The Risky Business of Paying Physicians as Contractors

California Ruling Has Contract Consequences

Both small and large practices often hire physicians as independent contractors—sometimes to fill a temporary need, and sometimes to be able to have another physician in their practice without incurring all the expenses and commitments of having another full-time employee.

Earlier this year, the California employment law landscape shifted in a way that is sure to affect all California business owners. The California Supreme Court, in its Dynamex Operations West v. Superior Court decision, created a new legal test for determining whether your licensed providers should be paid as independent contractors or employees. Before writing this off as legal “pop culture,” it is important to understand the direct consequences this ruling has for healthcare practices in particular.

How a principal company classifies and pays a service provider affects both employers and employees alike. The classification of a service provider as an independent contractor, generally seen as beneficial for the company’s bottom line, strips the protections a service provider would otherwise enjoy if classified as an employee. For example, independent contractors are not eligible for such benefits as participation in retirement plans, paid time off, or health insurance, and they must pay their own expenses, such as malpractice insurance.

Given this push and pull between the service provider and principal company, it comes as no surprise that there have been a number of lawsuits over the years brought by independent contractors who claim they were misclassified as employees, resulting in substantial penalties against the company for failure to follow overtime and meal and rest-break laws, state and federal Social Security and payroll tax requirements, workers’ compensation insurance requirements, and unemployment insurance requirements.

In addition to such lawsuits, companies face fines by the state of up to $25,000 per misclassification. Generally speaking, independent contractors cannot bring claims for discrimination or harassment and do not enjoy the protections afforded by leave laws, such as pregnancy disability leave and family and medical leave.

Applying the ‘ABC’ Test to Physicians

The Dynamex ruling makes these results even more likely. For the last 30 years or so, courts have used the Borello control test, a multifactor test applied on a more subjective, case-by-case basis to determine whether a service provider was properly classified.

In its recent ruling, the California Supreme Court adopted the new, more objective and simplified “ABC” test. There’s now a legal presumption that all service providers are employees, and the burden of proof is on companies to establish that they have properly classified a service provider as an independent contractor. To meet this burden under the ABC test, the principal company must establish all of the following:

1. The service provider is free from the control and direction of the company in the performance of his or her services, by the terms of a written contract and in actuality; and
2. The service provider performs services that are outside the usual scope of the company’s business; and
3. The service provider is customarily engaged in an independently established trade, occupation, or business.

How the Ruling Affects Your Practice

Healthcare practices, in particular, customarily engage the services of licensed physicians and other healthcare providers as independent contractors. However, as the old adage notes: Just because everyone else is doing it does not necessarily make it legal. This seems especially true now under the more demanding test. Under the new ABC test, classifying licensed service providers as independent contractors is problematic because healthcare practices in such situations will often be unlikely to establish part A and part B.

Part A of the test requires the practice to prove that it is not directing or controlling the licensed provider in the rendering of his or her services. This factor was one of the many factors of the old Borello test. Like the Borello test, a court would determine various facts, such as whether the healthcare practice provides the service provider with a facility; professional supplies; equipment; guidelines on how to perform the services; and administrative services, such as scheduling patient visits. The presence of any of these factors has historically indicated substantial control of the service provider by the healthcare practice and would be indicative of an employer-employee relationship.

Part B of the test requires the healthcare practice to prove that the licensed provider it engaged provides services outside the usual scope of services of the practice. For obvious reasons, this will be nearly impossible in the case of a healthcare practice that engages a doctor, because both practitioners render medical services.

It is possible that a court deems all providers to be engaged in the same ‘business’ even when the providers have different specialties or licenses.

An argument can be made that a medical specialist in one area who engages a medical specialist in another meets this test because the services wouldn’t necessarily be in the usual course of business, but this determination ultimately depends on how narrowly or broadly a court interprets this factor. In other words, it is possible that a court deems all providers to be engaged in the same “business” even when the providers have different specialties or licenses. Until enough case precedent has been established here, a healthcare practice runs a risk when it engages providers as independent contractors.

