BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Trade: President Trump signed an executive order late yesterday unleashing a wave of new tariffs on 69 US trading partners that will go into effect on August 7th. Here’s a handy list of tariffs and their economic effects for anyone else having trouble keeping track of all these new numbers.
Markets: Stocks opened lower and kept falling thanks to a double whammy of new tariff rates and a shocking slowdown in the labor market, while bond yields tumbled.
Commodities: Goldjumped as the likelihood of a rate cut rose due to the latest jobs report, while oil sank on reports that OPEC+ may announce a crude production boost as soon as this weekend.
Posted on July 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2026.
In addition to the agency’s suggested increase to physician payments, the proposed rule also announces a new payment model and more tele-health flexibilities.
According to CMS, the “proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better quality, efficiency, empowerment, and innovation for all Medicare beneficiaries.” (Read more…)
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
Classic Definition: Research from Ernst-Young [Nikhil Lele and Yang Shim] uncovered a chasm between how consumer patients think they’re doing financially, and the actual state of their finances. Even more striking, their study suggested that improving consumers’ financial health will become one of the top imperatives in reframing consumer financial services.
Modern Circumstance: For example, the study asked consumers to rate their own financial health, and 83 percent rated themselves “good,” “very good” or “excellent.” Now, contrast this figure with what is known about their actual situation:
60 percent of Americans say they are financially stressed.
56 percent of Americans have less than $10,000 saved for retirement.
40 million American families have no retirement savings at all.
40 percent of Americans are not prepared to meet a $400 short-term emergency.
Paradox Example: Fortunately, even though the vast majority of consumers rate themselves as financially healthy, the study found that most still want to improve. Importantly for health economists, the attractive 25-34 and 35-49 year-old age groups were most likely to be extremely or very interested in improving their financial and economic health.
Paradox Example: Massively affluent consumer patients are even more interested in improving this paradox than their mass market counterparts.
Posted on July 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2026.
Among other items, the agency proposes increasing payments to all outpatient providers, eliminating the Inpatient Only (IPO) List, and changing quality reporting programs.
This Health Capital Topics article reviews the proposed updates and changes to outpatient reimbursement. (Read more…)
Posted on July 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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Stocks: President Trump said there’s a “50/50 chance” of a deal with the EU ahead of next week’s deadline. Investors decided they like those odds, and pushed the NASDAQ and S&P 500 to yet another new closing record high—in fact, the S&P 500 set a new record every day this week. Meanwhile, trade deal talks with Brazil have reportedly stalled.
Commodities: Oil fell to a three-week low today as Iran signaled a willingness to come to the negotiating table with European powers for nuclear talks.
Hopes of trade deals and less need for a safe haven investment pushed gold prices lower.
Posted on July 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Rick Kahler MSFP CFP™
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When Maria needed $400,000 for a down payment on a new home, her broker at a large Wall Street firm offered a solution: “Don’t sell investments and trigger capital gains. Just take out a margin loan.”
A margin loan is a line of credit from a brokerage firm, secured by the client’s investment portfolio. It offers quick access to cash with no immediate tax consequences and minimal paperwork. But the convenience comes at a cost. As of mid-2025, margin loan interest rates range from 6.25% to over 11%.
Margin loan recommendations are often presented by brokers as tax-savvy strategies that allow clients to access “tax-free” cash while keeping their portfolios intact. In many cases, however, the math benefits the advisor more than the investor. The cost of borrowing often exceeds what an investor is likely to earn by holding on.
For example, let’s assume an interest rate of 7.5% on Maria’s $400,000 margin loan. While borrowing delayed the payment of $20,000 in capital gains tax, she will eventually have to pay that tax anyway unless she holds the investments until her death. Two years later, with portfolio returns of 4% annually, she had earned around $32,000 from the $400,000 in investments she might have sold. Meanwhile, she had paid $60,000 in interest—leaving her some $28,000 worse off. That’s without factoring in ongoing interest payments, or the risks of a margin call if the investments securing the loan drop in value.
Why do advisors keep recommending margin loans? Because selling investments reduces the portfolio size and the advisor’s fee. Borrowing keeps the portfolio intact and the compensation unchanged—while the firm receives additional income from interest on the loan. In some cases, advisors suggest using margin loans to buy more investments, increasing both the portfolio and the fee they collect.
None of this is illegal. But when the borrowing cost is higher than expected returns and the advisor benefits financially, the ethics are questionable. The client takes the risk, while the advisor keeps the revenue.
