BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on January 25, 2026 by Dr. David Edward Marcinko MBA MEd CMP™
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A paradox is a logically self-contradictory statement or a statement that runs contrary to one’s expectation. It is a statement that, despite apparently valid reasoning from true or apparently true premises, leads to a seemingly self-contradictory or a logically unacceptable conclusion. A paradox usually involves contradictory-yet-interrelated elements that exist simultaneously and persist over time. They result in “persistent contradiction between interdependent elements” leading to a lasting “unity of opposites”.
Classic Definition: Artificial intelligence (AI) refers to computer systems capable of performing complex tasks that historically only a human could do, such as reasoning, making decisions, or solving problems. The term “AI” describes a wide range of technologies that power many of the services and goods we use every day – from apps that recommend TV shows to chat-bots that provide customer support in real time.
Modern Circumstance: The role of artificial intelligence in health care is becoming an increasingly topical and controversial discussion. There remains uncertainty about what is achievable regarding ongoing medical artificial intelligence research. Although there are some people who believe that artificial intelligence will be used, at best, as a tool to assist clinicians in their day-to-day activities, there are others who believe that job automation and replacement is a looming threat.
Paradox Example: Moravec’s paradox is a phenomenon observed by robotics researcher Hans Moravec, in which tasks that are easy for humans to perform (eg, motor or social skills) are difficult for machines to replicate, whereas tasks that are difficult for humans (eg, performing mathematical calculations or large-scale data analysis) are relatively easy for machines to accomplish.
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For example, a computer-aided diagnostic system might be able to analyze large volumes of images quickly and accurately but might struggle to recognize clinical context or technical limitations that a human radiologist would easily identify.
Similarly, a machine learning algorithm might be able to predict a patient’s risk of a specific condition on the basis of their medical history and laboratory results but might not be able to account for the nuances of the patient’s individual case or consider the effect of social and environmental factors that a human physician would consider.
In surgery, there has been great progress in the field of robotics in health care when robotic elements are controlled by humans, but artificial intelligence-driven robotic technology has been much slower to develop.Thus far, research into clinical artificial intelligence has focused on improving diagnosis and predictive medicine.
Assessment
Moravec’s paradox also highlights the importance of maintaining a human element in the health-care system, and the need for collaboration between humans and technology to achieve the best possible outcomes.
Conclusion
In the field of medicine, it is becoming indisputable that artificial intelligence will have a role in population health analysis, predictive medicine, and personalized care.
However, for now, the job of doctors seems safe from automation.
Cite: Shuaib A: The increasing role of artificial intelligence in health care: will robots replace doctors in the future? Int J Gen Med. 2020; 13: 891-896
Gold has long been regarded as a cornerstone of wealth preservation, and its role within modern investment portfolios continues to attract scholarly attention. As both a tangible asset and a financial instrument, gold embodies characteristics that distinguish it from equities, fixed income securities, and other commodities. Its historical resilience, inflation-hedging capacity, and diversification benefits render it a subject of considerable importance in portfolio construction and risk management.
Historical and Monetary Significance
Gold’s enduring appeal is rooted in its function as a monetary standard and store of value. For centuries, gold underpinned global currency systems, most notably through the gold standard, which provided stability in international trade and monetary policy. Although fiat currencies have supplanted gold in official circulation, its symbolic and practical role as a measure of wealth persists. This historical continuity reinforces investor confidence in gold as a reliable repository of value during periods of economic uncertainty.
Inflation Hedge and Safe-Haven Asset
A substantial body of empirical research demonstrates that gold serves as a hedge against inflation and currency depreciation. When consumer prices rise and fiat currencies weaken, gold tends to appreciate, thereby preserving purchasing power. Moreover, gold’s status as a safe-haven asset is particularly evident during geopolitical crises, financial market turbulence, and systemic shocks. In such contexts, investors reallocate capital toward gold, seeking protection from volatility in traditional asset classes. This defensive quality underscores gold’s utility in stabilizing portfolios during adverse conditions.
Diversification and Risk Management
From the perspective of modern portfolio theory, gold offers diversification benefits due to its low correlation with equities and bonds. Incorporating gold into a portfolio reduces overall variance and enhances risk-adjusted returns. Studies suggest that even modest allocations—typically ranging from 5 to 10 percent—can improve portfolio resilience by mitigating downside risk. This non-correlation is especially valuable in environments characterized by heightened uncertainty, where traditional diversification strategies may prove insufficient.
Investment Vehicles and Accessibility
Gold’s versatility as an investment is reflected in the variety of instruments available to investors. Physical bullion, in the form of coins and bars, provides tangible ownership but entails storage and insurance costs. Exchange-traded funds (ETFs) offer liquidity and ease of access, while mining equities provide leveraged exposure to gold prices, albeit with operational risks. Futures contracts and derivatives enable sophisticated strategies, though they demand expertise and tolerance for volatility. The breadth of these vehicles ensures that gold remains accessible across diverse investor profiles.
Limitations and Critical Considerations
Despite its strengths, gold is not without limitations. Unlike equities or bonds, gold does not generate income, such as dividends or interest. This absence of yield can constrain long-term portfolio growth, particularly in low-inflation environments. Furthermore, gold prices are subject to volatility, influenced by investor sentiment, central bank policies, and global demand dynamics. Overexposure to gold may therefore hinder portfolio performance, underscoring the necessity of balanced allocation.
Conclusion
Gold’s dual identity as a historical store of value and a contemporary financial instrument secures its relevance in portfolio construction. Its inflation-hedging capacity, safe-haven qualities, and diversification benefits justify its inclusion as a strategic asset. Nevertheless, prudent management is essential, given its lack of yield and susceptibility to volatility. Within a scholarly framework of portfolio theory, gold emerges not as a panacea but as a complementary asset, enhancing resilience and stability in the face of evolving economic landscapes.
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 Impact of Medical Equipment Tariffs on Healthcare Systems
Tariffs on medical equipment have become a contentious issue in global trade and healthcare policy, particularly in the United States. These import taxes, designed to protect domestic industries and generate government revenue, can have unintended consequences when applied to essential healthcare supplies. As the U.S. healthcare system relies heavily on imported medical devices, consumables, and components, tariffs can significantly affect costs, accessibility, and innovation.
One of the most immediate impacts of medical equipment tariffs is the increase in operational costs for hospitals and healthcare providers. According to the American Hospital Association, the U.S. imported nearly $15 billion in medical equipment in 2024, much of it from countries like China. Recent tariff hikes on items such as syringes, respirators, gloves, and medical masks have raised concerns about affordability and supply chain stability. These cost increases are particularly burdensome for rural hospitals and smaller health systems, which operate on tighter budgets and have less flexibility to absorb price shocks.
Tariffs also disrupt supply chains by introducing unpredictability into procurement strategies. Unlike market-driven price changes, tariffs are policy-based and often implemented with little warning. This volatility can affect everything from disposable supplies to high-tech imaging equipment. Long-term contracts may temporarily shield hospitals from tariff impacts, but as these agreements expire, renegotiations often reflect the new cost realities. Manufacturers, in turn, may respond by relocating production, adding surcharges, or reducing product lines to manage tariff-related risks.
Beyond cost and logistics, tariffs can hinder innovation in the medical field. Many U.S.-based manufacturers rely on imported components to build advanced medical devices. When these parts become more expensive due to tariffs, companies may scale back research and development or pass costs onto consumers. This can slow the adoption of cutting-edge technologies and reduce the competitiveness of domestic firms in the global market.
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From a policy perspective, the rationale for imposing tariffs on medical equipment is often rooted in national security and economic protectionism. However, critics argue that such measures may weaken health security by limiting access to critical supplies during emergencies, such as pandemics or natural disasters. The National Taxpayers Union has emphasized that tariffs on personal protective equipment and other medical goods can undermine preparedness and increase vulnerability.
