If the Government Can Take A 15% Cut From Nvidia, Who Is Next?

By Rick Kahler; MSFP CFP

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This month, the U.S. government demanded a direct cut of a company’s foreign sales as the price for letting those sales happen.

Tech companies Nvidia and AMD had been stuck in regulatory limbo over selling their newest AI chips to China. According to an August 12, 2025, Reuters article by Karen Freifeld, Nvidia CEO Jensen Huang had even received a public “green light” for the company’s H20 chip, but the Commerce Department would not issue the export licenses.

The stalemate ended only after Huang met with President Trump and agreed to a deal: the licenses would be granted, but the U.S. Treasury would get 15% of all H20 revenue from China. AMD agreed to identical terms for its MI308 chip. Two days later, both companies had their licenses.

The numbers are staggering. Bernstein Research estimates Nvidia could sell $15 billion worth of H20 chips in China this year, and AMD about $800 million of MI308s. That is more than $2 billion flowing straight to Washington, not as taxes but as a contractual price for market access. The legality of this arrangement is questionable, and the deal also raises security concerns.

It is worth noting the administration first asked for 20% before “settling” on 15%. This was not a polite request but a “take it or leave it” demand. From a behavioral economics standpoint, the decision was predictable. The pain of losing an entire market is far greater than the pain of losing a fraction of it.

How is this any different from a tariff? A tariff is a standardized, legally defined tax that applies broadly to certain goods and is collected under public trade policy. This 15% cut is a one-off, privately negotiated condition aimed at just two companies, tied to export license approval. It is taken from gross revenue, not profit, meaning the government gets paid on every dollar of sales before the companies cover a single expense.

“Tax farmming” is an old practice where the state sold the right to collect taxes for a fixed sum, allowing the collectors to keep the rest. Its use in France made some people enormously rich, made everyone else furious, and eventually helped spark the French Revolution. Similar systems appeared in Ottoman Egypt, Qing China, and the early Dutch Republic until abuses finally brought them down.

The Nvidia/AMD deal is not exactly tax farming, but it is a similar dynamic. The government’s role is no longer just regulating. It is stepping in as a business partner, taking a direct share of private sales. Supporters might call it a smart use of national leverage. Critics will see a step away from free-market capitalism toward something more political and transactional.

Nor is this deal a one-off. In June, the administration approved foreign investment in U.S. Steel only after securing a “golden share” that gives it veto power over strategic corporate decisions. History teaches us that once a government finds a way to take a cut, it rarely stops with one sector. Today it is steel and AI chips to China. Tomorrow it could be pharmaceuticals, energy, or consumer goods.

What is the likely impact for average Americans? Money flowing to the U.S. Treasury from a source other than taxpayers may seem like a benefit. Yet any company required to give away 15% of its gross revenue, which could equal its entire profit, has to compensate in some way. The most likely result is higher prices. Hiking prices on computer chips sold to China may not seem to be a big deal—until you consider that many of the products that use those chips are sold to U.S. consumers.

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PHYSICIAN BURNOUT: Causes and Conclusions

By Dr. David Edward Marcinko; MBA MEd

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Healthcare comes with its share of mental challenges, especially considering that clinicians often care for patients when they’re in difficult and sometimes tragic situations. New research shows that even the path to getting into the workforce can be a challenge, with some physicians burning out before they make it to graduation.

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American medicine is undergoing vast changes, placing the status of physicians in the medical industrial complex at great risk. Most physicians feel overwhelmed by increasing bureaucratic mandates from insurers, hospitals, and government. At the same time, physicians are the front line employees of healthcare and assume the majority of the risk for patient care. This has left many in the profession with increasing disillusionment. 

Samantha Meltzer-Brody a psychiatrist and director of, Taking Care of Our Own, University of North Carolina, Chapel Hill, NC states it best:

“Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.”

What causes physician burnout?

The “Big 4” factors known to contribute to stress and burnout include:

  1. Time pressure, especially in patient visits or documentation
  2. Lack of control over work environment
  3. Chaotic, fast-paced workplaces
  4. Culture of the organization, specifically a culture that does not emphasize communication, cohesion, trust, and alignment of values between clinicians and their leaders

In addition to burnout rates, these factors can be assessed to help direct interventions toward those drivers that are most likely to be contributing to burnout at your organization.

OK BURNOUT: https://medicalexecutivepost.com/2022/08/30/u-s-hospitals-feeling-the-pain-of-physician-burnout/

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The burned-out physician is exhausted — mentally and physically — and often no longer able to find empathy or connection with patients. The question of how to escape from what has become a highly unpleasant situation becomes a frequent one. Given the high demands of the profession and serious consequences of mistakes, the burned-out doctor is a potentially impaired one. And the impaired physician is not able to maintain the unflappable, perpetually cool under fire, always objective, professional and yet compassionate demeanor that is expected by society. Worst of all, the impaired physician is at great risk for developing depression, suicidal ideation, or a serious addiction.

The doctors who contact me report feeling beaten down by an increasingly hostile work environment. They say that they don’t have time to take care of patients the way they envisioned when they decided to apply to medical school. Many describe feeling betrayed by a system that they say seems focused on achieving the bottom line with little regard for the impact on both doctors and patients.

Most of these doctors report spending a significant amount of their time dealing with the electronic medical record and documentation. The ratio of time spent on doctor-patient

interactions compared to physician-computer ones appears so horribly skewed that it has reached the point of complete dysmorphia. These good physicians call me when they feel like they can’t continue any longer in the profession. They want to quit medicine. They report a loss of joy and meaning in their work. They describe the toll that the profession has had on their mental health, physical health, and personal lives. And most wrenchingly, they don’t see an end.

What can we do? There are no easy answers to the complex issues that threaten our profession.  “The Taking Care of Our Own Program…has had an over 200% rate of growth in the first year, reflecting the enormous need…”  

PHYSICIAN COACHING: https://medicalexecutivepost.com/coach/

Assessment

Burned out physicians will eventually be labeled as disruptive, impaired, an outlier or arrogant.  There’s a reason it’s difficult and extremely expensive for physicians to find disability insurance; psychiatric claims.  Burnout leads to depression, anxiety, PTSD, suicide, divorce, drug abuse, surly behaviors and interactions, etc.  It’s nothing new; it’s been occurring for a long time.  Go without routine sleep, eat erratically, work long hours, operate under constantly stressful situations and have no time for your family or self and most individuals will de-compensate physically and psychologically within weeks. 

Conclusion

Physicians operate within these parameters year after year. 

How are they to remain healthy, functional humans? They can’t.  Even a superhero couldn’t, yet physicians are expected to endure and thrive under such conditions. 

If a physician makes a single mistake, or snaps just one day, their entire career is on the line.

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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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PHYSICIANS: Why Salary is Down?

MEDICAL PROVIDER PAYMENTS LOWERED

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Statistic: $2.8+ billion dollars

That’s how much Blue Cross and Blue Shield plans agreed to pay to settle litigation over claims they conspired to lower payments to providers. (Healthcare Dive)

COMMENTS APPRECIATED

EDUCATION: Books

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

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PARADOX OF EDUCATION: Cumulative Advantage and Disadvantage

By Dr. David Edward Marcinko MBA MEd

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A paradox is a self-contradictory statement. And, the ancient Greeks were well aware that a paradox can take us outside our usual way of thinking. They combined the prefix para – (“beyond” or “outside of”) with the verb dokein (“to think”), forming paradoxos, an adjective meaning “contrary to expectation.” Latin speakers used that word as the basis for a noun paradoxum, which English speakers borrowed during the 1500s to create paradox.

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Paradox of Education: Cumulative Advantage and Disadvantage

Classic Definition: Social status snowballs in either direction because people like associating with successful people, so doors are opened for them. And, folks avoid associating with unsuccessful people, for whom doors are closed.

SALARY PARADOX: https://medicalexecutivepost.com/2025/08/20/paradox-physician-compensation-v-medical-practice-value/

Modern Circumstance: Education’s positive effect on health gets larger as people age. The large socioeconomic differences in health among older Americans mostly accrue earlier in adulthood on gradients set by educational attainment. Education develops abilities that help individuals gain control of their own lives, encouraging and enabling a healthy life.

Paradox Example: The health-related consequences of education cumulate on many levels, from the socioeconomic (including work and income) and behavioral (including health behaviors like exercising) to the physiological and intra-cellular. Some accumulations even influence each other.

FINANCIAL PARADOX: https://medicalexecutivepost.com/2025/05/26/financial-paradox-compounding-interest-and-time/

In particular, a low sense of control over one’s own life accelerates physical impairment, which in turn decreases the sense of control. That feedback progressively concentrates good physical functioning and a firm sense of personal control together in the better educated while concentrating physical impairment and a sense of powerlessness together in the less well educated, creating large differences in health in old age.

SOCIAL MEDIA PARADOX: https://medicalexecutivepost.com/2025/06/29/paradox-social-media/

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

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SPECIAL PURPOSE VEHICLE: What it Is – When is It Needed?

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A SPECIAL MEDICAL-EXECUTIVE-POST GUEST PRESENTATION

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What Is a Special Purpose Vehicle (SPV)?

A special purpose vehicle is a subsidiary created by a parent company to isolate financial risk. It’s also called a special purpose entity (SPE). Its legal status as a separate company makes its obligations secure even if the parent company goes bankrupt. A special purpose vehicle is sometimes referred to as a bankruptcy-remote entity for this reason.

These vehicles can become a financially devastating way to hide company debt if accounting loopholes are exploited, as seen in the 2001 Enron scandal.

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WHY? Agents and Consultants Can’t Help With Startup Fundraising

ENTREPRENEURSHIP

SPECIAL REPRINT FOR THE MEDICAL EXECUTIVE-POST

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PHYSICIANS: Beware “Zombie” Debt and “Phantom” Debt Collectors

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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According to Wikipedia, Phantom debt or zombie debt is a debt that is old, defaulted, or not owed and is somehow still being pursued for collection to be paid by the presumed debtor. It generally refers to debt that is more than 3 years old, is long forgotten about or belonged to someone else – like someone with the same name or a deceased parent. The amount owed can grow to hundreds or thousands of dollars more than what was originally owed.

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

An example of this is from George Miller. George missed an 11 cent Verizon bill and seven years later it had grown to $4,000.00.

Sometimes it was never owed, was owed by a deceased parent, or that was previously owed by the presumed debtor, but was previously paid in full, settled, discharged via bankruptcy or a dismissed court case, is beyond the statute of limitations, or is otherwise not legally collectible, but that a collection agency or other similar service is aggressively attempting to collect, often fraudulently.

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While the concept of phantom debt is quite old, it has gotten a lot of attention since the 1990s.

Very often, collectors of phantom debt use intimidating, abusive, or otherwise illegal tactics in an attempt to collect phantom debt that include frequent phone calls, calls to the victim’s place of employment, or threats of scary consequences against the victim that sometimes include arrest and/or criminal prosecution. In the USA, such tactics violate the Fair Debt Collection Practices Act [FDCPA]

The source of phantom debt may be from collectors who buy the debt from other collectors for pennies on the dollar, some of which take action that is not legal in order to collect that debt. Unlawful techniques used include suing or threatening to sue, re-aging the debt on the victim’s credit report to circumvent limits on reporting, or falsely promising to remove a negative credit report entry in exchange for a partial payment.

