BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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The 3-5-7 Rule is a trading strategy that helps investors manage risk and maximize gains by setting clear limits on losses and targets for profits. It’s a simple yet powerful framework for disciplined decision-making.
In the volatile world of trading, success often hinges not just on identifying opportunities but on managing risk with precision. The 3-5-7 Rule is a widely respected risk management strategy designed to help traders protect their capital while pursuing consistent returns. This rule provides a structured approach to trading by setting specific thresholds for risk exposure and profit expectations.
At its core, the 3-5-7 Rule breaks down into three key components:
3% Risk Per Trade: Traders should never risk more than 3% of their total account value on a single trade. This limit ensures that even if a trade goes against them, the loss is manageable and doesn’t jeopardize their overall portfolio.
5% Total Exposure Across All Positions: The rule advises that total exposure across all open positions should not exceed 5% of the account value. This prevents over-leveraging and reduces the impact of correlated losses during market downturns.
7% Profit Target: For every trade, the goal is to achieve a profit that is at least 7% greater than the potential loss. This risk-to-reward ratio helps ensure that even with a lower win rate, traders can remain profitable over time.
The beauty of the 3-5-7 Rule lies in its simplicity and adaptability. It can be applied across various asset classes—stocks, forex, crypto—and suits both beginners and seasoned traders. By enforcing discipline, it helps traders avoid emotional decisions, such as chasing losses or holding onto losing positions too long. Moreover, this rule encourages thoughtful position sizing. Traders must calculate their entry and exit points carefully, factoring in stop-loss levels and account size. This analytical approach fosters better trade planning and reduces impulsive behavior.
Another advantage is its scalability. As a trader’s account grows, the percentages remain constant, but the dollar amounts adjust accordingly. This keeps the strategy relevant and effective regardless of portfolio size. In practice, the 3-5-7 Rule acts as a safety net. It doesn’t guarantee profits, but it significantly reduces the likelihood of catastrophic losses. It also promotes consistency, which is crucial for long-term success in trading.
In conclusion, the 3-5-7 Rule is more than just a guideline—it’s a mindset. It teaches traders to respect risk, plan strategically, and aim for favorable outcomes.
By adhering to this rule, traders can navigate the unpredictable markets with greater confidence and control.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
Historian Cyril Parkinson’s wrote in his book Parkinson’s Law,
“The time spent on any item of the agenda will be in inverse proportion to the sum [of money] involved.”
EXAMPLE: Parkinson described a fictional finance committee with three tasks: approval of a $10 million nuclear reactor, $400 for an employee bike shed, and $20 for employee refreshments in the break room.
The committee approves the $10 million nuclear reactor immediately, because the number is too big to contextualize, alternatives are too daunting to consider, and no one on the committee is an expert in nuclear power.
Bike Shed Effect: The bike shed gets considerably more debate. Committee members argue whether a bike rack would suffice and whether a shed should be wood or aluminum, because they have some experience working with those materials at home.
Employee refreshments take up two-thirds of the debate, because everyone has a strong opinion on what’s the best coffee, the best cookies, the best chips, etc.
Absurd: The world is filled with these absurdities. In personal finance, Ramit Sethi recently said we should stop asking $3 questions (should I buy coffee?) and ask more $30,000 questions (should I buy a smaller home?). Most people don’t, because it’s hard and intimidating. In any given moment the easiest way to deal with a big problem is to ignore it and fill your time thinking about a smaller one.
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Assessment: Your thoughts and comments related to the post Corona Virus Pandemic, meetings and time management and psychology are appreciated.
High-frequency trading (HFT) is a form of algorithmic trading that uses powerful computers and complex programs to execute thousands of trades in fractions of a second. It has transformed modern financial markets by increasing speed, liquidity, and efficiency—but also raised concerns about fairness and stability.
High-frequency trading emerged in the early 2000s as technological advances allowed financial firms to process market data and execute trades faster than ever before. HFT firms use sophisticated algorithms to analyze multiple markets and identify short-term opportunities. These trades are often held for mere seconds or milliseconds, and profits are made by exploiting tiny price discrepancies across assets or exchanges.
One of the defining features of HFT is its reliance on speed. Firms invest heavily in infrastructure—such as co-location services near exchange servers and fiber-optic cables—to gain microsecond advantages over competitors. This race for speed has led to a technological arms race, where milliseconds can mean millions in profit.
HFT contributes significantly to market liquidity, meaning it helps ensure that buyers and sellers can transact quickly at stable prices. By constantly placing and updating orders, HFT firms narrow bid-ask spreads and reduce transaction costs for other market participants. This has made markets more efficient and accessible, especially for retail investors.
However, HFT is not without controversy. Critics argue that it creates an uneven playing field, where firms with access to advanced technology and capital can dominate markets. Concerns about market manipulation—such as quote stuffing (flooding the market with orders to slow competitors) or spoofing (placing fake orders to move prices)—have led to increased regulatory scrutiny.
The 2010 Flash Crash is often cited as a cautionary example of HFT’s potential risks. During this event, the Dow Jones Industrial Average plunged nearly 1,000 points in minutes before rebounding. Investigations revealed that automated trading systems, including HFT algorithms, contributed to the sudden loss of liquidity and extreme volatility.
Regulators have responded by implementing safeguards such as circuit breakers, which pause trading during extreme price movements, and requiring firms to register and disclose their trading strategies. The Securities and Exchange Commission (SEC) and Commodity Futures Trading Commission (CFTC) continue to monitor HFT’s impact on market integrity.
Despite its challenges, HFT remains a dominant force in global finance. It accounts for a significant portion of trading volume in equities, futures, and foreign exchange markets. Many institutional investors rely on HFT strategies to manage large portfolios and hedge risks.
In conclusion, high-frequency trading represents both the promise and peril of technological innovation in finance. While it enhances market efficiency and liquidity, it also introduces new risks and ethical dilemmas.
As markets evolve, balancing innovation with fairness and stability will be essential to ensuring that HFT serves the broader interests of investors and the economy.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
Posted on November 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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The Sraffa–Hayek debate stands as a pivotal moment in the history of economic thought, highlighting deep philosophical and methodological differences between two influential schools: the Austrian School, represented by Friedrich Hayek, and the neo-Ricardian or Cambridge School, represented by Piero Sraffa. Taking place primarily in the 1930s, this intellectual exchange centered on the nature of capital, the role of equilibrium, and the validity of marginalist theory.
Friedrich Hayek, a staunch advocate of Austrian economics, had developed a theory of business cycles rooted in the mis allocation of capital due to artificially low interest rates. In his framework, interest rates serve as signals that coordinate inter temporal production decisions. When central banks distort these signals, they cause over investment in capital-intensive industries, leading to unsustainable booms followed by inevitable busts. Hayek’s theory was grounded in a time-structured view of capital, emphasizing the importance of temporal coordination in production.
Piero Sraffa, a Cambridge economist and close associate of John Maynard Keynes, challenged Hayek’s assumptions in a 1932 review of Hayek’s book Prices and Production. Sraffa’s critique was both technical and philosophical. He questioned the coherence of Hayek’s notion of a uniform natural rate of interest in a complex economy with heterogeneous capital goods. Sraffa argued that in such an economy, there could be multiple natural rates of interest, making it impossible to define a single rate that equilibrates savings and investment across all sectors.
Moreover, Sraffa criticized the Austrian reliance on equilibrium analysis in a world characterized by uncertainty and institutional complexity. He contended that Hayek’s model was overly abstract and detached from real-world dynamics. This critique foreshadowed Sraffa’s later work, Production of Commodities by Means of Commodities (1960), which laid the foundation for the neo-Ricardian critique of marginalist economics. In that work, Sraffa demonstrated that prices and distribution could be determined without recourse to subjective utility or marginal productivity, challenging the core of neoclassical theory.
The debate had far-reaching implications. For the Austrian School, it exposed vulnerabilities in their capital theory and prompted refinements in their approach to intertemporal coordination. For the broader economics profession, Sraffa’s critique contributed to a growing skepticism about the internal consistency of marginalist value theory, influencing the Cambridge capital controversies of the 1950s and 1960s.
While the Sraffa–Hayek debate did not produce a definitive victor, it underscored the importance of foundational assumptions in economic modeling. It also highlighted the tension between abstract theoretical elegance and empirical relevance—a tension that continues to shape economic discourse today. Ultimately, the debate enriched the intellectual landscape by forcing economists to confront the limitations of their models and to grapple with the complex realities of capital, time, and uncertainty.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
Short Interest Theory suggests that high levels of short interest in a stock may actually signal a potential price increase, contrary to traditional bearish interpretations.
Short Interest Theory is a contrarian investment concept that challenges conventional wisdom in financial markets. Traditionally, a high short interest—meaning a large percentage of a company’s shares are being sold short—is seen as a bearish signal, indicating that many investors expect the stock’s price to decline. However, Short Interest Theory flips this assumption, proposing that a high short interest can actually be a bullish indicator, suggesting a potential upward price movement due to a phenomenon known as a “short squeeze.”
To understand this theory, it’s important to grasp the mechanics of short selling. When investors short a stock, they borrow shares and sell them on the open market, hoping to repurchase them later at a lower price and pocket the difference. However, if the stock price rises instead of falling, short sellers face mounting losses. To limit these losses, they may be forced to buy back the stock at higher prices, which increases demand and drives the price up even further. This chain reaction is what’s known as a short squeeze.
Short Interest Theory posits that when short interest reaches unusually high levels, the stock becomes a prime candidate for a short squeeze. Investors who follow this theory look for stocks with high short interest ratios—often measured as the number of shares sold short divided by the stock’s average daily trading volume. A high ratio suggests that it would take many days for all short sellers to cover their positions, increasing the likelihood of a rapid price surge if positive news or buying pressure emerges.
This theory gained widespread attention during the GameStop (GME) saga in early 2021. Retail investors noticed that GME had an extremely high short interest—more than 100% of its float—and began buying shares en masse. This triggered a historic short squeeze, sending the stock price soaring and forcing institutional short sellers to cover their positions at massive losses. The event served as a real-world validation of Short Interest Theory and highlighted the power of collective investor behavior in modern markets.
Despite its appeal, Short Interest Theory is not without risks. Betting on a short squeeze can be speculative and volatile. Not all heavily shorted stocks experience upward momentum; some may continue to decline if the negative sentiment is justified by poor fundamentals or weak earnings. Moreover, timing a short squeeze is notoriously difficult, and investors can suffer significant losses if the anticipated rebound fails to materialize.
In conclusion, Short Interest Theory offers a compelling contrarian perspective on market sentiment. By interpreting high short interest as a potential bullish signal, it encourages investors to look beyond surface-level indicators and consider the dynamics of market psychology and trading behavior. While it can lead to lucrative opportunities, especially in the context of short squeezes, it also demands careful analysis and risk management. As with any investment strategy, understanding the underlying fundamentals and market context is essential for making informed decisions.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
The Life Cycle Hypothesis (LCH) is a foundational theory in economics and personal finance that explains how individuals plan their consumption and savings behavior over the course of their lives. Developed in the 1950s by economists Franco Modigliani and Richard Brumberg, the LCH posits that people aim to smooth their consumption throughout their lifetime, regardless of fluctuations in income. This theory has had a profound impact on how economists, financial planners, and policymakers understand saving patterns, retirement planning, and fiscal policy.
At its core, the LCH assumes that individuals are forward-looking and rational. They anticipate changes in income—such as those caused by retirement, unemployment, or career progression—and adjust their saving and spending accordingly. During high-income periods, typically in mid-career, individuals save more to prepare for low-income phases, such as retirement. Conversely, in early adulthood and old age, when income is lower, individuals are expected to dissave, or spend from their accumulated savings.
One of the key insights of the LCH is that consumption is not directly tied to current income but rather to expected lifetime income. This means that temporary changes in income should not significantly affect consumption patterns, as individuals base their spending decisions on long-term expectations. For example, a young professional may take out a loan to buy a car, anticipating higher future earnings that will allow them to repay the debt without drastically altering their lifestyle.
The LCH also provides a framework for understanding the role of pensions, social security, and other retirement savings mechanisms. By recognizing that individuals need to save during their working years to maintain consumption levels in retirement, the theory supports the development of policies that encourage long-term savings and financial literacy. It also helps explain why some people may under-save or over-consume if they misjudge their future income or lack access to financial planning resources.
Despite its elegance, the Life Cycle Hypothesis has faced criticism and refinement. Behavioral economists argue that individuals are not always rational and may struggle with self-control, procrastination, or lack of financial knowledge. These limitations have led to the development of the Behavioral Life Cycle Hypothesis, which incorporates psychological factors such as mental accounting and framing effects. Moreover, empirical studies have shown that many people do not smooth consumption as predicted, often due to liquidity constraints, uncertainty, or cultural influences.
