Understanding Investment Apps: A Guide for Beginners

DEFINITIONS

By Dr. David Edward Marcinko MBA MEd CMP

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SPONSOR: http://www.CertifiedMedicalPlanner.org

An app, which is short for “application,” is a type of software that can be installed and run on a computer, tablet, smartphone or other electronic devices. An app most frequently refers to a mobile application or a piece of software that is installed and used on a computer. Most apps have a specific and narrow function.

BROKE DOCTORS: https://medicalexecutivepost.com/2025/08/02/doctors-going-broke-and-living-paycheck-to-paycheck/

Robo-Advisors

An easy and fairly cheap way for novices to get into investing is to use a robo-advisor. Basically, the funds you contribute will be invested by an algorithm based upon your goals, which are usually determined by taking a survey. This helps keep fees low; the algorithm doesn’t rely on a human expert to make trades, and you don’t have to spend significant amounts of time researching your investments. While this is a good way to start, it may not be the best option in the long run.

Online Brokerage or Investment Apps

More options are becoming available all the time, and they have opened trading to a much larger percentage of the population. That is a great thing, but it’s important to remember that “easier to invest” doesn’t necessarily mean it’s easy to invest well.

Be wary of apps that “gamify” trading and encourage risky choices. Keep in mind that trusted names offer more security, so do your research when you are selecting a platform.

POOR DOCTORS: https://medicalexecutivepost.com/2024/04/04/why-physicians-do-not-get-rich/

Investing should be taken seriously, and we encourage you to have a good working relationship with a human financial services professional.

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Understanding Different Medical Degrees: MD, DO, and DPM

Doctor of Medicine

Doctor of Osteopathic Medicine

Doctor of Podiatric Medicine

By Staff Reporters and APMA

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APMA INFOGRAPHIC: https://www.apma.org/apmamain/document-server/?cfp=/apmamain/assets/file/public/about/physician-education-comparison-fact-sheet.pdf

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EDUCATION: Books

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Financial Self-Discovery for Medical Professionals

By Dr. David Edward Marcinko; MBA MEd CMP

PHYSICIAN COACHING: https://marcinkoassociates.com/process-what-we-do/

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SPONSOR: http://www.CertifiedMedicalPlanner.org

A Financial Self Discovery Questionnaire for Medical Professionals

For understanding your relationship with money, it is important to be aware of yourself in the contexts of culture, family, value systems and experience.  These questions will help you.  This is a process of self-discovery.  To fully benefit from this exploration, please address them in writing.  You will simply not get the full value from it if you just breeze through and give mental answers.  While it is recommended that you first answer these questions by yourself, many people relate that they have enjoyed the experience of sharing them with others who are important to them. 

As you answer these questions, be conscious of your feelings, actually describing them in writing as part of your process. 

Childhood

  • What is your first memory of money?
  • What is your happiest moment with Money? Your most unhappy?
  • Name the miscellaneous money messages you received as a child.
  • How were you confronted with the knowledge of differing economic circumstances among people, that there were people “richer” than you and people “poorer” than you?

Cultural heritage

  • What is your cultural heritage and how has it interfaced with money?
  • To the best of your knowledge, how has it been impacted by the money forces?  Be specific.  
  • To the best of your knowledge, does this circumstance have any motive related to Money?
  • Speculate about the manners in which your forebears’ money decisions continue to affect you today? 

Family

  • How is/was the subject of money addressed by your church or the religious traditions of your forebears?
  • What happened to your parents or grandparents during the Depression?
  • How did your family communicate about money?
  • How?  Be as specific as you can be, but remember that we are more concerned about impacts upon you than historical veracity.
  • When did your family migrate to America (or its current location)?
  • What else do you know about your family’s economic circumstances historically?

Your parents

  • How did your mother and father address money?
  • How did they differ in their money attitudes?
  • How did they address money in their relationship?
  • Did they argue or maintain strict silence?
  • How do you feel about that today?

Please do your best to answer the same questions regarding your life or business partner(s) and their parents.

Childhood: Revisited

  • How did you relate to money as a child?  Did you feel “poor” or “rich”? 
    Relatively?  Or, absolutely?  Why?
  • Were you anxious about money?
    Did you receive an allowance?  If so, describe amounts and responsibilities.
  • Did you have household responsibilities?
  • Did you get paid regardless of performance?
  • Did you work for money?

If not, please describe your thoughts and feelings about that.

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Same questions, as a teenager, young adult, older adult.

Credit

  • When did you first acquire something on credit?
  • When did you first acquire a credit card?
  • What did it represent to you when you first held it in your hands?
  • Describe your feelings about credit.
  • Do you have trouble living within your means?
  • Do you have debt?

Adulthood

  • Have your attitudes shifted during your adult life?  Describe.

Why did you choose your personal path? 
a)      Would you do it again?
b)      Describe your feelings about credit.

Adult attitudes

  • Are you money motivated? 
    If so, please explain why?  If not, why not? 
    How do you feel about your present financial situation? 
    Are you financially fearful or resentful?  How do you feel about that?
  • Will you inherit money?  How does that make you feel?
  • If you are well off today, how do you feel about the money situations of others? 
    If you feel poor, same question. 
  • How do you feel about begging?  Welfare?
    If you are well off today, why are you working?
  • Do you worry about your financial future?
  • Are you generous or stingy?  Do you treat?  Do you tip?
  • Do you give more than you receive or the reverse?  Would others agree?
  • Could you ask a close relative for a business loan?  For rent/grocery money?
  • Could you subsidize a non-related friend?  How would you feel if that friend bought something you deemed frivolous? 
  • Do you judge others by how you perceive they deal with their Money?
    Do you feel guilty about your prosperity?
    Are your siblings prosperous?
  • What part does money play in your spiritual life?
  • Do you “live” your Money values?

Conclusion

There may be other questions that would be useful to you.  Others may occur to you as you progress in your life’s journey. The point is to know your personal money issues and their ramifications for your life, work, and personal mission. 

This will be a “work-in-process” with answers both complex and incomplete.  Don’t worry. 

Just incorporate fine-tuning into your life’s process.

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SERIES #6 EXAM: Investment Company and Variable Contracts Products Representative

By A.I.and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The Series 6 exam — the Investment Company and Variable Contracts Products Representative Qualification Examination (IR) — assesses the competency of an entry-level representative to perform their job as an investment company and variable contracts products representative.

The exam measures the degree to which each candidate possesses the knowledge needed to perform the critical functions of an investment company and variable contract products representative, including sales of mutual funds and variable annuities.

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Candidates must pass the Securities Industry Essentials (SIE) exam and the Series 6 exam to obtain the Investment Company and Variable Contracts Products registration.

For more information about the SIE and Series 6 exams, refer to FINRA Rule 1210 and FINRA Rule 1220(b)(7).

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EDUCATION: Books

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VALUE STOCKS: Discovering Under Priced Investment Gems

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

Value Stocks – Looking for Bargains!

The bargain-hunting value style is looking for shares that are under priced in relation to the company’s future potential. A physician value investor will invest in a company in the expectation that its shares will increase in value over time. Value investing is based essentially on quantitative criteria; asset values, cash flow, and discounted future earnings. The key properties of value shares are low Price/Earnings, Price/Sales ratios, and normally higher dividend yields. 

On observing a company’s earnings growth, a value manager will decide whether to buy shares based on the company’s consistency or recovery prospects.

The key research questions are: 1) Does the current P/E ratio warrant an investment in a slow growth company or, 2) Is the company a higher growth candidate that has dropped in price due to a temporary problem.  If this is the case, will the company’s earnings growth recover, and if so, when? The key to value investing is to find bargain shares (priced low historically or for temporary and/or irrational reasons), avoiding shares that are merely cheap (priced low because the company is failing).

The buying opportunity is identified when a company undergoing some immediate problems is perceived to have good chances of recovery in the medium to long term.  If there is a loss in market confidence in the company, the share price may fall, and the value investor can step in. Once the share price has achieved a suitable value, reflecting the predicted turnaround in company performance, the shareholding is sold, realizing a capital gain.

And, a potential risk in value investing is that the company may not turn around, in which case the share price may stay static or fall.

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com 

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Understanding Merger Arbitrage Strategies

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How Much Should Start-Ups Pay Their Advisors?

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TEAL TALK DAY: September 23rd, 2025

BEACH

By A.I. and Staff Reporters

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Let’s talk.

September 23rd is Global Teal Talk Day, founded by Ovarcome.

Over 300,000 women are diagnosed annually with ovarian cancer, worldwide. Gather your friends, wear teal for a day out together and talk. Wearing teal is not enough.

Talk About Ovarian Cancer.

MORE: https://ovarcome.org/events/teal-talk-day/

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EDUCATION: Books

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3 Behavioral Biases Hurting Your Finances

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The study of behavioral economics has revealed much about how different biases can affect our finances—often for the worse.

Take loss aversion: Because we feel a financial setback more acutely than a commensurate gain, we often cling to failed investments to avoid realizing the loss. Another potential hazard is present bias, or the tendency to prefer instant gratification over long-term reward, even if the latter gain is greater.

When it comes to money, sometimes it’s difficult to make rational decisions. Here, are three behavioral financial biases that could be impeding financial goals.

ANCHORING BIAS

Anchoring Bias happens when we place too much emphasis on the first piece of information we receive regarding a given subject. Anchoring is the mental trick your brain plays when it latches onto the first piece of information it gets, no matter how irrelevant. You might know this as a ‘first impression’ when someone relies on their own first idea of a person or situation.

Example: When shopping for a wedding ring a salesman might tell us to spend three months’ salary. After hearing this, we may feel like we are doing something wrong if we stray from this financial advice, even though the guideline provided may cause us to spend more than we can afford.

Example: Imagine you’re buying a car, and the salesperson starts with a high price. That number sticks in your mind and influences all your subsequent negotiations. Anchoring can skew our decisions and perceptions, making us think the first offer is more important than it is. Or, subsequent offers lower than they really are.

Example: Imagine an investor named Jane who purchased 100 shares of XYZ Corporation at $100 per share several years ago. Over time, the stock price declined to $60 per share. Jane is anchored to her initial price of $100 and is reluctant to sell at a loss because she keeps hoping the stock will return to her original purchase price. She continues to hold onto the stock, even as it declines, due to her anchoring bias. Eventually, the stock price drops to $40 per share, resulting in significant losses for Jane.

In this example, Jane’s nchoring bias to the original purchase price of $100 prevents her from rationalizing to sell the stock and cut her losses, even though market conditions have changed. So, the next time you’re haggling for your self, a potential customer or client, or making another big financial decision, be aware of that initial anchor dragging you down.

HERD MENTALITY BIAS

Herd Mentality Bias makes it very hard for humans to not take action when everyone around us does.

Example: We may hear stories of people making significant monetary profits buying, fixing up, and flipping homes and have the desire to get in on the action, even though we have no experience in real estate.

Example: During the dotcom bubble of the late 1990’s many investors exhibited a herd mentality. As technology stocks soared to astronomical valuations, investors rushed to buy these stocks driven by the fear of missing out on the gains others were enjoying. Even though some of these stocks had questionable fundamentals, the herd mentality led investors to follow the crowd.

