Financial thoughts

Private nonresidential construction may pick up this year, as demand grows for new U.S. projects.

The Architecture Billings Index held at 52 last month, a sign of expansion, according to the American Institute of Architects. The commercial and industrial component — a proxy for private building activity — climbed to 54.1 in December, the highest in 10 months, the Washington-based association said Jan. 18.

The monthly survey of U.S.-based architecture firms is a leading indicator of nonresidential construction, said Kermit Baker, chief economist for the association.

Leaders of the world

An official at the main airport serving Yemen’s capital says that protesting troops have closed the runways with armored vehicles, demanding that the commander of the country’s air force be replaced.

The garrison at Sanaa airport’s attached military air base is demanding the removal of Maj. Gen. Mohammed Saleh, the brother of outgoing President Ali Abdullah Saleh, the official says.

He says the Sunday protest has caused two flights to be diverted to the airport at the southern city of Yemen.

Another official at the airport in the southern city of Taiz says troops there have been staging a similar protest demanding the ouster of their commander since Saturday. Both officials spoke anonymously in accordance with regulations.

Yemen has experienced an 11-month uprising against Saleh’s rule.

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Doctors in America are harboring an embarrassing secret: Many of them are going broke.

This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.

"A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.

Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."

Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. "Our total revenue was down about 9% last year compared to 2010," he said.

12 entrepreneurs reinventing health care

"These cuts have destabilized private cardiology practices," he said. "A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well."

Pentz is thinking about an out. "If this continues, I might seriously consider leaving medicine," he said. "I can’t keep working this way."

Also on his mind, the impending 27.4% Medicare pay cut for doctors. "If that goes through, it will put us under," he said.

Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary "patch," this dilemma continues to haunt doctors every year.

Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians’ financial woes.

"Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."

Donegan knows an oncologist "with a stellar reputation in the community" who hasn’t taken a salary from his private practice in over a year. He owes drug companies $1.6 million, which he wasn’t reimbursed for.

Dr. Neil Barth is that oncologist. He has been in the top 10% of oncologists in his region, according to U.S. News Top Doctors’ ranking. Still, he is contemplating personal bankruptcy.

That move could shutter his 31-year-old clinical practice and force 6,000 cancer patients to look for a new doctor.

Changes in drug reimbursements have hurt him badly. Until the mid-2000’s, drugs sales were big profit generators for oncologists low interest rate personal loans.

In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients.

"I grew up in that system. I was spending $1.5 million a month on buying treatment drugs," he said. In 2005, Medicare revised the reimbursement guidelines for cancer drugs, which effectively made reimbursements for many expensive cancer drugs fall to less than the actual cost of the drugs.

"Our reimbursements plummeted," Barth said.

Still, Barth continued to push ahead with innovative research, treating patients with cutting-edge expensive therapies, accepting patients who were underinsured only to realize later that insurers would not pay him back for much of his care.

"I was $3.2 million in debt by mid 2010," said Barth. "It was a sickening feeling. I could no longer care for patients with catastrophic illnesses without scrutinizing every penny first."

He’s since halved his debt and taken on a second job as a consultant to hospitals. But he’s still struggling and considering closing his practice in the next six months.

"The economics of providing health care in this country need to change. It’s too expensive for doctors," he said. "I love medicine. I will find a way to refinance my debt and not lose my home or my practice."

If he does declare bankruptcy, he loses all of it and has to find a way to start over at 60. Until then, he’s turning away new patients whose care he can no longer subsidize.

"I recently got a call from a divorced woman with two kids who is unemployed, house in foreclosure with advanced breast cancer," he said. "The moment has come to this that you now say, ’sorry, we don’t have the capacity to care for you.’ "

Small business 101: A private practice is like a small business. "The only thing different is that a third party, and not the customer, is paying for the service," said Lion.

"Many times I shake my head," he said. "Doctors are trained in medicine but not how to run a business." His biggest challenge is getting doctors to realize where and how their profits are leaking.

My biggest tax nightmare!

