Did you work your way through medical school, pay off debt, make tremendous sacrifices to end up in a successful medical practice, and believe that wealth would just “happen” once you started earning the salary you envisioned?

It seems like common sense: save more, have more. But the way most people handle their finances is broken.

Take note: If you don’t plan to accumulate wealth, you may not. With the monumental changes ahead in the practice of medicine, lack of financial planning for physicians can saddle them and their families with unseen burdens.

If less than 1 percent of all advisers are legally obligated to hold your interests above their own, do you feel confident that your financial advisers are looking out for you? As professional money managers, we want to debunk widespread, commonly held, yet wrong beliefs for you to make more informed decisions as your wealth increases. Below is our first “true or false” quiz.

Attention physicians: Do you have a 401(k) plan for yourself and your staff? There are some recent changes from the Department of Labor that you need to be aware of, especially if your plan has not been audited in the past 5 years. As of July 1, 2012, changes in the Employee Retirement Income Security Act (ERISA) regulations governing such plans hold you, the employer — also called the plan sponsor — accountable for complying with new regulations. If you fail to do so, your employees may be eligible for damages. That could mean money out of your pocket.

By Jan. 1, 2013, not only will millions of people owe up to 20 percent more in estate taxes, but their options for asset protection will be significantly worse, as everything over $1 million will be subject to the highest rate of taxation. Not fully exploring your options now could prove very costly.

Senator Charles Schumer (D-N.Y.) was recently quoted stating, “The old style of tax reform is obsolete in a 2012 world.” In 2013 taxes will increase with the expiration of the Bush tax cuts.

All of the data we have seen, and the intelligence we are hearing from our advisors in Washington, leads us to believe that the next 20 years are going to be a lot tougher than the past 20 years for physicians.

Medical doctors will still continue to make a comfortable living. According to the New England Journal of Medicine, the median specialist in this country earned just over $350,000 in 2011. What will differentiate the successful physician of the next 20 years will not be their prowess in medicine, as was historically the case, but rather decisions made outside the practice of medicine.

In the past, it was simple: Get through the rigors of a medical school education, training, interning, residencies. Become a physician. Earn a great living. Right? Not so these days. Being a physician just isn’t as “easy” as it used to be.

The Physician Family Office recently completed an extensive study that confirmed what we all know to be true: Reimbursement is falling while the costs of operating a practice are rising.

One of my employees recently told me a story about how her now-deceased parents got married in the 1950s and lived in a one-bedroom rental in the suburbs as newlyweds while her father worked full time in a modest-paying management training program and went to NYU part time for his MBA at night. His tuition was paid for by the GI Bill, as he had served in the Army during the Korean War. The three nights per week he went to school, his young wife offered to work overtime at her job as a bank secretary. They met at Grand Central Terminal late those nights, tired and hungry.

The Physician Family Office recently completed a study confirming what we all know to be true: reimbursement is falling while the costs of operating a practice are rising. Several unsettling trends facing physicians are expected to continue over the next two decades. The approaching trends in the healthcare system directly affect how physicians manage their practices and their wealth.

When confronted with a range of titles, be it financial adviser, consultant, or wealth manager, how can you be sure the person you hire always will be acting on your behalf? What makes the question especially confusing is that some brokers will say they are able to act as both fiduciary and salesperson, seamlessly alternating between each role (typically depending on which role pays the most) without taking 100% fiduciary responsibility 100% of the time.

Despite raking in higher compensation than most other Americans, more and more physicians say they lack the financial means to retire today. Why?

Declining reimbursements, rising operating costs, and increasing threat of litigation surely play a significant role. But something else may contribute to the problem: Physicians may be making mistakes when determining who to hire to handle their money, and how to manage those they choose to hire.