Wednesday, February 19, 2014

I sought professional help.

By Stephanie Bonne, MD

When I finished my training, my husband and I were overwhelmed by decisions - student loans, college planning, life insurance, oh my! So, we decided to seek the help of a financial advisor. It's definitely been one of the better decisions we have made.  To address financial planning this month, I decided to interview my financial advisor, Robert Balice of Bridgewater Asset Management, and the answers to my questions are below.

Q: Many people say, “I'm finishing training, so I’ll just quickly pay down my student loans and max out my 401k.  What do I need a financial advisor for?”
A:  Some people don't need one, but I cannot think of a case when an advisor would not provide significant benefit to someone, particularly someone just starting out. When you are starting out, you need to have some perspective of where you are going.  Set goals, then focus on what you do well (surgery), while having an advisor guide you through the rest can help you take advantage of the opportunities available to you, and help you miss some of the pitfalls on the way.  Even simply establishing an investment strategy for your 401(k) is fraught with pitfalls. 

Q: Okay, so I think I need an advisor. How do financial advisors get paid?
A: Good advice is not free, but it is important to understand how an advisor is compensated to make a choice that fits your situation.  There are 2 predominant ways:

1. Commissions – The advisor makes a commission on the products they sell you (insurance policies or investments).  This can work if you don’t need long term advice, like managing a one-time inheritance.  However, beware of implication that you don't pay anything for the investments they place you in simply because you don’t “see” the charge.  There may be up front, ongoing or back end sales charges. It may appear that you are not paying anything, but the advisor is definitely making something by recommending a certain investment or insurance product.

2. Advisory fees - for the vast majority of people, you want your advisor to be compensated in a way that he/she is motivated to keep your interests first, and stay engaged over the long term.  A fee-based advisor is not getting transactional compensation up front by selling products, they make money on your business over time, so it is in the interest of the advisor to keep you as a long term client and make sure you continue to get advice on your investments. 

Either one can be right for any individual.  A fee-based advisor is a true consultant and not a salesperson.

Q: What’s the best way to address my student loans?
A:  There are a few strategies that apply to everyone.  Consolidate your loans to get lower interest rates, and try to get fixed rate loans in case interest rates rise.  Next, consider what you can make in your investments versus the interest on your loans to decide what to pay off. If you are paying 2.5% on your loans, don't rush to pay those off and forego savings where you can earn 5% and build an investment account.  Remember you can always liquidate your savings to pay the loan off in the future for some other reason. To contrast, if your student loan rates are 8% annually, you should pay those down, because it's hard to expect that your investments will make 8% annually after tax.

Q: I have little kids at home.  How much is college going to cost for them?
A: Most children of educated parents, certainly doctors, would expect that their children are going to attend college. You can pay for college by either saving for it with discounted dollars, or pay for it afterwards with loans that have additional interest costs.  I suggest that you not plan for financial aid.  The best way to plan is to start early, and save for a good 4 year university, either private or public.  A child born today will need about $200,000 for a 4-year degree at a public school, or up to 3 times that for private school.  To achieve this, you need to save $400-$1000 per child per month from your child's birth. It's hard to imagine that private schools will cost over half a million dollars, but that's just the reality.  However, college inflation was previously 6-7% annually, but has recently slowed.  Still, I'd plan for the worst and hope for the best.  

Q: Taxes are always a concern for those in higher income brackets.  How do I avoid taxes?
A: Start by taking full advantage of employer matching contributions through your qualified plan (401k, 403b). Today, many companies offer traditional pre-tax savings or after-tax investment savings as in a Roth 401(k).  If you are still in residency, you tend to be in a lower tax bracket, and at that point, you are better off using Roth 401k or Roth IRAs, because the taxes today are not as large as the taxes you will pay when you take that money out.  If you are out of residency and in a higher tax bracket, then you definitely want to use the pre-tax options so you get the tax benefit today.  You can control your taxes better in retirement by choosing how much income you are going to take, whereas you have less control now, as your income is decided by your employer. If you have outside income due to speaking engagements or consulting, you should consider opening a personal qualified plan for that income.  The tax code allows you to have multiple qualified plans as long as there is no common ownership with your employer.

After your retirement accounts, your tax deductions dwindle quickly.  If you are saving for your child's education, some 529 plans offer state income tax deductibility.  