"On average, there’s a 10% to 15% profit leak in a private practice," he said. Much of that is tied to money owed to the practice by patients or insurers. "This is also why they are seeing a cash crunch."

Dr. Mike Gorman, a family physician in Loganvale, Nev., recently took out an SBA loan to keep his practice running and pay his five employees.

"It is embarrassing," he said. "Doctors don’t want to talk about being in debt." But he’s planning a new strategy to deal with his rising business expenses and falling reimbursements.

"I will see more patients, but I won’t check all of their complaints at one time," he explained. "If I do, insurance will bundle my reimbursement into one payment." Patients will have to make repeat visits — an arrangement that he acknowledges is "inconvenient."

"This system pits doctor against patient," he said. "But it’s the only way to beat the system and get paid."

— Are you a doctor who has made financial decisions you came to regret? E-mail Parija Kavilanzand you could be part of an upcoming article. Click here for CNNMoney.com comment policy. 

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Sale, schmale.

Used to be, customers would come running when stores cut prices. But these days, more Americans are becoming blase about bargains.

Jennifer Beasley recently left a Toys R Us in Cary, N.C., unimpressed by the retailer’s offers that day of 50 percent discounts on things like a $150 Sylvania tablet computer and a $45 My Baby Alive Doll.

“The sales just aren’t as good this year,” says Beasley, 30, who has three children. “It’s almost not worth getting up.”

People have been shopping more than ever this holiday season, largely because of a flood of sales. But Americans have become so used to deep discounts that they expect each sale to be bigger and better than the last. That means retailers will likely have to keep slashing prices, which could hurt their bottom line.

“I think they’re going to have to continue to do the kind of `come on’ pricing that you saw on Black Friday,” or the day after Thanksgiving, says Alison Paul, head of consulting firm Deloitte’s U.S. retail practice.

Merchants already are rolling out big holiday sales. The Body Shop is letting customers spin a wheel of chance to win different discounts, including offers of “buy three, get three.” The Gap is selling many of its pajamas, kids’ hoodies and men’s cardigans for 50 percent off. And Target has Barbie, Thomas the Tank Engine and many of its other toy brands for “buy one, get one half off.”

But shoppers are yawning at deals that once excited them.

“The ads and the sales _ I think it’s all hype,” says Karen Finch of Gresham, Ore., who is waiting to buy a tablet for her son until closer to Christmas Day because she thinks the discounts on Amazon.com _ 48 percent off a $500 Blackberry version, for instance _ aren’t good enough. “There’s no substance.”

To be sure, consumers’ perceptions of deals don’t always jibe with reality. Most retailers decline to discuss their pricing strategy because of competitive reasons, but research by analysts at Jefferies & Co. and other firms found that many deals this year are as good as _ if not better than _ last year’s.

For instance, American Eagle offered 40 percent off everything all day on Black Friday _ better than the 20 percent off until noon that it offered for the past two years, according to Jefferies analysts. The average discount at Best Buy on Black Friday was almost 45 percent, up from about 34 percent last year. The average discount at Wal-Mart was about 47 percent, better than last year’s average of 43 percent.

And anyway, what shoppers say and do often are two different things. Consumers told Deloitte in September that they planned to spend about 5 percent less on Christmas this year. But the reality so far is different: Americans spent $52.4 billion over the Thanksgiving holiday weekend, the highest total ever recorded for that period and 16 percent greater than last year, according to the National Retail Federation.

“You can’t always listen to what they say,” says Allen Adamson, managing director at the branding company Landor Associates. “What counts is what they do at checkout.”

Indeed, Atty Zschau of Portland, Ore., has been disappointed with the holiday sales she’s seen so far this year. But instead of going home empty-handed on Black Friday, she shelled out $800 _ full price _ for a Dell laptop that will be shared among her family.

“We’re normally `deal’ people,” says Zschau, an acupuncturist. But, “All the stuff that was on sale was not what we wanted.”

The discontent with discounts comes at a time when many Americans are struggling with job losses and stagnant wages. Many shoppers simply have less money to spend this holiday season: The median U.S. household income was $49,445 last year, down from $50,303 two years before.

