DOCTOR INVESTING MISTAKES: Top Five PLUS 1 Vital Tip

Posted on June 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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FIVE INVESTING MISTAKES OF DOCTORS; PLUS 1 VITAL TIP

As a former US Securities and Exchange Commission [SEC] Registered Investment Advisor [RIA] and business school professor of economics and finance, I’ve seen many mistakes that doctors must be aware of, and most importantly, avoid. So, here are the top 5 investing mistakes along with suggested guideline solutions.

Mistake 1: Failing to Diversify Investment but Beware Di-Worsification

A single investment may become a large portion of your portfolio as a result of solid returns lulling you into a false sense of security. The Magnificent Seven stocks are a current example:

  • Apple, up +5,064%% since 1/18/2008 
  • Amazon, up +30,328% since 9/6/2002 
  • Alphabet, up +1,200% since 7/20/2012 
  • Tesla, up +21,713% since 11/16/2012 
  • Meta, up +684% since 2/20/2015 
  • Microsoft, up +22% since 12/21/2023 
  • Nvidia, up +80,797% since 4/15/2005 

Guideline: The Magnificent Seven [7] has grown from 9% of the S&P 500 at the end of 2013 to 31% at the end of 2024! That means even if you don’t own them, you’re still very exposed if you have an Index Fund [IF] or Exchange Traded Fund [ETF] that tracks the market. Accordingly, diversification is the only free lunch in investing which can reduce portfolio risk. But, remember the Wall Street insider aphorism that states: “Di-Versification Means Always Having to Say Your Sorry.” 

The term “Di-Worsification” was coined by legendary investor Peter Lynch in his book, One Up On Wall Street to refer to over-diversifying an investment portfolio in such a way that it reduces your overall risk-return characteristics. In other words, the potential return rises with an increase in risk and invested money can render higher profits only if willing to accept a higher possibility of losses [1].

IPO: https://medicalexecutivepost.com/2025/03/02/ipo-road-show-with-pros-and-cons/

Mistake 2: Chasing Stock Market Performance

A podiatrist can easily fall into the trap of chasing securities or mutual funds showing the highest return. It is almost an article of faith that they should only purchase mutual funds sporting the best recent performance. But in fact, it may actually pay to shun mutual funds with strong recent performance. Unfortunately, many struggle to appreciate the benefits of their investment strategy because in jaunty markets, people tend to run after strong performance and purchase last year’s winners. 

Similarly, in a market downturn, investors tend to move to lower-risk investment options, which can lead to missed opportunities during subsequent market recoveries. The extent of underperformance by individual investors has often been the most awful during bear markets. Academic studies have consistently shown that the returns achieved by the typical stock or bond fund investors have lagged substantially.

Guideline: Understand chasing performance does not work.Continually monitor your investments and don’t feel the need to invest in the hottest fund or asset category.  In fact, it is much better to increase investments in poor performing categories (i.e. buy low). Also keep in remind rebalancing of assets each year is key. If stocks perform poorly and bonds do exceptionally well, then rebalance at the end of the year. In following this strategy, this will force a doctor into buying low and selling high each year. 

STOCKS: https://medicalexecutivepost.com/2025/04/18/stocks-basic-definitions/

Mistake 3: Assuming Annual Returns Follow Historical Averages

Often doctors make their investment decisions under the belief that stocks will consistently give them solid double-digit returns. But the stock markets go through extended long-term cycles.

In examining stock market history, there have been 6 secular bull markets (market goes up for an extended period) and 5 secular bear markets (market goes down) since 1900. There have been five distinct secular bull markets in the past 100+ years. Each bull market lasted for an extended period and rewarded investors.   

For example, if an investor had started investing in stocks either at the top of the markets in 1966 or 2000, future stock market returns would have been exceptionally below average for the proceeding decade. On the other hand, those investors fortunate enough to start building wealth in 1982 would have enjoyed a near two-decade period of well above average stock market returns.  They key element to remember is that future historical returns in stocks are not guaranteed. If stock market returns are poor, one must consider that he or she will have to accept lower projected returns and ultimately save more money to make up for the shortfall. For example,

The May 6th, 2010, flash crash, also known as the crash of 2:45, was a United States trillion-dollar stock market plunge which started at 2:32 pm EST and lasted for approximately 36 minutes.

And, investors who have embraced the “buy the dip” strategy in 2025 have been handsomely rewarded, with the S&P 500 delivering its strongest post-pull back returns in over three decades.

According to research from Bespoke Investment Group, the S&P 500 has gained an average of 0.36% in the trading session following a down day so far in 2025. The only year with a comparable performance was 2020, which saw a 0.32% average post-dip gain [2]. 

The most recent example came on May 27, 2025 when the S&P 500 surged more than 2% after falling 0.7% in the final session before the holiday weekend. The rally was sparked by President Trump’s decision to scale back huge previously threatened tariffs on EU —a recurring catalyst behind many of 2025’s rebound. 

Guideline: Beware of projecting forward historical returns. Doctors should realize that the stock markets are inherently volatile and that, while it is easy to rely on past historical averages, there are long periods of time where returns and risk deviate meaningfully from historical averages.

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

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Mistake 4: Attempting to Time the Stock Market

Some doctors believe they are “smarter than the market” and can time when to jump in and buy stocks or sell everything and go to cash. Wouldn’t it be nice to have the clairvoyance to be out of stocks on the market’s worst days and in on the best days?  

Using the S&P 500 Index, our agile imaginary doctor-investor managed to steer clear of the worst market day each year from January 1st, 1992 to March 31st, 2012. The outcome: s/he compiled a 12.42% annualized return (including reinvestment of dividends and capital gains) during the 20+ years, sufficient to compound a $10,000 investment into $107,100.

But what about another unfortunate doctor-investor that had the mistiming to be out of the market on the best day of each year. This ill-fated investor’s portfolio returned only 4.31% annualized from January 1992 – March 2012, increasing the $10,000 portfolio value to just $23,500 during the 20 years. The design of timing markets may sound easy, but for most all investors it is a losing strategy. 

More contemporaneously on December 18th 2024, the DJIA plummeted 2.5%, while the S&P 500 declined 3% and the NASDAQ tumbled 3.5% 

Guideline: If it looks too good to be true, it probably is. While jumping into the market at its low and selling right at the high is appealing in theory, we should recognize the difficulties and potential opportunity and trading costs associated with trying to time the stock market in practice. In general, colleagues are be best served by matching their investment with their time horizon and looking past the peaks / valleys along the way.

ALTERNATIVE INVESTMENTS: https://medicalexecutivepost.com/2025/05/12/stocks-and-alternative-investments/

Mistake 5: Failing to Recognize the Impact of Fees and Expenses

A free dinner seminar or a polished stock-broker sales pitch may hide the total underlying costs of an investment.  So, fees absolutely matter.

The first costing step is determining what the fees actually are. In a mutual fund, these costs are found in the company’s obligatory “Fund Facts”. This manuscript clearly outlines all the fees paid–including up front fees (commissions and loads), deferred sales charges and any switching fees. Fund management expense ratios are also part of the overall cost. Trading costs within the fund can also impact performance. 

Here is a list of the traditional mutual fund fees:

  • Front End Load: The commission charged to purchase a fund through a stock broker or financial advisor. The commission reduces the amount you have available to invest.  Thus, if you start with $100,000 to invest, and the advisor charges up to an 8 percent front end load, you end up actually investing $92,000.
  • Deferred Sales Charge (DSC) or Back End Load: Imposed if you sell your position in the mutual fund within a pre-specified period of time (normally one – five years).  It is initiated at a higher start percentage (i.e. as high as 10 percent) and declines over a specific period of time.
  • Operating Fees: Costs of the mutual fund including the management fee rewarded to the manager for investment services. It also includes legal, custodial, auditing and marketing fees.
  • Annual Administration Fee:  Many mutual fund companies also charge a fee just for administering the account – usually under $100-150 per year.

Guideline: Know and understand all fees.

For example: A 1 percent disparity in fees may not seem like much but it makes a considerable impact over a long time period. 

Consider a $100,000 portfolio that earns 8 percent before fees, grows to $320,714 after 20 years if the investor pays a 2 percent operating fee. In comparison, if s/he opted for a fund that charged a more reasonable 1 percent fee, after 20 years, the portfolio grows to be $386,968 – a divergence of over $66,000! 

This is the value of passive or index investing. In the case of an index fund, fees are generally under 0.5 percent, thus offering even more savings over a long period of time. 

One Vital Tip: Investing Time is on Your Side

Despite thousands of TV shows, podcasts, textbooks, opinions and university studies on investing, it really only has three simple components. Amount invested, rate of return and time. By far, the most important item is time! For example:

  • Nvidia: if you invested $1,000 in 2009, you’d have $338,103 today.
  • Apple: if you invested $1,000 in 2008, you’d have $48,005 today.
  • Netflix: if you invested $1,000 in 2004, you’d have $495,679 today.

Start prudently investing now and do not wait!

ETFs: https://medicalexecutivepost.com/2025/01/06/etfs-alternatively-weighted-investments/

CONCLUSION

Unfortunately, this list of investing mistakes is still being made by many doctors. Fortunately, by recognizing and acting to mitigate them, your results may be more financially fruitful and mentally quieting.

REFERENCES:

1. Lynch, Peter: One Up on Wall Street [How to Use What You Already Know to Make Money in the Market]: Simon and Shuster (2nd edition) New York, 2000.

2. https://www.bespokepremium.com

Readings:

1. Marcinko, DE; Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017. 

2. Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, New York, 2006.

3. Marcinko, DE; Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] CRC Press, New York, 2015.

BIO: As a former university Professor and Endowed Department Chair in Austrian Economics, Finance and Entrepreneurship, the author was a NYSE Registered Investment Advisor and Certified Financial Planner for a decade. Later, he was a private equity and wealth manager

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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EDUCATION: Books

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

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HEDGE FUNDS: Defined for Doctors

Posted on June 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP™

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WHAT IS A HEDGE FUND?

SPONSOR: http://www.MarcinkoAssociates.com

Many doctors are surprised to learn of an alternative investment known as a hedge fund, pooled investment vehicle or private investment fund. Unlike mutual funds, they can be structured in many ways. However, these funds cannot be marketed or advertised, but they are far from illegal or illicit.

In fact, physicians were among the early investors in one the most successful hedge funds. Warren Buffett got his start in 1957 running the Buffett Partnership, a hedge fund not open to the public. His first appearance as a money manager was before a group of physicians in Omaha, Nebraska. Eleven decided to invest some money with him. A few then followed into Berkshire Hathaway Inc, now among the most highly valued companies in the world.

And, more recently, Scion Asset Management® LLC, is a private investment firm founded and led by my eloquent colleague Michael J. Burry, MD and featured in the movie, The Big Short. Other hedge fund mangers of note include: George Soros, Carl Icahn, Ken Griffin, David Tepper, John Paulson and Bill Ackman.

