Introducing Parin Kothari MBA

Our Newest ME-P Thought-Leader

By Hope Rachel Hetico; RN, MHA, CMP™

[Managing Editor]Parin Kothari MBA

Parin Kothari is a seasoned management consultant with focus on strategy and operations. He earned his MBA from Syracuse University in New York and has eight years experience spanning various industries from automobiles & advertising to healthcare management & financial services.

Infamous Banking and Financial Services Industry

As Vice President of business architecture at Wells Fargo Bank, one of the leading financial institutions in US, Parin consults on realizing business strategy using information technology. He has presented at leading banks in Canada, Israel, Turkey and New Zealand, and is also a guest lecturer at Syracuse University. Besides working for the infamous banking industry, Parin is also a strong supporter of non profit work in the field of primary education. He works with several schools and non profit organizations in the San Francisco Bay area, as well as in developing countries such as Palestine, India, Cambodia and Iraql; and is deeply involved with education among Iraqi youth in Cambodia. 

Link: www.eachcentcounts.org

Assessment

We are all sure to learn much from Parin Kothari, our newest ME-P thought-leader.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

ME-P Now on Technorati Finance and Wikio Health

What is Technorati Authority and Wikio for Blogs?

By Staff Reporters

Pensive WomanOn Friday May 4th, 2007, Technorati.com was updated to include the Technorati Authority for blogs and listed on their Blog page and in search results. This update changed the earlier references of “N blogs link here” and “X links from Y blogs” with the single Technorati Authority number. On the blog page, it also shows the Technorati Rank.

Technorati Authority

Technnorati Authority [TA] is the number of blogs linking to a website, like this ME-P, in the last six months. The higher the number, the more Technorati Authority we have. It is important to note that Technorati measures the number of blogs, rather than the number of links. So, if a blog links to the ME-P many times, it still only counts as +1 toward our authority. Of course, new links mean the +1 will last another 180 days.

Technorati Calculations

Technorati Rank is calculated based on how far we are from the top. The blog with the highest Technorati Authority is the #1 ranked blog. The smaller our Technorati Rank, the closer we are to the top. Since at the lower end of the scale many blogs will have the same Technorati Authority, they will share the same Technorati Rank.

Technorati Rankings

The Technorati Top 100 shows the most popular 100 blogs based on Technorati Authority. The #1 ranked blog is the blog forum with the most other distinct blogs linking to it in the last 6 months. If our blog’s rank is, say 305,316, this indicates that there are 305,315 blog ranks separating our blog from the #1 position.

Help Increase our ME-P Rankings

The best way to increase our ME-P Technorati Authority is to write and submit cogent posts and fascinating comments that are interesting to other like-minded ME-P bloggers; so they’ll link to us. Why? Swagger, and free-labor journalistic entrepreneurship, of course. Linking to source material when you blog is also a great way to engage in conversation and help others find what you find interesting. Finally, since we want to let readers see our Technorati Authority on this blog, we have just installed the TA [and Wikio] widgets for all our ME-P readers and subscribers [June 2009]

Link: http://www.wikio.com/subscribe?url=http%3A%2F%2Ffeeds.feedburner.com%2FHealthcareFinancialsthePostForcxos.

Assessment

Remember, authority is determined by the number of unique blogs indexed by Technorati that have linked to us in the past 180 days. Thus, as links from blogs age out of this window and new links are added, our ME-P authority may rise, fall, or stay the same over time. Also, if the same blog links to us many times in the past 180 days, it only counts once towards our authority though it does renew the age of link. Additionally, the link must appear in our blog reactions to be applied to our authority. If the links are not in our blog reactions, please check to see if the blogs and/or your post with the links are in Technorati. If they are not, then encourage blog owners to ping Technorati; or better yet to claim their blogs in Technorati (gives the blog higher priority). And so, blogs are submitted for review and then indexed by Technorati for their blogs and posts.

Raising ME-P Authority

Your thoughts and comments on this Medical Executive-Post are appreciated to raise our Technorati Authority.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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http://www.BusinessofMedicalPractice.com

***

 

Become a Published Print Author with Us

The Business of Medical Practice [3rd Edition]

By Hope Rachel Hetico RN, MHA, CMP™

[Managing Editor]biz-book7

Dear Colleagues,

As you may know, we are commencing work on the third edition of our best selling book: The Business of Medical Practice

TOC 1st: http://www.amazon.com/Business-Medical-Practice-Maximizing-Doctors/dp/0826113117/ref=sr_1_8?ie=UTF8&s=books&qid=1231111232&sr=1-8

TOC 2nd: http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation to Contribute

Accordingly, we would be honored for you to consider contributing a new or revised chapter, in your area of expertise, for a low-effort but high-yield contribution. Our goal is to help physician colleagues and management executives benefit from nationally known experts, as an essential platform for their success in the healthcare 2.0 business industry. Many topics are still available: [health accounting and costing; law, policy and administration; Medicare fraud and abuse; coding and insurance; HIT, grid and cloud computing; finance and economics, competitive models, collaboration and leadership, etc].

Support Always Available

Editorial support is available, and you would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion. As a reader, or preferably a subscriber to the ME-P, your synergy in this space may be ideal. Time line for submission of a 5,000-7,500 word chapter is ample, and in a prose writing style that is “wide, not deep.” 

A Health 2.0 Initiative

And, be sure to address health 2.0 modernity. Update chapters from the second edition are also available. 

Definition: https://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives

Assessment

Please contact me for more details, if interested. A best selling-book is rare; while a third-edition volume even more so. Join us in this project. Regardless, we trust you will remain apostles of our core ME-P vision, “uniting medical mission and financial profit margin”, promoting it whenever possible.

Front Matter Link: frontmatter1advancedbusinessmedicine4 

Contact Info:

MarcinkoAdvisors@msn.com

770.448.0769

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Allscript’s Glenn Tullman is Video Interviewed

Join Our Mailing List

Video Clip from the HIMSS Meeting

By Ann Miller; RN, MHA

[Executive-Director]

stk323168rknThere is a major controversy in the modern healthcare community over eMRs and how to pay for them; or even if they are effective in improving medical outcomes. Of course, by eMRs we mean interoperable medical records that span the pan-healthcare ecosystem; and not just the stand-alone digital records that many, if not most, physicians use in their daily practices to some degree or another.

Link: https://healthcarefinancials.wordpress.com/2009/03/10/on-the-hitech-act-of-2009/

Proponents

As readers of the ME-P are aware, one vocal camp supports certification and eMR industry mandates, standards, and governmental initiatives, etc. The recent $20 billion taxpayer input from the Obama Administration, courtesy of HITECH, further emboldens CCHIT and related wonks.

Opponents

One the other hand, one vocal ME-P opponent is dentist Darrell Pruitt. He and many others believe that current eMRs may be too expensive, unwieldy, and counter-productive. This camp advocates a mix of other data sources, technology processes and doctor/patient education to get us where we need to be in terms of improving medial outcomes; quicker and less expensively.

Assessment

Rather than read, research and write more on this controversy, which was apparently a red-hot topic at the recent HIMSS meeting, we have embedded a video link of Glen Tullman [CEO of Allscripts] and Mark Leavitt, [Chair of CCHIT], below.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictment/

It even includes a clip of Jonathan Bush, CEO of AthenaHealth. And, although they don’t all agree; some common ground may be developing in this controversial issue.

Source: This link originally appeared on The Health Care Blog [THCB], by Matthew Holt.

Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/04/cats-and-dogs-on-film–tullman-leavitt-bush.html#comments

Disclaimer:We are members of AHIMA, HIMSS, MS-HUG and SUNSHINE. We just released the Dictionary of Health Information Technology and Security, with Foreword by Chief Medical Information Officer Richard J. Mata; MD MS MS-CIS, of Johns Hopkins University; and the second edition of the Business of Medical Practice with Foreword by Ahmad Hashem; MD PhD, who was the Global Productivity Manager for the Microsoft Healthcare Solutions Group at the time.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

 

Product Details 

More about Healthcare Organizations [Financial Management Strategies]

Our Print-Journal Preface

By Hope Rachel Hetico; RN, MHA, CMP™hetico1

As Managing Editor of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our Preface.