PSYCHOLOGY MONEY: https://medicalexecutivepost.com/2025/04/08/psychology-a-money-relationship-questionnaire-for-doctors/

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

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DOJ-HHS FCA Working Group Revived

By Health Capital Consultants, LLC

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On July 2, 2025, the Department of Justice (DOJ) and Department of Health & Human Services (HHS) announced during the American Health Law Association (AHLA) Annual Meeting that the agencies have reestablished a Working Group to “strengthen” their ongoing collaboration, specifically as relates to the False Claims Act (FCA).

This Health Capital Topics article discusses the Working Group’s priorities and the implications for providers. (Read more…)

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ALTERNATE INVESTMENTS: 401[k] Accounts

By A.I. and Staff Reporters

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President Trump is set to sign an executive order allowing alternative assets such as cryptocurrency, private equity investments, and real estate in 401(k) accounts. Those accounts are a veritable gold mine—Americans have stashed approximately $12.5 trillion away for retirement, and alternative asset managers have been chomping at the bit to get a piece of that pie.

WIND ENERGY: https://medicalexecutivepost.com/2012/08/20/wind-energy-alternate-investments/

According to Brew Markets, the changes have been a long time coming. All the way back in his first term, Trump ordered the Labor Department to review how to incorporate private equity investments into retirement accounts, an effort that was later reversed under President Biden. This latest move expands beyond private equity, coinciding with Trump’s push to bring crypto mainstream.

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

Proponents argue that alternative assets in 401(k) accounts will enhance investment diversification and could provide retirees with greater profits. Detractors note that these assets are less liquid, less transparent, and generally more risky than investing retirement funds into publicly traded stocks and bonds.

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

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PROSPECT THEORY: In Client Empowerment and Financial Decision Making

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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PROSPECT THEORY

In the early 1980s, Daniel Kahneman and Amos Tverskey proved in numerous experiments that the reality of decision making differed greatly from the assumptions held by economists. They published their findings in Prospect Theory: An analysis of decision making under risk, which quickly became one of the most cited papers in all of economics.

KAHNEMAN: https://medicalexecutivepost.com/2024/03/28/rip-daniel-kahneman-phd/

To understand the importance of their breakthrough, we first need to take a step back and explain a few things. Up until that point, economists were working under a normative model of decision making. A normative model is a prescriptive approach that concerns itself with how people should make optimal decisions. Basically, if everyone was rational, this is how they should act.

INVESTING PSYCHOLOGY: https://medicalexecutivepost.com/2025/02/21/investing-psychology/

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REAL-LIFE EXAMPLE

Amanda, an RN client, was just informed by her financial advisor that she needed to re-launch her 403-b retirement plan. Since she was leery about investing, she quietly wondered why she couldn’t DIY. Little does her Financial Advisor know that she doesn’t intend to follow his advice, anyway! So, what went wrong?

The answer may be that her advisor didn’t deploy a behavioral economics framework to support her decision-making. One such framework is the “prospect theory” model that boils client decision-making into a “three step heuristic.”
 
According to colleague Eugene Schmuckler PhD MBA MEd CTS, Prospect theory makes the unspoken biases that we all have more explicit. By identifying all the background assumptions and preferences that clients [patients] bring to the office, decision-making can be crafted so that everyone [family, doctor and patient] or [FA, client and spouse] is on the same page.

INVESTING MIND TRAPS: https://medicalexecutivepost.com/2025/06/12/psychology-common-finance-and-investing-mind-traps/

Briefly, the three steps are:

1. Simplify choices by focusing on the key differences between investment [treatment] options such as stock, bonds, cash, and index funds. 

2. Understanding that clients [patients] prefer greater certainty when it comes to pursuing financial [health] gains and are willing to accept uncertainty when trying to avoid a loss [illness].

3. Cognitive processes lead clients and patients to overestimate the value of their choices thanks to survivor bias, cognitive dissonance, appeals to authority and hindsight biases.

 CITE: Jaan E. Sidorov MD [Harrisburg, PA] 

Assessment

Much like in healthcare today, the current mass-customized approaches to the financial services industry fall short of recognizing more personalized advisory approaches like prospect theory and assisted client-centered investment decision-making.  

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

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MONEY ADDICTED PHYSICIANS: The Investing and Stock Trading Personality of Doctors

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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THE ADDICTIVE INVESTING / TRADING PERSONALITY OF DOCTORS

Dr. Donald J. Mandell, a pediatrician, always needs to leave the office fifteen minutes ahead of schedule. The reason is because it takes that long to make the necessary number of trips to ensure the front door is truly locked.

Dr. Kamela A. Shaw, a general surgeon, is constantly rushing to the bath room so that she can wash her hands. As far as she is concerned, it is not possible to get one’s hands clean enough considering the COVID pandemic or recent influenza outbreak.

Although the behaviors displayed by these two doctors are different, they are consistent in that each, to some degree, display behavior that might be called an obsessive-compulsive disorder [OCD].

COGNITIVE BIAS: https://medicalexecutivepost.com/2025/06/22/investing-cognitive-biases-for-financial-advisors-to-know-and-understand/

[A] When Investing or Trading In No Longer Fun

An obsession is a persistent, recurring preoccupation with an idea or thought. A compulsion is an impulse that is experienced as irresistible.

Obsessive-compulsive individuals feel compelled to think thoughts that they say they do not want to think or to carry out actions that they say are against their will. These individuals usually realize that their behavior is irrational, but it is beyond their control. In general, these individuals are preoccupied with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. Specifically, behaviors such as the following may be seen:

  • Preoccupation with details.
  • Perfectionism that interferes with task completion.
  • Excessive devotion to work and office productivity.
  • Scrupulous and inflexible about morality (not accounted for by cultural or religious identification);
  • Inability to discard worn-out or worthless objects without sentimental value;
  • Reluctance to delegate tasks or to work with others.
  • Adopts a miserly spending style toward both self and others.
  • Demonstrates a rigid, inflexible and stubborn nature.

Most people resort to some minor obsessive-compulsive patterns under severe pressure or when trying to achieve goals that they consider critically important. In fact, many individuals refer to this as superstitious behavior. The study habits required for medical students entail a good deal of compulsive behavior.

As the above examples suggest, there are a variety of addictions possible. Recent news accounts have pointed out that even high-level governmental officials can experience sex addiction. The advent of social-media has led to what is referred to as Internet addiction where an individual is transfixed to a computer, tablet PC or smart-phone, “working” for hours on end without a specific project in mind. The simple act of “surfing”, “tweeting-X”, “texting” or merely posting opinions offers the person afflicted with the addiction some degree of satisfaction.

Still another form of addictive behavior is that of the individual with gambling disorder (GD).

GD is recognized as a mental disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders-V. This is the behavior of an individual who is unable to resist the impulse to gamble. Many reasons have been posited for this type of behavior including the death instinct; a need to lose; a history of trauma; a wish to repeat a big win; identification with adults the “gambler” knew as an adolescent; and a desire for action and excitement. There are other explanations offered for this form of compulsive behavior. The act of betting allows the individual to express an immature bravery, courage, manliness, and persistence against unfavorable odds. By actually using money and challenging reality, he puts himself into “action” and intense emotion. By means of gambling, the addicted individual is able to pretend that he is favored by “lady luck,” specially chosen, successful, able to beat the system and escape from feelings of discontent.

Greed can also have addictive qualities. In fact, a poll conducted by the Chicago Tribune revealed that folks who earned less than $30,000 a year, said that $50,000 would fulfill their dreams, whereas those with yearly incomes of over $100,000 said they would need $250,000 to be satisfied. More recent studies confirm that goals keep getting pushed upward as soon as a lower level is reached.

PHYSICIAN IPS: https://medicalexecutivepost.com/2025/07/30/investment-policy-statement-construction-for-physicians-and-medical-professionals/

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Question: So how much money is enough?

Answer: Just a little bit more.

Edward Looney, executive director of the Trenton, New Jersey based Council on Compulsive Gambling (CCG) reports that the number of individuals calling with trading-associated problems is doubling annually. In the mid 1980s, when the council was formed, the number of people calling the council’s hotline (1 – 800 Gambler) with stock-market gambling problems was approximately 1.5 percent of all calls received. In 1998 that number grew to 3 percent, and rose to 8 percent by 2012. Today, that number is largely unknown because of its pervasiveness, but Dr. Robert Custer, an expert on compulsive gambling reported, that stock market gamblers represent over 20 percent of the gamblers that he has diagnosed. It is evident that on-line trading presents a tremendous risk to the speculator.

The CCG describes some of the consequences:

  • Dr. Fred B. is a 43-year-old Asian male physician with a salary above $150,000 and in debt for more than $150,000. He is married with two children. He was a day trader.   
  • Michael Q. is a 28-year-old Hispanic male registered nurse. He is married and the father of one (7 month old) child. He earns $65,000 and lost $50,000 savings in day trading and is in debt for $30,000. He has suicidal ideation.

[B] A Question of Suitability

Since online traders are in it for many reasons, investment suitability rarely enters the picture, according to Stuart Kaswell, general counsel of the Securities Industry Association, in Washington, DC.  The kind of question that has yet to be confronted, by day or online trading firms, is a statement, such as: “Equities look good this year. We favor technology stocks. We have a research report on our Web page that looks at the social media industry.” Those kinds of things are seldom considered because they do not involve a specific recommendation of a specific stock, like Apple, Google, Groupon, Facebook or Twitter.

However, if a firm makes a specific recommendation to an investor, whether over the cell-phone, iPad®, fax machine, face-to-face, instagram or over the Internet, or Twitter-X, suitability rules should apply. Opining similarly on the “know your customer” requirements is Steven Caruso, of Maddox, Koeller, Harget & Caruso of New York City. “The on-line firms obviously claim that they do not have a suitability responsibility because they do not want the liability for making a mistake as far as determining whether the investor was suitable or buying any security. I think that ultimately more firms are going to be required to make a suitability, [or eventually fiduciary] determination on every trade”.

[C] On-line Traders and Stock Market Gamblers

Some of the preferred areas of stock market gambling that attract the interest of compulsive gamblers include options, commodities, penny stocks and bit-coins, index investing, new stock offerings, certain types of CAT bonds, crowd-sourcing initiatives,  and some contracts for government securities. These online traders and investment gamblers think of themselves as cautious long-term investors who prefer blue chip or dividend paying varieties. What they fail to take into consideration is that even seemingly blue chips can both rise and precipitously drop in value again, as seen in the summer of 2003, the “crash” of 2008, or the “flash crash” of May 6, 2010.  On this day, the DJIA plunged 1000 points (about 9%) only to recover those losses within minutes. It was the second largest point swing 1,010.14 points, and the biggest one-day point decline, 998.5 points, on an intraday basis in Dow Jones Industrial Average history.

Regardless of investment choice, the compulsive investment gambler enjoys the anticipation of following the daily activity surrounding these investments. Newspaper, hourly radio and television reports, streaming computer, tablet and smart phone banners and hundreds of periodicals and magazines add excitement in seeking the investment edge. The name of the game is action. Investment goals are unclear, with many participating simply for the feeling it affords them as they experience the highs and lows and struggles surrounding the play.  And, as documented by the North American Securities Administrators Association’s president, and Indiana Securities Commissioner, Bradley Skolnik, most day or online traders lose money. “On-line brokerage was new and cutting edge and we enjoyed the best stock market in generations, until the crashes. The message of most advertisements was “just do it”, and you’ll do well. The fact is that research and common sense suggest the more you trade, the less well you’ll do”.