At a minimum, a true independent contractor must be incorporated and must provide services elsewhere. Thus, a healthcare practice could most plausibly establish part C, because many licensed healthcare providers render services in multiple practices and sometimes even have their own practice simultaneously. These factors certainly support an independent contractor classification, but establishing just one—or even two—factors still fails the new test, which requires all three standards to be met. This may prove especially problematic when it comes to locum tenens providers.

Making Sure Proper Classification Is Used

Practices that utilize independent contractors should consult with their legal counsel to ensure they have properly classified all of their providers. This is especially true for practices that regularly utilize locum tenens physicians. This is because the law does not presently distinguish between locum tenens and other types of independent contractors.

At present, the practical effects of this new ruling remain to be seen. Even if independent contractors must be reclassified as employees, many physicians, after transitioning to employee status, may already meet the professional exemption, which eliminates the need for the healthcare practice to follow overtime and break requirements if certain conditions are met. Practices that reclassify contractors as employees may be able to classify these employees as “part-time,” which could make them ineligible for certain types of benefits, such as retirement, medical insurance, and paid vacation, among others.

For example, a practice may have all of the following: (1) a retirement plan that requires an employee to work 1000 hours per year to participate in the plan; (2) a health insurance policy that requires that the employee works 30 hours per week to participate; and (3) a handbook that provides that only full-time employees are eligible for paid vacation. A physician who only works 15 hours per week for this employer would not be eligible for health insurance, retirement, or paid vacation.

Furthermore, in this decision, the court applies the new ABC test to employer wage requirements, but does not explicitly apply it to employer requirements related to workers’ compensation and payroll tax requirements, both of which incorporate their own definitions of “employee” and “independent contractor.”

Because of the uncertain practical effect of this new test, the surest way to mitigate any legal exposure in your practice is to classify your service providers as employees and comply with all employment requirements. Our hope is that as time goes on, the courts or the legislature will provide more clarity as to how to apply the new ABC test.

As a final reminder: If you own a healthcare practice and engage service providers, please remember that whether you classify those providers as independent contractors or employees, healthcare fraud and abuse laws encourage your service relationship to be set forth in a written, compliant contract.

https://www.medscape.com/viewarticle/905628_1

Federal Task Force Highlights Ways to Limit Opioid Exposure

A federal task force may propose a closer look at how insurers’ policies deny Americans ways to manage their acute and chronic pain without facing the risk for opioid addiction.

In a draft report released last week, the Pain Management Best Practices Inter-Agency Task Force also stressed the need for changes in the treatment of people already addicted to narcotics, including a call for efforts to address the stigma involved with substance abuse. The Department of Health and Human Services (HHS) told Medscape Medical News that it will accept comments on the draft report through April 1.

The draft report urges “consistent and timely insurance coverage” for interventional procedures, including targeted injections, early in the course of pain treatment. The task force also called for the establishment of criteria-based guidelines for properly credentialing physicians who are appropriately trained using interventional techniques to help manage patients with chronic pain.

The draft report also suggests establishing credentialing criteria that establishes minimum requirements for training physicians in interventional pain management, seeking to bolster use of this approach.

“Unfortunately, pain physician specialists are typically not involved in the multidisciplinary approaches of treating a pain patient early enough in his or her treatment, which can lead to suboptimal patient outcomes,” the task force writes.

In the draft report, the task force notes that an estimated 50 million people in the United States experience chronic daily pain, which has a significant impact on the lives of 19.6 million of them. The Comprehensive Addiction and Recovery Act of 2016 called for the establishment of this task force, which has 29 members. It includes federal officials and pain experts who work in both academia and private practice. The task force is overseen by HHS and the departments of Veterans Affairs and Defense. After receiving public comments, the task force intends to submit a final set of recommendations to Congress in 2019.

Opioid Epidemic

In the draft report, the task force examined the underlying causes of the nation’s current opioid epidemic.