MASTER FEEDER FUND: https://medicalexecutivepost.com/2025/05/27/master-feeder-structure-hedge-funds/

Definition

A hedge fund is a limited partnership of private investors whose money is managed by professional fund managers who use a wide range of strategies; including leveraging [debt] or trading of non-traditional assets [real-estate, collectible, commodities, cyrpto-currency, etc] to earn above-average returns. Hedge funds are considered a risky alternative investment and usually require a high minimum investment or net worth. This person is known as an “accredited investor” or “Regulation D” investor by the US Securities Exchange Commission and must have the following attributes:

  • A net worth, combined with spouse, of over $1 million, not including primary residence
  • An income of over $200,000 individually, or $300,000 with a spouse, in each of the past two years

MANAGERS: https://medicalexecutivepost.com/2025/05/23/hedge-fund-hiring-separate-managers/

TERMS AND FEES

Hurdle Rate

The hurdle rate is part of the fund manager’s performance incentive compensation. Also known as a “benchmark,” it is the amount, expressed in percentage points an investor’s capital must appreciate before it becomes subject to a performance incentive fee. Podiatrists should view the hurdle rate as a form of protection or the fee arrangement.

The hurdle rate benchmarks a single year’s performance and may be considered mutually exclusive of any other year, or the hurdle rate may compound each year. The former case is more common. In the latter case, a portfolio manager failing to attain a hurdle rate in the first year will find the effective hurdle rate considerably higher during the second year.

Once a fund manager attains the hurdle rate, the investor’s capital account may be charged a performance incentive fee only on the performance above and beyond the hurdle rate. Alternatively, the account may be charged a performance fee for the entire level of performance, including the performance required to attain the hurdle rate. Other variations on the use of the hurdle rate exist, and are limited only by the contract signed between the fund manager and the investor. The hurdle rate is not generally a negotiating point, however.

Example: A fund charges a performance fee with a 6 percent hurdle rate, calculated in mutually exclusive manner. A podiatrist places $100,000 with the fund. The first year’s performance is 5 percent. The doctor therefore owes no performance fee during the first year because the portfolio manager did not attain the hurdle rate. During year two, the portfolio manager guides the fund to a 7 percent return. Because the hurdle rate is mutually exclusive of any other year, the portfolio manager has attained the 6 percent hurdle rate and is entitled to a performance fee.

High Water Mark

Some hedge funds feature a “high water mark” provision known as a ”loss-carry forward.” As with the hurdle rate, the high water mark is a form of protection. It is an amount equal to the greatest value of an investor’s capital account, adjusted for contributions and withdrawals. The high water mark ensures that the manager charges a performance incentive fee only on the amount of appreciation over and above the high water mark set at the time the performance fee was last charged. The current trend is for newer funds to feature this high water mark, while older, larger funds may not feature it.

Example: A fund charges a 20 percent performance fee with a high water mark but no hurdle rate. A podiatrist contributes $100,000 to the fund. During the first year, the hedge fund manager grows that capital account to $110,000 and charges a 20 percent performance fee, or $2,000. The ending capital account balance and high water mark is therefore $108,000. During year two, the account falls back to $100,000, but the high water mark remains $108,000. During year three, in order for the manager to charge a performance fee, the manager must grow the capital account to a level above $108,000.

Claw Back Provision

Rarely, a hedge fund may provide investors with a “claw back” provision. This term results in a refund to the investor of all or part of a previously charged performance fee if a certain level of performance is not attained in subsequent years. Such refunds in the face of poor or inadequate performance may not be legal in some states or under certain authorities.

ASSESSMENT

Managers of hedge funds, like colleague Dimitri Sogoloff MBA who is the CEO of Horton Point investment-technology firm, often aim to produce returns that are relatively uncorrelated with market indices and are consistent with investors’ desired level of risk.

While hedging may reduce some risks overall, they cannot all be eliminated. According to a report by the Hennessee Group, hedge funds were approximately one-third less volatile between 1993 and 2010.

HEDGE FUND PENSION PLANS: https://medicalexecutivepost.com/2025/05/18/medical-practice-pension-plan-hedge-fund-difficulties/

CONCLUSION

For a podiatrist who already holds mutual funds and/or individual stocks and bonds, a hedge fund may provide diversification and reduce overall portfolio risk. Consider investing in them with care.

References and Readings:

1. https://www.scionasset.com 

2. Burry, Michael, J: Hedge Funds [Wall Street Personified]. In, Marcinko, DE and Hetico, HR: Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017.

3. Marcinko, DE and Hetico, HR: Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™]. Productivity Press, New York, 2015.

4. Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, NY 2006

5. https://www.hortonpoint.com/

6. http://hennesseegroup.com

EDUCATION: Books

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

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FINANCIAL ADVISORY FEES: What All Doctors Must Know

Posted on June 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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By Dr. David Edward Marcinko MBA MEd CMP™

WHAT YOU “MUST KNOW“ ABOUT FINANCIAL ADVISORY FEES

Investment fees still matter despite dropping dramatically over the past several decades due to computer automation, algorithms and artificial intelligence, etc. And, they can make a big difference to your financial health. So, before buying any investment, it’s vital to uncover all real financial advisor and stock broker costs.

HEDGE FUND FEES: https://medicalexecutivepost.com/2025/04/18/stocks-basic-definitions/

SIX TYPES OF FEES AND EXPENSES

1. Up-front salesperson commissions. It is easy to ask; “If I buy this investment today and want to get out tomorrow, how much money do I get back?” If the answer is not “all your money,” the difference is probably upfront fees and commissions. These fees may run as high as 30% of the money invested. If you were to earn 5% a year on the investment, it would take 8 years just to break even.

2. Ongoing advisory fees. These are monthly, quarterly, or annual fees paid to advisors for their investment advice and oversight. This includes working with you to pick the asset classes, set diversification, select a portfolio manager, optimize taxes, re-balance holdings and other periodic tasks.

These fees have many names including wrap fee or investment advisory fees. The normal “rule of thumb” is 1% of assets managed, although fees can range from 0 to 7%. Today, it can even be as low as .5%. It can be charged even if the advisor receives an upfront commission. It can be easy to see, or hidden in the fine print.

3. Additional service fees. Find out specifically what services are included financial advisory fees. Additional fees for financial planning or other services are rarely disclosed. They can range from minimal hand-holding focused on your investments to comprehensive financial planning.

4. Ongoing managerial expense ratio fees. These are incredibly well hidden that you may not see them in your statements or invoices. The only way to know is to read the prospectus or other third party analysis, like Morningstar.com. And, they can vary greatly for the same investment, depending on the class of share you buy.

For example, American Fund’s New Perspective Fund’s expense ratio ranges from 0.45% to 1.54%.  The average expense ratio of a mutual fund that invests in stocks is 1.35%. Conversely, the average expense ratio of a Vanguard S&P 500 Fund is 0.10%. The difference of 1.25% is staggering over time.

5. Miscellaneous fees. Some advisors charge $50 – $100 a year per account to open or close an account, and even fees to dollar cost average your funds into the market.

6. Transaction fees. Every time you buy or sell a fund, a fee is typically paid to a custodian. These can range from $5 to hundreds of dollars per transaction.

7. Fee Only: Paid directly by clients for their services and can’t receive other sources of compensation, such as payments from fund providers. Act as a fiduciary, meaning they are obligated to put their clients’ interests first

8. Fee Based: Paid by clients but also via other sources, such as commissions from financial products that clients purchase. Brokers and dealers (or registered representatives) are simply required to sell products that are “suitable” for their clients.

A “suitable” investment is defined by FINRA as one that fits the level of risk that an investor is willing and able, as measured by personal financial circumstances, to take on. The Financial Industry Regulatory Authority is a private American corporation that acts as a Self Regulatory Organization (SRO) that regulates member stock brokerage firms and exchange markets. These criteria must be met. It is not enough to state that an investor has a risk-friendly investment profile. In addition, they must be in a financial position to take certain chances with their money. It is also necessary for them to

A hedge fund is a limited partnership of private investors whose money is managed by professional fund managers who use a wide range of strategies; including leveraging [debt] or trading of non-traditional assets [real-estate, collectible, commodities, cyrpto-currency, etc] to earn above-average returns. Hedge funds are considered a risky alternative investment and usually require a high minimum investment or net worth. This person is known as an “accredited investor” or “Regulation D” investor by the US Securities Exchange Commission and must have the following attributes:

  • A net worth, combined with spouse, of over $1 million, not including primary residence
  • An income of over $200,000 individually, or $300,000 with a spouse, in each of the past two years

Not a fiduciary.

A Review of Investing Expenses

Ways to minimize fees

Choose the fee structure. The fee structure should align with your needs. Consider the type of advice you seek, the number of times needed and the complexity of your financial situation. You can always negotiating tactics are free to ask for a better deal.

Compare fees. It is essential to research and compare different fees. Be sure to read the fine print for details or costs that are not a base fee.

Robo-advisors: For simple investment goals, with little specificity, robo-advisors may be a cost-effective option. They charge lower fees than conventional financial advisors and provide an automated, algorithmic approach to managing your investments. 

Assessment

The average cost of working with a human financial advisor in 2024 was 0.5% to 2.0% of assets managed, $200 to $400 per hourly consultation, a flat fee of $1,000 to $3,000 for a one-time service, and/or a 3% to 6% commission fee on the product types sold.

ADVISORY FEES: https://medicalexecutivepost.com/2025/02/26/be-aware-financial-advisory-fees-fee-based-versus-fee-only/

Conclusion

When ruminating over financial advisory fees; read and understand the contract with disclosures, do not sign a confidentiality or non-disclosure agreement, and do not waive your right to a lawsuit. According to colleague Dr. Charles F. Fenton IIII JD, forced legal settlements almost always favor the advisor over the client.

References and Readings:

1. https://www.capitalgroup.com [American Funds]

2. Marcinko, DE and Hetico, HR; Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017. 

3. Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, NY 2006

EDUCATION: Books

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

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INVESTING: Stocks, Bonds & Oil Updates

Posted on June 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Generated by AI

SPONSOR: http://www.CertifiedMedicalPlanner.org

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  • Stocks: The S&P 500 touched 6,000 points for the first time since February and wrapped up its fifth positive week in the past seven following a better-than-expected jobs report. The vibes got even better in the afternoon following a President Trump announcement that the US and China trade teams will meet in London on Monday. STOCKS: https://medicalexecutivepost.com/2025/04/18/stocks-basic-definitions/
  • Bonds: Treasury yields ticked up in response to the solid May jobs report, a sign that investors were reducing bets on the scale of rate cuts this year. That’s not what Trump wants to hear: He urged Fed Chair Jerome Powell to slash interest rates by a jumbo-sized full point to pour “rocket fuel” on the economy. REVENUE BONDS: https://medicalexecutivepost.com/2024/12/20/bonds-revenue/
  • Oil: Oil prices have gone sideways for three straight weeks now, trading within a $4 range around $65/barrel since the middle of May. We’ll let you know when something interesting happens. CRUDE OIL: https://medicalexecutivepost.com/2024/08/14/wti-crude-oil/

EDUCATION: Books

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EMPLOYMENT: Growing Slowly

Posted on June 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By AI

BREAKING NEWS

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Job growth is slowing, but still bigger than expected

US employers added 139,000 jobs last month, government data released yesterday shows—that’s less than the down-wardly revised 147,000 new jobs that were added in April, but more than economists had predicted. Meanwhile, the unemployment rate held steady.

MAY: https://medicalexecutivepost.com/2025/06/06/may-jobs-report/

Overall, the highly anticipated jobs report reflects employers growing more cautious in the face of the economic uncertainty brought on by the trade war, but so far, there doesn’t seem to be a steep drop off in the labor market. That could give the Fed reason to stay in wait-and-see mode on interest rates, though President Trump still used the occasion to urge Jerome Powell to cut rates “a full point” on Truth Social.