Most day or online traders are young males, some who quit their day jobs before the just mentioned debacles; or more recently with the dismal economy. Many ceased these risky activities but there is some anecdotal evidence that is re-surging again with 2013-14 technology boom and market rise. Most of them start every day not owning any stock, then buy and sell all day long and end the trading day again without any stock – – just a lot of cash. Dr. Patricia Farrell, a licensed clinical psychologist states that day traders are especially susceptible to compulsive behaviors and addictive personalities. Mark Brando, registered principal for Milestone Financial, a day trading firm in Glendale, California states, “People that get addicted to trading employ the same destructive habits as a gambler. Often, it’s impossible to tell if a particular trade comes from a problem gambler or a legitimate trader.”

VALUE STOCKS: https://medicalexecutivepost.com/2025/02/28/value-stocks-bargain-hunting-investing-for-physicians/

Arthur Levitt, former Chairman of the Securities and Exchange Commission (SEC) in discussing the risks and misconceptions of investing are only amplified by on-line trading. In a speech before the National Press Club a few years ago, he attempted to impress individuals as to the risks and difficulties involved with day trading. Levitt cited four common misconceptions that knowledgeable medical professionals, and all investors, should know: 

  • Personal computers, tablets, mobile devices and smart-phones are not directly linked to the markets – Thanks to Level II computer software, day traders can have access to the same up-to-the-second information available to market makers on Wall Street.  “Although the Internet makes it seem as if you have a direct connection to the securities market, you don’t. Lines may clog; systems may break; orders may back-up.” 
  • The virtue of limit orders – “Price quotes are only for a limited number of shares; so only the first few investors will receive the currently quoted price. By the time you get to the front of the line, the price of the stock could be very different.” 
  • Canceling an order – “Another misconception is that an order is canceled when you hit ‘cancel’ on your computer. But, the fact is it’s canceled only when the market gets the cancellation. You may receive an electronic confirmation, but that only mean your request to cancel was received – not that your order was actually canceled”. 
  • Buying on margin – “if you plan to borrow money to buy a stock, you also need to know the terms of the loan your broker gave you. This is margin. In volatile markets, investors who put up an initial margin payment for a stock may find themselves required to provide additional cash if the price of the stock falls.

How then, can the medical professional or financial advisor tell if he or she is a compulsive gambler? A diagnostic may be obtained from Gamblers Anonymous. It is designed to screen for the identification of problem and compulsive gambling.

But, it is also necessary to provide a tool to be used by on-line traders. This questionnaire is as follows:

1. Are you trading in the stock market with money you may need during the next year?

2. Are you risking more money than you intended to?

3. Have you ever lied to someone regarding your on-line trading?

4. Are you risking retirement savings to try to get back your losses?

5. Has anyone ever told you that spend too much time on-line?

6. Is investing affecting other life areas (relationships, vocational pursuits, etc.)?

7. If you lost money trading in the market would it materially change your life?

8. Are you investing frequently for the excitement, and the way it makes you feel?

9. Have you become secretive about your on-line trading?

10. Do you feel sad or depressed when you are not trading in the market?

ALPHA: https://medicalexecutivepost.com/2025/07/02/managing-for-endowment-portfolio-alpha/

NOTE: If you answer to any of these questions you may be moving from investing to gambling.

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The cost of compulsive gambling and day trading is high for the individual medical or lay professional, the family and society at large. Compulsive gamblers, in the desperation phase of their gambling, exhibit high suicide ideation, as in the case of Mark O Barton’s the murderous day-trader in Atlanta who killed 12 people and injured 13 more in July 29th 1999. His idea actually became a final act of desperation.

Less dramatically, for doctors, is a marked increase in subtle illegal activity. These acts include fraud, embezzlement, CPT® up-coding, medical over utilization, excessive full risk HMO contracting, Stark Law aberrations and other “white collar crimes.”  Higher healthcare and social costs in police, judiciary (civil and criminal) and corrections result because of compulsive gambling. The impact on family members is devastating. Compulsive gamblers cause havoc and pain to all family members. The spouses and other family members also go through progressive deterioration in their lives.

In this desperation phase, dysfunctional families are left with a legacy of anger, resentment, isolation, and in many instances, outright hate.    

[D] Day Trading Assessment

Internet day trading, like the Internet and telecommunications sectors, become something of a investment bubble a few years ago, suggesting that something lighter than air can pop and disappear in an instant. History is filled with examples: from the tulip mania of 1630 Holland and the British South Sea Bubble of the 1700’s; to the Florida land boom of the roaring twenties and the Great Crash of 1929; to the collapse of Japans stock and real estate market in early 1990’s; and to an all-time high of $1,926 for an ounce of commodity gold a few years ago. 

Today it is Ask: $3,388.30 USD Bid: $3,367.30 USD

CONCLUSION

To this list, one might again include smart-phone or mobile day trading.

Cite: Eugene Schmuckler PhD MBA MEd CTS

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Why Your Startup Needs to be a C-Corporation

A SPECIAL MEDICAL EXECUTIVE-POST PRESENTATION

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PROPOSED: 2026 Physician Fee Schedule Payment Increases

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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…)

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INVESTMENT POLICY STATEMENT CONSTRUCTION: For Physicians and Medical Professionals

THE ESSENTIAL DOCUMENT

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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In order to create and monitor an investment portfolio for personal or institutional use, the physician executive, financial advisor, wealth manager, or healthcare institutional endowment fund manager, should ask three questions:

  1. How much do we have invested?
  2. How much did we make on our investments?
  3. How much risk did we take to get that rate of return?

Introduction to the IPS

Most doctors, and hospital endowment fund executives, know how much money they have invested.  If they don’t, they can add a few statements together to obtain a total. But, few can answers the questions above or actually know the rate of return achieved last year; or so far this year. Everyone can get this number by simply subtracting the ending balance from the beginning balance and dividing the difference.  But, few take the time to do it. Why? A typical response to the question is, “We’re doing fine.”

POOR DOCTORS: https://medicalexecutivepost.com/2025/07/29/why-too-many-physician-colleagues-dont-get-rich/

Now, ask how much risk is in the portfolio and help is needed [risk adjusted rate of return]. In fact, Nobel laureate Harry Markowitz, Ph.D. said, “If you take more risk, you deserve more return.” Using standard deviation, he referred to the “variability of returns;” in other words, how much the portfolio goes up and down, its volatility [Markowitz, H: Portfolio Selection. Journal of Finance, March, 1952].

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Why [Too Many] Physician Colleagues Don’t Get Rich?

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DAILY UPDATE: Stocks, Commodities and Trade as Stock Markets End Mixed

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  • Stocks: Investors cheered the news of an EU & US trade deal over the weekend, pushing the S&P 500 above 6,400 for the first time ever. But the index gave up most of its gains late in the day as attention turned to a huge week of data ahead (more on that in a minute).
  • Trade: Today was the first day of discussions between US and Chinese negotiators in Stockholm to keep the trade war truce alive. Elsewhere, President Trump foresees a baseline 15% to 20% tariff rate for the rest of the world.
  • Commodities: Gold fell as trade deal hopes heightened investors’ risk appetite, while oil spiked higher after Trump gave Russia a 10- to 12-day deadline to sign a truce with Ukraine.

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According to Bloomberg, 83% of the S&P 500 companies that have reported earnings have outpaced Wall Street’s estimates, putting the index on pace for its best season of beats since the second quarter of 2021.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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EMOTIONAL INTELLIGENCE & ORGANIZATIONAL BEHAVIOR: Economic Risk Management Classification for Medical Professionals

BY DR. DAVID EDWARD MARCINKO, MBA MEd CMP®

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ORGANIZATIONAL BEHAVIOR AND CLASSIFICATION OF RISKS

DEFINITION EMOTIONAL INTELLIGENCE: Emotional intelligence [EI] refers to the ability to identify and manage one’s own emotions, as well as the emotions of others. Emotional intelligence is generally said to include a few skills: namely emotional awareness, or the ability to identify and name one’s own emotions; the ability to harness those emotions and apply them to tasks like thinking and problem solving; and the ability to manage emotions, which includes both regulating one’s own emotions when necessary and helping others to do the same.

DEFINITIONAL ORGANIZATIONAL BEHAVIOR: Organizational behavior (OB) is the study of how individuals, groups, and organizations interact and influence one another. Though it is largely used within the field of business management as means to understand–and more effectively manage–groups of people. The reason businesses look to OB is because it can help organizations increase employee performance, while also creating a positive working environment.

CITE: Eugene Schmuckler; PhD MBA MEd CTS®

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And so, as we review the concept of Emotional Intelligence and Organizational Behavior, it is possible to set up five EI/OB risk classes, based on the economic consequences of the occurrence of specific individual risks:

1. Prevented risks: Risks whose cost of occurrence is higher than their cost of management and whose occurrence may invoke additional legal sanctions. This class would include intentional torts and injuries caused by gross negligence.

2. Normally prevented risks: Risks whose cost of occurrence is greater than the cost of their management but whose occurrence will be considered only as negligent. This class includes most negligent injuries
and most types of product liability actions.

3. Managed risks: Risks whose cost of occurrence is only slightly greater than their cost of management. The plaintiff usually has the burden of showing that the defendant owed the plaintiff a special duty to recover for one of these risks.

4. Un-Prevented risks: Risks whose cost of occurrence is less than their cost of management. The classic example of this class is the cost of railroad crossing barriers compared to the cost of people being hit by
trains.

5. Un-Preventable risks: Risks whose occurrence is unmanageable. The assignment of a risk to one of these classes is a major problem in medical and healthcare quality control, because the class of a risk determines how much effort must be expended to prevent the risk. The misclassification of a prevented or normally prevented risk as a managed or un-prevented risk can result in large financial losses.

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For example: A medical clinic that does not update obsolete equipment, such as inaccurate oxygen monitors, would be liable for any injuries attributable to the obsolete equipment. The classifications of risk must be reviewed periodically to determine if the cost of the risk-taking behavior has changed, thereby altering the classification.

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For example: A small hospital in a rural area would not be expected to have the sophisticated equipment as a major hospital in a city. If an accident victim is brought into the rural facility, the hospital’s duty may be to transfer the patient to a better-equipped facility. The patient will face the risk of dying because of the delay in treatment, but the risk of insufficient treatments outweighs the risk of transfer. If the same victim were brought into a hospital in a major metropolitan center, the duty would be to treat the patient without a transfer. The risk of transfer has not changed, but the risk of insufficient treatment has disappeared.

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FORENSIC BODY FARMS: Defined

By A.I.

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A decaying body at the University of Tennessee’s Anthropological Research Facility known as the The Body Farm in Knoxville, where up to 80 bodies at a time are studied as they decay in a variety of different scenarios. (Photo by David Howells/Corbis via Getty Images)

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The term “body farm” refers to a type of outdoor research facility in which human remains are left to decompose in a variety of environmental conditions naturally. While some individuals may find the concept of a body farm unsettling, these facilities are very useful for forensic science research.

Body farms facilitate the hard (or sometimes outright impossible) research on the various stages of human decomposition, aiming to gain a deeper understanding of how the process can differ under various conditions. This new-found knowledge can then be utilized to assist forensic investigators in determining the time and cause of death and potentially even more information.

Body farms in the US include: California University of Pennsylvania, Sam Houston State University, Texas State University, University of Tennessee at Knoxville, and Western Carolina University.

Cite: Segen’s Medical Dictionary ©2012Farlex, Inc. All rights reserved.

