BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on June 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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Stocks: Investors looked past the escalating conflict between Iran and Israel, even as President Trump mulled his options for a US intervention, and stocks rose ahead of today’s Federal Reserve meeting.
Economy: Trump called Jerome Powell “a stupid person” hours before the Fed Chair decided to keep interest rates where they were Stocks fell thanks to the Fed’s prediction that inflation will rise to 3.1% by the end of the year, above previous forecasts of 2.8%.
Commodities: Gold fell just a hair as analysts called the commodity’s top, while platinum climbed to a four-year high.
Correlation measures the relationship between two investments–the higher the correlation, the more likely they are to move in the same direction for a given set of economic or market events. Correlation, in the finance and investment industries, is a statistic that measures the degree to which two securities move in relation to each other. Correlations are used in advanced portfolio management, computed as the correlation coefficient which has a value that must fall between -1.0 and +1.0.
So if two securities are highly positively correlated, they will move in the same direction the vast majority of the time. Negatively correlated investments do the opposite–as one security rises, the other falls, and vice versa. No correlation means there is no relationship between the movement of two securities–the performance of one security has no bearing on the performance of the other.
Correlation is an important concept for portfolio diversification--combining assets with low or negative correlations can improve risk-adjusted performance over time by providing a diversity of payouts under the same financial conditions.
Posted on June 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By AI
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Stocks: Israel and Iran exchanged missile strikes for a fourth day, but investors are betting that the conflict will remain at least somewhat contained. Reports that Iran wants to de-escalate the conflict and even restart nuclear talks seemed to underline that idea, and markets rose strongly throughout the afternoon.
Commodities: Gold fell as hopes of a ceasefire between Israel and Iran made investors more bullish, while Iranian oil infrastructure was spared from the attacks, pushing crude prices lower.
Bonds: A $13 billion 20-year bond auction this afternoon yielded strong demand, rounding out a series of solid auctions over the last few days that seemingly point to renewed investor confidence in US fixed income.
Alternatively Weighted Exchange Traded Funds are designed to track an index that is constructed based on criteria other than market capitalization (the methodology used for most traditional indexes).
Instead, alternatively weighted indexes select and weight securities based on other factors, such as growth, valuation, and price momentum, among others. Examples include:
Invesco S&P 500 Equal Weight ETF (NYSEARCA: RSP)
SPDR Technology ETF (NYSEARCA: XNTK)
First Trust NYSE Arca Biotechnology Index Fund (NYSEARCA: FBT)
Amplify Online Retail ETF (NASDAQ: IBUY)
iShares MSCI USA Equal Weighted ETF (NYSEARCA: EUSA)
Posted on June 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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The National Debt Explained
The national debt is the amount of money the federal government has borrowed to cover the outstanding balance of expenses incurred over time. In a given fiscal year (FY), when spending (ex. money for roadways) exceeds revenue (ex. money from federal income tax), a budget deficit results. To pay for this deficit, the federal government borrows money by selling marketable securities such as Treasury bonds, bills, notes, floating rate notes, and Treasury inflation-protected securities (TIPS).
The national debt is the accumulation of this borrowing along with associated interest owed to the investors who purchased these securities. As the federal government experiences reoccurring deficits, which is common, the national debt grows.
Simply put, the national debt is similar to a person using a credit card for purchases and not paying off the full balance each month. The cost of purchases exceeding the amount paid off represents a deficit, while accumulated deficits over time represents a person’s overall debt.
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We make second investment portfolio opinions accurate
Fiduciary and non-sales orientated second opinions have the power to change financial lives in the long term. We’ve seen it happen many times. What characterizes a good second opinion? Three things: the opinion must be individualized to your investment portfolio[s], informed and results-oriented. That’s the informed fiduciary approach we take. We are colleagues and look forward to working with you.
Bonds: The 10-year yield fell after CPI came in lower than analysts expected. The Treasury Department’s auction of 10-year bonds also went well, with strong participation from traders a key sign of demand for fixed income. Zero Coupon: https://medicalexecutivepost.com/2024/11/12/bonds-zero-coupon/
FIVE INVESTING MISTAKES OF DOCTORS; PLUS 1 VITAL TIP
As a former US Securities and Exchange Commission [SEC] Registered Investment Advisor [RIA] and business school professor of economics and finance, I’ve seen many mistakes that doctors must be aware of, and most importantly, avoid. So, here are the top 5 investing mistakes along with suggested guideline solutions.
Mistake 1: Failing to Diversify Investment but Beware Di-Worsification
A single investment may become a large portion of your portfolio as a result of solid returns lulling you into a false sense of security. The Magnificent Seven stocks are a current example:
Apple, up +5,064%% since 1/18/2008
Amazon, up +30,328% since 9/6/2002
Alphabet, up +1,200% since 7/20/2012
Tesla, up +21,713% since 11/16/2012
Meta, up +684% since 2/20/2015
Microsoft, up +22% since 12/21/2023
Nvidia, up +80,797% since 4/15/2005
Guideline: The Magnificent Seven [7] has grown from 9% of the S&P 500 at the end of 2013 to 31% at the end of 2024! That means even if you don’t own them, you’re still very exposed if you have an Index Fund [IF] or Exchange Traded Fund [ETF] that tracks the market. Accordingly, diversification is the only free lunch in investing which can reduce portfolio risk. But, remember the Wall Street insider aphorism that states: “Di-Versification Means Always Having to Say Your Sorry.”
The term “Di-Worsification” was coined by legendary investor Peter Lynch in his book, One Up On Wall Street to refer to over-diversifying an investment portfolio in such a way that it reduces your overall risk-return characteristics. In other words, the potential return rises with an increase in risk and invested money can render higher profits only if willing to accept a higher possibility of losses [1].
A podiatrist can easily fall into the trap of chasing securities or mutual funds showing the highest return. It is almost an article of faith that they should only purchase mutual funds sporting the best recent performance. But in fact, it may actually pay to shun mutual funds with strong recent performance. Unfortunately, many struggle to appreciate the benefits of their investment strategy because in jaunty markets, people tend to run after strong performance and purchase last year’s winners.
Similarly, in a market downturn, investors tend to move to lower-risk investment options, which can lead to missed opportunities during subsequent market recoveries. The extent of underperformance by individual investors has often been the most awful during bear markets. Academic studies have consistently shown that the returns achieved by the typical stock or bond fund investors have lagged substantially.
Guideline: Understand chasing performance does not work.Continually monitor your investments and don’t feel the need to invest in the hottest fund or asset category. In fact, it is much better to increase investments in poor performing categories (i.e. buy low). Also keep in remind rebalancing of assets each year is key. If stocks perform poorly and bonds do exceptionally well, then rebalance at the end of the year. In following this strategy, this will force a doctor into buying low and selling high each year.
Often doctors make their investment decisions under the belief that stocks will consistently give them solid double-digit returns. But the stock markets go through extended long-term cycles.
In examining stock market history, there have been 6 secular bull markets (market goes up for an extended period) and 5 secular bear markets (market goes down) since 1900. There have been five distinct secular bull markets in the past 100+ years. Each bull market lasted for an extended period and rewarded investors.
For example, if an investor had started investing in stocks either at the top of the markets in 1966 or 2000, future stock market returns would have been exceptionally below average for the proceeding decade. On the other hand, those investors fortunate enough to start building wealth in 1982 would have enjoyed a near two-decade period of well above average stock market returns. They key element to remember is that future historical returns in stocks are not guaranteed. If stock market returns are poor, one must consider that he or she will have to accept lower projected returns and ultimately save more money to make up for the shortfall. For example,
The May 6th, 2010, flash crash, also known as the crash of 2:45, was a United States trillion-dollar stock market plunge which started at 2:32 pm EST and lasted for approximately 36 minutes.
And, investors who have embraced the “buy the dip” strategy in 2025 have been handsomely rewarded, with the S&P 500 delivering its strongest post-pull back returns in over three decades.