To mitigate these challenges, healthcare systems and policymakers must explore strategic solutions. These include advocating for tariff exemptions on essential medical supplies, diversifying sourcing strategies, and investing in domestic manufacturing capabilities. Additionally, standardizing procurement practices and implementing cost-saving measures can help health systems navigate tariff-related pressures more effectively.
In conclusion, while tariffs may serve broader economic goals, their application to medical equipment demands careful consideration. The stakes are high—not just in terms of dollars, but in the quality and accessibility of patient care. A balanced approach that protects domestic interests without compromising health outcomes is essential for a resilient and equitable healthcare system.
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
Posted on January 8, 2026 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
By Professor Eugene Schmuckler PhD MBA MEd CTS
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Physician gambling addiction is a growing concern that threatens both personal well-being and professional integrity. This essay explores its causes, consequences, and the urgent need for awareness and support.
Gambling addiction, or gambling disorder, is a recognized mental health condition characterized by an uncontrollable urge to gamble despite negative consequences. While it affects about 1% of the general population., its presence among physicians is particularly alarming due to the high stakes involved—both financially and ethically. Physicians are entrusted with lives, and addiction can impair judgment, compromise patient care, and lead to devastating personal and professional outcomes.
Several factors contribute to gambling addiction in physicians. The profession is inherently high-pressure, with long hours, emotional strain, and frequent exposure to trauma. These stressors can drive individuals to seek escape or excitement through gambling. Moreover, physicians often have access to substantial financial resources, making it easier to sustain gambling habits longer than others. The culture of perfectionism and stigma around mental health in medicine may also discourage seeking help, allowing addiction to fester in secrecy.
The consequences of gambling addiction for physicians are multifaceted. On a personal level, it can lead to financial ruin, strained relationships, and deteriorating mental health. Studies show that gambling activates the brain’s reward system similarly to drugs and alcohol, reinforcing compulsive behavior.
Professionally, addiction can result in medical errors, fraud, or even criminal activity—such as embezzling funds to cover gambling debts. These actions not only endanger patients but also erode public trust in the medical profession.
During the COVID-19 pandemic, gambling behavior intensified across many demographics, including healthcare workers. Increased isolation, stress, and access to online gambling platforms contributed to a surge in addiction cases. Physicians, already burdened by the pandemic’s demands, were particularly vulnerable. The rise of sports betting and fantasy leagues has further blurred the lines between entertainment and addiction, making it harder to recognize problematic behavior.
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Addressing physician gambling addiction requires a multifaceted approach. First, medical institutions must foster a culture that encourages mental health support without stigma. Confidential counseling services, peer support groups, and educational programs can help physicians recognize and address addiction early. Licensing boards and hospitals should implement policies that balance accountability with rehabilitation, ensuring that affected physicians receive treatment rather than punishment alone.
Additionally, research into gambling disorder must continue to evolve. Institutions like Yale Medicine are leading efforts to understand the neurological and genetic underpinnings of addiction, which could inform more effective treatments. Public awareness campaigns can also help destigmatize gambling addiction and promote responsible behavior.
In conclusion, physician gambling addiction is a hidden crisis with far-reaching implications. It stems from a complex interplay of stress, access, and stigma, and its consequences can be catastrophic.
By promoting awareness, support, and research, the medical community can better protect its members and the patients they serve.
Posted on November 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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⚠️ Cons of Compounding Pharmacies
1. Quality and Safety Concerns
Medications are not FDA-approved, meaning they don’t go through the same rigorous testing as commercial drugs.
Risk of contamination or incorrect formulation if strict standards aren’t followed.
Potency can vary between batches, leading to inconsistent therapeutic effects.
2. Limited Regulation
Oversight is less stringent compared to mass-produced pharmaceuticals.
Standards may differ depending on the state or the specific pharmacy.
Patients may not always know whether their compounding pharmacy meets high-quality benchmarks.
3. Insurance and Cost Issues
Compounded medications are often not covered by insurance.
They can be more expensive due to customization and small-scale production.
4. Availability and Accessibility
Not all pharmacies offer compounding services.
Patients may need to travel farther or wait longer to receive their medication.
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5. Evidence and Efficacy
Limited clinical trials or scientific evidence supporting compounded formulations.
Effectiveness may rely heavily on anecdotal reports rather than standardized studies.
6. Risk of Errors
Human error in measuring, mixing, or labeling can lead to incorrect dosages.
Lack of standardized packaging may increase confusion for patients.
👉 In short: while compounding pharmacies can provide personalized solutions, the downsides include less regulation, higher costs, safety risks, and limited evidence of efficacy compared to FDA-approved medications.
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 November 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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Shaping Well-being Beyond Medicine
Health is often thought of as the result of medical care, but in reality, it is deeply influenced by the conditions in which people are born, grow, live, work, and age. These conditions, known as social determinants of health, include a wide range of social, economic, and environmental factors that shape health outcomes. They are responsible for many of the differences in health status between individuals and communities. Understanding these determinants is essential for promoting fairness in health and designing policies that reduce disparities.
Economic Stability
Economic stability is one of the most powerful determinants of health. Individuals with steady income can afford nutritious food, safe housing, and preventive healthcare. Conversely, poverty increases vulnerability to chronic diseases, mental health challenges, and limited access to medical services. Families with fewer financial resources may struggle to afford medications or healthy diets, leading to higher rates of obesity, diabetes, and cardiovascular disease. Unemployment or unstable work further exacerbates stress, which itself is linked to poor health outcomes. Economic inequality directly translates into health inequality.
Education
Education shapes health both directly and indirectly. Higher educational attainment is associated with better employment opportunities, higher income, and improved health literacy. People with more education are more likely to understand medical information, adopt healthy behaviors, and navigate healthcare systems effectively. Limited education can perpetuate cycles of poverty and poor health. For instance, children who grow up in underfunded schools may face restricted opportunities, leading to lower lifetime earnings and poorer health outcomes. Education is therefore a critical lever for breaking intergenerational cycles of disadvantage.
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Neighborhood and Physical Environment
The environment in which individuals live plays a crucial role in determining health. Safe neighborhoods with clean air, accessible parks, and reliable transportation promote physical activity and reduce exposure to pollutants. In contrast, communities with high crime rates, poor housing, and environmental hazards contribute to stress, injury, and illness. Food deserts—areas with limited access to affordable, healthy food—are a striking example of how environment shapes health. Residents in these areas often rely on processed foods, increasing risks of obesity and related diseases. Housing quality also matters: overcrowding, mold, or lead exposure can lead to respiratory illnesses and developmental delays.
Healthcare Access and Quality
Access to healthcare is a fundamental determinant, but it is shaped by social and economic factors. Insurance coverage, affordability, and cultural competence of providers influence whether individuals receive timely and effective care. Marginalized groups often face barriers such as discrimination, language differences, or lack of nearby facilities. Even when healthcare is available, disparities in quality persist. For example, minority populations may receive less aggressive treatment for certain conditions compared to others. Addressing these inequities requires systemic reforms that prioritize inclusivity and affordability.
Social and Community Context
Social relationships and community support networks significantly affect health. Strong social ties provide emotional support, reduce stress, and encourage healthy behaviors. Communities with high levels of trust and civic engagement often experience better health outcomes. Conversely, discrimination, racism, and social exclusion undermine health by increasing stress and limiting opportunities. Social cohesion and equity are therefore vital for fostering healthier societies.
Conclusion
The social determinants of health highlight that medicine alone cannot ensure well-being. Economic stability, education, environment, healthcare access, and social context collectively shape health outcomes and drive disparities. Addressing these determinants requires a holistic approach that integrates public health, social policy, and community action. By investing in education, reducing poverty, improving neighborhoods, and ensuring equitable healthcare, societies can move closer to achieving health equity. Ultimately, health is not just about treating illness—it is about creating conditions in which everyone has the opportunity to thrive.
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 November 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
BASIC DEFINITIONS
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The Direct Reimbursement Payment Model allows physicians to receive payment directly from patients or employers, bypassing traditional insurance systems. This model emphasizes transparency, autonomy, and personalized care, offering an alternative to fee-for-service and managed care structures.
