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Posted on August 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko; MBA MEd
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Healthcare comes with its share of mental challenges, especially considering that clinicians often care for patients when they’re in difficult and sometimes tragic situations. New research shows that even the path to getting into the workforce can be a challenge, with some physicians burning out before they make it to graduation.
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American medicine is undergoing vast changes, placing the status of physicians in the medical industrial complex at great risk. Most physicians feel overwhelmed by increasing bureaucratic mandates from insurers, hospitals, and government. At the same time, physicians are the front line employees of healthcare and assume the majority of the risk for patient care. This has left many in the profession with increasing disillusionment.
Samantha Meltzer-Brody a psychiatrist and director of, Taking Care of Our Own, University of North Carolina, Chapel Hill, NC states it best:
“Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.”
What causes physician burnout?
The “Big 4” factors known to contribute to stress and burnout include:
Time pressure, especially in patient visits or documentation
Lack of control over work environment
Chaotic, fast-paced workplaces
Culture of the organization, specifically a culture that does not emphasize communication, cohesion, trust, and alignment of values between clinicians and their leaders
In addition to burnout rates, these factors can be assessed to help direct interventions toward those drivers that are most likely to be contributing to burnout at your organization.
The burned-out physician is exhausted — mentally and physically — and often no longer able to find empathy or connection with patients. The question of how to escape from what has become a highly unpleasant situation becomes a frequent one. Given the high demands of the profession and serious consequences of mistakes, the burned-out doctor is a potentially impaired one. And the impaired physician is not able to maintain the unflappable, perpetually cool under fire, always objective, professional and yet compassionate demeanor that is expected by society. Worst of all, the impaired physician is at great risk for developing depression, suicidal ideation, or a serious addiction.
The doctors who contact me report feeling beaten down by an increasingly hostile work environment. They say that they don’t have time to take care of patients the way they envisioned when they decided to apply to medical school. Many describe feeling betrayed by a system that they say seems focused on achieving the bottom line with little regard for the impact on both doctors and patients.
Most of these doctors report spending a significant amount of their time dealing with the electronic medical record and documentation. The ratio of time spent on doctor-patient
interactions compared to physician-computer ones appears so horribly skewed that it has reached the point of complete dysmorphia. These good physicians call me when they feel like they can’t continue any longer in the profession. They want to quit medicine. They report a loss of joy and meaning in their work. They describe the toll that the profession has had on their mental health, physical health, and personal lives. And most wrenchingly, they don’t see an end.
What can we do? There are no easy answers to the complex issues that threaten our profession. “The Taking Care of Our Own Program…has had an over 200% rate of growth in the first year, reflecting the enormous need…”
Burned out physicians will eventually be labeled as disruptive, impaired, an outlier or arrogant. There’s a reason it’s difficult and extremely expensive for physicians to find disability insurance; psychiatric claims. Burnout leads to depression, anxiety, PTSD, suicide, divorce, drug abuse, surly behaviors and interactions, etc. It’s nothing new; it’s been occurring for a long time. Go without routine sleep, eat erratically, work long hours, operate under constantly stressful situations and have no time for your family or self and most individuals will de-compensate physically and psychologically within weeks.
Conclusion
Physicians operate within these parameters year after year.
How are they to remain healthy, functional humans? They can’t. Even a superhero couldn’t, yet physicians are expected to endure and thrive under such conditions.
If a physician makes a single mistake, or snaps just one day, their entire career is on the line.
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
Posted on August 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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A paradox is a self-contradictory statement. And, the ancient Greeks were well aware that a paradox can take us outside our usual way of thinking. They combined the prefix para – (“beyond” or “outside of”) with the verb dokein (“to think”), forming paradoxos, an adjective meaning “contrary to expectation.” Latin speakers used that word as the basis for a noun paradoxum, which English speakers borrowed during the 1500s to create paradox.
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Paradox of Education: Cumulative Advantage and Disadvantage
Classic Definition: Social status snowballs in either direction because people like associating with successful people, so doors are opened for them. And, folks avoid associating with unsuccessful people, for whom doors are closed.
Modern Circumstance: Education’s positive effect on health gets larger as people age. The large socioeconomic differences in health among older Americans mostly accrue earlier in adulthood on gradients set by educational attainment. Education develops abilities that help individuals gain control of their own lives, encouraging and enabling a healthy life.
Paradox Example: The health-related consequences of education cumulate on many levels, from the socioeconomic (including work and income) and behavioral (including health behaviors like exercising) to the physiological and intra-cellular. Some accumulations even influence each other.
In particular, a low sense of control over one’s own life accelerates physical impairment, which in turn decreases the sense of control. That feedback progressively concentrates good physical functioning and a firm sense of personal control together in the better educated while concentrating physical impairment and a sense of powerlessness together in the less well educated, creating large differences in health in old age.
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
The so-called money factor (abbreviated as MF on invoices) is a number in a decimal form that dealers use to calculate the APR of a car lease. It’s a major part of your monthly payment and dealers are known to jack up the money factor to pad their profits.
Most doctors don’t ask to see it because they’re not aware of it or don’t know how to calculate it. Ask to see the money factor, then multiply it by 2,400.
For example, if the money factor is .00150, you multiply it by 2,400 to get 3.6%. If that’s higher than the prevailing rate, you have room to talk them down.
How to reduce it
So how do you get a good interest rate when you lease a vehicle? The same way you do when borrowing for any other reason, whether it’s buying a home or applying for a personal loan: by having good credit. This may reduce your interest rate because you’ll represent a lower risk to a lender.
A high residual value on the car could also help you get a better interest rate. A higher residual value means you’d have lower monthly payments because there would be less depreciation on the vehicle. Since interest is applied to your monthly payment, a lower monthly payment would equate to reduced interest charges.
The money factor is one of the many numbers you may want to learn about when leasing a car. It’s one of the transactional costs that come with leasing, and allows dealers and finance companies to make a profit on every lease they execute. As a consumer, it’s a smart idea to learn the financial implications of this number and how it’ll affect your overall costs over the course of a multi-year lease.
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If the interest rate is too high, you may need to shop around for a better rate, negotiate with the dealer or lender to lower the money factor, or consider leasing another vehicle that’s more in line with your budget. Either way, make sure you explore all your financial options before taking a car off the lot.
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
Posted on August 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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Dr. David Edward Marcinko with non-VIP patients
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The House Committee on Oversight and Government Reform expanded its investigation of the cover-up of former President Joe Biden’s health, prostate cancer, and mental decline.
On June 4th, Chairman James Comer subpoenaed five former senior White House aides to appear for transcribed interviews in addition to Biden’s physician, Kevin O’Connor, M.D. In May, Biden revealed he was diagnosed with advanced prostate cancer. The announcement left the public dumbfounded.
At 82, having spent more than five decades as a president, vice president and senator, Biden had access to world-class medical care. Donald Trump Jr. was one of many political observers who speculated the diagnosis might have been covered up to win the 2020 election. And, Biden’s doctors may have followed standard medical guidelines, and the recommendations about screenings for people of different ages can be controversial, writes health care economist Devon Herrick at the Goodman Institute Health Care Blog.
“Experts often say that men are more apt to die with prostate cancer than from prostate cancer,” wrote Herrick. “There is even some disagreement about whether doctors should treat most occurrences of prostate cancer in older men. That partly explains why Biden had not been screened in a decade.”
Screenings can be costly, time-consuming and uncomfortable, and false positive results can lead to invasive procedures that do not markedly extend life or health. Biden made his first public remarks about his cancer after a Memorial Day event. Biden said he was “feeling good” and expected to “be able to beat this.”
QUESTION: So, was this a case of VIP Patient Paradox?
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DEFINITION: “VIP medical patient paradox syndrome” is a term coined in 1964 by the psychiatrist Walter Weintraub to describe an intriguing paradox: Throughout history, the rich and famous, with all their resources and fancy doctors, have often received worse medical treatment, and suffered from worse health outcomes, than the average person.
Example: When physicians afford “special privileges” to their powerful patients, from “Mad King” George III to Michael Jackson, they seem to get sicker and even die.
While Weintraub, a psychoanalyst, attributed the problem in part to doctors unconsciously resenting their influential patients, it seems doctors simply get starstruck around famous people and high-ranking figures. Despite their medical expertise, these physicians find themselves opting out of basic tests for “privacy” or prescribing dangerous medications for “comfort.”
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
Posted on August 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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Medicine today is vastly different than a generation ago, and all health care professionals need new skills to be successful and reduce the emerging risks outlined in this textbook, as well as the “unknown-unknowns” elsewhere. Traditionally, the physician was viewed as the “captain of the ship”. Today, their role may be more akin to a ship’s navigator, using clinical, teaching skills and knowledge to chart the patient’s course through a confusing morass of insurance requirements, fees, choices, rules and regulations to achieve the best attainable clinical outcomes.
This new leadership paradigm includes many classic business school principles, now modified to fit the decade long PP-ACA, the era of health reform, and modern technical connectivity and EMRs.
Thus, the physician must be a subtle guide on the side; not bombastic sage on the stage. These, newer health 3.0 leadership philosophies might include:
•Negotiation – working to optimize appropriate treatment plans; ie., quality of life versus quantity of life, •Team play – working in concert with other allied healthcare professionals to coordinate care delivery ,ithin a clinically appropriate and cost-effective framework; •Working within the limits of competence – avoiding the pitfalls of the medical generalist versus the specialist that may restrict access to treatment, medications, physicians and facilities by clearly acknowledging when a higher degree of service is needed on behalf of the patient – all while embracing holistic primary care; •Respecting different cultures and values – inherent in the support of the medical Principle of Autonomy is the acceptance of values that may differ from one’s own. As the US becomes more culturally hetero geneous, medical providers are called upon to work within, and respect, the socio-cultural and/or spiritual framework of patients, students and their families; •Seeking clarity on what constitutes marginal care – within a system of finite resources; providers are called upon to openly communicate with patients regarding access to marginal medical information and/or treatments. •Supporting evidence-based practice – healthcare providers, should utilize outcomes data to reduce variation in treatments to achieve higher efficiencies and improved care delivery thru evidence based medicine [EBM]; •Fostering transparency and openness in communications – healthcare professionals should be willing, and prepared, to discuss all aspects of care, especially when discussing end-of-life issues or when problems arise; •Exercising decision-making flexibility – treatment algorithms, templates and clinical pathways are useful tools when used within their scope; but providers must have the authority to adjust the plan if circumstances warrant.