According to research from Bespoke Investment Group, the S&P 500 has gained an average of 0.36% in the trading session following a down day so far in 2025. The only year with a comparable performance was 2020, which saw a 0.32% average post-dip gain [2].
The most recent example came on May 27, 2025 when the S&P 500 surged more than 2% after falling 0.7% in the final session before the holiday weekend. The rally was sparked by President Trump’s decision to scale back huge previously threatened tariffs on EU —a recurring catalyst behind many of 2025’s rebound.
Guideline: Beware of projecting forward historical returns. Doctors should realize that the stock markets are inherently volatile and that, while it is easy to rely on past historical averages, there are long periods of time where returns and risk deviate meaningfully from historical averages.
Some doctors believe they are “smarter than the market” and can time when to jump in and buy stocks or sell everything and go to cash. Wouldn’t it be nice to have the clairvoyance to be out of stocks on the market’s worst days and in on the best days?
Using the S&P 500 Index, our agile imaginary doctor-investor managed to steer clear of the worst market day each year from January 1st, 1992 to March 31st, 2012. The outcome: s/he compiled a 12.42% annualized return (including reinvestment of dividends and capital gains) during the 20+ years, sufficient to compound a $10,000 investment into $107,100.
But what about another unfortunate doctor-investor that had the mistiming to be out of the market on the best day of each year. This ill-fated investor’s portfolio returned only 4.31% annualized from January 1992 – March 2012, increasing the $10,000 portfolio value to just $23,500 during the 20 years. The design of timing markets may sound easy, but for most all investors it is a losing strategy.
More contemporaneously on December 18th 2024, the DJIA plummeted 2.5%, while the S&P 500 declined 3% and the NASDAQ tumbled 3.5%
Guideline: If it looks too good to be true, it probably is. While jumping into the market at its low and selling right at the high is appealing in theory, we should recognize the difficulties and potential opportunity and trading costs associated with trying to time the stock market in practice. In general, colleagues are be best served by matching their investment with their time horizon and looking past the peaks / valleys along the way.
Mistake 5: Failing to Recognize the Impact of Fees and Expenses
A free dinner seminar or a polished stock-broker sales pitch may hide the total underlying costs of an investment. So, fees absolutely matter.
The first costing step is determining what the fees actually are. In a mutual fund, these costs are found in the company’s obligatory “Fund Facts”. This manuscript clearly outlines all the fees paid–including up front fees (commissions and loads), deferred sales charges and any switching fees. Fund management expense ratios are also part of the overall cost. Trading costs within the fund can also impact performance.
Here is a list of the traditional mutual fund fees:
Front End Load: The commission charged to purchase a fund through a stock broker or financial advisor. The commission reduces the amount you have available to invest. Thus, if you start with $100,000 to invest, and the advisor charges up to an 8 percent front end load, you end up actually investing $92,000.
Deferred Sales Charge (DSC) or Back End Load: Imposed if you sell your position in the mutual fund within a pre-specified period of time (normally one – five years). It is initiated at a higher start percentage (i.e. as high as 10 percent) and declines over a specific period of time.
Operating Fees: Costs of the mutual fund including the management fee rewarded to the manager for investment services. It also includes legal, custodial, auditing and marketing fees.
Annual Administration Fee: Many mutual fund companies also charge a fee just for administering the account – usually under $100-150 per year.
Guideline: Know and understand all fees.
For example: A 1 percent disparity in fees may not seem like much but it makes a considerable impact over a long time period.
Consider a $100,000 portfolio that earns 8 percent before fees, grows to $320,714 after 20 years if the investor pays a 2 percent operating fee. In comparison, if s/he opted for a fund that charged a more reasonable 1 percent fee, after 20 years, the portfolio grows to be $386,968 – a divergence of over $66,000!
This is the value of passive or index investing. In the case of an index fund, fees are generally under 0.5 percent, thus offering even more savings over a long period of time.
One Vital Tip: Investing Time is on Your Side
Despite thousands of TV shows, podcasts, textbooks, opinions and university studies on investing, it really only has three simple components. Amount invested, rate of return and time. By far, the most important item is time! For example:
Nvidia: if you invested $1,000 in 2009, you’d have $338,103 today.
Apple: if you invested $1,000 in 2008, you’d have $48,005 today.
Netflix: if you invested $1,000 in 2004, you’d have $495,679 today.
Unfortunately, this list of investing mistakes is still being made by many doctors. Fortunately, by recognizing and acting to mitigate them, your results may be more financially fruitful and mentally quieting.
REFERENCES:
1. Lynch, Peter: One Up on Wall Street [How to Use What You Already Know to Make Money in the Market]: Simon and Shuster (2nd edition) New York, 2000.
1. Marcinko, DE; Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017.
2. Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, New York, 2006.
3. Marcinko, DE; Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] CRC Press, New York, 2015.
BIO: As a former university Professor and Endowed Department Chair in Austrian Economics, Finance and Entrepreneurship, the author was a NYSE Registered Investment Advisor and Certified Financial Planner for a decade. Later, he was a private equity and wealth manager
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 June 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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Stocks: Equities inched higher on a handful of optimistic headlines. First, the US and China trade teams met in London today with hopes the two superpowers could resolve disputes over export curbs. Also, a new survey from the New York Fed found that consumer expectations for inflation eased across all time horizons in May. STOCKS: https://medicalexecutivepost.com/2025/04/18/stocks-basic-definitions/
Posted on June 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By AI
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Wall Street is stable right now as the technology trade has come roaring back.
The S&P 500 climbed above 6,000 points for the first time since February, while all three indexes posted their fifth winning week in the last seven. The S&P is now just over 2% from its all-time high.
Meanwhile, recent IPOs are party rocking, especially the stablecoin issuer Circle that went public last Thursday.
Many doctors are surprised to learn of an alternative investment known as a hedge fund, pooled investment vehicle or private investment fund. Unlike mutual funds, they can be structured in many ways. However, these funds cannot be marketed or advertised, but they are far from illegal or illicit.
In fact, physicians were among the early investors in one the most successful hedge funds. Warren Buffett got his start in 1957 running the Buffett Partnership, a hedge fund not open to the public. His first appearance as a money manager was before a group of physicians in Omaha, Nebraska. Eleven decided to invest some money with him. A few then followed into Berkshire Hathaway Inc, now among the most highly valued companies in the world.
And, more recently, Scion Asset Management® LLC, is a private investment firm founded and led by my eloquent colleague Michael J. Burry, MD and featured in the movie, The Big Short. Other hedge fund mangers of note include: George Soros, Carl Icahn, Ken Griffin, David Tepper, John Paulson and Bill Ackman.
A hedge fund is a limited partnership of private investors whose money is managed by professional fund managers who use a wide range of strategies; including leveraging [debt] or trading of non-traditional assets [real-estate, collectible, commodities, cyrpto-currency, etc] to earn above-average returns. Hedge funds are considered a risky alternative investment and usually require a high minimum investment or net worth. This person is known as an “accredited investor” or “Regulation D” investor by the US Securities Exchange Commission and must have the following attributes:
A net worth, combined with spouse, of over $1 million, not including primary residence
An income of over $200,000 individually, or $300,000 with a spouse, in each of the past two years
The hurdle rate is part of the fund manager’s performance incentive compensation. Also known as a “benchmark,” it is the amount, expressed in percentage points an investor’s capital must appreciate before it becomes subject to a performance incentive fee. Podiatrists should view the hurdle rate as a form of protection or the fee arrangement.
The hurdle rate benchmarks a single year’s performance and may be considered mutually exclusive of any other year, or the hurdle rate may compound each year. The former case is more common. In the latter case, a portfolio manager failing to attain a hurdle rate in the first year will find the effective hurdle rate considerably higher during the second year.
Once a fund manager attains the hurdle rate, the investor’s capital account may be charged a performance incentive fee only on the performance above and beyond the hurdle rate. Alternatively, the account may be charged a performance fee for the entire level of performance, including the performance required to attain the hurdle rate. Other variations on the use of the hurdle rate exist, and are limited only by the contract signed between the fund manager and the investor. The hurdle rate is not generally a negotiating point, however.