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CMS Proposes Updates to the OPPS

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…) 

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AGREE: Consistency and Group-Think Commitment Tendency

“lemming effect” or “group-think”

By Staff Reporters

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According to psychologist and colleague Dan Ariely PhD, human beings have evolved – probably both genetically and socially – to be consistent.  It is easier and safer to deal with others if they honor their commitments and if they behave in a consistent and predictable manner over time. This allows people to work together and build trust that is needed for repeat dealings and to accomplish complex tasks. 

In the jungle, this trust was necessary to for humans to successfully work as a team to catch animals for dinner, or fight common threats.  In business and life it is preferable to work with others who exhibit these tendencies.  Unfortunately, the downside of these traits is that people make errors in judgment because of the strong desire not to change, or be different (“lemming effect” or “group-think”).  So the result is that most people will seek out data that supports a prior stated belief or decision and ignore negative data, by not “thinking outside the box”. 

Additionally, future decisions will be unduly influenced by the desire to appear consistent with prior decisions, thus decreasing the ability to be rational and objective.  The more people state their beliefs or decisions, the less likely they are to change even in the face of strong evidence that they should do so.  This bias results in a strong force in most people causing them to avoid or quickly resolve the cognitive dissonance that occurs when a person who thinks of themselves as being consistent and committed to prior statements and actions encounters evidence that indicates that prior actions may have been a mistake.  It is particularly important therefore for advisors to be aware that their communications with clients and the press clouds the advisor’s ability to seek out and process information that may prove current beliefs incorrect. 

Since this is obviously irrational, one must actively seek out negative information, and be very careful about what is said and written, being aware that the more you shout it out, the more you pound it in.

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PARADOXES: Beware Financial and Investing Contradictions

By Staff Reporters

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As we plan for our financial future, I think it’s helpful to be cognizant of these paradoxes. While there’s nothing we can do to control or change them, there is great value in being aware of them, so we can approach them with the right tools and the right mindset.

Here are just seven of the paradoxes that can bedevil financial planning and investment decision-making:

  • There’s the paradox that all of the greatest fortunes—Carnegie, Rockefeller, Buffett, Gates—have been made by owning just one stock. And yet the best advice for individual investors is to do the opposite: to own broadly diversified index funds.
  • There’s the paradox that the stock market may appear overvalued and yet it could become even more overvalued before it eventually declines. And when it does decline, it may be to a level that is even higher than where it is today.
  • There’s the paradox that we make plans based on our understanding of the rules—and yet Congress can change the rules on us at any time, as it did just a few weeks ago.
  • There’s the paradox that we base our plans on historical averages—average stock market returns, average interest rates, average inflation rates and so on—and yet we only lead one life, so none of us will experience the average.
  • There’s the paradox that we continue to be attracted to the prestige of high-cost colleges, even though a rational analysis that looks at return on investment tells us that lower-cost state schools are usually the better bet.
  • There’s the paradox that early retirement seems so appealing—and has even turned into a movement—and yet the reality of early retirement suggests that we might be better off staying at our desks.
  • There’s the paradox that retirees’ worst fear is outliving their money and yet few choose the financial product that is purpose-built to solve that problem: the single-premium immediate annuity.

Assessment

QUESTION: How should you respond to these paradoxes? As you plan for your financial future, embrace the concept of “loosely held views.” In other words, make financial plans, but continuously update your views, question your assumptions and rethink your priorities.

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Can You Contribute to Both a Roth IRA & 401(k)?

By Staff Reporters, AI and the Linqto Team

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Yes, you can contribute to both a Roth IRA and a 401(k), provided you don’t exceed annual contribution limits for each account.

Determining whether to contribute to a Roth IRA, 401(k), or both can be an important step in planning for your retirement. Here are the key differences, including tax advantages, employer contributions, and investment options. 

Eligibility requirements are the first consideration when contributing to a Roth IRA and a 401(k). For Roth IRA contributions, your eligibility is determined by your income. Specifically, if your modified adjusted gross income (MAGI) exceeds certain thresholds, your ability to contribute to a Roth IRA may be reduced or eliminated. However, there are no income limits for contributing to a 401(k), making it accessible to anyone with earned income.

IRS rules do allow for contributions to both a Roth IRA and a 401(k), provided you adhere to the annual contribution limits for each account.

This means you can take advantage of the higher contribution limits of a 401(k) while also benefiting from the tax-free growth of a Roth IRA. This dual approach can be a strategy for maximizing your retirement savings. The advantages to contributing to both accounts present some key benefits, such as: 

  • Tax diversification in retirement, allowing for better management of taxable income. 
  • Potential reduction of overall tax burden. 
  • Maximization of savings potential by taking full advantage of the benefits each account offers.3

Balancing contributions between a Roth IRA and a 401(k) requires careful planning. You might start by contributing enough to your 401(k) to receive the full employer match, which is essentially free money, if your employer offers this. Once you’ve secured the match, consider maxing out your Roth IRA contributions, if you’re eligible.

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DAILY UPDATE: Private Market Investment Retirement Plans Up Along with Stock Markets

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Stocks up

  • 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.
  • United Airlines 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 Norfolk Southern 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, OpenDoor Technologies 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%.
  • US Bancorp sank 1.03% after revenue and net interest income missed forecasts last quarter.
  • Abbott Laboratories beat on both top and bottom line guidance, but still fell 8.53% after the pharma company narrowed its fiscal forecasts.
  • Elevance Health tumbled 12.22% af

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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.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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DOCTORS AND LAWYERS: Often Aren’t Millionaires

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ADLs versus IADLs

DEFINITIONS

By Staff Reporters

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Activities of Daily Living (ADLs)

According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. They are sometimes referred to as “Basic Activities of Daily Living” (BADLs). They include:

  • Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
  • Feeding, as in being able to get food from a plate into one’s mouth.
  • Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
  • Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
  • Bathing, which means washing one’s face and body in the bath or shower.
  • Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.

If a person is not fully independent with ADLs, then we usually include some information about the amount of assistance they require. ADLs were originally defined in the 1950s by a geriatrician named Sidney Katz, who was trying to define what it might look like for a person to recover to independence after a disabling event such as a stroke or hip fracture. So these measures are sometimes called the “Katz Index of Independence in Activities of Daily Living.”

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Instrumental Activities of Daily Living (IADLs)

These are the self-care tasks we usually learn as teenagers. They require more complex thinking skills, including organizational skills. They include:

  • Managing finances, such as paying bills and managing financial assets.
  • Managing transportation, either via driving or by organizing other means of transport.
  • Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
  • Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance.
  • Managing communication, such as the telephone and mail.
  • Managing medications, which covers obtaining medications and taking them as directed.

Because managing IADLs requires a fair amount of cognitive skill, it’s common for IADLs to be affected when an older person is having difficulty with memory or thinking. For those older adults who develop Alzheimer’s disease or a related dementia, IADLs will usually be affected before ADLs are.

IADLs were defined about ten years after ADLs, by a psychologist named M.P. Lawton. Dr. Lawton felt there were more skills required to maintain independence than were listed on the original Katz ADL index, and hence created the “Lawton Instrumental Activities of Daily Living Scale.”

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BIAS: Beware Overconfident Investing

By Staff Reporters and A.I.

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OVERCONFIDENT INVESTING BIAS

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

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

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

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MORE:

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Goldman Sachs and Bitcoin

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By A.I.

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Bitcoin notched another all-time record yesterday, beating the previous record that was set two days ago.

Goldman Sachs plans to ask junior bankers to certify their loyalty every three months in order to prevent poaching by private equity firms, Bloomberg reported.

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What is a “Market-Neutral” Fund?

Market Neutral Funds Demystified

[A Special Report]

By Dimitri Sogoloff MD MBA & Dr. David E. Marcinko MBA MEd CMP

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Introduction

SPONSOR: https://marcinkoassociates.com/

It’s hard to believe that just 30 years ago, physician investors had only two primary asset classes from which to choose: U.S. equities and U.S. bonds.

Today, the marketplace offers a daunting array of investment choices. Rapid market globalization, technology advancements and investor sophistication have spawned a host of new asset classes, from the mundane to the mysterious.

Even neophyte medical investors can now buy and sell international equities, emerging market debt, mortgage securities, commodities, derivatives, indexes and currencies, offering infinitely more opportunities to make, or lose, money.

Amidst this ongoing proliferation, a unique asset class has emerged, one that is complex, non-traditional and not easily understood like stocks or bonds. It does, however, offer one invaluable advantage; its returns are virtually uncorrelated with any other asset class. When this asset class is introduced into a traditional investment portfolio, a wonderful thing occurs; the risk-return profile of the overall portfolio improves dramatically.

This asset class is known as a Market-Neutral strategy. The reason few medical professionals have heard of market neutral strategies is that most of them are offered by private investment partnerships otherwise known as hedge funds.

To the uninitiated, “hedge fund” means risky, volatile or speculative. With a market-neutral strategy however, just the opposite is true. Funds utilizing market-neutral strategies typically emphasize the disciplined use of investment and risk control processes. As a result, they have consistently generated returns that display both low volatility and a low correlation with traditional equity or fixed income markets. 

Definition of Market-Neutral

All market-neutral funds share a common objective: to achieve positive returns regardless of market direction. Of course, they are not without risk; these funds can and do lose money. But a key to their performance is that it is independent of the behavior of the markets at large, and this feature can add tremendous value to the rest of a portfolio.

A typical market-neutral strategy focuses on the spread relationship between related securities, which is what makes them virtually independent of underlying debt or equity markets. When two related securities are mispriced in relation to one another, the disparity will eventually disappear as the result of some external event. This event is called convergence and may take the form of a bond maturity, completion of a merger, option exercise, or simply a market recognizing the inefficiency and eliminating it through supply and demand.

Here’s how it might work

When two companies announce a merger, there is an intended future convergence, when the shares of both companies will converge and become one. At the time of the announcement, there is typically a trading spread between two shares. A shrewd trader, seeing the probability of the successful merger, will simultaneously buy the relatively cheaper share and sell short the relatively more expensive share, thus locking in the future gain.

Another example of convergence would be the relationship between a convertible bond and its underlying stock. At the time of convergence, such as bond maturity, the two securities will be at parity. However, the market forces of supply and demand make the bond underpriced relative to the underlying stock. This mispricing will disappear upon convergence, so simultaneously buying the convertible bond and selling short an equivalent amount of underlying stock, locks in the relative spread between the two.  

Yet another example would be two bonds of the same company – one junior and one senior. For various reasons, the senior bond may become cheaper relative to the junior bond and thus display a temporary inefficiency that would disappear once arbitrageurs bought the cheaper bond and sold the more expensive bond.

While these examples involve different types of securities, scenarios and market factors, they are all examples of a market-neutral strategy. Locking a spread between two related securities and waiting for the convergence to take place is a great way to make money without ever taking a view on the direction of the market.

How large are these spreads, you may ask? Typically, they are tiny. The markets are not quite fully efficient, but they are efficient enough to not allow large price discrepancies to occur.

In order to make a meaningful profit, a market-neutral fund manager needs sophisticated technology to help identify opportunities, the agility to rapidly seize those opportunities, and have adequate financing resources to conduct hundreds of transactions annually.  

Brief Description of Strategies

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The universe of market-neutral strategies is vast, spanning virtually every asset class, country and market sector. The spectrum varies in risk from highly volatile to ultra conservative. Some market-neutral strategies are more volatile than risky low-cap equity strategies, while others offer better stability than U.S Treasuries.

One unifying factor across this vast ocean of seemingly disparate strategies is that they all attempt to take advantage of a relative mispricing between various securities, and all offer a high degree of “market neutrality,” that is, a low correlation with underlying markets.