After that, try minimizing taxes on the savings that you are making on an after-tax basis. These generate taxable income and capital gains.  Variable annuities or variable universal life policies can accomplish this, but consider all the pros and cons of these vehicles and the tax implications of such products.  Bottom line is: you can lose up to 1/3 of your investment earnings if you don’t pay attention to the tax treatment of your investments. .  Not all investments make sense for everyone - this is why you need a qualified advisor.

Q: I am concerned about an injury that causes a loss of my ability to do surgery.  How do I plan for this?
A: You’re right; statistically, you have a 40% chance of being disabled for 90 days or more before age 65. Your first line of protection is your employer’s group long term disability plan. However, be aware that it typically does not cover all your compensation; specifically, it may not cover your bonuses and will not cover any outside income. You may want a personal disability policy that overlaps the group coverage.  If you purchase options for future coverage, that guarantees your insurability as your income continues to go up.  If you plan on having your own practice, and therefore not working for an employer, then a personal disability policy is essential to do at a young age when you are healthy and costs are lower.  

Q:  Long term care insurance (LTCI) is getting more expensive and is of greater necessity for women than men.  How should we be prepared?
A: Because women statistically live longer than men, insurance companies have struggled to fully assess LTCI.  As a result, some states have recently taken away unisex rates for LTCI, resulting in up to 300% increases in rates for women, who use LTCI more and live longer.  Not all states have moved away from unisex rates, but they probably will at some time.  If you have any genetic conditions that would result in long term care needs (Parkinson’s, Alzheimer’s); then early coverage is essential.  

Q: What if I still live in a state with unisex rates?
A: If you are in a state that still has unisex rates, you should take advantage of some sort of coverage.  The premiums are not guaranteed, and all rates will go up as the demand for long term care increases. But, if you are in a unisex state, you would probably get a much better premium if you get a policy before your state changes. If your state changes later, your rate will probably be more than the unisex rate, but less than the female rate.

Q: Does long term care insurance follow you if you move?
A: Some employers have group long term care which are portable if you leave employment.  But, these tend to have limitations in coverage for things like in-home care. In that case, a personal long term care usually will provide more comprehensive coverage, and is portable if you change jobs. The timing of when you should acquire LTCI is based on many individual factors such as age and health.

Q:  Women typically have longer life spans.  What does this mean for financial planning?
A: We already addressed long term care.  The other challenge is to accumulate retirement assets.  If you live into your 90s, you may need to draw 30 years of income from your investments.  Longevity translates to a more aggressive savings strategy now. This does not necessary mean taking on more risk, but would require higher accumulation to meet their retirement needs. The advantage women have due to longevity is cheaper life insurance rates because insurance companies are less likely to have to pay your death benefit early.  What that means in terms of financial planning is that we can consider insurance-oriented products to provide sources of retirement income with relatively low insurance costs.

Q: I hear a lot about the debt accrual by the US Government, what does this mean to me?
A: This isn't meant to be political, but the fact is, the government has a lot of debt.   In the intermediate and long term, having so much debt is likely to translate to higher inflation and higher taxes.  This requires your retirement savings to outpace inflation, in particular.  In the short term, interest rates will likely need to increase. This means you should be aware of the impact of rising interest rates, in particular to fixed income investments.


Robert Balice is a full-service financial advisor at Bridgewater Asset Management in Chesterfield, MO.   He completed his undergraduate education at Lawrence Technological Institute in Michigan, and has an MBA from Washington University in St. Louis.  He has over 20 year experience in financial planning.

 Stephanie Bonne is an assistant professor in trauma, acute and critical care surgery at Washington University in St. Louis. 

Tuesday, February 18, 2014

How to Create Your Own Personal "Index Fund"

Amidst the universe that encompasses financial planning, what seems to perplex and puzzle people the most?  The casual answer usually is “the stock market” or “how to properly and safely invest.”  With financial planning, it is much easier to wrap our minds around proper insurance coverages, paying off the mortgage sooner rather than later, and understanding healthy debt versus corrosive consumer credit debt, compared with diving into the often murky waters of stock investing.   