Nevertheless, the LCH remains a powerful tool for analyzing financial behavior across different stages of life. It has influenced retirement planning strategies, tax policy, and the design of financial products. By emphasizing the importance of long-term planning and the intertemporal nature of financial decisions, the Life Cycle Hypothesis continues to shape how individuals and institutions approach economic well-being.
In conclusion, the Life Cycle Hypothesis offers a compelling lens through which to view personal finance. While it may not capture every nuance of human behavior, its emphasis on lifetime income and consumption smoothing provides a valuable foundation for understanding and improving financial decision-making.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
A paradox is a figure of speech that can seem silly or contradictory in form, yet it can still be true, or at least make sense in the context given. This is sometimes used to illustrate thoughts or statements that differ from traditional ideas. So, instead of taking a given statement literally, an individual must comprehend it from a different perspective. Using paradoxes in speeches and writings can also add wit and humor to one’s work, which serves as the perfect device to grab a reader or a listener’s attention.
But paradoxes can be quite difficult to explain by definition alone, which is why it is best to refer to a few examples to further your understanding.
A good paradox example is in the famous television show House. Here, Dr. House is a rude, selfish, and narcissistic character who alienates everyone around him, even his own colleagues. However, he is also a brilliant doctor who is committed to saving lives. Regardless of his mean exterior, Dr. House is a moral and compassionate man who cares about his patients. The paradox here is how the character strives to save people’s lives despite his ruthless personality and behavior.
Modern health care appears to be rich in contradictions, and it is claimed to be paradoxical in a number of ways. In particular health care is held to be a paradox itself: it is supposed to do good; but is also accused of doing harm.
The expression “first do no harm,” which is a Latin phrase, is not part of the original or modern versions of the Hippocratic Oath, which was originally written in Greek (“primum non nocere,” the Latin translation from the original Greek.)
The Hippocratic Oath, written in the 5th century BCE, does contain language suggesting that the physician and his assistants should not cause physical or moral harm to a patient.
The first known published version of “do no harm” dates to medical texts from the mid-19th century, and is attributed to the 17th century English physician Thomas Sydenham.
Difference between Paradox and Oxymoron
Most people tend to confuse a paradox with an oxymoron, and it’s not hard to see why. Most oxymoron examples appear to be compressed version of a paradox, in which it is used to add a dramatic effect and to emphasize contrasting thoughts. Although they may seem greatly similar in form, there are slight differences that set them apart.
A paradox consists of a statement with opposing definitions, while an oxymoron combines two contradictory terms to form a new meaning. But because an oxymoron can play out with just two words, it is often used to describe a given object or idea imaginatively. As for a paradox, the statement itself makes you question whether something is true or false. It appears to contradict the truth, but if given a closer look, the truth is there but is merely implied.
The Paradox in Medicine and Health Care
Dr. Bernard Brom [Editor: SA Journal of Natural Medicine] suggests modem medicine is riddled with paradoxes. Most doctors live with these paradoxes without being aware of the conflict of interest that these paradoxes represent. Intrinsic to a general understanding of science is the idea that science frees us from misunderstanding and guides us towards clear decision making.
Most veteran doctors with experience know that medical science still does not give definitive answers, that each individual is unique, that one can never be sure how a patient will respond to a particular drug, or what the outcome of a particular operation will be. Human beings are not machines and therefore do not respond according to Newtonian logic, and therefore a paradox in medicine is not surprising. Medicine is an art which uses scientific techniques and approaches. It is, however, important to face these paradoxes. It is both humbling and enlightening, enriching those who consider the implications deeply enough.
The Compensation versus Value Paradox
Regardless of specialty, degree designation or delivery model, private practice physician salary is traditionally inversely related to independent medical practice business value.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Nepo babies often go broke due to a mix of financial mismanagement, lack of resilience, and the illusion of inherited success. Their privileged upbringing can mask the need for discipline, adaptability, and long-term planning—traits essential for sustaining wealth.
The term nepo baby—short for nepotism baby—refers to children of celebrities or influential figures who benefit from family connections to launch careers, especially in entertainment, fashion, or media. While these individuals often start with significant advantages, including wealth, fame, and access, many struggle to maintain financial stability over time. The reasons are complex and rooted in both personal and systemic factors.
First, many nepo babies lack financial literacy. Growing up in environments where money flows freely, they may never learn budgeting, investing, or the value of money. Without these skills, they’re prone to overspending, poor investments, and unsustainable lifestyles. Lavish purchases—designer clothes, luxury cars, expensive homes—can quickly drain even sizable inheritances if not managed wisely.
Second, the illusion of guaranteed success can be dangerous. Nepo babies often enter industries where their family name opens doors, but that doesn’t guarantee longevity. Fame is fickle, and public interest can fade. If they don’t develop their own talents or work ethic, they may find themselves unemployable once the novelty wears off. This overreliance on family reputation can lead to complacency, making it harder to adapt when challenges arise.
Third, many nepo babies face identity crises and public scrutiny. Constant comparisons to their successful parents can erode confidence and create pressure to live up to unrealistic expectations. Some rebel by distancing themselves from their family’s legacy, while others try to prove themselves in unrelated fields. Either way, this struggle can lead to erratic career choices and unstable income streams.
Fourth, fame without privacy can fuel destructive habits. The entertainment world is rife with stories of young stars—many of them nepo babies—falling into substance abuse, reckless behavior, or toxic relationships. These issues not only affect mental health but also lead to legal troubles and financial loss. Without strong support systems or accountability, it’s easy to spiral.
Finally, inherited wealth can disappear quickly without proper estate planning. Trust funds and inheritances may be mismanaged or depleted by taxes, lawsuits, or poor financial advisors. Some nepo babies assume the money will last forever and fail to plan for long-term sustainability. Others are exploited by opportunistic friends or partners who take advantage of their naivety.
In contrast, those who succeed often do so by acknowledging their privilege, developing their own skills, and surrounding themselves with trustworthy mentors. They treat their inherited platform as a launchpad—not a safety net—and work to build something lasting.
In short, nepo babies go broke not because they lack opportunity, but because opportunity without discipline is a recipe for downfall. Wealth and fame are fleeting without the grit to sustain them. The lesson here isn’t just about celebrity—it’s a universal truth: success inherited must still be earned.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
Turning 50 with little to no savings can be daunting, especially for a doctor who has spent decades in a demanding profession. Yet, all is not lost. With strategic planning, discipline, and a willingness to adapt, a broke 50-year-old physician can still build a solid retirement foundation by age 65.
First, it’s essential to confront the financial reality. This means calculating current income, expenses, debts, and any assets, however small. A clear picture allows for realistic goal-setting. The target should be to save aggressively—ideally 30–50% of income—over the next 15 years. While this may seem steep, doctors often have above-average earning potential, even in their later years, which can be leveraged.
Next, lifestyle adjustments are crucial. Downsizing housing, eliminating unnecessary expenses, and avoiding new debt can free up significant cash flow. If possible, relocating to a lower-cost area or refinancing existing loans can also help. Every dollar saved should be redirected into retirement accounts such as a 401(k), IRA, or a solo 401(k) if self-employed. Catch-up contributions for those over 50 allow for higher annual deposits, which can accelerate growth.
Investing wisely is non-negotiable. A diversified portfolio with a mix of stocks, bonds, and alternative assets can provide both growth and stability. Working with a fiduciary financial advisor ensures that investments align with retirement goals and risk tolerance. Time is limited, so the focus should be on maximizing returns without taking reckless risks.
Increasing income is another powerful lever. Many doctors can boost earnings through side gigs like telemedicine, consulting, teaching, or locum tenens work. These flexible options can add tens of thousands annually without requiring a full career shift. Additionally, monetizing expertise—writing, speaking, or creating online courses—can generate passive income streams.
Debt reduction must be prioritized. High-interest loans, especially credit card debt, can erode savings potential. Paying off these balances aggressively while avoiding new liabilities is key. For student loans, exploring forgiveness programs or refinancing options may offer relief.
Finally, mindset matters. Retirement at 65 doesn’t have to mean complete cessation of work. It can mean transitioning to part-time roles, passion projects, or advisory positions that provide income and fulfillment. The goal is financial independence, not necessarily total inactivity.
In conclusion, while starting late is challenging, a broke 50-year-old doctor can still retire comfortably at 65. It requires a blend of financial discipline, income optimization, smart investing, and lifestyle changes. With focus and determination, the next 15 years can be transformative—turning a precarious situation into a secure and dignified retirement.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
Posted on October 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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Level-funded health care is an increasingly popular option for small to mid-sized businesses seeking a balance between cost control and comprehensive employee coverage. It blends features of fully insured and self-funded health plans, offering employers greater flexibility and potential savings while minimizing risk.
In a traditional fully insured plan, employers pay a fixed premium to an insurance carrier, which assumes all financial risk for employee claims. In contrast, self-funded plans allow employers to pay for claims out-of-pocket, which can lead to significant savings—but also exposes them to unpredictable costs. Level-funded plans sit between these two models, offering a structured and predictable approach to self-funding.
With level-funded health care, employers pay a fixed monthly amount that covers three components: estimated claims funding, stop-loss insurance, and administrative fees. The estimated claims portion is based on actuarial data and reflects the expected health care usage of the employee group. Stop-loss insurance protects the employer from catastrophic claims by capping their financial exposure. Administrative fees cover third-party services such as claims processing and customer support.
One of the key advantages of level-funded plans is the potential for cost savings. If actual claims fall below the estimated amount, employers may receive a refund or credit at the end of the year. This incentivizes wellness programs and preventive care, as healthier employees lead to lower claims. Additionally, level-funded plans often provide more transparency into claims data, allowing employers to better understand health trends and make informed decisions about benefits.
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Another benefit is flexibility. Level-funded plans can be customized to suit the needs of a specific workforce, offering a range of coverage options and provider networks. This contrasts with the rigid structure of many fully insured plans. Employers also gain more control over plan design, which can help attract and retain talent in competitive job markets.
However, level-funded health care is not without challenges. It requires careful planning and a solid understanding of risk. Employers must be prepared for the possibility that claims may exceed projections, although stop-loss insurance helps mitigate this. Additionally, level-funded plans may not be suitable for very small groups or those with high-risk populations, as the cost of stop-loss coverage can be prohibitive.
Regulatory considerations also play a role. Level-funded plans are typically governed by federal ERISA laws rather than state insurance regulations, which can affect compliance and reporting requirements. Employers should work closely with benefits consultants or brokers to ensure they understand the legal landscape and choose a plan that aligns with their goals.
In conclusion, level-funded health care offers a compelling alternative for businesses seeking to manage costs while providing quality coverage. By combining predictability with the potential for savings and customization, it empowers employers to take a more active role in their health benefits strategy. As the health care landscape continues to evolve, level-funded plans are likely to remain a valuable option for organizations looking to strike the right balance between affordability and employee well-being.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
Valuing a medical practice involves assessing its financial performance, assets, and intangible factors like goodwill and patient loyalty to determine its fair market worth.
Determining the value of a medical practice is a nuanced process that blends financial analysis with strategic insight. Whether you’re preparing to sell, merge, or bring in a partner, understanding how to value your practice ensures informed decision-making and fair negotiations.
There are several recognized methods for valuing a medical practice, each suited to different scenarios. The most common include the income approach, market approach, asset-based approach, and the rule-of-thumb method.
The income approach focuses on the practice’s ability to generate future earnings. This method involves analyzing historical financial statements, projecting future cash flows, and discounting them to present value using a risk-adjusted rate. It’s particularly useful when the practice has stable revenue and predictable expenses. Key metrics include net income, physician productivity, and reimbursement rates.
The market approach compares the practice to similar ones that have recently sold. It relies on data from comparable transactions, adjusted for differences in size, specialty, location, and profitability. This method is ideal when reliable market data is available, though such data can be scarce for niche specialties or rural practices.
The asset-based approach calculates the value of tangible and intangible assets. Tangible assets include medical equipment, office furniture, and real estate. Intangible assets—like patient records, brand reputation, and goodwill—are harder to quantify but can significantly impact value. Goodwill, for instance, reflects the practice’s reputation, patient loyalty, and referral networks.
The rule-of-thumb method uses industry benchmarks, such as a multiple of annual revenue or earnings. For example, a general practice might be valued at 60–80% of annual gross revenue. While quick and easy, this method oversimplifies and may not reflect the unique strengths or weaknesses of a specific practice.https:/https://medicalexecutivepost.com/2025/03/17/medial-practice-valuation-adjustments//medicalexecutivepost.com/2025/03/17/medial-practice-valuation-adjustments/
Beyond these methods, several qualitative factors influence valuation. These include the size and diversity of the patient base, the practice’s specialty, use of technology (like EHR systems or telemedicine), and whether key physicians will remain post-sale. A practice heavily reliant on one provider may be less valuable than one with a strong team and succession plan.