PHYSICIAN EMPLOYMENT CONTRACTS: https://medicalexecutivepost.com/2024/01/12/sample-new-physician-letter-of-employment-contract/

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MAY: Jobs Report

Posted on June 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS!

Generated By AI

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Markets: Stocks fell yesterday as investors readied themselves for today’s jobs report. The May jobs report is expected to show hiring slowed while the unemployment rate held flat. The data release will come as investors closely watch for any further signs of slowing in the US labor market.

CPI: https://medicalexecutivepost.com/2024/07/13/what-is-the-elderly-cpi/

The Bureau of Labor Statistics data is slated for release at 8:30 a.m. ET, today. Economists expect non-farm payroll to have risen by 125,000 in May and the unemployment rate to have held steady at 4.2%, according to consensus estimates compiled by Bloomberg.

PPI: https://medicalexecutivepost.com/2024/07/13/what-is-the-producer-price-index/

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INVESTING: Wrap-Up

Posted on June 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and Brew Markets

SPONSOR: http://www.CertifiedMedicalPlanner.org

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RISK MANAGEMENT FOR PHYSICIANS

https://www.amazon.sa/-/en/Risk-Management-Liability-Insurance-Asset/dp/1032917636

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Tariffs, Private Sector Jobs, Interest Rates, Gold and the US Dollar

Posted on June 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS!

By Staff Reporters with AI Generation

SPONSOR: http://www.CertifiedMedicalPlanner.org

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  • 50% tariffs on steel and aluminum went into effect today. To celebrate, President Trump hopped on Truth Social to put China’s President Xi on blast ahead of an expected call between the two heads of state. And, Temu lost 58% of its daily users thanks to tariffs.
  • The president also pushed Jerome Powell to “LOWER THE RATE” following terrible private sector job numbers. Stocks are seemingly immune to tough trade talk and interest rate rants at this point, but bond yields sank on fears of slower economic growth.
  • The US dollar slipped, propelling gold higher as investors sought safety.

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PROXY VOTE: Defined

Posted on June 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™


This ME-P was developed with AI-powered tools and reviewed by Editors

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What is in a proxy statement? 

A proxy statement tells you a lot about a company’s management and board of directors, providing details about compensation, large shareholders, and the accounting firm that audits the company books. It also includes information about shareholder resolutions and the board’s responses to those proposals.

Each publicly traded company files a proxy statement with the Securities and Exchange Commission (SEC) every year, and it’s used by shareholders to help cast votes on their proxy ballots. The board may provide recommendations to vote for or against a proposal, but investors should do their best to collect the facts and make a decision on their own.

HOSTILE TAKEOVER: https://medicalexecutivepost.com/2025/03/24/hostile-company-takeover-definition-defense-pharmaceutical-company-example/

What is in a proxy Vote? 

According to Motley Fool, about once every year, for most companies, you will have the right to vote your shares on a variety of topics related to the companies you own in your portfolio. These are called proxy votes. Regular individual shareholders generally receive one vote per share owned. Some companies have multiple classes of shares, and management and other insiders will have a higher level of voting power (for example, 10 votes per share).

COMMON STOCK: https://medicalexecutivepost.com/2008/02/12/what-is-common-stock/

Every year, you will receive a proxy statement in the mail or electronically. This document gives you insight into a variety of important issues to consider and vote on using your proxy ballot.

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EDUCATION: Books

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QUISHING: Scams Defined

Posted on June 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

QR Code Cyber Security Scams

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Cloudflare and AI

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What is quishing?

Quishing, or QR phishing, is a cybersecurity threat in which attackers use QR codes to redirect victims to malicious websites or prompt them to download harmful content. The goal of this attack is to steal sensitive information, such as passwords, financial data, or personally identifiable information (PII), and use that information for other purposes, such as identity theft, financial fraud, or ransomware.

This type of phishing often bypasses conventional defenses like secure email gateways. Notably, QR codes in emails are perceived by many secure email gateways as meaningless images, making the users vulnerable to specific forms of phishing attacks. QR codes can also be presented to intended victims in a number of other ways.

MISHING: https://medicalexecutivepost.com/2025/02/28/mishing-a-mobile-first-phishing-technique/

What are QR codes?

QR codes, or Quick Response codes, are two-dimensional barcodes that can be scanned easily with a camera or a code reader application. The main component of a QR code is data storage. QR codes have the capability to store significant amounts of information including URLs, product details, or contact information. Scanning technology allows smartphone cameras or code readers to easily and quickly access the website to which the URL points.

SMISHING: https://medicalexecutivepost.com/2025/01/08/smishing-beware-scams/

How does quishing work?

In a quishing attack, the attackers create a QR code and link it to a malicious website. Typically, the attacker will embed the QR code in phishing emails, social media, printed flyers, or physical objects, and use social engineering techniques to entice the victims. For example, victims might receive an email urging them to access an encrypted voice message via a QR code for a chance to win a cash prize.

Upon using their phones to scan the QR code, victims are directed to the malicious site. The site may prompt victims to enter private information, such as login information, financial details, or personal information. In the example above, the site may request the user’s name, email, address, date of birth, or account login information.

Once this sensitive information is captured, attackers can exploit it for various malicious purposes, including identity theft, financial fraud, or ransomware.

What is Cyber-Security SPOOFING and PHISHING?

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THOUGHT EXPERIMENT: The Colorblind Neuroscientist

Posted on June 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and AI

SPONSOR: http://www.CertifiedMedicalPlanner.org

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THOUGHT EXPERIMENT DEFINED

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.

INATTENTIONAL BLINDNESS: https://medicalexecutivepost.com/2025/03/11/inattentional-blindness/

Colorblind Neuroscientist [Inverted Spectrum Problem]

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.

MARYS ROOM: A Thought Experiment

The originator of the concept, Frank Jackson, explains it this way:

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.

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DIVIDEND STOCK ARISTOCRATS: Pros and Cons

Posted on June 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By AI

SPONSOR: http://www.CertifiedMedicalPlanner.org

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SPONSOR: http://www.MarcinkoAssociates.com

According to wikipedia, the S&P 500 Dividend Aristocrats is a stock market index composed of the companies in the S&P 500 index that have increased their dividends in each of the past 25 consecutive years. It was launched in May 2005.

There are other indexes of dividend aristocrats that vary with respect to market cap and minimum duration of consecutive yearly dividend increases. Components are added when they reach the 25-year threshold and are removed when they fail to increase their dividend during a calendar year or are removed from the S&P 500. However, a study found that the stock performance of companies improves after they are removed from the index The index has been recommended as an alternative to bonds for investors looking to generate income.

To invest in the index, there are several exchange traded funds (ETFs), which seek to replicate the performance of the index.

STOCK DIVIDENDS: https://medicalexecutivepost.com/2025/03/02/stock-dividends-company-earnings-distribution/

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And so, to clarify, the following are the advantages and disadvantages of US dividend aristocrats:

Advantages

  1. They certainly display consistent, blue-chirp corporations with an extended history of vital funds and dividend increments.
  2. Additionally, these stocks offer fixed revenue growth.
  3. In other words, they tend to possess lower price volatility.
  4. Please note that dividend investing supporters prefer a credible income source.
  5. They are sufficiently stable for continuous annual dividend increments across decades, certainly even through recessions.
  6. Above all, it helps quicker portfolio building through reinvestment in these stocks.
  7. They certainly ensure successful long-term investing.
  8. Regarded as among the most famous investment strategies, they relish extensive consumer confidence.

Disadvantages

  1. To clarify, they are considered taxable earnings.
  2. In other words, they offer a lack of control over their distribution timing.
  3. Above all, these shares have under performed S&P 500.
  4. Company development certainly consumes a lot of time.
  5. Additionally, they are subject to market fluctuations.
  6. Moreover, they are considered unimaginative.

STOCK: https://medicalexecutivepost.com/2024/08/20/preferred-versus-common-stock/

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DONOR ADVISED FUND: Defined

Posted on June 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

WHAT IS A DONOR ADVISED FUND?

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A donor-advised fund is a private account created to manage and distribute charitable donations on behalf of an organization, family, or individual. Donor-advised funds can democratize philanthropy by aggregating the contributions of multiple donors, thus multiplying their impact on worthy causes. Donor-advised funds also have abundant tax advantages.

DONOR DEPENDENCY: https://medicalexecutivepost.com/2025/01/02/culture-donation-dependency/

Donor-advised funds have become increasingly popular, as they offer the donor greater ease of administration while still allowing them to maintain significant control over the placement and distribution of charitable gifts. But, unlike private foundations, donor-advised fund holders enjoy a federal income tax deduction of up to 60% of adjusted gross income (AGI) for cash contributions and up to 30% of AGI for the appreciated securities they donate. Donors to these funds can contribute cash, stock shares, and other assets. When they transfer assets such as limited-partnership interests, they can avoid capital gains taxes and receive immediate fair market value tax deductions.

MEDICAL ETHICS: https://medicalexecutivepost.com/2024/06/20/medical-ethics-physician-and-financial-organizations/

According to the National Philanthropic Trust’s 2023 Donor-Advised Fund Report, these funds have continued to grow in recent years, despite some headwinds including the Covid-19 pandemic and occasional stock market setbacks. Total grants awarded by donor-advised funds in 2022 increased by 9% to $52.16 billion, while total contributions rose by 9% to $85.5 billion.

Many donor-advised funds accept non-cash assets—such as checks, wire transfers, and cash positions from a brokerage account—in addition to cash and cash equivalents.

Donating non-cash assets may be more beneficial for individuals and businesses, leading to bigger tax bigger write-offs.

PHILANTHROPY: https://medicalexecutivepost.com/2021/11/15/national-philanthropy-day-2021/

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ABOUT: Marcinko Associates; Inc.

Posted on May 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko; MBA MEd CMP™

PRACTICE MANAGEMENT AND FINANCIAL PLANNING ADVICE FOR MEDICAL PROFESSIONALS

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At http://www.MarcinkoAssociates.com, we follow Fiduciary Standards for your protection:

Embrace the legal fiduciary obligation to place Medical colleague clients’ interests first

Deliver comprehensive financial planning and practice management advice for medical professionals

Provide fee-only advice; not fee-based advice

Do not accept commissions or assets under management

Be transparent on client costs, fees, and terms at all times

Provide transparency on portfolios and investment suggestions

Remain independent from any bank, broker dealer, insurance provider, RIA or custodian

Measure client performance returns using independent third parties

Do not create products to sell or price any public securities

Do not physically hold or possess any client assets, securities, or money for management

Investment and financial planning advice only!

OUR EDUCATION: Books

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

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Safe Notes VERSUS Convertible Notes

Posted on May 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By AI

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What Is a SAFE Note?

A SAFE note is a type of convertible security that specifies a certain amount of money an investor will pay you as a business owner. In exchange, you agree to give the investor a certain amount of equity in your company at an agreed-upon future date. In other words, a SAFE note confers the right for an investor to purchase shares in your company in a future-priced round.

How SAFE Notes Work

According to ContractsCounsel, a SAFE note works in the following way:

  1. An investor provides funding in exchange for the right to future equity.
  2. You use the funding to grow your business.
  3. After your company grows sufficiently, you secure another investor, and your company receives a “post-money valuation.”
  4. You calculate your company’s price per share.
  5. You convert the SAFE note into the applicable number of shares and distribute them to the SAFE investor. Typically, a SAFE note converts after an equity financing round.