The treatment of pain in the United States began to undergo significant changes in the 1990s, with recommendations that clinicians consider patients’ reported pain scores as a “5th vital sign,” the task force says in its report.

There was aggressive marketing of newer opioid products at a time of limited coverage for other options for pain management. Hospital administrators and regulators pressed aggressive treatment to lower pain scores, while also increasing the bureaucratic demands on them, particularly those generated by electronic health records [EHRs].

“The administrative burden of using the EHR contributes significantly to physician burnout, likely affecting their capacity to manage the complexity of pain care,” the task force writes. “As the mandate for improved pain management has increased, there was and remains a need for greater education and greater time and resources to respond to the greater needs of patients with painful conditions.”

The number of 2017 overdose deaths involving opioids, including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl, was six times higher than in 1999, according to the Centers for Disease Control and Prevention (CDC). The CDC has said that the current mortality rate averages to 130 Americans dying each day from an opioid overdose.

The CDC describes the epidemic as having three waves, starting with abuse of prescription painkillers in the 1990s. The second wave starting around 2010 was marked by rapid increases in overdose deaths involving heroin.  The third wave, starting around 2013, has been marked by overdose deaths involving synthetic opioids — particularly those involving illicit fentanyl.

In the draft report, the federal task force notes the challenges in trying to address the opioid epidemic simultaneously on a number of fronts, including the unintended consequences of policies.

Successes in curbing opioid prescriptions through state monitoring programs, for example, may have caused some clinicians to refuse to provide prescriptions for people who were on a stable regimen with these drugs, the task force says in the report. Desperate to continue taking narcotics, some of these patients then may have turned to illicit drugs, including fentanyl and heroin, the task force says.

G. Caleb Alexander, MD, of the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore, Maryland, told Medscape Medical News that the draft report adds to a growing number of calls from medical groups for new approaches to pain management. He said it offered many good suggestions, especially its emphasis on multimodal strategies.

Still, Alexander sounded a note of caution about clinicians trying to predict how likely a patient may be to suffer ill effects from opioids.

“For far too long, we have assumed that we can use risk mitigation measures such as patient screening to appropriately channel patients to opioids vs nonopioid therapies,” Alexander said. “The bottom line is that opioids are inherently high-risk products and also not terribly effective for the treatment of chronic pain, so we need to be sure that we don’t invest more in patient screening, patient contracts, urine toxicology testing, or other risk mitigation measures than they can deliver.”

The task force says its work is meant in part to build on the CDC’s 2016 opioid guideline. In the draft report, the task force raised questions about the CDC’s guidelines, such as a general limit of opioids for acute pain to 3 or fewer days, saying that a “more even-handed approach” could result in less “workflow disruption” for clinicians while letting patients get their painkillers in “a timely manner.”

Other Suggestions

Among the other suggestions from the task force’s draft report are:

• Use multidisciplinary approaches for perioperative pain control such as preoperative psychology, screening and monitoring, and planning for managing pain of moderate to severe complexity. Clinicians may also consider preventive analgesia with nonopioid medications; and regional anesthesia techniques, such as continuous catheter-based local anesthetic infusion, the report states.
• Have the Centers for Medicare & Medicaid Services and other insurers align their reimbursement guidelines for nonopioid pharmacologic therapies with current clinical practice guidelines.
• Consider acupuncture, mindfulness meditation, movement therapy, art therapy, massage therapy, manipulative therapy, yoga, and tai chi in the treatment of acute and chronic pain.
• Conduct more research on these complementary approaches to determine therapeutic value, risk and benefits, mechanisms of action, and economic contribution to the treatment of various pain settings.
• Seek to counter societal attitudes that equate pain with weakness by launching a public relations campaign. It would encourage early treatment for pain that persists beyond the expected duration for that condition or injury.
• Address the stigma and perceived racial bias seen in connection with treatment of pain for people with sickle cell disease.