Timing also matters. Economic conditions, regulatory changes, and shifts in healthcare reimbursement can affect practice value. Tax implications and deal structure—such as asset sale vs. stock sale—should also be considered during negotiations.
Ultimately, valuing a medical practice is both art and science. Engaging a professional appraiser or valuation expert can help ensure accuracy and objectivity. They bring experience, access to market data, and the ability to tailor valuation methods to your specific situation.
In summary, a comprehensive valuation considers financial performance, assets, market trends, and intangible factors. By understanding these elements, practice owners can make strategic decisions that reflect the true worth of their medical enterprise.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
What Medical School Didn’t Teach Doctors About Money
Medical school is designed to mold students into competent, compassionate physicians. It teaches anatomy, pathology, pharmacology, and clinical skills with precision and rigor. Yet, despite the depth of medical knowledge imparted, one critical area is often overlooked: financial literacy. For many doctors, the transition from student to professional comes with a steep learning curve—not in medicine, but in money. From managing debt to understanding taxes, investing, and retirement planning, medical school leaves a financial education gap that can have long-term consequences.
The Debt Dilemma
One of the most glaring omissions in medical education is how to manage student loan debt. The average medical student graduates with over $200,000 in debt, yet few are taught how to navigate repayment options, interest accrual, or loan forgiveness programs. Many doctors enter residency with little understanding of income-driven repayment plans or Public Service Loan Forgiveness (PSLF), missing opportunities to reduce their financial burden. Without guidance, some make costly mistakes—such as refinancing federal loans prematurely or choosing repayment plans that don’t align with their career trajectory.
Income ≠ Wealth
Medical students often assume that a high salary will automatically lead to financial security. While physicians do earn more than most professionals, income alone doesn’t guarantee wealth. Medical school rarely addresses the importance of budgeting, saving, and investing. As a result, many doctors fall into the “HENRY” trap—High Earner, Not Rich Yet. They spend lavishly, assuming their income will always cover expenses, only to find themselves living paycheck to paycheck. Without a solid financial foundation, even high earners can struggle to build net worth.
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Taxes and Business Skills
Doctors are also unprepared for the complexities of taxes. Whether employed by a hospital or running a private practice, physicians face unique tax challenges. Medical school doesn’t teach how to track deductible expenses, optimize retirement contributions, or navigate self-employment taxes. For those who open their own clinics, the lack of business education is even more pronounced. Understanding profit margins, payroll, insurance billing, and compliance regulations is essential—but rarely covered in medical training.
Investing and Retirement Planning
Another blind spot is investing. Medical students are rarely taught the basics of compound interest, asset allocation, or retirement accounts. Many don’t know the difference between a Roth IRA and a traditional 401(k), or how to evaluate mutual funds and index funds. This lack of knowledge delays retirement planning and can lead to missed opportunities for long-term growth. Some doctors rely on financial advisors without understanding the fees or conflicts of interest involved, putting their wealth at risk.
Insurance and Risk Management
Medical school also fails to educate students on insurance—life, disability, malpractice, and health. Doctors need robust coverage to protect their income and assets, but many don’t know how to evaluate policies or understand terms like “own occupation” or “elimination period.” Inadequate coverage can leave physicians vulnerable to financial disaster in the event of illness, injury, or litigation.
Emotional and Behavioral Finance
Beyond technical knowledge, medical school overlooks the emotional side of money. Physicians often face pressure to maintain a certain lifestyle, especially after years of sacrifice. The desire to “catch up” can lead to impulsive spending, luxury purchases, and financial stress. Without tools to manage money mindset and behavioral habits, doctors may struggle with guilt, anxiety, or burnout related to finances.
The Case for Financial Education
Fortunately, awareness of this gap is growing. Organizations like Medics’ Money and podcasts such as “Docs Outside the Box” are working to fill the void by offering financial education tailored to physicians.
These resources cover everything from budgeting and debt management to investing and entrepreneurship. Some medical schools are beginning to incorporate financial literacy into their curricula, but progress is slow and inconsistent.
Conclusion
Medical school equips doctors to save lives, but it doesn’t prepare them to secure their own financial future. The lack of financial education leaves many physicians vulnerable to debt, poor investment decisions, and lifestyle inflation. To thrive both professionally and personally, doctors must seek out financial knowledge beyond the classroom. Whether through self-study, mentorship, or professional guidance, understanding money is as essential as understanding medicine. After all, financial health is a cornerstone of overall well-being—and every doctor deserves to master both.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
President Donald Trump signed a pardon on Wednesday for convicted crypto executive Changpeng Zhao, who founded the Binance crypto exchange, White House Press Secretary Karoline Leavitt said in a statement. “President Trump exercised his constitutional authority by issuing a pardon for Mr. Zhao, who was prosecuted by the Biden Administration in their war on cryptocurrency,” Leavitt said. “In their desire to punish the cryptocurrency industry, the Biden Administration pursued Mr. Zhao despite no allegations of fraud or identifiable victims.”
Zhao was sentenced to four months in prison after reaching a deal with the Justice Dept. to plead guilty to charges of enabling money laundering at Binance, which he ran at the time. The U.S. also ordered Binance to pay more than $4 billion in fines and forfeiture, while Zhao agreed to pay $50 million in fines. A spokesperson for Binance did not immediately respond to a request for comment yesterday.
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The History of Cryptocurrency: From Concept to Revolution
Cryptocurrency has transformed the global financial landscape, offering a decentralized alternative to traditional banking systems. Its history is rooted in decades of technological innovation, philosophical ideals, and economic experimentation.
🌐 Early Foundations
The concept of digital currency predates Bitcoin by several decades. In 1982, cryptographer David Chaum published a groundbreaking paper on secure digital transactions, laying the foundation for future developments in electronic money. Chaum later founded DigiCash in the 1990s, which introduced the idea of anonymous digital payments using cryptographic protocols. Although DigiCash eventually failed, it was a crucial stepping stone in the evolution of cryptocurrency.
The Birth of Bitcoin
The true revolution began in 2008 when an anonymous figure—or group—known as Satoshi Nakamoto released the Bitcoin whitepaper titled “Bitcoin: A Peer-to-Peer Electronic Cash System.” This document proposed a decentralized digital currency that used blockchain technology to record transactions transparently and securely without the need for a central authority.
On January 3, 2009, Nakamoto mined the first block of the Bitcoin blockchain, known as the Genesis Block. The first real-world Bitcoin transaction occurred in May 2010, when programmer Laszlo Hanyecz paid 10,000 BTC for two pizzas—an event now celebrated annually as Bitcoin Pizza Day.
Blockchain and Beyond
Bitcoin’s success inspired the development of other cryptocurrencies and blockchain platforms. Ethereum, launched in 2015 by Vitalik Buterin, introduced smart contracts—self-executing agreements coded directly into the blockchain. This innovation expanded the use of cryptocurrency beyond simple transactions to decentralized applications (dApps), finance (DeFi), and even digital art (NFTs).
Other notable cryptocurrencies include Litecoin, Ripple (XRP), and Cardano, each offering unique features such as faster transaction speeds, improved scalability, or enhanced privacy.
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⚖️ Challenges and Controversies
Despite its promise, cryptocurrency has faced significant hurdles. Regulatory uncertainty, security breaches, and market volatility have raised concerns among governments and investors. High-profile hacks, such as the Mt. Gox exchange collapse in 2014, highlighted the risks associated with digital assets.
Governments around the world have responded differently—some embracing crypto innovation, others imposing strict regulations or outright bans. The rise of central bank digital currencies (CBDCs) reflects an effort to merge the benefits of crypto with the stability of fiat systems.
🚀 The Future of Crypto
Today, cryptocurrency is more than a niche technology—it’s a global phenomenon. Major companies accept Bitcoin, institutional investors hold crypto assets, and blockchain is being integrated into industries from healthcare to supply chain management.
As the technology matures, the focus is shifting toward scalability, sustainability, and interoperability. Whether it becomes a mainstream financial tool or remains a disruptive alternative, cryptocurrency has undeniably reshaped how we think about money, trust, and digital ownership.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Turning 65 is often seen as the gateway to retirement—a time to slow down, reflect, and enjoy the fruits of decades of labor. But for some, including doctors who may have faced financial setbacks, poor planning, or unexpected life events, reaching this milestone without financial security can be deeply unsettling. The image of a broke 65-year-old doctor may seem paradoxical, given the profession’s reputation for high earnings. Yet, reality paints a more nuanced picture. Fortunately, even in the face of financial hardship, retirement is not a closed door—it’s a challenge that can be met with creativity, resilience, and strategic planning.
Understanding the Situation
Before exploring solutions, it’s important to understand how a physician might arrive at retirement age without adequate savings. Medical school debt, late career starts, divorce, health issues, poor investment decisions, or supporting family members can all contribute. Some doctors work in lower-paying specialties or underserved areas, sacrificing income for impact. Others may have lived beyond their means, assuming their high salary would always be enough. Regardless of the cause, the key is to shift focus from regret to action.
Traditional retirement—ceasing work entirely—is not the only option. For a broke 65-year-old doctor, retirement may mean transitioning to a less demanding role, reducing hours, or shifting to a new field. The goal is to create a sustainable lifestyle that balances income, purpose, and well-being.
Leveraging Medical Expertise
Even if full-time clinical practice is no longer viable, a physician’s knowledge remains valuable. Here are several ways to continue earning while easing into retirement:
Telemedicine: Remote consultations are in high demand, especially in primary care, psychiatry, and chronic disease management. Telemedicine offers flexibility, reduced overhead, and the ability to work from home.
Locum Tenens: Temporary assignments can fill staffing gaps in hospitals and clinics. These roles often pay well and allow for travel or seasonal work.
Medical Writing and Reviewing: Physicians can write for journals, websites, or pharmaceutical companies. Peer reviewing, editing, and content creation are viable options.
Teaching and Mentoring: Medical schools, nursing programs, and residency programs need experienced educators. Adjunct teaching or mentoring can be fulfilling and financially helpful.
Consulting: Doctors can advise healthcare startups, legal teams, or insurance companies. Their insights are valuable in product development, litigation, and policy.
Exploring Non-Clinical Opportunities
Some physicians may wish to pivot entirely. Transferable skills—critical thinking, communication, leadership—open doors in other industries:
Health Coaching or Life Coaching: With certification, doctors can guide clients in wellness, stress management, or career transitions.
Entrepreneurship: Starting a small business, such as a tutoring service, online course, or specialty clinic, can generate income and autonomy.
Real Estate or Investing: With careful planning, investing in rental properties or learning about the stock market can create passive income.
Maximizing Government and Community Resources
At 65, individuals become eligible for Medicare, which can significantly reduce healthcare costs. Additionally, Social Security benefits may be available, depending on work history. While delaying benefits until age 70 increases monthly payments, some may need to claim earlier to meet immediate needs.
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Other resources include:
Supplemental Security Income (SSI): For those with limited income and assets.
SNAP (food assistance) and LIHEAP (energy assistance): These programs help cover basic living expenses.
Community Organizations: Nonprofits and religious groups often provide support with housing, transportation, and social engagement.
Downsizing and Budgeting
Reducing expenses is a powerful way to stretch limited resources. Consider:
Relocating: Moving to a lower-cost area or state with favorable tax policies can reduce housing and living expenses.
Selling Assets: A large home, unused vehicle, or collectibles may be converted into cash.
Shared Housing: Living with family, roommates, or in co-housing communities can cut costs and reduce isolation.
Minimalist Living: Prioritizing needs over wants and embracing simplicity can lead to financial and emotional freedom.
Creating a realistic budget is essential. Track income and expenses, eliminate unnecessary costs, and prioritize essentials. Free budgeting tools and financial counseling services can help.
Financial stress can take a toll on mental health. It’s important to cultivate resilience and maintain a sense of purpose. Strategies include:
Staying Active: Physical activity improves mood and health. Walking, yoga, or swimming are low-cost options.
Volunteering: Giving back can provide structure, community, and fulfillment.
Learning New Skills: Online courses, hobbies, or certifications can reignite passion and open new doors.
Building a Support Network: Friends, family, and peer groups offer emotional support and practical advice.
Planning for the Future
Even at 65, it’s not too late to plan. Consider:
Debt Management: Negotiate payment plans, consolidate loans, or seek professional help.
Estate Planning: Create a will, designate healthcare proxies, and organize important documents.
Insurance Review: Ensure adequate coverage for health, life, and long-term care.