Example of a SAFE Note

An investor purchases a SAFE note with a valuation cap of $20 million. During the next funding round, the value of your company is set at $40 million at $20 a share. Because the SAFE note has a valuation cap of $20 million, its owner can purchase twice as many shares of your company as new investors can. This was the incentive for the SAFE investor to provide funding earlier.

STUDENT LOANS and State Taxes

What Is a CONVERTIBLE NOTE?

Within venture capital financing, a convertible note is a type of short-term debt financing that’s used in early-stage capital raises. In other words, convertible notes are loans to early-stage startups from investors who are expecting to be paid back when their note comes due. But, instead of being paid back in principal with interest—as would be the case with a typical loan—the investor can be repaid in equity in your company.

You might also think of a convertible note like an IOU. An investor provides you with capital now and the convertible note, acting as a short-term loan, ensures that you give the investor a stake in your startup later. From the investor’s point of view, the benefit in this exchange is that if they give you capital and a vote of confidence early on and you do well, you’ll repay them many times over.

How Do Convertible Notes Work?

Typically, an investor will provide an early-stage startup in need of capital with a loan (with repayment terms in the ballpark of a standard short-term loan, usually a year or two), along with repayment terms. This is the “note.” The note will include a due date at which time it’s mature and the balance will be due, along with interest. Generally, however, the note is not repaid like a normal short-term loan. Instead, you repay the investor for their loan with equity in your company, usually in conjunction with another funding round. 

If, however, the maturity date comes along and your startup has not yet converted the note to equity, the investor can either extend the convertible note’s maturity date or call for the actual repayment of the note.

Debt Paradox: https://medicalexecutivepost.com/2025/02/04/paradox-debt-may-be-necessary-to-build-wealth/

This being said, the whole idea behind convertible notes is that your company is on a strong growth trajectory and that is why the note is being issued—it amasses value for the investor and beelines to a priced round. Ultimately, the point of a convertible note is that the noteholder, or investor, doesn’t want to get their loan paid back— they want their debt to convert into a heavily discounted security in a successful, valuable company that’s growing extremely quickly.

Cons: The major downside of a convertible note is that you will eventually be giving up some control over your business. When the convertible note comes due, the investor will be granted equity in your business. If you’re not ready to split ownership of your business with outside parties, this is not the right financing option for you.

CASH ADVANCE LOANS: https://medicalexecutivepost.com/2024/12/14/merchant-cash-advance-loans/

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RIP: Robert Jarvik MD; 79

Posted on May 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BREAKING NEWS!

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Robert Jarvik, who developed the first artificial heart to be permanently implanted in a human — a breakthrough that captured the world’s imagination even as it triggered debates about medical ethics — died May 26th at his home in Manhattan, NY. He was 79.

Heart Attack: https://medicalexecutivepost.com/2021/01/08/heart-attack-symptoms/

Heart Disease Prevention for Caregivers

The cause was complications from Parkinson’s disease, said his wife, writer Marilyn vos Savant.

MORE: https://en.wikipedia.org/wiki/Robert_Jarvik

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Real Estate Agent VERSUS Realtor?

Posted on May 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By AI

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The terms “real estate agent” and “realtor” are often used interchangeably to describe a licensed professional who can help you buy or sell a home. But the terms have different meanings. 

Real Estate Investing: https://medicalexecutivepost.com/2025/04/14/physicians-on-real-estate-investing/

  • A realtor is a licensed salesperson who belongs to the National Association of Realtors (NAR), and must comply with NAR’s code of ethics. The term is capitalized when describing a NAR member, and NAR owns the trademark.
  • A real estate agent is simply a licensed salesperson who does not belong to NAR, and refers to any individual who holds a real estate salesperson’s license.

REITS: https://medicalexecutivepost.com/2024/08/13/on-non-traded-real-estate-investment-trusts-reits/

Should you hire a real estate agent or a realtor? Agents who belong to NAR aren’t necessarily better than non-member agents. NAR is just a trade association — not a licensing body — so membership is optional. 

Commercial RE: https://medicalexecutivepost.com/2013/09/10/financial-freedom-through-commercial-real-estate-education-and-investing/

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FINANCIAL LIFE PLANNING? For Physicians and Medical Professionals

Posted on May 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

By Dr. David Edward Marcinko; MBA MEd CMP™

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Life planning and behavioral finance as proposed for physicians and integrated by the Institute of Medical Business Advisors Inc., is unique in that it emanates from a holistic union of personal financial planning, human physiology and medical practice management, solely for the healthcare space.  Unlike pure life planning, pure financial planning, or pure management theory, it is both a quantitative and qualitative “hard and soft” science, with an ambitious economic, psychological and managerial niche value proposition never before proposed and codified, while still representing an evolving philosophy. Its’ first-mover practitioners are called Certified Medical Planners™.

Life planning, in general, has many detractors and defenders. Formally, it has been defined by Mitch Anthony, Gene R. Lawrence, AAMS, CFP© and Roy T. Diliberto, ChFC, CFP© of the Financial Life Institute, in the following trinitarian way.

Financial Life Planning is an approach to financial planning that places the history, transitions, goals, and principles of the client at the center of the planning process.  For the financial advisor or planner, the life of the client becomes the axis around which financial planning develops and evolves.

Financial Life Planning is about coming to the right answers by asking the right questions. This involves broadening the conversation beyond investment selection and asset management to exploring life issues as they relate to money.

Financial Life Planning is a process that helps advisors move their practice from financial transaction thinking, to life transition thinking. The first step is aimed to help clients “see” the connection between their financial lives and the challenges and opportunities inherent in each life transition.

But, for informed physicians, life planning’s quasi-professional and informal approach to the largely isolate disciplines of financial planning and medical practice management is inadequate. Today’s practice environment is incredibly complex, as compressed economic stress from HMOs managed care, financial insecurity from insurance companies, ACOs and VBC, Washington DC and Wall Street; liability fears from attorneys, criminal scrutiny from government agencies, and IT mischief from malicious electronic medical record [eMR] hackers. And economic bench marking from hospital employers; lost confidence from patients; and the Patient Protection and Affordable Care Act [PP-ACA] more than a decade ago. All promote “burnout” and converge to inspire a robust new financial planning approach for physicians and most all medical professionals. 

The iMBA Inc., approach to financial planning, as championed by the Certified Medical Planner™ professional certification designation program, integrates the traditional concepts of financial life planning, with the increasing complex business concepts of medical practice management. The former topics are presented in this textbook, the later in our recent companion text: The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors].

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For example, views of medical practice, personal lifestyle, investing and retirement, both what they are and how they may look in the future, are rapidly changing as the retail mentality of medicine is replaced with a wholesale and governmental philosophy. Or, how views on maximizing current practice income might be more profitably sacrificed for the potential of greater wealth upon eventual practice sale and disposition. 

Or, how the ultimate fear represented by Yale University economist Robert J. Shiller, in The New Financial Order: Risk in the 21st Century, warns that the risk for choosing the wrong profession or specialty, might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics. OR, if a medical degree is even needed for future physicians?

Say, what medical license?

Dr. Shirley Svorny, chair of the economics department at California State University, Northridge, holds a PhD in economics from UCLA. She is an expert on the regulation of health care professionals who participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that medical licensure not only fails to protect patients from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

Yet, the opportunity to revise the future at any age through personal re-engineering, exists for all of us, and allows a joint exploration of the meaning and purpose in life. To allow this deeper and more realistic approach, the informed transformation advisor and the doctor client, must build relationships based on trust, greater self-knowledge and true medical business management and personal financial planning acumen.

[A] The iMBA Philosophy

As you read this ME-P website, we hope you will embrace the opportunity to receive the focused and best thinking of some very smart people. Hopefully, along the way you will self-saturate with concrete information that proves valuable in your own medical practice and personal money journey. Maybe, you will even learn something that is so valuable and so powerful, that future reflection will reveal it to be of critical importance to your life.  The contributing authors certainly hope so.

At the Institute of Medical Business Advisors, and thru the Certified Medical Planner™ program, we suggest that such an epiphany can be realized only if you have extraordinary clarity regarding your personal, economic and [financial advisory or medical] practice goals, your money, and your relationship with it. Money is, after only, no more or less than what we make of it. 

Ultimately, your relationship with it, and to others, is the most important component of how well it will serve you. 

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EDUCATION: Books

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

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GIVING CIRCLES: Defined

Posted on May 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Giving circles are kick starting a new era of philanthropy where individuals give together to make social change happen.

A giving circle brings a group of people with shared values together to collectively discuss and decide where to make a pooled gift.

Philanthropy: https://medicalexecutivepost.com/2021/11/15/national-philanthropy-day-2021/

Giving circles support with their dollars, but also build awareness, volunteer, become board members and more. Individuals multiply their impact and knowledge, have fun, and connect with their local community.

Ethics: https://medicalexecutivepost.com/2024/06/22/medical-ethics-managing-risk-is-a-component-of-caring/

People are coming together around the world to create the change they want to see in the world. Giving circles are a growing global movement with more than 2,500 active circles around the world giving intentionally and thoughtfully.

Donor Advised Funds: https://medicalexecutivepost.com/2024/11/27/a-thanksgiving-donation-in-name-only/

Giving circles are a modern form of collective giving with roots in cultures across the globe for many decades!

EDUCATION: Books

Cite: https://johnsoncenter.org/2023-us-collective-giving-research-initiative/

Visit WhatIsAGivingCircle.com for more on this collective giving model and why people-centered philanthropy is so powerful.

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FROM: Zocdoc to Zo

Posted on May 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and AI

SPONSOR http://www.CertifiedMedicalPlanner.org

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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.

MD versus DO: https://medicalexecutivepost.com/2023/06/17/the-md-versus-do-degree/

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.

DPM Podiatrist: https://medicalexecutivepost.com/2024/03/20/is-a-podiatrist-a-physician/

“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.”

Tele-Health: https://medicalexecutivepost.com/2022/04/04/types-of-patient-care-healthcare-providers-deliver-via-tele-health/

Click here for more on the rise of voice agents in healthcare.

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HEDGE FUND: Hiring Separate Managers?

Posted on May 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

Growing Funds: https://medicalexecutivepost.com/2025/01/15/hedge-funds-a-growing-sector-of-investing/

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I want to invest with a manager that has the skills to “hedge” a portfolio, but I do not wish to mix my money with other investors as in a hedge fund.

QUESTION: Can I hire hedge fund managers to manage my account separately?

Some hedge fund managers do take the time to recruit and manage separate accounts, with or without the help of referring brokers.

However, before long the administrative burden of managing so many separate accounts can become quite significant. Hence, the minimums for such separate accounts are generally much higher than if one were to invest in the manager’s hedge fund.

Hedge Fees: https://medicalexecutivepost.com/2024/07/09/hedge-funds-understanding-fees-and-costs/

The best feature of these separate accounts is that potentially every aspect of the investment account, including fees, is negotiable. Other features include greater transparency and increased liquidity, since separately managed accounts can often be shut down on short notice.

Hedge Monitors: https://medicalexecutivepost.com/2024/07/09/how-to-monitor-hedge-funds/

Investors must be aware, however, that for practical purposes the portfolio manager generally will buy and sell the same securities in the separately managed accounts that the portfolio manager buys and sells in the hedge fund, yet the expenses incurred by the investor will likely be higher.