A Two-Volume Guide

As so, our hope is that Healthcare Organizations: [Financial Management Strategies] will shape the hospital management landscape by following three important principles.

What it is – How it works

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace. Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Second, our writing style allows us to condense a great deal of information into each quarterly issue.  We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists.  The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite.  Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.ho-journal9

www.HealthcareFinancials.com

Assessment

Rest assured, Healthcare Organizations: [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to your subscription. Most importantly, we hope to increase your return on investment [ROI] in some small increment.

Visit and Order Now

Specialty Technical Publishers

8 – 14th Street

Blaine, WA 98230

1-800-251-0381

orders@stpub.com

http://www.stpub.com/pubs/ho.htm

TOC: http://www.stpub.com/pdfs/toc_ho.pdf

Conclusion

And so, your thoughts and comments on this Medical Executive-Post, complimentary e-companion are appreciated. If you would like to contribute material or suggest topics for a future update, please contact me. Subscribers, have we attained our goals and objectives, as a work-in-progress in this preface statement?

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

About: Healthcare Organizations [Financial Management Strategies]

Our Print Mission Statement

[By Dr. David Edward Marcinko; MBA, CMP™]

Publisher-in-Chief

dem25As Editor-in-Chief of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our mission statement; or the journal’s raison d’etra.

A Two-Volume Guide

As so, Healthcare Organizations: [Financial Management Strategies], with its quarterly updates, will promote and integrate academic and applied research, and serve as a multi-disciplined communications forum for the dissemination of financial, managerial, business and related economic information to decision makers in hospitals, outpatient centers, clinics, medical practices and all mature and emerging healthcare organizations. 

Target Market and Ideal Reader

Healthcare Organizations [Financial Management Strategies] and its quarterly updates should be in the hands of all:

* CFOs, CEOs, COOs, CTOs, VPs and CIOs from every type of hospital and healthcare organization including: public, federal, state, Veteran’s Administration and Indian Health Services hospitals; district, rural, long-term care and community hospitals; specialty, children’s and rehabilitation hospitals; diagnostic imaging centers and laboratories; private, religious-sponsored, and psychiatric institutions.

*  Physician Hospital Organizations, Management Services Organizations (MSOs), Independent Practice Associations (IPAs), Group Practices Without Walls (GPWWs), Integrated Delivery Systems (IDSs) and their administrators, comptrollers, cost accountants, budget directors, cash managers, auditors, healthcare attorneys and consultants,  and actuaries, and all endowment fund directors, executives, consultants and strategic financial managers.

*  Ambulatory care centers, hospices, and outpatient clinics; skilled nursing facilities, integrated networks and group practices; academic medical centers, nurses and physician executives; business school and health administration students, and all economic decision-makers and directors of allopathic, dental, podiatric and osteopathic healthcare organizations.

Assessment

After publication, my suggestion is to read, study and act upon the guide in this way:

1. First, browse through the entire text.

2. Next, slowly read those chapters and sections that are of specific interest to your professional efforts.

3. Then, extrapolate portions that can be implemented in specific strategies helpful to your healthcare setting.

4. Finally, use its’ ME-P updates as a reference manual to return to time and time again; and enjoy!

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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I Jealously “Shake my Fist” at Somnath Basu PhD

On CFP® Mis [Trust] – One Doctor’s Painful Personal Experience

[“So Sorry to Say it … but I Told You So”]

By: Dr David Edward Marcinko; FACFAS, MBA, CMP™

[Publisher-in-Chief]dem21

According to Somnath Basu, writing on April 6, 2009 in Financial Advisor a trade magazine, the painful truth is that many financial practitioners are merely sales people masquerading, as financial planners [FPs] and/or financial advisors [FAs] in an industry whose ethical practices have a shameful track record. Well, I agree, and completely. This includes some who hold the Certified Financial Planner® designation, as well as the more than 98 other lesser related organizations, logo marks and credentialing agencies [none of which demand ERISA-like fiduciary responsibility]. For more on this topic, the ME-P went right to the source last month, in an exclusive interview with Ben Aiken; AIF® of Fi360.com  

fp-book4

The CFP® Credential – What Credential?

Basu further writes that stockbrokers and insurance agents who earn commissions from buying and selling stocks, insurance and other financial products realize that a Certified Financial Planner® credential will help grow the volume of their business or branch them into other related and lucrative products and services. After all, there are more than 55,000 of these “credentialed” folks. And, this marketing designation seems to have won the cultural wars in the hearts and minds of an unsuspecting – i.e., duped public; probably because of sheer numbers. Didn’t a CFP Board CEO state that its’ primary goal was growth, a few years ago? Can you say “masses of asses”, as the oft quoted Bill Gates of Microsoft used to say when only 2,000 micro-softies defeated 400,000 IBMers during the PC operating system wars of the early 1980’s. Quantity, and marketing money, can trump quality in the public-relations business; ya’ know … if you repeat the lie often enough … yada … yada … yada! Yet, as the so-called leading industry designation, the CFP® entry-barrier standard is woefully low. Moreover, the SEC’s [FINRA] Series #7 general securities licensure sales examination is not worth much more than a weekend’s study attention, even to the uninitiated.

insurance-book2

Easy In – Worth Less Out

In our experience, we agree with Basu and others who suggest that scores of lightly educated, and sometimes wholly in-articulate and impatient individuals are zipping through the CFP® Board of Standards approved curriculum in three to six months of online, on-ground, or “self-study”. But, that some can do so without a bachelor’s degree when they join wire-houses and financial institutions, which cannot be trusted to adequately train them, is an abomination. And, even more sadly, some of these CFP™ mark-holders, and other folks, believe they have actually received an “education” from same. Of course, their writing skills are often non-existent and I have cringed when told that, in their opinion, advertiser-driven trade magazines constitute “peer-reviewed” and academic publications. Incidentally, have you noticed how thin these trade-rags are getting lately? Much like the print newspaper industry, are they becoming dinosaurs? One agent even told me, point-blank, that his CLU designation was the equivalent of an “academic PhD in insurance.” This was at an industry seminar, where he thought I was a lay insurance prospect.

THINK: No critical thinking skills.

biz-book4

Education

There is another sentiment that may be applied in many of these cases; “hubris.” I mean, these CFP® people … just don’t know – how much they don’t know.”  The very real difference between training versus education is unknown to many wire-houses and FAs, isn’t it? And, please don’t get me started on the differences in pedagogy, heutagogy and androgogy. Moreover, it’s sad when we see truly educated youngsters become goaded by wire-houses into thinking that these practices are de-rigor for the industry. One such applicant to our Certified Medical Planner™ program, for example, had both an undergraduate degree in finance and a graduate degree in economics from the prestigious Johns Hopkins University – in my home town of Baltimore, MD [name available upon request]. He was told, in his Smith Barney wire-house training program, to eschew CMP™ accountability and RIA fiduciary responsibility, when working with potential physician and lay clients; but to get his CFP® designation to gather more clients. To mimic my now 12 year-old daughter; it seems that: SEC Suitability Rules – and – Fiduciary Accountability Drools. And, to quote Hollywood’s “Mr. T”; I pity the fools, er-a, I mean clients. But, T was an actor, and this is serious business.

cmp-logo1

Of CEU Credits and Ethics

Beside trade-marks and logos, we are all aware that continuing education, and a code of ethics, is another important marketing and advertising component of state insurance agents and CFP licensees. It’s that old “be” – or “pretend to be” – a trusted advisor clap-trap. Well, I say horse-feathers for two reasons. First, both my insurance and CFP® Continuing Educational Unit [CEU] requirements were completed by my daughter [while age 7-10], by filling in the sequentially identical and bubble-coded, multiple-choice, answer-blanks each year. Second, this included the mandatory “ethics” portions of each test. When I complained to my CEU vendor, and state insurance department, I was told to “enjoy-the-break.”  My daughter even got fatigued after the third of fourth time she took the “home-based tests” for me.  After I opened my big mouth, the exact order of questions was changed to increase acuity, but remained essentially the same, nevertheless. My daughter got bored, and quit taking the tests for me, shortly thereafter. She always “passed.”dhimc-book3

Thus, like Basu, I also find that far too many financial advisors are unwilling to devote the time necessary to achieve a sound education that will help attain their goals, and would rather sell variable or whole life products than simple term life, even when the suitability argument overwhelmingly suggests so, for a higher payday. We not only have met sale folks without undergraduate degrees, but also too many of those with only a HS diploma, or GED. Perhaps this is why a popular business truism suggests that the quickest way for the uneducated/under educated class to make big bucks, is in sales. Just note the many classified ads for financial advisors placed in the newspaper job-section, under the heading “sales.” Or, in more youthful cultural terms, “fake it – until you make it.”