Becoming skilled in the art of listening and interpreting — In her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD PhD, a professor at Columbia University, writes of the extraordinary value of using the patient’s personal story in the treatment plan. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases; convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship.
These thoughts represent only a handful of examples to illustrate the myriad of new skills that tomorrows’ healthcare professionals must master in order to meet their timeless professional obligations of compassionate care and contemporary treatment effectiveness; all within the context modern risk management principles.
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
Posted on August 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
LEADERSHIP versus MANAGEMENT
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By Dr. David Edward Marcinko MBA MEd
By Professor Gary A. Cook PhD
By Professor Eugene Schmuckler PhD MBA MEd CTS
Many of us have encountered a person who may intellectually be at upper levels, but whose ability to interact with others appears to that of one who is highly immature. This is the individual who is prone to becoming angry easily, verbally attacks co-workers, is perceived as lacking in compassion and empathy, and cannot understand why it is difficult to get others to cooperate with them and their agendas.
THINK: Sheldon Cooper PhD D.Sc MA BA of the The Big Bank Theory TV show.
The concept of Emotional Intelligence [EQ] was brought into the public domain when Daniel Goleman authored a book entitled, Emotional Intelligence.” According to Goleman, emotional intelligence consists of four basic non-cognitive competencies: self awareness, social awareness, self management and social skills. These are skills which influence the manner in which people handle themselves and their relationships with others. Goleman’s position was that these competencies play a bigger role than cognitive intelligence in determining success in life and in the workplace. He and others contend that emotional intelligence involves abilities that may be categorized into five domains:
Self awareness: Observing and recognizing a feeling as it happens.
Managing emotions: Handling feelings so that they are appropriate; realizing what is behind a feeling; finding ways to handle fears and anxieties, anger and sadness.
Motivating oneself; Channeling emotions in the service of a goal; emotional self control; delaying gratification and stifling impulses.
Empathy: Sensitivity to others’ feelings and concerns and taking their perspective appreciating the differences in how people feel about things.
Handling relationships: Managing emotions in others; social competence & social skills.
In 1995, Goleman then expanded on the works of Howard Gardner, Peter Salovey and John Mayer. He further defined Emotional Intelligence as a set of competencies demonstrating the ability one has to recognize his or her behaviors, moods and impulses and to manage them best, according to the situation. Mike Poskey, in “The Importance of Emotional Intelligence in the Workplace.” continued this definition by stating that emotional intelligence is considered to involve emotional empathy; attention to, and discrimination of one’s emotions; accurate recognition of one’s own and others’ moods; mood management or control over emotions; response with appropriate emotions and behaviors in various life situations (especially to stress and difficult situations); and balancing of honest expression of emotions against courtesy, consideration, and respect.
Source: Emotional Intelligence: what is and why it matters” – Cary Cherniss, PhD, presented at the annual conference of the Society of Industrial and Organizational Psychology, April 2000.
EQ differs from what has generally been considered intelligence which is described in terms of one’s IQ.
Traditional views of intelligence focused on cognition, memory and problem solving. Even today individuals are evaluated on the basis of cognitive skills. Entrance tests for medical, law, business, undergraduate and graduate schools base admissions in large part on the scores of the SAT, GMAT, LSAT, MCAT, etc. Without question, cognitive ability is critical but has been demonstrated, it is not a very good predictor of future direct job performance and indirect liability management. In fact, in 1940, David Wechsler the developer of a widely used intelligence test made reference to “non-intellective” elements. By this Wechsler meant affective, personal and social factors.
Source: Non-Intellective factors in intelligence. Psychological Bulletin, 37, 444-445.
Goleman became aware of the work of Salovey and Mayer having trained under David McClelland and was influenced by McClelland’s concern with how little traditional tests of cognitive intelligence predicted success in life. In fact, a study of 80 PhDs in science underwent a battery of personality tests, IQ tests and interviews in the 1950s while they were graduate students at Berkeley. Forty years later they were re-evaluated and it turned out that social and emotional abilities were four times more important than IQ in determining professional success and prestige.
Source: Feist & Barron: Emotional Intelligence and academic intelligence in career and life success. Paper presented at the Annual Convention of the American Psychological Society, San Francisco, 1996.
Undoubtedly, we want to have individuals work with us who have persistence which enables to them have the energy, drive, and thick skin to develop and close new business, or to work with the patients and other members of the staff. It is important to note that working alongside one with a “good” personality may be fun, energetic, and outgoing.
However, a “good personality does not necessarily equate to success. An individual with a high EQ can manage his or her own impulses, communicate effectively, manage change well, solve problems, and use humor to build rapport in tense situations. This clarity in thinking and composure in stressful and chaotic situations is what separates top performers from weak performers.
Poskey outlined a set of five emotional intelligence competencies that have proven to contribute more to workplace achievement than technical skills, cognitive ability, and standard personality traits combined.
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A. Social Competencies: Competencies that Determine How We Handle Relationships
Intuition and Empathy – Our awareness of others’ feelings, needs, and concern. He suggested that this competency is important in the workplace for the following reasons:
Understanding others: an intuitive sense of others’ feelings and perspectives, and showing an active interest in their concerns and interests
Patient service orientation: the ability to anticipate, recognize and meet customer’s’ (patients) needs
People development: ability to sense what others need in order to grow, develop, and master their strengths
Leveraging diversity: cultivating opportunities through diverse people.
B. Political Acumen and Social Skills: Our adeptness at inducing desirable responses in others. This competency is important for the following reasons:
Influencing: using effective tactics and techniques for persuasion and desired results.
Communication: sending clear and convincing messages that are understood by others
Leadership: inspiring and guiding groups of people
Change catalyst: initiating and/or managing change in the workplace
Conflict resolution: negotiating and resolving disagreements with people
Collaboration and cooperation: working with coworkers and business partners toward shared goals
Team capabilities: creating group synergy in pursuing collective goals.
C. Personal Competencies: Competencies that determine how we manage ourselves
D. Self Awareness: Knowing out internal states, preferences, resources, and intuitions. This competency is important for the following reasons.
Emotional awareness: recognizing one’s emotions and their effects and impact on those around us
Accurate self-assessment: knowing one’s strengths and limits
Self-confidence: certainty about one’s self worth and capabilities
Self-Regulation: managing one’s internal states, impulses, and resources. This competency is important in the workplace for the following reasons.
Self-control: managing disruptive emotions and impulses
Trustworthiness: maintaining standards of honesty and integrity
Conscientiousness: taking responsibility and being accountable for personal performance
Adaptability: flexibility in handling change
Innovation: being comfortable with an openness to novel ideas, approaches, and new information.
E. Self-Expectations and Motivation: Emotional tendencies that guide or facilitate reaching goals. This competency is important in the workplace for the following reasons.
Achievement drive: striving to improve or meet a standard of excellence we impose on ourselves
Commitment: aligning with the goals of the group or the organization
Initiative: readiness to act on opportunities without having to be told
Optimism: Persistence in pursuing goals despite obstacles and setbacks
A note of caution is necessary. Goleman and Salovey both stated that emotional intelligence on its own is not a strong predictor of job performance. Instead they contend that it provides the bedrock for competencies that are predictors.
Obviously, EQ is an important attribute and it behooves each of us to promote emotional intelligence in the workplace. A number of guidelines have been developed for the Consortium for Research on Emotional Intelligence in Organizations by Goleman and Cherniss. The guidelines cover 21 phases which include preparation, training, transfer and evaluation.
Assess the organization’s needs: Determine the competencies that are most critical for effective job performance in a particular type of job. In doing so, us a valid method, such as the comparison of the behavioral interviews of superior performs and average performers. Also make sure the competencies to be developed are congruent with the organization’s culture and overall strategy.
Assess the individual: This assessment should be based on the key competencies needed for a particular job, and the data should come from multiple sources using multiple methods to maximize credibility and validity.
Deliver assessments with care: Give the individual information on his/her strengths and weaknesses. In doing so, try to be accurate and clear. Also, allow plenty of time for the person to digest and integrate the information. Provide feedback in a safe and supportive environment in order to minimize resistance and defensiveness. Avoid making excuses or downplaying the seriousness of deficiencies.
Maximize choice: People are motivated to change when they freely choose to do so. As much as possible, allow people to decide whether or not they will participate in the development process, and have them change goals themselves.
Encourage people to participate: People will be more likely to participate in development efforts if they perceive them to be worthwhile and effective. Organizational policies and procedures should encourage people to participate in development activity, and supervisors should provide encouragement and the necessary support. Motivation will be enhanced if people trust the credibility of those who encourage them to undertake the training.
Link learning goals to personal values: People are most motivated to pursue change that fits with their values and hopes. If a change matters little to people, they won’t pursue it. Help people understand whether a given change fits with what matters most to them.
Adjust expectations: Builds positive expectations by showing learners that social and emotional competence can be improved and that such improvement will lead to valued outcomes. Also, make sure that the learner has a realistic expectation of what the training process will involve.
Gauge readiness: Assess whether the individual is ready for training. If the person is not ready because of insufficient motivation or other reasons, make readiness the focus of intervention efforts.
Foster a positive relationship between the trainers and learners: Trainers who are warm, genuine, and empathic our best able to engage the learners in the change process. Select trainers who have these qualities, and make sure that they use them when working with the learners.
Make change self-directed: Learning is more effective when people direct their own learning program, tailoring it to their unique needs and circumstances. In addition to allowing people to set their own learning goals, let them continue to be in charge of their learning throughout the program, and tailor the training approach to the individual’s learning style.