This kind of conflict appears more often in portfolios where compensation is tied to asset volume and the company’s primary culture rewards gathering assets over delivering unbiased advice. By contrast, fee-only financial planning and investment advisors typically operate on simpler hourly, flat, or tiered fee structures. Their compensation doesn’t depend on whether a client borrows, sells, or holds. The culture of the firm focuses on conflict-free advice aligned with the client’s best interest.
Wall Street brokers are often held to a fiduciary standard, but structure still matters. In 2024 the SEC reported their examinations of brokers would continue to focus on advisor recommendations unduly influenced by the company’s compensation and incentives.
There are rare situations where a margin loan may be appropriate. A client with large unrealized gains might use a short-term margin loan to minimize taxes. An elderly investor might borrow tax-free rather than sell assets that will receive a step-up in basis at their death. Even in those cases, the math must be exact and the client must clearly understand the risks, including the possibility of a margin call.
If your advisor recommends a margin loan, especially to buy more investments, ask strong questions. What’s the interest rate? What return is realistic? What are the tax consequences of selling? How does this affect the advisor’s income?
In a high-rate, low-return environment, margin loans rarely favor the client. The exceptions are narrow. The risks are significant. And the conflict of interest is measurable.
Sometimes the smartest move is the simplest: sell what you need, pay the tax, and leave leverage out of your plan.
Posted on July 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Lucid exploded 36.24% higher on the news that the EV maker is partnering with Uber to roll out the ridesharing company’s new robotaxis.
PepsiCo popped 7.45% thanks to a strong quarter for the snack and soda giant, while shareholders cheered the details of its turnaround plan.
UnitedAirlines may have missed Wall Street’s revenue forecast, but its profits were enough to impress investors. Shares rose 3.11%.
Reports that Union Pacific is thinking about acquiring a rival sent shares of fellow train operators CSX and NorfolkSouthern up 3.73% and 3.65%, respectively.
Sarepta Therapeutics soared 19.53% after the biotech announced it will lay off 500 employees and restructure its entire business.
Quantumscape continued its hot streak, rising yet another 19.82% thanks to its recent battery breakthrough.
Speaking of hot streaks, OpenDoorTechnologies rose another 10.74% as retail traders pour into what is quickly becoming the next big meme stock.
Stocks down
GE Aerospace crushed earnings expectations and raised its fiscal guidance, but it still wasn’t enough to impress investors, who pushed shares of the engine maker down 2.10%.
USBancorp sank 1.03% after revenue and net interest income missed forecasts last quarter.
AbbottLaboratories beat on both top and bottom line guidance, but still fell 8.53% after the pharma company narrowed its fiscal forecasts.
President Trump is expected to sign an executive order in the coming days designed to help make private-market investments more available to U.S. retirement plans, according to people familiar with the matter. The order would instruct the Labor Department and the Securities and Exchange Commission to provide guidance to employers and plan administrators on including investments like private assets in 401(k) plans.
The Fed Drama: A White House official said President Trump will likely fire Jerome Powell soon. Stockssank at the thought of the Fed head being shown the door, offsetting the pleasant surprise of a flat wholesale inflation reading.
Markets: Stocks managed to recoup their losses after Trump said it’s “highly unlikely” that he will fire Powell, but bonds remained shaken.
Crypto: Bitcoin bounced higher after the crypto bills currently under consideration in the House of Representatives cleared a key hurdle.
Overconfident Investing Bias happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. This causes the results of a study to be unreliable and hard to reproduce in other research settings.
Example: Data convincingly shows that people and financial planners/advisors and wealth managers who trade most often under-perform the market by a significant margin over time. Active traders lose money.
Example: Overconfidence Investing Bias moreover leads to: (1) excessive trading (which in turn results in lower returns due to costs incurred), (2) underestimation of risk (portfolios of decreasing risk were found for single men, married men, married women, and single women), (3) illusion of knowledge (you can get a lot more data nowadays on the internet) and (4) illusion of control (on-line trading).
Posted on July 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Power station: Crude oil prices reversed as tensions in the Middle East cooled, but AI likely raises electricity demand over the longer term, creating investment opportunities and risks.
Oil supplies now exceed demand, noted Michelle Gibley, director of international research at the Schwab Center for Financial Research, in her latest analysis, though “AI is transforming the energy sector,” raising power shortage concerns.
Solar stocks got a reprieve today after the Senate dropped the excise tax on clean energy projects. Sunrun soared 10.51%, EnphaseEnergy rose 3.18%, SolarEdgeTechnologies popped 7.16%, and ArrayTechnologies climbed 12.54%.