[A] Convertible Arbitrage

Convertible arbitrage is the oldest market-neutral strategy. Designed to capitalize on the relative mispricing between a convertible security (e.g. convertible bond or preferred stock) and the underlying equity, convertible arbitrage was employed as early as the 1950s.

Since then, convertible arbitrage has evolved into a sophisticated, model-intensive strategy, designed to capture the difference between the income earned by a convertible security (which is held long) and the dividend of the underlying stock (which is sold short). The resulting net positive income of the hedged position is independent of any market fluctuations. The trick is to assemble a portfolio wherein the long and short positions, responding to equity fluctuations, interest rate shifts, credit spreads and other market events offset each other.  

A convertible arbitrage strategy involves taking long positions in convertible securities and hedging those positions by selling short the underlying common stock. A manager will, in an effort to capitalize on relative pricing inefficiencies, purchase long positions in convertible securities, generally convertible bonds, convertible preferred stock or warrants, and hedge a portion of the equity risk by selling short the underlying common stock. Timing may be linked to a specific event relative to the underlying company, or a belief that a relative mispricing exists between the corresponding securities.

Convertible securities and warrants are priced as a function of the price of the underlying stock, expected future volatility of returns, risk free interest rates, call provisions, supply and demand for specific issues and, in the case of convertible bonds, the issue-specific corporate/Treasury yield spread.

Thus, there is ample room for relative misvaluations. Because a large part of this strategy’s gain is generated by cash flow, it is a relatively low-risk strategy. 

[B] Fixed-Income Arbitrage

Fixed-income arbitrage managers seek to exploit pricing inefficiencies across global markets.

Examples of these anomalies would be arbitrage between similar bonds of the same company, pricing inefficiencies of asset-backed securities and yield curve arbitrage (price differentials between government bonds of different maturities). Because the prices of fixed-income instruments are based on interest rates, expected cash flows, credit spreads, and related factors, fixed-income arbitrageurs use sophisticated quantitative models to identify pricing discrepancies.

Similarly to convertible arbitrageurs, fixed-income arbitrageurs rely on investors less sophisticated than themselves to misprice a complex security.

[C] Equity Market-Neutral Arbitrage

This strategy attempts to offset equity risk by holding long and short equity positions. Ideally, these positions are related to each other, as in holding a basket of S&P500 stocks and selling S&P500 futures against the basket. If the manager, presumably through stock-picking skill, is able to assemble a basket cheaper than the index, a market-neutral gain will be realized.

A related strategy is identifying a closed-end mutual fund trading at a significant discount to its net asset value. Purchasing shares of the fund gains access to a portfolio of securities valued significantly higher. In order to capture this mispricing, one needs only to sell short every holding in the fund’s portfolio and then force (by means of a proxy fight, perhaps) conversion of the fund from a closed-end to an open-end (creating convergence).

Sounds easy, right?

In considering equity market-neutral, you must be careful to differentiate between true market-neutral strategies (where long and short positions are related) and the recently popular long/short equity strategies.

In a long/short strategy, the manager is essentially a stock-picker, hopefully purchasing stocks expected to go up, and selling short stocks expected to depreciate. While the dollar value of long and short positions may be equivalent, there is often little relationship between the two, and the risk of both bets going the wrong way is always present.

[D] Merger Arbitrage (a.k.a. Risk Arbitrage)

Merger arbitrage, while a subset of a larger strategy called event-driven arbitrage, represents a sufficient portion of the market-neutral universe to warrant separate discussion.

Merger arbitrage earned a bad reputation in the 1980s when Ivan Boesky and others like him came to regard insider trading as a valid investment strategy. That notwithstanding, merger arbitrage is a respected stratagey, and when executed properly, can be highly profitable. It bets on the outcomes of mergers, takeovers and other corporate events involving two stocks which may become one.

A textbook example was the acquisition of SDL Inc (SDLI), by JDS Uniphase Corp (JDSU). On July 10, 2000 JDSU announced its intent to acquire SDLI by offering to exchange 3.8 shares of its own shares for one share of SDLI.

At that time, the JDSU shares traded at $101 and SDLI at $320.5. It was apparent that there was almost 20 percent profit to be realized if the deal went through (3.8 JDSU shares at $101 are worth $383 while SDLI was worth just $320.5). This apparent mispricing reflected the market’s expectation about the deal’s outcome. Since the deal was subject to the approval of the U.S. Justice Department and shareholders, there was some doubt about its successful completion. Risk arbitrageurs who did their homework and properly estimated the probability of success bought shares of SDLI and simultaneously sold short shares of JDSU on a 3.8 to 1 ratio, thus locking in the future profit.

Convergence took place about eight months later, in February 2001, when the deal was finally approved and the two stocks began trading at exact parity, eliminating the mispricing and allowing arbitrageurs to realize a profit. 

Merger Arbitrage, also known as risk arbitrage, involves investing in securities of companies that are the subject of some form of extraordinary corporate transaction, including acquisition or merger proposals, exchange offers, cash tender offers and leveraged buy-outs. These transactions will generally involve the exchange of securities for cash, other securities or a combination of cash and other securities.

Typically, a manager purchases the stock of a company being acquired or merging with another company, and sells short the stock of the acquiring company. A manager engaged in merger arbitrage transactions will derive profit (or loss) by realizing the price differential between the price of the securities purchased and the value ultimately realized when the deal is consummated. The success of this strategy usually is dependent upon the proposed merger, tender offer or exchange offer being consummated.  

When a tender or exchange offer or a proposal for a merger is publicly announced, the offer price or the value of the securities of the acquiring company to be received is typically greater than the current market price of the securities of the target company.

Normally, the stock of an acquisition target appreciates while the acquiring company’s stock decreases in value. If a manager determines that it is probable that the transaction will be consummated, it may purchase shares of the target company and in most instances, sell short the stock of the acquiring company. Managers may employ the use of equity options as a low-risk alternative to the outright purchase or sale of common stock. Many managers will hedge against market risk by purchasing S&P put options or put option spreads. 

[E] Event-Driven Arbitrage

Funds often use event-driven arbitrage to augment their primary market-neutral strategy. Generally, any convergence which is produced by a future corporate event would fall into this category.

Accordingly, Event-Driven investment strategies or “corporate life cycle investing” involves investments in opportunities created by significant transactional events, such as spin-offs, mergers and acquisitions, liquidations, reorganizations, bankruptcies, recapitalizations and share buybacks and other extraordinary corporate transactions.

Event-Driven strategies involve attempting to predict the outcome of a particular transaction as well as the optimal time at which to commit capital to it. The uncertainty about the outcome of these events creates investment opportunities for managers who can correctly anticipate their outcomes.

As such, Event-Driven trading embraces merger arbitrage, distressed securities and special situations investing. Event-Driven managers do not generally rely on market direction for results; however, major market declines, which would cause transactions to be repriced or break, may have a negative impact on the strategy. 

Event-driven strategies are research-intensive, requiring a manager to do extensive fundamental research to assess the probability of a certain corporate event, and in some cases, to take an active role in determining the event’s outcome. 

Risk and Reward Characteristics

To help understand market-neutral performance and risk, let’s take a look at the distribution of returns of individual strategies and compare it to that of traditional asset classes.

 Table 1:  Average Return / Volatility of Market Neutral Strategies And Selected Traditional Asset Classes 

 

Strategy Average Return Annualized Volatility
Convertible Arbitrage 11.95% 3.57%
Fixed Income Arbitrage 8.33% 4.90%
Equity Market-Neutral 11.62% 4.95%
Merger Arbitrage 13.29% 3.51%
Relative Value Arbitrage 15.69% 4.31%
   Traditional Asset Classes:    
S&P 500 12.62% 13.72%
MSCI World 8.57% 13.05%
High Grade U.S. Corp. Bonds 7.26% 3.73%
World Government Bonds 5.91% 5.96%

The most important observation about this chart is that the Market Neutral funds exhibits considerably lower risk than most traditional asset classes.

While market-neutral strategies vary greatly and involve all types of securities, the risk-adjusted returns are amazingly stable across all strategies. The annualized volatility – a standard measure of performance risk – varies between 3.5 and 5 percent, comparable to a conservative fixed-income strategy.     

Another interesting statistics is the correlation between Market Neutral strategies and traditional asset classes and traditional asset classes

Table 2: Correlation between Market Neutral Strategies and Traditional Asset Classes

 

Asset Class/Strategy S&P500 MSCI World GovBonds CorpBonds

The correlation of all market neutral strategies to traditional assets is quite low, or negative in some cases. This suggests that these strategies would indeed play a useful role in the ultimate goal of efficient portfolio diversification.

To test the “market neutrality” of these strategies, we asked, “How well, on average, did these strategies perform during bad, as well as good, market months?”

It turns out, in good times and bad, these strategies displayed consistent solid performance. From 12/31/91, in months when S&P 500 was down, the average down month was 3.03 percent. Market Neutral strategies performed as follows:

  

Strategy Average Monthly Return
Convertible Arbitrage + 0.65%
Fixed Income Arbitrage + 0.50%
Equity Market-Neutral + 1.19%
Merger Arbitrage + 0.88%
Relative Value Arbitrage + 0.81%

In months when S&P 500 was up, the average up month was +3.24 percent.  Market Neutral strategies performed as follows:

  

Strategy Average Monthly Return
Convertible Arbitrage +1.17%
Fixed Income Arbitrage +1.20%
Equity Market-Neutral +1.37%
Merger Arbitrage +0.60%
Relative Value Arbitrage +1.25%

Clearly, a compelling picture emerges. While these strategies, on average, underperform during good times, they show a positive average return during both good and bad markets.

Inclusion of Market-Neutral in a Long-term Investment Portfolio

A critical concern for any medical investor considering a foray into a new asset class is how it will alter the long-term risk/reward profile of the overall portfolio. To better understand this, we constructed several hypothetical portfolios consisting of traditional asset classes:

·  US Treasuries (Salomon Treasury Index 10yrs+)

·  High Grade Corporate Bonds  (Salomon Investment Grade Index)

·  Speculative Grade Corporate Bonds  (High Yield Index)

·  US Blue chip equities  (Dow Jones Industrial Average)

·  US mid-cap equities  (S&P 400 Midcap Index)

·  US small-cap equities (S&P 600 Smallcap Index)

Portfolios varied in the level of risk from 100 percent U.S Treasuries (least risky) to 100 percent small-cap equities (most risky), and are ranked from 1 to 10, 1 representing the least risky portfolio.Each portfolio was analyzed on a Risk/Return basis using monthly return data since December 1991. The results are shown in Chart 1.Predictably, the least risky portfolio produced the smallest return, while the riskiest produced the highest return. This is perfectly understandable – you would expect to be compensated for taking a higher level of risk.

Chart 1: Risk/Return characteristics of traditional portfolios vs. Market Neutral strategies 

Clearly, the risk-return picture offered by Market Neutral strategies is much more compelling (lower risk, higher return) than that offered by portfolios of traditional assets. What happens if we introduce these market-neutral strategies into traditional portfolios? Let’s take 20 percent of the traditional investments in our portfolio and reinvest them in market-neutral strategies.

The change is dramatic: the new portfolios (denoted 1a through 10a) offer significantly less risk for the same return. The riskiest portfolio, for instance (number 10) offered 20 percent less risk for a similar return of a new portfolio containing market-neutral strategies (number 10a).   
 
Chart 2:  Result of inclusion of 20% of Market Neutral strategies in traditional portfolios 

This is quite a difference.  Everything else being equal, anyone would choose the new, “improved” portfolios over the traditional ones.