When it comes to retirement planning with an advisor, we are often told to max out our 401(k), or other type of IRA.  The planning process typically concludes with the individual getting excited about putting together a mutual fund portfolio that will bring him or her the proverbial pot of gold at the end of the retirement rainbow.  This is all fine and wonderful, and certainly possible.  But, there is another young tree that you can plant, which if cared for properly, and with surprisingly minimal attention, could be one of the tallest and strongest trees among your different nest egg strategies.  It entails the selection of individual stocks in your brokerage account.  You may have to talk with your bank or financial advisor on how to properly open an IRA in which you can select and purchase individual stock within a discount brokerage, but it is easy to do.  The hard part is knowing how to select good companies yourself or with minimal help.  In this article, I’ll highlight one strategy of doing it yourself, versus relying solely on mutual funds, which is the way most individuals and couples invest.  
First off, the advantages of owning a mutual fund involve the diversification and ability to have a professional fund manager watch over the fund, and ultimately, your money.  If you go this route, it’s best to choose a no-load fund company such as T. Rowe Price or Vanguard.  The easiest way possible is to choose an index fund that mimics the S&P 500 or the Dow.  This is not a bad way to invest, albeit at a basic level.  It works, provided you are several years away from retirement, and can handle the periodic swings of the market.   

Now the disadvantages to mutual fund ownership are the yearly management fees (typically .5 to 2%) which, however small, with eat into your returns year after year.  Over a lifetime, it will add up.  In addition, most mutual funds are too diversified, meaning they have to own dozens if not hundreds of stocks.  Again, not a huge problem, but it will be hard for most mutual funds to consistently beat the averages year after year.  Yes, some funds will outperform.  However, every year, the business news reports how a majority of funds did not outperform the market.

How does a person with no financial or accounting background select a portfolio, which will take little more than an hour per month, to monitor?  One way is to purchase the DOW Jones Industrial Average.  For example, purchase every stock (currently 30 stocks) in the DOW in equal dollar amounts, and then hold onto them.  This amounts to an index fund that you have created yourself, without the management fees to eat into your returns.  The benefit of using the DOW is that it represents some of the best companies in America in which to invest.  Many of those companies also pay dividends. Even better, many of them increase the dividend yearly.   For example, Proctor and Gamble has increased its dividend for more than 55 consecutive years.  By mimicking the Dow, you have eliminated the necessity of having to start from scratch researching companies. 

As for the downsides of the above approach, first off, make sure (as with any mutual fund) you have a long term time horizon that is several years into the future. If you are less than five years from retirement, you may want to seek the advice of a professional regarding how to put together a conservative portfolio.  If you have no interest at all in looking at your portfolio, at least monthly, then you may be better off using mutual funds.  Third, if you are going to mimic the DOW and purchase all thirty stocks, then it is best to have approximately $1,000 invested per company, for a total of $30,000, so your brokerage commissions are not too large a percentage of your purchase. , If you have $15,000, then choose fifteen stocks in the DOW that pay dividends with a history of increasing the dividend over time.  The dividend history is often located in the investor relation section of the company website.  It may be under the heading of “stock information” within the investor relations tab.  If you have $10,000, then invest in ten DOW stocks with a history of annual dividend increases.  If you have less than $10,000 to invest, best to stick with a mutual fund or funds for diversification, as the commissions in purchasing stocks may be too costly for this approach.  

The above approach should require very little buying or selling, as you are mimicking the DOW.  If one stock becomes too large a percentage of the total portfolio, for your comfort level, then sell some shares and redistribute the proceeds among the other names in your portfolio for a more equitable weighting.  If you invest in this manner, you will closely, although not exactly, be following the DOW in a way similar to a mutual fund.  

For the above reasons, if you have the time, and the interest, consider putting together your own “index fund.” You will save on the management fees, closely mirror the DOW’s returns, and likely have some fun in the process.  However, if you have no time to devote to this approach, rest assured that purchasing an index fund with a  reputable no load mutual fund company is a great way to go.  Best of luck in whichever journey you decide to embark upon. 

By Ken McLemore, licensed CPA in the State of California

Financial Planning for Young Physicians

By Christina Cellini, MD, FACS, FASCRS

Financial planning is something that gets overlooked during medical school and residency (likely because you probably don’t have much of it!). Before you know it you are an attending and making a real salary for the first time and its imperative to learn how to spend and invest wisely.  I reached out to my personal accountant Paul Visca, CPA in Rochester NY, as to what is advice he would give to young professionals.  Here are his pearls of wisdom: 
  1. Save for retirement. Begin as early as possible. Take full advantage of a company’s retirement plans. The earlier you start the more time will be available to take advantage of compounding. Money doubles every 7 years at 10%.
  2. Take control of your finances through self-education. Read investing literature as much as possible. Learn the basics. The biggest hurdle I've seen is a complete lack of knowing investment "jargon." Even if you hire a financial planner, knowing the terminology is powerful.
  3. Start saving for kids college early. Again the power of compounding comes into play here. 529 plans are great vehicles for this.
  4. Live below your means!! Especially if debt is involved. Save monthly.
  5. Books to read to help achieve these goals - I particularly like books by John Bogle (founder of Vanguard Funds). 