Financial Advising: A fee-only advisor can help create a sustainable plan without selling products.
Embracing a New Chapter
Retirement is not a destination—it’s a transition. For a broke 65-year-old doctor, it may not look like the glossy brochures, but it can still be rich in meaning. By leveraging experience, reducing expenses, accessing resources, and nurturing well-being, retirement becomes a journey of reinvention.In many ways, doctors are uniquely equipped for this challenge. They’ve faced long hours, high stakes, and complex problems. That same grit and adaptability can guide them through financial hardship and into a fulfilling retirement.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
🏦 100 Minus Age Rule: Subtract your age from 100 to estimate the percentage of your portfolio to invest in stocks. The rest goes to bonds or safer assets.
Rule of 110 or 120: A modern twist—subtract your age from 110 or 120 to allow for more stock exposure in a low-interest environment.
Diversify, Don’t Speculate: Spread investments across asset classes to reduce risk.
Don’t Invest What You Can’t Afford to Lose: Especially for speculative assets like crypto or startups.
📈 Growth & Returns
Rule of 72: Divide 72 by your annual return rate to estimate how many years it takes to double your money.
Time in the Market Beats Timing the Market: Staying invested long-term usually outperforms trying to predict short-term moves.
Start Early, Compound Often: The earlier you invest, the more compound interest works in your favor.
🧾 Budgeting & Saving
50/30/20 Rule: Allocate 50% of income to needs, 30% to wants, and 20% to savings/investments.
Emergency Fund Rule: Save 3–6 months of living expenses before investing aggressively.
Pay Yourself First: Automatically invest a portion of your income before spending.
🧠 Behavioral & Strategy Tips
Buy What You Understand: Don’t invest in companies or assets you don’t comprehend.
Avoid Emotional Decisions: Fear and greed are the enemies of smart investing.
Rebalance Annually: Adjust your portfolio to maintain your target asset allocation.
Don’t Chase Past Performance: What worked last year may not work this year.
🏦 Retirement & Withdrawal
The 4% Rule: Withdraw 4% of your retirement savings annually to make it last ~30 years.
Save 15% of Income for Retirement: A common target for long-term financial security.
Max Out Tax-Advantaged Accounts First: Prioritize 401(k), IRA, or Roth IRA before taxable accounts.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Population health and public health are two interrelated disciplines that strive to enhance the health outcomes of communities. While they share a common mission—to reduce health disparities and promote wellness—their approaches, target populations, and operational frameworks differ significantly.
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Public health is traditionally defined as the science and art of preventing disease, prolonging life, and promoting health through organized efforts and informed choices of society, organizations, public and private sectors, communities, and individuals. It focuses on the health of the general population and emphasizes broad interventions such as vaccination programs, sanitation, health education, and policy advocacy. Public health professionals often work in government agencies, nonprofit organizations, and academic institutions to implement community-wide initiatives that prevent disease and promote healthy behaviors.
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In contrast, population health takes a more targeted approach. It refers to the health outcomes of a specific group of individuals, including the distribution of such outcomes within the group. This field is particularly concerned with the social determinants of health—factors like income, education, environment, and access to care—that influence health disparities. Population health strategies often involve data-driven interventions tailored to the needs of defined groups, such as rural communities, ethnic minorities, or patients with chronic conditions.
One key distinction lies in scope and granularity. Public health initiatives are typically designed for the entire population, aiming to create systemic change. For example, anti-smoking campaigns or water fluoridation programs benefit everyone regardless of individual risk. Population health, however, might focus on reducing diabetes rates among Hispanic adults in a specific urban area, using targeted outreach and culturally sensitive care models.
Another difference is in data utilization. Population health relies heavily on health informatics and analytics to identify trends, allocate resources, and evaluate outcomes. This evidence-based approach supports precision in addressing health inequities. Public health also uses data, but often at a broader level to guide policy and monitor general health indicators like life expectancy or disease prevalence.
Despite these differences, the two fields are complementary. Public health lays the foundation for healthy societies through preventive infrastructure, while population health builds on this by addressing nuanced needs within subgroups. Together, they form a holistic framework for improving health outcomes across diverse communities.
In today’s healthcare landscape, the integration of public and population health is increasingly vital. The COVID-19 pandemic underscored the importance of both approaches: public health measures like mask mandates and vaccination campaigns were essential, while population health efforts ensured vulnerable groups received targeted support.
In conclusion, while public health and population health differ in focus and methodology, they are united by a shared goal: to foster healthier communities. Understanding their distinctions enables more effective collaboration and innovation in health policy, care delivery, and community engagement.
SPEAKING: ME-P Editor Dr. David Edward Marcinko MBA MEd will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Investing may seem complicated, but today there are many ways for the newly minted physician [MD, DO, DPM, DMD or DDS] to begin, even with minimal knowledge and only a small amount to invest. Starting as soon as possible will help you get closer to the retirement you deserve.
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Why is investing important?
Investing often feels like a luxury reserved for the already wealthy physician. Many of us find it difficult to think about investing for the future when there are so many things we need that money for right now; medical school loans, auto, home and children; etc. But, at some point, we’re going to want to stop working and enjoy retirement. And simply put, retirement is expensive.
Most calculations advise that you aim for enough savings to give you 70% to 80% of your pre-retirement income for 20 years or more. Depending on your goals for retirement, that means you could need between $500,000 and $1 million in savings by the time you retire. That may not sound attainable, but with the power of compounding growth, it’s not as hard to achieve as you think. The key is starting as soon as possible and making smart choices.
The short answer is “now,” no matter what your age. Due to the way the gains in investments can compound, the earlier you start the better. Money invested in your 20s could very easily grow over 20 times before you retire, without you having to do much.That is powerful. Even if you’re in your 50s or older, you can still make significant progress toward meeting your goals in retirement.
How much should you invest per month?
Most financial experts say you should invest 10% to 15% of your annual income for retirement. That’s the goal, but you don’t have to get there immediately. Whatever you can start investing today is going to help you down the road.
So, if 10% to 15% is too much right now, start small and build toward that goal over time. You can actually start investing with $5 if you want. And you should. Some investment products require a minimum investment, but there are plenty that don’t, and a lot of online brokerage accounts can be started for free.
The best investments for you are going to depend on your age, goals, and strategy. The important thing is to get started. You’ll learn as you go. If you have questions, a dedicated DIYer or investment advisor can help give you the guidance and options you need.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Understanding Stock Market Options: A Strategic Investment Tool
Stock market options are financial instruments that offer investors a versatile way to participate in the equity markets. Unlike traditional stock trading, options provide the right—but not the obligation—to buy or sell an underlying asset at a predetermined price within a specified time frame. This flexibility makes options a powerful tool for hedging, speculation, and income generation.
There are two primary types of options: calls and puts. A call option gives the holder the right to buy a stock at a specific price, known as the strike price, before the option expires. Investors typically purchase call options when they anticipate a rise in the stock’s price. Conversely, a put option grants the right to sell a stock at the strike price, and is used when an investor expects the stock to decline. Each option contract typically represents 100 shares of the underlying stock.
Options are traded on regulated exchanges such as the Chicago Board Options Exchange (CBOE), and their prices are influenced by several factors. These include the underlying stock’s price, the strike price, time until expiration, volatility, and prevailing interest rates. The premium, or cost of the option, reflects these variables and represents the maximum loss for the buyer.
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One of the most compelling uses of options is hedging. Investors can use options to protect their portfolios against adverse price movements. For example, owning put options on a stock can offset potential losses if the stock’s value drops. This strategy is akin to purchasing insurance and is especially valuable during periods of market uncertainty.
Options also enable speculative strategies with limited capital. Traders can leverage options to bet on price movements without owning the underlying asset. While this can lead to significant gains, it also carries substantial risk, particularly if the market moves against the position. Therefore, understanding the mechanics and risks of options is crucial before engaging in such trades.
Another popular strategy involves writing options, or selling them to collect premiums. Covered call writing, for instance, involves holding a stock and selling call options against it. This generates income but caps potential upside if the stock surges beyond the strike price. Similarly, cash-secured puts allow investors to earn premiums while potentially acquiring stocks at a discount.
Despite their advantages, options are not suitable for all investors. Their complexity and potential for rapid loss require a solid grasp of financial concepts and disciplined risk management. Regulatory bodies and brokerages often require investors to pass suitability assessments before granting access to options trading.
In conclusion, stock market options are dynamic instruments that offer a range of strategic possibilities. Whether used for hedging, speculation, or income, they provide flexibility that traditional stock trading cannot match. However, their effective use demands education, experience, and a clear understanding of market behavior. For informed investors, options can be a valuable addition to a diversified financial toolkit.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Posted on October 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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Understanding the Differences Between Microeconomics and Macroeconomics
Economics is the study of how societies allocate scarce resources to meet the needs and wants of individuals. It is broadly divided into two main branches: microeconomics and macroeconomics. While both aim to understand economic behavior and decision-making, they differ significantly in scope, focus, and application. Understanding these differences is essential for grasping how economies function at both individual and national levels.
Microeconomics focuses on the behavior of individual economic agents—such as consumers, firms, and households—and how they make decisions regarding resource allocation. It examines how these entities interact in specific markets, how prices are determined, and how supply and demand influence economic outcomes.
Key concepts in microeconomics include:
Demand and Supply: Microeconomics analyzes how the quantity of goods demanded by consumers and the quantity supplied by producers interact to determine market prices.
Elasticity: This measures how responsive demand or supply is to changes in price or income.
Consumer Behavior: Microeconomics studies how individuals make choices based on preferences, budget constraints, and utility maximization.
Production and Costs: It explores how firms decide on the optimal level of output and the costs associated with production.
Market Structures: Microeconomics categorizes markets into perfect competition, monopolistic competition, oligopoly, and monopoly, each with distinct characteristics and implications for pricing and output.
Microeconomic analysis is crucial for understanding how specific sectors operate, how businesses strategize, and how consumers respond to changes in prices or income. For example, a company might use microeconomic principles to determine the price point that maximizes profit or to assess the impact of a new competitor entering the market.
Macroeconomics: The Study of the Economy as a Whole
Macroeconomics, on the other hand, deals with the performance, structure, and behavior of an entire economy. It looks at aggregate indicators and phenomena, such as national income, unemployment, inflation, and economic growth. Macroeconomics seeks to understand how the economy functions at a broad level and how government policies can influence economic outcomes.
Key areas of macroeconomics include:
Gross Domestic Product (GDP): This measures the total value of goods and services produced within a country and serves as a key indicator of economic health.
Unemployment: Macroeconomics examines the causes and consequences of unemployment and the effectiveness of policies aimed at reducing it.
Inflation and Deflation: It studies changes in the general price level and their impact on purchasing power and economic stability.
Fiscal and Monetary Policy: Macroeconomics evaluates how government spending, taxation, and central bank actions influence economic activity.
International Trade and Finance: It explores exchange rates, trade balances, and the impact of globalization on national economies.
Macroeconomic analysis is essential for policymakers, economists, and financial institutions. For instance, central banks use macroeconomic data to set interest rates, while governments design fiscal policies to stimulate growth or curb inflation.
Despite their differences, microeconomics and macroeconomics are deeply interconnected. Micro-level decisions collectively shape macroeconomic outcomes. For example, widespread consumer spending boosts aggregate demand, influencing GDP and employment levels. Conversely, macroeconomic conditions—such as inflation or interest rates—affect individual behavior. A rise in interest rates may discourage borrowing and reduce consumer spending, impacting businesses at the micro level.
Economists often use insights from both branches to develop comprehensive models and forecasts. For instance, understanding consumer behavior (micro) helps predict changes in aggregate consumption (macro), which in turn informs policy decisions.
Microeconomics and macroeconomics offer distinct yet complementary perspectives on economic activity. Microeconomics provides a granular view of individual decision-making and market dynamics, while macroeconomics offers a broader understanding of national and global economic trends. Together, they form the foundation of economic theory and practice, guiding businesses, governments, and individuals in making informed decisions.
A well-rounded grasp of both branches is essential for anyone seeking to understand how economies function and evolve in an increasingly complex world.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Posted on October 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and A.I.
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Stocks: Stock Market Indexes recovered yesterday from their losses, though the Dow remained in the red.
Commodities: Gold is rising above $4,200 to another new all-time high. Meanwhile, oil dropped to nearly a five-month low as trade tensions raised the specter of slowing economic growth.
Crypto: Bitcoin, ethereum, and altcoins of all shapes and sizes remain repressed after a massive selloff last weekend erased billions in crypto positions.