Set clear goals: People need to be clear about what the competence is, how to acquire it, and how to show it on the job. Spell out the specific behaviors and skills that make up the target competence. Make sure that the goals are clear, specific, and optimally challenging.
Break goals into manageable steps: change. That is more likely to occur if the change process is divided into manageable steps. Encourage both trainers and trainees to avoid being overly ambitious.
Provide opportunities to practice: Lasting change requires sustained practice on the job and elsewhere in life. An automatic habit is being unlearned and different responses are replacing it. Use naturally occurring opportunities for practice at work, and in life. Encourage the trainees to try the new behaviors repeatedly and consistently over a period of months.
Give performance feedback: Ongoing feedback encourages people and direct change. Provide focused and sustained feedback as the learners practice new behaviors. Make sure that supervisors, peers, friends, family members-or some combination of these- give periodic feedback on progress.
Rely on experiential methods: Active, concrete, experiential methods tend to work best for learning social and emotional competencies. Development activities that engage all the senses and our dramatic and powerful can be especially effective.
Build in support: Change is facilitated through ongoing support of others who are going through similar changes. Programs should encourage the formation of groups where people give each other support, throughout the change effort. Coaches and mentors also can be valuable in helping support the desired change.
Use models: Use modern webinars, patient portals, live or videotaped models that clearly show how the competency can be used in realistic situations. Encourage learners to study, analyze, and emulate the models.
Enhance insight: Self-Awareness is the cornerstone of emotional and social competence. Help learners acquire greater understanding about how their thoughts, feelings, and behavior affect themselves and others.
Prevent relapse: Use relapse prevention, which helps people use lapses and mistakes as lessons to prepare themselves for further efforts.
Moreover:
Encourage use of skills on the job: Supervisors, peers and subordinates should reinforce and reward learners for using their new skills on the job. Coaches and mentors also can serve this function. Also, provide prompts and cues, such as through periodic follow-ups. Change also is more likely to indoor. When high status persons, such as supervisors and upper-level management model it.
Develop an organizational culture that supports learning: Change will be more enduring if the organization’s culture and tone support the change and offer a safe atmosphere for experimentation.
Finally, see if the development effort has lasting effects evaluated. When possible, find a true set of measures of the competence or skill, as shown on the job, before and after training, and also at least two months later. One-year follow-ups also are highly desirable. In addition to charting progress on the acquisition of competencies, also assess the impact on important job related outcomes, such as performance measures, and indicators of adjustments such as absenteeism, grievances, health status, etc.
Managers V. Leaders
These abilities are important for one to be successful as a manager and even more so as a leader, or physician executive. But, before we begin an examination of strategic leadership, it is necessary to make a deeper distinction between a manager and a leader. There are many different definitions as well as descriptions regarding leadership and management.
Many people talk as though leadership and management is the same thing. Fundamentally, they are quite different. Management focuses on work. We manage work activities such as money, time, paperwork, materials, equipment, and personnel, among other things. As can be found in any basic book on management, management focuses on planning, organizing, controlling, coordinating, budgeting, finance and money management as well as decision making. In effect, managers are generally those individuals who have been given their authority by virtue of their role. It is the function of a manager to ensure that the work gets done as well as to oversee the activities of others. In many healthcare organizations we find that those individuals elevated to a managerial position occur as a result of being a high performer on their previous assignment. A manager receives authority on the basis of role; while a leader’ authority is more innate in nature.
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
Posted on August 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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In today’s dynamic economic landscape, the concept of a “side hustle” has evolved from a mere trend to an essential component of personal financial strategy for many individuals; even doctors.
A side hustle is a way to earn extra income outside of your primary job or main source of employment. It typically involves part-time work, freelancing, small businesses, or gig-based activities that can be pursued flexibly in your free time. Unlike traditional employment, side hustles often offer more autonomy, creative freedom, and the potential to monetize skills, hobbies, or passions.
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Doctor Gigs?
So, if you’re a doctor, dentist or podiatrist considering a side hustle, focus on something sustainable and long-term. Ask yourself: What am I already good at? What do people already ask me to help with? The best side hustles don’t require reinventing the wheel — just monetizing the one you’ve already been pushing uphill.
But, avoid gigs that require a huge upfront investment or promise overnight success. Instead, look for something that offers flexibility, ideally something that works with your schedule, not against your sanity.
Track your earnings and how much time you’re putting in. Side income should support your goals, whether that’s paying off debt, saving for a trip or just breathing easier when office rent comes due.
But, if it’s draining your energy from your medical practice with little to show for it, it might be time to rethink the hustle.
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
An important component of hospital credit analysis is essentiality. Hospitals are unusual businesses that many times possess some form of essentiality to their communities. Health care is important to the economic vitality of every community. Many hospitals have served their communities for many years; it is not uncommon to find hospitals that have been continuously operating for more than 100 years in the same community.
Most hospitals are not-for-profit. In not-for-profit hospitals, no private party actually “owns” the hospital; control is vested in various boards, but no one explicitly owns a not-for-profit hospital. In a broad sense, communities own not-for-profit hospitals. They are considered “charities” with a “charitable purpose.” Though a not-for-profit hospital may not have owners, it has many “stakehold-ers,” parties that have vested interests in the continuing success of the hospital.
Many hospitals have broad and vast webs of stakeholders. Stakeholders are why hospitals rarely close or are shut down. Too many stakeholders have interests in the continuing successful operation of hospitals.
Another dimension of the essentiality analysis is service analysis. How significant are the hospital’s services? If the hospital shuts down, what population segments would suffer? How significant is the population that would suffer? How much would they suffer?
And so, hospital stakeholder relationships need to be considered in the analysis of essentiality. How strong are these relations? How many are there? How important is the continuing success of this hospital to these stakeholders?
Analysis of hospital’s stakeholders and services should provide a credible view of the degree of essentiality associated with a hospital. Higher degrees of essentiality suggest higher likelihoods that hospitals, one way or another, will meet their commitments, particularly their payment commitments.
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
An obstetrician-gynecologist, or OB-GYN, has expertise in female reproductive health, pregnancy, and childbirth. Some OB-GYNs offer a wide range of general health services similar to a primary care doctor. Others focus on the medical care of the female reproductive system. OB-GYNs also provide routine medical services and preventive screenings. This type of doctor has studied obstetrics and gynecology. The term “OB-GYN” can refer to the doctor, an obstetrician-gynecologist, or to the sciences that the doctor specializes in, which are obstetrics and gynecology.
Obstetrician
Obstetrics is the branch of medicine related to medical and surgical care before, during, and after a woman gives birth. Obstetrics focuses on caring for and maintaining a woman’s overall health during maternity. This includes:
pregnancy
labor
childbirth
the postpartum period
OB-GYNs can conduct office visits, perform surgery, and assist with labor and delivery. Some OB-GYNs provide services through a solo or private practice. Others do so as part of a larger medical group or hospital.
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Gynecologist
Gynecology is the branch of medicine that focuses on women’s bodies and their reproductive health. It includes the diagnosis, treatment, and care of women’s reproductive system. This includes the:
vagina
uterus
ovaries
fallopian tubes
This branch of medicine also includes screening for and treating issues associated with women’s breasts. Gynecology is the overarching field of women’s health from puberty through adulthood. It represents most of the reproductive care received during a lifetime. If pregnant, one goes to an obstetrician.
Mid-Wife
Midwives are registered nurses who specialize in midwifery. As such, they’re trained healthcare providers who can oversee low-risk pregnancies, labor, and birth. They can provide other obstetric and gynecological services too. They can do exams and help with basic gynecological concerns like sexually transmitted infections, urinary tract infections, or yeast infections. They help support during labor and in the postpartum period with breastfeeding and birth control.
Doula
Doulas aren’t clinical professionals and can’t give medical advice. They can’t prescribe medicines, and they can’t deliver a baby. But they can offer physical and emotional support during labor—and sometimes during and after pregnancy. Doulas can help with breathing techniques, positional changes, and relaxation strategies during labor. Studies show doulas are associated with fewer C-sections and more vaginal births.
Doctors and dentists earn money by treating patients. CPAs and Attorneys have clients, and retail stores buy items low and sell them at higher prices. This is called a business model.
More formally, a business model identifies the products or services the business plans to sell, the target market, and any anticipated expenses, in order to outline how to generate a profit. Business models are important for both new and established businesses. They help companies attract investment, recruit talent, and motivate management and staff.
Businesses should regularly update their business model, or they’ll fail to anticipate trends and challenges ahead. Business models also help investors to evaluate companies that interest them and employees to understand the future of a company they may aspire to join.
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The Business Model of Pharmacy Benefits Managers
In the United States, health insurance providers often hire a third party to handle price negotiations, insurance claims, and distribution of prescription drugs. Providers that use such pharmacy benefit managers include commercial health plans, self-insured employer plans, Medicare Part D [drug] plans, the Federal Employees Health Benefits Program, and state government employee plans. PBMs are designed to aggregate the collective buying power of en-rollees through their client health plans, enabling plan sponsors and individuals to obtain lower prices for their prescription drugs. PBMs negotiate price discounts from retail pharmacies, rebates from pharmaceutical manufacturers, and mail-service pharmacies which home-deliver prescriptions without consulting face-to-face with a pharmacist.
Pharmacy benefit management companies can make revenue in several ways.
First, they collect administrative and service fees from the original insurance plan.
Then, they can also collect rebates from the manufacturer.
Traditional PBMs do not disclose the negotiated net price of the prescription drugs, allowing them to resell drugs at a public list price (also known as a sticker price), which is higher than the net price they negotiate with the manufacturer. This practice is known as “spread pricing”. The industry argues that savings are trade secrets. Pharmacies and insurance companies are often prohibited by PBMs from discussing costs and reimbursements. This leads to lack of transparency.
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Therefore, states are often unaware of how much money they lose due to spread pricing, and the extent to which drug rebates are passed on to en-rollees of Medicare plans. In response, states like Ohio, West Virginia, and Louisiana have taken action to regulate PBMs within their Medicaid programs.