The Direct Reimbursement Payment Model is a healthcare financing approach in which physicians are paid directly by patients or sponsoring entities—such as employers—rather than through insurance companies or government programs. This model is gaining traction as a response to the administrative burdens, opaque billing practices, and fragmented care often associated with traditional insurance-based systems.
One prominent example of direct reimbursement is Direct Primary Care (DPC). In DPC, patients pay a recurring fee—monthly, quarterly, or annually—that covers a broad range of primary care services. These include routine checkups, preventive screenings, chronic disease management, and basic lab work. By eliminating third-party billing, DPC practices reduce overhead costs and administrative complexity, allowing physicians to spend more time with patients and focus on quality care.
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Employers have also embraced direct reimbursement models to manage healthcare costs and improve employee wellness. In such arrangements, employers reimburse physicians or clinics directly for services rendered to their employees, often through a defined benefit structure. This can be part of a self-funded health plan or a supplemental offering alongside high-deductible insurance policies. The goal is to provide accessible, cost-effective care while avoiding the inefficiencies of traditional insurance networks.
Key advantages of the direct reimbursement model include:
Price transparency: Patients know upfront what services cost, reducing surprise billing and financial stress.
Improved access: Physicians often offer same-day or next-day appointments, extended visits, and direct communication via phone or email.
Lower administrative burden: Without insurance paperwork, practices can operate more efficiently and focus on patient care.
Stronger patient-physician relationships: More time per visit fosters trust, continuity, and better health outcomes.
However, the model is not without limitations. Direct reimbursement may not cover specialist care, hospitalization, or emergency services, requiring patients to maintain supplemental insurance. Additionally, the model may be less accessible to low-income populations who cannot afford recurring fees or out-of-pocket payments. Critics also argue that widespread adoption could fragment care and reduce risk pooling, undermining the broader goals of universal coverage.
Despite these concerns, the direct reimbursement model aligns with broader trends in healthcare reform, including value-based care, consumer empowerment, and decentralized service delivery. It offers a viable path for physicians seeking autonomy and for patients desiring personalized, transparent care. As healthcare continues to evolve, hybrid models that combine direct reimbursement with traditional insurance may emerge, offering flexibility and choice across diverse patient populations.
In conclusion, the Direct Reimbursement Payment Model represents a meaningful shift in how healthcare services are financed and delivered.
By prioritizing simplicity, transparency, and patient-centered care, it challenges the status quo and opens new possibilities for sustainable, high-quality medical practice.
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 November 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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The Pitfalls of Capitation in Medicine
Capitation, a payment model in healthcare where providers receive a fixed amount per patient regardless of the services rendered, has been promoted as a way to control costs and incentivize efficiency. However, despite its theoretical appeal, capitation medicine presents significant drawbacks that can compromise patient care, distort provider incentives, and exacerbate systemic inequities.
One of the most concerning aspects of capitation is the potential for under-treatment. Since providers are paid a set fee per patient, regardless of how much care that patient requires, there is a financial incentive to minimize services. This can lead to situations where necessary tests, referrals, or treatments are delayed or denied in order to preserve profit margins. Patients with complex or chronic conditions—who require more frequent and intensive care—may be especially vulnerable under this model. The risk is that medical decisions become driven by cost containment rather than clinical need, undermining the ethical foundation of healthcare.
Capitation also introduces challenges in maintaining quality standards. Unlike value-based care, which ties reimbursement to outcomes, capitation focuses solely on cost predictability. Without robust oversight and accountability mechanisms, providers may cut corners or avoid high-risk patients altogether. This can result in cherry-picking, where healthier individuals are favored, and sicker patients are subtly discouraged from enrolling. Such practices not only distort the patient pool but also deepen health disparities, particularly among marginalized populations who already face barriers to care.
Furthermore, capitation can strain the provider-patient relationship. Physicians may feel pressured to limit time spent with each patient or avoid costly interventions, leading to a sense of transactional care rather than personalized attention. This erosion of trust can diminish patient satisfaction and reduce adherence to treatment plans. In a system where providers are rewarded for doing less, the intrinsic motivation to go above and beyond for patients may be compromised.
Operationally, capitation demands sophisticated infrastructure to manage risk, track utilization, and ensure compliance. Smaller practices or those serving underserved communities may lack the resources to implement such systems effectively. This can create a two-tiered system where well-funded organizations thrive while others struggle to deliver basic care. Additionally, the administrative burden of managing capitation contracts, monitoring performance metrics, and navigating complex reimbursement rules can divert attention from clinical priorities.
Critics also argue that capitation may stifle innovation. When providers are locked into fixed budgets, there is little room to experiment with new technologies, therapies, or care models that might improve outcomes but carry upfront costs. This conservative approach can hinder progress and limit access to cutting-edge treatments.
In conclusion, while capitation medicine aims to control costs and streamline care, its inherent risks—under-treatment, inequity, and diminished quality—make it a problematic model when not carefully regulated. To truly reform healthcare, payment systems must balance financial sustainability with ethical responsibility, ensuring that every patient receives the care they need, not just the care that fits a budget.
Posted on November 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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An October 2025 Health Affairs study found that payment equity between facilities owned by hospitals, known as hospital outpatient departments (HOPDs), and independent outpatient facilities such as ambulatory surgery centers (ASCs), is still far from reality. Comparing payments for common procedures, researchers found commercial prices were 78% higher in HOPDs compared to ASCs, although payment differentials varied considerably.
This Health Capital Topics article reviews the article and potential policy implications. (Read more…)
Posted on November 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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By Health Capital Consultants, LLC
On October 23, 2025, both Democratic and Republican lawmakers expressed support during a Senate Health, Education, Labor, and Pensions (HELP) Committee hearing for reforming the 340B Drug Discount Program. Although senators acknowledged that any reform would necessitate an intentional, considered approach to mitigate unintended consequences, the bipartisan agreement (particularly during a government shutdown deadlocked on healthcare) indicates that changes to the program may be on the horizon.
This Health Capital Topics article outlines the 340B program, discusses issues that have made the program controversial, and discusses potential reform options. (Read more…)
Posted on November 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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Since lawmakers failed to pass a bill to fund the federal government before the September 30, 2025 deadline, lawmakers have remained deadlocked over the spending bill. The deadlock is centered on the continuation of health insurance exchange subsidies, but the shutdown has broader implications on the healthcare industry.
This Health Capital Topics article provides an update on the continuing saga. (Read more…)
Posted on October 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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In the evolving landscape of digital health care, Amazon Pharmacy and GoodRx have emerged as two leading platforms offering consumers affordable and convenient access to prescription medications. While both aim to simplify the process of obtaining prescriptions, they differ significantly in their approach, pricing models, and user experience.
Amazon Pharmacy, launched in 2020, is a full-service online pharmacy that allows customers to order medications directly through Amazon. It offers fast, free delivery for Prime members and integrates with most insurance plans. One of its standout features is RxPass, a subscription service available to Prime members for $5 per month, which covers unlimited eligible generic medications. This model is particularly attractive to individuals who take multiple generics regularly, as it can significantly reduce out-of-pocket costs.
In contrast, GoodRx, founded in 2011, operates primarily as a price comparison and discount platform. It does not dispense medications itself but partners with local and mail-order pharmacies to help users find the lowest prices. GoodRx provides coupons that can be used at thousands of pharmacies nationwide, often resulting in substantial savings—especially for those without insurance. It also offers GoodRx Gold, a paid membership that unlocks deeper discounts and telehealth services.
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When comparing the two, pricing transparency is a key differentiator. GoodRx excels in showing users a range of prices across different pharmacies, empowering them to choose the most cost-effective option. Amazon Pharmacy, while competitive, typically offers fixed prices and focuses more on convenience and integration with its broader ecosystem.
Convenience is another area where Amazon Pharmacy shines. With its streamlined ordering process, automatic refills, and integration with Amazon’s delivery network, it appeals to users who prioritize ease and speed. GoodRx, while convenient in its own right, requires users to present coupons at the pharmacy or use mail-order services, which may involve more steps.