The S&P 500, short for the Standard & Poor’s 500 Index, is one of the most widely followed stock market indices in the world. It tracks the performance of 500 of the largest publicly traded companies in the United States, offering a broad snapshot of the overall health and direction of the U.S. economy. Created in 1957 by the financial services company Standard & Poor’s, the index has become a benchmark for investors, analysts, and economists alike.
Composition and Criteria The S&P 500 includes companies from a wide range of industries, such as technology, healthcare, finance, energy, and consumer goods. To be included in the index, a company must meet specific criteria: it must be based in the U.S., have a market capitalization of at least $14.5 billion (as of 2025), be highly liquid, and have a public float of at least 50% of its shares. Additionally, the company must have positive earnings in the most recent quarter and over the sum of its most recent four quarters.
Some of the most recognizable names in the S&P 500 include Apple, Microsoft, Amazon, Johnson & Johnson, JPMorgan Chase, and ExxonMobil. These companies are selected by a committee that reviews eligibility and ensures the index remains representative of the broader market.
How It Works The S&P 500 is a market-capitalization-weighted index, meaning that companies with larger market values have a greater influence on the index’s performance. For example, a significant movement in Apple’s stock price will affect the index more than a similar movement in a smaller company’s stock. This weighting system helps reflect the real impact of large corporations on the economy.
The index is updated in real time during trading hours and is used by investors to gauge market trends. It also serves as the basis for many investment products, such as mutual funds and exchange-traded funds (ETFs), which aim to replicate its performance.
Why It Matters The S&P 500 is considered a leading indicator of U.S. equity markets and the economy as a whole. When the index rises, it often signals investor confidence and economic growth. Conversely, a decline may indicate uncertainty or economic slowdown. Because it includes companies from diverse sectors, the S&P 500 provides a more balanced view than narrower indices like the Dow Jones Industrial Average, which only tracks 30 companies.
Investment and Strategy Many investors use the S&P 500 as a benchmark to measure the performance of their portfolios. Passive investment strategies, such as index funds, aim to match the returns of the S&P 500 rather than beat it. This approach has gained popularity due to its low fees and consistent long-term performance.
In summary, the S&P 500 is more than just a number—it’s a powerful tool that reflects the pulse of the American economy. By tracking the performance of 500 major companies, it offers insights into market trends, investor sentiment, and economic health. Whether you’re a seasoned investor or just starting out, understanding the S&P 500 is essential to navigating the world of finance.
The Looming Cryptocurrency Crisis: Risks on the Horizon
Cryptocurrency has revolutionized the financial landscape, offering decentralized alternatives to traditional banking and investment systems. However, as digital assets become more integrated into global markets, concerns about a potential future cryptocurrency crisis are mounting. From regulatory uncertainty to systemic vulnerabilities, the risks associated with crypto are increasingly being scrutinized by economists, governments, and investors.
One of the most pressing concerns is regulatory instability. Cryptocurrencies operate in a fragmented legal environment, with different countries adopting varying stances—from full embrace to outright bans. The lack of unified global regulation creates loopholes that can be exploited for money laundering, tax evasion, and fraud. If major economies suddenly impose strict regulations or sanctions, it could trigger a rapid devaluation of crypto assets and erode investor confidence.
Another risk stems from market volatility and speculative behavior. Unlike traditional assets backed by tangible value or government guarantees, cryptocurrencies are often driven by hype, social media trends, and speculative trading. This creates a fragile ecosystem where prices can swing wildly. A sudden crash—similar to the 2022 Terra/Luna collapse—could wipe out billions in investor wealth and destabilize related financial institutions.
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Technological vulnerabilities also pose a threat. While blockchain is considered secure, the platforms built on it are not immune to hacks, bugs, or exploitation. High-profile breaches of exchanges and wallets have already resulted in massive losses. As crypto adoption grows, so does the incentive for cybercriminals to target these systems. A coordinated attack on a major exchange or blockchain network could have cascading effects across the entire crypto economy. Geopolitical tensions may also catalyze a crisis. For instance, recent reports suggest that aggressive trade policies—such as the U.S. imposing 100% tariffs on Chinese imports—can indirectly impact crypto markets by shaking investor sentiment and triggering sell-offs.
The interconnection with traditional finance is another area of concern. As banks and hedge funds increasingly invest in crypto, the line between decentralized finance and conventional markets blurs. This integration means that a crypto collapse could spill over into broader financial systems, potentially triggering a global crisis. The 2023 banking collapses, which were partially linked to crypto exposure, serve as a warning of how intertwined these systems have become.
Geopolitical tensions may also catalyze a crisis. For instance, recent reports suggest that aggressive trade policies—such as the U.S. imposing 100% tariffs on Chinese imports—can indirectly impact crypto markets by shaking investor sentiment and triggering sell-offs. In such scenarios, cryptocurrencies may not serve as the safe haven they were once believed to be.
Lastly, overreliance on stablecoins and algorithmic assets introduces systemic risk. Many investors use stablecoins to hedge volatility, but these assets are only as stable as their underlying reserves and governance. If a major stablecoin fails, it could lead to a liquidity crunch and panic across exchanges and DeFi platforms.
In conclusion, while cryptocurrency offers transformative potential, it also carries significant risks that could culminate in a future crisis. To mitigate these dangers, stakeholders must push for clearer regulations, stronger technological safeguards, and more transparent financial practices. Without proactive measures, the next financial meltdown may not come from Wall Street—but from the blockchain.
NOTE: A crypto mogul has been found dead inside his luxury car in Ukraine after the digital currency market nosedived. Konstantin Galich, 32, also known as Kostya Kudo, has died after one of the worst turmoils shook the cryptocurrency market. The entrepreneur, who became a well-known figure in the crypto industry, was reportedly found with a gunshot wound to his head in his black Lamborghini parked up in Kyiv’s Obolonskyi neighbourhood. His death was later confirmed on his Telegram channel in a post saying ‘Konstantin Kudo tragically passed away. The causes are being investigated. We will keep you posted on any further news.’
Posted on October 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I. and Staff Reporters
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The VIX, or CBOE Volatility Index, is often called the “fear gauge” of the stock market. It measures the market’s expectations for volatility over the next 30 days, based on options prices for the S&P 500.
The Dow Jones Industrial Average (DJIA), often referred to simply as “the Dow,” is one of the oldest and most well-known stock market indices in the world. It was created in 1896 by Charles Dow, the co-founder of The Wall Street Journal, and is designed to represent the performance of the broader U.S. stock market, specifically focusing on 30 large, publicly traded companies. These companies are considered leaders in their respective industries and serve as a barometer for the overall health of the U.S. economy.
The Composition of the DJIA
The DJIA includes 30 companies, which are selected by the editors of The Wall Street Journal based on various factors such as market influence, reputation, and the stability of the company. These companies represent a wide array of sectors, including technology, finance, healthcare, consumer goods, and energy. Notably, the companies chosen for the DJIA are not necessarily the largest companies in the U.S. by market capitalization, but rather those that are most indicative of the broader economy. Some of the prominent companies listed in the DJIA include names like Apple, Microsoft, Coca-Cola, and Johnson & Johnson.
However, the list of 30 companies is not static. Over time, companies may be added or removed to reflect changes in the economic landscape. For example, if a company experiences significant decline or no longer represents a leading sector, it might be replaced with another company that better reflects modern economic trends. This periodic reshuffling ensures that the DJIA continues to be a relevant measure of economic activity.
How the DJIA is Calculated
The DJIA is a price-weighted index, which means that the value of the index is determined by the share price of the component companies, rather than their market capitalization. To calculate the DJIA, the sum of the stock prices of all 30 companies is divided by a special divisor. This divisor adjusts for stock splits, dividends, and other corporate actions to maintain the integrity of the index over time. The price-weighted method means that higher-priced stocks have a greater impact on the movement of the index, regardless of the overall size or economic weight of the company.
For instance, if a company with a higher stock price like Apple experiences a significant change in value, it will influence the DJIA more than a company with a lower stock price, even if the latter has a larger market capitalization. This makes the DJIA somewhat different from other indices, like the S&P 500, which is weighted by market cap and gives more weight to larger companies in terms of their economic impact.
Significance of the DJIA
The DJIA is widely regarded as a barometer of the U.S. stock market’s performance. Investors and analysts closely monitor the movements of the Dow to gauge the overall health of the economy. When the DJIA rises, it generally suggests that investors are optimistic about the economic outlook and that large companies are performing well. Conversely, when the DJIA falls, it often signals economic uncertainty or a downturn in market conditions.
Despite being a narrow index, with only 30 companies, the DJIA holds substantial sway in financial markets. It is widely covered in the media and is often cited in discussions about the state of the economy. In fact, the performance of the DJIA is considered a key indicator of investor sentiment and economic confidence.
However, the DJIA has its limitations. Since it only includes 30 companies, it does not necessarily represent the broader market or capture the performance of smaller companies. Other indices, like the S&P 500, which includes 500 companies, offer a more comprehensive view of the market’s performance.
Conclusion
The Dow Jones Industrial Average is a key metric for understanding the state of the U.S. economy and the stock market. Although it has evolved over the years, it continues to provide valuable insights into the performance of large, influential companies. While it is not a perfect reflection of the market as a whole, the DJIA remains one of the most important and widely recognized indices in global finance. Through its historical significance and its role in shaping market sentiment, the Dow has cemented its place as a cornerstone of financial analysis.
Posted on October 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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Stocks: The S&P 500 hit its seventh record close in a row today, its longest win streak since May. The NASDAQ was buoyed by big tech, while the DJIA fell.
Commodities: Oil climbed thanks to a decision by OPEC+ to boost crude production at a more modest rate than experts expected. Gold continued its record run, rising above $3,900 for the first time ever, while bitcoin hovered just below a new all-time high.
Japan and France: Japanese stocks rose after the country elected its first female prime minister, and French stocks dropped after its prime minister quit less than a month into the job.
Artificial Intelligence and Investing: A Transformative Partnership
Artificial Intelligence (AI) is revolutionizing the world of investing, reshaping how decisions are made, risks are assessed, and portfolios are managed. As financial markets grow increasingly complex and data-driven, AI offers powerful tools to navigate this landscape with greater precision, speed, and insight.
At its core, AI refers to systems that can perform tasks typically requiring human intelligence—such as learning, reasoning, and problem-solving. In investing, this translates into algorithms that can analyze vast amounts of financial data, detect patterns, and make predictions with remarkable accuracy. Machine learning, a subset of AI, enables these systems to improve over time by learning from new data, making them especially valuable in dynamic markets.
One of the most significant applications of AI in investing is algorithmic trading. These systems can execute trades at lightning speed, responding to market fluctuations in milliseconds. By analyzing historical data and real-time market conditions, AI-driven trading platforms can identify optimal entry and exit points, often outperforming human traders. High-frequency trading firms have long relied on such technologies to gain competitive advantages.
AI also enhances portfolio management through robo-advisors—digital platforms that use algorithms to provide personalized investment advice. These tools assess an investor’s goals, risk tolerance, and time horizon, then construct and manage a diversified portfolio accordingly. Robo-advisors democratize access to financial planning, offering low-cost, automated solutions to individuals who might not afford traditional advisory services.
Risk assessment is another area where AI shines. By processing alternative data sources—such as social media sentiment, news articles, and satellite imagery—AI can uncover hidden risks and opportunities. For instance, a sudden spike in negative sentiment around a company on Twitter might signal reputational issues, prompting investors to reevaluate their positions. AI models can also forecast macroeconomic trends, helping investors anticipate shifts in interest rates, inflation, or geopolitical events.
Moreover, AI is transforming fundamental analysis. Natural language processing (NLP) allows machines to read and interpret earnings reports, SEC filings, and analyst commentary. This enables investors to extract insights from unstructured data that would be time-consuming to analyze manually. AI can even detect subtle linguistic cues that may indicate a company’s future performance or management’s confidence.
Despite its advantages, AI in investing is not without challenges. Models can be opaque, making it difficult to understand how decisions are made—a phenomenon known as the “black box” problem. There’s also the risk of overfitting, where algorithms perform well on historical data but fail in real-world scenarios. Ethical concerns, such as bias in data and the potential for market manipulation, must also be addressed.
In conclusion, AI is reshaping the investing landscape, offering tools that enhance efficiency, accuracy, and accessibility. While it’s not a panacea, its integration into financial markets marks a profound shift in how capital is allocated and wealth is managed. As technology continues to evolve, investors who embrace AI will be better positioned to thrive in an increasingly data-driven world.
The major indexes ticked lower last week, though, as artificial intelligence names like Oracle got hit after some analysts expressed concerns over the eye-watering costs of the AI build-out.
Economy: Headline PCE rose from 2.6% on an annual basis in July to 2.7% in August, while core PCE stayed flat at 2.9%—all in line with analyst expectations.
