businesses that grew into family conglomerates. Such patriarchs learned about business the hard way. Many may not have been educated past primary school. But their grandsons - and granddaughters - may well have been to top international business schools, and have very different ideas about how the family business should be run. They may even consider whether the business should be sold off, and the cash invested instead. Watch out for a growing number of trust fund babies in Asia.

Research suggests that many rich families in Asia are ill-prepared for generational change. Only half of the 33 families surveyed in Hong Kong, India, Malaysia and Taiwan said they involved the next generation in managing the business. Many young graduates even felt that inheriting the family company would be a burden, as it constrained their career choices.

Asia, outside of Japan, and the Middle East would need 10,000 new private bankers by 2010. Private bankers need more than quantitative skills. They must watch the markets, in case the client asks their opinion. It also helps to speak a few languages, especially Chinese dialects. Such people are rare and no bank seems happy with the recruitment situation. Publicly, managers talk about providing staff with friendly environments and great career opportunities to win the battle for talent.  93% of customer relationship managers in private banks in Asia said they had been approached by rivals in the past year.  One in seven private banks risked losing a third of its staff or more. It is not unusual for entire teams to follow a talented manager and take their clients with them. 

The boom in private banking is sharpening traditional rivalries between the north and south-east Asian hubs of Hong Kong and Singapore. Both have trustworthy reputations as financial centres. Wealth managers have traditionally clustered in Hong Kong. But Singapore, which has the world’s fastest growing population of dollar millionaires, has been catching up.

If you love each other, shouldn’t you be able to live and work together, right?

For many couples, this major decision is the ticket to wealth, self-actualization and happiness. For others, it can lead to severe financial and relationship stress. Such a move takes more than planning; it requires a full assessment of your personalities and your money issues to determine whether working and living side by side is right for you. Your first step should be a visit to a trusted certified financial planner. Here are some key steps to consider:

Give yourselves a timetable to startup. You might be tempted to give notice tomorrow morning, but it’s much wiser to lay out a timetable over the coming months with specific tasks, goals and objectives.

Study the viability of your business model. Talk about worst-case scenarios. Bring in trusted advisors to ask tough questions about what you’re planning to do and the viability of your idea. Convincing each other you’ll make it work isn’t enough.

Draft a business plan. Even if you don’t anticipate the need to seek outside financing, it is always a good idea to formalize your ideas with a business plan. Include profit and loss projections, so that you have a benchmark for evaluating your progress at a given point in time. Factor in both best- and worst-case scenarios, which could help with decisions down the road.

Understand how your tax situation will change. Depending on which business structure you choose, you may need to plan for income taxes, self-employment taxes and payroll taxes. You want to make sure you have reserves set aside for these liabilities. 

Set a spending plan for your business and personal life. Since startups have unpredictable cash inflows, you will want to establish adequate emergency funds–both business and personal–to carry you through the startup phase.

Set boundaries. Couples who live and work together need to assess whether they want to keep their work and personal lives separate. Some people are comfortable discussing their personal lives at work, while others make it clear that during working hours, they are at work and won’t discuss personal matters.

Make sure your legal documents are in order. If you haven’t had your estate planning documents updated in a while or don’t have them at all, this is a great time to have them drafted. Don’t forget to tell your attorney about your new business venture, which should be factored into the equation.

Plan for your kids in the business. There may be good opportunities to employ children for work commensurate with their skills.

 How Well Are You Dealing With Stress?

One-third of Americans are living with extreme stress and nearly half of Americans (48%) believe that their stress has increased over the past five years. Stress is taking a toll on people — contributing to health problems, poor relationships and lost productivity at work, according to a new national survey released today by the American Psychological Association (APA).

Money and work continue as the leading causes of stress for three quarters of Americans. Nearly half of all Americans report that stress has a negative impact on both their personal and professional lives. Stress causes more than half of Americans (54%) to fight with people close to them. One in four people report that they have been alienated from a friend or family member because of stress, with 8% connecting stress to divorce or separation.

Stress in America continues to escalate and is affecting every aspect of people’s lives — from work to personal relationships to sleep patterns and eating habits, as well as their health. Physical symptoms of stress include: fatigue); headache; upset stomach; muscle tension; change in appetite; teeth grinding; change in sex drive and feeling dizzy.  Psychological symptoms of stress include: experiencing irritability or anger,  feeling nervous, lack of energy and feeling as though you could cry.  In addition, almost half (48%) of Americans report lying awake at night due to stress.

While many Americans recognize that stress has a negative impact on their health, they may lack the motivation to make lifestyle and behavior changes. Only 35% report that they would modify their behavior following the diagnosis of a chronic condition. Encouragement from a spouse or partner would motivate 38% to make behavioral changes.

