My “One” Criterion for Hiring Physician Consultants and Doctor Advisors

More about the Frightening “F” Word

Dr. David Edward Marcinko MBA CMP™


As you begin to search for a medical practice business advisor or healthcare consultant, be sure to contact the advisor and request a short initial meeting that should be free of charge.

Just as you would select your own physician, you should base your consulting decision on credentials, experience and especially education. Fee schedules are probably of least importance. And, by understanding the “F” word, you stand the best chance of finding an advisor that’s right for your budget, practice and personality.

The Traditional View

The traditional view of medical management consulting, or the financial advisory or financial planning business, is not of a fiduciary. Historically, in the view of many, attorneys, doctors, CPAs and the clergy are proto-typical fiduciaries, as are the small but emerging class of contemporary Certified Medical Planners [CMP™]. They have a clear duty to put the best interests of their clients, patients, congregation, etc., above their own and to disclose conflicts of interest, etc. Too many others who retain this title function as poseurs.


The stock market collapse, SEC debacle, home mortgage and real estate fiascos of the past few years, all highlight the lack of general accounting, financial, business and advisory oversight of Wall Street, the NASD/FINRA and related private and government monitoring agencies. This includes financial and investment advisors, wealth managers and healthcare consultants.

Fiduciary Definition

According to Bennett Aikin, Accredited Investment Fiduciary [AIF®], a fiduciary consultant is someone who offers advice, or manages the assets of another person and stands in a special relationship of trust, confidence, and/or legal responsibility [personal communication].


Financial designations that indicate fiduciary duty do not exist absent the proto-types mentioned above. Rather, it is function that determines who is a fiduciary; not designations, certifications or licenses to hold a particular trade-mark, service-mark or registration-mark.

So, a fiduciary advisory, according to these definitions can be held accountable for a breach in fiduciary duty, regardless of any expertise they do, or do not have. This underscores the critical nature of understanding the fiduciary standard and delegating certain duties to qualified “professionals” who can fulfill the parts of the process that a non-qualified fiduciary cannot.

Fiduciary? – Get it in Writing!

But, this does not mean it is impossible to find a healthcare consultant who accepts fiduciary responsibility and acknowledges the same. The best way to rectify confusion is to get fiduciary status acknowledged in writing and review all of the necessary steps in the fiduciary process to ensure fulfillment. An acknowledgement of fiduciary status letter can even be a simple checklist to ensure the entire fiduciary process is being covered.



Public resources for understanding the fiduciary process and for choosing appropriate consultants include the Department of Labor, the AICPA’s Personal Financial Planning division, and iMBA Inc. Private resources are available from the law firm of Reish Luftman Reicher & Cohen. The firm specializes in employee-benefits law and is considered leading ERISA experts. More resources from include:

  • Fiduciary Standard of Excellence
  • Safe Steward Document
  • Stewardship Handbook
  • Legal Memorandum Handbook


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8 Responses

  1. Is disclosing conflicts of interests enough to qualify as a financial advisory fiduciary?

    Can a financial advisor recommend that a client invest in FUND XYZ (A shares) [which also includes the payment of a 5.75% sales commission to the financial advisor] and still say that he/she is looking out for the best interest of the client? What if the financial advisor knows that the client can purchase those same shares of FUND XYZ (no load shares) without a 5.75% sales commission at competitor firm, is the financial advisor still a fiduciary looking out for the best interests of his client? Does not the charging of even a disclosed sales commission disqualify an advisor from being a financial advisory fiduciary?

    Dodd Frank passed without requiring a universal fiduciary-duty rule which would require broker-dealers (Merrill Lynch, Morgan Stanley, UBS, Wells Fargo Advisors, etc) to meet the investment adviser standard. The SEC is now left to grapple with this. Central to the conflict is the question of sales commissions. In the above questions about sales commissions, broker-dealers would answer “no” while fee-only investment advisors would answer “yes”. How would you answer?

    David K. Luke
    Physician Financial Planner (Fee Only)


  2. **Clarification**

    In the above questions about charging sales commissions, a broker dealer would answer “no, the charging of even a disclosed sales commission does not disqualify an advisor from being fiduciary,” whereas a fee-only investment advisor would agree that the charging of such disqualifies fiduciary status.

    David K. Luke
    Physician Financial Planner (Fee Only)


  3. Corzine-run firm admits using clients’ money

    “CME has determined MF Global is not in compliance with Commodity Futures Trading Commission and CME customer segregation requirements,” CME Group Inc Chief Executive Craig Donohue just reported.

    Futures brokers must keep customer accounts separate from each other and from the firm’s own money.

    So, I suspect the “Big C” is NOT a fiduciary-eh!



  4. Fiduciary and SRO Issues to be Put On Hold?

    Did you know that the two biggest issues facing financial advisors — a fiduciary standard and a self-regulatory organization (SRO) — probably won’t be resolved until next year — maybe not even until after the November election.

    This appears to be the consensus of regulators, lobbyists and politically active advisors.

    And, on requiring all who give investment advice (including insurance agents selling products tied to the stock market) to live by a fiduciary standard, the SEC probably won’t unveil a proposed ruling until sometime in 2012.

    Well, that’s my opinion; what’s yours?

    Dr. David Edward Marcinko MBA


  5. Seven Ways Investors get Taken by Wall $treet and Financial “Advisors”

    1. Commission brokerage plans that work to Wall Street’s advantage.
    2. Cleverly crafted marketing and sales systems that mislead naive investors.
    3. Favorable Securities and Exchange Commission regulations won by Wall Street lobbyists.
    4. Deceptive portfolio alternatives, practices and advice that skim fees.
    5. Systemic data manipulation with stocks, bonds, mutual funds and derivatives.
    6. Psychological profiles of investors that are used against them.
    7. High-frequency trading algorithms that run circles around individual investors by making thousands of trades in hundreds of milliseconds.

    Dr. Marcinko – thanks for all the fiduciary material.

    Dr. Alonzo


  6. Is the SEC Playing Hardball?

    The Securities and Exchange Commission (SEC) filed 30% more enforcement actions against investment advisors in the fiscal year ending September 30th, than in 2009-10.

    The increase in actions against broker-dealers was 60% – double that for investment advisors [RIAs].



  7. More on Fiduciary Designations

    Excellent post, Dr. Marcinko with good comments from all. Now, did you know there is a new “F” designation from DALBAR, Inc?

    From their website:

    The Registered Fiduciary™ certification identifies financial professionals that have met the necessary requirements to serve in the important new role of Fiduciary Adviser. RF™ certified professionals are identified as having met the highest fiduciary standard in the financial industry. The RF™ certification is continuously being updated to reflect the most recent regulatory, marketplace and technology changes.

    What do you think of that?



  8. Is FINRA’s BrokerCheck Broken?

    Dr. Marcinko – Excellent post and blog. I can tell that you are an industry insider.

    But, while regulators have just seemingly made it easier for investors to dig into financial advisors’ backgrounds, even with the new disclosure rules, FINRA BrokerCheck doesn’t supply investors with all of the information that, in my humble opinion, they should be able to access.

    Furthermore, the multiple sources that investors or interested parties need to research to get a complete picture of an advisors’ disciplinary history make the current system unnecessarily burdensome and difficult to use.

    Perhaps worst of all, an individual checking on an advisor will probably not be aware of the many sources or that each source can provide a very different picture.



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