More information on the Pain Management Best Practices Inter-Agency Task Force report is available on the HHS website.

https://www.medscape.com/viewarticle/907112#vp_1

Private-Equity Firms Create Funds That Are Built to Last

Private-equity firms, known for buying and selling companies, would like to do more buying and holding.

Blackstone Group LP, Carlyle Group LP, CVC Capital Partners and others over the past couple of years have launched funds that can own companies for 15 years or longer. Carlyle and CVC are back in the market raising new long-term buyout funds, and others are joining the fray. KKR & Co. said it has raised $5.5 billion from a few large investors, which it is pairing with $3 billion from its own balance sheet to do longer-term deals.

Meanwhile, firms such as investment giant BlackRock Inc., which doesn’t have a significant private-equity business, have eschewed the traditional fund structure altogether in launching vehicles that can hold assets indefinitely.

A typical buyout fund owns companies — acquired largely with borrowed money — for around five years. Managers will usually tinker with a company’s operations or structure with the goal of selling it or taking it public at a profit. Most investments are supposed to be unloaded by the end of a fund’s 10-year lifespan.

Private-equity executives say the condensed timeline can force them to sell at the wrong time, say, when a company is down on its luck or before it has had time to achieve its full potential. It also helps explain why private-equity firms so often unload assets to rival firms, which continue to reap returns from them. These so-called secondary buyouts incur transaction costs that irk investors, particularly those backing both the buyer and the seller.

The moves toward longer-term capital are connected to a broader shift in favor of so-called permanent or perpetual capital — pools of money that don’t need to be constantly refreshed, at great effort and expense. These can come in different guises, including business-development companies, which lend to midsize companies; insurance platforms such as Apollo Global Management LLC’s Athene Holdings Ltd.; private real-estate investment trusts; and long-term real estate, infrastructure and private-equity funds.

Blackstone, the biggest private-equity firm with $456.7 billion of assets, said in September it had $64 billion in perpetual vehicles or long-term funds with an average of 12 years remaining, up more than sevenfold over the past five years. That is thanks largely to a sharp increase in its real-estate assets under management. Such vehicles were responsible for 90% of Blackstone’s revenue over the prior 12 months.

For publicly traded investment firms, such capital is prized because it gives shareholders more visibility into future management fees, which are paid on money invested. The market gives more weight to management fees than to less predictable profits on investments.

Cranemere Group Ltd. operates as a private holding company that can own businesses for as long as it wants. Its founder and chairman, Vincent Mai, formerly served as chief executive of private-equity firm AEA Investors LP. Mr. Mai was sometimes frustrated by being forced to sell the best companies in the portfolio and wanted a structure that allowed him to retain them, according to Cranemere Chief Executive Jeffrey Zients.

“There is excessive short-termism in our economy,” Mr. Zients said in an interview. “That creates opportunity for long-term owners to make disciplined investments in areas like R&D that make sense and have strong returns when you plan to hold companies, not sell them.”

Long-term vehicles tend to buy businesses that are stable with steady cash flows and aren’t fixer-uppers. That means they often cost more. As a result, the vehicles typically have annualized return expectations of 12% to 15%, versus the 20%-plus touted by traditional buyout funds.

Skeptical investors say long-term funds being launched by multistrategy asset managers are just a way to continue to grow their fee streams and that traditional funds already offer the ability for investors to approve extensions beyond the 10-year time horizon. They also question whether firms can predict which companies will be worth owning for longer.

“There is a healthy discipline in having to buy and sell at the right point in the cycle,” said Brian Rodde, who oversees the private-equity portfolio at Makena Capital Management, an investor in buyout funds.

Sponsors of the new funds cite the appeal of the long-term nature of the capital to family businesses, which may otherwise be reluctant to sell to private equity. Last year, CVC invested in family-owned Asplundh Tree Expert LLC out of its long-term fund. The company, which trims trees alongside rail and power lines, had been coveted by private-equity firms for years but the family was finally encouraged to sell in part because CVC would be sticking around for longer, according to people familiar with the deal.