Stocks: Solid inflation numbers helped equities arrest their recent selloff and offset the latest batch of tariffs. However, all three major indexes still ended the week lower than where they started.
Commodities: Oil climbed as Ukrainian drones continue to strike Russian energy infrastructure. Meanwhile, gold hit another all-time high, and rose above $3,800 for the first time ever at one point today.
Posted on September 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I. and Staff Reporters
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Bonds: The 10-year Treasury yield popped on solid economic data yesterday, including weekly jobless claims falling to their lowest since mid-July and Q2 GDP rising unexpectedly.
Stocks: But good news for the labor market and economy is bad news for anyone hoping the Federal Reserve cuts interest rates next month, and the major indexes sank for a third day in a row yesterday. All eyes now turn to today’s key PCE reading.
Crypto: Digital assets continued to tumble yesterday with ether falling below $4,000 for the first time in months. There may be more pain ahead: $22 billion in crypto options expire today.
The Series 6 exam — the Investment Company and Variable Contracts Products Representative Qualification Examination (IR) — assesses the competency of an entry-level representative to perform their job as an investment company and variable contracts products representative.
The exam measures the degree to which each candidate possesses the knowledge needed to perform the critical functions of an investment company and variable contract products representative, including sales of mutual funds and variable annuities.
Candidates must pass the Securities Industry Essentials (SIE) exam and the Series 6 exam to obtain the Investment Company and Variable Contracts Products registration.
The study of behavioral economics has revealed much about how different biases can affect our finances—often for the worse.
Take loss aversion: Because we feel a financial setback more acutely than a commensurate gain, we often cling to failed investments to avoid realizing the loss. Another potential hazard is present bias, or the tendency to prefer instant gratification over long-term reward, even if the latter gain is greater.
When it comes to money, sometimes it’s difficult to make rational decisions. Here, are three behavioral financial biases that could be impeding financial goals.
ANCHORING BIAS
Anchoring Bias happens when we place too much emphasis on the first piece of information we receive regarding a given subject. Anchoring is the mental trick your brain plays when it latches onto the first piece of information it gets, no matter how irrelevant. You might know this as a ‘first impression’ when someone relies on their own first idea of a person or situation.
Example: When shopping for a wedding ring a salesman might tell us to spend three months’ salary. After hearing this, we may feel like we are doing something wrong if we stray from this financial advice, even though the guideline provided may cause us to spend more than we can afford.
Example: Imagine you’re buying a car, and the salesperson starts with a high price. That number sticks in your mind and influences all your subsequent negotiations. Anchoring can skew our decisions and perceptions, making us think the first offer is more important than it is. Or, subsequent offers lower than they really are.
Example: Imagine an investor named Jane who purchased 100 shares of XYZ Corporation at $100 per share several years ago. Over time, the stock price declined to $60 per share. Jane is anchored to her initial price of $100 and is reluctant to sell at a loss because she keeps hoping the stock will return to her original purchase price. She continues to hold onto the stock, even as it declines, due to her anchoring bias. Eventually, the stock price drops to $40 per share, resulting in significant losses for Jane.
In this example, Jane’s nchoring bias to the original purchase price of $100 prevents her from rationalizing to sell the stock and cut her losses, even though market conditions have changed. So, the next time you’re haggling for your self, a potential customer or client, or making another big financial decision, be aware of that initial anchor dragging you down.
HERD MENTALITY BIAS
Herd Mentality Bias makes it very hard for humans to not take action when everyone around us does.
Example: We may hear stories of people making significant monetary profits buying, fixing up, and flipping homes and have the desire to get in on the action, even though we have no experience in real estate.
Example: During the dotcom bubble of the late 1990’s many investors exhibited a herd mentality. As technology stocks soared to astronomical valuations, investors rushed to buy these stocks driven by the fear of missing out on the gains others were enjoying. Even though some of these stocks had questionable fundamentals, the herd mentality led investors to follow the crowd.
In this example, the herd mentality contributed to the overvaluation of technology stocks. Eventually, it led to the dot-com bubble’s burst, causing significant losses for those who had unthinkingly followed the crowd without conducting proper research or analysis.
OVERCONFIDENT INVESTING BIAS
Overconfident Investing Bias happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. This causes the results of a study to be unreliable and hard to reproduce in other research settings.
Example: Data convincingly shows that people and financial planners/advisors and wealth managers who trade most often under-perform the market by a significant margin over time. Active traders lose money.
Example: Overconfidence Investing Bias moreover leads to: (1) excessive trading (which in turn results in lower returns due to costs incurred), (2) underestimation of risk (portfolios of decreasing risk were found for single men, married men, married women, and single women), (3) illusion of knowledge (you can get a lot more data nowadays on the internet) and (4) illusion of control (on-line trading).
ASSESSMENT
Finally, questions remain after consuming this cognitive bias review.
Question: Can behavioral cognitive biases be eliminated by financial advisors in prospecting and client sales endeavors?
A: Indeed they can significantly reduce their impact by appreciating and understanding the above and following a disciplined and rational decision-making sales process.
Question: What is the role of financial advisors in helping clients and prospects address behavioral biases?
A: Financial advisors can provide an objective perspective and help investors recognize and address their biases. They can assist in creating well-structured investment and financial plans, setting realistic goals, and offering guidance to ensure investment decisions align with long-term objectives.
Question:How important is self-discipline in overcoming behavioral biases?
A; Self-discipline is crucial in overcoming behavioral biases. It helps investors and advisors adhere to their investment plans, avoid impulsive decisions, and stay focused on long-term goals reducing the influence of emotional and cognitive biases.
CONCLUSION
Remember, it is far more useful to listen to client beliefs, fears and goals, and to suggest options and offer encouragement to help them discover their own path toward financial well-being. Then, incentivize them with knowledge of the above psychological biases to your mutual success!
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
REFERENCES:
Marcinko, DE; Dictionary of Health Insurance and Managed Care. Springer Publishing Company, New York, 2007.
Marcinko, DE: Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™. Productivity Press, NY, 2016.
Marcinko, DE: Risk Management, Liability and Insurance Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™. Productivity Press, NY, 2017.
Nofsinger, JR: The Psychology of Investing. Rutledge Publishing, 2022
Winters, Scott: The 10X Financial Advisor: Your Blueprint for Massive and Sustainable Growth. Absolute Author Publishing House, 2020.
Despite their high salaries, not all doctors are wealthy, and some live paycheck to paycheck. Here are 5 reasons why many doctors today are broke, according to https://medschoolinsiders.com
1 | Believing They Are Universally Smart
The first reason so many doctors are broke is that many doctors believe they are universally smart. While most doctors have deep specialized knowledge, there’s a big difference between being smart in your profession and being smart with money. A physician’s schooling is quite thorough when it comes to the human body, but med school doesn’t include a prerequisite class on how to handle finances.
Graduating medical school is a major feat and certainly demonstrates superior work ethic and cognitive abilities. But many new doctors believe these accomplishments transcend all aspects of life. If you’re smart enough to earn an MD, you’re certainly smart enough to handle your finances, but only once you properly and intentionally educate yourself.
The truth is doctors, especially traditional graduates, haven’t had an opportunity to manage large sums of money until they become fully trained attending physicians and start pulling in low to mid six figures in income. Prior to that, there was very little of it to manage.
Far too many aspiring doctors, and students in general, don’t take the time to learn financial basics, in part because it’s uncomfortable and seems like something they can figure out “later”, whenever that may be. Their poor spending habits and lack of investment knowledge carry over into their careers, causing many to make irresponsible decisions.
The second factor is overspending too soon, and this comes up at two points in training.
First, it’s natural to want to start spending more as soon as you get into residency and start making a little more money. After all, you’ve been a broke student for 8 or more years, and now you’re finally making a reasonable and reliable wage. But that’s where young doctors get into trouble. Residency pays, but not nearly as much as you will be making once you become an attending physician. The average resident makes about $60K a year, and if you begin spending all of that money right away, thinking you’ll handle your loans once you become an attending, you delay paying off your medical school debt, which means the compounding effect through your student loan interest rate works against you.
Now that $250,000 in student loans has ballooned to over $350,000 by the time you finish residency. The compounding effect, which can be one of your greatest allies in your financial life, becomes an equally powerful enemy when working against you through debt. But of course, pinching pennies is easier said than done, especially when you’re in residency and are surrounded by peers in different professions. They’ve been earning good money much longer than you have, and they can afford more luxurious lifestyles.
They may not be worried about indulging in fine dining or how much a hotel costs when traveling. Students in college and medical school are often confident they will resist the temptations, but the desire to keep up with your friends and family can be difficult to ignore, which causes many to overspend before they technically have the money to do so.
The same is true of attending physicians. As soon as those six-figure salaries come rolling in, many physicians go overboard with spending, trying to make up for lost time and to treat yourself.
Now, we are not suggesting you shouldn’t reward yourself for completing residency, but that reward shouldn’t be a Lamborghini. It’s best to continue living like a resident in your first few years after becoming an attending to pay off loans, put a down payment on a home, and get your financial foundation built before loosening the purse strings.
3 | Decreasing Salaries
Third, doctors continue to make less money than they did before. And this includes nearly all 44 medical specialties. For example, while physician compensation technically rose from $343k to $391k between 2017 and 2022, this rise does not keep up with inflation. The real average compensation in 2022 was less than $325k—a $20k decrease in purchasing power in only six years.
For doctors who are already spending to the limits of their salaries with huge mortgages, car payments, business costs, and other luxuries, a decreased salary can have a huge impact. You might be able to cut back by going on fewer vacations or eating out less frequently, but many accrued costs are locked in, such as a mortgage payment, car loan, or leased rental space for your practice.
4 | Increasing Costs of Private Practice
In the past, running a private practice was much simpler, but recent stricter guidelines and regulations have made it difficult for solo practices to keep up. While regulations like the Health Insurance Privacy and Portability Act, or HIPAA, and mandatory Electronic Medical Records, or EMRs, are necessary to protect patients, they make costs higher for physicians who run their own private practice. These physicians need to spend their own money to set up and maintain EMRs as well as invest in security to ensure patient data is protected.
With the steep rise of inflation we’ve seen over the past couple of years, everything is more expensive, which means costs, such as business space, equipment, and even office supplies, have gone up for private practice physicians while salaries have not. 2013 to 2020 saw an annual inflation rate of anywhere from 0.7% to 2.3%. This skyrocketed to an annual inflation rate of 7.0% in 2021 and another 6.5% in 2022. In fact, the cost of running a private practice has increased by almost 40% between 2001 and 2021.
These increased costs are exacerbated by another problem plaguing private practices; decreased reimbursement. While costs increased by almost 40%, Medicare reimbursement only increased by 11%. When doctors see patients who are insured, the insurance companies pay the physicians for their time. For Medicare, the new proposed rules for 2023 would cut reimbursement by around 5%. When adjusting for inflation, Medicare reimbursement decreased by 20% in the last 20 years.
These costs add up, making it extremely difficult for physicians to thrive financially while running a private practice.
5 | Tuition Debt
Lastly, we can’t talk about a doctor’s finances without mentioning the exorbitant debt so many graduating physicians are left with. It won’t shock you to hear that med school is expensive. Extremely expensive. The average cost of tuition for a single year is nearly $60k, with significant variance from school to school, and that’s before accounting for living expenses.
In-state applicants pay less than out-of-state applicants, and students at private schools typically pay more than students at public medical schools. The astronomical costs mean the vast majority of students can’t pay for medical school out of their own pockets. And unless your family is part of the 1%, even with your parents footing the bill, it’s difficult to cover tuition, let alone rent, groceries, transportation, tech, social activities, exam fees, and application costs.
The average total student debt after college and med school is over $250k. But keep in mind that’s the average, which includes 27% of students who graduate with no debt at all. This means the vast majority of students leave medical school owing much more than $250k.
For some perspective, in 1978, the average debt for graduating MDs was $13,500, which, when adjusted for inflation, is a little over $60,000. There are multiple ways to eventually repay these loans, but time and discipline are essential to ensure this money is paid off as quickly as possible.
According to financial advisor Dr. David Edward Marcinko MEd MBA CMP™; consider the following:
Place a portion of your salary (15-20% or more) into a savings account, and another portion (10-20% or more) into wise investments [stocks, bonds, mutual funds, and/or ETFs].
Pay off your bills each month, and then use leftover spending money to purchase fun things like vacations and fancy dinners, within your means. Shop sales, buy used clothes, and use credit card points for travel.
Hire an excellent tax professional and meet with an investment advisor once or twice a year about your investment status and strategy. http://www.MarcinkoAssociates.com
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
The Series 7 exam — the General Securities Representative Qualification Examination (GS) — assesses the competency of an entry-level registered representative to perform their job as a general securities representative.