Example: A fund charges a performance fee with a 6 percent hurdle rate, calculated in mutually exclusive manner. A podiatrist places $100,000 with the fund. The first year’s performance is 5 percent. The doctor therefore owes no performance fee during the first year because the portfolio manager did not attain the hurdle rate. During year two, the portfolio manager guides the fund to a 7 percent return. Because the hurdle rate is mutually exclusive of any other year, the portfolio manager has attained the 6 percent hurdle rate and is entitled to a performance fee.
High Water Mark
Some hedge funds feature a “high water mark” provision known as a ”loss-carry forward.” As with the hurdle rate, the high water mark is a form of protection. It is an amount equal to the greatest value of an investor’s capital account, adjusted for contributions and withdrawals. The high water mark ensures that the manager charges a performance incentive fee only on the amount of appreciation over and above the high water mark set at the time the performance fee was last charged. The current trend is for newer funds to feature this high water mark, while older, larger funds may not feature it.
Example: A fund charges a 20 percent performance fee with a high water mark but no hurdle rate. A podiatrist contributes $100,000 to the fund. During the first year, the hedge fund manager grows that capital account to $110,000 and charges a 20 percent performance fee, or $2,000. The ending capital account balance and high water mark is therefore $108,000. During year two, the account falls back to $100,000, but the high water mark remains $108,000. During year three, in order for the manager to charge a performance fee, the manager must grow the capital account to a level above $108,000.
Claw Back Provision
Rarely, a hedge fund may provide investors with a “claw back” provision. This term results in a refund to the investor of all or part of a previously charged performance fee if a certain level of performance is not attained in subsequent years. Such refunds in the face of poor or inadequate performance may not be legal in some states or under certain authorities.
ASSESSMENT
Managers of hedge funds, like colleague Dimitri Sogoloff MBA who is the CEO of Horton Point investment-technology firm, often aim to produce returns that are relatively uncorrelated with market indices and are consistent with investors’ desired level of risk.
While hedging may reduce some risks overall, they cannot all be eliminated. According to a report by the Hennessee Group, hedge funds were approximately one-third less volatile between 1993 and 2010.
For a podiatrist who already holds mutual funds and/or individual stocks and bonds, a hedge fund may provide diversification and reduce overall portfolio risk. Consider investing in them with care.
2. Burry, Michael, J: Hedge Funds [Wall Street Personified]. In, Marcinko, DE and Hetico, HR: Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017.
3. Marcinko, DE and Hetico, HR: Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™]. Productivity Press, New York, 2015.
4. Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, NY 2006
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Stocks: The S&P 500 touched 6,000 points for the first time since February and wrapped up its fifth positive week in the past seven following a better-than-expected jobs report. The vibes got even better in the afternoon following a President Trump announcement that the US and China trade teams will meet in London on Monday. STOCKS: https://medicalexecutivepost.com/2025/04/18/stocks-basic-definitions/
Bonds: Treasury yields ticked up in response to the solid May jobs report, a sign that investors were reducing bets on the scale of rate cuts this year. That’s not what Trump wants to hear: He urged Fed Chair Jerome Powell to slash interest rates by a jumbo-sized full point to pour “rocket fuel” on the economy. REVENUE BONDS: https://medicalexecutivepost.com/2024/12/20/bonds-revenue/
Oil: Oil prices have gone sideways for three straight weeks now, trading within a $4 range around $65/barrel since the middle of May. We’ll let you know when something interesting happens. CRUDE OIL:https://medicalexecutivepost.com/2024/08/14/wti-crude-oil/
Posted on June 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Meta Platforms popped 3.62% on a report in the Wall Street Journal that the company is going all-in on using AI to create advertisements.
Applied Digital skyrocketed 48.46% after the data center operator announced two 15-year leases with CoreWeave that will bring in $7 billion in new revenue. CoreWeave rose 7.99%.
BioNTech soared 18.05% on news of a multibillion-dollar collaboration with Bristol Myers Squibb to develop cancer treatments. Bristol Myers Squibb rose 1.06%.
Moderna gained 1.84% thanks to the FDA’s approval of its new Covid vaccine, though it’s only for certain patients.
Blueprint Medicines exploded 26.09% after the biopharma company agreed to be acquired by Sanofi for $9.5 billion.
Auto stocks suffered from fears of higher pricing thanks to President Trump’s steel tariff hike. GeneralMotors tumbled 3.87%, Ford fell 3.86%, and Stellantis slid 3.55%.
Sports-betting stocks took a loss after Illinois lawmakers decided to tax the companies $0.25 per wager made on their apps. DraftKings lost 5.99%, and FlutterEntertainment dropped 2.74%.
Advertising stocks sank on Meta Platforms’ announcement of AI advances in its advertisements. Omnicom Group lost 4.02%, and WPP Group fell 2.45%.
Markets: Stocks closed out a winning month Friday with the S&P500 having its best one since 2023. But the markets are still rattled by the trade war, and stocks wavered during the day after President Trump accused China of breaching its recent trade deal with the US. Investors declined to fall into the Gap after the retail chain said tariffs would cost it up to $150 million this fiscal year.
According to wikipedia, the S&P 500 Dividend Aristocrats is a stock market index composed of the companies in the S&P 500 index that have increased their dividends in each of the past 25 consecutive years. It was launched in May 2005.
There are other indexes of dividend aristocrats that vary with respect to market cap and minimum duration of consecutive yearly dividend increases. Components are added when they reach the 25-year threshold and are removed when they fail to increase their dividend during a calendar year or are removed from the S&P 500. However, a study found that the stock performance of companies improves after they are removed from the index The index has been recommended as an alternative to bonds for investors looking to generate income.
To invest in the index, there are several exchange traded funds (ETFs), which seek to replicate the performance of the index.
Posted on June 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and AI
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Consistency and Commitment Tendency: Human beings have evolved – probably both genetically and socially – to be consistent. It is easier and safer to deal with others if they honor their commitments and if they behave in a consistent and predictable manner over time. This allows people to work together and build trust that is needed for repeat dealings and to accomplish complex tasks.
In the jungle, this trust was necessary to for humans to successfully work as a team to catch animals for dinner, or fight common threats. In business and life it is preferable to work with others who exhibit these tendencies. Unfortunately, the downside of these traits is that people make errors in judgment because of the strong desire not to change, or be different (“lemming effect” or “group-think”). So the result is that most people will seek out data that supports a prior stated belief or decision and ignore negative data, by not “thinking outside the box”.
Additionally, future decisions will be unduly influenced by the desire to appear consistent with prior decisions, thus decreasing the ability to be rational and objective. The more people state their beliefs or decisions, the less likely they are to change even in the face of strong evidence that they should do so. This bias results in a strong force in most people causing them to avoid or quickly resolve the cognitive dissonance that occurs when a person who thinks of themselves as being consistent and committed to prior statements and actions encounters evidence that indicates that prior actions may have been a mistake.
According to colleague Dan Ariely PhD, it is particularly important therefore for advisors to be aware that their communications with clients and the press clouds the advisor’s ability to seek out and process information that may prove current beliefs incorrect. Since this is obviously irrational, one must actively seek out negative information, and be very careful about what is said and written, being aware that the more you shout it out, the more you pound it in.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Posted on May 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By AI
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What Is a SAFE Note?
A SAFE note is a type of convertible security that specifies a certain amount of money an investor will pay you as a business owner. In exchange, you agree to give the investor a certain amount of equity in your company at an agreed-upon future date. In other words, a SAFE note confers the right for an investor to purchase shares in your company in a future-priced round.
How SAFE Notes Work
According to ContractsCounsel, a SAFE note works in the following way:
An investor provides funding in exchange for the right to future equity.
You use the funding to grow your business.
After your company grows sufficiently, you secure another investor, and your company receives a “post-money valuation.”
You calculate your company’s price per share.