Hedge IRA: https://medicalexecutivepost.com/2025/04/02/hedge-funds-in-individual-retirement-accounts/

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PARADOX: Baumol’s Economic Cost Disease

Posted on May 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.HealthDictionarySeries.org

Staff Reporters

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According to Baumol’s Cost Disease, in theory, workers should get higher pay because they get more productive. But an economist named William J. Baumol PhD noticed this isn’t always true; as in a paradox.

For example, musicians take the same time to play a string quartet as they did in Mozart’s day, but are paid more nevertheless. The reason is competition for labor; musicians can take other jobs. So rising wages in productive parts of the economy (eg, manufacturing) lead to higher wages in less productive sectors.

MORE: For more on the paradoxical disease, read this article; and for more on Baumol, read this one.

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FINANCIAL ADVISORS: Usually Aren’t Millionaires

Posted on May 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

THE TRUTH MUST BE TOLD!

By Dr. David Edward Marcinko MBA MEd CMP™

http://www.MarcinkoAssociates.com

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Financial Advisors and Financial Planners Usually Aren’t Millionaires

According to the most recent data from the Bureau of Labor Statistics (BLS), financial advisors had a median annual salary of $99,580 in 2023, which is significantly higher than the national average of $65,470. Of course, salaries of financial advisors can differ significantly by their location and level of expertise. The client’s profile may also have an impact on their compensation. But, many are not rich.

REPLACE FINANCIAL PLANNERS: https://medicalexecutivepost.com/2023/03/15/why-your-financial-planner-may-be-replaced/

This is unfortunate. Financial advisors and Financial planners don’t rank among the millionaire professions in Thomas J. Stanley and William D. Danko’s book The Millionaire Next Door. Many work as salaried employees rather than entrepreneurs, lacking the scalable income potential of business owners who reinvest profits.

Certified Medical Planner: https://medicalexecutivepost.com/2024/12/17/certified-medical-planner-niche-advisors-thrive/

Stanley and Danko also stressed frugality, a challenge for advisors pressured to flaunt success—think luxury cars or upscale offices—making them “income-statement affluent” rather than “balance-sheet affluent.”

BEST DOG FINANCIAL ADVISOR: https://medicalexecutivepost.com/2025/03/23/dog-nearly-fetches-prestigious-financial-advisor-honor/

CONCLUSION

The truth is that a Financial Advisors’ success isn’t measured in client returns. Instead it is measured in their ability to gather assets and retain clients. In other words; Financial Advisors do not need to be good with money.

Financial Advisors need to be good with marketing, advertising, sales and people.

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EDUCATION: Books

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

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MENTAL HEALTH: Awareness Month in May 2025

Posted on May 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Mental Health Awareness Month

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.

START-UPS: https://medicalexecutivepost.com/2024/07/14/mental-health-entrepreneurial-start-up-companies/

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.

SAMHSA: https://www.samhsa.gov/about/digital-toolkits/mental-health-awareness-month

MORE: https://www.whitehouse.gov/presidential-actions/2025/05/national-mental-health-awareness-month-2025/

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World Lupus Day

Posted on May 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko; MBA MEd

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Every year on May 10th, the world comes together to observe World Lupus Day.

Lupus is a disease that occurs when your body’s immune system attacks your own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for lupus, treatments can help control symptoms.

In 2025, this important day continues its mission of raising awareness about lupus, supporting those affected, and promoting further research into this complex autoimmune condition.

READ: https://tinyurl.com/4bfcvjtx

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DAVID SOUTER: RIP

Posted on May 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

BREAKING NEWS

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Former Supreme Court Justice of the United States, David Souter, the intellectual from New England who disappointed Republicans and delighted liberals by slowing a conservative transformation of the high court, died May 8th at his home in New Hampshire. He was 85 years old.

The high court announced his death but did not cite a cause.

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OSTRICH BIAS: Negative Information

Posted on May 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

Financial Advisor, Planner and Insurance Agent Information

By Staff Reporters

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Ostrich Bias is a behavioral phenomenon describing the tendency of individuals to avoid or ignore information that they perceive as negative or threatening. This term is derived from the popular but inaccurate belief that ostriches bury their heads in the sand when faced with danger, even though they do not exhibit such behavior.

Evidence: There is neuro-scientific evidence of the ostrich effect. Sharot et al. (2012) investigated the differences in positive and negative information when updating existing beliefs. Consistent with the ostrich effect, participants presented with negative information were more likely to avoid updating their beliefs; wills, estate plans, investment portfolios, and insurance policies, etc..

Moreover, they found that the part of the brain responsible for this cognitive bias was the left IFG – inferior frontal gyrus – by disrupting this part of the brain with TMS – transcranial magnetic stimulation – participants were more likely to accept the negative information provided.

EXAMPLE: The Ostrich Bias can cause someone to avoid looking at their bills, because they’re worried about seeing how far behind they are on home mortgage payments, credit cards, education or auto loans, etc.

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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.

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LONG TERM CARE INSURANCE: A Hobson’s Choice Decision?

Posted on May 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Long Term Care Insurance [LTCI]

Some retired people live on a fixed income and many of them live right on the edge of their financial capability.  At some time in their life, they may have to make a choice regarding many purchases.  

In this case, we will illustrate “choice” using a couple’s purchase of Long-Term-Care Insurance [LTCI]. Of course, economics is the study of choice; wants, needs and scarcity, etc. In our case, if they decide to make the purchase they commit to a lifetime of premium payments. The financial tradeoff is this; if they make the commitment to purchase LTCI, they must give up something else.

EXAMPLE: In order to maintain a monthly premium of $100 ($1,200per year), an elderly patient, retired layman or couple must essentially relegate about $30,000 of financial assets to generate the $100 necessary to make an average premium payment (assumes a 7% rate of return with 4% withdrawal rate) or [4% X $30,000 = $1,200 year]. Thus, if the monthly premium cost is $500 per month, the elder must give up the use of $150,000 of retirement asset just to generate enough cash flow to pay for the LTC insurance. 

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The married elder couple has to make the Hobson’s Choice decision among lifestyle (dinners, vacations, gifts to children, prescription drugs, medical care or food and shelter) versus paying an insurance premium to provide for nursing home coverage for a need, which may be very real, but will not occur until sometime in the ambiguous future. 

And so, when faced with such a tough economics Hobson’s Medicine Choice, neither of which delivers peace of mind or a respectable solution; many will simply decide that, in either case, they may already end up impoverished. Thus, many will often opt for the better lifestyle now … while they can enjoy it … together. 

Cite: Anonymous Health Insurance Agent, Norcross, Georgia

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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.

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PHANTOM: Stock Equity Plans

Posted on May 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITIONS

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Phantom equity is an increasingly popular tool within businesses, particularly startups and private companies, for incentivizing employees without diluting ownership. It allows firms to reward key personnel by linking compensation to the company’s performance, aligning employee interests with those of shareholders.

Basic Mechanisms of Phantom Equity

Phantom equity operates as a contractual agreement offering employees a simulated stake in the business without issuing actual stock. This arrangement appeals to companies aiming to maintain control over their equity structure while providing performance-based incentives. The benefits mimic stock ownership, such as dividends and capital appreciation, without the complexities of transferring actual shares.

The company establishes a phantom equity plan that defines terms such as vesting schedules, performance metrics, and payout conditions. Vesting schedules, often ranging from three to five years, encourage employee retention. Performance metrics may include revenue growth, profit margins, or other financial indicators aligned with strategic goals. Once vested, employees receive cash payments based on the value of the phantom shares, determined by the company’s valuation at payout.

Valuations, often conducted through third-party appraisals or internal financial metrics, directly affect payouts. If the company grows significantly, the value of phantom shares increases, resulting in higher payouts. Conversely, if performance declines, the value of these shares decreases, reducing compensation.

Types of Phantom Equity Plans

Phantom equity plans can be customized to suit a company’s goals, with two primary types being most common: appreciation-only arrangements and full-value arrangements.

Appreciation-Only Arrangements

Appreciation-only arrangements reward employees for the increase in the company’s value over a specified period. Employees are granted phantom shares that reflect the appreciation in the company’s valuation from the grant date to the payout date.

For instance, if phantom shares are initially valued at $10 each and the valuation rises to $15, the employee receives a payout of $5 per share. This structure ties employee rewards to company growth without affecting equity. Companies must rely on precise valuation methods, often adhering to GAAP or IFRS, to ensure fairness and compliance.

Full-Value Arrangements

Full-value arrangements provide payouts equivalent to the full value of phantom shares at vesting or payout. This includes both the initial value and any appreciation.

For example, if phantom shares are initially valued at $10 and later rise to $15, the employee receives $15 per share. While offering greater potential rewards, full-value arrangements require a larger financial commitment from the company. Careful financial planning and adherence to standards like ASC 718, which governs share-based compensation, are essential for managing these plans effectively.

Tax Implications: https://eqvista.com/phantom-stock/phantom-stock-plans-taxation/

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FOURTH MARKET: Private Security Transactions

Posted on April 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITIONS

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The Fourth Market?

The fourth market is defined as private transactions made directly between large medical investors, institutions such as banks, mutual funds, and insurance companies, without the use of a securities firm. In other words, fourth market trading is usually one institution swapping securities in its portfolio with another large institution.

From the stock broker’s viewpoint, there is one problem with the fourth market. Since no broker/dealer is involved, no registered representative is involved and there is no commission to be earned. These trades are reported on a system called Instinet.

This is advantageous to larger medical foundations or institutional investors.

What Is Instinet?

Instinet is a global financial securities service that operates an electronic securities order matching, trading, and information system which allows members, primarily institutional traders, and investors, to display bids and offer quotes for stocks, and conduct transactions with each other.

Instinet is an example of a dark pool of liquidity, a private exchange for trading securities that is not accessible by the investing public. The name implies a lack of transparency. and it facilitates block trading by institutional investors who do not wish to impact the markets with their large orders.

According to the SEC, there were 74 registered Alternative Trading Systems, or dark pools, as of February 2024.

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ECONOMIC COMPETITION MODELS: In Medicine and Health Care

Posted on April 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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HEALTH CARE ECONOMIC COMPETITION MODELS

In a discussion of competitive healthcare economic models, assumptions must include normal demand quantities, many fully informed patients and the fact that physicians cannot directly influence demand for medical care. These assumptions, although fluid, also preclude that patient buyers are large enough to have any influence over price and result in the following”:

  • In a “pure monopoly”, there is only one provider with a unique service. The doctor   is a “price maker” and charges whatever s/he wishes.
  • In an “oligopoly”, there are a few physicians who provide similar services. For example, when it becomes clear to Dr. Smith and Dr. Jones that neither can win their price war, oli-gopolists return prices to prior, but still inflated levels!  
  • In “monopolistic competition”, there are many providers with differentiated services. For example, should Dr. Jones decide to have evening hours, she may charge a premium for her fees if Dr. Jones doe not follow suit.
  • Finally, when “pure competition” occurs, there are many physicians, providing providing similar and substitutable services. Marketing and advertising does not affect fees, and prices are determined by supply and demand. The doctors become “price takers” by accepting fees arrived at by practicing competitively.

COMMENTS APPRECIATED

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.