I would also add to hire an accountant to help you with your tax returns if you don’t already do so. These get significantly more complicated to do once you are in a higher tax bracket and things like houses, cars, spouses and kids are involved. The small price tag of doing so significantly pays off in terms of what you end up paying the government otherwise. Finally, below are two articles that are found on the web that detail some of these points.

Both can be accessed for free online, but registration to the site is required.

Dr. Christina Cellini is an Assistant Professor of Surgery and Oncology at the University of Rochester Medical Center in the Division of Colorectal Surgery.

OH No—Money!

By Janet Meller, MD, FACS

On March 29, 2013, the New York Times published an article entitled Money Advice for Doctors and Lawyers and the Rest of Us by Paul Sullivan. It echoed a very familiar theme, that physicians are not good at finances.  In particular, we do not know how to save and we do not know how to invest.  We come out of our residencies and are faced with decisions that we have little experience or knowledge to make.  This includes negotiating a salary and benefits package, managing a business (for those going into private practice), and managing a private income that increases dramatically after years of struggle.

Women, in particular, are at a disadvantage because we are historically poor negotiators. I learned this first hand, joining an academic practice only to discover that my associate (male) was earning more than I even though we did the same work and I was also the clerkship director.  It took several years to rectify this problem and would have been easier to fix at the start.  

Furthermore, we are much more likely to have a duel income and a spouse that also has an agenda.  Most consistently, the most important thing that we can do is to get help and not try to manage everything ourselves—that includes a trustworthy, experienced financial planner and a lawyer (as much as we don’t like the “l” word) for contract negotiations and estate planning (not the same person). Lastly, if it feels unfair, speak up!

Planning for the future is also paramount.  We need to save for our retirement which seems far away, saving for our kids to go to college so that they aren’t burdened by debt, and planning for catastrophic illnesses or other events.  The smartest thing I did was to start saving for my kids as soon as they were born by opening accounts and putting money aside every month, more than you think you need to.  Now, I have put three variously through college, grad school and medical school.  They are all debt free.  I didn’t start maxing out my retirement accounts early enough, though, and now that I am getting close to that age, I am having to work hard at saving.  The recommendation is that you have 10 x your yearly salary ( at the age of retirement) saved to preserve your lifestyle.  It is easier to do if you start early!

Janet Meller, MD, FACS is an associate professor of pediatric surgery at Texas Tech University Health Sciences Center School of Medicine at Amarillo. 

Monday, February 17, 2014

Blogger Q&A: Why AWS?

Brittany Bankhead-Kendall, MD: Camaraderie and advice from women in the same boat as I! As women surgeons we are in a very unique situation and it's so beneficial to have others who have walked before you and have practical advice and inspiration to offer.

Christina Cellini, MD
: I originally joined AWS to take advantage of the excellent research funding opportunities that are offered. I have benefited from remaining a member by being inspired by other members who are able to balance work and family and are open and realistic about the many challenges we face in our field.

Amalia Cochran, MD
: I joined AWS as a resident when I realized the networking benefits that membership provided. I attended my first AWS meeting in Chicago and still remember being very impressed with this roomful of women surgeons (because, quite frankly, we had 3 women surgeons on faculty where I was a resident, and had no women surgeons on faculty where I went to med school). It was an exciting prospect for me!

As an AWS member, I have benefitted from precisely those networking opportunities. I’ve received some great advice on wisdom over the years from women who are senior to me and I’ve had the opportunity to mentor women who are junior to me. One of the important lessons I’ve learned is that of shared experiences and what we can learn from each other; while we often have a tendency to think that a challenge is unique to each of us as individuals, more often than not someone else has been through something similar and is eager to share what they did right and what they did wrong. 

Erin Gilbert, MD: I joined as a medical student because I was concerned about being a woman surgeon in a predominantly male field (at the time!) 