The exam measures the degree to which each candidate possesses the knowledge needed to perform the critical functions of a general securities representative, including sales of corporate securities, municipal securities, investment company securities, variable annuities, direct participation programs, options and government securities.
Posted on September 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BREAKING NEWS!
By Staff Reporters
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Federal Reserve Chairman Jerome Powell just announced that the central bank [FOMC] would cut interest rates amid President Donald Trump’s attempts to reshape the Fed’s independence.
The chairman announced that the Federal Reserve would cut the interest rate by .25 points, the first time that it cut interest rates since December.
A paradox is a statement or situation that seems contradictory but actually makes sense when you think about it more deeply. It challenges logic and often reveals a hidden truth.
FLEXIBLY DOGMATIC PARADOX
The Flexibly Dogmatic Paradox suggests that no matter how sensible your financial planning, investing or wealth management process is there will be uncomfortably long periods when it looks broken. And process is the best way of ensuring you keep standing for something because if you don’t stand for something, you’ll fall for anything. This is why, when assessing an investment fund, focus 50% on the manager’s character and 50% on their process. Everything else is detail. There are few guarantees in investing, but the fact that markets will batter you emotionally is one of them.
Example: During volatile times, the temptation to abandon the process is strong. But that’s why it’s there. Process is what forces one fund manager to keep buying unbroken companies when everyone else thinks they’re bust, and another to keep faith with a top-quality company when the mob says it’s too expensive The best fund managers dogmatically stick to their process when it’s out of favor. Then, when it returns to favor, the elastic pings back: they recapture lost ground surprisingly fast. However, every rule has an exception. And spotting the exceptions to their process is something the true greats have a knack for buying and selling.
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Example: In 2007, US value manager Bill Miller had the makings of an investment legend, but the financial crisis wrecked all that. His process told him to double down into falling share prices, which had worked well for years. But it doesn’t work if the companies go bust, which many of his financial stocks did in 2008.
The fact is that no matter how good it is, a process operated without human judgment is just an algorithm. The best fund managers and financial prospectors and sales men/women know this.
They stick dogmatically to their process but somehow remain flexible enough to spot the occasions when it’s about to drive them into a brick wall.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Dr. Harry Markowitz is credited with developing the framework for constructing investment portfolios based on the risk-return tradeoff. William Sharpe, John Lintner, and Jan Mossin are credited with developing the Capital Asset Pricing Model (CAPM).
CAPM is an economic model based upon the idea that there is a single portfolio representing all investments (i.e., the market portfolio) at the point of the optimal portfolio on the Capital Market Line (CML) and a single source of systematic risk, beta, to that market portfolio. The resulting conclusion is that there should be a “fair” return investors should expect to receive given the level of risk (beta) they are willing to assume.
The excess return, or return above the risk-free rate, that may be expected from an asset is equal to the risk-free return plus the excess return of the market portfolio times the sensitivity of the asset’s excess return to the market portfolio excess return. Beta, then, is a measure of the sensitivity of an asset’s returns to the market as a whole. A particular security’s beta depends on the volatility of the individual security’s returns relative to the volatility of the market’s returns, as well as the correlation between the security’s returns and the markets returns.
While a stock may have significantly greater volatility than the market, if that stock’s returns are not highly correlated with the returns of the overall market (i.e., the stock’s returns are independent of the overall market’s returns), then the stock’s beta would be relatively low. A beta in excess of 1.0 implies that the security is more exposed to systematic risk than the overall market portfolio, and likewise, a beta of less 1.0 means that the security has less exposure to systematic risk than the overall market.
MPT has helped focus investors on two extremely critical elements of investing that are central to successful investment strategies.
First, MPT offers the first framework for investors to build a diversified portfolio. Furthermore, an important conclusion that can be drawn from MPT is that diversification does in fact help reduce portfolio risk.
Thus, MPT approaches are generally consistent with the first investment rule of thumb, “understand and diversify risk to the extent possible.”
Additionally, the risk/return tradeoff (i.e., higher returns are generally consistent with higher risk) central to MPT based strategies has helped investors recognize that if it looks too good to be true, it probably is.
Passive Investing
Passive investing is a monetary plan in which an investor invests in accordance with a pre-determined strategy that doesn’t necessitate any forecasting of the economy or an individual company’s prospects. The primary premise is to minimize investing fees and to avoid the unpleasant consequences of failing to correctly predict the future. The most accepted method to invest passively is to mimic the performance of a particular index. Investors typically do this today by purchasing one or more ‘index funds’. By tracking an index, an investor will achieve solid diversification with low expenses.
An ivestor could potentially earn a higher rate of return than an investor paying higher management fees. Passive management is most widespread in the stock markets. But with the explosion of exchange traded funds on the major exchanges, index investing has become more popular in other categories of investing. There are now literally hundreds of different index funds.
Passive management is based upon the Efficient Market Hypothesis theory. The Efficient Market Hypothesis (EMH) states that securities are fairly priced based on information regarding their underlying cash flows and that investors should not anticipate to consistently out-perform the market over the long-term.
The Efficient Market Hypothesis evolved in the 1960s from the Ph.D. dissertation of Eugene Fama. Fama persuasively made the case that in an active market that includes many well-informed and intelligent investors, securities will be appropriately priced and reflect all available information. If a market is efficient, no information or analysis can be expected to result in out-performance of an appropriate benchmark. There are three distinct forms of EMH that vary by the type of information that is reflected in a security’s price:
Weak Form
This form holds that investors will not be able to use historical data to earn superior returns on a consistent basis. In other words, the financial markets price securities in a manner that fully reflects all information contained in past prices.
Semi-Strong Form
This form asserts that security prices fully reflect all publicly available information. Therefore, investors cannot consistently earn above normal returns based solely on publicly available information, such as earnings, dividend, and sales data.
Strong Form
This form states that the financial markets price securities such that, all information (public and non-public) is fully reflected in the securities price; investors should not expect to earn superior returns on a consistent basis, no matter what insight or research they may bring to the table.
While a rich literature has been established regarding whether EMH actually applies in any of its three forms in real world markets, probably the most difficult evidence to overcome for backers of EMH is the existence of a vibrant money management and mutual fund industry charging value-added fees for their services.
The notion of passive management is counterintuitive to many investors. Passive investing proponents follow the strong market theory of EMH. These proponents argue several points including;
In the long term, the average investor will have a typical before-costs performance equal to the market average. Therefore the standard investor will gain more from reducing investment costs than from attempting to beat the market over time.
The efficient-market hypothesis argues that equilibrium market prices fully reflect all existing market information. Even in the case where some of the market information is not currently reflected in the price level, EMH indicates that an individual investor still cannot make use of that information. It is widely interpreted by many academics that to try and systematically “beat the market” through active management is a fools game.
Not everyone believes in the efficient market. Numerous researchers over the previous decades have found stock market anomalies that indicate a contradiction with the hypothesis. The search for anomalies is effectively the hunt for market patterns that can be utilized to outperform passive strategies. Such stock market anomalies that have been proven to go against the findings of the EMH theory include;
Low Price to Book Effect
January Effect
The Size Effect
Insider Transaction Effect
The Value Line Effect
All the above anomalies have been proven over time to outperform the market. For example, the first anomaly listed above is the Low Price to Book Effect. The first and most discussed study on the performance of low price to book value stocks was by Dr. Eugene Fama and Dr. Kenneth R. French. The study covered the time period from 1963-1990 and included nearly all the stocks on the NYSE, AMEX and NASDAQ. The stocks were divided into ten subgroups by book/market and were re-ranked annually. In the study, Fama and French found that the lowest book/market stocks outperformed the highest book/market stocks by a substantial margin (21.4 percent vs. 8 percent). Remarkably, as they examined each upward decile, performance for that decile was below that of the higher book value decile. Fama and French also ordered the deciles by beta (measure of systematic risk) and found that the stocks with the lowest book value also had the lowest risk.
Today, most researchers now deem that “value” represents a hazard feature that investors are compensated for over time. The theory being that value stocks trading at very low price book ratios are inherently risky, thus investors are simply compensated with higher returns in exchange for taking the risk of investing in these value stocks. The Fama and French research has been confirmed through several additional studies. In a Forbes Magazine 5/6/96 column titled “Ben Graham was right–again,” author David Dreman published his data from the largest 1500 stocks on Compustat for the 25 years ending 1994. He found that the lowest 20 percent of price/book stocks appreciably outperformed the market.
One item a medical professional should be aware of is the strong paradox of the efficient market theory. If each investor believes the stock market were efficient, then all investors would give up analyzing and forecasting. All investors would then accept passive management and invest in index funds. But if this were to happen, the market would no longer be efficient because no one would be scrutinizing the markets. In actuality, the efficient market hypothesis actually depends on active investors attempting to outperform the market through diligent research.
The case for passive investing and in favor of the EMH is that a preponderance of active managers do actually underperform the markets over time. The latest study by Standard and Poor’s (S&P) confirms this fact. S&P recently compared the performance of actively-managed mutual funds to passive market indexes twice per year. The 2012 S&P study indicated that indexes were once again outperforming actively-managed funds in nearly every asset class, style and fund category. The lone exception in the 2012 report was international equity, where active outperformed the index that S&P chose. The study examined one-year, three-year and five-year time periods. Within the U.S. equity space, active equity managers in all the categories failed to outperform the corresponding benchmarks in the past five year period. More than 65 percent of the large-cap active managers lagged behind the S&P 500 stock index. More than 81 percent of mid-cap mutual funds were outperformed by the S&P MidCap 400 index.
Lastly, 77 percent of the small-cap mutual funds were outperformed by the S&P SmallCap 600 index. U.S. bond active managers fared no better that equity managers over a five year period. More than 83 percent of general municipal mutual funds under-performed the S&P National AMT-Free Municipal Bond index, 93 percent of government long-term funds under-performed the Barclays Long Government index, nearly 95 percent of high yield corporate bond funds under-performed the Barclays High Yield index. Although the performance measurements for index investing are very strong, many analysts find three negative elements of passive investing;
Downside Protection: When the stock market collapses like in 2008, an index investor will assume the same loss as the market. In the case of 2008, the S&P 500 stock index fell by more than 50 percent, offering index investors no downside protection.
Portfolio Control: An index investor has no control over the holdings in the fund. In the event that a certain sector becomes over-owned (i.e. technology stocks in 2000), an index investor maintains the same weight as the index.
Average Returns: An index investor will never have the opportunity to outperform the market, but will always follow. Although the markets are very efficient, an investor can perhaps take advantage of market anomalies and invest with those managers who have maintained a long-term performance edge over the respective index.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Capitation is a type of healthcare payment system in which a physician or hospital is paid a fixed amount of money per patient for a prescribed period by an insurer or physician association. The cost is based on the expected healthcare utilization costs for a group of patients for that year.
With capitation, the physician—otherwise known as the primary care physician— is paid a set amount for each enrolled patient whether a patient seeks care or not. The PCP is usually contracted with an HMO whose role it is to recruit patients.
According to Richard Eskow, CEO of Health Knowledge Systems of Los Angeles, capitated medical reimbursement has been used in one form or another, in every attempt at healthcare reform since the Norman Conquest. Some even say an earlier variant existed in ancient China [personal communication].
Initially, when Henry I assumed the throne of the newly combined kingdoms of England and Normandy, he initiated a sweeping set of healthcare reforms. Historical documents, though muddled, indicate that soon thereafter at least one “physician,” John of Essex, received a flat payment honorarium of one penny per day for his efforts. Historian Edward J. Kealey opined that sum was roughly equal to that paid to a foot-soldier or a blind person. Clearer historical evidence suggests that American doctors in the mid-19th century were receiving capitation-like payments. No less an authoritative figure than Mark Twain, in fact, is on record as saying that during his boyhood in Hannibal, MO his parents paid the local doctor $25/year for taking care of the entire family regardless of their state of health.
Later, Sidney Garfield MD [1905-1984] is noted as one of the great under-appreciated geniuses of 20th century American medicine stood in the shadow cast by his more celebrated partner, Henry J. Kaiser. Garfield was not the first physician to embrace the notion of prepayment capitation, nor was he the first to understand that physicians working together in multi-specialty groups could, through collaboration and continuity of care, outperform their solo practice colleagues in almost every measure of quality and efficiency. The Mayo brothers, of course, had prior claim to that distinction. What Garfield did, was marry prepayment to group practice, providing aligned financial incentives across every physician and specialty in his medical group, as well as a culture of group accountability for the care of every member of the affiliated health plan. He called it “the new economics of medicine,” and at its heart was a fundamentally new paradigm of care that emphasized – prevention before treatment – and health before sickness. Under his model: the fewer the sick – the greater the remuneration. And: the less serious the illness, the better off the patient and the doctors.