In this example, the herd mentality contributed to the overvaluation of technology stocks. Eventually, it led to the dot-com bubble’s burst, causing significant losses for those who had unthinkingly followed the crowd without conducting proper research or analysis.

OVERCONFIDENT INVESTING BIAS

Overconfident Investing Bias happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. This causes the results of a study to be unreliable and hard to reproduce in other research settings.

Example: Data convincingly shows that people and financial planners/advisors and wealth managers who trade most often under-perform the market by a significant margin over time. Active traders lose money.

Example: Overconfidence Investing Bias moreover leads to: (1) excessive trading (which in turn results in lower returns due to costs incurred), (2) underestimation of risk (portfolios of decreasing risk were found for single men, married men, married women, and single women), (3) illusion of knowledge (you can get a lot more data nowadays on the internet) and (4) illusion of control (on-line trading).

ASSESSMENT

Finally, questions remain after consuming this cognitive bias review.

Question: Can behavioral cognitive biases be eliminated by financial advisors in prospecting and client sales endeavors?

A: Indeed they can significantly reduce their impact by appreciating and understanding the above and following a disciplined and rational decision-making sales process.

Question: What is the role of financial advisors in helping clients and prospects address behavioral biases?

A: Financial advisors can provide an objective perspective and help investors recognize and address their biases. They can assist in creating well-structured investment and financial plans, setting realistic goals, and offering guidance to ensure investment decisions align with long-term objectives.

Question: How important is self-discipline in overcoming behavioral biases?

A; Self-discipline is crucial in overcoming behavioral biases. It helps investors and advisors adhere to their investment plans, avoid impulsive decisions, and stay focused on long-term goals reducing the influence of emotional and cognitive biases.

CONCLUSION

Remember, it is far more useful to listen to client beliefs, fears and goals, and to suggest options and offer encouragement to help them discover their own path toward financial well-being. Then, incentivize them with knowledge of the above psychological biases to your mutual success!

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com 

REFERENCES:

  • Marcinko, DE; Dictionary of Health Insurance and Managed Care. Springer Publishing Company, New York, 2007.
  • Marcinko, DE: Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™. Productivity Press, NY, 2016.
  • Marcinko, DE: Risk Management, Liability and Insurance Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™. Productivity Press, NY, 2017.
  • Nofsinger, JR: The Psychology of Investing. Rutledge Publishing, 2022
  • Winters, Scott:  The 10X Financial Advisor: Your Blueprint for Massive and Sustainable Growth. Absolute Author Publishing House, 2020.
  • Woodruff, Mandy: https://www.mandimoney.com

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Why Many Doctors Struggle Financially: 5 Key Reasons

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Despite their high salaries, not all doctors are wealthy, and some live paycheck to paycheck. Here are 5 reasons why many doctors today are broke, according to https://medschoolinsiders.com

1 | Believing They Are Universally Smart

The first reason so many doctors are broke is that many doctors believe they are universally smart. While most doctors have deep specialized knowledge, there’s a big difference between being smart in your profession and being smart with money. A physician’s schooling is quite thorough when it comes to the human body, but med school doesn’t include a prerequisite class on how to handle finances.

MORE: https://medicalexecutivepost.com/2022/11/18/what-is-the-dunning-kruger-effect/

Graduating medical school is a major feat and certainly demonstrates superior work ethic and cognitive abilities. But many new doctors believe these accomplishments transcend all aspects of life. If you’re smart enough to earn an MD, you’re certainly smart enough to handle your finances, but only once you properly and intentionally educate yourself.

The truth is doctors, especially traditional graduates, haven’t had an opportunity to manage large sums of money until they become fully trained attending physicians and start pulling in low to mid six figures in income. Prior to that, there was very little of it to manage.

Far too many aspiring doctors, and students in general, don’t take the time to learn financial basics, in part because it’s uncomfortable and seems like something they can figure out “later”, whenever that may be. Their poor spending habits and lack of investment knowledge carry over into their careers, causing many to make irresponsible decisions.

MORE: https://medicalexecutivepost.com/2025/07/17/doctors-and-lawyers-often-arent-millionaires/

2 | Overspending Too Soon

The second factor is overspending too soon, and this comes up at two points in training.

First, it’s natural to want to start spending more as soon as you get into residency and start making a little more money. After all, you’ve been a broke student for 8 or more years, and now you’re finally making a reasonable and reliable wage. But that’s where young doctors get into trouble. Residency pays, but not nearly as much as you will be making once you become an attending physician. The average resident makes about $60K a year, and if you begin spending all of that money right away, thinking you’ll handle your loans once you become an attending, you delay paying off your medical school debt, which means the compounding effect through your student loan interest rate works against you.

Now that $250,000 in student loans has ballooned to over $350,000 by the time you finish residency. The compounding effect, which can be one of your greatest allies in your financial life, becomes an equally powerful enemy when working against you through debt. But of course, pinching pennies is easier said than done, especially when you’re in residency and are surrounded by peers in different professions. They’ve been earning good money much longer than you have, and they can afford more luxurious lifestyles.

They may not be worried about indulging in fine dining or how much a hotel costs when traveling. Students in college and medical school are often confident they will resist the temptations, but the desire to keep up with your friends and family can be difficult to ignore, which causes many to overspend before they technically have the money to do so.

The same is true of attending physicians. As soon as those six-figure salaries come rolling in, many physicians go overboard with spending, trying to make up for lost time and to treat yourself.

Now, we are not suggesting you shouldn’t reward yourself for completing residency, but that reward shouldn’t be a Lamborghini. It’s best to continue living like a resident in your first few years after becoming an attending to pay off loans, put a down payment on a home, and get your financial foundation built before loosening the purse strings.

3 | Decreasing Salaries

Third, doctors continue to make less money than they did before. And this includes nearly all 44 medical specialties. For example, while physician compensation technically rose from $343k to $391k between 2017 and 2022, this rise does not keep up with inflation. The real average compensation in 2022 was less than $325k—a $20k decrease in purchasing power in only six years.

For doctors who are already spending to the limits of their salaries with huge mortgages, car payments, business costs, and other luxuries, a decreased salary can have a huge impact. You might be able to cut back by going on fewer vacations or eating out less frequently, but many accrued costs are locked in, such as a mortgage payment, car loan, or leased rental space for your practice.

4 | Increasing Costs of Private Practice

In the past, running a private practice was much simpler, but recent stricter guidelines and regulations have made it difficult for solo practices to keep up. While regulations like the Health Insurance Privacy and Portability Act, or HIPAA, and mandatory Electronic Medical Records, or EMRs, are necessary to protect patients, they make costs higher for physicians who run their own private practice. These physicians need to spend their own money to set up and maintain EMRs as well as invest in security to ensure patient data is protected.

With the steep rise of inflation we’ve seen over the past couple of years, everything is more expensive, which means costs, such as business space, equipment, and even office supplies, have gone up for private practice physicians while salaries have not. 2013 to 2020 saw an annual inflation rate of anywhere from 0.7% to 2.3%. This skyrocketed to an annual inflation rate of 7.0% in 2021 and another 6.5% in 2022. In fact, the cost of running a private practice has increased by almost 40% between 2001 and 2021.

These increased costs are exacerbated by another problem plaguing private practices; decreased reimbursement. While costs increased by almost 40%, Medicare reimbursement only increased by 11%. When doctors see patients who are insured, the insurance companies pay the physicians for their time. For Medicare, the new proposed rules for 2023 would cut reimbursement by around 5%. When adjusting for inflation, Medicare reimbursement decreased by 20% in the last 20 years.

These costs add up, making it extremely difficult for physicians to thrive financially while running a private practice.

5 | Tuition Debt

Lastly, we can’t talk about a doctor’s finances without mentioning the exorbitant debt so many graduating physicians are left with. It won’t shock you to hear that med school is expensive. Extremely expensive. The average cost of tuition for a single year is nearly $60k, with significant variance from school to school, and that’s before accounting for living expenses.

In-state applicants pay less than out-of-state applicants, and students at private schools typically pay more than students at public medical schools. The astronomical costs mean the vast majority of students can’t pay for medical school out of their own pockets. And unless your family is part of the 1%, even with your parents footing the bill, it’s difficult to cover tuition, let alone rent, groceries, transportation, tech, social activities, exam fees, and application costs.

The average total student debt after college and med school is over $250k. But keep in mind that’s the average, which includes 27% of students who graduate with no debt at all. This means the vast majority of students leave medical school owing much more than $250k.

For some perspective, in 1978, the average debt for graduating MDs was $13,500, which, when adjusted for inflation, is a little over $60,000. There are multiple ways to eventually repay these loans, but time and discipline are essential to ensure this money is paid off as quickly as possible.

MORE: https://medicalexecutivepost.com/2024/12/03/12-investing-mistakes-of-physicians/

THE FINANCIAL FIX

According to financial advisor Dr. David Edward Marcinko MEd MBA CMP; consider the following:

  • Place a portion of your salary (15-20% or more) into a savings account, and another portion (10-20% or more) into wise investments [stocks, bonds, mutual funds, and/or ETFs].
  • Pay off your bills each month, and then use leftover spending money to purchase fun things like vacations and fancy dinners, within your means. Shop sales, buy used clothes, and use credit card points for travel.
  • Hire an excellent tax professional and meet with an investment advisor once or twice a year about your investment status and strategy. http://www.MarcinkoAssociates.com

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EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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PALACE FALLACY: Memory Loss

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters and A.I.

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The Memory Palace Fallacy – Learning Styles Don’t Actually Exist

Remember being told you’re a “visual learner” or an “auditory learner”? Well, turns out that whole learning styles theory is pretty much bunk.

Common Learning Myths have been thoroughly debunked by modern educational research, and this is a big one. Studies consistently show that matching teaching methods to supposed learning styles doesn’t improve outcomes at all.

What actually matters is matching the teaching method to the content itself – you learn geography better with maps because geography is visual, not because you’re a “visual person.” It’s like trying to learn piano by reading about it versus actually playing keys. The activity should match what you’re trying to learn, not some made-up category about how your brain supposedly works.