Of the iMBA, Inc Experience

According to Executive Director Ann Miller RN MHA, and my experience at the Institute of Medical Business Advisors, Inc:

“Far too many financial advisors who contact us about matriculation in our online Certified Medical Planner™ program – in health economics and management for medical professionals – don’t even know what a Curriculum Vitae [CV] is? Instead, they send in Million Dollar Roundtable awards, Million Dollar Producer awards, or similar sales accomplishments as resume’ boosters. It is also not unusual for them to list some sort of college participation on their resumes, and websites, but no school affiliation or dates of graduation, etc. And, they become furious to learn that we require a college degree for our fiduciary focused CMP™ program, and not from an online institution, either. The onslaught of follow-up nasty phone-calls; faxes and emails are laughable [frightening] too.”  

www.MedicalBusinessAdvisors.com

Assessment

More often than not, it is the financial institutions that FAs and CFP™ certificants’ work for that reward sales behavior with higher commissions, rather than salaries; which encourage such behavior and create the vicious cycles that are now the norm.

THINK: ML, AIG, Citi, WAMU, Wachovia, Hartford, Prudential, etc.

Note: Original author of Restoring Trust in the CFP Mark, Somnath Basu PhD, is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu. We have asked him to respond further.

My Story: I am a retired surgeon and former Certified Financial Planner® who resigned my “marketing trademark” over the long-standing fiduciary flap. I watched this chicanery for more than a decade after protesting to magazines like Investment Advisor, Financial Advisor, Registered Rep, Financial Planner, the FPA, etc; up to, and even including the CFP® Board of Standards; to no avail. Feel free to contact me for a copy of a 43 page fax, and other supportive documentation from the CFP® Board of Standards – and their outsourced intellectual property attorneys – over a Federal trademark infringement lawsuit they tried to institute against me for innocent website errors placed by a visually impaired intern. Obviously, they disliked the launch of our CMP™ program. As a health economist and devotee of Ken Arrow PhD, I polity resigned my license, as holding no utility for me, to the shocked CFP Board. They later offered to consider re-instatement for a mere $600 fee with letter of explanation, to which I politely declined. Of course, my first thought after living in the streets of South Philadelphia while in medical school, during the pre-Rocky era, was to say f*** off – but I didn’t. Nevertheless, I still seem to be on their mailing list, years later. No doubt, the list is sold, and re-sold, to various advertisers for much geld. And, why shouldn’t they; an extra bachelor, master and medical degree holder on their PR roster looks pretty good. I distrust the CFP® Board almost as much as I distrust the AMA, and its parsed and disastrous big-pharma funding policies. Right is right – wrong is wrong – and you can’t fool all of the people, all of the time, especially in this age of internet transparency.

Shaking my Fist at Somnath … in Envy

And so, why do I shake my fist at Somnath Basu? It’s admittedly with congratulations, and a bit of schadenfreude, because he wrote an article more eloquently than I ever could, and will likely receive much more publicity [good or slings-arrows] for doing so. You know, it’s very true that one is never a prophet in his own tribe. Oh well, Mazel Tov anyway for stating the obvious, Somnath. The financial services industry – and more specifically – the CFP® emperor have no clothes! Duh!

ho-journal5

Good Guys and White Hats

Now that Basu’s article has appeared in Financial Advisor News e-magazine, the other industry trade magazines are sure to follow the CFP® certification denigration reportage, in copy-cat fashion. And, the fiduciary flap is just getting started. This is indeed unfortunate, because I do know many fine CFP® certificants, and non-CFP® certified financial advisors, who are well-educated, honest and work very diligently on behalf of their clients. It’s just a shame the public has no way of knowing about them – there is no white hat imprimatur or designation for same – most of whom are Registered Investment Advisors [RIAs] or RIA reps. For example, we know great folks like Douglas B. Sherlock MBA, CFA; Robert James Cimasi MHA, AVA, CMP™; J. Wayne Firebaugh, Jr CPA, CFP®, CMP™; Lawrence E. Howes MBA, CFP®; Pati Trites PhD; Gary A. Cook MSFS, CFP®, CLU; Tom Muldowney MSFS, CLU, CFP®, CMP™;  Jeffrey S. Coons PhD, CFP®; Alex Kimura MBA, CFP®; Ken Shubin-Stein MD, CFA; and Hope Hetico RN, MHA, CMP™; etc. And, to use a medical term, there are TNTC [too many, to count] more … thankfully!

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Social Media in Health 2.0

Join Our Mailing List

Emerging Collaborative Trends

[By Staff Reporters]

stk166326rkeAll readers of the ME-P are aware that social media is going to play a significant role in health 2.0 initiatives going forward.

Social Media Use Growing

According to Dan Bowman of FierceHealthIT, on April 3, 2009, whether we want it to happen or not, social media – much like mobile technology – is going to play a big role in the future of healthcare. From professional networks, to collaborative consumer media and doctor rating websites, healthcare professionals across the nation are jumping on the bandwagon. And, with the federal government pushing physicians’ offices to utilize electronic medical records, it is only a matter of time before healthcare make a concerted push into social media, as well.

Publishers and Editors

“As a medical, practice management and health economics writer for almost four decades, I appreciated how electronic connectivity and social media facilitates communication in a quick and effective manner, and allows broadcast to large groups of people”

Dr. David Edward Marcinko; MBA

[ME-P Publisher-in-Chief]

The Research

A Manhattan Research survey found that 60 million US healthcare consumers use social media to find healthcare information online. A similar survey found that 60 percent of physicians are interested in, or are already using physician social networks. That same study concluded that “physicians who are currently participating in online physician communities and social networks write a mean of 24 more prescriptions a week than” their more old-fashioned counterparts.

Assessment

Of course, more Rxs – or more medical care for that matter – is not a quality indicator at all. Nevertheless, social media is not to be taken lightly.

Link: http://www.fiercehealthit.com/tags/ozmosis?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FHI

Conclusion

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Impact of Size on Mutual Fund Performance

Vital Information for Doctors to Consider

[By Dr. David Edward Marcinko; FACFAS, MBA, CMP™]

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]dave-and-hope3

The actual size of a mutual or index fund, in terms of amount of assets, and the growth rate of a fund are the two aspects of size to consider. The impact of size on mutual fund performance varies—it can be negative, neutral, or positive. Size affects different types of funds differently; it also affects the manager’s ability to achieve objectives. Monitor size changes and make investment decisions accordingly.

Economies of Scale

A relatively large amount of assets available to a portfolio manager presents various economies. The costs at most funds (e.g., expense ratios) are reduced as a percentage of net asset value as the fund grows. Expense ratios can have a major impact on performance. In addition to being an effect of size, low fees can cause size changes. Funds do at times waive some fees to attract assets.