And deals just don’t seem as good if the iPad tablet computer you want is still outside of your budget. A $1,000 TV marked down 20 percent might seem like a good deal for a shopper who has $800 to spend. But it’s not such a fab find for someone with only $700 in his pocket.

“Discounts are supposed to mean, `I can get it,’” says Michael Norton, a Harvard Business School professor specializing in consumer psychology. “So if you can’t get it, it doesn’t feel like a very good discount.”

Cost-conscious shoppers also have a long memory about the better sales they’ve seen in the last few years, says Alison Jatlow Levy, retail strategist with consulting firm Kurt Salmon. For instance, teen retailer Aeropostale offered discounts on Black Friday of 50 percent off everything and another 20 percent off until mid-afternoon. But that may not have been enough for Aeropostale shoppers who remember that the chain slashed prices up to 70 percent all day in previous years.

“Customers probably remember that last year things were 60 percent off, and this year maybe they’re only 25 or 40 percent off,” Levy says of some store discounts. “But those things probably weren’t 60 percent off until closer to Christmas.”

Rebecca Walden of Birmingham, Ala., learned that lesson the hard way. Last year, she and her husband stayed up late on Thanksgiving night buying Christmas gifts online for their daughter, who was then one-years-old. They were patting themselves on the back about the discounts of 10 to 20 percent off they got on toys like a rocking horse, a play kitchen and a set of 150 building blocks. That is, until they found many of those same items on sale for half off later in the season.

Walden, 33, decided not to repeat that mistake. So she’s done virtually none of her Christmas shopping yet. She’s waiting it out for a deal on a few items, like a sale on a Wiggles guitar, which generally runs at least $65.

“I’m not convinced they’ve hit rock-bottom prices yet and Christmas is still several weeks away,” Walden says. “I think the phrase is `playing chicken.’”

____

Sarah Skidmore reported from Portland, Ore. Christina Rexrode reported from New York.

Follow AP retail coverage at http://www.twitter.com/AP_Retail.

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Marlboro maker Altria Group Inc. said Thursday that it will cut the number of salaried workers at its cigarette business and related service subsidiaries by 15 percent as cigarette sales continue to decline industrywide.

The owner of the nation’s largest cigarette maker, Philip Morris USA, announced plans to trim $400 million in annualized costs by the end of 2013 as it reported quarterly earnings Thursday, which would include about $300 million in employee separation costs and additional reductions in spending.

Altria, based in Richmond, Va., would not say how many people would be impacted by the layoffs. The company said employees that will lose their jobs will be informed by mid-December and most will leave the company by late February. The reductions announced Thursday do not include hourly manufacturing workers.

Altria has 10,000 employees across the U.S., including about 4,600 in Virginia. Cigarettes make up the bulk of its business.

Cigarette volumes have declined annually by about 3 percent in recent years and have fallen significantly since a 62-cents-per-pack federal tax increase in 2009. Additional state tax hikes, smoking bans, health concerns and social stigma have made the cigarette business tougher. Consumers also face economic challenges, and unemployment remains high.

“One of the things that you’re going to have to do in this business is as volume declines … you have to take out cigarette-related infrastructure cost, in order to manage the business properly,” CEO Michael E. Szymanczyk said in a conference call with investors regarding the company’s third-quarter financial results. “You can’t carry infrastructure for a business that was originally designed for a bigger business. You have to continue to shrink it as the overall business shrinks.”

The number of cigarettes that Altria sold declined 9 percent in the third quarter to 33.3 billion cigarettes compared with a year ago, and the segment’s revenue during the quarter fell 6 percent to $3.64 billion, excluding excise taxes.

Tobacco companies like Altria have tried to offset declines in cigarette sales by reining in expenses and raising prices.

During the third quarter, Altria said it completed a multiyear cost savings program, exceeding its goal of reducing costs by $1.5 billion between 2007 and 2011. That program included the closure of its Cabarrus manufacturing facility in North Carolina in 2009.

Others in the industry also have made cost-cutting moves, including closing or consolidating factories and sales forces, and offering buyouts to some workers.