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EDUCATION: Books

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RISK MANAGEMENT TERMS: All Financial Advisors Should Know

By Staff Reporters

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Authentication:

The verification of the identity of an individual, system, machine, or any other unique entity

Authorization:

The process of allowing access to specific areas of a system based on the role and needs of the user

Committee Charter:

A document that defines the purposes and responsibilities of the oversight committee

Compliance Risk Profile:

The current and prospective risk to earnings or capital arising from violations of or nonconformance with laws, rules, regulations, prescribed practices, internal policies and procedures, or ethical standards

Control Assessment:

A high-level review and analysis of controls relating to a process; should encompass both current and missing controls

Controls:

Methods that preserve the integrity of important information, meet operational or financial targets, and/or communicate management policies (See also: Key Control, Secondary Control, Tertiary Control)

ERM Policy Statement:

Defines an organization’s approach to and method of enterprise risk management

Governance:

Processes and structures implemented to communicate, manage, and monitor organizational activities

Impact:

The influence and effect of a risk

Inherent Risk:

Risk that is inherent to a process, taking into consideration the likelihood and impact of a risk

Key Control:

A primary control that is essential for a business process; typically takes place during the process it applies to

Key Indicators:

Measurements that are important for organizations to monitor for potential issues; examples include key performance indicators (KPIs) and key risk indicators (KRIs)

Key Performance Indicator (KPI):

A measurement with a defined set of goals and tolerances that gauges the performance of an important business activity

Key Risk Indicator (KRI):

A proactive measurement for future and emerging risks that indicates the possibility of an event that adversely affects business activities

Likelihood:

The probability of a risk occurring

Mitigation Actions:

The necessary steps, or action items, to reduce the likelihood and/or impact of a potential risk

Operation Risk Profile:

1) The risk arising from the execution of an organization’s business processes;
2) The risk of loss resulting from failed or inadequate internal processes, systems, people, or other entities

Price Risk Profile:

The risk to earning or capital arising from adverse changes in portfolio values

Process:

1) The principle elements of essential business functions within work groups or business units;
2) A set of tasks completed by business continuity plan owners within a department

Reputation Risk Profile:

The current and prospective risk to earnings or capital arising from negative public opinion or perception

Residual Risk:

Risk remaining after considering the existing control environment

Risk:

A potential event or action that would have an adverse effect on the organization

Risk Appetite:

A statement that broadly considers the risk levels that management deems acceptable

Risk Assessment:

The prioritization of potential business disruptions based on the impact and likelihood of occurrence; includes an analysis of threats based on the impact to the organization, its customers, and financial markets

Risk Tolerance:

A metric that sets the acceptable level of variation around organizational objectives and provides assurance that the organization remains within its risk appetite

Secondary Control:

An important control that typically takes place after the process it applies to (i.e., reporting or ongoing monitoring)

Strategic Risk Profile:

The current and prospective risk to earnings or capital raising from adverse business decisions, improperly implemented decisions, or lack of responsiveness to industry changes

Tertiary Control:

A non-essential control that can still be applied effectively to a business process

Velocity:

The time it takes a risk event to manifest itself

Vulnerability:

An entity’s susceptibility to a risk event as determined by the entity’s preparedness, agility, and adaptability

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How Investment Banking Works for Corporations

By Dr. David Edward Marcinko MBA MEd

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SPONSOR: http://www.MarcinkoAssociates.com

Investment bankers are not really bankers at all. The fact that the word banker appears in the name is partially responsible for the false impressions that exist in the medical community regarding the functions they perform.

For example, they are not permitted to accept deposit, provide checking accounts, or perform other activities normally construed to be commercial banking activities. An investment bank is simply a firm that specializes in helping other corporations obtain money they need under the most advantageous terms possible. When it comes to the actual process of having securities issued, the corporation approaches an investment banking firm, either directly, or through a competitive selection process and asks it to act as adviser and distributor.

MORE: https://www.amazon.ca/Management-Liability-Insurance-Protection-Strategies/dp/1498725988

Investment bankers, or under writers, as they are sometimes called, are middlemen in the capital markets for corporate securities. The corporation requiring the funds discusses the amount, type of security to be issued, price and other features of the security, as well as the cost to issuing the securities. All of these factors are negotiated in a process known as negotiated underwriting. If mutually acceptable terms are reached, the investment banking firm will be the middle man through which the securities are sold to the general public. Since such firms have many customers, they are able to sell new securities, without the costly search that individual corporations may require to sell its own security.

Thus, although the firm in need of additional capital must pay for the service, it is usually able to raise the additional capital at less expense through the use of an investment banker, than by selling the securities itself. The agreement between the investment banker and the corporation may be one of two types. The investment bank may agree to purchase, or underwrite, the entire issue of securities and to re-offer them to the general public. This is known as a firm commitment.

When an investment banker agrees to underwrite such a sale; it agrees to supply the corporation with a specified amount of money. The firm buys the securities with the intention to resell them. If it fails to sell the securities, the investment banker must still pay the agreed upon sum.

Thus, the risk of selling rests with the underwriter and not with the company issuing the securities.

INVESTMENT BANKING: https://medicalexecutivepost.com/2024/04/17/understanding-tnvestment-banking-rules-securities-markets-brokerage-accounts-margin-and-debt/

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The alternative agreement is a best efforts agreement in which the investment banker makes his best effort to sell the securities acting on behalf of the issuer, but does not guarantee a specified amount of money will be raised. When a corporation raises new capital through a public offering of stock, one might inquire where the stock comes from. The only source the corporation has is authorized, but previously un-issued stock. Anytime authorized, but previously un-issued stock (new stock) is issued to the public, it is known as a primary offering.

If it’s the very first time the corporation is making the offering, it’s also known as the Initial Public Offering (IPO). Anytime there is a primary offering of stock, the issuing corporation is raising additional equity capital.

A secondary offering, or distribution, on the other hand, is defined as an offering of a large block of outstanding stock. Most frequently, a secondary offering is the sale of a large block of stock owned by one or more stockholders. It is stock that has previously been issued and is now being re-sold by investors. Another case would be when a corporation re-sells its treasury stock.

STOCK BROKERS: https://medicalexecutivepost.com/2024/09/04/understanding-traditional-full-service-brokers/

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SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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SERIES #7 EXAM: General Securities Representative Qualification

By A. I. and FINRA

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The Series 7 exam — the General Securities Representative Qualification Examination (GS) — assesses the competency of an entry-level registered representative to perform their job as a general securities representative.

The exam measures the degree to which each candidate possesses the knowledge needed to perform the critical functions of a general securities representative, including sales of corporate securities, municipal securities, investment company securities, variable annuities, direct participation programs, options and government securities.

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Candidates must pass the Securities Industry Essentials (SIE) exam and the Series 7 exam to obtain the General Securities Representative registration.

For more information about the SIE and Series 7 exams, refer to FINRA Rule 1210 and FINRA Rule 1220(b)(2).

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INTRODUCTION: Meme DORK Stocks

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QUANTUM COMPUTERS: A Peek into the Future?

NIST, A.I. and Staff Reporters

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SPONSOR: http://www.CertifiedMedicalPlanner.org

A computer that could break the encryption that safeguards your private information on the internet. A machine that can design powerful new drugs by precisely simulating the behavior of individual molecules. A device that optimizes complex supply chains to help companies get the parts they need and assemble them in the most efficient way possible.

These are all examples of how an emerging technology — the quantum computer — could change our world.

These computers work by harnessing quantum physics — the strange, often counterintuitive laws that govern the universe at its smallest scales and coldest temperatures. Today’s quantum computers are rudimentary and error-prone. But if more advanced and robust versions can be made, they have the potential to rapidly crunch through certain problems that would take current computers years. That’s why governments, companies and research labs around the world are working feverishly toward this goal.

Quantum computers will not replace our familiar “classical” computers. Rather, the two types of machines could work together to solve problems that stymie classical computers, potentially supercharging scientific research in fields such as materials and drug discovery, giving a boost to industry and upending cybersecurity as we know it.

So, let’s explore how quantum computers work.

MORE: https://www.nist.gov/quantum-information-science/quantum-computing-explained

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Stocks, Commodities and Bonds

By Staff Reporters and A.I.

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*Stock data as of market close. Here’s what these numbers mean.
Stocks: The Russell 2000 went 967 days without hitting a new record high until Thursday. But, it looks like it will have to keep waiting for the next one—the small-cap-focused index fell, even as the DJIA, NASDAQ and S&P 500 rose to new closing highs on Friday.*
Bonds: 2-year yields and 10-year yields both hit two-week intra-day highs even after the FOMC cut interest rates, indicating that traders still aren’t sure how the economy will perform in the months ahead.
Commodities: Arabica futures fell on reports that lawmakers will introduce a bipartisan bill to exempt coffee from tariffs.

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PURE: Absolute Risks of Physicians

By Dr. David Edward Marcinko MBA MEd

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What Is Pure Risk?

Pure risk is a category of risk that cannot be controlled and has two outcomes: complete loss or no loss at all. There are no opportunities for gain or profit when pure risk is involved. Pure risk is generally prevalent in situations such as natural disasters, fires, or death. These situations cannot be predicted and are beyond anyone’s control. Pure risk is also referred to as absolute risk.

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1. Personal Risks

Now, there are basically 3 types of pure risks that concern individual physicians. These incur losses like loss of income, additional expenses and devaluation of property. There are 4 risk factors affecting them:

  • Premature death. This is death of a breadwinner who leaves behind financial responsibilities.
  • Old age / retirement. The risk of being retired without sufficient savings to support retirement years.
  • Health crisis. Individual with health problem may face a potential loss of income and increase in medical expenditures.
  • Unemployment. Jobless individual may have to live on their savings. If savings are depleted, a bigger crisis is awaiting.

2. Property Risks

This means the possibility of damage or loss to the property owned due to some cause. There are two types of losses involved.

  • Direct loss which means financial loss as a result of property damage.
  • Consequential loss which means financial loss due to the happenings of direct loss of the property.

For instance, a medical practice that burned down may incur repair costs as the direct loss. The consequential loss is being unable to run the practice business to generate income.

3. Liability Risks

A doctor is legally liable to his wrongful act that cause damage to a third party; physically, by reputation or property. S/he can be legally sued with no maximum in the compensation amount if found guilty.

Knowing how risks are classified, and the types of pure risks an individual is exposed to, will provide a fundamental overview on these risk topics and prepare you to further acquire the knowledge of how to deal with and manage them as a physician executive, leader, or manager.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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HIPAA COMPLIANCE: Securing Electronic Communications

By Carol Miller RN MBA

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New-Wave Technology

To help hospitals and health systems comply with Health Insurance Portability and Accountability Act regulations, best practices are emerging for securing all electronic communication – cloud, wireless, and texting –  of protected health information.  These new technologies will continually be evolving with hospitals, providers and patients move to new means of communication.  Below is a description of how each are impacted by HIPAA.

Cloud Solutions.  Cloud solutions are becoming a needed commodity in treating patients today but also present a risk to privacy and security violation.  Despite the advantages of cloud computing, organizations are often hesitant to use it because of concerns about security and compliance. Specifically, they fear potential unauthorized access to patient data and the accompanying liability and reputation damage resulting from the need to report HIPAA breaches. While these concerns are understandable, a review of data on HIPAA breaches published by the HHS shows that these concerns are misplaced.  In fact, by using a cloud-based service with an appropriate security and compliance infrastructure, a facility can significantly reduce its compliance risk.

Because HIPAA compliance involves stringent privacy and security protections for electronic health information (PHI), many cloud providers are balking at signing new Business-Associate agreements. Most cloud-technology providers, such as Box and Dropbox, do not include the built-in privacy protections that guarantee HIPAA compliance. Because many cloud storage companies store plaintext data on their servers, PHI is especially vulnerable to breaches and compliance violations.

HIPAA CLOUD: https://medicalexecutivepost.com/2016/11/22/hipaa-cloud-solutions/

Mobility Solutions.  The recent launches of Apple Health and Google Fit have stirred a lot of interest in health application development.  It is important that hospitals and providers understand the laws around PHI and HIPAA compliance for any healthcare-focused mobile application or software.  While not all healthcare applications fall under HIPAA rules, those that collect, store, or share personally identifiable health information with covered entities (such as hospitals and providers) must be HIPAA-compliant. 