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CPA, CMA, CFA and Enrolled Agents

Posted on April 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITIONS

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Certified Public Accountant

A Certified Public Accountant (CPA) is a licensed professional who has passed an examination administered by a state’s Board of Accountancy. State CPA exams are created under guidelines issued by The American Institute of Certified Public Accountants (AICPA). The Uniform CPA Exam can only be taken by accountants who already have professional experience in the field and a bachelor’s degree.CPAs are not fiduciaries.

Not all accountants are CPAs. Accountants who are CPAs are licensed by their state’s Board of Accountancy after passing the Uniform CPA Exam. CPAs prepare reports that accurately reflect the business dealings of the companies and individuals that hire them. Many prepare tax returns for individuals or businesses and advise them on ways to minimize taxes. Obtaining the CPA designation requires a bachelor’s degree, typically with a major in business administration, finance, or accounting. Other majors are acceptable if the applicant meets the minimum requirements for accounting courses.  

Enrolled Agent

Although not a CPA, an Enrolled Agent [EA] is a person who has earned the privilege of representing taxpayers before the Internal Revenue Service [IRS]. This is done by either passing a three-part comprehensive IRS test covering individual and business tax returns, or through experience as a former IRS employee. Enrolled agent status is the highest credential the IRS awards. Individuals who obtain this elite status must adhere to ethical standards and complete 72 hours of continuing education courses every three years.

Certified Managerial Accountant

A Certified Management Accountant (CMA), which is issued by the Institute of Management Accountants (IMA), builds on financial accounting proficiency by adding management skills that aid in making strategic business decisions based on financial data.

Oftentimes, the reports and analyses prepared by certified management accountants (CMAs) will go above and beyond those required by generally accepted accounting principles (GAAP). 

For example, in addition to a company’s required GAAP financial statements, CMAs may prepare additional management reports that provide specific insights useful to corporate decision-makers, such as performance metrics on specific company departments, products, or even employees.

Certified Financial Analyst

A Certified Financial Analyst [CFA] is a globally-recognized professional designation offered by the CFA Institute, an organization that measures and certifies the competence and integrity of financial analysts. Candidates are required to pass three levels of exams covering areas such as accounting, economics, ethics, money management, and security analysis. From 1963 through November 2023, more than 3.7 million candidates had taken the CFA exam. The overall pass rate was 45%. From 2014 through 2023, the 10-year average pass rate was 43%.1

CFA Institute. The CFA Institute was formerly the Association for Investment Management and Research (AIMR).

The CFA charter is one of the most respected designations in finance and is widely considered to be the gold standard in the field of investment analysis. To become a charter holder, candidates must pass three difficult exams, have a bachelors degree, and have at least 4,000 hours of relevant professional experience over a minimum of three years. Passing the CFA Program exams requires strong discipline and an extensive amount of studying. 

There are more than 200,000 CFA charter holders worldwide in 164 countries.The designation is handed out by the CFA Institute, which has 11 offices worldwide and 160 local member societies.

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JOHN B. TAYLOR’S: Monetary Policy Rule

Posted on April 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters

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Named for a U.S. economist, the JB Taylor Rule is a mathematical monetary-policy formula that recommends how much a central bank should change its nominal short-term interest rate target (such as the U.S. Federal Reserve’s federal funds rate target) in response to changes in economic conditions, particularly inflation and economic growth. It’s typically viewed as guideline for raising short-term interest rates as inflation and potentially inflationary pressures increase. The rule recommends a relatively high interest rate (“tight” monetary policy) when inflation is above its target or when the economy is above its full employment level, and a relatively low interest rate (“easy” monetary policy) under the opposite conditions.

To illustrate, the monetary policy of the FOMC changed throughout the 20th century. The period between the 1960s and the 1970s is evaluated by Taylor and others as a period of poor monetary policy; the later years typically characterized as stagflation. The inflation rate was high and increasing, while interest rates were kept low. Since the mid-1970s monetary targets have been used in many countries as a means to target inflation.

However, in the 2000s the actual interest rate in advanced economies, notably in the US, was kept below the value suggested by the Taylor rule.

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The DOCTOR EFFECT

Posted on April 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Dr. David Edward Marcinko; MBA MEd CMP™

Medical Colleagues Beware the Advisors

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SPONSOR: http://www.MarcinkoAssociates.com

Several years ago a group of highly trusted and deeply  experienced financial advisors, insurance service professionals and estate planners noted that far too many of their mature retiring physician clients, using traditional stock brokers, management consultants and financial advisors, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.”

In fact, an informal inverse related relationship was noted, and dubbed the “Doctor Effect.” In others words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning and medical practice management, continuum.

Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, dinners and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.”  This realization confirmed the industry culture which seemed to be:

Bread for the advisor – Crumbs for the client!

And so, Marcinko Associates formed a cadre’ of technology focused and highly educated multi-degreed doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries who decided there must be a better way for their healthcare colleagues to receive financial planning advice, products and related advisory services within a culture of fiduciary responsibility.

We trust you agree with this specific niche knowledge, and collegial consulting philosophy, as illustrated thru our firm and these two books.

EDUCATION: Books

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

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MARKETING, ADVERTISING & SALES: Public Relations, Change and Crisis Management

Posted on April 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

THE BASICS FOR FOR PHYSICIANS, INSURANCE AGENTS AND FINANCIAL ADVISORS

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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There’s often a disconnect between physicians, insurance agents and financial advisors and the patients and clients they’d like to serve. Both might ostensibly share the same goal but there’s often a big difference in perspective. Advisors / Physicians and would-be clients / patients likely have different communication styles, especially in an age where technology has greatly changed the way we talk with one another. Their expectations and priorities can also often dramatically diverge. Those structural gaps can hinder collaboration and trust.

To bridge this divide, you must understand how prospective clients and patients think nowadays and be able to adjust your M.A.S. approach accordingly.

THE BASICS

Marketing is the business process of identifying, anticipating and satisfying patient’s, client’s or customers’ needs and wants. It is your unique value proposition or strategic competitive advantage. Marketers can direct product to other businesses or directly to consumers. But, we believe it is actually your strategic competitive advantage [SCA] which differentiates yourself from competitors. It is the “moat” around your business.

Advertising is a marketing communication that employs an openly sponsored, non-personal message to promote or sell a product, service or idea. Sponsors of advertising are typically businesses wishing to promote their products or services. Advertising is communicated through various mass media outlet, including traditional media such as newspapers, magazines, television, radio, outdoor advertising or direct mail; and new media such as search results, blogs, social media, websites or text messages. The actual presentation of the message in a medium is referred to as an advertisement, or “ad” or advert for short. But, we believe that is simply how you disseminate your strategic competitive advantage [SCM] to potential clients.

Sales close the deal and collects money. Sales are activities related to selling or the number of goods or services sold in a given targeted time period. The seller, or the provider of the goods or services, completes a sale in response to an acquisition, appropriation, requisition, or a direct interaction with the buyer at the point of sale. There is a passing of title (property or ownership) of the item, and the settlement of a price, in which agreement is reached on a price for which transfer of ownership of the item will occur. The seller, not the purchaser, typically executes the sale and it may be completed prior to the obligation of payment. In the case of indirect interaction, a person who sells goods or service on behalf of the owner is known as a salesman or saleswoman or salesperson, but this often refers to someone selling goods in a store/shop, in which case other terms are also common, including salesclerk, shop assistant, and retail clerk.

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DERIVATIVE THOUGHTS

Public Relations [PR] is differentiated than advertising from in that an advertiser pays for and has control over the message. It differs from personal selling in that the message is non-personal, i.e., not directed to a particular individual. We pay for advertising but pray for public relations. But public relations are not controllable but it is free, while advertising is not. PR suggests that “good news or bad news”; just spell the name correctly

Change Management is the discipline that guides how we prepare, equip and support individuals to successfully adopt to change in order to drive organizational success and outcomes.

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.

MODERNITY NOW

CRM stands for Customer Relationship Management, which is a system for managing all interactions with current and potential customers, clients or patients. The goal is simple: improve relationships to grow your business or medical practice. CRM technology helps companies stay connected to customers, streamline processes, and improve profitability.

When people talk about CRM, they’re usually referring to a CRM system: software that helps track each interaction you have with a prospect, patient or customer. That can include sales calls, treatment plans or service interactions, marketing e-mails, and more. CRM tools can unify customer and company data from many sources and even use Artificial Intelligene [AI] to help better manage relationships across the entire customer – patient lifecycle – spanning departments described in the M.A.S. basics, above.

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DECOY BIAS EFFECT: The Asymmetric Dominance Effect of Choice Manipulation

Posted on April 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

A Concept All Financial Advisors, Planners and Insurance Sales Agents Should Know

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters

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Decoy Bias Effect is a dubious phenomenon in decision-making where the introduction of a third, less attractive option (the “decoy”) influences individuals to change their preference between two other options.

The decoy bias effect describes how, when we are choosing between two alternatives, the addition of a third, less attractive option (the decoy) can influence our perception of the original two choices. Decoys are “asymmetrically dominated:” they are completely inferior to one option (the target) but only partially inferior to the other (the competitor). For this reason, the decoy effect is sometimes called the “asymmetric dominance effect.”

EXAMPLE: This bias is commonly used in financial planning sales; as well as marketing and mutual fund, ETF, REIT, stock broker, insurance agent and financial advisor pricing strategies to manipulate investor choices.

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Very Few Stocks UP but Many Stocks DOWN

Posted on April 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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🟢 What’s up

  • Hertz Global soared 56.44% on the news that Bill Ackman’s Pershing Square Capital has taken a $46.5 million stake in the rental car company.
  • Travelers Cos. rose 1.13% in spite of massive losses from California wildfires, which didn’t hurt the insurer’s bottom line as badly as Wall Street feared.
  • Abbott Laboratories gained 2.77% after the pharma company missed sales estimates but still beat earnings forecasts.
  • Gold miners continue to climb as gold keeps hitting new highs. Newmont rose 2.51%, while Gold Fields gained 3.35%.

What’s down

  • Tesla sank 4.94% after the company’s share of EV sales in California fell below 50% in the first quarter, while export controls threaten plans to produce Cybercabs in the US.
  • United Airlines fell 0.01% despite reporting its “best first-quarter financial results in five years,” according to management. The airline took the unique measure of providing two different financial outlooks for the year ahead: one for a stable economy, and one for a recession.
  • Lyft shed just 0.46% on the news that the ride-hailing company is acquiring European taxi app Free Now for $199 million.
  • Interactive Brokers Group reported a 47% increase in trading volume last quarter that helped it beat revenue expectations, but the brokerage still tumbled 8.95% after missing profit forecasts.
  • Palantir gave up some of its recent gains following its big NATO announcement, sinking 5.78% today as investors collected profits.
  • JB Hunt Transport Services’ management team warned that the logistics company sits squarely in the crosshairs of the trade war, pushing shares down 7.68%.
  • Omnicom Group tumbled 7.28% after the advertising firm missed revenue estimates thanks to economic uncertainty.

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AOMB: Assignment of Medical Benefits

Posted on April 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Classic: An arrangement by which a patient requests that their health benefit payments be made directly to a designated person or facility, such as a physician or hospital. It is a legally binding agreement between patient and Insurance company asking them to send your reimbursement checks directly to your doctor.
 