For instance, they have created new contracts that require all discounts and rebates to be reported to the states. In return, Medicaid pays PBMs a flat administrative fee.
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
An ophthalmologist is a physician [MD, DO] who undergoes sub-specialty training in medical and surgical eye care. Following a medical degree, a doctor specializing in ophthalmology must pursue additional postgraduate residency training specific to that field. In the United States, following graduation from medical school, one must complete a four-year residency in ophthalmology to become an ophthalmologist. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology.
Ophthalmologists prescribe medications to treat ailments, such as eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists provide both primary and specialty eye care—medical and surgical. Most ophthalmologists participate in academic research on eye diseases at some point in their training and many include research as part of their career. Ophthalmology has always been at the forefront of medical research with a long history of advancement and innovation in eye care.
Optometrist
Optometrists focus on regular vision care and primary health care for the eye. After college, they spend 4 years in a professional program and get a doctor of optometry degree. But they don’t go to medical school. Some optometrists get additional clinical training or complete a specialty fellowship after optometry school. They:
Monitor eye conditions related to diseases like diabetes
Manage and treat conditions like dry eye and glaucoma
Provide low-vision aids and vision therapy
There are specialties among optometrists. They include:
Pediatric optometry. These providers work with babies, toddlers, and children, using special techniques to test their vision.
Neuro-optometry. If you have vision problems that result from a brain injury, this is the type of optometrist you might visit.
Low-vision optometry. If you have low vision—that means you can’t see well enough to perform your daily activities and your sight can’t be corrected by glasses or contact lenses, medicine, or surgery—low-vision optometrists offer devices and strategies that can improve your quality of life.
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Optician
An optician is an eye care specialist who helps you choose the right eyeglasses, contact lenses or other vision correction devices. They can’t diagnose or treat conditions that affect your eyes or vision. They’ll work with you to get the right corrective lenses after your optometrist or ophthalmologist gives you a prescription.
Ocularist
An ocularist is an eye care specialist who provides care for people needing prosthetic eyes due to injury, infection or congenital disease (present at birth). Losing or damaging an eye can be a traumatic experience, and the need for a prosthetic can be overwhelming. Ocularists offer long-term care. They collaborate with your healthcare team to create or restore a more natural facial appearance with the goal of enhancing your health-related quality of life.
Trump says pharma tariffs could be as high as 250%
The president revealed that he plans to formally announce tariffs on the pharmaceutical industry “within the next week or so” in an attempt to force drug manufacturing to the US, he told CNBC several days ago.
In the early 1980s, Daniel Kahneman and Amos Tverskey proved in numerous experiments that the reality of decision making differed greatly from the assumptions held by economists. They published their findings in Prospect Theory: An analysis of decision making under risk, which quickly became one of the most cited papers in all of economics.
To understand the importance of their breakthrough, we first need to take a step back and explain a few things. Up until that point, economists were working under a normative model of decision making. A normative model is a prescriptive approach that concerns itself with how people should make optimal decisions. Basically, if everyone was rational, this is how they should act.
Amanda, an RN client, was just informed by her financial advisor that she needed to re-launch her 403-b retirement plan. Since she was leery about investing, she quietly wondered why she couldn’t DIY. Little does her Financial Advisor know that she doesn’t intend to follow his advice, anyway! So, what went wrong?
The answer may be that her advisor didn’t deploy a behavioral economics framework to support her decision-making. One such framework is the “prospect theory” model that boils client decision-making into a “three step heuristic.”
According to colleague Eugene Schmuckler PhD MBA MEd CTS, Prospect theory makes the unspoken biases that we all have more explicit. By identifying all the background assumptions and preferences that clients [patients] bring to the office, decision-making can be crafted so that everyone [family, doctor and patient] or [FA, client and spouse] is on the same page.
1. Simplify choices by focusing on the key differences between investment [treatment] options such as stock, bonds, cash, and index funds.
2. Understanding that clients [patients] prefer greater certainty when it comes to pursuing financial [health] gains and are willing to accept uncertainty when trying to avoid a loss [illness].
3. Cognitive processes lead clients and patients to overestimate the value of their choices thanks to survivor bias, cognitive dissonance, appeals to authority and hindsight biases.
CITE: Jaan E. Sidorov MD [Harrisburg, PA]
Assessment
Much like in healthcare today, the current mass-customized approaches to the financial services industry fall short of recognizing more personalized advisory approaches like prospect theory and assisted client-centered investment decision-making.
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
THE ADDICTIVE INVESTING / TRADING PERSONALITY OF DOCTORS
Dr. Donald J. Mandell, a pediatrician, always needs to leave the office fifteen minutes ahead of schedule. The reason is because it takes that long to make the necessary number of trips to ensure the front door is truly locked.
Dr. Kamela A. Shaw, a general surgeon, is constantly rushing to the bath room so that she can wash her hands. As far as she is concerned, it is not possible to get one’s hands clean enough considering the COVID pandemic or recent influenza outbreak.
Although the behaviors displayed by these two doctors are different, they are consistent in that each, to some degree, display behavior that might be called an obsessive-compulsive disorder [OCD].
An obsession is a persistent, recurring preoccupation with an idea or thought. A compulsion is an impulse that is experienced as irresistible.
Obsessive-compulsive individuals feel compelled to think thoughts that they say they do not want to think or to carry out actions that they say are against their will. These individuals usually realize that their behavior is irrational, but it is beyond their control. In general, these individuals are preoccupied with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. Specifically, behaviors such as the following may be seen:
Preoccupation with details.
Perfectionism that interferes with task completion.
Excessive devotion to work and office productivity.
Scrupulous and inflexible about morality (not accounted for by cultural or religious identification);
Inability to discard worn-out or worthless objects without sentimental value;
Reluctance to delegate tasks or to work with others.
Adopts a miserly spending style toward both self and others.
Demonstrates a rigid, inflexible and stubborn nature.
Most people resort to some minor obsessive-compulsive patterns under severe pressure or when trying to achieve goals that they consider critically important. In fact, many individuals refer to this as superstitious behavior. The study habits required for medical students entail a good deal of compulsive behavior.
As the above examples suggest, there are a variety of addictions possible. Recent news accounts have pointed out that even high-level governmental officials can experience sex addiction. The advent of social-media has led to what is referred to as Internet addiction where an individual is transfixed to a computer, tablet PC or smart-phone, “working” for hours on end without a specific project in mind. The simple act of “surfing”, “tweeting-X”, “texting” or merely posting opinions offers the person afflicted with the addiction some degree of satisfaction.
Still another form of addictive behavior is that of the individual with gambling disorder (GD).
GD is recognized as a mental disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders-V. This is the behavior of an individual who is unable to resist the impulse to gamble. Many reasons have been posited for this type of behavior including the death instinct; a need to lose; a history of trauma; a wish to repeat a big win; identification with adults the “gambler” knew as an adolescent; and a desire for action and excitement. There are other explanations offered for this form of compulsive behavior. The act of betting allows the individual to express an immature bravery, courage, manliness, and persistence against unfavorable odds. By actually using money and challenging reality, he puts himself into “action” and intense emotion. By means of gambling, the addicted individual is able to pretend that he is favored by “lady luck,” specially chosen, successful, able to beat the system and escape from feelings of discontent.
Greed can also have addictive qualities. In fact, a poll conducted by the Chicago Tribune revealed that folks who earned less than $30,000 a year, said that $50,000 would fulfill their dreams, whereas those with yearly incomes of over $100,000 said they would need $250,000 to be satisfied. More recent studies confirm that goals keep getting pushed upward as soon as a lower level is reached.
Edward Looney, executive director of the Trenton, New Jersey based Council on Compulsive Gambling (CCG) reports that the number of individuals calling with trading-associated problems is doubling annually. In the mid 1980s, when the council was formed, the number of people calling the council’s hotline (1 – 800 Gambler) with stock-market gambling problems was approximately 1.5 percent of all calls received. In 1998 that number grew to 3 percent, and rose to 8 percent by 2012. Today, that number is largely unknown because of its pervasiveness, but Dr. Robert Custer, an expert on compulsive gambling reported, that stock market gamblers represent over 20 percent of the gamblers that he has diagnosed. It is evident that on-line trading presents a tremendous risk to the speculator.
The CCG describes some of the consequences:
Dr. Fred B. is a 43-year-old Asian male physician with a salary above $150,000 and in debt for more than $150,000. He is married with two children. He was a day trader.
Michael Q. is a 28-year-old Hispanic male registered nurse. He is married and the father of one (7 month old) child. He earns $65,000 and lost $50,000 savings in day trading and is in debt for $30,000. He has suicidal ideation.
[B] A Question of Suitability
Since online traders are in it for many reasons, investment suitability rarely enters the picture, according to Stuart Kaswell, general counsel of the Securities Industry Association, in Washington, DC. The kind of question that has yet to be confronted, by day or online trading firms, is a statement, such as: “Equities look good this year. We favor technology stocks. We have a research report on our Web page that looks at the social media industry.” Those kinds of things are seldom considered because they do not involve a specific recommendation of a specific stock, like Apple, Google, Groupon, Facebook or Twitter.
However, if a firm makes a specific recommendation to an investor, whether over the cell-phone, iPad®, fax machine, face-to-face, instagram or over the Internet, or Twitter-X, suitability rules should apply. Opining similarly on the “know your customer” requirements is Steven Caruso, of Maddox, Koeller, Harget & Caruso of New York City. “The on-line firms obviously claim that they do not have a suitability responsibility because they do not want the liability for making a mistake as far as determining whether the investor was suitable or buying any security. I think that ultimately more firms are going to be required to make a suitability, [or eventually fiduciary] determination on every trade”.