For years, hospitals have wanted to bring computers into exam rooms, waiting rooms, and treatment rooms to eliminate hard-to-read patient charts, making sure everyone treating the patient was seeing the same information, assuring that everything was recorded as it occurred, and enabling doctors, nurses, and technicians to stay connected to vital information and services wherever they were throughout the hospital.  Many hospitals have adopted Computer on Wheels (COWs) or tablets but many of these were hard to use, had poor touchscreen interface and did not last long on a battery.  Ipads seem to be the logical replacement as long as the iPad can comply with HIPAA rules.

HIPAA was written nearly 30 years ago, before mobile health applications were ever envisioned.  Because of this, some areas of the law make it hard to determine which applications must be HIPAA- compliant and which are exempt.  Considering the numerous ways security breaches can occur with a mobile device, it is not wonder that HHS is very leery about how PHI is handled on smartphones, wearables, and portable devices.

If the applications are going to send or share health data to a hospital, doctor or other covered entity, it MUST be HIPAA-compliant.  Adhering to the Privacy and Security Rules of HIPAA is essential, especially considering the dangers that come with handling protected health data on a device.  Examples include:

  • Phones, tablets, and wearables can be easily stolen and lost, meaning PHI could be compromised
  • Social media and email are easily accessible by the device, making it easy for users to post information that breaches HIPAA privacy laws.
  • Push notifications and other user communications can violate HIPAA laws if they contain PHI
  • Users may intentionally or unintentionally share personally identifiable information, even if the application’s intended use doesn’t account for it
  • Not all users take advanage of the password-protected screen-lock feature, making data visible and accessible to anyone who comes in contact with the device
  • Devices like the iPhone do not include physical keyboards, so users are more likely to use basic passwords that are not as safe as complex options.

This protected health information can include everything from medical records and images to scheduled appointment dates.  Regardless of the device, it is important to take all the steps possible to comply with HIPAA guidelines.

MOBILE HIPAA: https://medicalexecutivepost.com/2016/02/06/mobile-hipaa-solutions-for-hospital-health-systems/

Texting. Text (or SMS) messaging has become nearly ubiquitous on mobile devices. According to one survey, approximately 72 percent of mobile phone users send text messages. Clinical care is not immune from the trend, and in fact physicians appear to be embracing texting on par with the general population. Another survey found that 73 percent of physicians text other physicians about work. 

(Source:  Journal of AHIMA, “HIPAA Compliance for Clinician Texting”, by Adam Green, April 2012)

Texting can offer providers numerous advantages for clinical care. It may be the fastest and most efficient means of sending information in a given situation, especially with factors such as background noise, spotty wireless network coverage, lack of access to a desktop or laptop, and a flood of e-mails clogging inboxes. Further, texting is device neutral—it will work on personal or provider-supplied devices of all shapes and sizes. Because of these advantages, physicians may utilize texting to communicate clinical information, whether authorized to do so or not.

All forms of communication involve some level of risk. Text messaging merely represents a different set of risks that, like other communication technologies, needs to be managed appropriately to ensure both privacy and security of the information exchanged.

Text messages may reside on a mobile device indefinitely, where the information can be exposed to unauthorized third parties due to theft, loss, or recycling of the device. Text messages often can be accessed without any level of authentication, meaning that anyone who has access to the mobile phone may have access to all text messages on the device without the need to enter a password.

Texts also are generally not subject to central monitoring by the IT department. Although text messages communicated wirelessly are usually encrypted by the carrier, interception and decryption of such messages can be done with inexpensive equipment and freely available software (although a substantial level of sophistication is needed.  If text messages are used to make decisions about patient care, then they may be subject to the rights of access and amendment. There is a risk of noncompliance with the privacy rule if the covered entity cannot provide patients with access to or amend such text messages.

According to 2012 data from CTIA–The Wireless Association, U.S. citizens alone exchange nearly 200 billion text messages every month. So it’s not surprising that an increasing number of clinicians are using text messaging to exchange clinical information, along with a wide range of other modes — smartphones, pagers, computerized physician order entry, emails, etc. Electronic communication is certainly faster, can be more efficient, enhances clinical collaboration and enables clinicians to focus on patient care. But with these benefits comes an increased risk of security breaches.

HIPAA TEXTING: https://medicalexecutivepost.com/2016/11/22/hipaa-cloud-solutions/

(Source:  Clarifying the Confusion about HIPAA – Compliant Texting, by Megan Hardiman and Terry Edwards, May 2013)

Unfortunately, vendor hype about the Health Insurance Portability and Accountability Act is causing many hospitals and health systems to implement stop-gap measures that address part — but not all — of a problem. To identify all vulnerabilities, health care leaders need to consider not only text messaging, but all mechanisms by which protected health information in electronic form is transmitted — as well as the security of those mechanisms.

Mobile device-to-mobile device SMS text messages are generally not secure because they lack encryption.  The sender does not know with certainty that his or her message is indeed received by the intended recipient.  In addition, telecommunications vendor/wireless carrier may store the text messages.  Recent HHS guidance indicates text messaging, as a means of communicating PHI, can be permissible under HIPAA depending in large part on the adequacy of the controls used.  A hospital or provider may be approved for texting after performing a risk analysis or implementing a third-party messaging solution that incorporates measures to establish a secure communication platform that will allow texting on approved mobile devices.

A study reported in Computer World in May 2013 by the Ponemon Institute with 577 healthcare and It professional in facilities that ranged from fewer than 100 beds to over 500 beds stated that fifty-one percent of the respondents felt HIPAA compliance requirements can be a barrier to providing effective patient care.  Specifically HIPAA reduces time available for patient care (85% of the respondents), makes access to electronic patient information difficult (79% of the respondents) and restricts the use of electronic mobile communications (56% of the respondents).  The study stated “respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. “ They also stated “they recognized the value of implementing smartphones, text messaging and other modern forms of communications, but cited overly restrictive security policies as a primary reason why these technologies were not used.”  Clinicians in the survey stated that only 45% of each workday is spent with patients; the remaining 55% is spent communicating and collaborating with other clinicians and using the electronic medical record and other clinical IT systems. 

Several other statements made were:

  • Because of the need for security, hospitals and other healthcare organizations continue to use older, outdate technology such as pagers, email and facsimile machines.  The use of older technology can also delay patient discharges – now taking an average of 102 minutes.
  • The Ponemon Institute estimated that the lengthy discharge process costs the U.S. hospital industry more than $3.189 billion a year in lost revenue, with another $5 billion lost through decrease doctor productivity and use of outdated technology.  Secure text messaging could cut discharge time by 50 minutes.   

(Source:  Computer World, “HIPAA rules, outdate tech cost U.S. hospitals $3.38 B a year”, by Lucas Mearian, May, 2013)

Several suggestions offered for these preferred mobile devises are:  1) ensure encryption and access to individuals who need to have access; 2) use secure texting applications; and 3) even consider alerting employees with warnings before they send an email or share files that lets them know they are liable for the information sent.

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FEDERAL RESERVE: Cuts Interest Rates

BREAKING NEWS!

By Staff Reporters

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Federal Reserve Chairman Jerome Powell just announced that the central bank [FOMC] would cut interest rates amid President Donald Trump’s attempts to reshape the Fed’s independence.

The chairman announced that the Federal Reserve would cut the interest rate by .25 points, the first time that it cut interest rates since December.

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INVESTING PARADOX: Flexibile and Dogmatic

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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A paradox is a statement or situation that seems contradictory but actually makes sense when you think about it more deeply. It challenges logic and often reveals a hidden truth.

FLEXIBLY DOGMATIC PARADOX

The Flexibly Dogmatic Paradox suggests that no matter how sensible your financial planning, investing or wealth management process is there will be uncomfortably long periods when it looks broken. And process is the best way of ensuring you keep standing for something because if you don’t stand for something, you’ll fall for anything. This is why, when assessing an investment fund, focus 50% on the manager’s character and 50% on their process. Everything else is detail. There are few guarantees in investing, but the fact that markets will batter you emotionally is one of them.

FINANCIAL PARADOX: https://medicalexecutivepost.com/2025/07/27/paradox-of-financial-health/

Example: During volatile times, the temptation to abandon the process is strong. But that’s why it’s there. Process is what forces one fund manager to keep buying unbroken companies when everyone else thinks they’re bust, and another to keep faith with a top-quality company when the mob says it’s too expensive The best fund managers dogmatically stick to their process when it’s out of favor. Then, when it returns to favor, the elastic pings back: they recapture lost ground surprisingly fast. However, every rule has an exception. And spotting the exceptions to their process is something the true greats have a knack for buying and selling.

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Example:  In 2007, US value manager Bill Miller had the makings of an investment legend, but the financial crisis wrecked all that. His process told him to double down into falling share prices, which had worked well for years. But it doesn’t work if the companies go bust, which many of his financial stocks did in 2008.

ADVISORS PARADOX: https://medicalexecutivepost.com/2025/06/20/paradoxical-contradictions-all-financial-advisors-must-know-to-win-clients/

Conclusion

The fact is that no matter how good it is, a process operated without human judgment is just an algorithm. The best fund managers and financial prospectors and sales men/women know this.

They stick dogmatically to their process but somehow remain flexible enough to spot the occasions when it’s about to drive them into a brick wall.

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EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Understanding the Capital Asset Pricing Model

CAP-M

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By Dr. David Edward Marcinko MBA MED CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Dr. Harry Markowitz is credited with developing the framework for constructing investment portfolios based on the risk-return tradeoff. William Sharpe, John Lintner, and Jan Mossin are credited with developing the Capital Asset Pricing Model (CAPM).

CAPM is an economic model based upon the idea that there is a single portfolio representing all investments (i.e., the market portfolio) at the point of the optimal portfolio on the Capital Market Line (CML) and a single source of systematic risk, beta, to that market portfolio.  The resulting conclusion is that there should be a “fair” return investors should expect to receive given the level of risk (beta) they are willing to assume. 

The excess return, or return above the risk-free rate, that may be expected from an asset is equal to the risk-free return plus the excess return of the market portfolio times the sensitivity of the asset’s excess return to the market portfolio excess return.  Beta, then, is a measure of the sensitivity of an asset’s returns to the market as a whole.  A particular security’s beta depends on the volatility of the individual security’s returns relative to the volatility of the market’s returns, as well as the correlation between the security’s returns and the markets returns. 

While a stock may have significantly greater volatility than the market, if that stock’s returns are not highly correlated with the returns of the overall market (i.e., the stock’s returns are independent of the overall market’s returns), then the stock’s beta would be relatively low.  A beta in excess of 1.0 implies that the security is more exposed to systematic risk than the overall market portfolio, and likewise, a beta of less 1.0 means that the security has less exposure to systematic risk than the overall market. 

MPT has helped focus investors on two extremely critical elements of investing that are central to successful investment strategies. 

First, MPT offers the first framework for investors to build a diversified portfolio.  Furthermore, an important conclusion that can be drawn from MPT is that diversification does in fact help reduce portfolio risk. 

Thus, MPT approaches are generally consistent with the first investment rule of thumb, “understand and diversify risk to the extent possible.” 