How to invest

The mutual fund world does not offer a great choice of market neutral strategies. 

Currently, there are only a handful of good mutual funds that label themselves market-neutral (AXA Rosenberg Market Netural fund and Calamos Market Neutral fund are two examples).

Mutual fund offerings are slim due to excessive regulations imposed by the SEC with respect to short selling and leverage, and consequently these funds lack flexibility in constructing truly hedged portfolios. The dearth of market-neutral offerings among mutual funds is offset by a vast array of choices in the hedge fund universe. Approximately 400 market-neutral funds, managing $60 billion, represent roughly 25% of all hedge funds.

Therefore, further focus will relate to the hedge fund universe, rather than the limited number of market-neutral mutual funds.

Direct investing in a market-neutral hedge fund is restricted to qualifying individuals who must meet high net worth and/or income requirements, and institutional investors, such as corporations, qualifying pension plans, endowments, foundations, banks, insurance companies, etc.

This does not mean that retail investors cannot get access to hedge fund exposure. Various private banking institutions offer funds of funds with exposure to hedge funds. Maaket-neutral funds are nontraditional investments. They are part of a larger subset of strategies known as alternative investments, and there is nothing traditional in the way doctors invest in them.

Hedge funds are private partnerships, which gives them maximum flexibility in constructing and managing portfolios, but also requires medical investors to do a little extra work.

[A] Lockup Periods

One of the main differences between mutual funds and hedge funds is liquidity. Market-neutral strategies have less liquidity than traditional portfolios. Quarterly redemption policies with 45- or 60-days notice are common. Many funds allow redemptions only once a year and some also have lock-up periods. In addition, few of these funds pay dividends or make distributions. These investments should be regarded strictly as long-term strategies.

[B] Managerial Risks

Success of a market-neutral strategy depends much less on the market direction than on the manager’s skill in identifying arbitrage opportunities and capitalizing on them.

Thus, there is significantly more risk with the manager than with the market. It’s vital for investors to understand a manager’s style and to monitor any deviations from it due to growth, personnel changes, bad decisions, or other factors.

[C] Fees

If you are accustomed to mutual fund fees, brace yourself; market-neutral investing does not come cheap.

Typical management fees range from 1 to 2 percent per year, plus a performance fee averaging 20 percent of net profits. Most managers have a “high watermark” provision; they cannot collect the performance fees until investors recoup any previous losses. Look for this provision in the funds’ prospectus and avoid any fund that lacks it. Even with higher fees, market-neutral investing is superior to most traditional mutual fund investing on a risk-adjusted return basis.

[D] Transparency

Mutual funds report their positions to the public regularly. This is not the case with market-neutral hedge funds. Full transparency could jeopardize accumulation of a specific position. It also generates front running: buying or selling securities before the fund is able to do so. While you should not expect to see individual portfolio positions, many hedge fund managers do provide a certain level of transparency by indicating their geographical or sector exposures, level of leverage and extent of hedging.

It does take a bit of education to understand these numbers, but the effort is definitely worthwhile. 

[E] Taxation

The issue of hedge fund taxation is quite complex and is often dependent on the fund and the personal situation of the investor. Advice from a competent accountant, specialized financial advisor, tax attorney with relevant experience is worthwhile. The bottom line is that investing in market-neutral funds is not a tax-planning exercise and it will not minimize your taxes.

On the other hand, it should not generate any more or fewer taxes than if you invested in more traditional funds.

From the medical investor’s perspective, the principal advantages of market-neutral investing are attractive risk-adjusted returns and enhanced diversification.

Ten years of data indicate that market-neutral portfolios have produced risk-adjusted returns superior to traditional investments. In addition, the correlation between the returns of market-neutral funds and traditional asset classes has been historically negligible.

Adding exposure of market-neutral return strategies to the asset mix within a consistent, long-term investment program offers a medical investor the opportunity to improve overall returns, as well as achieving some protection against negative market movements.

Now, after all of the above, has your impression of hedge funds in general or MN funds in particular, changed?

APPENDIX:  

Asset class weighting in traditional portfolios:
Portfolio US Treasuries US High Grade Corp Bonds US Low Grade Corp Bonds Large Cap Stocks Mid Cap Stocks Small Cap Stocks
1 50% 50%        
2   50% 50%      
3 10% 30% 50% 40%    
4   50%   50%    
5   10% 10% 50% 30%  
6     10% 50% 20% 20%
7     10% 30% 20% 40%
8       20% 20% 60%
9         20% 80%
10           100%

 

Conclusion

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IADLs: Instrumental Activities of Daily Living

DEFINITIONS

By Staff Reporters

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Instrumental Activities of Daily Living (IADLs)

According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. These are the self-care tasks we then learn as teenagers. They require more complex thinking skills, including organizational skills. They include:

  • Managing finances, such as paying bills and managing financial assets.
  • Managing transportation, either via driving or by organizing other means of transport.
  • Shopping and meal preparation. This covers everything required to get a meal on the table. It also covers shopping for clothing and other items required for daily life.
  • Housecleaning and home maintenance. This means cleaning kitchens after eating, keeping one’s living space reasonably clean and tidy, and keeping up with home maintenance.
  • Managing communication, such as the telephone and mail.
  • Managing medications, which covers obtaining medications and taking them as directed.

Because managing IADLs requires a fair amount of cognitive skill, it’s common for IADLs to be affected when an older person is having difficulty with memory or thinking. For those older adults who develop Alzheimer’s disease or a related dementia, IADLs will usually be affected before ADLs are.

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IADLs were defined about ten years after ADLs, by a psychologist named M.P. Lawton. Dr. Lawton felt there were more skills required to maintain independence than were listed on the original Katz ADL index, and hence created the “Lawton Instrumental Activities of Daily Living Scale.”

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Gerontologist V. Geriatrician?

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ADLs: Activities of Daily Living

DEFINITIONS

By Staff Reporters

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Activities of Daily Living (ADLs)

According to Leslie Kernisan MD MPH, these are the basic self-care tasks that we initially learn as very young children. They are sometimes referred to as “Basic Activities of Daily Living” (BADLs). They include:

  • Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
  • Feeding, as in being able to get food from a plate into one’s mouth.
  • Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
  • Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
  • Bathing, which means washing one’s face and body in the bath or shower.
  • Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device.

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If a person is not fully independent with ADLs, then we usually include some information about the amount of assistance they require. ADLs were originally defined in the 1950s by a geriatrician named Sidney Katz, who was trying to define what it might look like for a person to recover to independence after a disabling event such as a stroke or hip fracture. So these measures are sometimes called the “Katz Index of Independence in Activities of Daily Living.”

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ELDER ABUSE: Financial Exploitation Protection

By Rick Kahler CFP

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One serious risk to financial wellbeing in retirement that is difficult to talk about is financial exploitation. Someone whose cognitive abilities are declining is vulnerable to harm from both financial predators and their own financial misjudgments. Protecting such clients is a crucial part of a financial advisor’s role.

A little-known but important law, the Senior Safe Act, was enacted in 2018. It encourages financial advisors and institutions to report suspected elder abuse by offering immunity from legal liability when reports are made in good faith and with reasonable care. To qualify for these protections, financial professionals must undergo annual training to recognize the signs of exploitation and know how to act on their suspicions.

In many ways, the Senior Safe Act mirrors the duty of therapists to report when clients are threats to themselves, such as when a client becomes suicidal. Just as a therapist must balance confidentiality with the moral and legal responsibility to protect their client from harm, a financial advisor must weigh privacy against the need to prevent financial exploitation. Both roles rely on professional judgment, training, and the courage to act when the stakes are high.

Financial advisors, accountants, and attorneys are often the first to notice troubling signs that someone is being taken advantage of financially. These might include sudden large withdrawals, changes to account ownership or beneficiaries, or a newly and overly involved friend or family member. Behavioral shifts like confusion, anxiousness, secretiveness, or uncharacteristic deference are also red flags. These patterns are unsettling and demand attention, even when stepping in is uncomfortable.

Reporting possible elder abuse isn’t always straightforward, especially if the suspected abuser is a family member. As an advisor, I worry about misunderstandings, potential conflicts with the family, and even the possibility of damaging a relationship with the client. None of this is easy, But when the signs of exploitation become clear, staying silent could mean allowing harm to continue. That’s a risk I can’t take.

One of the tools I started using decades ago is the trusted contact disclosure form. This simple but powerful document allows clients to name someone my firm can contact if they notice unusual activity, such as a suspicious withdrawal or transfer. The trusted contact does not have control over the client’s account but serves as a resource to verify their well-being and ensure that their financial decisions align with their long-term goals. If you as a client have not signed such a form, it’s worth discussing with your advisor as a preventative step.

If you are concerned about the financial well-being of an elderly loved one, it’s crucial to alert not only their financial advisor but also other professionals like accountants, attorneys, or bankers. These professionals may have insights or access to information you don’t have, and by sharing your concerns, you provide a broader picture that can help them detect and address issues more effectively. Even if they are already monitoring for red flags, your input can provide valuable context to guide their next steps.

Difficult though it may be, stepping into uncomfortable territory is often essential to protecting vulnerable individuals. Whether it’s a financial advisor detecting exploitation or a therapist intervening in a mental health crisis, the goal is the same—to prevent harm while respecting the person’s autonomy.

The Senior Safe Act is a reminder that sometimes the most impactful safeguards work quietly behind the scenes. Taking simple steps like completing a trusted contact form or encouraging your loved one to work with a reputable, fiduciary advisor can make all the difference. Vigilance is an act of care that helps protect someone’s financial assets as well as their dignity and well-being.

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OREGON BANS: Corporate Control of Physicians

By Health Capital Consultants LLC

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On June 9th, 2025, Oregon’s governor signed into law the country’s strictest corporate practice of medicine (CPOM) prohibition. Senate Bill (SB) 951 will severely curtail the involvement of private equity firms and other corporations in the state’s medical practices.

This Health Capital Topics reviews the bill and discusses the implications on the healthcare industry. (Read more…)

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Stocks, Bonds & Commodities

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DAILY UPDATE: Crude Oil Prices Reverse as Stock Markets Diverge

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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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.

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🟢 What’s up

  • Solar stocks got a reprieve today after the Senate dropped the excise tax on clean energy projects. Sunrun soared 10.51%, Enphase Energy rose 3.18%, SolarEdge Technologies popped 7.16%, and Array Technologies 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. Wynn Resorts climbed 8.85%, Las Vegas Sands added 8.95%, and MGM Resorts gained 7.24%.

What’s down

  • AMC Entertainment tumbled 9.03% after the one-time meme stock announced its new debt restructuring plan.
  • Progress Software sank 13.03% after the business application software company reported mixed results last quarter, beating on profit but missing on revenue.
  • Joby Aviation 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 Beta Bionics sank 4.26%.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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Stocks, Bonds and Safe Havens

By A.I.

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Liberation Day Comeback

By A.I.

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The S&P 500 closed within a hair of a new record yesterday marking an enormous comeback that followed the April announcement of “Liberation Day” tariffs.

Despite a persistent vibe of uncertainty related to US economic policy and geopolitics:

  • The S&P 500 closed less than 0.1% away from a record high which it notched in February before cratering nearly 20% in April. The index has regained ground in fits and starts since then and briefly surpassed its record in intra-day trading yesterday.
  • On Monday, the tech-heavy NASDAQ 100 one-upped the broader market and logged its highest-ever close. It came after President Trump said Israel and Iran agreed to a ceasefire, which eased investors’ concerns about a potential oil crisis.