Asset Base

A larger asset base provides more liquidity to a fund. With more assets, the manager can buy more shares and more stocks. Transaction costs are reduced if higher trading volumes are achieved. A larger asset base also can reduce relative tax costs. Realized but undistributed capital gain can be spread over more shares at the time of year-end distribution. A larger asset base and manager success attracts higher-caliber managers to the management team.

fp-book20

Fund Growth

Growth of fund assets impairs certain funds more than others. Generally, bond funds are less affected by asset growth and size than equity funds. Growth may have a positive impact on bond funds because buying bonds of similar characteristics further diversifies credit, event, and other risks. Equity funds that invest in larger capitalization stocks can be less affected than funds buying less liquid small-cap stocks. (This is so because funds usually limit their investments in a single company, i.e., many funds will not buy more than 5% of a specific company. Five percent of a small company uses up less cash than 5% of a large company. Therefore, a small-cap fund is more likely to exhaust its choice of available companies sooner than a large-cap fund. A large-cap fund could increase its investment to a 5% level, whereas a small-cap fund may already be fully invested in the companies the manager likes to own.)

Growth Rate

The rate of growth can affect performance. Rapid growth may mean that a large portion of the portfolio remains un-invested. A rapidly growing growth-type equity fund with a high percentage of cash earns lower returns in a rising market than a fully invested fund. With rapid growth, the fund may not provide pure exposure to the desired asset class. At a certain point, however, fund asset growth impairs the manager’s ability to achieve objectives. For this reason, funds often close to new investors or to new investment once they have reached a certain size. Growth affects managers in many ways. Many fund managers or teams of managers direct a number of funds and possibly even private accounts. As the fund grows, managers are spread thin and may have difficulty in reacting quickly or efficiently to changing market conditions. Managers may need to hire assistant portfolio managers or delegate work to analysts or other employees. As a result, the manager manages people, administration, or internal quality control systems rather than studying companies or investment strategies. Also, a manager may become complacent in periods of rapid asset growth. Such growth can mean their own compensation is substantially greater, which may in turn change the manager’s motivation. Rapid growth often changes a fund because there are not enough opportunities to invest in the targeted securities. For example, a fund can change from aggressive to conservative, small cap to large cap. Managers may have to slow trading or increase liquidity in the portfolio to prevent this occurrence.

Meaningful Positions Difficult

Rapid growth or a large asset base can prevent managers from taking meaningful positions in market sectors they believe will outperform others. Smaller funds are more flexible and may take advantage of opportunities or liquidate unwanted positions faster than larger funds. A large fund that owns a significant position will negatively affect a security’s market price if it unloads shares all at one time. Rapid growth also impairs research of funds, affecting an investor’s choice of funds. A fund with outstanding performance over the past 5 years and a $150 million asset base may be much different when its base grows to $1 billion; at that point, it may no longer be the “right choice” for an investor.

insurance-book9Asset Declinations

Just as rapid asset growth affects performance, a rapid decline of fund assets also may impact performance. Significant quantities of redemptions over short periods force managers to liquidate security positions, often at the wrong time (i.e., they would rather be buying in a declining market than selling to accommodate redemptions). To prevent this scenario, some funds have redemption charges to discourage investors from such short-term decisions. Such environments can negatively impact bond funds as easily as equity funds. Large redemptions compound the effect of declining fund net asset values.

What a Doctor-Investor Can Do?

What can physician-investors do to avoid negative effects on investment? Avoid overloading a portfolio with hot, rapidly growing funds, if possible. Generally, size should be a neutral factor for most bond funds. Small and/or aggressive equity funds can be affected by growth, however. Emphasize funds that promise to close to new investors after assets reach a certain size. Once a fund becomes large, monitor it closely for problems caused by the growth. If there is a better, smaller fund, it may be wise to change. Also, closed-end funds are always a possibility. These funds have a major advantage in that their asset base is a factor of growth in security values, not new investment (unless the fund makes a secondary stock offering). Closed-end managers work with a finite portfolio, which reduces the problem of sudden asset growth.

Assessment

To the extent that a lack of SEC and FINRA over-sight, and the recent financial, insurance and banking meltdown has affected the above; such investing is left up to the doctor’s discretion and personal situation.  When it comes to the financial services product sales industry; always remember “caveat emptor” or “buyer-beware.”

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

Conclusion

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Impact of Performance Fees on Mutual Funds and Physician Portfolios

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More Complex than Realized by Some Doctors

[By Dr. David Edward Marcinko; FACFAS, MBA, CMP™]

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]dave-and-hope4

Physician-investors may find themselves paying advisory fees, brokerage commissions, and other sales charges and expenses. All of these layers of expense can reduce or eliminate the advantage of professional management, if not monitored carefully. Also, fees can have a major impact on investment results. As a percentage of the portfolio, they normally range from low of 15–30 basis points (or .15% to .30%, a basis point is one one-hundredth of one percent) to a high of 300–400 basis points or even higher.

Charges are Universal

All portfolio managers, mutual funds, and investment advisors charge fees in one form or another. Ultimately, they must justify their fees by creating value added, or they would not be in business. Value added includes tangibles, such as greater investment return, as well as intangibles, such as assurance that the investment plan is successfully implemented and monitored, investor convenience, and professional service.

Comparisons Required

Always compare investment performance of funds or managed accounts after fees are deducted; only then can adequate comparisons be made. Also, compare fees within asset classes. Management fees and expenses of investing in bonds or bond funds are much different than the fees of investing in, for example, small companies or emerging market stocks. Whereas 100–200 basis points of fees may be appropriate for an equity portfolio or fund, similar charges may offset the advantages of a managed bond portfolio. With managed bond portfolios, real bond returns have limited long-term potential, because returns are ultimately based on interest rates. For example, if a 3% real (i.e., after inflation) return is expected, 200 basis points in fees may produce a negative after-tax result: 3% real return minus 2% fees minus 10% taxes equals a negative 9% total return.fp-book22

Sales Charges

Mutual funds (and some private portfolio managers) charge sales charges to sell or “distribute” the product. Investors who buy funds through the advice of brokers or “commission based” financial planners will pay a sales load. The many combinations of sales charges fall into three basic categories: front-end, deferred (or back-end), and continuous.

Front-End Fees

Front-end fees are a direct assessment against the initial investment and are limited to a maximum of 8.5%. They usually are stated either as a percentage of the investment or as a percentage of the investment, net of sales charges. For example, a 6% charge on a $10,000 investment is really a $600 charge to invest $9,400 or a real charge of 6.4%. Many low-load funds charge in the range of 1% to 3%. Rather than pay brokers or other purveyors, these fund companies or sponsors use the charges to offset selling or distribution costs. Although rare, some funds charge a load against reinvested dividends.

Deferred Charges

Deferred charges (or back-end loads, or redemption fees) come in many forms. Often, the longer the investor stays with the fund the smaller the charge is upon fund redemption. A typical sliding scale used for deferred charges may be 5-4-3-2-1, where redemption in year 1 is charged 5%, and redemption in year 5 is charged 1%; after year 5, there are no sales charges. Sometimes deferred charges are combined with front-end charges.

Redemption Fees

Certain quoted redemption fees may not apply after a period, such as one year. Funds often use such fees to discourage the trading of funds. Frequently, these charges are paid to the fund itself rather than to the fund management company; or broker. Long-term physician investors actually benefit from this fee structure; short-term shareholders who redeem shares bear the additional liquidation costs to satisfy redemption requests.

Continuous Charges

Continuous sales charges, known as 12b-1 fees for the SEC rule governing such charges, represent ongoing charges to pay distribution costs, including those of brokers who sell and maintain accounts, in which case they are known as “trail commissions.” The fund company may be reimbursed for distribution costs as well. In the prospectus, funds quote 12b-1 charges in the form of a maximum charge. This does not mean that the full charge is incurred, however. For example, a fund with a .75% 12b-1 approved plan may actually incur much lower expenses than .75%. Compared to front-end charges, a .75% per year sales charge of this type could be more costly to investment performance, given enough time.

Sales Loads

Portfolio managers can charge sales loads as well, usually in the form of a traditional WRAP fee arrangement (the investor pays a broker an all-inclusive fee that covers portfolio manager fees and transactions costs). No-load funds can be purchased through brokers or discount brokerage firms. The broker charges a commission for such purchases or sales.