Celeste Hollands, MD: I joined the AWS in order to apply for the AWS Ethicon grant. Receiving that grant funding launched my academic career. The personal and professional relationships I have developed as a result of becoming involved in the AWS have guided and supported my career and afforded me the opportunity to lead with a group of women I am proud to share my personal and professional journey with.

Bharti Jasra, MD: I was introduced to AWS by my mentor Dr Janet Tuttle-Newhall. She not only introduced me to it but also paid for my membership. Since then I had the opportunity to not only meet and get inspired by great women surgeons but also network with fellow residents and students. Overall it has been a great experience and I would like to continue to work for this organization after completing residency this year.

Sophia Kim McKinley: I joined AWS on a lark - I had just developed an interest in surgery and wanted to see what kind of resources there were for students going into surgery. I did a quick internet search for "Women in Surgery" and that is how I found out about AWS! I was so pleased to discover the electronic version of the Pocket Mentor as well as information about the annual AWS meeting. At that time, none of my friends were planning on going into general surgery, so it was a great comfort to find an organization committed to the flourishing of women like myself. I wanted career resources, the opportunity to network with like-minded individuals, and perhaps even some mentoring. AWS membership has given me all of these things and more, including the chance to contribute to the organization's mission through participating on the medical student committee and writing for the wonderful AWS Blog. When more junior medical students approach me about resources for medical students interested in surgery, I always point to AWS!

Lauren Nosanov: I initially was introduced to the AWS through one of our newer female surgeons. I was immediately impressed by the incredible level of professional success represented by the AWS membership. Through my involvement with social media and the Communications Committee, I have come to be better acquainted with a number of members and organization leaders. Each of these women continually impresses me and inspires me, and serves as a reminder of the person and surgeon I want to become. I am grateful for both the friendships and mentorships that have emerged, and expect to be involved for many years to come.

Minerva Romero-Arenas, MD: I joined the AWS to find a support network and mentors in surgery who are open to discussing ways in which women can become leaders in our field. I have truly enjoyed the initiatives from the Association for education, networking, and scholarship.

Mona Singh: I joined AWS at the end of my third year of medical school, shortly after I realized I wanted to be a surgeon. I wanted to get to know, learn from, and be part of an inclusive community of women surgeons at various levels in their career and representing diverse surgical specialties, practices, and perspectives. I was looking for inspirational and grounded mentors and role models, as well as a community where I would be welcome to contribute and grow as a surgeon-in-training. I renew my AWS membership because I have truly found both in this association.

Callie Thompson, MD: I joined because I wanted to connect with more female surgeons. I am surrounding by amazing role models and mentors and I wanted to seek out a greater community of women in surgery. I would say that I have not taken advantage of even 10% of what AWS has to offer but I have received wonderful advice and support from the online community and I look forward to experiencing more in the future.

Jessica Wilson
: I study medicine in a country where doctors regularly imply (or sometimes just state outright) that I can't/shouldn't be a surgeon because I am female- that perhaps I should become a pediatrician or a family physician, because those careers are better suited to the demands of womanhood. I joined AWS to learn more about the profession of surgery, to make connections with other surgeons, and to be a part of an encouraging community.

Jane Zhao: At the time I joined, I was involved in the creation of a women in surgery lecture series at my school, and Dr. Lillian Kao suggested that I check out the AWS. Dr. Rosemary Kozar provided extra incentive by offering to sponsor my first year's membership. I can't thank my lucky stars enough that I joined. Since that time, I have forged some truly wonderful friendships and have been blessed to work with extremely talented and open-minded individuals to introduce new initiatives such as social media to the surgical community. I plan on renewing my AWS membership annually for the indefinite future, and I am excited to continue making meaningful contributions to the community via the AWS.

Why did YOU join the Association of Women Surgeons? Share with us in the comments below.

Tuesday, February 11, 2014

Green Solutions for the OR - Part 2

In 2013, the Association of Women Surgeons sponsored its second Green Solutions for the Operating RoomContest in a partnership with Practice Greenhealth.  We received many innovative and creative approaches to reducing the environmental impact of the operating room.  Today we are featuring a submission from Hena Ahmed, a 2nd year medical student at Harvard Medical School.  Hena’s submission describing her OR RecylingProject  won second place in the contest.  Congratulations, Hena!