I have to agree that there is a lot of pressure to specialize.

1. “They should put me on the endangered-species list.”   A good primary-care doctor (someone to coordinate your health care, help choose your specialists and be the first to diagnose just about any problem) is the key to good medical treatment. But they’re getting harder to come by. Why? Fewer med students are going into primary care: Interest is so low that the number of primary-care internal medicine residency positions dropped by more than 50% in the past decade.

2. “I’m the pauper of my profession.” One big reason fewer medical students are specializing in primary care is pure and simple economics. In 2006 primary-care doctors earned an average of $171,519. That might sound like a lot to most working people, but it’s less than half of what dermatologists made that same year. And the call of more-lucrative specialities is only likely to get louder for today’s residents: According to one study, the income of primary-care doctors, adjusted for inflation, actually fell by 10% between 1995 and 2003.

3. “Sorry, your 12 minutes are up.” Some doctors are able to see 40 patients a day. That’s one every 12 minutes. And it doesn’t show signs of slowing: According to one survey the average number of patients doctors saw grew by 7.5% from 2004 to 2005. While this system isn’t inherently bad, it can be abused. Assistants may have a different philosophy from the doctor, leading them to treat problems differently as well. Communication can break down, causing confusion about medications, and a misdiagnosis by an assistant is always possible.

4. “I hawk for Big Pharma in my spare time.” Your physician relies on his best judgment when deciding what drugs to prescribe. And influencing that judgment is big business. Market-research firm IMS has found that the pharmaceutical industry spends $7.2 billion a year targeting doctors with ads and sales representatives.  Drug companies know doctors are more likely to take their cues from other doctors, so they sponsor weekend seminars at expensive resorts featuring presentations by physicians.

5. “Sore throat? You might be better off going to the mall.”  Walk-in clinics are springing up across the country. They’re run by nurse practitioners, who diagnose simple maladies, like strep throat or flu, and provide prescriptions, medical advice or referrals if the problem is beyond their scope. These clinics have caught on in part because they’re fast and don’t require an appointment. They’re also cheap — $40 to $60 a visit, versus $150 for a doctor or $300 for an ER visit — and many take insurance. Today there are about 460 such clinics, but analysts expect the number to jump to 4,000 by 2009.

6. “I hate technology.” Primary-care physicians have been slow to adopt the technology: A recent study found that only 28% use these systems. Why? They can cost up to $70,000, and cash-strapped GPs see little payoff. For most patients the benefits of the technology are huge. It eliminates prescription errors due to illegible handwriting. It ensures that patients get the right dosage. Records won’t get lost. It reminds doctors when they need to monitor their patients. And specialists and others can easily forward electronic records to your GP.

7. “Your insurance company is calling the shots.” These days doctors have more freedom to send you to a specialist or order expensive tests than they once did under managed care. But that doesn’t mean the system is fixed. With increased deductibles, it’s often the patient who foots the bill for a referral or an expensive test. Insurers also still wield the power when it comes to hospital stays.

8. “My legal history is none of your business.” Today’s insurance plans give patients a wider range of doctors to choose from, but patients don’t have any more information to help them decide. The best information about doctors is off-limits to patients. It’s the National Practitioner Data Bank, which state medical boards and hospitals use to do background checks, and it includes information on disciplinary actions and malpractice payments. The best publicly available information is tracked by state medical boards, many of which publish this information on their Web pages. If yours doesn’t, you can pay $9.95 for a report from DocInfo.org, a site run by the Federation of State Medical Boards.

9. “If you’re over 65, don’t bother me…” Doctors who specialize in geriatrics are increasingly rare. Right now there is just one geriatrician in the U.S. for every 5,000 seniors, about half of what we should have, according to the American Geriatrics Society. Treating older patients who have multiple, often complex problems is about the worst way a doctor can make a living. Medicare doesn’t compensate much more for a 45-minute appointment with a patient with dementia, hearing loss and a half-dozen other maladies than it does for seeing someone for a simple checkup.

10. “…unless, of course, you’re willing to pay extra.” Unfortunately, the shortage of geriatricians is worsening. The American Geriatrics Society estimates that by 2030, there will be a shortage of about 36,000 geriatricians in the U.S., up from 7,000 today. Though the situation seems dire, there are ways to guarantee qualified care. One approach is to see a good primary-care doctor who is also a geriatrician long before you need one. Other approaches can be costly. In Sarasota, Fla., many doctors provide “concierge” service: Patients pay an annual retainer of about $4,000 in exchange for their doctor’s cell number and upgraded access. These pricey options aren’t what most people have in mind when they think of health care reform, but they may be the only way to maintain ready access to a good doctor.