Management Advisory Fees

Private account managers and mutual funds charge a fee for managing the portfolio. These fees typically range between 25 and 150 basis points. Bond funds tend to charge in the range of 25 to 100 basis points, and equity funds charge 75 to 150 basis points. Fees charged by private account managers usually are higher because of the direct attention given to a single doctor client. These managers do not pass along additional administrative costs, however, because they pay them out of the management fee. These management fees come in many forms. Tiered fees can charge smaller accounts a higher fee than larger accounts. Mutual funds often charge “group fees”: a fund family may tier its fee structure to encompass all funds offered by the fund family or by a group of similar funds (such as all international equity funds). Performance fees, although subject to SEC regulations, may be charged as well. A performance fee may be charged if the manager exceeds a certain return or outperforms a particular index or benchmark portfolio.

Administrative Expenses and Expense Ratios

Most private managers are compensated with higher management fees, as mentioned above. Therefore, many private accounts usually do not incur separate administrative expenses. Some management firms charge custodial fees or similar account maintenance fees. Mutual funds incur a number of administrative expenses, including shareholder servicing, prospectuses, reporting, legal and auditing costs, and registration and custodial costs. Mutual funds report these expenses and management fees as an expense ratio—the ratio of expenses to the average net assets of the fund. Expense ratios also include distribution costs or 12b-1 charges.insurance-book10 

Brokerage Commissions

Almost all buyers and sellers of securities incur brokerage commissions. Private “wealth managers” usually provide commission schedules to prospective physician-investors or current clients. Some private managers charge higher management fees and a discounted commission schedule, while others charge lower fees and higher commissions. These combinations of management and commission fees make comparison of prospective managers’ cost structures a difficult task. Most portfolio managers obtain research from brokerage firms, which can affect the commission relationship between broker and manager. Reduced commission schedules exchanged for information are known as “soft dollar costs.” Mutual funds may negotiate similar reduced commission schedules. In this regard, more-competitive brokerage firms can charge lower fees to investors. Commissions are not part of the expense ratio, because they are a part of the security cost basis. Firms with higher portfolio turnover are more likely to have higher commission costs than those with low turnover. Asset class impacts such costs as well. For example, small-cap stocks may be more expensive than large-cap stocks, or foreign bonds may be more expensive than domestic bonds.

Total Cost Approach

To arrive at a relevant comparison of fees among funds and managers, and to see what the total effect of fees on investment performance is, analyze the various charges on a net present value basis. Begin with a given investment amount (e.g., $10,000) and factor in fees over time to arrive at the present value of those fees. Present the comparisons in an easy-to-use table.

Sources of Fee Information

Consult the mutual fund prospectus for fee information. The prospectus has a fund expenses section that summarizes sales charges, expense ratios, and management fees; it does not cover commissions, however. Expense ratios usually are reported for the past 10 years. Commission or brokerage fees are more difficult to find. The statement of additional information and often the annual report disclose the annual amounts paid for commissions. When the total commission paid is divided by average asset values a sense of commission costs can be determined. Private wealth managers disclose fee structures in the ADV I filed with the SEC. Managers must disclose these fees to potential and current clients by providing either ADV Part II or equivalent form to the investor.

Reporting Services

Reporting services, such as Morningstar and Lipper, provide similar information from their own research of mutual funds. These services can be extremely beneficial, because fee information is summarized and often accounted for in the reports’ investment return calculations. This helps the investor and planner make good comparisons of funds. Information services that cover private managers provide information, primarily about management fees.

Assessment

To the extent that online trading, deep discount brokerages, lack of SEC and FINRA oversight, and the recent financial, insurance and banking meltdown has affected the above, it is left up to your discretion and personal situation. Generally, all fess are, and should be, negotiable.

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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About Sharkey, Howes & Javer

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Enhanced Listing about Our Practiceshj

At Sharkey, Howes & Javer, we specialize in people, their money and their choices. We offer our clients peace of mind and the guidance to help them make wise lifetime decisions along their path to success.

Team Approach

We are a team, working in partnership with our clients and their other professional advisors to ensure a comprehensive approach to long-lasting financial decisions.

Our History

We were established in Denver, Colorado in 1990, when Eileen M. Sharkey, CFP®, formed the firm of Sharkey, Howes & Javer, a partnership with Lawrence E. Howes, MBA, CFP® and Joel B. Javer, CLU, CFP®. Since then, our team of professional planners and support staff has grown to serve over 1000 clients.

Industry Acknowledged Certifications

Larry Howes, MBA, AIF®, CFP® is a founder and principal of Sharkey, Howes & Javer, Inc., a firm that provides financial planning and portfolio management to individuals and businesses. He received his MBA from Regis University and Bachelor of Science degree in Management from Metropolitan State College in Denver and was admitted to the Registry of Financial Planning Practitioners in 1986. He received his CFP® designation in 1987. Larry was awarded an AIF®, Accredited Investment Fiduciary, in 2004 from the University of Pittsburgh. He is also a Certified Medical Planner™ (Hon).

Fiduciary – Yes

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Published Authors and Educators

Mr. Howes is an adjunct professor of financial planning at Metropolitan State College – Denver.

Larry teaches the Investment course for the Certified Financial Planning certification program for Metro.

Larry is a featured writer for the Metropolitan Denver Dental Society’s journal entitled Articulator.  Larry is also a featured writer for Colorado Medicine.  In addition, Larry co-authored the Estate Planning and Execution chapter in the book entitled the Financial Planning Handbook for Physicians and Advisors

 

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Clean CRD record – Yes

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More information:

Tammy K. Durnford; MA

Manager of Client Relations

tammy@shwj.com

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By Ann Miller; RN, MHA

[Executive Director]solo-consultant

We would like to better understand who is visiting the Medical Executive-Post, and what you like, or do not like, about our blog site, print journal and/or communications forum. Most of all, we wish to know who is just visiting versus who is posting, commenting and subscribing; and why?

Assessment

Your responses are confidential, and will only be used for internal use to improve the website blog. We will not sell your information to anyone, ever!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please send in your considered responses to me at: MarcinkoAdvisors.@msn.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Healthcare Experts versus Health Journalists

Appreciating the Distinction

By Dr. David Edward Marcinko; MBA

Publisher-in-Chiefdr-david-marcinko2

As the healthcare reform, and eMR controversy unfolds, I am struck by the more-than-linguistic distinction between the terms “healthcare expert” and “health journalist.”

Link: www.HealthDictionarySeries.com

Historical Perspectives

Historically, as a peer-reviewed writer, editor, medical expert witness and now electronic publisher for almost four decades, I always sought the journalist’s title. I think the longing began in my formative years when I read that after the French Revolution, Sir Edmund Burke, looked up at the Press Gallery of the House of Commons, and said, ‘”Yonder sits the Fourth Estate, and they are more important than them all.”

Link: www.MedicalBusinessAdvisors.com

Expert versus Reporter

However, I no longer covet this title. Why? I’ve finally realized that it is far better to be a real subject-matter expert, than a journalist [read reporter]. The former creates news through knowledge, informed deeds and thought-leadership; while the later simply writes about various topics without same.

Link: www.HealthcareFinancials.com

Assessment

And so, in light of the eHR controversy, perhaps a word to the “wise” AMA, ADA, APMA, AOA and CCHIT leadership is sufficient; with apologies to Sir Edmund? Regardless of specialty, our guiding medical principles should always be; Omnia pro Aegroto [all for the patient].

Link: https://healthcarefinancials.wordpress.com/2009/01/31/about-the-ahcj/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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On Emergency Funds for Physicians

dr-david-marcinko3Cash Reserves Now More Important Than Ever!

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

CEO: www.MedicalBusinessAdvisors.com

This is a basic question in financial planning circles that has generated much activity in the medical community, of late. Previously considered so mundane – as to be dismissed by some haughty physicians – it has acquired increased urgency with the current financial meltdown.

What Security Level Desired?

Yet, the answer to this question is dependent upon the security level desired by the medical provider and his/her family. Traditionally, financial planners suggested most people with solid employment, and transferrable skills, have at least three months of living expenses (not including taxes) in a reserve fund that is easily accessible (i.e., liquid). The amount needed for a one-month reserve is equal to the amount of expenses for the month, rather than the amount of monthly income. This is because during no-income months – there is no income tax.