[C] On-line Traders and Stock Market Gamblers
Some of the preferred areas of stock market gambling that attract the interest of compulsive gamblers include options, commodities, penny stocks and bit-coins, index investing, new stock offerings, certain types of CAT bonds, crowd-sourcing initiatives, and some contracts for government securities. These online traders and investment gamblers think of themselves as cautious long-term investors who prefer blue chip or dividend paying varieties. What they fail to take into consideration is that even seemingly blue chips can both rise and precipitously drop in value again, as seen in the summer of 2003, the “crash” of 2008, or the “flash crash” of May 6, 2010. On this day, the DJIA plunged 1000 points (about 9%) only to recover those losses within minutes. It was the second largest point swing 1,010.14 points, and the biggest one-day point decline, 998.5 points, on an intraday basis in Dow Jones Industrial Average history.
Regardless of investment choice, the compulsive investment gambler enjoys the anticipation of following the daily activity surrounding these investments. Newspaper, hourly radio and television reports, streaming computer, tablet and smart phone banners and hundreds of periodicals and magazines add excitement in seeking the investment edge. The name of the game is action. Investment goals are unclear, with many participating simply for the feeling it affords them as they experience the highs and lows and struggles surrounding the play. And, as documented by the North American Securities Administrators Association’s president, and Indiana Securities Commissioner, Bradley Skolnik, most day or online traders lose money. “On-line brokerage was new and cutting edge and we enjoyed the best stock market in generations, until the crashes. The message of most advertisements was “just do it”, and you’ll do well. The fact is that research and common sense suggest the more you trade, the less well you’ll do”.
Most day or online traders are young males, some who quit their day jobs before the just mentioned debacles; or more recently with the dismal economy. Many ceased these risky activities but there is some anecdotal evidence that is re-surging again with 2013-14 technology boom and market rise. Most of them start every day not owning any stock, then buy and sell all day long and end the trading day again without any stock – – just a lot of cash. Dr. Patricia Farrell, a licensed clinical psychologist states that day traders are especially susceptible to compulsive behaviors and addictive personalities. Mark Brando, registered principal for Milestone Financial, a day trading firm in Glendale, California states, “People that get addicted to trading employ the same destructive habits as a gambler. Often, it’s impossible to tell if a particular trade comes from a problem gambler or a legitimate trader.”
Arthur Levitt, former Chairman of the Securities and Exchange Commission (SEC) in discussing the risks and misconceptions of investing are only amplified by on-line trading. In a speech before the National Press Club a few years ago, he attempted to impress individuals as to the risks and difficulties involved with day trading. Levitt cited four common misconceptions that knowledgeable medical professionals, and all investors, should know:
Personal computers, tablets, mobile devices and smart-phones are not directly linked to the markets – Thanks to Level II computer software, day traders can have access to the same up-to-the-second information available to market makers on Wall Street. “Although the Internet makes it seem as if you have a direct connection to the securities market, you don’t. Lines may clog; systems may break; orders may back-up.”
The virtue of limit orders – “Price quotes are only for a limited number of shares; so only the first few investors will receive the currently quoted price. By the time you get to the front of the line, the price of the stock could be very different.”
Canceling an order – “Another misconception is that an order is canceled when you hit ‘cancel’ on your computer. But, the fact is it’s canceled only when the market gets the cancellation. You may receive an electronic confirmation, but that only mean your request to cancel was received – not that your order was actually canceled”.
Buying on margin – “if you plan to borrow money to buy a stock, you also need to know the terms of the loan your broker gave you. This is margin. In volatile markets, investors who put up an initial margin payment for a stock may find themselves required to provide additional cash if the price of the stock falls.
How then, can the medical professional or financial advisor tell if he or she is a compulsive gambler? A diagnostic may be obtained from Gamblers Anonymous. It is designed to screen for the identification of problem and compulsive gambling.
But, it is also necessary to provide a tool to be used by on-line traders. This questionnaire is as follows:
1. Are you trading in the stock market with money you may need during the next year?
2. Are you risking more money than you intended to?
3. Have you ever lied to someone regarding your on-line trading?
4. Are you risking retirement savings to try to get back your losses?
5. Has anyone ever told you that spend too much time on-line?
6. Is investing affecting other life areas (relationships, vocational pursuits, etc.)?
7. If you lost money trading in the market would it materially change your life?
8. Are you investing frequently for the excitement, and the way it makes you feel?
9. Have you become secretive about your on-line trading?
10. Do you feel sad or depressed when you are not trading in the market?
NOTE: If you answer to any of these questions you may be moving from investing to gambling.
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The cost of compulsive gambling and day trading is high for the individual medical or lay professional, the family and society at large. Compulsive gamblers, in the desperation phase of their gambling, exhibit high suicide ideation, as in the case of Mark O Barton’s the murderous day-trader in Atlanta who killed 12 people and injured 13 more in July 29th 1999. His idea actually became a final act of desperation.
Less dramatically, for doctors, is a marked increase in subtle illegal activity. These acts include fraud, embezzlement, CPT® up-coding, medical over utilization, excessive full risk HMO contracting, Stark Law aberrations and other “white collar crimes.” Higher healthcare and social costs in police, judiciary (civil and criminal) and corrections result because of compulsive gambling. The impact on family members is devastating. Compulsive gamblers cause havoc and pain to all family members. The spouses and other family members also go through progressive deterioration in their lives.
In this desperation phase, dysfunctional families are left with a legacy of anger, resentment, isolation, and in many instances, outright hate.
[D] Day Trading Assessment
Internet day trading, like the Internet and telecommunications sectors, become something of a investment bubble a few years ago, suggesting that something lighter than air can pop and disappear in an instant. History is filled with examples: from the tulip mania of 1630 Holland and the British South Sea Bubble of the 1700’s; to the Florida land boom of the roaring twenties and the Great Crash of 1929; to the collapse of Japans stock and real estate market in early 1990’s; and to an all-time high of $1,926 for an ounce of commodity gold a few years ago.
Today it is Ask: $3,388.30 USD Bid: $3,367.30 USD
CONCLUSION
To this list, one might again include smart-phone or mobile day trading.
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
Posted on August 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I and Staff Reporters
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Illinois just became the first US state to regulate AI mental health services this week when Gov. JB Pritzker signed a law banning AI therapy.
The law forbids chatbots from acting as therapists and limits how human mental health professionals can use AI to aid their work. Companies face up to $10,000 in fines if they violate the law, according to Morning Brew.
The move comes as ChatGPT users—particularly younger ones—increasingly turn to the app for what amounts to free therapy. OpenAI recently made updates to its model to encourage users to use ChatGPT in a healthier way.
An acute care inpatient hospital is a health care organization or “anchor hospital” in which a patient is treated for an acute (immediate and severe) episode of illness or the subsequent treatment of injuries related to an accident or trauma, or during recovery from surgery. Specialized personnel using complex and sophisticated technical equipment and materials usually render acute professional care in a hospital setting. Unlike chronic care, acute care is often necessary for only a short time. Measures of acute health care utilization are represented by three separate rates:
Rate of admissions per 1000 patients.
Average length of stay per admission.
Total days of care per 1000 patients.
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Psychiatric Hospital
A psychiatric hospital (behavioral health, mental hospital, or asylum) specializes in the treatment of patients with mental illness or drug-related illness or dependencies. Psychiatric wards differ only in that they are a unit of a larger hospital.
Specialty Hospital
A specialty hospital is a type of health care organization that has a limited focus to provide treatment for only certain illnesses such as cardiac care, orthopedic or plastic surgery, elder care, radiology / oncology services, neurological care, or pain management cases. These organizations are often owned by doctors who refer patients to them. In recent years, single-specialty hospitals have emerged in various locations in the United States. Instead of offering a full range of inpatient services, these hospitals focus on providing services relating to a single medical specialty or cluster of specialties.
Long-Term Care Hospital
A long-term care hospital is an entity that provides assistance and patient care for the activities of daily living (ADLs), including reminders and standby help for those with physical, mental, or emotional problems. This includes physical disability or other medical problems for 3 months or more (90 days). The criteria of five ADLs may also be used to determine the need for help with the following: meal preparation, shopping, light housework, money management, and telephoning. Other important considerations include taking medications, doing laundry, and getting around outside.
Rural Hospital
The parameters of a rural hospital are determined based on distance. A rural hospital is defined as a hospital serving a geographic area 10 or more miles from the nexus of a population center of 30,000 or more.
More specifically, a rural hospital means an entity characterized by one of the following:
Type A rural hospital—small and remote, has fewer than 50 beds, and is more than 30 miles from the nearest hospital
Type B rural hospital—small and rural, has fewer than 50 beds, and is 30 miles or less from the nearest hospital
Type C rural hospital—considered rural and has 50 or more beds
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
In order to create and monitor an investment portfolio for personal or institutional use, the physician executive, financial advisor, wealth manager, or healthcare institutional endowment fund manager, should ask three questions:
How much do we have invested?
How much did we make on our investments?
How much risk did we take to get that rate of return?
Introduction to the IPS
Most doctors, and hospital endowment fund executives, know how much money they have invested. If they don’t, they can add a few statements together to obtain a total. But, few can answers the questions above or actually know the rate of return achieved last year; or so far this year. Everyone can get this number by simply subtracting the ending balance from the beginning balance and dividing the difference. But, few take the time to do it. Why? A typical response to the question is, “We’re doing fine.”
Now, ask how much risk is in the portfolio and help is needed [risk adjusted rate of return]. In fact, Nobel laureate Harry Markowitz, Ph.D. said, “If you take more risk, you deserve more return.” Using standard deviation, he referred to the “variability of returns;” in other words, how much the portfolio goes up and down, its volatility [Markowitz, H: Portfolio Selection. Journal of Finance, March, 1952].
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
Posted on July 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
THE FOOT & ANKLE DOCTORS
By A.I.
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Podiatry offers a promising career with a balanced mix of specialization and income. By understanding the factors that influence salaries—such as location, experience, and practice type—a doctor can strategically enhance his/er earning potential. Staying informed about healthcare policies and market trends is crucial for maximizing income.
With an aging population and advancements in technology, the demand for podiatrists is expected to grow, making it a rewarding field both professionally and financially. Investing in specialized training and adapting to policy changes will help doctors remain competitive and successful in the evolving healthcare landscape.