Additionally, the risk/return tradeoff (i.e., higher returns are generally consistent with higher risk) central to MPT based strategies has helped investors recognize that if it looks too good to be true, it probably is.

Passive Investing

Passive investing is a monetary plan in which an investor invests in accordance with a pre-determined strategy that doesn’t necessitate any forecasting of the economy or an individual company’s prospects.  The primary premise is to minimize investing fees and to avoid the unpleasant consequences of failing to correctly predict the future. The most accepted method to invest passively is to mimic the performance of a particular index. Investors typically do this today by purchasing one or more ‘index funds’. By tracking an index, an investor will achieve solid diversification with low expenses. 

An ivestor could potentially earn a higher rate of return than an investor paying higher management fees.  Passive management is most widespread in the stock markets.  But  with the explosion of exchange traded funds on the major exchanges, index investing has become more popular in other categories of investing.  There are now literally hundreds of different index funds.  

Passive management is based upon the Efficient Market Hypothesis theory.  The Efficient Market Hypothesis (EMH) states that securities are fairly priced based on information regarding their underlying cash flows and that investors should not anticipate to consistently out-perform the market over the long-term.

The Efficient Market Hypothesis evolved in the 1960s from the Ph.D. dissertation of Eugene Fama.  Fama persuasively made the case that in an active market that includes many well-informed and intelligent investors, securities will be appropriately priced and reflect all available information. If a market is efficient, no information or analysis can be expected to result in out-performance of an appropriate benchmark. There are three distinct forms of EMH that vary by the type of information that is reflected in a security’s price:

  • Weak Form

This form holds that investors will not be able to use historical data to earn superior returns on a consistent basis.  In other words, the financial markets price securities in a manner that fully reflects all information contained in past prices. 

  • Semi-Strong Form

This form asserts that security prices fully reflect all publicly available information.  Therefore, investors cannot consistently earn above normal returns based solely on publicly available information, such as earnings, dividend, and sales data. 

  • Strong Form

This form states that the financial markets price securities such that, all information (public and non-public) is fully reflected in the securities price; investors should not expect to earn superior returns on a consistent basis, no matter what insight or research they may bring to the table.

While a rich literature has been established regarding whether EMH actually applies in any of its three forms in real world markets, probably the most difficult evidence to overcome for backers of EMH is the existence of a vibrant money management and mutual fund industry charging value-added fees for their services. 

The notion of passive management is counterintuitive to many investors.  Passive investing proponents follow the strong market theory of EMH.  These proponents argue several points including;

  1. In the long term, the average investor will have a typical before-costs performance equal to the market average. Therefore the standard investor will gain more from reducing investment costs than from attempting to beat the market over time. 
  • The efficient-market hypothesis argues that equilibrium market prices fully reflect all existing market information.  Even in the case where some of the market information is not currently reflected in the price level, EMH indicates that an individual investor still cannot make use of that information. It is widely interpreted by many academics that to try and systematically “beat the market” through active management is a fools game.

Not everyone believes in the efficient market.  Numerous researchers over the previous decades have found stock market anomalies that indicate a contradiction with the hypothesis.  The search for anomalies is effectively the hunt for market patterns that can be utilized to outperform passive strategies.  Such stock market anomalies that have been proven to go against the findings of the EMH theory include;

  1. Low Price to Book Effect
  2. January Effect
  3. The Size Effect
  4. Insider Transaction Effect
  5. The Value Line Effect

All the above anomalies have been proven over time to outperform the market.  For example, the first anomaly listed above is the Low Price to Book Effect.  The first and most discussed study on the performance of low price to book value stocks was by Dr. Eugene Fama and Dr. Kenneth R. French.  The study covered the time period from 1963-1990 and included nearly all the stocks on the NYSE, AMEX and NASDAQ. The stocks were divided into ten subgroups by book/market and were re-ranked annually. In the study, Fama and French found that the lowest book/market stocks outperformed the highest book/market stocks by a substantial margin (21.4 percent vs. 8 percent).  Remarkably, as they examined each upward decile, performance for that decile was below that of the higher book value decile.  Fama and French also ordered the deciles by beta (measure of systematic risk) and found that the stocks with the lowest book value also had the lowest risk. 

Today, most researchers now deem that “value” represents a hazard feature that investors are compensated for over time.  The theory being that value stocks trading at very low price book ratios are inherently risky, thus investors are simply compensated with higher returns in exchange for taking the risk of investing in these value stocks. The Fama and French research has been confirmed through several additional studies.  In a Forbes Magazine 5/6/96 column titled “Ben Graham was right–again,” author David Dreman published his data from the largest 1500 stocks on Compustat for the 25 years ending 1994. He found that the lowest 20 percent of price/book stocks appreciably outperformed the market.  

One item a medical professional should be aware of is the strong paradox of the efficient market theory.   If each investor believes the stock market were efficient, then all investors would give up analyzing and forecasting.  All investors would then accept passive management and invest in index funds.  But if this were to happen, the market would no longer be efficient because no one would be scrutinizing the markets.  In actuality, the efficient market hypothesis actually depends on active investors attempting to outperform the market through diligent research.

The case for passive investing and in favor of the EMH is that a preponderance of active managers do actually underperform the markets over time.  The latest study by Standard and Poor’s (S&P) confirms this fact.  S&P recently compared the performance of actively-managed mutual funds to passive market indexes twice per year. The 2012 S&P study indicated that indexes were once again outperforming actively-managed funds in nearly every asset class, style and fund category. The lone exception in the 2012 report was international equity, where active outperformed the index that S&P chose.  The study examined one-year, three-year and five-year time periods. Within the U.S. equity space, active equity managers in all the categories failed to outperform the corresponding benchmarks in the past five year period.  More than 65 percent of the large-cap active managers lagged behind the S&P 500 stock index.  More than 81 percent of mid-cap mutual funds were outperformed by the S&P MidCap 400 index. 

Lastly, 77 percent of the small-cap mutual funds were outperformed by the S&P SmallCap 600 index.  U.S. bond active managers fared no better that equity managers over a five year period. More than 83 percent of general municipal mutual funds under-performed the S&P National AMT-Free Municipal Bond index, 93 percent of government long-term funds under-performed the Barclays Long Government index, nearly 95 percent of high yield corporate bond funds under-performed the Barclays High Yield index.  Although the performance measurements for index investing are very strong, many analysts find three negative elements of passive investing;

  1. Downside Protection:  When the stock market collapses like in 2008, an index investor will assume the same loss as the market.  In the case of 2008, the S&P 500 stock index fell by more than 50 percent, offering index investors no downside protection.
  • Portfolio Control:  An index investor has no control over the holdings in the fund. In the event that a certain sector becomes over-owned (i.e. technology stocks in 2000), an index investor maintains the same weight as the index.
  • Average Returns:  An index investor will never have the opportunity to outperform the market, but will always follow.  Although the markets are very efficient, an investor can perhaps take advantage of market anomalies and invest with those managers who have maintained a long-term performance edge over the respective index. 

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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CAPITATION REIMBURSEMENT: A Historical Economic Review

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By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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DEFINITION

Capitation is a type of healthcare payment system in which a physician or hospital is paid a fixed amount of money per patient for a prescribed period by an insurer or physician association. The cost is based on the expected healthcare utilization costs for a group of patients for that year.

With capitation, the physician—otherwise known as the primary care physician— is paid a set amount for each enrolled patient whether a patient seeks care or not. The PCP is usually contracted with an HMO whose role it is to recruit patients.

ACOs: https://medicalexecutivepost.com/2024/12/01/record-breaking-savings-for-acos-in-2023/

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CAPITATION REIMBURSEMENT HISTORY

According to Richard Eskow, CEO of Health Knowledge Systems of Los Angeles, capitated medical reimbursement has been used in one form or another, in every attempt at healthcare reform since the Norman Conquest. Some even say an earlier variant existed in ancient China [personal communication]. 

Initially, when Henry I assumed the throne of the newly combined kingdoms of England and Normandy, he initiated a sweeping set of healthcare reforms. Historical documents, though muddled, indicate that soon thereafter at least one “physician,” John of Essex, received a flat payment honorarium of one penny per day for his efforts. Historian Edward J. Kealey opined that sum was roughly equal to that paid to a foot-soldier or a blind person. Clearer historical evidence suggests that American doctors in the mid-19th century were receiving capitation-like payments. No less an authoritative figure than Mark Twain, in fact, is on record as saying that during his boyhood in Hannibal, MO his parents paid the local doctor $25/year for taking care of the entire family regardless of their state of health.

Later, Sidney Garfield MD [1905-1984] is noted as one of the great under-appreciated geniuses of 20th century American medicine stood in the shadow cast by his more celebrated partner, Henry J. Kaiser. Garfield was not the first physician to embrace the notion of prepayment capitation, nor was he the first to understand that physicians working together in multi-specialty groups could, through collaboration and continuity of care, outperform their solo practice colleagues in almost every measure of quality and efficiency. The Mayo brothers, of course, had prior claim to that distinction. What Garfield did, was marry prepayment to group practice, providing aligned financial incentives across every physician and specialty in his medical group, as well as a culture of group accountability for the care of every member of the affiliated health plan. He called it “the new economics of medicine,” and at its heart was a fundamentally new paradigm of care that emphasized – prevention before treatment – and health before sickness.  Under his model: the fewer the sick – the greater the remuneration. And: the less serious the illness, the better off the patient and the doctors.

VBC: https://medicalexecutivepost.com/2018/12/07/the-state-of-value-based-care-vbc/

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Such ideas were heresy to the reigning fee-for-service, solo practice, ideologues of the mainstream medical establishment of the 1940s and ‘50s, of course. Throughout the period, Garfield and his group physicians were routinely castigated by leaders of the AMA and county medical associations as socialistic and unethical. The local medical associations in Garfield’s expanding service areas – the San Francisco Bay Area, Los Angeles, and Portland, Oregon – blocked group practice physicians from association membership, effectively shutting them out of local hospitals, denying them patient referrals or specialty society accreditation. Twice in the 1940s, formal medical association charges were brought against Garfield personally, at one time temporarily succeeding in suspending his license to practice medicine.

Of course, capitation payments made a comeback in the first cost-cutting managed care era of the 1980-90s because fee-for-service medicine created perverse incentives for physicians by paying more for treating illnesses and injuries than it does for preventing them — or even for diagnosing them early and reducing the need for intensive treatment later. Nevertheless, the modern managed care industry’s experience with capitation wasn’t initially a good one. The 1980-90s saw a number of HMOs attempt to put independent physicians, especially primary care doctors, into a capitation reimbursement model. The result was often negative for patients, who found that their doctors were far less willing to see them — and saw them for briefer visits — when they were receiving no additional income for their effort. Attempts were also made to aggregate various types of health providers — including hospitals and physicians in multiple specialties — into “capitation groups” that were collectively responsible for delivering care to a defined patient group. These included healthcare facilities and medical providers of all types: physicians, osteopaths, podiatrists, dentists, optometrists, pharmacies, physical therapists, hospitals and skilled nursing homes, etc.

However, the healthcare industry isn’t collective by nature, and these efforts tended to be too complicated to succeed. One lesson that these experiments taught is that provider behavior is difficult to change unless the relationship between that behavior and its consequences is fairly direct and easy to understand.