You convert the SAFE note into the applicable number of shares and distribute them to the SAFE investor. Typically, a SAFE note converts after an equity financing round.
Example of a SAFE Note
An investor purchases a SAFE note with a valuation cap of $20 million. During the next funding round, the value of your company is set at $40 million at $20 a share. Because the SAFE note has a valuation cap of $20 million, its owner can purchase twice as many shares of your company as new investors can. This was the incentive for the SAFE investor to provide funding earlier.
Within venture capital financing, a convertible note is a type of short-term debt financing that’s used in early-stage capital raises. In other words, convertible notes are loans to early-stage startups from investors who are expecting to be paid back when their note comes due. But, instead of being paid back in principal with interest—as would be the case with a typical loan—the investor can be repaid in equity in your company.
You might also think of a convertible note like an IOU. An investor provides you with capital now and the convertible note, acting as a short-term loan, ensures that you give the investor a stake in your startup later. From the investor’s point of view, the benefit in this exchange is that if they give you capital and a vote of confidence early on and you do well, you’ll repay them many times over.
How Do Convertible Notes Work?
Typically, an investor will provide an early-stage startup in need of capital with a loan (with repayment terms in the ballpark of a standard short-term loan, usually a year or two), along with repayment terms. This is the “note.” The note will include a due date at which time it’s mature and the balance will be due, along with interest. Generally, however, the note is not repaid like a normal short-term loan. Instead, you repay the investor for their loan with equity in your company, usually in conjunction with another funding round.
If, however, the maturity date comes along and your startup has not yet converted the note to equity, the investor can either extend the convertible note’s maturity date or call for the actual repayment of the note.
This being said, the whole idea behind convertible notes is that your company is on a strong growth trajectory and that is why the note is being issued—it amasses value for the investor and beelines to a priced round. Ultimately, the point of a convertible note is that the noteholder, or investor, doesn’t want to get their loan paid back— they want their debt to convert into a heavily discounted security in a successful, valuable company that’s growing extremely quickly.
Cons: The major downside of a convertible note is that you will eventually be giving up some control over your business. When the convertible note comes due, the investor will be granted equity in your business. If you’re not ready to split ownership of your business with outside parties, this is not the right financing option for you.
Posted on May 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Rick Kahler MSFP CFP®
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OVER HEARD IN THE FINANCIAl ADVISOR’S LOUNGE
A basic strategy for asset protection is to hold various assets in different entities. Putting real estate, small businesses, and other assets into trusts, corporations, or limited liability companies (LLCs) is effective protection that is relatively easy to put into practice. Not only do I recommend this strategy to clients, I use it myself. Recently, however, I discovered a potential downside.
About 25 years ago, I invested in some rare coins in a corporation I owned and put them into a safe deposit box owned by the corporation. When my business relocated 12 years ago, the safe deposit box billing was not forwarded to the new address and was never paid again. Last year I went to retrieve the coins from the safe deposit box, which I had not visited in 25 years. I discovered the box had been drilled open three years earlier and my collection turned over to the unclaimed property division of the State Treasurer’s office.
I was told getting the coins back would be simple enough. I just needed to verify that I owned the company which owned them by providing the corporation’s tax ID number. However, the corporation no longer existed. I didn’t have a record of its tax ID number. The IRS wouldn’t verify the number without my giving them the address the company had used. That address was a post office box number that I no longer used and couldn’t remember. The state’s position was “no tax ID, no coins.” The only verification of my identity as owner of the corporation was my signature on the bank’s safe deposit box application. Eventually, with the support of bank officers who were willing to swear that I was who I claimed to be, I got my coin collection back. The hassle involved in this process was a reminder of an important component of asset protection. Maintain accurate records so you don’t end up hiding assets from yourself.
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A good start is to create a master file of all the entities that hold your assets. This can be any system that’s easy for you to use: a computer spreadsheet, a set of file folders, or a single paper list. Share it as appropriate with your CPA, attorney, or financial planner. The master list should include the name of each company, its date of incorporation, tax ID number, address, and other relevant information like phone or bank account numbers. Also keep an inventory of the assets each company owns.
Once you’ve created a master list, it’s essential to keep it up to date as you buy or sell assets, close companies, or transfer ownership. Set up a system, as well, to remind yourself of tasks like filing tax returns, completing minutes of annual meetings, and paying the annual safe deposit box rent. Make your record-keeping easier by eliminating unnecessary complications.
For example, you probably don’t need a separate address for each trust, corporation, or LLC. Instead of creating a separate company for each asset, you might consider grouping smaller assets within one entity. I’d suggest first discussing the pros and cons with an attorney or financial planner. For larger assets like real estate, I do recommend holding each one separately.
When I talk to clients about asset protection, I mention that part of the price we pay for it is an increase in paperwork. It’s easy to accept that idea with casual good intentions. The case of my reclaimed coin investment is a good reminder of the importance of keeping up with that paperwork. If we don’t, we might protect ourselves right out of access to our own assets.
Posted on May 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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Stock markets are coming off their worst week since April as President Trump’s tariff threats on Europe and Apple revived trade war jitters. The president has since delayed tariff threats on the EU, giving European stocks a boost yesterday, while Wall Street had the day off for Memorial Day.
No such relief appears to be coming for Apple, which has fallen 8% so far this month, and is the only Magnificent Seven member in the red for May, per FactSet.
Giving circles support with their dollars, but also build awareness, volunteer, become board members and more. Individuals multiply their impact and knowledge, have fun, and connect with their local community.
People are coming together around the world to create the change they want to see in the world. Giving circles are a growing global movement with more than 2,500 active circles around the world giving intentionally and thoughtfully.
A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.
I want to invest with a manager that has the skills to “hedge” a portfolio, but I do not wish to mix my money with other investors as in a hedge fund.
QUESTION:Can I hire hedge fund managers to manage my account separately?
Some hedge fund managers do take the time to recruit and manage separate accounts, with or without the help of referring brokers.
However, before long the administrative burden of managing so many separate accounts can become quite significant. Hence, the minimums for such separate accounts are generally much higher than if one were to invest in the manager’s hedge fund.
The best feature of these separate accounts is that potentially every aspect of the investment account, including fees, is negotiable. Other features include greater transparency and increased liquidity, since separately managed accounts can often be shut down on short notice.
Investors must be aware, however, that for practical purposes the portfolio manager generally will buy and sell the same securities in the separately managed accounts that the portfolio manager buys and sells in the hedge fund, yet the expenses incurred by the investor will likely be higher.
Posted on May 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINED
By Staff Reporters
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Stocks ticked down yesterday, ending a six-day rally after some influential CEOs—including JPMorgan Chase’s Jamie Dimon—warned that markets have grown too complacent about tariffs and potential stagflation. But it was a spectacular day for Warby Parker, which climbed more than 15% after Google announced it’s partnering with the eyewear company on Google Glass (RIP) a new smart glasses device.
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Stagflation is the simultaneous appearance in an economy of slow growth, high unemployment, and rising prices.
Once thought by economists to be impossible, stagflation has occurred repeatedly in the developed world since the 1970s.
Policy solutions for slow growth tend to worsen inflation, and vice versa. That makes stagflation hard to fight.
Stagflation is the combination of high inflation, stagnant economic growth, and elevated unemployment.
The term stagflation, a blend of “stagnation” and “inflation,” was popularized by British politician Lain MacLeod in the 1960s, during a period of economic distress in the United Kingdom. It gained broader recognition in the 1970s after a series of global economic shocks, particularly the 1973 oil crisis, which disrupted supply chains and led to rising prices and slowing growth. Stagflation challenges traditional economic theories, which suggest that inflation and unemployment are inversely related, as depicted by the Phillips Curve.
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According to Wikipedia, stagflation presents a policy dilemma, as measures to curb inflation—such as tightening monetary policy—can exacerbate unemployment, while policies aimed at reducing unemployment may fuel inflation.