The Usual Checklist

We suggest the following questions as helpful in determining the amount of reserve needed by medical professionals:

1. How many incomes do you have in your household?

2. How secure is your current practice, or medical job?

3. Do you have other unrelated sources of income; medically or non-medically related?

4. How long would it take you to find another position in your specialty, if suddenly unemployed? [Hint: Assume one month per ten grand of income; at $150-k annually, this means searching for 15 months].

5. How much money do you spend, and save, each month?

6. Would you be willing [able] to lower your monthly [fixed or variable] expenses, if you were unemployed?

Many Factors to Considerinsurance-book1

But, many other factors come into play when determining how much money a particular physician and his/her family should have on hand. Does the family have one income or two? How stable is this income source? Does the doctor work for himself [managing partner], or is she employed [minority partner, associate, etc]? What kind of firm, company or hospital employs him; private, HMO, MCO, Federal or State entity? Does the family use all of the income each month? What about, life, health, disability or LTC insurance as fringe benefits? Does the family anticipate the possibility of large liability exposures and expenses occurring in the future (i.e., medical school or practice start-up debt, private tuition for the kids, medical expenses, liability suits etc.)? Are you willing to relocate for a new job?

Family Situation Appraisal

If the doctor is in a dual-income family – with stable incomes – and/or lives on a single income – the need for a liquid reserve is minimal; but still much more than for the average layman. On the other hand, if the doctor is a single individual, with an unstable income and she spends everything each month, the need for a liquid cash reserve is higher.

In the previous example, and in the stable past, the doctor may have opted for a six-to-nine month reserve if the need for security was high; and a three-to-six month reserve if the need for security was low. For the last five to seven years however, we have suggested to our medical clients that they expand this reserve cash corpus to 12-24 months; and as a blanket rule of thumb for all medical professionals. Of course, I was roundly criticized for it; until now.

Today, we are suggesting 3-5 years; with considerably less criticism. Cash is power, choice, swagger, potency, freedom and represents options. Acquire it!

Stashing the Cash

Once the amount of reserve is determined, the doctor should consider the appropriate investment vehicles for the reserve fund. At minimum, the reserve should be invested in a money market mutual fund with NAV @ 1.00 USD. Larger income earners may opt for tax-exempt money market mutual funds, as needed.  For larger reserves, an ultra-short term, no-low bond fund, might be appropriate for amounts over three months – in periods of deflation; not so during inflationary periods.

Assessment

Today, we recommend doctors keep 3-5 years of cash-on-hand. Yes, I am aware of the “paradox-of-thrift” conundrum. But, do you want to help the domestic GDP, or your family; you decide? Personally, my own concern is not the macro-economic milieu.

Full disclosure: I am a former insurance agent, registered investment advisor; board certified surgeon and Certified Financial Planner™

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How stressed out are you, right now? You are sleepless if previously considered cash, as trash.

But, if sitting on a little pile; you should be sleeping like a baby.    

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM) 

Front Matter with Foreword by Jason Dyken MD MBA

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“BY DOCTORS – FOR DOCTORS – PEER REVIEWED – FIDUCIARY FOCUSED”

***

Upcoming Health Economics Interview with Dr. David Marcinko

Coming Soon from Medical Business News, Inc

By Ann Miller; RN, MHA

ME-P Executive-Directordr-david-marcinko22

Medical Business News, Inc., the publisher of Medical News of Arkansas, is a leading source for healthcare industry news that is truly useful. With a professional readership comprised of physicians and key industry decision makers, Medical News publications are devoted entirely to healthcare issues that impact both clinical and administrative best practices. Written and edited specifically for healthcare professionals, MBN writers work with experts at the local, regional and national level to keep stakeholders informed about the ever-evolving healthcare system.

Out Reach

It is no wonder then, why local market MNA editor Jennifer Boulden recently contacted us to arrange an interview with Dr. David Edward Marcinko, our Publisher-in-Chief, who is also a former insurance agent, registered investment advisor, health economist and Certified Financial Planner™

Link: www.MedicalBusinessAdvisors.com  

Interview Topics

The wide open topic in this environment of medically specific lethargy and macro economic insecurity – personal and business planning for physicians. Of course, since this is a broad field, we will use the rating and ranking system of this blog to help Jennifer and her staff, winnow down categories to top-of-mind concerns of our ME-P subscribers and her MNA readers.

Link: www.HealthcareFinancials.com

Assessment

But, we also ask you to send in any particular issues that you may have in order to make the interview helpful and exciting for all concerned.

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Link: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Collaborative Dental Health 2.0 [Part One of a Three Part Series]

Consumerism is the Hippocratic Way

By Darrell K. Pruitt; DDSpruitt1

The Appearance of DR. Oogle

By September of 2005, when I finally worked up enough courage to ask a patient to post a review for me on DR. Oogle (doctoroogle.com) – a web-based patient referral site – my dental practice had been invisible and struggling for a few years and was still disappearing.  It was the most discouraging period in my career. 

Following the Golden Rule 

In spite of my efforts to always treat my patients like I would want to be treated myself, I was headed for either managed care, which I consider to be an unethical model for dentistry, or bankruptcy. The progressive betrayal of my profession and my patients by leaders in dentistry spawned bitterness and high blood pressure that I still suffer today – even though my practice has fully recovered. My hygienist and I are currently booked almost solid for the next two weeks. I know also that in the next three, misfortune could arise. I have no idea what is in store for dentistry in tomorrow’s economy. If I was in the business of selling advice, or DR. Oogle, I would probably be tempted to radiate much more confidence than I truly feel.

Back in the Day 

When I graduated from dental school in 1982, I was reassured by dentists I respected that one’s practice location is not important if one works hard to consistently provide patients with one’s best efforts.  Dr. Earl Estep, a practice development guru from Athens, Texas, taught me decades ago that word-of-mouth is much more effective for attracting patients who are ready to spend money than advertisements provide, and that one should never forget to ask for referrals, even if it feels “unprofessional.”  This is still solid advice.  For example, two days ago, in a special marketing feature on Jim Du Molin’s The Wealthy Dentist Blog, Chris Barnard suggested,

“Enlist your existing patients in your practice success. Actively seek those all-important word of mouth referrals from your patients.”

Link: http://www.thewealthydentist.com/blog/727/practice-marketing-in-down-times

Even though Barnard doesn’t mention patient referral sites such as DR. Oogle, his other ideas which may or may not fit one’s practice image include quarterly letters, $10 gas cards and iPod raffles in order to

“… Let them know who you are beyond that white lab coat …!”

Just Do it … and Ask

I personally think it is much less complicated, as well as much cheaper, to simply select a recently satisfied patient, look the person in the eye and ask,

“Would you mind putting in a good word for me on this website?” 

Handing a patient a business card with the website handwritten on it becomes easier to do after the first dozen or so, but don’t expect immediate results. My success rate was around 45% when I was actively pursuing favors. When I reached 90 reviews after around nine months, I quit pestering my patients with requests for reviews. Active participation in a patient referral site also provides the incentive to improve one’s practice by motivating both dentists and staff to become wrapped up in treating each patient with extra-special care in the hopes of a nice review. Before anyone knows it, personalized, attentive care becomes a habit, I have found. Other than those who sell ads and party favors, everyone wins.

Enter Dr. Oogle 

I came across DR. Oogle in March 2005. The open-source patient satisfaction measurement application was born in San Francisco at the very end of the .com bust, and had been actively gathering word-of-mouth data about dentists for over two years when I began observing its progress.  By then, DR. Oogle had already accumulated an impressive amount of information concerning patient satisfaction with many of nation’s dentists. I suspect that today, Dr. Oogle’s volume of data is insurmountable by potential competitors. 