MORE: https://medicalexecutivepost.com/wp-content/uploads/2008/11/capitation-actuarial-medical-econometrics.pdf

Today, the concept of prepayment and medical capitation is to uncouple compensation from the actual number of patients seen, or treatments and interventions performed. This is akin to a fixed price restaurant menu, as opposed to an àla carte eatery.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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FORENSIC PODIATRY: Previously Unknown But Now in the Forefront

By Dr. David Edward Marcinko MBA MEd

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BREAKING NEWS

Law enforcement officials in Utah released a video of the suspected shooter in the assassination of Turning Point USA co-founder and CEO Charlie Kirk, saying that the person wore Converse tennis shoes and left a hand print and a shoe print at the scene.

The suspect in Charlie Kirk’s assassination has been identified as Tyler Robinson, a 22-year-old Utah resident. Law enforcement sources told the Daily Mail that Robinson was taken into custody as the alleged assassin who killed Kirk at a rally at Utah Valley University on Wednesday.

PODIATRY EDUCATION: https://medicalexecutivepost.com/2025/09/11/education-md-do-and-dpm/

Forensic Podiatry on TV

Before today, forensic podiatry has even made it into the public zeitgeist with the hit TV show “Bones” which premiered on September 13, 2005, and concluded on March 28, 2017, airing for 246 episodes over 12 seasons. The show was based on forensic anthropology and forensic archaeology, with each episode focusing on the mystery behind human body remains brought in for examination and identification.

PODIATRY TYPES: https://medicalexecutivepost.com/2025/07/28/podiatrist-types-specialization-and-salary/

In one show, eight pairs of dismembered feet washed ashore after a flood on the U.S.-Canada border, but things didn’t add up when only seven pairs of feet were identified as research corpses from a nearby university body farm.

When the fictional Canadian forensic podiatrist Dr. Douglas Filmore took the remains back to Canada, he had to form a jurisdictional alliance with the United States to match the pairs of feet and identify the victims. A rare and expensive pair of sneakers led the team to the victim’s murderer.

In 2016, an actual forensic podiatry club was started at the Barry University School of Podiatric Medicine. And, a formal class covering aspects of forensic podiatry is held at the New York College of Podiatric Medicine. Students exit the class with an in depth knowledge of forensic podiatry and other legal knowledge applicable to current cases.

More expertly, real-life colleague Michael Steven Nirenberg DPM actually testified in the murder trial of defendants Kailie Brackett and Donnell Dana with the state calling three witnesses to testify, including the podiatrist who claimed Brackett’s footprints match the ones found in blood at the apartment of the victim, Kimberly Neptune. The forensic podiatrist focused on the footprints discovered at Neptune’s apartment, using prints and images of the defendant’s feet taken by law enforcement. After study, he claimed the prints at the scene bore a resemblance to Kailie Brackett’s in the width of the foot. The defense questioned the field of forensic podiatry and pressed Dr. Nirenberg on whether the measurements would be altered depending on how thick the sock covering the foot was woven.

Dr. Nirenberg was also interviewed on National Public Radio’s Morning Edition on April 14th 2023 about the gait of the bombing suspect associated with the capital riot on Wednesday January 6th, 2021. Dr. Nirenberg is president of the American Society of Forensic Podiatry and co-editor of the textbook: “Forensic Gait Analysis: Principles and Practice”. The bombing suspect had placed bombs at the DNC and RNC headquarters in Washington, DC on the night before. NPR asked Dr. Nirenberg to comment on the features of the person’s gait.

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Additionally, Nirenberg was interviewed by Nancy Grace on her TV show Crime Stories. Grace interviewed Nirenberg about his forensic podiatry work in helping to solve the murder of a mother of 3 who was killed in a church. The case remains unsolved. The episode, “Fitness-Mom Missy Bevers Bludgeoned Dead in Creekside Church” aired June 6th, 2024 and is available online at Merit+ TV.

And, Netflix’s 2023 docu-series, “Till Murder Do Us Part”, recounts the killings of Derek and Nancy Haysom by including a series of interviews with a cast of real people. The four-part docu-series revolves around the unpacking of how a wealthy couple was murdered in Virginia in 1985. It also focuses on how the suspects, Elizabeth Haysom, and her boyfriend, Jens Soehring, betrayed each other during the trial.  Dr. Sarah Reel DPM was the forensic podiatrist who was involved with Jens’ and Elizabeth’s footprint examination. Dr. Reel pointed out that, statistically, there was no difference “between a bare footprint and a socked footprint.” The doctor suggested that Jens’ reference footprint matched closely with the crime scene footprint. 

Cite: Aeron Mer Eclarinal, The Direct [11/9/23]

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Stocks, Bonds and Commodities

By A.I. and Staff Reporters

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  • Stocks: The NASDAQ rose to its fifth record high of the week, while the S&P 500 and the Dow sank late in the day as investors turned their attention to the FOMC meeting next week.
  • Bonds: While equities climbed all week long, the bond market has been sending signals that weak economic data really isn’t great news.
  • Commodities: Oil rallied after President Trump expressed his growing frustration with Vladimir Putin and threatened further energy and financial sanctions. Meanwhile, the US may ask its G7 counterparts to apply 100% tariffs against China and India for purchasing Russian crude.

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BIAS: Financial Myopia

By A.I. and Staff Reporters

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BIAS

Bias is a prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair.

MYOPIA

Myopia (nearsightedness) is a common condition that’s usually diagnosed before age 20. It affects your distance vision — you can see objects that are near, but you have trouble viewing objects that are farther away like grocery store aisle markers or road signs. Myopia treatments include glasses, contact lenses or surgery.

MYOPIA BIAS

Myopia Bias makes it hard for us to imagine what our lives might be like in the future.

Financial Example: When we are young, healthy and in our prime economic earning years it may be hard for us to picture what life will be like when our health depletes and we no longer have the earnings necessary to support our standard of living.

Irony: This short-sightedness makes it hard to save adequately when we are young … when saving does the most good.

COMMENTS APPRECIATED

EDUCATION: Books

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FIXED INCOME SECURITY RISKS: All Physician Investors Should Know

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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Here are some of the most common risks associated with fixed income securities.

Interest Rate Risk

The market value of the securities will be inversely affected by movements in interest rates. When rates rise, market prices of existing debt securities fall as these securities become less attractive to investors when compared to higher coupon new issues. As prices decline, bonds become cheaper so the overall return, when taking into account the discount, can compete with newly issued bonds at higher yields. When interest rates fall, market prices on existing fixed income securities tend to rise because these bonds become more attractive when compared to the newly issued bonds priced at lower rates. 

Price Risk

Investors who need access to their principal prior to maturity have to rely on the secondary market to sell their securities. The price received may be more or less than the original purchase price and may depend, in general, on the level of interest rates, time to term, credit quality of the issuer and liquidity.

Among other reasons, prices may also be affected by current market conditions, or by the size of the trade (prices may be different for 10 bonds versus 1,000 bonds), etc. It is important to note that selling a security prior to maturity may affect actual yield received, which may be different than the yield at which the bond was originally purchased. This is because the initially quoted yield assumed holding the bond to term. As mentioned above, there is an inverse relationship between interest rates and bond prices. Therefore, when interest rates decline, bond prices increase, and when interest rates increase, bond prices decline.

Generally, longer maturity bonds will be more sensitive to interest rate changes. Dollar for dollar, a long-term bond should go up or down in value more than a short-term bond for the same change in yield. Price risk can be determined through a statistic called duration, which is featured at the end of the fixed income section.

REVENUE BONDS: https://medicalexecutivepost.com/2024/12/20/bonds-revenue/

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Liquidity Risk

Liquidity risk is the risk that an investor will be unable to sell securities due to a lack of demand from potential buyers, sell them at a substantial loss and/or incur substantial transaction costs in the sale process. Broker/dealers, although not obligated to do so, may provide secondary markets.

Reinvestment Risk

Downward trends in interest rates also create reinvestment risk, or the risk that the income and/or principal repayments will have to be invested at lower rates. Reinvestment risk is an important consideration for investors in callable securities. Some bonds may be issued with a call feature that allows the issuer to call, or repay, bonds prior to maturity. This generally happens if the market rates fall low enough for the issuer to save money by repaying existing higher coupon bonds and issuing new ones at lower rates. Investors will stop receiving the coupon payments if the bonds are called. Generally, callable fixed income securities will not appreciate in value as much as comparable non-callable securities.

ZERO COUPON BONDS: https://medicalexecutivepost.com/2024/11/12/bonds-zero-coupon/

Prepayment Risk

Similar to call risk, prepayment risk is the risk that the issuer may repay bonds prior to maturity. This type of risk is generally associated with mortgage-backed securities. Homeowners tend to prepay their mortgages at times that are advantageous to their needs, which may be in conflict with the holders of the mortgage-backed securities. If the bonds are repaid early, investors face the risk of reinvesting at lower rates.

Purchasing Power Risk

Fixed income investors often focus on the real rate of return, or the actual return minus the rate of inflation. Rising inflation has a negative impact on real rates of return because inflation reduces the purchasing power of the investment income and principal.

GENERAL OBLIGATION BONDS: https://medicalexecutivepost.com/2022/03/24/general-obligation-and-revenue-bonds/

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EDUCATION: Books

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STOCK MARKET: Beware Manipulation Schemes

By Dr. David Edward Marcinko MBA MEd CMP

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SPONSOR: http://www.MarcinkoAssociates.com

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What are types of market manipulation schemes?

Pump and Dump

Bear Raids

  • Refer to attempts by investors to move the price of a stock opportunistically by selling large numbers of shares short. The investors pocket the difference between the initial price and the new, lower price after this maneuver. This technique is illegal under SEC rules, which stipulate that every short sale must be on an uptick. For more information on this complex tactic, read on in this piece from the Wharton School of Business.

Wash Trading

Matched Orders

  • When fraudsters manipulate the market through matched orders, they enter trades to buy or sell securities with the knowledge that a matching order on the opposite side has been or will be entered. During his tenure at the Commission, our partner Jordan Thomas was involved in a case where the SEC won summary judgement and obtained settlements with an astonishing 16 defendants who engaged in matched trades, among other illicit tactics.

Painting the Tape

  • Painting the tape refers to placing successive orders in small amounts at increasing or decreasing prices.

Spoofing & Layering

  • High frequency traders are known to use the tactics of Spoofing & Layering to manipulate share prices. Spoofing is the placing of a bid or offer with the intent to cancel before execution. Layering is a form of spoofing in which the trader places multiple orders on one side of the book, in order to create a false impression of heavy buying or selling.
  • PONZI: https://medicalexecutivepost.com/2021/09/22/what-exactly-is-a-ponzi-scheme/

Read more about stock manipulation.

For further details about other common securities violations, see our Securities Law Primer.

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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RATE REVIEW: The 80/20 Health Insurance Rule

DEFINITIONS

By Staff Reporters

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Rate Review & the 80/20 Rule

The health care law provides 2 ways to hold insurance companies accountable and help keep your costs down: Rate Review and the 80/20 rule.