Such ideas were heresy to the reigning fee-for-service, solo practice, ideologues of the mainstream medical establishment of the 1940s and ‘50s, of course. Throughout the period, Garfield and his group physicians were routinely castigated by leaders of the AMA and county medical associations as socialistic and unethical. The local medical associations in Garfield’s expanding service areas – the San Francisco Bay Area, Los Angeles, and Portland, Oregon – blocked group practice physicians from association membership, effectively shutting them out of local hospitals, denying them patient referrals or specialty society accreditation. Twice in the 1940s, formal medical association charges were brought against Garfield personally, at one time temporarily succeeding in suspending his license to practice medicine.
Of course, capitation payments made a comeback in the first cost-cutting managed care era of the 1980-90s because fee-for-service medicine created perverse incentives for physicians by paying more for treating illnesses and injuries than it does for preventing them — or even for diagnosing them early and reducing the need for intensive treatment later. Nevertheless, the modern managed care industry’s experience with capitation wasn’t initially a good one. The 1980-90s saw a number of HMOs attempt to put independent physicians, especially primary care doctors, into a capitation reimbursement model. The result was often negative for patients, who found that their doctors were far less willing to see them — and saw them for briefer visits — when they were receiving no additional income for their effort. Attempts were also made to aggregate various types of health providers — including hospitals and physicians in multiple specialties — into “capitation groups” that were collectively responsible for delivering care to a defined patient group. These included healthcare facilities and medical providers of all types: physicians, osteopaths, podiatrists, dentists, optometrists, pharmacies, physical therapists, hospitals and skilled nursing homes, etc.
However, the healthcare industry isn’t collective by nature, and these efforts tended to be too complicated to succeed. One lesson that these experiments taught is that provider behavior is difficult to change unless the relationship between that behavior and its consequences is fairly direct and easy to understand.
Today, the concept of prepayment and medical capitation is to uncouple compensation from the actual number of patients seen, or treatments and interventions performed. This is akin to a fixed price restaurant menu, as opposed to an àla carte eatery.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Posted on September 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I. and Staff Reporters
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Stocks: The NASDAQ rose to its fifth record high of the week, while the S&P 500 and the Dow sank late in the day as investors turned their attention to the FOMC meeting next week.
Bonds: While equities climbed all week long, the bond market has been sending signals that weak economic data really isn’t great news.
Commodities: Oil rallied after President Trump expressed his growing frustration with Vladimir Putin and threatened further energy and financial sanctions. Meanwhile, the US may ask its G7 counterparts to apply 100% tariffs against China and India for purchasing Russian crude.
Posted on September 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I. and Staff Reporters
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BIAS
Bias is a prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair.
MYOPIA
Myopia (nearsightedness) is a common condition that’s usually diagnosed before age 20. It affects your distance vision — you can see objects that are near, but you have trouble viewing objects that are farther away like grocery store aisle markers or road signs. Myopia treatments include glasses, contact lenses or surgery.
MYOPIA BIAS
Myopia Bias makes it hard for us to imagine what our lives might be like in the future.
FinancialExample: When we are young, healthy and in our prime economic earning years it may be hard for us to picture what life will be like when our health depletes and we no longer have the earnings necessary to support our standard of living.
Irony: This short-sightedness makes it hard to save adequately when we are young … when saving does the most good.
Here are some of the most common risks associated with fixed income securities.
Interest Rate Risk
The market value of the securities will be inversely affected by movements in interest rates. When rates rise, market prices of existing debt securities fall as these securities become less attractive to investors when compared to higher coupon new issues. As prices decline, bonds become cheaper so the overall return, when taking into account the discount, can compete with newly issued bonds at higher yields. When interest rates fall, market prices on existing fixed income securities tend to rise because these bonds become more attractive when compared to the newly issued bonds priced at lower rates.
Price Risk
Investors who need access to their principal prior to maturity have to rely on the secondary market to sell their securities. The price received may be more or less than the original purchase price and may depend, in general, on the level of interest rates, time to term, credit quality of the issuer and liquidity.
Among other reasons, prices may also be affected by current market conditions, or by the size of the trade (prices may be different for 10 bonds versus 1,000 bonds), etc. It is important to note that selling a security prior to maturity may affect actual yield received, which may be different than the yield at which the bond was originally purchased. This is because the initially quoted yield assumed holding the bond to term. As mentioned above, there is an inverse relationship between interest rates and bond prices. Therefore, when interest rates decline, bond prices increase, and when interest rates increase, bond prices decline.
Generally, longer maturity bonds will be more sensitive to interest rate changes. Dollar for dollar, a long-term bond should go up or down in value more than a short-term bond for the same change in yield. Price risk can be determined through a statistic called duration, which is featured at the end of the fixed income section.
Liquidity risk is the risk that an investor will be unable to sell securities due to a lack of demand from potential buyers, sell them at a substantial loss and/or incur substantial transaction costs in the sale process. Broker/dealers, although not obligated to do so, may provide secondary markets.
Reinvestment Risk
Downward trends in interest rates also create reinvestment risk, or the risk that the income and/or principal repayments will have to be invested at lower rates. Reinvestment risk is an important consideration for investors in callable securities. Some bonds may be issued with a call feature that allows the issuer to call, or repay, bonds prior to maturity. This generally happens if the market rates fall low enough for the issuer to save money by repaying existing higher coupon bonds and issuing new ones at lower rates. Investors will stop receiving the coupon payments if the bonds are called. Generally, callable fixed income securities will not appreciate in value as much as comparable non-callable securities.
Similar to call risk, prepayment risk is the risk that the issuer may repay bonds prior to maturity. This type of risk is generally associated with mortgage-backed securities. Homeowners tend to prepay their mortgages at times that are advantageous to their needs, which may be in conflict with the holders of the mortgage-backed securities. If the bonds are repaid early, investors face the risk of reinvesting at lower rates.
Purchasing Power Risk
Fixed income investors often focus on the real rate of return, or the actual return minus the rate of inflation. Rising inflation has a negative impact on real rates of return because inflation reduces the purchasing power of the investment income and principal.
When owners of a security spread false information to pump up the price of the security and subsequently sell off their shares, making a profit—the “dump.”
Refer to attempts by investors to move the price of a stock opportunistically by selling large numbers of shares short. The investors pocket the difference between the initial price and the new, lower price after this maneuver. This technique is illegal under SEC rules, which stipulate that every short sale must be on an uptick. For more information on this complex tactic, read on in this piece from the Wharton School of Business.
Wash Trading
Involves the simultaneous or near-simultaneous sale and repurchase of the same security for the purpose of generating activity and increasing the price.
When fraudsters manipulate the market through matched orders, they enter trades to buy or sell securities with the knowledge that a matching order on the opposite side has been or will be entered. During his tenure at the Commission, our partner Jordan Thomas was involved in a case where the SEC won summary judgement and obtained settlements with an astonishing 16 defendants who engaged in matched trades, among other illicit tactics.
Painting the Tape
Painting the tape refers to placing successive orders in small amounts at increasing or decreasing prices.
Spoofing & Layering
High frequency traders are known to use the tactics of Spoofing & Layering to manipulate share prices. Spoofing is the placing of a bid or offer with the intent to cancel before execution. Layering is a form of spoofing in which the trader places multiple orders on one side of the book, in order to create a false impression of heavy buying or selling.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Although 97% of people aren’t yet millionaires, many could eventually meet that target if they start investing sooner rather than later; especially doctors [MD, DO, DPM, DDS or DMD].
A 20-year-old, for instance, needs to invest just $330 a month into an asset class that delivers a 7% to 8% annual return to reach $1.26 million by the time s/he turns 65 years old. The luxury of time significantly boosts your chances of becoming a millionaire.
This doesn’t mean it’s too late for middle-aged savers to reach that millionaire milestone, but it will take a significantly greater investment. If a 50-year-old doctor hasn’t started saving for retirement, s/he would need to invest $3,958 a month at a steady 7% return to reach $1.26 million by retirement.
However, according to one Goldman Sachs report, investors could expect the S&P 500 to deliver just 3% annualized nominal returns over the next 10 years.
After an average 13% yearly return for the past decade, a new strategy outside of the stock market may be needed for that level of outsized gain, especially if you’re late to investing.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
According to Medical Economics, there were 10 clinic and physician practices filing bankruptcy in 2024, making it the highest level of the last six years, according to a new analysis of cases with liabilities of at least $10 million.
Meanwhile, the Steward Health Care System bankruptcy, which was based in Massachusetts but making headlines across the nation, has become “the largest hospital sector bankruptcy by far in the last 30 years,” according to a new analysis by Gibbins Advisors, based in Nashville, Tennessee.
Health care bankruptcy filings totaled 57 last year, down from 79 in 2023, said “Healthcare Restructuring: Trends and Outlook.” The report analyzed Chapter 11 health care bankruptcy cases with liabilities of at least $10 million, since 2019.
Last year’s total was down 28% from 2023’s peak, but greater than the 2019 to 2022 average of 42 filings a year, the report said.
Bankruptcy, often considered a last financial resort, is a legal process that can help alleviate outstanding debts for individuals and businesses. Reasons to file for bankruptcy can include divorce, job loss, exorbitant medical bills or credit card debt.
There are several types of bankruptcy — six, as a matter of fact. The two most common types of bankruptcy for individuals are Chapter 7 and Chapter 13.
But there are four other types as well: Chapter 9, Chapter 11, Chapter 12 and Chapter 15. And, the type of bankruptcy filed depends on the situation.
Regardless of which type, the process is typically the same: You’ll usually retain an attorney and make your case before a judge, who will then erase some debts or set up a repayment plan.
Also note that an eligibility requirement — for all bankruptcy chapters — is that you must undergo credit counseling within the 180 days before filing.
Posted on September 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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A recent study of hospital physician acquisition and employment found that such acquisitions decrease competition and raise prices. A National Bureau of Economic Research (NBER) working paper, released in July 2025, “empirically analyze[d] the effects of mergers between complementary firms on competition and pricing,” and found hospital prices increased by an average of 3.3%, while physician prices increased by an average of 15.1%.
This Health Capital Topics article reviews the study’s findings and implications for the healthcare industry. (Read more…)
Posted on September 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and A.I.
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Markets: Stocks started off Friday on a high note after a weak jobs report raised hopes that the Fed will cut interest rates this month. But the rally faded as the afternoon wore on, while 10-year bond yields tumbled to their lowest level since April.
Trade: President Trump said “fairly substantial” tariffs for semi-conductors are coming “very shortly,” but hinted that companies like Apple will be spared. He also clapped back at EU regulators for fines against Google.
Offbeat commodities: Raw sugar prices hit a two-month low as Brazilian producers churn out more of the sweet stuff, cocoa prices are expected to pop after Cargill paused production in Ivory Coast, and corn hit its highest price since July thanks to strong export demand.
Ikea Effect Bias describes the tendency of people to place a higher value on products they have partially created or assembled themselves. This phenomenon is named after the Swedish furniture retailer Ikea, known for selling furniture in flat-pack kits that customers must assemble at home.
he IKEA effect was identified and named by Michael Norton of Harvard Business School, Daniel Mochon of Yale University and colleague Dan Ariely PhD of Duke University, who published the results of three studies in 2011. They described the IKEA effect as “labor alone can be sufficient to induce greater liking for the fruits of one’s labor: even constructing a standardized bureau, an arduous, solitary task, can lead people to overvalue their (often poorly constructed) creations.”
Example: A prospect is more likely to pursue his/her own financial plan than that one from an informed financial planner, CPA or professional advisor.
2011 study found that subjects were willing to pay 63% more for furniture they had assembled themselves than for equivalent pre-assembled items.
IN FINANCE AND INVESTING
The IKEA effect can contribute to reducing panic selling. Investors typically reduce their stock market exposure after a financial crash which often results in “buy high, sell low” strategy that is detrimental to long-run wealth accumulation.
Ashtiani et al.’s study proposes a nudge utilizing the IKEA effect to counteract this phenomenon: “actively involving investors in the selection process of the risky investments, while restricting their selections in a way that preserves a large degree of diversification.”
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
Posted on September 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I. and Staff Reporters
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Stocks: Equities climbed slowly but steadily yesterday as investors braced themselves for today’s all-important jobs report.
Crypto: Bitcoin fell as a selloff in cryptocurrencies associated with the Trump family pulled the entire crypto market lower.
Commodities: Gold remains in the spotlight as traders bulk up on bullion to protect their portfolios in case the FOMC loses its independence. If that does happen,Goldman Sachs analysts think gold could climb to $5,000.
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