Insurance compatibility also varies. Amazon Pharmacy accepts most major insurance plans, making it a viable option for insured individuals. GoodRx, on the other hand, is often used by those without insurance or with high deductibles, as its discounts can sometimes beat insurance copays.
However, both platforms have limitations. Amazon Pharmacy’s RxPass is restricted to generic medications and excludes certain states due to regulatory issues. GoodRx’s discounts may not apply to all medications, and prices can fluctuate depending on location and pharmacy.
In terms of user experience, Amazon offers a seamless, tech-driven interface with customer support and medication management tools. GoodRx provides educational resources, price alerts, and a mobile app that helps users track savings and prescriptions.
Ultimately, the choice between Amazon Pharmacy and GoodRx depends on individual needs. For those seeking a one-stop solution with predictable costs and fast delivery, Amazon Pharmacy may be ideal. For users who want to shop around for the best deal or lack insurance, GoodRx offers unmatched flexibility and savings.
As digital health continues to grow, both platforms are reshaping how Americans access medications—making prescriptions more affordable, transparent, and accessible than ever before.
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 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
DEFINED
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A physician practice management corporation (PPMC) is a business entity that provides non-clinical administrative and operational support to medical practices, allowing physicians to focus on patient care while the corporation handles the business side of healthcare.
Physician practice management corporations emerged in response to the increasing complexity of running a medical practice. As healthcare regulations, insurance requirements, and operational costs grew, many physicians found it challenging to manage both clinical responsibilities and business operations. PPMCs offer a solution by taking over the administrative burdens, enabling physicians to concentrate on delivering quality care.
At their core, PPMCs are responsible for a wide range of non-medical services. These include billing and coding, human resources, payroll, marketing, compliance, information technology, and financial management. By centralizing these functions, PPMCs can achieve economies of scale, reduce overhead costs, and improve operational efficiency for the practices they manage. This model is particularly attractive to small and mid-sized practices that may lack the resources to manage these functions independently.
PPMCs typically enter into long-term management agreements with physician groups. In some cases, they may purchase the non-clinical assets of a practice—such as equipment, office space, and administrative staff—while the physicians retain control over clinical decisions and patient care. This arrangement allows for a clear division between medical and business responsibilities, which is essential for maintaining compliance with healthcare regulations like the Stark Law and the Anti-Kickback Statute.
A physician practice management corporation (PPMC) is a business entity that provides non-clinical administrative and operational support to medical practices, allowing physicians to focus on patient care while the corporation handles the business side of healthcare.
Physician practice management corporations emerged in response to the increasing complexity of running a medical practice. As healthcare regulations, insurance requirements, and operational costs grew, many physicians found it challenging to manage both clinical responsibilities and business operations. PPMCs offer a solution by taking over the administrative burdens, enabling physicians to concentrate on delivering quality care.
At their core, PPMCs are responsible for a wide range of non-medical services. These include billing and coding, human resources, payroll, marketing, compliance, information technology, and financial management. By centralizing these functions, PPMCs can achieve economies of scale, reduce overhead costs, and improve operational efficiency for the practices they manage. This model is particularly attractive to small and mid-sized practices that may lack the resources to manage these functions independently.
PPMCs typically enter into long-term management agreements with physician groups. In some cases, they may purchase the non-clinical assets of a practice—such as equipment, office space, and administrative staff—while the physicians retain control over clinical decisions and patient care. This arrangement allows for a clear division between medical and business responsibilities, which is essential for maintaining compliance with healthcare regulations like the Stark Law and the Anti-Kickback Statute.
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One of the key advantages of working with a PPMC is access to capital and advanced infrastructure. PPMCs often invest in state-of-the-art electronic health record (EHR) systems, data analytics tools, and revenue cycle management platforms. These technologies can enhance patient care, streamline operations, and improve financial performance. Additionally, PPMCs may offer strategic guidance on practice expansion, mergers and acquisitions, and payer contract negotiations.
However, the relationship between physicians and PPMCs must be carefully managed. While PPMCs bring valuable expertise and resources, there is a risk that business priorities could overshadow clinical autonomy. To mitigate this, successful PPMCs prioritize physician engagement, transparent governance, and aligned incentives. They work collaboratively with physicians to ensure that business strategies support, rather than hinder, the delivery of high-quality care.
The physician practice management industry has evolved significantly over the past few decades. After a wave of failures in the 1990s due to overexpansion and misaligned incentives, modern PPMCs have adopted more sustainable and physician-centric models. Today, they play a crucial role in helping practices adapt to value-based care, population health management, and other emerging trends in healthcare delivery.
In conclusion, a physician practice management corporation serves as a strategic partner to medical practices, offering the business acumen and operational support needed to thrive in a complex healthcare environment. By offloading administrative tasks and providing access to advanced resources, PPMCs empower physicians to focus on what they do best—caring for patients—while ensuring the long-term success and sustainability of their practices.
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
The U.S. healthcare system is often criticized for its high costs, unequal access, and inconsistent outcomes. With nearly 30 million Americans uninsured and many more underinsured, the question arises: could socialized medicine be the solution to these systemic issues?
Socialized medicine refers to a system where the government owns and operates healthcare facilities and employs medical professionals, funded primarily through taxation. While the term is often used pejoratively in American discourse, countries like the United Kingdom and Sweden have long embraced such models. These systems guarantee universal access to healthcare, regardless of income or employment status.
One of the strongest arguments in favor of socialized medicine is its potential to reduce overall healthcare costs. In the U.S., administrative expenses, profit margins, and fragmented billing systems contribute to exorbitant prices. A centralized system could streamline operations, negotiate better drug prices, and eliminate the need for private insurance middlemen. Countries with socialized systems typically spend less per capita on healthcare while achieving comparable or better health outcomes.
Moreover, socialized medicine could address the issue of healthcare access. In the current U.S. model, losing a job often means losing health insurance. Even with the Affordable Care Act, many Americans face high premiums and deductibles. A government-run system would ensure that healthcare is a right, not a privilege, and that no one is denied care due to financial constraints.
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However, critics argue that socialized medicine could lead to longer wait times, reduced innovation, and lower quality of care. They point to examples in Canada and the U.K. where patients sometimes wait weeks or months for non-emergency procedures. Additionally, skeptics fear that government control could stifle competition and reduce incentives for medical advancement.
Yet, these concerns may be overstated. Many countries with socialized systems still foster innovation through public-private partnerships and maintain high standards of care. France, for example, combines universal coverage with private providers and consistently ranks among the top healthcare systems globally.
Transitioning to socialized medicine in the U.S. would be a monumental task, requiring political will, public support, and a reimagining of healthcare financing. It would disrupt entrenched interests, including insurance companies and pharmaceutical firms. But if the goal is to create a more equitable, efficient, and humane system, socialized medicine deserves serious consideration.
In conclusion, while not a panacea, socialized medicine offers a compelling framework for addressing the deep-rooted problems in U.S. healthcare. By prioritizing access, affordability, and public health over profit, it could pave the way for a healthier and more just society.
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
Do you ever wish you could acquire specific information for your career activities without having to complete a university Master’s Degree or finish our entire Certified Medical Planner™ professional designation program? Well, Micro-Certifications from the Institute of Medical Business Advisors, Inc., might be the answer. Read on to learn how our three Micro-Certifications offer new opportunities for professional growth in the medical practice, business management, health economics and financial planning, investing and advisory space for physicians, nurses and healthcare professionals.
Micro-Certification Basics
Stock-Brokers, Financial Advisors, Investment Advisors, Accountants, Consultants, Financial Analyists and Financial Planners need to enhance their knowledge skills to better serve the changing and challenging healthcare professional ecosystem. But, it can be difficult to learn and demonstrate mastery of these new skills to employers, clients, physicians or medical prospects. This makes professional advancement difficult. That’s where Micro-Certification and Micro-Credentialing enters the online educational space. It is the process of earning a Micro-Certification, which is like a mini-degree or mini-credential, in a very specific topical area.