Akin to Wikipedia 

I found DR Oogle’s revolutionary marketing concept fascinating simply because like Wikipedia, it is not supported by advertising – thus avoiding a tremendous built-in and transparent bias. The company’s profits are derived solely from dentists like me who agree to pay reasonable monthly fees for the opportunity to participate in the application by displaying their customers’ opinions for public scrutiny. It is what I call playing to win rather than playing not to lose. Five months before I purchased the service, I published an article about DR. Oogle in The Twelfth Night, the monthly newsletter of my local dental society. I believe mine was the first mention of such web-based patient referral sites in any dental publication. Here is the article:

Patient Driven Referral Services

[From: “The Twelfth Night” April, 2005]

In a small community people as a general rule know a lot more about their neighbors than do people in a city.  They also know a lot more about the doctors and dentists in town since there are only a few.  It is fairly common to talk to neighbors and friends to get opinions on who is the best dentist, who to avoid, who is the cheapest, who has the most up to date equipment. 

In a small community, as well as in a city, even a neighbor’s recommendation carries more weight than a dentist’s paid advertisement.  I would imagine that sales of 1 800 Dentist subscriptions are significantly lower in rural Texas than in the metropolitan areas on a per capita basis.  The dentists in small communities know that they are far too easy to find to need to spend money for a referral service or for much advertisement at all. 

Well, Fort Worth and cities across the nation are becoming smaller dental communities because of the internet.  If any of you have googled your name, you may have picked up a hit by one or more patient driven referral services (PDRS). And, if you have not done this lately, you should.  There is a good possibility that the information about your practice location may contain errors.  But more importantly, you may read something pleasingly flattering or terribly humbling about your practice written by a patient you saw last week.

Dr. Oogle is presently the most popular PDRS. A patient’s comments about his or her dentist is posted only after the patient accepts the terms of the agreement; which are that the patient is neither a relative nor an employee of the dentist and that the patient is not otherwise being compensated for the review. The website also requires an authentic e-mail address and other personal information for verification purposes.

There is a filtering system in place in which employees of Dr. Oogle reject (at their discretion) comments which are too good or too bad to be credible.  And there are other ways in which dentists can handle bad reviews and are described on their website. There is, I suppose, always room for an attorney or two if the other attempts at removing a bad review fail.

But, if the PDRS’s survive the lawsuits, and if the first review which comes up under your name happens to be a real stinker written by an easily disgruntled and fervently vindictive patient (I think his name is Fred. You probably know him as he changes dentists often), and if you cannot get it otherwise removed, perhaps you should bury it under as many good reviews as you can encourage your patients to submit. This reaction, not surprisingly, is the reaction recommended by Dr. Oogle.  In fact, they also recommend that we routinely ask our patients to submit reviews to them.  I imagine that there are already dentists who have had cards printed for this purpose. 

Like it or not, our patients are being given more power in the marketing of our practices and their influence is growing. Dr. Oogle’s first reviews of dentists in the greater Ft. Worth area occurred in September of ’04. By the first of February, 5½ months later, there were only 18 dentists who had been reviewed by at least one patient.  As of today, one month later (March 7), there are 16 more. By the time this is published the number could be close to 50. Who knows how many reviews will be posted a year from now if the public perceives value in this kind of information. Many more of us will be listed as either good or bad dentists; legitimately or not. 

Regardless of the outcome of Dr. Oogle’s venture into dentistry, the fact that the public has a thirst for “unbiased” sources of information concerning our practices tells us that more than ever before we have to treat each patient as our most important source of new business or a disappointed patient could soon become a significant obstacle for growth.

Another good thing is that a patient who has to choose a dentist from a list at least soon may have some guidance; other than the fact that his insurance company thinks they are all equally swell.

Darrell K. Pruitt; DDS

[April 2005]

Investigative Reporting 

Since writing the unprecedented article, I have performed numerous simple investigations comparing DR. Oogle’s ratings to dentists’ names on preferred provider lists for various cities.  Invariably, the vast majority of the dentists who sign managed care contracts are found in the bottom 50% of the ratings. Sorry if I hurt some colleagues’ feelings, but that is cold fact. Anyone with a preferred provider list can confirm it. I suspect it has been done thousands of times by many anxious people holding new annual lists of strangers’ names in just the last year. Alert dentists should note that humans are choosy when it comes to trusting someone to use sharp, rotating instruments in their mouths. Dentistry is not like buying a can of beans as discount brokers would have their naïve and trusting clients believe, and most importantly, ethics are not for free.

Apart from the common sense rule that a purchaser of intricate handwork to exacting tolerances generally gets what the dental patient pays for, what else causes fee-for-service dentists to be generally favored over preferred providers?  I think it has to do with hunger.  If one’s meals arrive daily without effort, one forgets how to fish.

Managed care and preferred provider lists protect contract dentists from the naturally cleansing free-market principles taught by economist Adam Smith centuries ago. The beauty of competition in the marketplace occurs every time a dis-satisfied patient shops for a new dentist. When reliable information about patient satisfaction is available, quality is rewarded and encouraged in the neighborhood. Free-market capitalism works as reliably as classical operant conditioning in the best of possible worlds.

Assessment 

It is my opinion that there has always been something dishonest and un-American about discount dentistry with no quality control. I think we need to expose the unfair and unethical managed care business model to free-market forces even if it involves the calculated promotion of a simple, foolproof scheme for dentists interested in graduating from preferred provider lists. Those who feel trapped can begin their escape immediately by preparing some business cards for their managed care dental patients who by now are easily impressed by compassion. I’ll share more in Part 2.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. If US dental patients are lucky, Web 2.0 transparency arrived just in time. Consumerism rules naturally.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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About Free-Labor Contributing Authors

The Most Important Medical Executive-Post Asset

By Hope Rachel Hetico; RN, MHA

Managing Editorhetico4

The Medical Executive-Post is a knowledge aggregator of user-generated content. It is a network where users share, recommend, rank and comment on professional submissions by experts and thought-leaders. We believe that better submissions, lead to better actionable knowledge and professional lives.

Great information can also help us do, become and experience the professional goals and accomplishments that make us happy and more successful. Our mission is to help people discover and use this deeply gratifying electronic and/or print content.

Content Broadcasting

Every Medical Executive-Post is submitted by members of our community. You send-in content and comments, and we rate the clicks as recommendations on this blog. We call this ranking process “content-broadcasting.” It increases your exposure and helps to establish and disseminate your uniquely professional brand-image. Your submit content, and we do the rest.

A Niche Industry

When you make a submission, click-on a post or make a comment, you are in-effect saying that you think the content is worth reading and spending time to review. You are answering the question, “What do I need to know and where can I find the answer“, for people who share your interests and passion in the healthcare industrial complex and related health economics and nice practice management space.

Built by Free-Labor Entrepreneurs

The Medical Executive-Post is a privately-funded Web 2.0 company. We are committed to improving the overall quality of deeply specific Internet content search experiences by offering this utility platform for professional user-generated content and recommendations. The Medical Executive-Post was initially built by a team of seasoned Internet entrepreneurs, editors, and bloggers. But you, our free-labor entrepreneurs and contributing authors are now our most important long-term survival asset. Thank you.submission-frenzy

Assessment

To see what else we are up to; please visit our related websites, links, books and products on each side-bar. Learn how your bottom-up efforts – become valuable real-world print content.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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About Doctor Evidence.com

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Providing Evidence Based and Medical Data Driven Solutions

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Doctor Evidence.com is devoted to delivering revolutionary solutions to address the current deficiency in the evidence-based clinical market. Unlike most “evidence-based” companies that summarize and reference evidence found in clinical studies, Doctor Evidence actually delivers answers derived directly from the clinical data. It is this Data-Driven approach that makes Doctor Evidence a unique company, offering the highest level of transparency in the marketplace today.

Mission

According to their website, The Doctor Evidence mission is:

to improve clinical outcomes by finding and delivering medical evidence to healthcare professionals, medical associations, policy makers and manufacturers through revolutionary solutions that enable anyone to make informed decisions and policies using medical data that is more accessible, relevant and readable.

Goals

Doctor Evidence aims to succeed in achieving their mission by providing state-of-the-art tools and technologies that find, categorize, store and convert complex medical information from clinical studies into distributive databases to be delivered in a user-friendly format. A team of clinicians, librarians, and IT specialists work in tandem with medical or lay clients to increase the value of their most important asset: clinical evidence.