In economic theory, there are two main explanations for stagflation: supply shocks, such as a sharp increase in oil prices, and misguided government policies that hinder industrial output while expanding the money supply too rapidly.
NOTE: A portmanteau word or part of a word made by combining the spellings and meanings of two or more other words or word parts (such as smog from smoke and fog).
The stagflation of the 1970s led to a re-evaluation of Keynesian economic policies and contributed to the rise of alternative economic theories, including monetarism and supply-side economics.
Posted on May 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Coinbase under investigation – Hit with ransom attack
Coinbase’s wild week got much wilder when the New York Times reported that the SEC has been looking into whether the crypto exchange misstated the size of its user base in securities filings. Per the New York Times, the investigation started under President Biden and has continued under President Trump.
The subject of the investigation appears to be Coinbase’s claim in past disclosures and marketing materials that it has 100 million “verified users.” A company spokesperson said it no longer reports that metric and the investigation should not continue.
The report came days after Coinbase joined the S&P 500, and just hours after it said it could lose $400 million following a recent hack by “rogue overseas” agents looking to steal customer data.
Posted on May 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BREAKING NEWS [12:09 am, EST]
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Stock Futures are contracts to buy or sell a specific underlying asset at a future date. The underlying asset can be a commodity, a security, or other financial instrument. Futures trading requires the buyer to purchase or the seller to sell the underlying asset at the set price, whatever the market price, at the expiration date.
Stock futures pointed lower on Monday morning as investors weighed fresh warnings on U.S. debt and the potential for President Donald Trump’s trade war to heat up again.
Dow Futures: 42,406.00
Fair Value: 42,752.14
Change: – 330.000.77%
Implied Open: – 346.14
Late Friday night, Moody’s downgraded the U.S. credit rating one notch. This came as Congress tries to extend Trump’s tax cuts and add new ones, which are expected to deepen federal deficits.
A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.
My medical practice has a small self-directed pension plan with profit sharing features.
QUESTION: Can my medical practice’s retirement plan invest in a hedge fund?
Such a pension fund falls under a category called self-directed “plan” assets.
Among the rules are that each participant in the plan counts toward the 100 investor maximum under which most hedge funds operate, that each plan participant be a fully accredited investor, and that the hedge fund keep investments such as pension plans and other funds covered under ERISA to less than 25 percent of total assets under management.
Posted on May 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Health Insurance Co-Payments Upfront or Lose Your Appointment
Definition: A co-payment is a fixed amount you pay each time you get a particular type of healthcare service, and co-pays will generally be quite a bit smaller than deductibles. However, deductibles and co–pays are both fixed amounts, as opposed to coinsurance, which is a percentage of the claim.
On some health plans, certain services are covered with a co-pay before you’ve met the deductible, while other health insurance plans have co-pays only after you’ve met your deductible. And, the pre-deductible versus post-deductible co-pay rules often vary based on the type of medical service you’re receiving.
Starting in June 2025, Cleveland Clinic patients who can’t pay their co-pay on the spot will have non-emergency appointments rescheduled or cancelled. This new policy could make it harder for low-income people who prefer to be billed to see a clinic doctor, and create delays that could lead to medical emergencies down the road.
For example, a delay in care can mean six to eight more weeks of a tumor growing or a blood clot developing or an infection brewing.
Posted on May 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Vitaliy Katsenelson CFA
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I am back from what has become over the past two decades an annual pilgrimage to Omaha.
What’s fascinating about this trip is that it has everything and nothing to do with Warren Buffett. The main event that draws everyone to Omaha – the Berkshire Hathaway (BRK) annual meeting – is actually the least important part. I could have watched the shareholder meeting livestreamed on YouTube from the comfort of my living room couch.
The emergence of the Berkshire phenomenon reminds me of China’s manufacturing evolution. China initially attracted capital because of its cheap labor. But over time, China took this capital and plowed it into infrastructure. Factories were built next to each other, each specializing in certain areas. A specialized ecosystem emerged.
Today, Chinese labor is no longer cheap. It’s been replaced by automation, and now China is a powerhouse for manufacturing anything and everything.
The transformation that the BRK weekend has undergone followed a similar progression. Initially, the only way to absorb Buffett and Munger’s wisdom was to come to Omaha, as the event was not streamed. But then something interesting happened. The BRK weekend attracted people who shared the same value system, and friendships were formed. A variety of smaller events began to be scheduled throughout the same weekend across Omaha, and an equally specialized ecosystem emerged.
The shareholder meeting began to be streamed about ten years ago, but that has had no impact on attendance. This is one reason why I think Buffett is at peace with the idea of no longer presiding at the meeting – people will still come to Omaha the weekend before Mother’s Day. The BRK weekend now features dozens of excellent events.
I spoke at several, including an investing panel at Creighton University, alongside the wonderful Bob Robotti, a die-hard value investor who runs Robotti & Co. I’ve known Bob for years – at 72, he exhibits the same enthusiasm for stocks as someone decades younger – and this panel was an excellent example of what the BRK Omaha ecosystem has produced.
Bob and I have very different approaches to value investing. He loves cyclical businesses, while I generally shun them. Bob mentioned that he’d buy a very cheap business run by a mediocre manager, while I would not touch it with a ten-foot pole.
There is absolutely nothing wrong with either approach; indeed, there is an important lesson in it. Your investment philosophy and process have to fit your personality and your EQ. In my case, I get nervous (and thus irrational) when I own companies run by imbeciles who don’t have either skin or soul in the game. But the great thing about the BRK weekend is that I learn from Bob every time I spend time with him. He’s a thoughtful and genuinely kind human being.
From the outside, the BRK weekend may seem like a place where people simply want to learn how to get and stay rich. But this gathering transcends value investing and capitalism and genuinely celebrates human values. People (like me) bring their kids to this event. And just like at the main event, at the Q&A breakfast I hosted for my readers, many questions centered on life rather than investing.
My first Omaha reader meetup fit around a small restaurant table. This year, to my surprise, 450 people packed into a venue with standing-room only. I answered questions on every imaginable topic for just over two hours, and by the end I was exhausted.
This gave me even greater admiration for Buffett, who is four decades my senior, yet still fielded questions for four solid hours. I was delighted to hear Warren give a similar answer to one I had given the day before when asked what advice he’d give to graduating students: “Don’t worry too much about starting salaries and be very careful who you work for because you will take on the habits of the people around you.”
(Incidentally, we are going to host our next Q&A Breakfast on May 1, 2026. You can sign up for it here. It’s free, but I suggest you sign up early, as it fills up fast.)
I also participated (as I have for over a decade) in an investing panel at YPO (Young President Organization) in the beautiful Holland Performance Art Center with Tom Gaynor, CEO of Markel (often described as a baby Berkshire Hathaway) and Lawrence Cunningham. Lawrence authored perhaps the most important book about Buffett, The Essays of Warren Buffett, masterfully editing Warren’s annual letters into a cohesive volume. This year’s panel was one of those occasions where I found myself listening intently to my fellow panelists instead of speaking more.
Lawrence has met Greg Abel – Buffett’s designated successor – and feels optimistic about him. He’s probably right – this was one of Buffett’s most crucial decisions, which he did not make lightly. Yet I can’t imagine sitting for four hours listening to Greg Abel. I am sure he is a brilliant CEO, but he’s neither Buffett nor Munger – few individuals possess so much worldly wisdom and communicate it with such clarity and humor.
This brings me to the point of this note: the dramatic (yet not unexpected) announcement that Buffett is stepping down as CEO of BRK at the end of the year.
Before I comment on this, let me tell you a story. Imagine you have been watching a soap opera for 17 years. You arrive dutifully every year to watch every episode in person. And then you miss the last five minutes of the explosive finale before it goes off the air. This is what happened to me when Buffett announced his retirement as CEO.
A few minutes before noon, while Buffett was answering a question I’d heard before and appeared to be winding down, I suggested we slip out early for lunch to avoid the crowds. When we came back, I discovered that the meeting had gone on until 1 pm, and just before it ended, Buffett announced that he would step down at the end of the year. Seventeen years of watching Warren speak and I missed the most dramatic moment of all, followed by a five-minute standing ovation.