A podiatrist is a healthcare professional specialized in diagnosing and treating conditions related to the feet and ankles. Their responsibilities include performing surgeries, prescribing orthotics, and providing preventive care.
What education is required to become a podiatrist?
To become a podiatrist, one must complete a Doctor of Podiatric Medicine (DPM) degree, which typically takes four years after earning a bachelor’s degree. Following this, a residency program lasting 2-3 years is required for practical training.
What factors influence the salary of a podiatrist?
Geographic location, level of experience, specialization, and type of practice significantly affect a podiatrist’s salary. Areas with a higher cost of living or demand for services usually offer higher salaries.
How does the salary of a podiatrist compare to other medical professions?
Podiatrists generally earn more than general practitioners but less than specialty surgeons. This disparity is due to differences in training length, specialization, and practice complexity among these professions.
Can the salary of a podiatrist increase over time?
Yes, a podiatrist’s salary can increase with additional experience, further specialization, and strategic practice location choices. Continuing education and staying updated on healthcare policies can also enhance earning potential.
What impact do healthcare policies have on podiatrist salaries?
Healthcare policies, including changes in insurance reimbursement rates and government health initiatives, can affect podiatrist salaries. Adapting to these policy shifts is crucial for maximizing earning potential in the field.
What are the future trends in podiatry salaries?
Future trends suggest potential salary growth due to increasing demand from an aging population, technological advancements, and geographic disparities in healthcare access. Keeping informed about these trends can help podiatrists plan their careers strategically.
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, hospitals, financial advisory firms, RIAs, 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
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
Posted on July 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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A decaying body at the University of Tennessee’s Anthropological Research Facility known as the The Body Farm in Knoxville, where up to 80 bodies at a time are studied as they decay in a variety of different scenarios. (Photo by David Howells/Corbis via Getty Images)
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The term “body farm” refers to a type of outdoor research facility in which human remains are left to decompose in a variety of environmental conditions naturally. While some individuals may find the concept of a body farm unsettling, these facilities are very useful for forensic science research.
Body farms facilitate the hard (or sometimes outright impossible) research on the various stages of human decomposition, aiming to gain a deeper understanding of how the process can differ under various conditions. This new-found knowledge can then be utilized to assist forensic investigators in determining the time and cause of death and potentially even more information.
Body farms in the US include: California University of Pennsylvania, Sam Houston State University, Texas State University, University of Tennessee at Knoxville, and Western Carolina University.
Posted on July 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
“lemming effect” or “group-think”
By Staff Reporters
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According to psychologist and colleague Dan Ariely PhD, human beings have evolved – probably both genetically and socially – to be consistent. It is easier and safer to deal with others if they honor their commitments and if they behave in a consistent and predictable manner over time. This allows people to work together and build trust that is needed for repeat dealings and to accomplish complex tasks.
In the jungle, this trust was necessary to for humans to successfully work as a team to catch animals for dinner, or fight common threats. In business and life it is preferable to work with others who exhibit these tendencies. Unfortunately, the downside of these traits is that people make errors in judgment because of the strong desire not to change, or be different (“lemming effect” or “group-think”). So the result is that most people will seek out data that supports a prior stated belief or decision and ignore negative data, by not “thinking outside the box”.
Additionally, future decisions will be unduly influenced by the desire to appear consistent with prior decisions, thus decreasing the ability to be rational and objective. The more people state their beliefs or decisions, the less likely they are to change even in the face of strong evidence that they should do so. This bias results in a strong force in most people causing them to avoid or quickly resolve the cognitive dissonance that occurs when a person who thinks of themselves as being consistent and committed to prior statements and actions encounters evidence that indicates that prior actions may have been a mistake. It is particularly important therefore for advisors to be aware that their communications with clients and the press clouds the advisor’s ability to seek out and process information that may prove current beliefs incorrect.
Since this is obviously irrational, one must actively seek out negative information, and be very careful about what is said and written, being aware that the more you shout it out, the more you pound it in.
Posted on July 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and AI
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Better make sure it’s Secure?
UnitedHealth Group’s Optum healthcare company got caught with its digital pants down in December, when TechCrunch reported that its internal AI chatbot, which employees asked for advice in determining claims, was publicly accessible.
Posted on July 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Drug and medical device companies paid at least $13.2 billion to medical professionals in 2024, according to CMS data released June 30th. There’s been steady growth in these payments over the last few years, which include everything from research payments to free meals to promotional or conference fees. Drug and medical device companies paid out $13.1 billion in 2023, $13.1 in 2022, and $12.6 in 2021. If you’re a medical provider, you’ve probably gotten one of those perks from a drug or medical device company and thought it wouldn’t affect your decision-making.
But research suggests physicians are more likely to prescribe drugs from companies that pay them, with some studies specifically associating this with drugs that are costlier to patients. “Really well-trained people who affirm an oath to do no harm can be influenced, and are,” Neil Jay Sehgal, associate professor of health systems and population health at the University of Washington School of Public Health, told Healthcare Brew.
Bitcoin is booming, and crypto stocks climbed along with it. MicroStrategy rose 3.86%, RobinhoodMarkets added 1.67%. and Coinbase gained 1.80%.
Boeing rose 1.64% on preliminary reports that investigators have found no evidence of malfunction in the plane that crashed in India last month. Engine-maker GEAerospace also gained 2.71%.
Warner Bros Discovery climbed 2.39% thanks to a strong opening weekend for the new Superman movie.
Autodesk popped 5.05% on the news that it is not pursuing an acquisition of rival software maker PTC. PTC fell 1.25%.
Kenvue, the company behind Band Aids and Listerine, gained 2.18% after kicking its CEO to the curb.
PayPal climbed 3.55% despite the news that JPMorgan will start charging the fintech fees for access to customer data.
Stocks Down
Starbucks sank 1.60% on news that employees will have to return to the office four days a week. Shareholders were also unimpressed with the coffee giant’s new secret menu.
Synopsys stumbled 1.74% after getting regulatory approval from Chinese authorities to acquire software designer Ansys for $35 billion. Ansys rose 3.03% on the news.
Waters plunged 13.81% on the news that it will merge with Becton Dickinson’s bioscience and diagnostic solutions business in a $17.5 billion deal.
RivianAutomotive lost 2.15% thanks to a downgrade from Guggenheim analysts, who forecast soft sales for the automaker’s latest models.
According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. They are sometimes referred to as “Basic Activities of Daily Living” (BADLs). They include:
Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
Feeding, as in being able to get food from a plate into one’s mouth.
Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
Bathing, which means washing one’s face and body in the bath or shower.
Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.
If a person is not fully independent with ADLs, then we usually include some information about the amount of assistance they require. ADLs were originally defined in the 1950s by a geriatrician named Sidney Katz, who was trying to define what it might look like for a person to recover to independence after a disabling event such as a stroke or hip fracture. So these measures are sometimes called the “Katz Index of Independence in Activities of Daily Living.”
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Instrumental Activities of Daily Living (IADLs)
These are the self-care tasks we usually learn as teenagers. They require more complex thinking skills, including organizational skills. They include:
Managing finances, such as paying bills and managing financial assets.
Managing transportation, either via driving or by organizing other means of transport.
Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance.
Managing communication, such as the telephone and mail.
Managing medications, which covers obtaining medications and taking them as directed.
Because managing IADLs requires a fair amount of cognitive skill, it’s common for IADLs to be affected when an older person is having difficulty with memory or thinking. For those older adults who develop Alzheimer’s disease or a related dementia, IADLs will usually be affected before ADLs are.
IADLs were defined about ten years after ADLs, by a psychologist named M.P. Lawton. Dr. Lawton felt there were more skills required to maintain independence than were listed on the original Katz ADL index, and hence created the “Lawton Instrumental Activities of Daily Living Scale.”
The terms “psychologist” and “psychiatrist” are often used interchangeably to describe anyone who provides therapy services, but the two professions and the services they provide differ in terms of content and scope. A major difference between the two types of experts is that psychiatrists can prescribe medication [Rx].
As physicians [MD/DO] psychiatrists are trained to recognize the ways biological processes affect mental functioning.
Psychologists are oriented to how thoughts, feelings, and social factors influence mental functioning.
PSYCHIATRIST
Psychiatrists are medical or osteopathic doctors who are able to prescribe psychotropic medications, which they do in conjunction with providing psychotherapy though medical and pharmacological interventions are often their focus.
PSYCHOLOGIST
Though many psychologists hold doctorate degrees, they are not medical doctors, and most cannot prescribe medications. Rather, they solely provide psycho-therapy, which may involve cognitive and behavioral interventions, psycho-dynamic or psycho-analytic approaches.
NOTEPROTECTED TITLE: The title of “psychologist” can only be used by an individual who has completed the required education, training, and state license requirements. Informal titles, such as “counselor” or “therapist,” are often used as well. Other mental health care professionals, such as licensed social workers, can claim those titles, but not the title of “psychologist.”
Posted on July 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US measles cases have reached a 33-year high. A little more than halfway into 2025, the US has reported 1,288 measles cases, marking the highest yearly total since 1992, according to data from the Centers for Disease Control and Prevention.
Cereal legend WK Kellogg popped 30.57% after chocolate giant Ferrero agreed to acquire it for north of $3 billion.
Tesla (+4.73%) continued to rebound from its plunge on Monday. Elon Musk said that Tesla’s robotaxi service would expand into the Bay Area “probably in a month or two” and that his AI chatbot Grok is coming to Tesla vehicles by next week.
Estée Lauder gained 6.32% after Bank of America slapped a buy rating on the stock, implying a 27% upside from Wednesday’s closing price.
ProKidney continued its remarkable rally, rising another 19.35%, after the biotech announced positive trial results for its diabetes treatment. It’s gone from a penny stock to a $1.55 billion market cap in the past four days.
Copper companies Freeport-McMoRan (+3.51%) and Southern Copper (+2.34%) gained thanks to Trump’s announcement that copper tariffs would begin on August 1.
Stocks down
Biotech partners Ultragenyx (-25.11%) and Mereo BioPharma Group (-42.52%) plunged after issuing a disappointing update on their trial of a treatment for a rare genetic bone condition.