Micro-Certification Requirements
Once you’ve completed all of the requirements for our Micro-Certification, you will be awarded proof that you’ve earned it. This might take the form of a paper or digital certificate, which may be a hard document or electronic image, transcript, file, or other official evidence that you’ve completed the necessary work.
Uses of Micro-Certifications
Micro-Certifications may be used to demonstrate to physicians prospective medical clients that you’ve mastered a certain knowledge set. Because of this, Micro-Certifications are useful for those financial service professionals seeking medical clients, employment or career advancement opportunities.
Examples of iMBA, Inc., Micro-Certifications
Here are the three most popular Micro-Certification course from the Institute of Medical Business Advisors, Inc:
1. Health Insurance and Managed Care: To keep up with the ever-changing field of health care physician advice, you must learn new medical practice business models in order to attract and assist physicians and nurse clients. By bringing together the most up-to-date business and medical prctice models [Medicare, Medicaid, PP-ACA, POSs, EPOs, HMOs, PPOs, IPA’s, PPMCs, Accountable Care Organizations, Concierge Medicine, Value Based Care, Physician Pay-for-Performance Initiatives, Hospitalists, Retail and Whole-Sale Medicine, Health Savings Accounts and Medical Unions, etc], this iMBA Inc., Mini-Certification offers a wealth of essential information that will help you understand the ever-changing practices in the next generation of health insurance and managed medical care.
2. Health Economics and Finance: Medical economics, finance, managerial and cost accounting is an integral component of the health care industrial complex. It is broad-based and covers many other industries: insurance, mathematics and statistics, public and population health, provider recruitment and retention, health policy, forecasting, aging and long-term care, and Venture Capital are all commingled arenas. It is essential knowledge that all financial services professionals seeking to serve in the healthcare advisory niche space should possess.
3. Health Information Technology and Security: There is a myth that all physician focused financial advisors understand Health Information Technology [HIT]. In truth, it is often economically misused or financially misunderstood. Moreover, an emerging national HIT architecture often puts the financial advisor or financial planner in a position of maximum uncertainty and minimum productivity regarding issues like: Electronic Medical Records [EMRs] or Electronic Health Records [EHRs], mobile health, tele-health or tele-medicine, Artificial Intelligence [AI], benefits managers and human resource professionals.
Other Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.
How to Start Learning and Earning Recognition for Your Knowledge
Now that you’re familiar with Micro-Credentialing, you might consider earning a Micro-Certification with us. We offer 3 official Micro-Certificates by completing a one month online course, with a live instructor consisting of twelve asynchronous lessons/online classes [3/wk X 4/weeks = 12 classes]. The earned official completion certificate can be used to demonstrate mastery of a specific skill set and shared with current or future employers, current clients or medical niche financial advisory prospects.
Mini-Certification Tuition, Books and Related Fees
The tuition for each Mini-Certification live online course is $1,250 with the purchase of one required dictionary handbook. Other additional guides, white-papers, videos, files and e-content are all supplied without charge. Alternative courses may be developed in the future subject to demand and may change without notice.
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Contact: For more information, or to speak with an academic representative, please contact Ann Miller RN MHA CMP™ at Email: MarcinkoAdvisors@msn.com [24/7].
Posted on October 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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A paradox is a logically self-contradictory statement or a statement that runs contrary to one’s expectation. It is a statement that, despite apparently valid reasoning from true or apparently true premises, leads to a seemingly self-contradictory or a logically unacceptable conclusion. A paradox usually involves contradictory-yet-interrelated elements that exist simultaneously and persist over time. They result in “persistent contradiction between interdependent elements” leading to a lasting “unity of opposites”.
THE TELE-MEDICINE PARADOX
Classic Definition: Refers specifically to the treatment of various medical conditions without seeing the patient in person. Healthcare providers may use electronic and internet platforms like live video, audio, PCs, tablets, or instant messaging to address a patient’s concerns and diagnose their condition remotely.
Modern Circumstance: This may include giving medical advice, walking them through at-home exercises, or recommending them to a local provider or facility. Even more exciting is the emergence of telemedicine apps which give patients access to care right from their phones or computer screens.
Paradox Examples: Treating certain conditions remotely can be challenging. Tele-medicine is often used to treat common illnesses, manage chronic conditions, or provide specialist services. If a patient is dealing with an emergent or serious condition, the remote provider suggests they seek in-person medical care.
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 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A. I.
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Value-Based Medical Care: A Paradigm Shift in Healthcare
In recent years, the healthcare industry has undergone a transformative shift from volume-driven services to outcome-focused care. This evolution is embodied in the concept of value-based medical care, a model that emphasizes delivering high-quality healthcare while controlling costs and improving patient outcomes. Unlike traditional fee-for-service systems, which reward providers for the quantity of services rendered, value-based care aligns incentives with the value of care provided—measured by patient health outcomes relative to the cost of achieving them.
Core Principles of Value-Based Care
At its heart, value-based medical care is built on several foundational principles:
Patient-Centeredness: Care is tailored to individual needs, preferences, and values, promoting shared decision-making and holistic treatment.
Quality Over Quantity: Providers are rewarded for improving health outcomes, reducing hospital readmissions, and preventing disease rather than performing more procedures.
Integrated Care Delivery: Coordination among healthcare professionals ensures seamless transitions between services, reducing fragmentation and duplication.
Data-Driven Accountability: Performance metrics and health analytics guide clinical decisions and track progress toward better outcomes.
Cost Efficiency: By focusing on prevention and effective management of chronic conditions, value-based care aims to reduce unnecessary spending.
Benefits for Patients and Providers
For patients, value-based care offers a more personalized and proactive approach to health. It encourages preventive screenings, chronic disease management, and wellness programs that lead to longer, healthier lives. Providers benefit from shared savings programs, performance bonuses, and stronger relationships with their patients. Moreover, healthcare systems can allocate resources more effectively, reducing waste and improving overall population health.
Posted on October 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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On September 22, 2025, the Government Accountability Office (GAO) released a report estimating “the Extent and Effects of Physician Consolidation.” The GAO, the non-partisan audit, evaluation, and investigative arm of Congress, undertook the analysis of physician consolidation in response to lawmakers’ request.
This Health Capital Topics article reviews the GAO report and stakeholder reactions. (Read more…)
Posted on October 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BREAKING NEWS!
UNITED STATES GOVERNMENT SHUTS DOWN
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By Health Capital Consultants, LLC
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With hours to go until the midnight deadline on September 30th, 2025 to fund the government, lawmakers appear deadlocked over whether certain healthcare provisions should be included in the temporary funding bill.
Should this deadlock continue, the federal government will shut down beginning today October 1st and remain shut down until that deadlock is resolved.
This Health Capital Topics article provides an update on the developing saga. (Read more…)
Posted on September 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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A paradox is a statement that appears at first to be contradictory, but upon reflection then makes sense. This literary device is commonly used to engage a reader to discover an underlying logic in a seemingly self-contradictory statement or phrase. As a result, paradox allows readers to understand concepts in a different and even non-traditional
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GOVERNMENT HEALTH INFORMATION IS TRUSTED?
Classic Definition: Despite the PP-ACA, there is ambivalence about the role of the US Government as a source of quality healthcare information.
Modern Circumstance: Of brands presented to respondents in a Consumer Reports (50 percent), and AARP (37 percent) survey, they outpolled the “US Government Healthcare Quality Reporting Website” (36 percent) and Medicare Website (32 percent).
Paradox Example: The focus groups expressed “mixed reactions and raised doubts about government involvement in quality ratings information. At least one participant in each group expressed skepticism about trusting ‘the government’ to compile information.”
Younger consumers especially questioned the relevance of Medicare measures to the non-elderly population. Yet participants gravitated to “.gov” websites over “.org” websites as a more authoritative source.