Long-term ownership also appeals to large investors such as insurance companies and sovereign-wealth funds, which have billions to put to work and long-dated liabilities, and family offices, which, unlike pension funds, must pay capital-gains taxes and may not need liquidity; indeed, they may not want to have to find new places to park distributed cash.

Just by eliminating costs incurred from buying and selling companies, a theoretical long-hold fund selling an investment after 24 years could outperform a typical buyout fund selling four successive companies by almost two times on an after-tax basis, according to an analysis by consulting firm Bain & Co.

https://www.marketscreener.com/BLACKSTONE-GROUP-LP-51975/news/Private-Equity-Firms-Create-Funds-That-Are-Built-to-Last-27811964/?countview=0

Tenet announces new multi-year agreement with Cigna

Tenet Healthcare (THC) announced that it has signed a new, multi-year agreement with Cigna (C). The agreement provides Cigna members covered under its commercial health plans with “uninterrupted in-network access to Tenet providers, including hospitals, outpatient centers and employed physicians,” Tenet says in a statement. In addition, all Tenet facilities remain in-network providers for Medicare beneficiaries that are insured by a Cigna-HealthSpring Medicare Advantage plan, it added. Ron Rittenmeyer, Tenet CEO, said, “We are pleased to have reached a successful resolution with Cigna. We believe this is the right outcome for our patients, employees and communities, and we look forward to continuing to serve Cigna members around the country today and in years to come. We remain committed to providing them with the trusted, compassionate care they deserve.”

https://thefly.com/landingPageNews.php?id=2842279

Being Bullied May Alter the Teen Brain

Teens who are often bullied may be left with shrinkage in key parts of their brain, increasing their risk for mental illness, European researchers report.

They said such shrinkage eventually appears to create a growing sense of anxiety, even after taking into account the possible onset of other mental health concerns, such as stress and/or depression.

“We don’t know how early in life these brain changes begin,” said study author Erin Burke Quinlan. “But the earlier bullying is identified, and the sooner it can be dealt with, the better.”

Her team analyzed brain scans of nearly 700 14- to 19-year-olds in England, Ireland, France and Germany. The teens were part of a long-term project called IMAGEN that is studying adolescent brain development and mental health.

“We found that the relationship between chronic peer victimization — an umbrella term that includes bullying — relates to the development of anxiety partly via changes in the volume of brain structures,” Quinlan said.

She’s an IMAGEN project coordinator at the Center for Population Neuroscience and Precision Medicine at King’s College London.

Researchers aren’t sure if the bullied teens’ brain shrinkage is permanent or if it may be reversible.

“We would need to follow adolescents into adulthood to start to answer this question,” Quinlan said. “In this study we did not look at changes in brain activity, which could be a mechanism by which the effects of bullying on mental health could persist even if structural changes were halted or reversed.”

And that, Quinlan said, means the focus should be on preventing bullying in the first place. “Or at least, stopping bullying as soon as it’s been identified,” she added. “While prevention still takes resources and education, it’s likely easier than trying to reverse brain changes years later.”

Quinlan noted that as many as 3 teens in 10 are affected by bullying, some almost daily.

The participants completed surveys at ages 14, 16 and 19 to gauge their exposure to bullying. Brain scans were done at ages 14 and 19.

Thirty-six students — about 5 percent — were characterized as victims of chronic bullying.

By age 19, those teens had reduced size in two key regions of the brain, compared to age 14. The two affected regions — known as “caudate” and “putamen” — are involved in regulation of motivation, attention and emotional processing. However, the researchers only found an association between bullying and brain changes.

Quinlan suggested parents who suspect bullying is taking place speak with a child’s principal or teacher about it. But, she cautioned, victims are often reluctant to tell anyone what’s happening.

“Sometimes a child may not verbally admit they’re being bullied, so parents can watch out for nonverbal cues or changes in their child’s behavior or their attitudes towards school,” Quinlan said. “A mental health professional could be useful to help a child develop tools to deal with being bullied.”