Vertiv, the maker of liquid cooling equipment,declined 5.96% when Amazon said it was rolling out a new liquid cooling system for its AI servers.
Hydro Flask owner Helen of Troy tumbled 22.71% after reporting a $450 million loss in its fiscal first quarter. CEO Brian Grass said “tariff-related impacts” were its Achilles heel.
Autodesk fell 6.89% after Bloomberg reported on Wednesday it was weighing a takeover of rival engineering software company PTC.
According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. These are the self-care tasks we then learn as teenagers. They require more complex thinking skills, including organizational skills. They include:
Managing finances, such as paying bills and managing financial assets.
Managing transportation, either via driving or by organizing other means of transport.
Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance.
Managing communication, such as the telephone and mail.
Managing medications, which covers obtaining medications and taking them as directed.
Because managing IADLs requires a fair amount of cognitive skill, it’s common for IADLs to be affected when an older person is having difficulty with memory or thinking. For those older adults who develop Alzheimer’s disease or a related dementia, IADLs will usually be affected before ADLs are.
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IADLs were defined about ten years after ADLs, by a psychologist named M.P. Lawton. Dr. Lawton felt there were more skills required to maintain independence than were listed on the original Katz ADL index, and hence created the “Lawton Instrumental Activities of Daily Living Scale.”
Posted on July 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
BREAKING NEWS!
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The Villages Health System, LLC, a health care provider operating in The Villages, Florida, filed for Chapter 11 bankruptcy protection on July 3rd, 2025, in the United States Bankruptcy Court for the Middle District of Florida.
“The bankruptcy petition indicates significant financial challenges, with assets estimated between $50 million and $100 million and liabilities between $100 million and $500 million. The United States of America is listed as the largest creditor with a contingent, unliquidated claim of approximately $361 million. The filing indicates that funds will be available for distribution to unsecured creditors,”
According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. They are sometimes referred to as “Basic Activities of Daily Living” (BADLs). They include:
Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
Feeding, as in being able to get food from a plate into one’s mouth.
Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
Bathing, which means washing one’s face and body in the bath or shower.
Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.
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If a person is not fully independent with ADLs, then we usually include some information about the amount of assistance they require. ADLs were originally defined in the 1950s by a geriatrician named Sidney Katz, who was trying to define what it might look like for a person to recover to independence after a disabling event such as a stroke or hip fracture. So these measures are sometimes called the “Katz Index of Independence in Activities of Daily Living.”
Posted on July 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants LLC
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On June 9th, 2025, Oregon’s governor signed into law the country’s strictest corporate practice of medicine (CPOM) prohibition. Senate Bill (SB) 951 will severely curtail the involvement of private equity firms and other corporations in the state’s medical practices.
This Health Capital Topics reviews the bill and discusses the implications on the healthcare industry. (Read more…)
One Big Beautiful Bill Act (OBBBA; OBBB; BBB), or the Big Beautiful Bill, is a budget reconciliation bill in the 119th US Congress.
Hospitals are not happy with the health care provisions of the bill, which would reduce the support they receive from states to care for Medicaid enrollees and leave them with more uncompensated care costs for treating uninsured patients.
“The real-life consequences of these nearly $1 trillion in Medicaid cuts – the largest ever proposed by Congress – will result in irreparable harm to our health care system, reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients,” said Rick Pollack, CEO of the American Hospital Association.
The association said it is “deeply disappointed” with the bill, even though it contains a $50 billion fund to help rural hospitals contend with the Medicaid cuts, which hospitals say is not nearly enough to make up for the shortfall.
A brand is a name, term, design, symbol or any other feature that distinguishes one seller’s goods or service from those of other sellers. Brands are used in business, marketing and advertising for recognition and, importantly, to create and store value as brand equity for the object identified, to the benefit of the brand’s clients, patients, customers, its owners and shareholders. Brand names are sometimes distinguished from generic or store brands.
Brand management, also known as Marketing, is responsible for the overall management of a brand. This includes everything from product or service development and marketing to advertising and public relations. All of these aspects work together to create a particular image or reputation for a brand. The goal of brand management is to create a robust and positive reputation for a brand that will result in increased sales and market share.This process helps companies create a unique identity for their products or services in the marketplace. A successful brand management strategy can build client, patient and customer loyalty .
Branding is essential for financial advisors, doctors and businesses because it involves creating a unique identity for a company’s products, offerings and services. It can also help build customer, client and patient loyalty and emotionally connect with the practitioner. Branding can be complex, but it is essential to understand the basics before starting a brand strategy.
Thus, doctors, podiatrists, dentists, CPAs, insurance agents, financial advisors and their practices need to understand the different aspects of branding and brand management to create a strong brand identity.
Assets under advisement refer to assets on which your firm provides advice or consultation but for which your firm does either does not have discretionary authority or does not arrange or effectuate the transaction. Such services would include financial planning or other consulting services where the assets are used for the informational purpose of gaining a full perspective of the client’s financial situation, but you are not actually placing the trade.
Assets under advisement could also be those which you monitor for a client on a non-discretionary basis, where you may make recommendations but where the client is the party responsible for arranging or effecting the purchase or sale. A common example of this AUM scenario is when an advisor reviews a participant’s 401(k) allocations. If the adviser does not have the authority or ability to effect changes in the portfolio, these assets are likely considered assets under advisement rather than regulatory assets under management.
Assets under advisement are permitted to be disclosed on Form ADV Part 2A as a separate asset figure from the assets under management. There is no requirement to disclose the assets under advisement figure, but some advisors opt to include the figure to give prospective clients a more complete picture of the firm’s responsibilities. If you choose to report your assets under advisement, be sure to make a clear distinction between this figure and your regulatory assets under management.
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D. E. Marcinko & Associates Core Operating Values
9. We act with honesty, integrity and are always straightforward. 8. We strive to be innovative, creative, iconoclastic, and flexible. 7. We admit and learn from mistakes and don’t repeat them. 6. We work hard always as competitors are trying to catch up. 5. We treat others with dignity and respect. 4. We are the onus of consulting advice for the fiduciary well being of others. 3. We fight complacency as former success is in the past. 2. The best management styles are timeless, not timely. 1. Our clients are colleagues and always come first.
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
Posted on June 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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According to BetterHealth.com, billions of people worldwide use social media platforms today. While social media can be a helpful tool for connection in the digital age, it also has the power to contribute to loneliness and isolation. This is the essence of the social media paradox.
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What is the social media paradox?
The Merriam-Webster dictionary defines a paradox as “a statement that is seemingly contradictory or opposed to common sense and yet is perhaps true.” The social media paradox is a term coined to point out how, despite “social” being in the very name of it, social media has the potential to make people feel disconnected and lonely.
As a Public Health Post article published by Boston University puts it, “The more time people spend actively engaging on social media—whether through posting, commenting, or messaging—the lonelier they may feel,” calling it “a double-edged sword.” This simple statement summarizes the core of the social media paradox.
So how could something “social” be so closely tied to isolation?
The effects of social media are complex. On the one hand, it has brought many positives to the lives of many people. It can help individuals stay connected, learn about themselves, and receive important information.
On the other hand, excessive social media use in particular also has the potential to separate and contribute to negative mental health outcomes.
Posted on June 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
NEWS UPDATE!
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On June 10th, Bobby Mukkamala was inaugurated as the 180th president of the American Medical Association (AMA).
An otolaryngologist from Flint, Michigan, Mukkamal chairs the organization’s substance use and pain care task force, won the AMA Foundation’s Excellence in Medicine Leadership Award last June, and served on the AMA board of trustees in 2017 and 2021.
It is going to be very difficult to show students the beauty of Wolfram Alpha and still find ways to prevent them from turning to the dark side of its power. This website is great for showing multiple representations of certain data, and it is lightning quick in producing answers compared to your hand on a tedious problem. While these two pros are at the forefront and really all that one needs to hear to become interested in exploring the site, the tide can easily and quickly turn from being a task servant to a task I’ll-do-it-all-for-you-every-time-and-you-do-nothing. One student in our 5040 class suggested that we might show this to our students at the end of the year when we are reviewing for final exams. The only problem with this is that they will not forget about this website the following year. With these things in mind, the best policy…
Posted on June 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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By Dr. David Edward Marcinko MBA MED CMP™
SPONSOR: wwwCertifiedMedicalPlanner.org
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Crisis Management is the precautions and identification of threats to an organization and its stakeholders, and the methods used by the organization to deal with these threats.
For example, recall in 1982, that Tylenol™ commanded 35 percent of the over-the-counter analgesic market in America and it represented nearly 17 percent of Johnson & Johnson’s profits. But, when seven people died from consuming the tainted drug, a national panic ensued. Moreover, Americans started to question the safety of all over-the-counter medications.
Fortunately, J&J commenced the proto-typical good crisis response in the following way:
J&J acted quickly, with complete candidness about what happened and within hours of learning of the deaths, J&J installed toll-free numbers for consumers, sent alerts to healthcare providers nationwide, and stopped advertising the product. J&J recalled 31 million bottles of Tylenol™ capsules and offered replacement products free of charge. J&J did not wait for evidence to see whether the contamination might be more widespread.
J&J’s leadership was in the lead and seemed in full control throughout the crisis. The chairman was admired for his leadership to pull Tylenol™ capsules off the market and his forthrightness in dealing with the media. The Tylenol™ crisis led the news every night on every station for six weeks.
J&J placed consumers first. J&J spent more than $100 million for the recall and re-launch of Tylenol™. The stock had been trading near a 52-week high just before the tragedy, dropped for a time, but recovered to its highs only two months later.
J&J accepted responsibility. The disaster could have been described in many different ways: as an assault on the company, as a problem somewhere in the process of getting Tylenol™ from J&J factories to retail stores, or as the acts of a crazed criminal.
J&J sought to ensure that measures were taken to prevent a recurrence of the problem. J&J introduced tamper-proof packaging that would make it much more difficult for a similar incident to occur in the future.