Apple tumbled this summer after investors were disappointed by its AI rollout, but rose 1.29% on the news that the company may pivot to using Anthropic or OpenAI in iPhones instead of building something in-house.
Wolfspeed, the best name for a company that makes computer chips, exploded 98.09% after the company officially filed for Chapter 11 bankruptcy.
Hasbro got a nice 4.29% bump thanks to Goldman Sachs analysts, who are big old nerds who think Magic: The Gathering will boost the toymaker’s sales.
Ford popped 4.61% after the automaker reported an impressive 14% increase in sales last quarter.
Casino stocks soared on the news that gaming revenue in Macau rose 19% in June. WynnResorts climbed 8.85%, Las Vegas Sands added 8.95%, and MGMResorts gained 7.24%.
What’s down
AMC Entertainment tumbled 9.03% after the one-time meme stock announced its new debt restructuring plan.
ProgressSoftware sank 13.03% after the business application software company reported mixed results last quarter, beating on profit but missing on revenue.
JobyAviation fell 7.01% after traders took profits following the air taxi company’s big pop yesterday.
AeroVironment dropped 11.42% after defense contractor announced it’s offering $750 million in common stock and $600 million in convertible senior notes to pay off its debt.
Diabetes device makers tumbled on the news that the government may change the reimbursement rate for glucose monitors and insulin pumps. Insulet lost 4.52%, Dexcom fell 4.25%, and BetaBionics sank 4.26%.
Posted on June 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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Markets: That feeling when you have a $10 trillion rally. To wit:
The S&P 500 closed at a record high this week despite a brief dip as trade tensions with Canada ratcheted up. That puts the index about 20% up from its April low, when the broad tariff announcement sent it spiraling, and up ~5% for the year.
NVIDIA also hit an all-time high, and it keeps edging closer to becoming the first company to hit a $4 trillion valuation.
Posted on June 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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Markets: Stocks climbed yesterday as oil prices fell, with investors reacting positively to what appeared to be limited retaliation from Iran in response to the US bombing its nuclear facilities over the weekend.
Meanwhile, Tesla had its biggest jump in two months following the successful, albeit limited, rollout of its robotaxi service in Austin.
Posted on June 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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As economist Jason Furman pointed out, 250 years ago the Continental Congress created a brand-new currency and authorized the printing of $2 million worth to help George Washington pay his soldiers and procure weapons and supplies for the war effort.
Markets: Until now, Wall Street has mostly shrugged off the Israel–Iran conflict in the Middle East, with the S&P 500 and NASDAQ closing just a hair lower for the week on Friday. But, investors’ thinking might—or might not—change this coming week, after the US entered the war on Saturday with strikes on key Iranian nuclear infrastructure.
And, eyes are on oil prices, which, due to the war, are having their most volatile stretch since Russia invaded Ukraine in 2022.
A psychological paradox is a figure of speech that can seem silly or contradictory in form, yet it can still be true, or at least make sense in the context given.
This is sometimes used to illustrate thoughts or statements that differ from traditional ideas. So, instead of taking a given statement literally, an individual must comprehend it from a different perspective. Using paradoxes in speeches and writings can also add wit and humor to one’s work, which serves as the perfect device to grab a reader or a listener’s attention and/or persuade them to action, sales and closing statements. But paradoxes for the financial sector can be quite difficult to explain by definition alone, which is why it is best to refer to a few examples to further your understanding.
One good psychological paradox example is The Paradox of Thrift which suggests that while saving money is generally considered a prudent financial behavior, excessive saving during times of economic downturn can actually hinder economic recovery. When consumers collectively reduce their spending and increase their savings, it creates a decrease in aggregate demand. This reduction in demand can lead to lower production levels, job losses, and ultimately a decline in economic output. In other words, what may be individually rational behavior (financial saving) can have negative consequences for the overall economy.
The following paradoxical contradictions will help financial advisors guide clients to close more sales to the benefit of both.
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In the intricate world of finance sales, advisors are often at the crossroads of various paradoxes that challenge client decision-making. While the journey towards financial security involves calculated strategies, it’s the nuanced understanding of paradoxes that can help the advisor close more sales.
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But, what seems trueabout money often turns out to be false, according to colleague Finance Professor John Goodell, PhD from the University Akron:
The more we try to trade our way to profits, the less likely we are to profit.
The more boring an investment—think index funds—the more exciting the long-run performance will probably be.
The more exciting an investment—name your latest Wall Street concoction, Special Purpose Acquisition Company [SPAC] or anything crypto—the less exciting the long-term results typically are.