I think Buffett has engineered his exit brilliantly. He will still remain chairman, and even before the announcement he was not managing BRK’s day-to-day operations. As a collection of hundreds of companies that often have absolutely nothing in common with each other, BRK is already highly decentralized. Buffett’s main contribution has been capital allocation.
Giving up the CEO title while he’s still alive means Buffett has brought in his replacement in an orderly way and created a smooth transition. But I have a feeling that on January 1, 2026, when Greg Abel officially becomes CEO, nothing will really change, and Warren will continue doing what he’s been doing for as long as he can. If Buffett is able – he’ll be 95 – he’ll still drive to the office and stop by McDonald’s for a breakfast sandwich (there’s a lot of wisdom in finding pleasure in little things). His son Howard Buffett will become chairman after Warren, with his only job being to preserve the culture. I’ve been asked what I think of BRK stock. We bought the stock during the pandemic. It has done better than I expected, in part because of the strong performance of Apple, which was BRK’s largest holding. But BRK today is an unexciting investment at its current price. In all honesty, it is a conglomerate with some good and some merely okay businesses.
As a consumer, I get a (small) glimpse into how BRK businesses are being run by visiting Dairy Queen. BRK owns DQ, and I love their soft-serve ice cream (though I only eat it when I travel). My favorite part of research!
DQ has (or maybe had) a strong brand and operates on a capital-light model as a franchisor. But most stores I have visited looked like they have been neglected and need fresh paint. To be sure, I understand the limitations of this “analysis,” and DQ overall amounts to a rounding error on BRK’s financials. But little things often reveal much about big things.
BRK’s big businesses, from what I can glean through their financials, are not particularly well managed – GEICO and BNSF (railroad) have definitely been undermanaged lately. BNSF is not nearly as efficient as its competitors that embraced precision railroading, and until recently GEICO was losing market share to Progressive.
BRK’s reinsurance business, a significant source of BRK’s profitability, is run by the extraordinary Ajit Jain. Ajit is in his 70s and unfortunately it seems he is not in great health. Is his replacement going to shoot the lights out, like he did? We don’t know. But Ajit is probably more important to BRK today than Buffett.
BRK is not going to melt into oblivion after Buffett is gone, but its best days are behind it. As Buffett has acknowledged, just its size alone makes it very difficult for BRK to grow. Truth be told, even if Buffett were thirty years younger and continued to run BRK, I am not sure the results would be much different than what I think the future holds with Abel at the helm.
Buffett and Charlie Munger had a tremendous impact on me as an investor and human being. I am incredibly thankful to both. I hope Warren is there next year, but, in either case, I will be.
Posted on May 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Vitaliy Katsenelson CFA
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The technology at the core of the mania is different every time. What doesn’t change over time is human emotion – the fear of missing out and then the fear of loss.
AI has a feel of “this time is different.” Optimism rarely erupts about the same technology twice; this is why history doesn’t repeat but rhymes. The technology at the core of the mania is different every time. What doesn’t change over time is human emotion – the fear of missing out and then the fear of loss, in that order.
Humans are an optimistic bunch. We need it; it’s essential to our survival and progress; but eventually, we take our optimism too far. The graveyard of financial ruins is full of these stories.
I have beat the dotcoms and Nifty Fifties to death, so let’s go to back another century. My friend the brilliant Edward Chancellor wrote about the railroad boom and bust in England in the 1800s. Here he is, edited for brevity:
The first railway to use steam locomotives opened in 1825 and was designed to carry coal, not passengers. Railway promoters simply did not appreciate the potential demand for high-speed travel. The successful launch of the Liverpool and Manchester Railway in 1830, however, demonstrated the commercial viability of passenger travel. By the early 1840s, Britain’s railway network stretched to more than 2,000 miles. Railway companies were delivering acceptable, if not spectacular, returns for investors.
Then railway fever suddenly gripped the nation. Enthusiasts touted rail transport not just for its economic benefits, but for its benign effects on human civilization. One journal envisaged a day when the “whole world will have become one great family speaking one language, governed in unity by like laws, and adoring one God.” In the two years after 1843, the index of rail stocks doubled.
Investment peaked at around 7% of Britain’s national income. Railway enthusiasts predicted that rail would soon replace all the country’s roads and that “horse and foot transit shall be nearly extinct.”
In 1845, Britain’s railways carried nearly 34 million passengers. If the 8,000 miles of newly authorized railways were to deliver their expected 10% return, then the industry’s total revenue and passenger traffic would have to climb five fold or more – all within the space of just five years. “This should have alarmed observers by itself … But they were deluded by the collective psychology of the Mania”, writes Odlyzko.
In 1847 a severe financial crisis broke out, induced in part by the diversion of large amounts of capital into unprofitable railway schemes. It turned out that the revenue projections provided by so-called “traffic takers” were wildly overoptimistic. Railway engineers underestimated costs. The vogue for constructing direct lines between large urban centers proved mistaken, as most traffic turned out to be local. As a result, Britain’s rail network was plagued with overcapacity. By the end of the decade, the index of railway stocks was down 65% from its 1845 peak.
The railroad bubble in England is just one example; there are hundreds of similar stories across market history. They all share this theme:
A new technology appears on the horizon. In the early stages, investment is rational, but then at some point excitement, imagination, and optimism take over, leading to overinvestment (usually creating a financial bubble). Investors make a lot of money until most lose it all. When the dust settles, only a few companies survive.
This AI boom reminds me of the telecom sector in the 1990s. The internet was going to change the world, and it did, but first we had tremendous overcapacity in global fiber and telecom equipment.
One could say that telecommunications companies overestimated demand for broadband and underestimated changes in technology, and that would be true. But there was a more nuanced dynamic at play, what economists call the fallacy of composition.
What’s true for one participant isn’t necessarily true for the group.
Posted on May 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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The National Nurses in Business Association (NNBA) is the premier nursing organization for nurse entrepreneurs, and a springboard for nurses transitioning from employees to entrepreneurs and business owners. The NNBA is an invaluable resource for existing nurse business owners seeking to expand, and maximize their business success.
Members’ resumes include thousands of nurse owned businesses, local, national and international awards, and millions of dollars in revenue. The experience, knowledge and impact of the NNBA community is amazing, as well as the support provided to fellow nurse entrepreneurs and aspiring entrepreneurs.
As the forerunner of the nurse entrepreneur movement, the NNBA provides valuable business information customized for nurses on how to start, plan, expand and grow your nurse owned business. They provide expert guidance, marketing and promotional opportunities, and continuing education in professional growth and career development.
Posted on April 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
FUNDAMENTAL INDUSTRY CHANGES
By Staff Reporters
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Index Funds
An index mutual fund or ETF (exchange-traded fund) tracks the performance of a specific market benchmark—or “index,” like the popular S&P 500 Index—as closely as possible. That’s why you may hear people refer to indexing as a “passive” investment strategy.
Instead of hand-selecting which stocks or bonds the fund will hold, the fund’s manager buys all (or a representative sample) of the stocks or bonds in the index it tracks.
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Quantum Computing
Unlike traditional computers that use bits, quantum computers utilize qubits. These qubits are capable of being in a state of superposition, where they can represent both 0 and 1 simultaneously, enabling the processing of multiple calculations at once. This could allow quantum computers to outperform classical computers in solving certain complex problems. However, the field is still overcoming challenges such as qubit stability and decoherence; especially in these three areas:
Quantum computing could fundamentally alter healthcare by accelerating drug discovery and improving individualized medicine. Rapid analysis of enormous volumes of biological data allows quantum computers to find trends that might guide the creation of more potent treatments. In addition to accelerating drug development, this will enable customized treatments tailored to unique genetic profiles.
Faster and more accurate financial models produced by quantum computing will transform the banking sector. Through real-time analysis of intricate financial systems, it can help investors to control risk and make better decisions. More precise market forecasts will help maximize portfolio management and trading strategies.