CITE: Williams, Jason: Health Affairs, December 28, 2016
[An Internet WIKI CROWD-SOURCED Curation Project]*
To keep up with the ever-changing healthcare industrial complex, we must learn new definitions and re-learn old terminology in order to correctly apply it to practice. By aggregating the most up-to-date abbreviations, acronyms, definitions and terms, the Health DictionarySeries offers a wealth of information to help understand the ever-changing terms-of-art in healthcare today.
Each 10,000 item handbook is essential for doctors, nurses, benefits managers and insurance agents, CPAs, and administrators; as well as graduate and under graduate students and professors. Our goal to for each dictionary to be designated as a Doody’s Core Title.
Dictionary of Health Insurance and Managed Care
With more than 8,000 definitions, 4,000 abbreviations and acronyms, and a 3,000 item oeuvre of resources, readings, and nomenclature derivatives, this dictionary covers the Medicare, managed care and Medicaid, private insurance, Veteran’s Administration and PP-ACA language of the entire health and long-term care insurance sector.
Dictionary of Health Economics and Finance
Health economics and finance is an integral component of the health care industrial complex. Its language is a diverse and broad-based concept covering many other industries: accounting, mathematics, the actuarial sciences, stochastics and statistics, salary reimbursements, physician payments, compensation and forecasting are all commingled arenas.
Dictionary of Health Information Technology Security
There is a myth that all healthcare stakeholders understand the meaning of information technology jargon. In truth, the vernacular of contemporary systems is unique, and often misused or misunderstood. Moreover, emerging Heath Information Technology (HIT) thru the HITECG initiatives; in the guise of terms, definitions, acronyms, abbreviations and standards; often puts the non-expert in a position of maximum uncertainty and minimum productivity.
*NOTE: A wiki website allows users to add or update content using their browser thru a hosted server created by the collaborative effort of site visitors. The Hawaiian term “wiki wiki” means “super fast.”
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
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
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 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
U.S. Department for Health & Human Services & Centers for Medicare & Medicaid Services
By Health Capital Consultants, LLC
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On August 21, 2025, the U.S. Department for Health & Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced the formation of a new Healthcare Advisory Committee.
The Committee is expected to be comprised of a group of experts who will make strategic recommendations to HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz.
This Health Capital Topics article discusses this announcement and potential implications on the healthcare industry. (Read more…)
Posted on September 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
Medicare Inpatient Prospective Payment System
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By Health Capital Consultants, LLC
On July 31, 2025, the Centers for Medicare & Medicaid Services (CMS) released its finalized payment and policy updates for the Medicare Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year (FY) 2026.
The final rule authorized Medicare inpatient reimbursement increases for 2026 and moved forward with improvements to quality measurement, and provided more information on a new value-based payment model.
This Health Capital Topics article will discuss the IPPS final rule and stakeholder reactions. (Read more…)
A silent, non-directed, ghost, blind, faux, or “mirror” PPO, HMO, or other provider model is not really a formalized managed care organization [MCO] at all. Rather, it was simply an intermediary attempt, and Ponzi-like scheme, to negotiate practitioner fees downward, by promising a higher volume of patients in exchange for the discount.
Of course, the intermediary [discount-broker] then resells the packaged contract product to any willing insurance company, HMO, PPO or other payer, thereby pocketing the difference as a nice profit. Sometime, these virtual organizations are just indemnity companies in disguise.
NOTE: The term indemnity insurance refers to an insurance policy that compensates an insured party for certain unexpected damages or losses up to a certain limit—usually the amount of the loss itself. Insurance companies provide coverage in exchange for premiums paid by the insured parties.
These policies are commonly designed to protect professionals and business owners when they are found to be at fault for a specific event such as misjudgment or malpractice. They generally take the form of a letter o indemnity.
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As part of a silent PPO scheme, insurers try to pass off the discount as legitimate on Explanation of Benefit [EOB] forms. Physicians should not fall for this ploy, since pricing pressure will be forced even lower in the next round of “real” PPO negotiations!
Medical providers should also be on guard for silent HMOs, MCOs and any other silent insurance variation, since these virtual organizations do not exist, except as exploitable arbitrage situations for the middleman.
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 August 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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Medicine today is vastly different than a generation ago, and all health care professionals need new skills to be successful and reduce the emerging risks outlined in this textbook, as well as the “unknown-unknowns” elsewhere. Traditionally, the physician was viewed as the “captain of the ship”. Today, their role may be more akin to a ship’s navigator, using clinical, teaching skills and knowledge to chart the patient’s course through a confusing morass of insurance requirements, fees, choices, rules and regulations to achieve the best attainable clinical outcomes.
This new leadership paradigm includes many classic business school principles, now modified to fit the decade long PP-ACA, the era of health reform, and modern technical connectivity and EMRs.
Thus, the physician must be a subtle guide on the side; not bombastic sage on the stage. These, newer health 3.0 leadership philosophies might include:
•Negotiation – working to optimize appropriate treatment plans; ie., quality of life versus quantity of life, •Team play – working in concert with other allied healthcare professionals to coordinate care delivery ,ithin a clinically appropriate and cost-effective framework; •Working within the limits of competence – avoiding the pitfalls of the medical generalist versus the specialist that may restrict access to treatment, medications, physicians and facilities by clearly acknowledging when a higher degree of service is needed on behalf of the patient – all while embracing holistic primary care; •Respecting different cultures and values – inherent in the support of the medical Principle of Autonomy is the acceptance of values that may differ from one’s own. As the US becomes more culturally hetero geneous, medical providers are called upon to work within, and respect, the socio-cultural and/or spiritual framework of patients, students and their families; •Seeking clarity on what constitutes marginal care – within a system of finite resources; providers are called upon to openly communicate with patients regarding access to marginal medical information and/or treatments. •Supporting evidence-based practice – healthcare providers, should utilize outcomes data to reduce variation in treatments to achieve higher efficiencies and improved care delivery thru evidence based medicine [EBM]; •Fostering transparency and openness in communications – healthcare professionals should be willing, and prepared, to discuss all aspects of care, especially when discussing end-of-life issues or when problems arise; •Exercising decision-making flexibility – treatment algorithms, templates and clinical pathways are useful tools when used within their scope; but providers must have the authority to adjust the plan if circumstances warrant.
Becoming skilled in the art of listening and interpreting — In her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD PhD, a professor at Columbia University, writes of the extraordinary value of using the patient’s personal story in the treatment plan. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases; convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship.
These thoughts represent only a handful of examples to illustrate the myriad of new skills that tomorrows’ healthcare professionals must master in order to meet their timeless professional obligations of compassionate care and contemporary treatment effectiveness; all within the context modern risk management principles.
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
An obstetrician-gynecologist, or OB-GYN, has expertise in female reproductive health, pregnancy, and childbirth. Some OB-GYNs offer a wide range of general health services similar to a primary care doctor. Others focus on the medical care of the female reproductive system. OB-GYNs also provide routine medical services and preventive screenings. This type of doctor has studied obstetrics and gynecology. The term “OB-GYN” can refer to the doctor, an obstetrician-gynecologist, or to the sciences that the doctor specializes in, which are obstetrics and gynecology.
Obstetrician
Obstetrics is the branch of medicine related to medical and surgical care before, during, and after a woman gives birth. Obstetrics focuses on caring for and maintaining a woman’s overall health during maternity. This includes:
pregnancy
labor
childbirth
the postpartum period
OB-GYNs can conduct office visits, perform surgery, and assist with labor and delivery. Some OB-GYNs provide services through a solo or private practice. Others do so as part of a larger medical group or hospital.
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Gynecologist
Gynecology is the branch of medicine that focuses on women’s bodies and their reproductive health. It includes the diagnosis, treatment, and care of women’s reproductive system. This includes the:
vagina
uterus
ovaries
fallopian tubes
This branch of medicine also includes screening for and treating issues associated with women’s breasts. Gynecology is the overarching field of women’s health from puberty through adulthood. It represents most of the reproductive care received during a lifetime. If pregnant, one goes to an obstetrician.