According to Morning Brew, between unresolved geopolitical conflicts and President Trump’s still-unfolding tariff policies, a portfolio manager with Capital Wealth Planning, Kevin Simpson, told CNBC that he was “surprised by the magnitude of the rebound.”

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FINANCIAL COACHING: For Physicians!

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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DEAR COLLEAGUES

If you are just starting out managing your finances and don’t know where to begin, a financial coach may be a good option for you. They are helpful for someone who wants to become proficient in the basics of finance, from learning how to budget or save money to building an emergency fund or creating a plan for paying off debt. If you have short-term money goals, like saving for a big purchase or just practicing better money habits, a financial coach can help you reach them by working with you to create a plan and holding you accountable. Even more for physicians and most all medical professionals.

Pros and Cons of Working with a Financial Coach
A financial coach can have a positive impact on your financial well–being and your life in a number of ways:

  • Financial coaches see the bigger picture of how you relate to money. They can help you develop better habits, resulting in positive personal growth.
  • By providing education and encouragement, they can reduce financial stress, confusion, and what it is about money that overwhelms you.
  • Through accountability and support, they can help you accomplish your goals and help you feel more confident in your finances.
  • Available 24/7/365.
  • Modest fees.

At you service.
Dr. David Edward Marcinko MBA MEd CMP

CONTACT: MarcinkoAdvisors@outlook.com

LINK: https://medicalexecutivepost.com/2025/01/23/personal-coaching-dr-marcinko-at-your-service/

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DAILY UPDATE: Health Insurance Options as Bull Market Edges Upward

MEDICAL EXECUTIVE-POST TODAY’S NEWSLETTER BRIEFING

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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.

http://www.MedicalBusinessAdvisors.com

SPONSORED BY: Marcinko & Associates, Inc.

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http://www.MarcinkoAssociates.com

Daily Update Provided By Staff Reporters Since 2007.
How May We Serve You?
© Copyright Institute of Medical Business Advisors, Inc. All rights reserved. 2025

REFER A COLLEAGUE: MarcinkoAdvisors@outlook.com

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CITE: https://www.r2library.com/Resource

A June 11th report from global professional services firm Alvarez & Marsal (A&M) predicts that more beneficiaries might soon ditch insurance coverage for options like short-term, limited duration plans or healthcare sharing ministries (HCSMs), which aren’t regulated like health insurance and aren’t required to comply with ACA protections like covering maternity care or pre-existing conditions.

CITE: https://tinyurl.com/2h47urt5

🟢 What’s up

  • Nvidia extended its winning streak to five days, rising another 1.73% as the AI trade continues to recover.
  • EchoStar climbed 13.16% after the parent company of Dish TV disclosed that President Trump did in fact prod the FCC to make a deal.
  • Cyngn soared another 20.07% following a big day of gains after the company that makes self-driving tech for industrial vehicles announced a partnership with Nvidia.
  • Strong earnings from Nike (more on that later) propelled sporting goods stocks higher today. ON Holdings rose 1.74%, while Dick’s Sporting Goods climbed 3.59%.
  • Domestic power producers popped on reports that Trump is planning to issue an executive order increasing energy production to meet AI demand. Vistra gained 2.44%, GE Vernova climbed 2.54%, and Vertiv added 2.71%.

What’s down

  • Coinbase Global ended its winning streak, tumbling 5.77% after GENIUS Act hype propelled the crypto stock skyward all week long. Traders took profits in Circle as well, pushing the stablecoin stock down 15.54%.
  • Chinese EV maker Li Auto fell 1.93% on its weaker-than-expected deliveries forecast for the second quarter.
  • Fellow Chinese EV maker Xiaomi stunned markets with reports that it received 240,000 orders for its new SUV within 18 hours of its debut, but shares still sank 4%.
  • Pony.ai lost 6.31% on a report that Uber is considering helping its founder Travis Kalanick fund his acquisition of the US subsidiary of the Chinese autonomous vehicle company.
  • Gold miners tumbled while the price of the precious metal fell as investors took a risk-on stance. Newmont lost 4.11%, Barrick Mining fell 3.44%, and Kinross Gold shed 6.18%.
  • Today’s trade deal reopens the door for Chinese rare earth imports, bad news for US producers like MP Materials (down 8.59%) and USA Rare Earth (down 12.14%).

CITE: https://tinyurl.com/tj8smmes

Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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EDUCATIONAL TEXTBOOKS: https://tinyurl.com/4zdxuuwf

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INVESTMENT ADVISORY: Portfolio Second Opinions for Physician Colleagues

INVESTMENT PORTFOLIO REVIEWS

By Dr David Edward Marcinko MBA MEd CMP

http://www.MarcinkoAssociates.com

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“FROM CHAOS-TO-CALM

If you’re looking at this tab, chances are you are fed up with your financial brokerage accounts, thinking of finances, investing, retirement or all of the above.

And so, we can help

An investment portfolio second opinion, also called a “ portfolio review,” is an analysis of your financial holdings and associated strategies, allocations, fees and performance to determine whether the most effective instruments and methodologies are being utilized to reach your goals.

No Worries! You may have come to the right place.

E-Mail Ann Miller RN MHA CPHQ for an Initial Appointment: MarcinkoAdvisors@outlook.com

The purpose of this initial appointment is for you to ask a lot of questions to make sure you are comfortable with potentially working with us. It also helps if you are prepared to provide a verbal summary of your current situation.

Here are some questions to consider asking us during your first meeting:

1) Can you tell us about your financial qualifications, experience, education and training; if any?

2) Can you provide some information about your current financial advisory team?

3) On what type of investments do you typically purchase and own?

5) How much do pay your financial management firm?

6) How long have you been working with your current financial management firm?

8) What other services does your financial team provide?

9) What is your own investment philosophy?

A Fiduciary Opinion At Your Service

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Stocks, Deals and Commodities

BY A.I.

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Stocks: The S&P 500 briefly traded a few cents above its February all-time closing high yesterday afternoon, but couldn’t sustain the gain and fell just short at the end of the day. The NASDAQ remains inches away from its record high as well.

Deals: The end of the 90-day tariff pause is less than two weeks away, but the White House said that the July 9th deadline “is not critical.”

Meanwhile, the Treasury Department is doing everything it can to make the dreaded “revenge tax” in the big, beautiful bill irrelevant.

Commodities: Gold and oil had muted moves upward but copper climbed to a three-month high after Goldman Sachs analysts warned of shortages ahead

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Stocks, Economics & Commodities

By AI

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  • Stocks: The S&P 500 and NASDAQ started the day inches away from their all-time highs, but the market rally faltered in mid-afternoon as relief from an Israel/Iran ceasefire faded and investors turned their attention to Friday’s PCE report.
  • Economy: Speaking of inflation, Jerome Powell stuck to his guns during his second day of congressional testimony, endorsing a wait-and-see mentality. President Trump is apparently tired of waiting, and says he has “3 or 4” candidates in mind to replace Powell.
  • Commodities: Oil bounced back after posting its biggest two-day decline since 2022.

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Why Investors Don’t Want Common Stock Shares

By Pitching Angels

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STOCK PERFORMANCE: Growth v. Value Investing for Physicians

BY DR. DAVID EDWARD MARCINKO: MBA MEd CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

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Performance of Growth & Value Stocks

Although many academics argue that value stocks outperform growth stocks, the returns for individuals investing through mutual funds demonstrate a near match. 

Introduction

A 2005 study Do Investors Capture the Value Premium? written by Todd Houge at The University of Iowa and Tim Loughran at The University of Notre Dame found that large company mutual funds in both the value and growth styles returned just over 11 percent for the period of 1975 to 2002. This paper contradicted many studies that demonstrated owning value stocks offers better long-term performance than growth stocks. 

The studies, led by Eugene Fama PhD and Kenneth French PhD, established the current consensus that the value style of investing does indeed offer a return premium. There are several theories as to why this has been the case, among the most persuasive being a series of behavioral arguments put forth by leading researchers. The studies suggest that the out performance of value stocks may result from investors’ tendency toward common behavioral traits, including the belief that the future will be similar to the past, overreaction to unexpected events, “herding” behavior which leads at times to overemphasis of a particular style or sector, overconfidence, and aversion to regret. All of these behaviors can cause price anomalies which create buying opportunities for value investors.

Another key ingredient argued for value out performance is lower business appraisals. Value stocks are plainly confined to a P/E range, whereas growth stocks have an upper limit that is infinite.  When growth stocks reach a high plateau in regard to P/E ratios, the ensuing returns are generally much lower than the category average over time. 

Moreover, growth stocks tend to lose more in bear markets.  In the last two major bear markets, growth stocks fared far worse than value.  From January 1973 until late 1974, large growth stocks lost 45 percent of their value, while large value stocks lost 26 percent. Similarly, from April 2000 to September 2002, large growth stocks lost 46 percent versus only 27 percent for large value stocks. These losses, academics insist, dramatically reduce the long-term investment returns of growth stocks.

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However, the study by Houge and Loughran reasoned that although a premium may exist, investors have not been able to capture the excess return through mutual funds.  The study also maintained that any potential value premium is generated outside the securities held by most mutual funds.  Simply put, being growth or value had no material impact on a mutual fund’s performance.

Listed below in the table are the annualized returns and standard deviations for return data from January 1975 through December 2002.

Index                              Return                         SD      

S&P 500                            11.53%                     14.88%

Large Growth Funds         11.30%                     16.65%

Large Value Funds             11.41%                    15.39%

 Source:  Hough/Loughran Study

The Hough/Loughran study also found that the returns by style also varied over time.  From 1965-1983, a period widely known to favor the value style, large value funds averaged a 9.92 percent annual return, compared to 8.73 percent for large growth funds. This performance differential reverses over 1984-2001, as large growth funds generated a 14.1 percent average return compared to 12.9 percent for large value funds.  Thus, one style can outperform in any time period.

However, although the long-term returns are nearly identical, large differences between value and growth returns happen over time.   This is especially the case over the last ten years as growth and value have had extraordinary return differences – sometimes over 30 percentage points of under performance. 

This table indicates the return differential between the value and growth styles since 1992.

YEARLY RETURNS OF GROWTH/VALUE STOCKS

YearGrowthValue
19925.1%10.5%
19931.7%18.6%
19943.1%-0.6%
199538.1%37.1%
199624.0%22.0%
199736.5%30.6%
199842.2%14.7%
199928.2% 3.2%
2000-22.1%6.1%
2001-26.7%7.1%
2002-25.2%-20.5%
200328.2%27.7%
2004 6.3%16.5%
2005 3.6%6.1%
2006 10.8%20.6%
20078.8%1.5%
2008-38.43%-36.84%
200937.2%19.69%
201016.71%15.5%
20112.64%0.39%
201215.25%17.50%

Source:  Ibbottson.

Between the third quarter of 1994 and the second quarter of 2000, the S&P Growth Index produced annualized total returns of 30 percent, versus only about 18 percent for the S&P Value Index.  Since 2000, value has turned the tables and dramatically outperformed growth.  Growth has only outperformed value in two of the past eight years.  Since the two styles are successful at different times, combining them in one portfolio can create a buffer against dramatic swings, reducing volatility and the subsequent drag on returns. 

Assessment

In our analysis, the surest way to maximize the benefits of style investing is to combine growth and value in a single portfolio, and maintain the proportions evenly in a 50/50 split through regular rebalancing.  Research from Standard & Poor’s showed that since 1980, a 50/50 portfolio of value and growth stocks beats the market 75 percent of the time.