Through greatly enhanced medical diagnosis and patient care, quantum computing can transform the healthcare industry. Quantum computers can remarkably accurately find trends and possible health hazards by analyzing enormous volumes of medical data in a fraction of the time. Early diagnosis and more customized treatment alternatives follow from this.
B–QTUM Index Fund
Index Description: The BlueStar® Machine Learning and Quantum Computing Index (BQTUM) tracks liquid companies in the global quantum computing and machine learning industries, including products and services related to quantum computing or machine learning, such as the development or use of quantum computers or computing chips, superconducting materials, applications built on quantum computers, embedded artificial intelligence chips, or software specializing in the perception, collection, visualization, or management of big data.
Posted on April 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Coca-Cola rose 0.84% after the beverage behemoth beat earnings expectations. Not only that, it also doubled down on its forward-looking guidance, saying that revenue will grow 5% to 6% while comparable earnings per share will jump 2% to 3% in 2025. Tariff mania may raise some costs, but the company said it would be “manageable,” putting it a step ahead of arch-rival PepsiCo.
Pfizer jumped 3.28% today after the pharma giant announced that it expects to cut costs by about $7.7 billion by the end of 2027 thanks to advances in AI and automation. Despite lower sales in Q1, the company managed to keep its 2025 revenue guidance of $61 billion to $64 billion intact. While that forecast takes into account the $150 million blow from tariffs, it does not include any future tariffs (which President Trump has threatened to slap on the pharma industry).—LB
Meta Platforms gained 0.85% after the social media giant announced it will launch a standalone AI app to compete with ChatGPT. Expect more details in its earnings call tomorrow.
JetBlue Airways may have pulled guidance, but investors like the airline’s lower-than-expected loss last quarter so pushed shares 2.70% higher.
Speaking of fintech, PayPal climbed 2.14% thanks in no small part to a 20% pop in Venmo revenue.
Honeywell International gained 5.40% thanks to strong earnings and sales for the manufacturing conglomerate.
Deutsche Bank climbed 4.08% after Germany’s largest lender reported a 39% increase in profit last quarter.
Sherwin-Williams may have missed on revenue last quarter, but the paint company beat earnings estimates and kept its forward guidance intact, so shareholders pushed it up 4.80%.
Royal Caribbean eked out a 0.02% despite reporting record bookings and boosting its profit outlook, a rare move these days amid tariff uncertainty.
Leggett & Platt may not be a household name, but it sells household goods—and the bedding company’s solid earnings and strong fiscal guidance sent shares 31.73% higher.
What’s down
General Motors fell 0.64% after the automaker beat on top and bottom line estimates but warned that it will have to pull its forward guidance and suspend stock buybacks.
Spotify dropped 3.04% despite active monthly users rising 10% last quarter. The problem, believe it or not, was lower guidance.
Regeneron lost 6.87% thanks to disappointing sales for its hit eye drug Eylea.
NXP Semiconductors may have beaten analyst estimates last quarter, but management’s lower-than-expected earnings guidance disappointed investors, and pushed shares 6.94% lower.
Posted on April 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Plug Power soared 25.68% on the news that the hydrogen fuel cell manufacturer has signed a deal that allows it to issue $525 million in secured debentures.
Tesla eked out a 0.33% gain as investors took profits following the EV company’s strong week in spite of terrible earnings.
IBM rose 1.61% after the tech company pledged to invest $150 billion in US manufacturing over the next five years.
Peloton climbed 4.93% thanks to an upgrade from Truist analysts, who said the home workout company has cleaned up the “BS.”
MGM Resorts International gained 1.71% after reporting an impressive 34% increase in revenue last quarter thanks to its BetMGM platform.
ADMA Biologics popped 12.12% on FDA approval of its new production process that draws 20% more usable material from donated plasma than current methods.
What’s down
Nvidia sank 2.05% on the news that China’s Huawei Technologies is preparing to test a new semiconductor that could rival Nvidia’s most powerful tech.
Coinbase fell 2.08% on a double downgrade from Compass Point analysts, who cited a decline in retail trading activity.
DraftKings dropped 1.51% after Mizuho analysts lowered their price target on the company, cutting their expectations for the gambling stock’s EBITDA.
Posted on April 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants LLC
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On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) published their 2026 Rate Announcement for Medicare Advantage (MA) and Medicare Part D Prescription Drug Plans.
For 2026, the payment rate to MA plans will increase 5.06%, the largest increase in the past ten years, and up significantly from the 2.2% rate increase proposed by the Biden Administration.
This Health Capital Topics article will review the Rate Announcement.(Read more…)
Much like a springy inflatable structure often resembling a four-sided building and used by children for jumping for sport and fun, stocks staged a much-needed bounce-house back week on hopes that the trade war would de-escalate, with the S&P 500 climbing for four straight days to close 4.6% higher.
Whether the rally continues this week may depend on the Magnificent Seven earnings on tap—each of those Big Tech stocks has fallen at least 6.5% this year, shedding a combined $2.5 trillion in market value, per the Wall Street Journal.
The fourth market is defined as private transactions made directly between large medical investors, institutions such as banks, mutual funds, and insurance companies, without the use of a securities firm. In other words, fourth market trading is usually one institution swapping securities in its portfolio with another large institution.
From the stock broker’s viewpoint, there is one problem with the fourth market. Since no broker/dealer is involved, no registered representative is involved and there is no commission to be earned. These trades are reported on a system called Instinet.
This is advantageous to larger medical foundations or institutional investors.
What Is Instinet?
Instinet is a global financial securities service that operates an electronic securities order matching, trading, and information system which allows members, primarily institutional traders, and investors, to display bids and offer quotes for stocks, and conduct transactions with each other.
Instinet is an example of a dark pool of liquidity, a private exchange for trading securities that is not accessible by the investing public. The name implies a lack of transparency. and it facilitates block trading by institutional investors who do not wish to impact the markets with their large orders.
According to the SEC, there were 74 registered Alternative Trading Systems, or dark pools, as of February 2024.
Posted on April 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Alphabet has been declared a monopoly for the second time in under a year. Analysts will have plenty of questions about the repercussions of the most recent ruling, but don’t expect a breakup of Google’s many businesses just yet.
And, the best business unit of them all these days is YouTube, which has seen a stunning surge in popularity lately that the search company will likely try to capitalize on, while it continues to tinker with its Gemini AI model. Consensus: $2.02 EPS, $89.25 billion in revenue.
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Intel seems like a bit of an also-ran in the AI race these days, with shares down over 40% in the last 12 months. But to bulls, that just means the stock is cheap, while the company itself has plenty of opportunities for growth ahead, including partnerships with Nvidia and TSMC.
And, don’t forget that Intel’s status as a dark horse lets it slip below the tariff radar—the domestic chip producer dodged the latest round of restrictions that hit Nvidia and AMD. Shareholders will be hoping to hear more good news ahead. Consensus: $0.09 EPS, $12.31 billion in revenue.
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The Medical Executive-Post is a news and information aggregator and social media professional network for medical and financial service professionals. Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed. Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.
An annuity is a contract between you and an insurance company. When you purchase an annuity, you make a lump-sum contribution or a series of contributions, generally each month. In return, the insurance company makes periodic payments to you beginning immediately or at a pre-determined date in the future. These periodic payments may last for a finite period, such as 20 years, or an indefinite period, such as until both you and your spouse are deceased. Annuities may also include a death benefit that will pay your beneficiary a specified minimum amount, such as the total amount of your contributions.
The growth of earnings in your annuity is typically tax-deferred; this could be beneficial as you may be in a lower tax bracket when you begin taking distributions from the annuity.
Warning: A word of caution: Annuities are intended as long-term investments. If you withdraw your money early from an annuity, you may pay substantial surrender charges to the insurance company as well as tax penalties to the IRS and state.