She and her colleagues discuss their findings in the current issue of Molecular Psychiatry.

Stephen Russell is a professor of child development at the University of Texas at Austin. He said the findings suggest “an obvious link between bullying, stress and long-term health,” and called the study important.

“Hopefully,” Russell added, “this will be additional data that will help change the minds of people who think that bullying is ‘natural’ or a normal part of growing up.”

He said the research should underscore the importance of efforts to reduce bullying at the individual and school levels. Russell said several strategies have proved successful.

“Many, many youth experience bullying and grow up to be thriving adults,” he said. “So even though bullying may even [affect] the structure of our brains, that doesn’t mean that we don’t have the ability to cope and compensate. And the very things that bullying may change — like attention or sensitivity — could be things that people learn to use to their advantage.”

More information

The U.S. Department of Health and Human Services offers more about bullying.

SOURCES: Erin Burke Quinlan, Ph.D., project coordinator, Social, Genetic and Developmental Psychiatry Center, Center for Population Neuroscience and Precision Medicine, King’s College London, England; Stephen Russell, Ph.D., professor, child development, University of Texas at Austin; Dec. 12, 2018, Molecular Psychiatry

https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/being-bullied-may-alter-the-teen-brain-740869.html

How to Develop Better Habits in 2019

Just about everyone wants to cultivate better habits. The problem is, very few of us want to do the work to make those habits a reality. We hope they will magically develop, that one day we’ll just wake up (early, without even considering the snooze button) and head straight to the gym. Then we’ll have a healthy breakfast and sit right down with that creative project we’ve been putting off for months. At some point our desire to smoke or lie or complain will mysteriously disappear too.

The reality? This has never happened for anyone, and it’s never going to happen. This is what inspired Epictetus’ famous quote from 2,000 years ago: “How long are you going to wait before you demand the best for yourself?” He’s really asking how much longer you are going to wait until you demand the best of yourself.

I know I want to eat better and be more present. For a long time, I’ve wanted to do push-ups every day. I also want to work less and spend less time checking my phone. I want to start saying no so I can say yes to things I have been putting off. But I’ve wanted to make these changes for a long time. How do I transform my vague hopes into reality?

To start, I need to develop better habits, better accountability, and a clearer vision for my day-to-day life. Here are the steps I am taking. We are all staring down the barrel of a new year, and if we aren’t going to do it now, when will we?

Think Small—Really Small

The writer James Clear talks a lot about the idea of “atomic habits” (and has a really good book with the same title). An atomic habit is a small habit that makes an enormous difference in your life. He talks about how the British cycling team was completely turned around by focusing on 1 percent improvements in every area. That sounds small, but it accumulates and adds up in a big way. He emphasizes thinking small with big habits. Don’t promise yourself you’re going to read more; instead, commit to reading one page per day. Thinking big is great, but thinking small is easier. And easier is what we’re after when it comes to getting started. Because once you get started, you can build.

Create a Physical Reminder

A physical totem can make the habit or standard you’re trying to hold yourself to into something more than an idea, and that helps—a lot. The author and minister Will Bowen has a simple system that helps people quit complaining. He provides each member of his congregation with a purple bracelet, and each time they complain, they switch the bracelet from one wrist to the other. This method is simple and straightforward and makes it easy to hold yourself accountable. Over my desk, I have a picture of Oliver Sacks. In the background he has a sign that reads “NO!” that helped remind him (and now me) to use that powerful word. One of the reasons we made coins for Daily Stoic was that when you have something physical you can touch, it grounds you. The coins are made at the same mint where the first Alcoholics Anonymous chips were invented, and they represent the same idea. If you have 10 years of sobriety sitting in your pocket or clasped in your hand, you’re less likely to throw it away for a drink.