Mid-Wife
Midwives are registered nurses who specialize in midwifery. As such, they’re trained healthcare providers who can oversee low-risk pregnancies, labor, and birth. They can provide other obstetric and gynecological services too. They can do exams and help with basic gynecological concerns like sexually transmitted infections, urinary tract infections, or yeast infections. They help support during labor and in the postpartum period with breastfeeding and birth control.
Doula
Doulas aren’t clinical professionals and can’t give medical advice. They can’t prescribe medicines, and they can’t deliver a baby. But they can offer physical and emotional support during labor—and sometimes during and after pregnancy. Doulas can help with breathing techniques, positional changes, and relaxation strategies during labor. Studies show doulas are associated with fewer C-sections and more vaginal births.
An ophthalmologist is a physician [MD, DO] who undergoes sub-specialty training in medical and surgical eye care. Following a medical degree, a doctor specializing in ophthalmology must pursue additional postgraduate residency training specific to that field. In the United States, following graduation from medical school, one must complete a four-year residency in ophthalmology to become an ophthalmologist. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology.
Ophthalmologists prescribe medications to treat ailments, such as eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists provide both primary and specialty eye care—medical and surgical. Most ophthalmologists participate in academic research on eye diseases at some point in their training and many include research as part of their career. Ophthalmology has always been at the forefront of medical research with a long history of advancement and innovation in eye care.
Optometrist
Optometrists focus on regular vision care and primary health care for the eye. After college, they spend 4 years in a professional program and get a doctor of optometry degree. But they don’t go to medical school. Some optometrists get additional clinical training or complete a specialty fellowship after optometry school. They:
Monitor eye conditions related to diseases like diabetes
Manage and treat conditions like dry eye and glaucoma
Provide low-vision aids and vision therapy
There are specialties among optometrists. They include:
Pediatric optometry. These providers work with babies, toddlers, and children, using special techniques to test their vision.
Neuro-optometry. If you have vision problems that result from a brain injury, this is the type of optometrist you might visit.
Low-vision optometry. If you have low vision—that means you can’t see well enough to perform your daily activities and your sight can’t be corrected by glasses or contact lenses, medicine, or surgery—low-vision optometrists offer devices and strategies that can improve your quality of life.
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Optician
An optician is an eye care specialist who helps you choose the right eyeglasses, contact lenses or other vision correction devices. They can’t diagnose or treat conditions that affect your eyes or vision. They’ll work with you to get the right corrective lenses after your optometrist or ophthalmologist gives you a prescription.
Ocularist
An ocularist is an eye care specialist who provides care for people needing prosthetic eyes due to injury, infection or congenital disease (present at birth). Losing or damaging an eye can be a traumatic experience, and the need for a prosthetic can be overwhelming. Ocularists offer long-term care. They collaborate with your healthcare team to create or restore a more natural facial appearance with the goal of enhancing your health-related quality of life.
Posted on August 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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On July 2, 2025, the Department of Justice (DOJ) and Department of Health & Human Services (HHS) announced during the American Health Law Association (AHLA) Annual Meeting that the agencies have reestablished a Working Group to “strengthen” their ongoing collaboration, specifically as relates to the False Claims Act (FCA).
This Health Capital Topics article discusses the Working Group’s priorities and the implications for providers. (Read more…)
Trump says pharma tariffs could be as high as 250%
The president revealed that he plans to formally announce tariffs on the pharmaceutical industry “within the next week or so” in an attempt to force drug manufacturing to the US, he told CNBC several days ago.
An acute care inpatient hospital is a health care organization or “anchor hospital” in which a patient is treated for an acute (immediate and severe) episode of illness or the subsequent treatment of injuries related to an accident or trauma, or during recovery from surgery. Specialized personnel using complex and sophisticated technical equipment and materials usually render acute professional care in a hospital setting. Unlike chronic care, acute care is often necessary for only a short time. Measures of acute health care utilization are represented by three separate rates:
Rate of admissions per 1000 patients.
Average length of stay per admission.
Total days of care per 1000 patients.
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Psychiatric Hospital
A psychiatric hospital (behavioral health, mental hospital, or asylum) specializes in the treatment of patients with mental illness or drug-related illness or dependencies. Psychiatric wards differ only in that they are a unit of a larger hospital.
Specialty Hospital
A specialty hospital is a type of health care organization that has a limited focus to provide treatment for only certain illnesses such as cardiac care, orthopedic or plastic surgery, elder care, radiology / oncology services, neurological care, or pain management cases. These organizations are often owned by doctors who refer patients to them. In recent years, single-specialty hospitals have emerged in various locations in the United States. Instead of offering a full range of inpatient services, these hospitals focus on providing services relating to a single medical specialty or cluster of specialties.
Long-Term Care Hospital
A long-term care hospital is an entity that provides assistance and patient care for the activities of daily living (ADLs), including reminders and standby help for those with physical, mental, or emotional problems. This includes physical disability or other medical problems for 3 months or more (90 days). The criteria of five ADLs may also be used to determine the need for help with the following: meal preparation, shopping, light housework, money management, and telephoning. Other important considerations include taking medications, doing laundry, and getting around outside.
Rural Hospital
The parameters of a rural hospital are determined based on distance. A rural hospital is defined as a hospital serving a geographic area 10 or more miles from the nexus of a population center of 30,000 or more.
More specifically, a rural hospital means an entity characterized by one of the following:
Type A rural hospital—small and remote, has fewer than 50 beds, and is more than 30 miles from the nearest hospital
Type B rural hospital—small and rural, has fewer than 50 beds, and is 30 miles or less from the nearest hospital
Type C rural hospital—considered rural and has 50 or more beds
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 July 31, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2026.
In addition to the agency’s suggested increase to physician payments, the proposed rule also announces a new payment model and more tele-health flexibilities.
According to CMS, the “proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better quality, efficiency, empowerment, and innovation for all Medicare beneficiaries.” (Read more…)
Posted on July 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
THE FOOT & ANKLE DOCTORS
By A.I.
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Podiatry offers a promising career with a balanced mix of specialization and income. By understanding the factors that influence salaries—such as location, experience, and practice type—a doctor can strategically enhance his/er earning potential. Staying informed about healthcare policies and market trends is crucial for maximizing income.
With an aging population and advancements in technology, the demand for podiatrists is expected to grow, making it a rewarding field both professionally and financially. Investing in specialized training and adapting to policy changes will help doctors remain competitive and successful in the evolving healthcare landscape.
A podiatrist is a healthcare professional specialized in diagnosing and treating conditions related to the feet and ankles. Their responsibilities include performing surgeries, prescribing orthotics, and providing preventive care.
What education is required to become a podiatrist?
To become a podiatrist, one must complete a Doctor of Podiatric Medicine (DPM) degree, which typically takes four years after earning a bachelor’s degree. Following this, a residency program lasting 2-3 years is required for practical training.
What factors influence the salary of a podiatrist?
Geographic location, level of experience, specialization, and type of practice significantly affect a podiatrist’s salary. Areas with a higher cost of living or demand for services usually offer higher salaries.
How does the salary of a podiatrist compare to other medical professions?
Podiatrists generally earn more than general practitioners but less than specialty surgeons. This disparity is due to differences in training length, specialization, and practice complexity among these professions.
Can the salary of a podiatrist increase over time?
Yes, a podiatrist’s salary can increase with additional experience, further specialization, and strategic practice location choices. Continuing education and staying updated on healthcare policies can also enhance earning potential.
What impact do healthcare policies have on podiatrist salaries?
Healthcare policies, including changes in insurance reimbursement rates and government health initiatives, can affect podiatrist salaries. Adapting to these policy shifts is crucial for maximizing earning potential in the field.
What are the future trends in podiatry salaries?
Future trends suggest potential salary growth due to increasing demand from an aging population, technological advancements, and geographic disparities in healthcare access. Keeping informed about these trends can help podiatrists plan their careers strategically.