J&J presented itself prepared to handle the short-term damage in the name of consumer safety. Within a year of the disaster, J&J’s share of the analgesic market, which had fallen to 7 percent from 37 percent following the poisoning, had climbed back to 30 percent.
This wildly successful response in now the stuff of graduate and business school case models for excellence in teaching!
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
A forensic pathologist is a medical doctor who studies diseases and performs autopsies, while a coroner investigates and determines the cause of sudden or unexplained deaths, often without a medical degree.
An autopsy (also referred to as post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or the exam may be performed to evaluate any disease or injury that may be present for research or educational purposes. The term necropsy is generally used for non-human animals.
Autopsies are usually performed by a specialized medical doctor called a pathologist. Only a small portion of deaths require an autopsy to be performed, under certain circumstances. In most cases, a medical examiner or coroner can determine the cause of death.
A coroner is elected or appointed to a local government office, while a forensic pathologist is a medical doctor trained to perform autopsies and other procedures to determine the cause of death.
A forensic pathologist is able to perform medical operations while coroners may specialize in the legal paperwork and law enforcement side of a death.
The title of “medical examiner” is usually the job title of a forensic pathologist who works for a government.
In many jurisdictions, a coroner does not need to possess a medical degree.
The Medical Executive-Post is a news and information aggregator and social media professional network for medical and financial service professionals. Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed. Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.
A thought experiment is a mental exercise where you imagine a situation or scenario to explore an idea, test a theory, or examine a problem. It does not involve physical experiments or data. Instead, it uses reasoning, imagination, and logic to draw conclusions or raise important questions.
Sometimes referred to as the Inverted Spectrum Problem or the Knowledge Argument, this thought experiment is meant to stimulate discussions against a purely physical view of the universe, namely the suggestion that the universe, including mental processes, is entirely physical. This thought experiment tries to show that there are indeed non-physical properties — and attainable knowledge — that can only be learned through conscious experience.
Mary is a brilliant scientist who is, for whatever reason, forced to investigate the world from a black and white room via a black and white television monitor. She specializes in the neuro-physiology of vision and acquires, let us suppose, all the physical information there is to obtain about what goes on when we see ripe tomatoes, or the sky, and use terms like ‘red’, ‘blue’, and so on. She discovers, for example, just which wavelength combinations from the sky stimulate the retina, and exactly how this produces via the central nervous system the contraction of the vocal cords and expulsion of air from the lungs that results in the uttering of the sentence ‘The sky is blue’…What will happen when Mary is released from her black and white room or is given a color television monitor? Will she learn anything or not?
Put another way, Mary knows everything there is to know about color except for one crucial thing: She’s never actually experienced color consciously. Her first experience of color was something that she couldn’t possibly have anticipated; there’s a world of difference between academically knowing something versus having actual experience of that thing.
Posted on May 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
By Staff Reporters
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Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis. The examination of variability or heterogeneity in study results is also a critical outcome.
The benefits of meta-analysis include a consolidated and quantitative review of a large, and often complex, sometimes apparently conflicting, body of literature. The specification of the outcome and hypotheses that are tested is critical to the conduct of meta-analyses, as is a sensitive literature search. A failure to identify the majority of existing studies can lead to erroneous conclusions; however, there are methods of examining data to identify the potential for studies to be missing; for example, by the use of funnel plots.
Rigorously conducted meta-analyses are useful tools in evidence-based medicine. The need to integrate findings from many studies ensures that meta-analytic research is desirable and the large body of research now generated makes the conduct of this research feasible.
When New York-based Zocdoc was founded back in 2007, the idea was to help patients get off the phone, founder and CEO Oliver Kharraz told Healthcare Brew. The company created a website that helps patients find clinicians who fit their needs in their area and are under their insurance, and books appointments online.
But on May 1st, Zocdoc launched a new product to get people back on the phone: an artificial intelligence (AI) voice agent called Zo. Zo helps people book doctor appointments 24/7—but instead of speaking with a person, patients speak with an AI voice that is trained to meet their needs.
“Until recently, we didn’t do the phone because the experience on the phone was just so miserable,” Kharraz said. “Now you can actually have a consistent experience, where the AI can pick up after the first ring an unlimited number of times concurrently [and] have a natural conversation with you.”
When you visit health clinic or hospital for a medical appointment, you’ll be seen by a doctor, healthcare provider and/or medical prescriber. But what do these words really mean?
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Doctors / Physicians
Doctor of Medicine (MD), Doctor of Podiatric Medicine (DPM), Doctor of Osteopathy (DO, or Doctor of Dental Surgery (DDS/DMD). Doctors, also known as physicians, have extensive prescription privileges across various specialties. They can diagnose medical conditions, prescribe medication, and oversee the overall management of patient care. Doctors include general practitioners, specialists such as cardiologists or dermatologists, and surgeons. Their prescription authority encompasses a wide range of medications to address acute and chronic health conditions, ranging from antibiotics to specialized treatments for complex diseases.
A medical provider is a general term that encompasses a wide range of education levels, skill-sets, and specializations. A provider could be a Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Doctor of Medicine (MD), Doctor of Podiatric Medicine (DPM), Dentist (DDSDMD) or Doctor of Osteopathy (DO).
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Medical Drug Prescribers
Generally, psychologists and therapists do not have prescription privileges. They focus on psychotherapy and counseling rather than medication management. However, some jurisdictions may grant limited prescription rights to psychologists who undergo additional training and certification. Like psychologists, therapists typically do not have prescription privileges. They focus on providing counseling and psychotherapy to address mental health issues and emotional concerns.
Psychiatrists are medical doctors (MD/DO) who specialize in the diagnosis and treatment of mental health disorders. They have full prescription privileges and can prescribe a wide range of medications to manage psychiatric conditions.
In most cases, physical therapistsdo not have the authority to prescribe medication. They primarily focus on rehabilitation and physical interventions to improve mobility and function.
Nurse practitioners are advanced practice nurses with the authority to diagnose, treat, and prescribe medication independently in many states and countries. They undergo extensive education and training, which allows them to provide a wide range of healthcare services, including medication management.
Similar to nurse practitioners, psychiatric nurse practitioners have the authority to prescribe medication for mental health conditions. They specialize in psychiatric and mental health care, offering comprehensive treatment that may include medication management.
Chiropractors primarily focus on diagnosing and treating musculoskeletal disorders through manual adjustments and therapies. They do not have surgical or prescription privileges in most jurisdictions.
Optometrists are trained to diagnose and treat vision problems, including prescribing corrective lenses and medications for certain eye conditions such as infections or inflammation.
Registered nursestypically do not have prescription privileges. They work under the direction of physicians and nurse practitioners, assisting with patient care but not prescribing medication themselves.
Dentists have limited prescription privileges related to dental care, such as antibiotics or pain medications for dental procedures. However, they do not have the authority to prescribe general medications outside of their scope of practice.
Nutritionists typically do not have prescription privileges. They specialize in providing dietary advice and counseling to promote health and well-being through nutrition but do not prescribe medication.
Depending on their scope of practice and legal regulations in their jurisdiction, nurse midwives may have limited prescription privileges for certain medications related to prenatal care, childbirth, and postpartum care.
Posted on May 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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GENDER
Gender is a subclass within a grammatical class (such as noun, pronoun, adjective, or verb) of a language that is partly arbitrary but also partly based on distinguishable characteristics (such as shape, social rank, manner of existence, or sex) and that determines agreement with and selection of other words or grammatical forms.
Gender paradox: Women conform more closely than men to socio-linguistics norms that are overtly prescribed, but conform less than men when they are not.
Gender-equality paradox: Countries which promote gender equality tend to have less gender balance in some fields.
The Medical Executive-Post is a news and information aggregator and social media professional network for medical and financial service professionals. Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed. Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.
Posted on May 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Health Insurance Co-Payments Upfront or Lose Your Appointment
Definition: A co-payment is a fixed amount you pay each time you get a particular type of healthcare service, and co-pays will generally be quite a bit smaller than deductibles. However, deductibles and co–pays are both fixed amounts, as opposed to coinsurance, which is a percentage of the claim.
On some health plans, certain services are covered with a co-pay before you’ve met the deductible, while other health insurance plans have co-pays only after you’ve met your deductible. And, the pre-deductible versus post-deductible co-pay rules often vary based on the type of medical service you’re receiving.
Starting in June 2025, Cleveland Clinic patients who can’t pay their co-pay on the spot will have non-emergency appointments rescheduled or cancelled. This new policy could make it harder for low-income people who prefer to be billed to see a clinic doctor, and create delays that could lead to medical emergencies down the road.
For example, a delay in care can mean six to eight more weeks of a tumor growing or a blood clot developing or an infection brewing.
Cognitive science is the interdisciplinary study of the mind and cognition. According to linguistics Professor Mackenzie H. Marcinko PhD, it combines various aspects from neuroscience, computer science, psychology, philosophy, linguistics, anthropology, and other fields, into a comprehensive study on the nature of intelligence.
Linguistics is the scientific study of language and its structure, including the study of morphology, syntax, phonetics, and semantics. Specific branches of linguistics include sociolinguistics, dialectology, psycholinguistics, computational linguistics, historical-comparative linguistics and applied linguistics.
Now, language and linguistics are closely related fields of study but they have distinct focuses.
Language refers to the system of communication used by humans, encompassing spoken, written, and signed forms. It is a means of expressing thoughts, ideas, and emotions.
On the other hand, linguistics is the scientific study of language itself. It examines the structure, sounds, meaning, and evolution of languages, as well as how they are acquired and used by individuals and communities.
While language is a broader concept that encompasses various forms of communication, linguistics delves into the intricate details and mechanics of language, aiming to understand its underlying principles and patterns.
Mental Health Awareness Month was established in 1949 to increase awareness of the importance of mental health and wellness in Americans’ lives and to celebrate recovery from mental illness.
For more than 20 years, the Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized Mental Health Awareness Month (MHAM) every May to increase awareness about the vital role mental health plays in our overall health and well-being and provide resources and information to support individuals and communities who may need mental health support.
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