Rate Review

Rate Review helps protect you from unreasonable rate increases. Insurance companies must now publicly explain any rate increase of 15% or more before raising your premium. This does not apply to grandfathered plans.

Look up your insurance plan to see its proposed and final rate increase.

80/20 Rule

The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.

The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR. If an insurance company uses 80 cents out of every premium dollar to pay for your medical claims and activities that improve the quality of care, the company has a Medical Loss Ratio of 80%.

Insurance companies selling to large groups (usually more than 50 employees) must spend at least 85% of premiums on care and quality improvement.

If your insurance company doesn’t meet these requirements, you’ll get a rebate on part of the premium that you paid.

Will I get a rebate check from my insurance company?

If your insurance company doesn’t meet its 80/20 targets for the year, you’ll get back some of the premium that you paid.

You may see the rebate in a number of ways:

  • A rebate check in the mail
  • A lump-sum deposit into the same account that was used to pay the premium, if you paid by credit card or debit card
  • A direct reduction in your future premium
  • Your employer may also use one of the above rebate methods, or apply the rebate in a way that benefits employees

If you or your employer will get a rebate, your insurance company must notify you by August 1.

If you have an individual insurance policy, you’ll get the rebate directly from your insurance company.

For small group and large group plans, the rebate is usually paid to the employer. It may use one of the above rebate methods, or apply the rebate in a way that benefits employees.

FYI: The 80/20 rebate rules don’t apply when an insurance company has fewer than 1000 enrollees in a particular state or market.

Does this apply to my plan?

It depends.

For Rate Review: These requirements don’t apply to grandfathered plans. Check your plan’s materials or ask your employer or your benefits administrator to find out if your health plan is grandfathered.

For the 80/20 Rule: These rights apply to all individual, small group, and large group health plans, whether your plan is grandfathered or not.

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DOCTORS: Early Investing Needed for Retirement

NEW FINANCIAL STRATEGIES?

By A.I. and Dr. David Edward Marcinko; MBA MEd CMP

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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Starting early is key to saving for retirement

Although 97% of people aren’t yet millionaires, many could eventually meet that target if they start investing sooner rather than later; especially doctors [MD, DO, DPM, DDS or DMD].

BROKE DOCTORS: https://medicalexecutivepost.com/2025/08/02/doctors-going-broke-and-living-paycheck-to-paycheck/

A 20-year-old, for instance, needs to invest just $330 a month into an asset class that delivers a 7% to 8% annual return to reach $1.26 million by the time s/he turns 65 years old. The luxury of time significantly boosts your chances of becoming a millionaire.

This doesn’t mean it’s too late for middle-aged savers to reach that millionaire milestone, but it will take a significantly greater investment. If a 50-year-old doctor hasn’t started saving for retirement, s/he would need to invest $3,958 a month at a steady 7% return to reach $1.26 million by retirement.

MONEY ADDICTION: https://medicalexecutivepost.com/2025/08/07/moiney-addicted-physicians-the-investing-and-trading-personality-of-doctors/

However, according to one Goldman Sachs report, investors could expect the S&P 500 to deliver just 3% annualized nominal returns over the next 10 years.

After an average 13% yearly return for the past decade, a new strategy outside of the stock market may be needed for that level of outsized gain, especially if you’re late to investing.

RETIREMENT VISION: https://medicalexecutivepost.com/2025/08/04/physicians-determine-your-retirement-vision/

COMMENTS APPRECIATED

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

AI/HIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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MEDICAL EXPENSES: Out of Pocket and Out of Network Fees

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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OUT OF POCKET [OOP] EXPENSES

Classic: The portion of medical expenses a patient is responsible for paying.

Modern: Refers to the maximum you will pay during your policy period, which is typically a year, before your plan starts to pay 100% of your allowed amount. The costs of your deductible, co-pay, and co-insurance are included here, but not your premium.

CO-PAYS: https://medicalexecutivepost.com/2025/05/17/cleveland-clinic-controversial-new-health-insurance-co-payment-policy/

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OUT OF NETWORK [OON] EXPENSES

Classic: “Out-of-network” health care providers do not have an agreement with your insurance company to provide care. While insurance companies may have some out-of-network benefits, medical care from an out-of-network provider will usually cost more out-of-pocket than an in-network provider. 

Modern: The amount that a health care insurance plan will contribute toward out-of-network services will vary by your insurance company and is often based on a “reasonable and customary” amount that the service should cost

Example: If you go to an out-of-network dentist and are billed $300 for the service, your insurance company may contribute $200 toward paying this cost because $200 is the amount it has decided is “reasonable and customary” for this service. When out-of-network, any remaining cost above this amount ($100 in this case) may have to be fully covered by the person receiving care. When out-of-network, the usual coinsurance rates that apply in-network may not apply out-of-network. Additionally, out-of-network service costs may not count toward an annual deductible.

CHARGE-MASTER: https://medicalexecutivepost.com/2024/11/20/charge-master-medical-bills-paradox/

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EDUCATION: Books

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QUATERNARY: Medical Care Defined

Primary – Secondary – Tertiary Care

By A.I. and Staff Reporters

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In medicine, there are four levels of care: primary, secondary, tertiary, and quaternary. The levels of care refer to the complexity of the medical cases that doctors and healthcare providers treat and the skills and specialties of the providers. 

Primary care involves consulting with a primary care provider. Secondary care refers to seeing a specialist such as a dermatologist, neurologist or oncologist. Tertiary care is specialized care in a hospital setting such as brain surgery, renal dialysis or heart surgery.

Quaternary care is thus an advanced level of specialized care.

PRIMARY CARE: https://medicalexecutivepost.com/2024/09/27/cms-a-new-primary-care-medicine-model/

QUATERNARY CARE

Classic: Sometimes used as an extension of tertiary medical and surgical care in reference to advanced levels of medicine which are highly specialized and not widely accessed by most patients.

Modern: A higher level of specialized care within a hospital. Experimental medicine and some types of uncommon diagnostic or surgical procedures are also considered quaternary care.

According to the Wonca International Dictionary for General/Family Practice -Quaternary Prevention [QP] – is defined as: ‘Action taken to identify patient at risk of over medicalization, to protect him/her from new medical invasion, and to suggest to him interventions, which are ethically acceptable’.

Examples: Types of quaternary care include: experimental medicine, procedures and uncommon and specialized surgeries. This includes sub-specialty services such as advanced trauma care and organ [heart, lung, liver, kidney, etc] transplantation.

MEDICAL CARE: https://medicalexecutivepost.com/2024/07/29/survey-primary-care-doctors-deliver-most-medical-care/

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EDUCATION: Books

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Understanding Newton’s First Law of Start-Up Investing

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PHYSICIAN BANKRUPTCY: Six Total Types to Know!

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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According to Medical Economics, there were 10 clinic and physician practices filing bankruptcy in 2024, making it the highest level of the last six years, according to a new analysis of cases with liabilities of at least $10 million.

Meanwhile, the Steward Health Care System bankruptcy, which was based in Massachusetts but making headlines across the nation, has become “the largest hospital sector bankruptcy by far in the last 30 years,” according to a new analysis by Gibbins Advisors, based in Nashville, Tennessee.

Health care bankruptcy filings totaled 57 last year, down from 79 in 2023, said “Healthcare Restructuring: Trends and Outlook.” The report analyzed Chapter 11 health care bankruptcy cases with liabilities of at least $10 million, since 2019.

Last year’s total was down 28% from 2023’s peak, but greater than the 2019 to 2022 average of 42 filings a year, the report said.

BROKE DOCTORS: https://medicalexecutivepost.com/2025/08/02/doctors-going-broke-and-living-paycheck-to-paycheck/

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Bankruptcy, often considered a last financial resort, is a legal process that can help alleviate outstanding debts for individuals and businesses. Reasons to file for bankruptcy can include divorce, job loss, exorbitant medical bills or credit card debt.

There are several types of bankruptcy — six, as a matter of fact. The two most common types of bankruptcy for individuals are Chapter 7 and Chapter 13.

But there are four other types as well: Chapter 9, Chapter 11, Chapter 12 and Chapter 15. And, the type of bankruptcy filed depends on the situation.

Regardless of which type, the process is typically the same: You’ll usually retain an attorney and make your case before a judge, who will then erase some debts or set up a repayment plan.

Also note that an eligibility requirement — for all bankruptcy chapters — is that you must undergo credit counseling within the 180 days before filing.

DOCTORS: https://medicalexecutivepost.com/2025/07/17/doctors-and-lawyers-often-arent-millionaires/

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Hospital Acquisitions of Physician Practices Increase Prices

By Health Capital Consultants, LLC

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A recent study of hospital physician acquisition and employment found that such acquisitions decrease competition and raise prices. A National Bureau of Economic Research (NBER) working paper, released in July 2025, “empirically analyze[d] the effects of mergers between complementary firms on competition and pricing,” and found hospital prices increased by an average of 3.3%, while physician prices increased by an average of 15.1%.

This Health Capital Topics article reviews the study’s findings and implications for the healthcare industry. (Read more…)

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Stock Markets, Trade Tariffs and Commodities

By Staff Reporters and A.I.

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  • Markets: Stocks started off Friday on a high note after a weak jobs report raised hopes that the Fed will cut interest rates this month. But the rally faded as the afternoon wore on, while 10-year bond yields tumbled to their lowest level since April.
  • Trade: President Trump said “fairly substantial” tariffs for semi-conductors are coming “very shortly,” but hinted that companies like Apple will be spared. He also clapped back at EU regulators for fines against Google.
  • Offbeat commodities: Raw sugar prices hit a two-month low as Brazilian producers churn out more of the sweet stuff, cocoa prices are expected to pop after Cargill paused production in Ivory Coast, and corn hit its highest price since July thanks to strong export demand.

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New HHS-CMS Committee Announced

U.S. Department for Health & Human Services & Centers for Medicare & Medicaid Services

By Health Capital Consultants, LLC

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On August 21, 2025, the U.S. Department for Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the formation of a new Healthcare Advisory Committee.

The Committee is expected to be comprised of a group of experts who will make strategic recommendations to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz.

This Health Capital Topics article discusses this announcement and potential implications on the healthcare industry. (Read more…)

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PSYCHOLOGICAL BIAS: The Ikea Effect in Finance?

By Dr. David Edward Marcinko; MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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IKEA EFFECT BIAS

Ikea Effect Bias describes the tendency of people to place a higher value on products they have partially created or assembled themselves. This phenomenon is named after the Swedish furniture retailer Ikea, known for selling furniture in flat-pack kits that customers must assemble at home.

he IKEA effect was identified and named by Michael Norton of Harvard Business School, Daniel Mochon of Yale University and colleague Dan Ariely PhD of Duke University, who published the results of three studies in 2011. They described the IKEA effect as “labor alone can be sufficient to induce greater liking for the fruits of one’s labor: even constructing a standardized bureau, an arduous, solitary task, can lead people to overvalue their (often poorly constructed) creations.”

Example: A prospect is more likely to pursue his/her own financial plan than that one from an informed financial planner, CPA or professional advisor.

2011 study found that subjects were willing to pay 63% more for furniture they had assembled themselves than for equivalent pre-assembled items.