Efforts to reduce costs are commonplace for consumer goods companies in recent times, Edward Jones analyst Jack Russo said.

“Especially in developed markets such as the U.S. and Europe, it’s been very hard to grow for these consumer companies,” Russo said. “And when you can’t grow the top line, you’ve still got to grow profits in line with what Wall Street’s expecting, there’s only one way to do it, you’ve got to cut costs and headcount is part of that.”

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About 200 Longshore workers involved in a hostile labor dispute in Washington state gathered at a courthouse on Friday, challenging the sheriff to peacefully arrest anyone in the crowd accused of committing a crime.

“We’re here. If you want us, come and get us,” shouted ILWU Local 21 President Dan Coffman, looking up at the building. Union members cheered his declaration but largely stood quietly in two long lines.

No law enforcement officers approached the crowd, and nobody was arrested during the demonstration. After about 30 minutes, Coffman led the group away and said he hoped they could live their lives without fear of confrontation from authorities.

But later in the day, authorities arrested ILWU Local 21 Vice President Jake Whiteside, said Grover Laseke, a spokesman for the Cowlitz County Sheriff’s Office. He was charged with criminal trespass in 2nd degree and obstructing a train in connection with a massive protest that blocked a train in Longview last week.

Union leaders balked at the arrest, which came just after they had offered themselves to authorities. Laseke said the union had not communicated to law enforcement about their plans to visit the courthouse.

“That isn’t the way we’re going to be doing business,” Laseke said. He said officers were going out and making arrests as they would do with any other crime.

The union had complained that authorities have not responded to requests to peacefully coordinate with those charged with crimes related to the protest.

Officials estimate they have made roughly 200 arrests throughout the months-long labor dispute. Many of the charges have been minor _ such as for trespassing _ but authorities are also investigating a raid last week in which witnesses said Longshore workers stormed a grain terminal, damaged property and overwhelmed security guards.

One of them _ 45-year-old Ronald Patrick Stavas of Kelso _ has been charged with first-degree burglary, second-degree assault, intimidating a witness and sabotage.

The union had characterized the arrests that have occurred as “abusive.”

Laseke said he would be glad to facilitate a discussion between union leadership and the sheriff about how to bring in those suspected of crimes, but he disputed the suggestion that workers were being unfairly targeted. He also said investigators still have a “pretty good handful of arrests that they want to make.”

ILWU workers believe they have the right to work at a new grain terminal operated by EGT. The company has instead hired another firm that is staffing the site with a different set of union workers.

The aggressive tactics used by union protesters has not only drawn the ire of local law enforcement but also the National Labor Relations Board and a federal judge. The judge found the union in contempt on Thursday and is considering a fine in connection to last week’s protests.

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The problems that have weighed on investors all summer _ European debt and fear of a new recession in the United States _ hammered the stock market Friday. The Dow Jones industrial average fell more than 300 points.

The plunge erased the week’s gains for stocks and sent the Dow below 11,000. It had not closed below that level since Aug. 22, after several weeks of extraordinary volatility.

The European Central Bank said a top official, Juergen Stark, was resigning almost three years before the end of his term in 2014, revealing deep disagreement over how to solve economic problems in Europe.

Traders fear that one of the continent’s heavily indebted economies could default, an event that would ripple through the global banking system and make it difficult for other European countries to borrow money.

Such an outcome could tip the world economy back into recession. In the U.S., economic growth is already slowing, and unemployment is stuck above 9 percent.

Friday was also the first chance for the markets to react after President Barack Obama presented Congress and the nation a $447 billion jobs program. It is not clear to traders that the plan will get through a bitterly divided Congress.

The Dow finished down 304 points, or 2.7 percent, its steepest drop in more than three weeks. It closed at 10,992. The average approached a 400-point drop at some points in the afternoon.

“Markets always vacillate between fear and greed, and today we’re coming down pretty much all on the fear side,” said Kim Caughey Forrest, equity research analyst at Fort Pitt Capital Group.