Assessment

You are invited to investigate the technologies and services of Doctor Evidence and report back to us with your findings.

Link: www.DoctorEvidence.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Deeper Financial Management Insight

Our Executive-Post Growth

Ann Miller; RN, MHA

Wow! That’s the best word to describe our recent growth! 

Outcomes

The September issue of the Executive-Post was the most successful to-date. Unfortunately, this was – no doubt – in-part to the recent stock market collapse and lack of confidence in the domestic credit and industrial-complex.

Economic Commentary

Read the opinion of Schwab’s Liz Ann Sonders, on the US economy, here:

Link: liz-ann-sonders

And, going forward, we trust our deeper-insight into health economics and financial management will carry the day even more.

Data

Almost 10,000 readers and subscribers visited or signed-in to our complimentary blogs and communications forum. We now reach folks nationally; working in healthcare finance, accounting pharma/biotech, consulting, government, academia, medical management, business and physician recruiting.   

Assessment

Of course, our 2 volume, 1,200 pages, professional quarterly and peer-reviewed premium-print subscription journal-guide is also growing in the hospital and institutional markets. www.HealthcareFinancials.com Many thanks to all supporters; both online and in-print.

Conclusion 

And so, if you want to reach your target audience of healthcare executives, physicians, administrators and medical leaders; with information on your company, product, service, or job opening, just contact Ann: MarcinkoAdvisors@msn.com

Plus, don’t forget to book mark us: www.HealthcareFinancials.wordpress.com

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Physician Malpractice Liability Immunity

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Free Charity Medical Care?

[By Staff Reporters]insurance-book

Sen. Mike Enzi [R-Wyoming], the senior Republican on the Senate Health, Education, Labor and Pensions Committee [HELP], recently introduced legislation that would allow physicians and other medical professionals to volunteer their services at charity clinics and community health centers free from medical liability concerns.

Query

What is your opinion on this idea, given that there are more than 42 million uninsured Americans, in need? Please comment and explain? We are especially interested in hearing from doctors, lawyers, actuaries and health economists.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Meet an Executive-Post Sponsor

The Institute of Medical Business Advisors, Inc

July 7, 2008

PRESS RELEASE: iMBA, Inc

Atlanta, Georgia

The Executive-Post at www.HealthcareFinancials.com is now proudly sponsored, in-part, by the Institute of Medical Business Advisors Inc.

Since inception in 2000, iMBA Inc has become one of North America’s leading professional health consulting firms; and focused provider of textbooks, CDs, tools, templates, onsite and distance education for the health economics, administration and financial management policy space. Other consulting services include:

  • Medical Practice Valuations and Appraisals
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  • Special Projects, etc.

As competition increases, and the cognitive demands of the global marketplace change, iMBA Inc is well positioned with offices in five states and Europe to meet the needs of medical colleagues, related advisory and corporate health clients today; and into the future.

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Edwin P. Morrow; CFP, ChFC, CLU, RFC

About:

Financial Planner’s Library on CD-ROM [third edition] 

fp-book3

The financial planner is a like juggler, trying to keep a variety of balls simultaneously in the air.  Each aspect of practice becomes critical, just as action is needed. 

Some of the activities of operating a successful financial planning practice generally attract more attention than others, such as marketing and advertising, closing engagements, and office administration.  Because product review, selection and implementation are often related to advisor compensation, they attract a great deal of the financial juggler’s concentration. 

The heart of financial planning, advice, often receives little attention.  Not because it is unimportant, it just doesn’t seem immediately and predictably urgent.  That ball does not seem to be dropping so rapidly. 

However, retaining clients and receiving referrals from other professionals is very dependent on the quality of the advice delivered.  And, the first line of protection from practitioner liability exposure is to not deliver incorrect or incomplete advice. 

But, where does the advisor turn for ideas and organized research? 

There are many sources. Perhaps there was treatment of a critical topic at a prior conference?  But, which one?  Were the ideas in the presentation, or the handout?  Where is the workbook, white paper or cassette?  And, how can the professional advisor instantly search, retrieve, review and use the knowledge of experts? 

That’s what the Financial Planner’s Library on CD-ROM is all about.  It represents the collected wisdom of 40 noted experts, in 30 chapters.  Their vast experience, research and application techniques are assembled for quick access and easy use.   

Find the references you need from among 3,000 pages almost instantly.  Read the well-written discourse.  Discard what is not applicable.  Copy and retain that which is helpful, and paste it right into your analysis. There is nothing as valuable as a tool that is handy and right for the job.  The mechanic who left a critical tool back in the shop can’t fix a car on the road. 

Likewise the financial planner that suddenly recognizes the need for expert opinion to suggest an idea or confirm a suspicion cannot suddenly order the tool required, Financial Planner’s Library on CD-ROM.  It must be at hand, installed in your computer and tested. Every tool requires a bit of experience to be used effectively. 

The best time to learn is not under the urgency of a plan to be delivered to the client within a few hours.  The planner needs to reach into the toolbox, grasp the proper instrument, apply it correctly and voila – the problem is solved! 

Now that you have acquired a very powerful toolbox, you need to take a few moments while you are not under pressure, to learn how to use it. This will be most valuable for your business: 

  • You’ll be amazed at the learning you will be able to acquire by leisurely reading those sections most relevant to your practice; and also wander intellectually in the fields you’ve never explored, but would like to know more about.
  • You’ll know how to perform searches to instantly find the documents you need, and how to read and extract this information when it is required.

It only makes sense to practice with your new Financial Planner’s Library with CD-ROM.  If you are a prior user, quickly review the new features that have been added, and check out the revised and more efficient procedures.

By acquiring the Financial Planner’s Library on CD-ROM, you have equipped yourself with an entire box of very effective tools.  With only 10 to 15 minutes of practice you will know how to use it efficiently.  Then, just when you suddenly need the resources of great minds and endless experience – here it is at the click of your mouse! 

Edwin P. Morrow; CFPTM, CLU, ChFC, RFC

Middletown, Ohio, USA 

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA – Editor and Publisher-in-Chief – is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

Product DetailsProduct DetailsProduct Details      

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Seeking Deeper Knowledge and Wisdom

Experts Invited … A Call for Professionally Generated Content

Are you a health economist, policy wonk, attorney or accountant, HR or HIT guru, CXO or industry expert in a specific topic or subject related to medical practice management, or physician-focused financial planning?  

Healthcare Financialsthe Executive Post is always looking for subject-matter experts and would like to hear from you. 

You may be called upon to do one or more of the following: 

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· Provide feedback on a particular matter … and more! 

Contact MarcinkoAdvisors@msn.com to submit your name and your area of interest; or call 770.448.0769.  

Lead the discussion. No topic is too small or too large!  Share your expertise – help us produce industry leading books, newsletters, white-papers, presentations, guides and innovative R&D projects.

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Feel free to link to our forum blog site. Just let us know by sending an email with the name and address of your site, the contact information of the webmaster, and a brief description of products or services offered on the site. 

We also have several new resources for potential contributing authors. For example: Do you have an idea on how to publicize your work? Did you set up a website or blog and are looking to link to the Executive Post Homepage? Do you have a project idea? If so, we want to hear from you.

Send an email or give us a call and let us know how we can help MarcinkoAdvisors@msn.com or 770.448.0769

Want to Take Your Professional Journalism Career to the Next Level?

wis

As you know, our two volume 1,200 page print periodical, Healthcare Organizations (Financial Management Strategies) was successfully launched more than a two years ago and is now updated in a regular quarterly fashion.

Accordingly, we would be honored for you to consider a brand new or updated contribution to most any existing chapter in your field of healthcare finance and economics, for a low-effort contribution. Our goal is to help physician colleagues, health care organizations, hospitals and medical executives benefit from nationally known experts, as an essential platform for success in the healthcare industry.

Editorial support is available, and all would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion.

And so, please advise and thanks again for your consideration. A sample TOC and more info are available upon request.

Ann Miller, RN (Executive Director)

INSTITUTE MEDICAL BUSINESS ADVISORS, Inc

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