Innovation in Practicing Cost-Saving Health Care

Using technology to reduce health care waste and deliver supplies to resource poor communities

by Hena Ahmed

A plastic bottle can sit unchanged in a landfill for decades. The same is true for single-use plastic devices in operating rooms. Consider the trajectory of equipment in today’s operating rooms: many of these devices are opened as part of surgical kits but not always used. Due to current hospital policies, these items are discarded after each procedure, perfectly intact. A discarded suture kit could sit in a landfill for decades, or be used to repair a wound in a low-income community.

As a first year medical student, I became interested in the intersection between resource recovery, global health delivery, and health care expenditure. In an era of rapidly rising health care costs, I developed an interest in finding a win-win-win solution for recovering and redirecting materials in hospital operating rooms while supporting health care delivery in resource poor settings. This resulted in the creation of the Medical Resource Delivery Project at Harvard Medical School.

With experience as an undergraduate in collecting supplies for global health projects, I found that a bottleneck for global health delivery often occurs at the level of resource and medication procurement to support projects abroad. Through my interaction with physicians interested in global health, I discovered a demand in other countries for recoverable resources from health care settings in the U.S.

Operating rooms are one of the main sources of hospital expenditure and waste generation. Despite efforts to reduce resource usage, operating rooms have limited data-driven assessments of their daily energy and equipment usage. Evaluation of these practices rests on yearly assessments. However, real-time data collection using mobile technology can improve practice and reduce waste.

Recovery programs currently in place, including at MGH and through nonprofits such as Remedy Inc, and the Afya Foundation, do not generate resources in a sustainable manner. These programs also have minimal tracking of their supply collection and shipping to other organizations. I developed a mobile application that would allow us to track recoverable materials from operating rooms. The purpose of the application is to use quick-response codes, similar to barcodes but customizable to individual items, linked with cloud-storage spreadsheets powered through Google Docs. The items that are collected are then shipped to nonprofit organizations. The application not only eliminates the need for manual tracking of supplies, but also allows us to understand the monetary value of the supplies being discarded and recovered. On a daily basis, surgical departments would be able to track both their resource consumption and their waste generation, while also tracking materials that are available for recovery. Hospital administrators would find this data invaluable as they work to target hospital costs that do not directly impact patient care and outcomes.

So how exactly does this application work? (Figure 1).

Figure 1. Process of Operating Room Resource Recovery

In just two years and in only two operating rooms, the application found more than $31,000 of materials that were recoverable from procedures in the obstetrics and gynecology floors at Massachusetts General Hospital (Figure 2).

Figure 2. Materials Recovered in Operating Rooms ($)

The findings were documented and presented at the 2013 Association of Women Surgeons Conference in Washington, D.C. The project was also recognized with an award in the Green Solutions for the Operating Room Contest.

The application continues to generate interest among the environmentally conscious surgeons, and our group recently partnered with UCSF School of Medicine and the Cleveland Clinic to implement the technology in their operating rooms. Future goals of the project include expanding to other operating rooms in MGH as well as other hospitals around the country, and partnering with nonprofit organizations to create sustainable delivery programs.

Ultimately, limiting waste is a key goal of operating rooms and hospitals across the country, and by implementing technology that allows for real-time evaluation and data collection, we can ultimately improve health care practice while simultaneously supporting health care delivery in global health settings.

About the author:

 Hena Ahmed is a second year M.D. candidate at Harvard Medical School. A native of Indiana, she graduated from Indiana University with highest distinction and Phi Beta Kappa in 2012 with a B.S. in neuroscience and a B.A. in chemistry. She co-founded Global Medical Brigades at Indiana University and collected over $100,000 in funding for two brigades to Honduras, forming the largest global health organization on campus. Her interest in neurodegenerative disease led her to complete an honors thesis in neuroscience as a 2011 Beckman Research Scholar. As a medical student, she received the 2012 Bertarelli Foundation Fellowship in Neuroscience and support to conduct a translational neuroscience project in Lausanne, Switzerland. She founded the Medical Resource Delivery Project at HMS through which she worked at Massachusetts General Hospital to build a mobile application aimed at collecting and delivering unused equipment to resource-poor communities. Hena is ultimately interested in the intersection of neuroscience and global health. She hopes to pursue a clinical career in surgery and impact health outcomes in the U.S. and globally. In her free time, she enjoys oil painting.