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There are three basic types of annuities — fixed, indexed, and variable
1. With a fixed annuity, the insurance company agrees to pay you no less than a specified (fixed) rate of interest during the time that your account is growing. The insurance company also agrees that the periodic payments will be a specified (fixed) amount per dollar in your account.
2. With an indexed annuity, your return is based on changes in an index, such as the S&P. Indexed annuity contracts also state that the contract value will be no less than a specified minimum, regardless of index performance.
3. A variable annuity allows you to choose from among a range of different investment options, typically mutual funds. The rate of return and the amount of the periodic payments you eventually receive will vary depending on the performance of the investment options you select.
The Medical Executive-Post is a news and information aggregator and social media professional network for medical and financial service professionals.
Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.
Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.
Posted on April 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
OFTEN CONFUSING TO ALL
By Staff Reporters
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A vehicle typically has two prices: the manufacturer’s suggested retail price (MSRP) and the invoice price. The MSRP is the sticker price, while the invoice price is what the dealer paid the manufacturer for the vehicle. The MSRP includes a hefty profit, so that’s what dealers want you to focus on. However, your goal should be to get the invoice price and focus on that for your negotiations.
However, finding invoice pricing on new cars can be difficult when going through the dealer. Dealers don’t want their invoice price on a vehicle to be public knowledge because that gives customers more leverage when it comes to negotiations. Just like any company, car dealers are in the business to make money. They can’t make money if they give you a huge discount on a car.
What is a Vehicle Invoice Price?
When it comes to the car buying process, there are several other terms and types of pricing you should understand. One of them is the vehicle invoice price. This is also known as the dealer cost, or what a car manufacturer charges the dealer for that specific vehicle. Freight charges are typically included in this total.
However, the numbers on the invoice may not be the true price the dealer paid for the vehicle, because it has hidden profits already built-in. Dealers are often given manufacturer rebates, allowances, discounts, and other incentives for selling a car. The invoice price on a vehicle may range from several hundred to several thousand dollars below its sticker price, which is why service will help you determine what the real numbers look like.
So, once you determine the car invoice price, you have added leverage when it comes to negotiating the best price possible with the auto dealer.
Posted on April 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BREAKING NEWS
Artificial Intelligence Enhanced
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Markets drop as tariff concerns shake the market
Key takeaways (1:30 EST)
The Dow Jones Industrial Average experienced a significant drop of more than 1,100 points, reflecting investor anxiety over tariff policies finance. The S&P was down 150 and the NASDAQ was down 550.
This decline is part of a broader trend affecting the S&P 500 and NASDAQ, as geopolitical tensions and economic uncertainties weigh heavily on market sentiment finance.yahoo.com .
Investors are closely monitoring developments regarding trade policies and their potential impact on the economy, leading to heightened volatility in the stock market
Several years ago a group of highly trusted and deeply experienced financial advisors, insurance service professionals and estate planners noted that far too many of their mature retiring physician clients, using traditional stock brokers, management consultants and financial advisors, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.”
In fact, an informal inverse related relationship was noted, and dubbed the “Doctor Effect.” In others words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning and medical practice management, continuum.
Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, dinners and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.” This realization confirmed the industry culture which seemed to be:
Bread for the advisor – Crumbs for the client!
And so, Marcinko Associates formed a cadre’ of technology focused and highly educated multi-degreed doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries who decided there must be a better way for their healthcare colleagues to receive financial planning advice, products and related advisory services within a culture of fiduciary responsibility.
We trust you agree with this specific niche knowledge, and collegial consulting philosophy, as illustrated thru our firm and these two books.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
When you buy a share of stock, you are taking ownership in a company. Collectively, the company is owned by all the shareholders, and each share represents a claim on assets and earnings. If the company distributes profits to its shareholders, you should receive a proportionate share of the earnings.
Stocks are often categorized by the size of the company, or their market capitalization. The market capitalization is determined by multiplying the number of outstanding shares by the current share price. The most common market cap classes are small-cap (valued from $100 million to $1 billion), mid-cap ($1 billion to $10 billion), and large cap ($10 billion to $100 billion).
Stocks are also categorized by their sector, or the type of business the company conducts. Common sectors include utilities, consumer staples, energy, communications, financial, health care, transportation, and technology.
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Stocks are often viewed as being in one of two categories — growth or value.
Growth stocks are ones that are associated with high quality, successful companies that are expected to continue growing at a better-than-average rate as compared to the rest of the market.
Value stocks are ones that have generally solid fundamentals, but are currently out of favor with the market. This may be due to the company being relatively new and unproven in the market, or because the company has recently experienced a decline due to the company’s sector being affected negatively. An example of this would be if the federal government was to levy a new tax on all cell phones, thus negatively affecting all cell phone company stocks.
History has shown that, over time, stocks have provided a better return than bonds, real estate, and other savings vehicles. As a result, stocks may be the ideal investment for investors with long-term goals.
Posted on April 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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UnitedHealth stock nosedived 20% in morning trading, falling by $116 per share from Wednesday’s $585 close to $469. The Minnesota-based firm is on track for its steepest daily loss since Aug. 6, 1998.
The losses came after UnitedHealth’s first-quarter financial report was worse than analysts expected across each of the three major quarterly yardsticks: revenue, earnings per share and future earnings outlook.
Furthermore, after the opening bell, the Dow Jones Industrial Average tumbled 1.3%, or around 500 points. The S&P 500 moved up 0.4%, while the tech-heavy NASDAQ composite gained 0.5%.
Abbott Laboratories gained 2.77% after the pharma company missed sales estimates but still beat earnings forecasts.
Gold miners continue to climb as gold keeps hitting new highs. Newmont rose 2.51%, while Gold Fields gained 3.35%.
What’s down
Tesla sank 4.94% after the company’s share of EV sales in California fell below 50% in the first quarter, while export controls threaten plans to produce Cybercabs in the US.
United Airlines fell 0.01% despite reporting its “best first-quarter financial results in five years,” according to management. The airline took the unique measure of providing two different financial outlooks for the year ahead: one for a stable economy, and one for a recession.
Lyft shed just 0.46% on the news that the ride-hailing company is acquiring European taxi app Free Now for $199 million.
Interactive BrokersGroup reported a 47% increase in trading volume last quarter that helped it beat revenue expectations, but the brokerage still tumbled 8.95% after missing profit forecasts.
Palantir gave up some of its recent gains following its big NATO announcement, sinking 5.78% today as investors collected profits.
JB HuntTransport Services’ management team warned that the logistics company sits squarely in the crosshairs of the trade war, pushing shares down 7.68%.
Omnicom Group tumbled 7.28% after the advertising firm missed revenue estimates thanks to economic uncertainty.
Posted on April 16, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Investors were apparently tired of all the volatility yesterday, leading to a relatively calm day where indexes ever-so-slightly slipped. But it was a big day for Netflix after the Wall Street Journal reported that the streaming giant has plans to double its revenue and reach a $1 trillion valuation by 2030.
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🟢 What’s up
Hewlett Packard Enterprise popped 5.11% after Elliott Investment Management took a $1.5 billion stake in the tech company.
Rocket Lab rocketed (sorry) 10.14% higher after the space stock inked deals with both the US Air Force and the UK Ministry of Defense.
Netflix rose 4.83% on a report from the Wall Street Journal that the streaming giant plans to hit a $1 trillion market capitalization and double its revenue by 2030. The company announces earnings on Thursday.
Bank of America and Citigroup both posted strong Q1 earnings that beat analyst forecasts (more on that below). BofA climbed 3.60%, while Citi rose 1.76%.
Albertsons tumbled 7.49% after the grocer’s full-year guidance came in below expectations.
Allegro Microsystems sank 9.68% on the news that ON Semiconductor has withdrawn its offer to acquire the chipmaker.
Applied Digital plummeted 35.94% after the digital infrastructure company missed analyst revenue estimates, despite sales climbing 22% last quarter.
#recessionindicator: Coty sank 8.57% after the beauty retailer was double downgraded by Bank of America analysts, citing a slowdown in makeup spending.
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What’s down
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