Conclusion

Due to the fact that both styles have near equal performance and either style can outperform for a significant time period, a medical professional might consider a blending of styles.  Rather than attempt to second-guess the market by switching in and out of styles as they roll with the cycle, it might be prudent to maintain an equal balance your investment between the two.

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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ASSETS: Under Advisement V. Management

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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What are Assets Under Management?

Assets under management (AUM) is a significant parameter in the financial world. It answers financial questions like – how many investments does a company manage? What is the net value of the investments that the company manages? Finally, how many investors have trusted their assets with the company? The higher the answer to these three questions, the more glory to the company.

A wealthy investor who is not concerned by higher fees but wants maximum returns of their asset will probably choose an asset manager based on its AUM. Thus, the AUM indicates the financial performance of the firm. Also, based on the funds under management, the firm collects fees from other clients.

So, what are the investments which qualify as AUM? Any liquid asset of the investor they have entrusted the asset manager with monitoring and control. For example, bank deposits, cash balances, equity shares, bonds, mutual funds, and other investments.

What are the services an asset manager provides to their clients? The most important function is decision-making. With the constant fluctuations and rapid movements in the market, an asset manager has to make decisions about holding or selling an investment. The firm communicates with the investors and advises them about the necessary action.

Once the decision is taken, the firm acts on the decision, i.e., the investor does not have to enter the field. In addition, the asset management company will buy, sell, and make any other transactions on behalf of the investor. Finally, the firm also renders services like accounting, tax reporting, proxy voting (equity shares), client reporting, and other financial services.

What are Assets Under Advisement?

Assets under advisement refer to assets on which your firm provides advice or consultation but for which your firm does either does not have discretionary authority or does not arrange or effectuate the transaction. Such services would include financial planning or other consulting services where the assets are used for the informational purpose of gaining a full perspective of the client’s financial situation, but you are not actually placing the trade.

Assets under advisement could also be those which you monitor for a client on a non-discretionary basis, where you may make recommendations but where the client is the party responsible for arranging or effecting the purchase or sale.  A common example of this scenario is when an adviser reviews a participant’s 401(k) allocations. If the adviser does not have the authority or ability to effect changes in the portfolio, these assets are likely considered assets under advisement rather than regulatory assets under management.

Assets under advisement are permitted to be disclosed on Form ADV Part 2A as a separate asset figure from the assets under management.  There is no requirement to disclose the assets under advisement figure, but some advisers opt to include the figure to give prospective clients a more complete picture of the firm’s responsibilities.  If you choose to report your assets under advisement, be sure to make a clear distinction between this figure and your regulatory assets under management.

NOTE: Essay with thanks to Chat GPT.

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CORRELATION: Diversification in Finance and Investments

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

DEFINITION

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Correlation measures the relationship between two investments–the higher the correlation, the more likely they are to move in the same direction for a given set of economic or market events. Correlation, in the finance and investment industries, is a statistic that measures the degree to which two securities move in relation to each other. Correlations are used in advanced portfolio management, computed as the correlation coefficient which has a value that must fall between -1.0 and +1.0.

So if two securities are highly positively correlated, they will move in the same direction the vast majority of the time. Negatively correlated investments do the opposite–as one security rises, the other falls, and vice versa. No correlation means there is no relationship between the movement of two securities–the performance of one security has no bearing on the performance of the other.

CAUSATION: https://medicalexecutivepost.com/2024/06/05/correlation-is-not-causation/

Correlation is an important concept for portfolio diversification--combining assets with low or negative correlations can improve risk-adjusted performance over time by providing a diversity of payouts under the same financial conditions.

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MUTUAL FUNDS, SECTOR FUNDS, ETFs & INDEX FUNDS

By Dr. David Edward Marcinko MBA MEd CMP

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MUTUAL FUNDS, SECTOR FUNDS, ETFs AND INDEX FUNDS

SPONSOR: http://www.MarcinkoAssociates.com

here are many ways for a doctor, osteopath, podiatrist or dentist to financially invest. Traditionally, this meant picking individual stocks and bonds. Today, there are many other ways to purchase securities en mass. For example:

MUTUAL FUND: A regulated investment company that manages a portfolio of securities for its shareholders.

Open End Mutual Funds: An investment company that invests money in accordance with specific objectives on behalf of investors. Fund assets expand or contract based on investment performance, new investments and redemptions. Trade at Net Asset Value or the price the fund shares scheduled with the US Securities and Exchange Commission (SEC) trade. NAV can change on a daily basis. Therefore, per-share NAV can, as well.

Closed End Mutual Funds: Older than open end mutual funds and more complex. A CEMF is an investment company that registers shares SEC regulations and is traded in securities markets at prices determined by investments. Shares of closed-end funds can be purchased and sold anytime during stock market hours. CEMF managers don’t need to maintain a cash reserve to redeem or / repurchase shares from investors. This can reduce performance drag that may otherwise be attributable to holding cash. CEMFs may be able to offer higher returns due to the heavier use of leverage [debt]. They are subject to volatility, less liquid than open-end funds, available only through brokers and may sells at a heavily discount or premium to [NAV] determined by subtracting its liabilities from its assets. The fund’s per-share NAV is then obtained by dividing NAV by the number of shares outstanding.  .

Sector Mutual Funds: Sector funds are a type of mutual fund or Exchange-Traded Fund (ETF) that invests in a specific sector or industry such as technology, healthcare, energy, finance, consumer goods, or real estate. Sector funds focus on a particular industry, allowing investors to gain targeted exposure to specific market areas. The goal is to outperform the overall market by investing in companies within a specific sector that is expected to perform well. However, they are also more susceptible to market fluctuations and specific sector risks, making them a more specialized and potentially higher-risk investment option.

STOCKS, BONDS AND MUTUAL FUNDS: https://medicalexecutivepost.com/2025/06/11/stocks-bonds-and-commodities/

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EXCHANGE TRADED FUNDS:  ETFs are a type of fund that owns various kinds of securities, often of one type. For example, a stock ETF holds stocks, while a bond ETF holds bonds. One share of the ETF gives buyers ownership of all the stocks or bonds in the fund. If an ETF held 100 stocks, then those who owned the fund would own a stake – albeit a very tiny one – in each of those 100 stocks.

ETFs are typically passively managed, meaning that the fund usually holds a fixed number of securities based on a specific preset index of investments. These are tax efficient. In contrast, many mutual funds are actively managed, with professional investors trying to select the investments that will rise and fall.

The Standard & Poor’s 500 Index is perhaps the world’s best-known index, and it forms the basis of many ETFs. Other popular indexes include the Dow Jones Industrial Average and the National Association of Securities Dealers Automated Quotations [NASDAQ] Composite Index.

ETFs based on these funds are called Index Funds and just buy and hold whatever is in the index and make no active trading decisions. ETFs trade on a stock exchange during the day, unlike mutual funds that trade only after the market closes. With an ETF you can place a trade whenever the market is open and know exactly the price you’re paying for the fund.

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

INDEX FUNDS: Index funds mirror the performance of benchmarks like the DJIA. These passive investments are an unimaginative way to invest. Passive index funds tracking market benchmarks accounted for just 21% of the U.S. equity fund market in 2012. By 2024, passive index funds had grown to about half of all U.S. fund assets. This rise of passive funds has come as they often outperform their actively managed peers. According to the widely followed S&P Indices Versus Active (SPIVA) scorecards, about 9 out of 10 actively managed funds didn’t match the returns of the S&P 500 benchmark in the past 15 years.

ASSESSMENT

Investing in individual stocks is psychologically and academically different than investing in the above funds, according to psychiatrist and colleague Ken Shubin-Stein MD, MPH, MS, CFA who is a professor of finance at the Columbia University Graduate School of Business  When you buy shares of a company, you are putting all your eggs in one basket. If the company does well, your investment will go up in value. If the company does poorly, your investment will go down. Fund diversification helps reduce this risk.

CONCLUSION

Investing in the above fund types will help mitigate single company security risk.

References: 

1. Fenton, Charles, F: Non-Disclosure Agreements and Physician Restrictive Covenants. In, 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.

Readings:

1. 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 

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

3.  https://www.ft.com

4. Shubin-Stein, Kenneth: Unifying the Psychological and Financial Planning Divide [Holistic Life Planning, Behavioral Economics, Trading Addiction and the Art of Money]. 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

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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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MARCINKO ASSOCIATES: How our Second Investment Portfolio Opinions are Different?

SPONSOR: http://www.MarcinkoAssociates.com

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We make second investment portfolio opinions affordable

Approximately 1 million allopathic physicians, 150,000 dentists, 200,000 osteopaths, 15,000 podiatrists and 6 million nurses often find it difficult to get an unbiased and fiduciary second opinion on their retirement or brokerage accounts. By offering second opinions for a flat fee, the monetary barriers that prevented colleagues from receiving a second opinion in the past have been removed.

We make second investment portfolio opinions convenient

Here’s how we work: you book an initial appointment with us, answer a few preliminary questions and email us your portfolio information. We then provide a second opinion. It is then up to you to incorporate or not.

INVESTMENT ADVISORY: https://medicalexecutivepost.com/2025/05/04/investment-advisory-portfolio-second-opinions-for-physician-colleagues/

We make second investment portfolio opinions timely

Financial markets, jobs and colleague age change like the weather. It is not always okay to wait a week, year or more, to seek a professional second financial portfolio opinion. You need to receive an opinion now. That’s where we come in. We are standing by, ready to take your email [MarcinkoAdvisors@outlook.com] and schedule a free initial consultation within two or three days, or less.

ASSET ALLOCATION: https://medicalexecutivepost.com/2024/10/23/musings-on-a-famous-portfolio-asset-allocation-study-3/

We make second investment portfolio opinions accurate

Fiduciary and non-sales orientated second opinions have the power to change financial lives in the long term. We’ve seen it happen many times. What characterizes a good second opinion? Three things: the opinion must be individualized to your investment portfolio[s], informed and results-oriented. That’s the informed fiduciary approach we take. We are colleagues and look forward to working with you.

PORTFOLIO MANAGEMENT: https://medicalexecutivepost.com/2025/05/27/physicians-personal-portfolio-management/

CONTACT: Ann Miller RN MHA CPHQ: Email: MarcinkoAdvisors@outlook.com

Invite Dr. Marcinko

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CMMI’s Evolving Strategy: Initial Indications from Recent Actions

By Health Capital Consultants, LLC

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On May 13th, 2025, the CMS Center for Medicare & Medicaid Innovation (CMMI) introduced a new strategic plan for its models going forward. After ending four payment models early and canceling two not-yet-implemented models in March 2025, the agency had promised to release a new strategy. Nearly two weeks later, CMMI released that strategy, as well as a preliminary evaluation of, and changes to, one of its core payment models.

This Health Capital Topics article will review CMMI’s recent actions and what initial indications these actions provide. (Read more…) 

LTC: https://medicalexecutivepost.com/2025/06/05/cms-proposes-increasing-inpatient-long-term-care-payments-2/

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PRIVATE EQUITY: Role in Vascular Medical Care

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Role of Private Equity in Vascular Care,” authored by HCC’s Todd A. Zigrang and Jessica Bailey-Wheaton, as well as Bhagwan Satiani, MD, and Hiranya A. Rajasinghe, MD, was featured in the recent issue of the Journal of Vascular Surgery – Vascular Insights published by the Society of Vascular Surgery.

 Read Here

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EDUCATION: Books

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