IN FINANCE AND INVESTING

The IKEA effect can contribute to reducing panic selling. Investors typically reduce their stock market exposure after a financial crash which often results in “buy high, sell low” strategy that is detrimental to long-run wealth accumulation.

Ashtiani et al.’s study proposes a nudge utilizing the IKEA effect to counteract this phenomenon: “actively involving investors in the selection process of the risky investments, while restricting their selections in a way that preserves a large degree of diversification.”

DIVERSIFICATION: https://medicalexecutivepost.com/2025/06/17/correlation-diversification-in-finance-and-investments/

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EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Stocks, Crypto-Currency and Commodities

By A.I. and Staff Reporters

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  • Stocks: Equities climbed slowly but steadily yesterday as investors braced themselves for today’s all-important jobs report.
  • Crypto: Bitcoin fell as a selloff in cryptocurrencies associated with the Trump family pulled the entire crypto market lower.
  • Commodities: Gold remains in the spotlight as traders bulk up on bullion to protect their portfolios in case the FOMC loses its independence. If that does happen, Goldman Sachs analysts think gold could climb to $5,000.

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EDUCATION: Books

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7 Ways to Fund Your Start-Up Without Venture Capital

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ARTIFICIAL INTELLIGENCE: Stock Market Features – Not Bugs

A.I. by Artificial Intelligence

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Artificial intelligence (AI) refers to computer systems capable of performing complex tasks that historically only humans could do, such as reasoning, making decisions, or solving problems. Today, the term “AI” describes a wide range of technologies that power many of the services and goods we use every day – from apps that recommend TV shows to chatbots that provide customer support in real time. And yet, there is a hierarchy among related concepts such as machine learning and deep learning.

So, to summarize the hierarchy:

  • AI is the goal: machines that can think and act intelligently.
  • Machine learning is a method within AI that lets machines learn from data.
  • Deep learning is a specialized form of machine learning that uses multi-layered neural networks to analyze data in a way that mimics the human brain.

It’s a feature, not a bug

And, there’s no shortage of companies leveraging AI today to remain profitable, to the delight of Salesforce investors: among others:

  • Wells Fargo’s CEO has touted trimming its workforce for 20 straight quarters. Its stock is up 228% over the past five years.
  • Bank of America CEO Brian Moynihan wasn’t hiding it during a recent earnings call when he said the company has let go of 88,000 employees over the past 15 years. BofA stock is up 95% since 2020.
  • Amazon, with its share value up 28% over the past year, recently told staff that AI implementation would lead to layoffs.
  • Microsoft has cut 15,000 jobs in the past two months as the company pivots to AI—and its stock is also up since the beginning of July.

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Stocks, Bonds and Commodities

By A.I. and Staff Reporters

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  • Stocks: Markets slowed along yesterday with the S&P 500 and NASDAQ buoyed after a pivotal antitrust ruling for Alphabet pushed big tech stocks higher across the board.
  • Bonds: The 30-year Treasury pushed 5% yesterday as traders fret about the Fed’s independence and the odds of interest rate cuts.
  • Commodities: Oil sank on reports that OPEC+ is contemplating increasing its crude output next month, while gold reached yet another new record high as uncertainty swirling around the future of tariffs continued to rise. JPMorgan analysts now think the precious metal could climb as high as $4,250 by the end of next year.

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EDUCATION: Books

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MEDICAL LOSS RATIO: Defined

By A.I. and Staff Reporters

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Medical Loss Ratio (MLR)

A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees.

MLR: https://medicalexecutivepost.com/2022/07/30/health-insurance-medical-loss-ratios/

If an insurer uses 80 cents out of every premium dollar to pay its customers’ medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions.

The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws.

MLR: https://medicalexecutivepost.com/2013/08/17/commercial-health-plans-medical-loss-ratio-2nd-quarter-2013/

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CMS: Releases 2026 IPPS Final Rule

Medicare Inpatient Prospective Payment System

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By Health Capital Consultants, LLC

On July 31, 2025, the Centers for Medicare & Medicaid Services (CMS) released its finalized payment and policy updates for the Medicare Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year (FY) 2026.

The final rule authorized Medicare inpatient reimbursement increases for 2026 and moved forward with improvements to quality measurement, and provided more information on a new value-based payment model.

This Health Capital Topics article will discuss the IPPS final rule and stakeholder reactions. (Read more…) 

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EDUCATION: Books

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Stocks, Bonds and Commodities

By A.I.

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Bonds
: Treasury yields rose yesterday as investors dug into a Federal appeals court ruling last Friday stating that most of President Trump’s tariffs are illegal. The 30-year yield closed in on the key 5% level.
Stocks: Equities tumbled across the board as technology stocks sold off and pulled the rest of the market down with them.
Commodities: Gold hit a new record high as traders hedged against tariff uncertainty and braced themselves for an extremely important US jobs report on Friday that could make or break the case for the Fed to start cutting rates.

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PHYSICIANS: Alimony V. Palimony

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What is Alimony

According to Hello Divorce, alimony, often referred to as spousal support, is a court-ordered payment from one spouse to the other following a divorce or legal separation. Its existence is tied to the legal status of marriage. The underlying principle is that both spouses contributed to the marital standard of living, and the dissolution of the marriage should not cause an inequitable economic outcome for the lower-earning spouse. This support is not intended as a punishment but as a means of mitigating the financial impact of divorce.

The purpose of alimony can vary. In some cases, it is rehabilitative, providing temporary support while one spouse obtains education or job training to become self-sufficient. For longer marriages, it might serve to help maintain the standard of living established during the partnership. Alimony is a legal tool derived from family law statutes to address the financial interdependence created by marriage.

DIVORCE: https://medicalexecutivepost.com/2025/08/14/physician-divorce-within-the-medical-profession/

Note: The federal tax treatment for alimony changed with the Tax Cuts and Jobs Act of 2017. For any divorce or separation agreement executed after December 31st, 2018, alimony payments are no longer tax-deductible for the person paying them. The recipient of the support does not report the payments as taxable income. This change is permanent and does not expire with other provisions of the act.

What is Palimony

According to Wikipedia, Palimony refers to financial support that may be awarded after an unmarried couple separates. Unlike alimony, palimony is not rooted in family law but is a concept derived from contract law. An award depends on the existence of an agreement between the partners. This agreement can be a formal written contract or an oral or implied agreement for support in exchange for services, such as managing the household.

The legal basis for palimony was established by the 1976 California Supreme Court case, Marvin v. Marvin. In that case, the court ruled that unmarried cohabitants could make enforceable contracts for support, as long as the agreement was not based on sexual services. Because it is a contract claim, a palimony case is pursued in civil court, not family court. Palimony is not available in all states and is only recognized in a minority of jurisdictions.

MEDIATION: https://medicalexecutivepost.com/2023/08/12/a-step-wise-approach-to-the-divorce-mediation-process-for-doctors/

Note: The tax implications of palimony are less defined than alimony because the IRS does not have a specific rule for it. How palimony is treated depends on the nature of the underlying claim. If the payments are a settlement for services rendered, they may be considered taxable income to the recipient. If the payments are characterized as a gift, they are not considered taxable income for the recipient.

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BEWARE: Stocks and the U.S. Stock Markets?

By A.I.

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  • Markets: After a day off for Labor Day, Wall Street is entering September with little confidence as stocks shrugle with tariffs and AI-slowdown jitters to rise for four straight months. September has historically been the weakest month for US stocks, plus a hugely consequential Federal Reserve meeting looms on September17th.
  • Stock spotlight: An already booming Celsius hit a 52-week high last week after Pepsi said it would up its stake in the energy drink maker.

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SEPTEMBER: Blood Cancer Awareness Month

By Staff Reporters

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This September, along with survivors, caregivers, advocates, and healthcare professionals, HealthTree is commemorating Blood Cancer Awareness Month!

In this article, you’ll learn why this month receives special attention in the HealthTree community and what they will feature throughout September so you don’t miss a thing.  

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HAPPY: Labor Day 2025

Dear Medical Executive-Post Readers and Subscribers

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HISTORY OF LABOR DAY

The first Labor Day holiday was celebrated on Sept. 5th, 1882, in New York City, in accordance with the plans of the Central Labor Union. President Grover Cleveland signed a law on June 28th, 1894, that made the first Monday in September of each year a national holiday, according to the Department of Labor.

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MY SEPTEMBER HEALTH RE-SET

To give my health a boost after Labor Day, I’m taking a complete break from alcohol, sugar, cookies, ice cream, coffee and tea for the entire month of September. Besides that, I’ll also prioritize sleep and increase my exercise from 7 to at least 10 times [hours] a week. This will allow me to focus on my diet and mental well-being. It’s essentially a month of health and wellness rejuvenation.

I’ve chosen to focus on alcohol and sugar because I want to challenge the idea that moderate drinking is part of a healthy lifestyle. In reality, only those who maintain a healthy lifestyle can afford to enjoy alcohol in moderation. But, sugar is everywhere and must be minimized for Type II diabetes and weight control.

Moreover, the long-term and excessive intake of sugary beverages and refined sugars can negatively impact your overall caloric intake and create a domino effect on your health. For example, excess sugar in the body can turn into fat deposits and lead to fatty liver disease.

A low sugar diet can help you lose weight and also help you manage and/or prevent diabetes, heart disease and stroke, reduce inflammation, and even improve your mood and the health of your skin. That’s why the low sugar approach is a key tenet of other well-known healthy eating patterns, such as the Mediterranean diet and the DASH diet.

QUESTION: And so, do you also commit to such “factory resets” now and then? Please comments.

Do, enjoy the Labor Day Weekend, Bar-B-Ques with friends, family and colleagues. And, I hope you continue to find the Medical Executive-Post useful!

Many thanks for your likes and referrals.
Dr. David Edward Marcinko MBA MEd CMP
[Editor and Chief]

EDUCATION: Books

SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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PHILOSOPHY: Five Major Branches

By A.I.

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Philosophy (‘love of wisdom’) is a systematic study of general and fundamental questions concerning topics like existence, reason, knowledge, value, mind and language. It is a rational and critical inquiry that reflects on its methods and assumptions.

Philosophy is broadly divided into several main branches that explore fundamental questions about reality, knowledge, ethics, logic, and values, each addressing different aspects of human thought and existence.

STOIC: https://medicalexecutivepost.com/2022/11/20/stoic-the-philosophy-of-knowing-and-doing/

Major Branches of Philosophy

  1. Metaphysics
    This branch explores the nature of reality and existence. It addresses questions about what things exist, the nature of objects and their properties, time and space, causality, and the mind-body relationship.
  2. Epistemology
    Epistemology studies knowledge and belief. It concerns how we know what we know, the nature and limits of knowledge, justification, and skepticism.
  3. Ethics (Moral Philosophy)
    Ethics examines what is right and wrong, good and bad. It investigates moral values, principles, and theories about how people ought to act and what constitutes a good life.
  4. Logic
    Logic deals with the rules of correct reasoning. It studies principles of valid inference, argument structure, deduction, and induction, enabling critical thinking and sound judgment.
  5. Aesthetics
    This branch explores questions related to beauty, art, and taste. It considers what constitutes aesthetic value and how art influences human experience.

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