Modern: To accept assignment means that the provider agrees to accept what ever the insurance company allows or approves as payment in full for the claim. The patient signs paperwork requiring his health insurance provider to pay his physician or hospital directly.
 
EXAMPLES:
 
CMS: The approved amount, also known as the Medicare-approved amount, is the fee that Medicare sets as how much a provider or supplier should be paid for a particular service or item. Original Medicare calls this “assignment.”
 
Tardiness: When a medical office accepts an assignment of benefits, the insured patients may have to wait several months for their insurance reimbursement to arrive.

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HONESTY BOX: Experiment

Posted on April 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters

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Classic: It’s no surprise that people are more honest when they know that they’re being watched. But what about just reminding them of the idea of being watched, without them actually being watched?

Modern: Researchers at the University of Newcastle’s Division of Psychology have an honor (or trust) system where they are requested to deposit payment for coffee in an “honesty box.” There was a note saying how much they should pay.

In 2006, Dr. Melissa Bateson and colleagues decided to do a little experiment: they placed an image above the note. They alternate between two pictures: one week they would use a picture of alleged human eyes and the other week, flowers. After 10 weeks, they plotted the amount of money received versus drinks consumed and found that people paid nearly three times as much for their drinks when eyes were displayed.

“There’s an argument that if nobody is watching us it is in our interests to behave selfishly. But when we think we’re being watched we should behave better, so people see us as co-operative and behave the same way towards us,” — Dr Bateson said

EXAMPLE:

Tax: This has great exemplar potential in things like federal, state and local income tax preparation, etc.

Insight: “It’s a definite that you’re all going to screw up, but it’s not a definite that any of you will learn from that,” declared one of our medical school instructors, years ago. “Cultivate the attitude that allows you to own your mistakes, and then, not repeat them” — reported Monique Tello MD MPH.

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MEDICAL PRACTICE: As a Financial Asset Class?

Posted on April 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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By Dr. David Edward Marcinko; MBA MEd CMP™

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What Is an Alternative Investment?

An alternative investment is a financial asset that does not fall into one of the conventional investment categories. Conventional categories include stocks, bonds, and cash. Alternative investments can include private equity or venture capital, hedge funds, managed futures, art and antiques, commodities, and derivatives contracts. Real estate is also often classified as an alternative investment.

QUESTION: But what about a medical, podiatric or dental practice?

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An Alternate Asset Class Surrogate?

A medical practice is much like an alternative investment [AI], or alternate asset class in, two respects.

  • First, it provides the work environment that generates personal income which has been considered generous, to date. 
  • Second, it has inherent appreciation and sales value that can be part of an exit (retirement) or succession planning transfer strategy.

Conclusion

So, unlike the emerging thought that offers Social Security payments as a surrogate for an asset classes; or a federally insured AAA bond – a medical practice might also be considered by some folks as an asset class within a well diversified modern investment portfolio.

EDUCATION: Books

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

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FINANCIAL MODELING TERMS: All Physicians Should Review and Know

Posted on April 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Financial Modeling is one of the most highly valued, but thinly understood, skills in financial analysis. The objective of financial modeling is to combine accounting, finance, and business metrics to create a forecast of a company’s future results.

According to Jeff Schmidt, a financial model is simply a spreadsheet, usually built in Microsoft Excel, that forecasts a business’s financial performance into the future. The forecast is typically based on the company’s historical performance and assumptions about the future and requires preparing an income statement, balance sheet, cash flow statement, and supporting schedules (known as a three-statement model, one of many types of approaches to financial statement modeling). From there, more advanced types of models can be built such as discounted cash flow analysis (DCF model), leveraged buyout (LBO), mergers and acquisitions (M&A), and sensitivity analysis

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DEFINED TERMS

Discounted Cash Flow (DCF): A valuation method used to estimate the value of an investment based on its expected future cash flows, adjusted for the time value of money. It’s like deciding whether a treasure chest is worth diving for now, based on the gold coins you’ll be able to cash in later.

Sensitivity Analysis: This involves changing one variable at a time to see how it affects an outcome. Imagine tweaking your coffee-to-water ratio each morning to achieve the perfect brew strength.

Budget – A budget is the amount of money a department, function, or business can spend in a given period of time. Usually, but not always, finance does this annually for the upcoming year.

Rolling Forecast – A rolling forecast maintains a consistent view over a period of time (often 12 months). When one period closes, finance adds one more period to the forecast.

Topside – A topside adjustment is an overlay to a forecast. This is typically completed by the corporate or headquarter team. As individual teams submit a forecast, the consolidated result might not make sense or align with expectations. When this occurs, the high-level teams use a topside adjustment to streamline or adjust the consolidated view.

Monte Carlo Simulation: Picture yourself at the casino, but instead of gambling your savings away, you’re using this technique to predict different outcomes of your business decisions based on random variables. It’s like playing financial roulette with the odds in your favor.

What-If Analysis: Ever daydream about what would happen if you took that leap of faith with your business? This tool allows you to explore various scenarios without risking a dime. It’s like trying on outfits in a virtual dressing room before making a purchase.

Leveraged Buyout (LBO) Model: This is a bit like orchestrating a heist, but legally. It’s about acquiring a company using borrowed money, with plans to pay off the debts with the company’s own cash flows. High stakes, high rewards.

Mergers and Acquisitions (M&A) Model: Picture two puzzle pieces coming together. This model evaluates how combining companies can create a new, more valuable entity. It’s the corporate version of a matchmaker.

Three Statement Model: The holy trinity of financial modeling, linking the income statement, balance sheet, and cash flow statement. It’s like weaving a tapestry where each thread is crucial to the overall picture.

Capital Asset Pricing Model (CAPM): A formula that calculates the expected return on an investment, considering its risk compared to the market. It’s like choosing the best roller coaster in the park, balancing thrill and safety.

Cash Flow Forecasting: This is your financial weather forecast, predicting the cash flow climate of your business. It helps you plan for sunny days and save for the rainy ones.

Cost of Capital: The price of financing your business, whether through debt or equity. It’s like the interest rate on your growth engine, pushing you to maximize every dollar invested.

Debt Schedule: A timeline of your business’s debts, showing when and how much you owe. It’s your roadmap to becoming debt-free, one milestone at a time.

Equity Valuation: Determining the value of a company’s shares. It’s like assessing the worth of a rare gemstone, ensuring investors pay a fair price for a piece of the treasure.

Financial Leverage: Using debt to amplify returns on investment. It’s like using a lever to lift a heavy object, increasing force but also risk.

Forecast Model: A crystal ball for your finances, projecting future performance based on past and present data. It’s your guide through the financial wilderness, helping you navigate with confidence.

Operating Model: A detailed blueprint of how a business generates value, mapping out operational activities and their financial impact. It’s like laying out the inner workings of a clock, ensuring every gear turns smoothly.

Revenue Growth Model: This tracks potential increases in sales over time, charting a course for expansion. It’s like plotting your ascent up a mountain, anticipating the effort required to reach the summit.

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BLACK MONDAY REDEUX: Interesting Day or Financial Crisis?

Posted on April 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BILL ACKMAN versus JIM KRAMER

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Interesting Day?

Markets: Last week’s market bloodbath will go down in the history books. The S&P 500’s 10% plunge on Thursday and Friday, after President Trump announced massive tariffs, ranks among the steepest two-day decline in the last 70 years, on par with Black Monday in 1987, the post-Lehman Brothers rout in 2008, and the Covid plunge in March 2020. More than $6 trillion was wiped out from stocks over two days, and the NASDAQ entered a bear market, down 20% from a previous high.

Trading restarted at 9:30 am ET for what Bill Ackman predicts will be “one of the more interesting days in our country’s economic history.”

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Monday Crash?

On the other hand, CNBC host and market commentator Jim Cramer just warned that America is in store for another “Black Monday” market crash similar to the record 1987 collapse if President Trump doesn’t curtail his tariff plan.

Cramer — who noted that the 1987 crash saw the Dow Jones Industrial Average fall by 22.6% in a single day — said the bloodbath could be repeated after the brutal two-day sell-off following the announcement of Trump’s sweeping tariffs against nearly 90 countries.

If the president doesn’t try to reach out and reward these countries and companies that play by the rules, then the 1987 scenario … the one where we went down three days and then down 22% on Monday, has the most cogency,” Cramer said on his show Saturday, referencing the worst single-day fall in the history of the Dow.

QUESTION: Who is correct; Ackman or Cramer?

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Registered Investment Advisor VERSUS Hedge Fund Manager

Posted on April 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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The Hedge Fund manager I am considering is a Registered Investment Adviser [RIA]

QUESTION: What is a Registered Investment Advisor?

If the fund manager is an entity, then any individual you deal with will be a registered investment adviser representative. If the fund manager is an individual, then that individual is a registered investment adviser. In either case, the designation implies several steps have been taken.

In order to become a registered investment adviser, an individual must register for and pass the Series 65 Uniform Investment Adviser Law Exam, a three-hour, 130-question computer-based exam administered by the North American Securities Administrators Association. Topics covered include economics and analysis, investment vehicles, investment recommendations and strategies, and ethics and legal guidelines. A passing score is 70 percent or higher.

Once an individual has passed the Series 65, he or she must then apply via Form ADV to become a registered investment adviser. This application is made to either a state authority or to the SEC, depending on the adviser’s assets under management. If assets under management exceed $30 million, then the adviser must register with the SEC.

Form ADV consists of two parts. Part I provides general information to the regulatory authority. Part II is designed to be distributed to potential clients, and includes disclosure of a decent amount of information about the adviser. If the manager is a registered investment adviser, then you should expect to receive as part of the offering documentation either a current copy of Part II of the adviser’s Form ADV or a brochure that contains all the current information in Part II of Form ADV.

In addition to filing Form ADV and paying a small fee, the registered investment adviser becomes subject to extra administrative/regulatory burden as well as capital adequacy requirements that state the Adviser must maintain certain net worth levels.

By and large, because of the extra administrative burden as well as restrictions on certain activities, hedge fund managers attempt to avoid registering as investment advisers. Whether such managers can or cannot avoid such registration is largely dependent upon the state in which the manager operates. In California, for instance, hedge fund managers must register as investment advisers. In New York, such registration is not necessary. Not surprisingly, hedge fund managers located in California are rare, while they are quite plentiful in New York. 

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HEDGE FUND: Wrap Fees?

Posted on April 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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My stock broker is telling me about a “wrap-fee” program involving a hedge fund manager.

QUESTION: What is a Wrap Fee?

A wrap fee program is a service that provides investment advice and portfolio management to clients for one all-inclusive fee. The fee pays for the services provided to the client, including but not limited to securities transactions, portfolio management, research, brokerage, and administrative services. Wrap fee programs also provide an understanding of a client’s financial goals and objectives; research and selection of assets; implementation of investment decisions; account statements, and access to real-time financial data.

The Investment Advisers Act of 1940 regulates investment advisors when they offer these wrap fee programs and requires them to provide comprehensive disclosure documents before investing. This act helps ensure clients have access to all important information that affects their investment decisions.

QUESTION: Why do I need my stock broker? Can I just go directly to the hedge fund manager?

Yes, you can, but you may find a different fee arrangement when you reach the hedge fund manager, and you may be participating in an unethical transaction. When hedge fund managers set up separate accounts for wrap-fee clients, they agree to take a set fee in exchange for managing this money. They also enter into agreements with one or more brokers to help market this aspect of their money management business. A portion of the wrap fee you pay goes to the broker, and a portion goes to the manager. Incentive compensation is not generally used.