Lay Out Your Supplies

When I get to my desk in the morning, the three journals I write in are sitting right there. If I want to skip the habit, I have to pick them up and move them aside. So most mornings I don’t move them, and I write in them. You can use the same strategy if, for example, you want to start running in the morning. Place your shoes, shorts, and jacket next to your bed or in the doorway of your bedroom so you can put them on immediately. You’ll be less likely to take the easy way out if it’s embarrassingly simple to do the thing you want to do.

Piggyback New Habits on Old Habits

In 2018, I kept telling myself I wanted to contribute more to my community or be of more service. When I heard about someone volunteering, I would say to myself, “I’m going to start doing that.” I read about William MacAskill giving up a great deal of his income and thought, “Wow, I’d like to do something like that.” And then, of course, I didn’t do much of either. Then I listened to an interview with David Sedaris, who talked about how he likes to go on long walks and pick up trash near his home. I go for a walk nearly every morning. It’s an ingrained habit that’s part of my routine. Boom: I just added picking up garbage to my walk. This was easy because I had already done the heavy lifting of creating the first habit. Now it’s harder not to pick up trash, like when I don’t have a bag. Will this little activity save the world? Of course not. But it helps. And I can build on it.

Surround Yourself With Good People

“Tell me who you spend time with and I will tell you who you are” was Goethe’s line. Jim Rohn came up with the phrase that we are the average of the five people we spend the most time with. If you want to have better habits, find better friends. Most of my friends are in good shape. None smokes. Most are in good relationships. Most seem to have their shit together. I’m inspired to be better because I’m around them (and I get lots of good ideas for habits and activities). I’m also shamed into not being worse. If I started slipping, I would stand out.

Commit to a Challenge

In 2018, we did our first Daily Stoic Challenge, which was 30 consecutive days of different challenges and activities based on Stoic philosophy. It was an awesome experience. Even I, the person who created the challenge, got a lot out of it. Why? I think it was the process of handing myself over to a script. It’s the reason personal trainers are so effective. You just show up at the gym and they tell you what to do, and it’s never the same thing as the last time. Deciding what we want to do, determining our own habits, and making the right choices is exhausting. Handing the wheel over to someone else is a way to narrow our focus and put everything into the commitment. That’s why Whole30 is so popular. You buy a book and follow a regimen, and then you know what you’re doing for the next month.

To kick off 2019 we’re doing another Daily Stoic Challenge, this time for 14 days. The idea is that you ought to start the new year right—with 14 great days to create momentum for the rest of the year. If you want to have better habits this year, find a challenge you can participate in. Just try one: It doesn’t matter what it’s about or who else is doing it.

Make It Interesting

As I mentioned before, I’ve always tried to be someone who does push-ups every day. Since June, I’ve done at least 50 push-ups a day (sometimes as many as 100) almost without fail. How? I’ve been using Spar!, which is basically the most addictive and rewarding app I’ve ever downloaded. Right now I’m in a 50-push-up challenge with about two dozen people. Every day, we do 50 push-ups and upload video proof that we’ve done them. If you miss a day, the app charges you $5. At first you do the daily deed just so you don’t lose money. But soon enough, it’s about competing with the people in the group. Then a few days in, another motivation kicks in: The winners (people with the fewest misses) split the pot of everyone else’s fees. So you keep going because you want the reward. I’ve done thousands of push-ups, squats, burpees, and sit-ups (and even did one about cleaning my car and another about writing 500 words a day)—and in the process I also made a couple hundred bucks.

It’s About the Ritual

Professional dancer Twyla Tharp has written about how every morning she gets up early, dresses, and takes a cab to the same gym, where she works out for several hours. This is how she trains and keeps herself fit. Her workouts are tough and exhausting, and you’d think she would need a lot of discipline to commit to showing up each morning. But, as she writes in The Creative Habit, she just has to get herself to the cab. That’s it. The rest takes care of itself. The ritual takes over.

It Doesn’t Have to Be an Everyday Thing

I read a lot, but not usually every day. I do most of my reading when I travel, when I binge on books. Trying to force myself to read every single day (or for a set amount of time or a set amount of pages) would not be as productive or as enjoyable as periods of three to five days of really heavy reading (where I might finish three to five books). Binge reading may not be the right thing for everyone, but not every good habit has to be part of a daily routine. Sprints or batching can work too. What matters is that the results average out.