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, hospitals, financial advisory firms, RIAs, 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 July 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants, LLC
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On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2026.
Among other items, the agency proposes increasing payments to all outpatient providers, eliminating the Inpatient Only (IPO) List, and changing quality reporting programs.
This Health Capital Topics article reviews the proposed updates and changes to outpatient reimbursement. (Read more…)
Posted on July 24, 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.
Insurers selling plans on ACA exchanges are expected to hike premiums next year as subsidies on them are set to expire, with the average person expected to be paying 75% more, according to an analysis from the nonpartisan research group KFF.
Posted on July 15, 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.
Drug and medical device companies paid at least $13.2 billion to medical professionals in 2024, according to CMS data released June 30th. There’s been steady growth in these payments over the last few years, which include everything from research payments to free meals to promotional or conference fees. Drug and medical device companies paid out $13.1 billion in 2023, $13.1 in 2022, and $12.6 in 2021. If you’re a medical provider, you’ve probably gotten one of those perks from a drug or medical device company and thought it wouldn’t affect your decision-making.
But research suggests physicians are more likely to prescribe drugs from companies that pay them, with some studies specifically associating this with drugs that are costlier to patients. “Really well-trained people who affirm an oath to do no harm can be influenced, and are,” Neil Jay Sehgal, associate professor of health systems and population health at the University of Washington School of Public Health, told Healthcare Brew.
Bitcoin is booming, and crypto stocks climbed along with it. MicroStrategy rose 3.86%, RobinhoodMarkets added 1.67%. and Coinbase gained 1.80%.
Boeing rose 1.64% on preliminary reports that investigators have found no evidence of malfunction in the plane that crashed in India last month. Engine-maker GEAerospace also gained 2.71%.
Warner Bros Discovery climbed 2.39% thanks to a strong opening weekend for the new Superman movie.
Autodesk popped 5.05% on the news that it is not pursuing an acquisition of rival software maker PTC. PTC fell 1.25%.
Kenvue, the company behind Band Aids and Listerine, gained 2.18% after kicking its CEO to the curb.
PayPal climbed 3.55% despite the news that JPMorgan will start charging the fintech fees for access to customer data.
Stocks Down
Starbucks sank 1.60% on news that employees will have to return to the office four days a week. Shareholders were also unimpressed with the coffee giant’s new secret menu.
Synopsys stumbled 1.74% after getting regulatory approval from Chinese authorities to acquire software designer Ansys for $35 billion. Ansys rose 3.03% on the news.
Waters plunged 13.81% on the news that it will merge with Becton Dickinson’s bioscience and diagnostic solutions business in a $17.5 billion deal.
RivianAutomotive lost 2.15% thanks to a downgrade from Guggenheim analysts, who forecast soft sales for the automaker’s latest models.
The terms “psychologist” and “psychiatrist” are often used interchangeably to describe anyone who provides therapy services, but the two professions and the services they provide differ in terms of content and scope. A major difference between the two types of experts is that psychiatrists can prescribe medication [Rx].
As physicians [MD/DO] psychiatrists are trained to recognize the ways biological processes affect mental functioning.
Psychologists are oriented to how thoughts, feelings, and social factors influence mental functioning.
PSYCHIATRIST
Psychiatrists are medical or osteopathic doctors who are able to prescribe psychotropic medications, which they do in conjunction with providing psychotherapy though medical and pharmacological interventions are often their focus.
PSYCHOLOGIST
Though many psychologists hold doctorate degrees, they are not medical doctors, and most cannot prescribe medications. Rather, they solely provide psycho-therapy, which may involve cognitive and behavioral interventions, psycho-dynamic or psycho-analytic approaches.
NOTEPROTECTED TITLE: The title of “psychologist” can only be used by an individual who has completed the required education, training, and state license requirements. Informal titles, such as “counselor” or “therapist,” are often used as well. Other mental health care professionals, such as licensed social workers, can claim those titles, but not the title of “psychologist.”
Posted on July 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants LLC
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On June 25th, 2025, the Centers for Medicare & Medicaid Services (CMS) released its forecast on U.S. healthcare spending through 2033. The analysis, published in Health Affairs, estimated healthcare spending growth in 2024 and projected the growth into 2033. CMS found that overall healthcare spending growth has decreased slightly but is still elevated compared to pre-pandemic levels, and is expected to continue to moderately grow.
This Health Capital Topics article examines the factors underlying the forecasts. (Read more…)
Posted on July 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
BREAKING NEWS!
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The Villages Health System, LLC, a health care provider operating in The Villages, Florida, filed for Chapter 11 bankruptcy protection on July 3rd, 2025, in the United States Bankruptcy Court for the Middle District of Florida.
“The bankruptcy petition indicates significant financial challenges, with assets estimated between $50 million and $100 million and liabilities between $100 million and $500 million. The United States of America is listed as the largest creditor with a contingent, unliquidated claim of approximately $361 million. The filing indicates that funds will be available for distribution to unsecured creditors,”
Posted on July 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants LLC
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On June 9th, 2025, Oregon’s governor signed into law the country’s strictest corporate practice of medicine (CPOM) prohibition. Senate Bill (SB) 951 will severely curtail the involvement of private equity firms and other corporations in the state’s medical practices.
This Health Capital Topics reviews the bill and discusses the implications on the healthcare industry. (Read more…)
One Big Beautiful Bill Act (OBBBA; OBBB; BBB), or the Big Beautiful Bill, is a budget reconciliation bill in the 119th US Congress.
Hospitals are not happy with the health care provisions of the bill, which would reduce the support they receive from states to care for Medicaid enrollees and leave them with more uncompensated care costs for treating uninsured patients.
“The real-life consequences of these nearly $1 trillion in Medicaid cuts – the largest ever proposed by Congress – will result in irreparable harm to our health care system, reducing access to care for all Americans and severely undermining the ability of hospitals and health systems to care for our most vulnerable patients,” said Rick Pollack, CEO of the American Hospital Association.
The association said it is “deeply disappointed” with the bill, even though it contains a $50 billion fund to help rural hospitals contend with the Medicaid cuts, which hospitals say is not nearly enough to make up for the shortfall.
Posted on June 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Health Capital Consultants; LLC
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On May 22, 2025, the U.S. House of Representatives moved President Trump’s budget proposal forward, sending to the Senate a budget reconciliation bill (with a one-vote margin) – the One Big Beautiful Bill Act of 2025 – that renews expiring tax cuts and enacts new ones at a cost of almost $4 trillion. These costs would largely be paid for by cuts to other programs, including to federal healthcare programs, which cuts will have significant ramifications for the healthcare industry.
This Health Capital Topics article reviews the current status of the budget bill and healthcare industry implications. (Read more…)
Posted on June 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
NEWS UPDATE!
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On June 10th, Bobby Mukkamala was inaugurated as the 180th president of the American Medical Association (AMA).
An otolaryngologist from Flint, Michigan, Mukkamal chairs the organization’s substance use and pain care task force, won the AMA Foundation’s Excellence in Medicine Leadership Award last June, and served on the AMA board of trustees in 2017 and 2021.
Consumer Fraud in the Health Insurance Marketplace
Don’t be a Victim of Consumer Fraud in the Health Care Marketplace
Beware of…
People asking for money to enroll you in Marketplace or “Obamacare” insurance. Legitimate enrollment agents will NOT ask for money.
High-pressure visits, mail solicitations, e-mails, and phone calls from people pretending to work for the government. No one should threaten you with legal action if you do not sign up for a plan. Always ask for identification if someone comes to your door.
People you did not contact who request personal information. They may be trying to steal your identity. No one from the government will call or email you to sell you an insurance plan or ask for personal identifying information. Be careful when giving out personal information, such as credit card, banking, or Social Security numbers.
Sham websites. Always look for official government seals, logos or website addresses.
Note: If you are a Medicare beneficiary, you do NOT need to buy insurance in the new Health Insurance Marketplace.
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Trump says pharma tariffs could be as high as 250%
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 