When approached directly, hedge fund managers will typically offer only the hedge fund, complete with incentive compensation and pooled investment features. However, if the hedge fund manager is willing to set up a separate account, it is possible that the investor will find the set fee much less than what he or she would have paid in a wrap fee account through a broker.

Finally, the very large caveat to all this is that the ethics of a hedge fund manager who steals clients from brokers with whom he has a marketing relationship ought to be called into question. And when it comes to hedge funds, the ethics of the manager are of paramount importance.

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MONEY SCRIPTS: Fundamental Subconscious Beliefs and Economic Behavioral Patterns Defined

Posted on April 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SALES PSYCHOLOGY FOR INVESTMENT ADVISORS, FINANCIAL ADVISORS, INSURANCE AGENTS, WEALTH MANAGERS AND FINANCIAL PLANNERS

By Dr. David Edward Marcinko; MBA MEd CMP®

http://www.MarcinkoAssociates.com

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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Stocks were decimated yesterday in the first full trading day following President Trump’s tariff announcement. It was the biggest single-day decline since the start of the Covid-19 pandemic in March 2020. Every Magnificent Seven stock was battered—Apple worst of all. And so perhaps it is a good time to discuss the concept of “Money Scripts”.

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Money Scripts are unconscious beliefs about money that are typically only partially true, are developed in childhood, and drive adult financial behaviors. Money scripts may be the result of “financial flashpoints,” which are salient early experiences around money that have a lasting impact in adulthood. Money scripts are often passed down through the generations and social groups often share similar money scripts. And so, we argue that Money scripts are at the root of all illogical, ill-advised, self-destructive, or self-limiting financial behaviors.

In research at Kansas State University [KSU], researchers identified four distinct Money script patterns, which are associated with financial health and predict financial behaviors. These include: (a) money avoidance, (b) money worship, (c) money status, and (d) money vigilance [personal communication Brad Klontz, PsyD, CFP®, Kenneth Shubin-Stein, MD, MPH, MS, CFA and Sonya Britt, PhD, CFP®].

And so, we all like to think our financial decisions are fully rational, but the truth is that our subconscious beliefs have a dramatic impact on our money and financial decisions. These money scripts are important to know and understand. A summary is below:

            Money Avoidance

Money avoidance scripts are illustrated by beliefs such as “Rich people are greedy,” “It is not okay to have more than you need,” and “I do not deserve a lot of money when others have less than me.” Money avoiders believe that money is bad or that they do not deserve money. They believe that wealthy people are corrupt and there is virtue in living with less money. They may sabotage their financial success or give money away even though they cannot afford to do so. Money avoidance scripts may be associated with lower income and lower net worth and predict financial behaviors including ignoring bank statements, overspending, financial dependence on others, financial enabling of others, and having trouble sticking to a budget.

            Money Worship 

Money worship is typified by beliefs such as “More money will make you happier,” “You can never have enough money,” and “Money would solve all my problems.” Money worshipers are convinced that money is the key to happiness. At the same time, they believe that one can never have enough. Money worships have lower income, lower net worth, and higher credit card debt. They are more likely to be hoarders, spend compulsively, and put work ahead of family.

            Money Status

Money status scripts include “I will not buy something unless it is new,” “Your self-worth equals you net worth,” and “If something isn’t considered the ‘best’ it is not worth buying.” Money status seekers see net worth and self-worth as being synonymous. They pretend to have more money than they do and tend to overspend as a result. They often grew up in poorer families and believe that the universe should take care of their financial needs if they live a virtuous life. Money status scripts are associated with compulsive gambling, overspending, being financially dependent on others, and lying to one’s spouse about spending.

            Money Vigilance

Money vigilant beliefs include “It is important to save for a rainy day,” “You should always look for the best deal, even if it takes more time,” and “I would be a nervous wreck if I did not have an emergency fund.” The money vigilants are alert, watchful and concerned about their financial welfare. They are more likely to save and less likely to buy on credit. As a result, they tend to have higher income and higher net worth. They also have a tendency to be anxious about money and are secretive about their financial status outside of their household. While money vigilance is associated with frugality and saving, excessive anxiety can keep someone from enjoying the benefits that money can provide.

Identification

When money scripts are identified, it is helpful to examine where they came from. A simple behavioral finance technique involves reflecting on the following questions:

  • What three lessons did you learn about money from your mother?
  • What three lessons did you learn about money from your father?
  • What is your first memory around money?
  • What is your most painful money memory?
  • What is your most joyful money memory?
  • What money scripts emerged for you from this experience?
  • How have they helped you?
  • How have they hurt you?
  • What money scripts do you need to change?

Conclusion

Ideally, from a balanced middle ground, we can see past the limitations of money scripts, our self and others who are polarized. Those who believe “Money is meant to be spent” or “Money is meant to be saved” have a world view that results in extreme positions. Labeling them as “correct” or “wrong” is not a useful way to try to shift anyone’s polarized money script beliefs.

EDUCATION: Books

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

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MEDICAL OFFICE: Patient Satisfaction Management

Posted on April 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

The “Soft Science” of Patient Relationship Management

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By Dr. David Edward Marcinko; MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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INTRODUCTION

Patient satisfaction occurs when patient perceptions exceed their expectations. They get an intangible “something extra” from their visit, above what they paid for. When patient expectations match their perceptions, mutual obligations are fulfilled, making both practitioner and patient “break-even”.

The clinical result, within a relevant range, is only part of the patient’s perceptions. Numerous sub-conscious impressions comprise the remainder. We’ve all had patients love us despite a less than optimal result. We’ve all had patients angrily leave the practice over some non-clinical matter like a trivial billing dispute. A patient’s perception of any health care service is colored by a vast array of prior experiences that set up current expectations. The patient is pleased to the extent that his current perceptions exceed his/her pre existing expectations. This encompasses far more than the clinical result (within a relevant range), and includes such non-treatment issues as the demeanor of the staff, condition of the physical premises, psychological comfort during the visit, etc.

Remember, all patients talk about you anyway. In the past, a happy patient told four others about what a nice doctor you are. Today, patients post website comments or blogs immediately after their visits. They are more likely to complete treatment and follow instructions, thus obtaining a better medical outcome, and, generating additional fees for the practice. They pay quicker, cause less bad-debt and help create a pleasant environment for us to work in.

An unhappy patient vehemently tells nine others, onground or online, what a nasty greedy rip-off artist you are. Sad, but true! They are not as likely to complete treatment, thus incurring a less than optimal result, and generate fewer fees. They pay slower, if at all, create a stressed environment and detrimentally affect the attitude of other patients in the office.

Try to eliminate problems that might cause negative perceptions (i.e., a filthy restroom) and implement controls that help assure positive perceptions. Patient satisfaction is a soft managerial science. It is a numbers game. Most patients don’t pre-define what would be “acceptable” from this encounter, but have vaguely defined ranges of prior expectations anyway, gleaned from a lifetime of health care related experience. Any variance between these this “acceptable” range of expectations and each trivial encounter invokes some degree positive or negative feeling in the patient.

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The total perception of the office experience is an aggregate of multiple trivial, often subliminal, observations. Patient satisfaction is an intangible and amorphous process complicated by:

Inter patient variables: Significant differences between patients in their “expectations”.
Intra patient variables: A single patient can perceive the same thing or situation differently at different times, depending on uncontrollable variables like mood, or, context of occurrence which may (sometimes and/or partially) be controllable by the practice.
Luck of the draw” in physical variables: Does Sally or Mary escort the patient to the exam room? Was it the blue or green exam room? Did the last patient to use the rest room, five minutes ago, leave a disgusting mess?
Heterogeneous staff variables: Even with appropriate training, people are not machines and have their own quirks.

ASSESSMENT

By proactively anticipating the entire visit, from the patient’s perspective, the practitioner can structure and arrange things such that most patients have, mostly positive perceptions, most of the time. This can be done despite all the potential hetero-genicity of the above factors. Patient satisfaction can be improved in any office, and can be done by anyone.

CONCLUSION

Because patient satisfaction is a multi-faceted amorphous subject, there are multiple correct approaches to the subject and no “cook book” recipe on how to proceed. Try and get the big picture. Identify the worst areas and fix them. Identify the best areas and reinforce them. Proceed slowly. It can be done one facet at a time. Adapt things to your own managerial style and personality. Be completely open to suggestion and change.

Finally, be aware that patient relationship and satisfaction implementation strategies frequently overlap.

EDUCATION: Books

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

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HEDGE FUNDS: In Individual Retirement Accounts?

Posted on April 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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QUESTION: What is a Hedge Fund?

A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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QUESTION: Can I invest my Individual Retirement Account [IRA] in a Hedge Fund?

This is up to the manager, but there is no legal restriction on a hedge fund accepting individual retirement account (IRA) assets. IRA accounts are not well suited for funds that make extensive use of leverage, however. In such cases, the fund is likely to generate significant amounts of unrelated business taxable income (UBTI) – profits of the fund attributable to the use of leverage. The holder of an IRA account must pay taxes on UBTI, even if the UBTI was generated in an IRA account.

But, today’s hedge funds may or may not use leverage. Many hedge funds are not hedged at all, but rather are just specialized versions of regular long stock portfolios. If such funds do not use much leverage, IRA investors will not encounter much difficulty with UBTI and should not hesitate in considering these funds.

In considering whether to accept IRA money, hedge fund managers must consider several factors. If the only type of retirement money accepted by the hedge funds is IRA money, then the manager has no limit on how much retirement money the fund can accept. If, however, there are other types of retirement money invested in the fund, such as pension funds, IRA money will be counted towards a total of 25 percent of fund assets that can be invested in retirement accounts before the fund becomes subject to the Employment Retirement Income Security Act of 1974 (ERISA). Funds subject to ERISA regulations face a heavy administrative burden and more restrictions than most fund managers like.

Finally, IRA distributions from a hedge fund are subject to the standard 20 percent withholding unless the funds are directly rolled over to other qualified plans.

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ACCOUNTABLE CARE ORGANIZATION: A Financially Toxic Contract Example for Physicians

Posted on April 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

By. Dr. David Edward Marcinko; MBA MEd CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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WARNING – DISASTROUS ACO EXAMPLE – WARNING

GIVEN CASH FLOW MODEL

Suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.

Cost of Medical Services Provided (COMSP):

The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract.  Since gross margin is 35% of revenues, the COMSP is 65% or $65,000.  Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.

Assumptions

Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:

  • All income tax, salaries and Accounts Payable (AP) are paid at once.
  • Durable medical equipment inventory and pre-paid advertising remain constant.
  • Gains/losses on sale of equipment and depreciation expenses remain stable.
  • Gross margins remain constant.
  • The office is efficient so major new marginal costs will not be incurred.

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Physician Reactions:

Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era.  Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:

1. Extend Account’s Payable

Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business

2. Reduce Accounts Receivable

According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.

The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.

3. Borrow with Short-Term Bridge Loans

Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.

4. Cut Expenses

While this is often possible, it has to be done without demoralizing the practice’s staff.

5.  Reduce Supply Inventories

If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.

6. Taxes

Do not stop paying withholding taxes in favor of cash flow because it is illegal.

Hyper-Growth Model:

Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses. 

Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows!  Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.

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EDUCATION: Books

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

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