Focus on Yourself

One of the reasons I’ve talked about watching less news and not obsessingover things outside your control is simple: resource allocation. If your morning is ruined because you woke up to CNN reports of another ridiculous Trump 2 a.m. tweet-storm, you’re not going to have the energy or the motivation to focus on making the right dietary choices or sitting down to do that hard piece of work. I don’t watch the news, I don’t check social media much, and I don’t stress about everything going on in the world—not because I’m apathetic, but because there are all sorts of changes I want to make. I just believe these changes start at home. I want to get myself together before I bemoan what’s going on in Washington or whether the U.K. will figure out a Brexit strategy. “If you wish to improve,” Epictetus said, “be content to be seen as ignorant or clueless about some things.” (Or a lot of things.)

Make It About Your Identity

Generally, I agree with Paul Graham that we should keep our identities small, and generally, I think identity politics are toxic. It’s a huge advantage, however, to cultivate certain habits or commitments that are foundational to your identity. For example, it is essential to my understanding of the kind of person I am that I am punctual. I also have decided that I am the kind of person who does not miss deadlines. That I see myself as a writer is also valuable because if I’m not writing, I’m not earning that image. You can see why being vegan becomes part of people’s identity too. If it was just about choosing not to eat any animal products, the diet would be extremely difficult to adhere to. But because it is a lifestyle and an ideology, vegans are willing to push through all that. They don’t see it as a choice, but rather as the right thing to do.

Keep It Simple

Most people are way too obsessed with productivity and optimization. They want to know all the tools a successful writer or an artist uses because they think this is what makes these individuals so great. In reality, they are great because they love what they do and they have something they’re trying to say. When I look at some people’s routines and all the stuff they’re trying to manage, I shudder. Their habits require habits! No wonder they don’t make progress. My to-do lists are always short. I want my goals to be reachable, and I don’t want to be constantly busy or get burned out. This is why James Clear’s concept of atomic habits is so important. Look at the little things that make a big difference—not only is this more manageable, but the results will also create momentum.

Pick Yourself Up When You Fall

The path to self-improvement is rocky, and slipping and tripping is inevitable. You’ll forget to do the push-ups, you’ll cheat on your diet, you’ll get sucked into the rabbit hole of Twitter, or you’ll complain and have to switch the bracelet from one wrist to another. That’s okay. It doesn’t mean you’re a bad person. I’ve always been fond of this advice from Oprah: If you catch yourself eating an Oreo, don’t beat yourself up; just try to stop before you eat the whole sleeve. Don’t turn a slip into a catastrophic fall. And a couple of centuries before her, Marcus Aurelius said something similar:

When jarred, unavoidably, by circumstance, revert at once to yourself, and don’t lose the rhythm more than you can help. You’ll have a better group of harmony if you keep on going back to it.

In other words, when you mess up, come back to the habits you’ve been working on. Come back to the ideas here in this post. Don’t quit just because you’re not perfect.

No one is saying you have to magically transform yourself in 2019, but if you’re not making progress toward the person you want to be, what are you doing? And, more important, when are you planning to do it?

I’ll leave you with Epictetus once more, who wrote so eloquently about feeding the right habit bonfire. It’s the perfect passage to recite as we set out to begin a new year, hopefully, as better people.

From now on, then, resolve to live as a grown-up who is making progress, and make whatever you think best a law that you never set aside. And whenever you encounter anything that is difficult or pleasurable, or highly or lowly regarded, remember that the contest is now: you are at the Olympic Games, you cannot wait any longer…

https://medium.com/s/notes-on-changing-your-life/how-to-develop-better-habits-in-2019-143e1e21ecbc

2018 Sector ETF Performance

https://macromon.wordpress.com/2018/12/31/2018-sector-etf-performance/