The only certainty is uncertainty and the only constant is change. Today’s market decline will eventually become a bull market, and today’s market leaders will eventually yield to other stocks.
Big market trends play a huge role in investment results, and yet trying to time macroeconomic cycles or guess which market sectors will outperform is a fool’s errand. Many big market rotations are set in motion by something wholly unanticipated, like a virus pandemic or a war.
To be happy when wealthy, we also need to be happy with far less money. The fact is, above a relatively modest income level, no amount of extra money will change our level of happiness. More money might even make us miserable, as many lottery winners have discovered.
The more we hate an investing trait—or any trait for that matter—the more likely it is that we’re resisting seeing that trait in ourselves. It’s what Carl Jung MD called the Shadowof Undesirable Personality Aspects that we hide from ourselves. Do prospects get irritated listening to your unsolicited financial advice? There’s a good chance that you often give unsolicited financial advice but don’t like to admit it.
The more we learn about investing, the more we realize we don’t know anything. We should just buy index funds and instead spend our time worrying about stuff we can actually control.
The more an investor is convinced he’s right, the more likely he is to be wrong. Short sellers, in particular, are likely to succumb to this paradoxical trap.
The more options we have, the less satisfied we’ll be with each one. This is the Paradox of Choice; revised. Anyone who has spent hours “optimizing” his or her portfolio knows this all too well. Its close cousin is information overload, another frustration paradox when investing.
The more afraid we are of losing money, the more likely we are to take unwitting risks that lose us money. Sitting in cash seems wise during market selloffs. But the truth is, none of us can reliably time the market. Pull up any chart of the stock market over any period longer than a decade and you’ll see that the riskiest decision is sitting in cash, which gets destroyed by inflation.
The more we think about our investments and look at our financial accounts, the more likely we are to damage our results by buying high because of greed and selling low because of fear. It can pay to look away.
ASSESSMENT
How should you respond to these financial paradoxes? As you plan for your own financial future, as well as your own client prospecting endeavors, embrace the concept of “loosely held views.”
In other words, make financial and client acquisitions plans, but continuously update your views, question your assumptions and paradoxes and rethink your priorities. Years of experience with clients certainly support the futility of trying to help them change their financial behavior by telling them what they “should” know or do.
CONCLUSION
Remember, it is far more useful to listen to client beliefs, fears and goals, and to suggest options and offer encouragement to help them discover their own path toward financial well-being. Then, incentivize them with knowledge of the above psychological paradoxes to your mutual success!
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
Marcinko, DE and Hetico, HR: Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™]. CRC Productivity Press, New York, 2016.
Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, New York. 2006
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™]. CRC Productivity Press, New York, 2015.
Posted on June 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By AI
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Stocks: Investors looked past the escalating conflict between Iran and Israel, even as President Trump mulled his options for a US intervention, and stocks rose ahead of today’s Federal Reserve meeting.
Economy: Trump called Jerome Powell “a stupid person” hours before the Fed Chair decided to keep interest rates where they were Stocks fell thanks to the Fed’s prediction that inflation will rise to 3.1% by the end of the year, above previous forecasts of 2.8%.
Commodities: Gold fell just a hair as analysts called the commodity’s top, while platinum climbed to a four-year high.
The average directional movement index (ADX) was developed in 1978 by J. Welles Wilder as a technical indicator of trend strength in a series of prices of a financial instrument. ADX has become a widely used indicator for technical analysts, and is provided as a standard in collections of indicators offered by various trading platforms.
The ADX is a combination of two other indicators developed by Wilder, the positive directional indicator (abbreviated +DI) and negative directional indicator (-DI). The ADX combines them and smooths the result with a smoothed moving average.
The average directional index (ADX) is a technical indicator used by traders to determine the strength of a financial security’s price trend. It helps them reduce risk and increase profit potential by trading in the direction of a strong trend. Many traders consider the ADX to be the ultimate trend gauge because it is so reliable.
ADX quantifies trend strength by measuring the degree of directional movement in price. ADX calculations are based on a moving average of price range expansion or contraction over a given period. The default setting is 14 periods, although other settings can be used.
ADX can be used with any financial security, including stocks, exchange-traded funds, and futures.
Posted on June 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By AI
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Wall Street is stable right now as the technology trade has come roaring back.
The S&P 500 climbed above 6,000 points for the first time since February, while all three indexes posted their fifth winning week in the last seven. The S&P is now just over 2% from its all-time high.
Meanwhile, recent IPOs are party rocking, especially the stablecoin issuer Circle that went public last Thursday.
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.
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.