The Standard & Poor’s 500 closed down 32, or 2.7 percent, at 1,154. The Nasdaq composite is down 61, or 2.4 percent, at 2,468. All three indexes finished down for the week.

Investors drove the yield on the 10-year Treasury note to 1.92 percent, its lowest since the Federal Reserve Bank of St. Louis began keeping daily records in 1962. The yield was 1.99 percent a day earlier.

Wall Street traders have poured money into U.S. government debt all summer, driving the price up and the yield, which moves in the opposite direction, down.

Even after Congress narrowly met a deadline for raising the limit on how much the government can borrow, barely avoiding a default for the country, investors think U.S. government can be counted on to pay its bills.

Word of the resignation of Stark, the top economist at the ECB, came shortly after U.S. markets opened. He was an advocate for higher interest rates, and published reports said he left because he opposed the bank’s extensive purchases of debt issued by European countries.

Stark’s departure rattled traders because the U.S. economy is “teetering on the verge of recession,” and the outcome in Europe might determine which way it goes, said Andrew Goldberg, market strategist with J.P. Morgan Funds.

He said traders are latching onto any piece of news that might signal a positive or negative outcome in Europe.

Banks in Europe hold bonds issued by nations deep in debt, including Greece, Ireland and Portugal, but investors don’t know exactly how much each bank holds from each country.

The value of the bonds would quickly diminish if one of those nations defaults. Banks might stop lending to each other because of fears that some would fail.

Stark’s departure was seen as “a bit of news that contributes to a worse outcome, so if you’re thinking of being a seller, today that’s what you are,” Goldberg said.

The central bank’s troubles raise the stakes for a meeting this weekend in of financial leaders from the world’s most developed economies.

High volatility returned to the market Friday. One measure known as the VIX, which measures investors’ fears, increased 18 percent.

Friday’s plunge extends a tough quarter for the stock market. The S&P 500 is down 13 percent since the third quarter started in July. However, it has recovered almost 4 percent since its lowest close this year Aug. 8.

Analysts say stocks are likely to fall further as the crisis in Europe goes on. A shrinking European economy would hurt the U.S. because roughly a quarter of American companies’ revenue comes from Europe, said Sam Stovall, chief investment strategist for S&P in New York.

“Maybe the market has already priced in a very, very soft spot, but it has not priced in quicksand _ it has not priced in a recession,” he said.

Forrest, of Fort Pitt Capital, said the sell-off had brought some stock prices “within buying range.” She said traders have few other places to invest, with Treasury yields near record lows and currency markets gyrating because of fears about the euro.

Markets in Europe also fell sharply. France’s CAC 40 and Germany’s Dax fell about 4 percent. London’s FTSE lost more than 2 percent.

In the U.S., McDonald’s Corp. stock fell 4 percent because of disappointing revenue. McDonald’s said that revenue at restaurants open at least 13 months rose 3.5 percent in August. Analysts expected 4.9 percent.

Bank of America Corp. fell 3 percent after The Wall Street Journal reported that it might cut up to 14 percent of its work force as part of a massive restructuring. Bank of America already has cut at least 6,000 jobs this year. CEO Brian Moynihan announced a management shake-up this week.

VeriSign Inc., which manages Internet domain names, fell 15 percent after its chief financial officer resigned. Specialty glass maker Corning Inc. fell 6 percent a day after it said it expected to sell less glass for LCD TVs than originally forecast.

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U.S. stock futures are falling ahead of a vote in the Senate to raise the nation’s borrowing limit.

The Treasury Department has said that Congress must raise the debt ceiling by the end of Tuesday in order to allow the government to pay all of its bills. The Senate is expected to vote on the bill before the market closes. The House passed the measure Monday night.

Investors are growing concerned about the U.S. economy and will be looking at consumer spending figures that are expected to be released before the market opens.

Ahead of the opening bell, Dow Jones industrial average futures are down 41 points, or 0.3 percent, to 11,999. S&P 500 futures are down 6, or 0.4 percent, to 1,274. Nasdaq 100 futures are down 9, or 0.4 percent, to 2,337.

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