Unlocking the Power of Compounding in Investments

SPONSOR: http://www.MarcinkoAssociates.com

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Time is both our ally and our enemy?

In the case of financial investments, compounding interest relies on time to reveal its true magic.

Here’s how: a young investor can invest less money over a longer period of time than an older investor who invests more money over a shorter period and ends up with more in the end. Compounding returns grow exponentially, making time more than an ally – but a force of the universe driving growth. 

Time is certainly our ally in investing, but according to ME-P Editor Dr. David Edward Marcinko MBA MEd, you’ll kick yourself wishing you had invested earlier when you witness compounding after a few years (or a decade).

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Understanding Merger Arbitrage Strategies

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HIPAA COMPLIANCE: Securing Electronic Communications

By Carol Miller RN MBA

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New-Wave Technology

To help hospitals and health systems comply with Health Insurance Portability and Accountability Act regulations, best practices are emerging for securing all electronic communication – cloud, wireless, and texting –  of protected health information.  These new technologies will continually be evolving with hospitals, providers and patients move to new means of communication.  Below is a description of how each are impacted by HIPAA.

Cloud Solutions.  Cloud solutions are becoming a needed commodity in treating patients today but also present a risk to privacy and security violation.  Despite the advantages of cloud computing, organizations are often hesitant to use it because of concerns about security and compliance. Specifically, they fear potential unauthorized access to patient data and the accompanying liability and reputation damage resulting from the need to report HIPAA breaches. While these concerns are understandable, a review of data on HIPAA breaches published by the HHS shows that these concerns are misplaced.  In fact, by using a cloud-based service with an appropriate security and compliance infrastructure, a facility can significantly reduce its compliance risk.

Because HIPAA compliance involves stringent privacy and security protections for electronic health information (PHI), many cloud providers are balking at signing new Business-Associate agreements. Most cloud-technology providers, such as Box and Dropbox, do not include the built-in privacy protections that guarantee HIPAA compliance. Because many cloud storage companies store plaintext data on their servers, PHI is especially vulnerable to breaches and compliance violations.

HIPAA CLOUD: https://medicalexecutivepost.com/2016/11/22/hipaa-cloud-solutions/

Mobility Solutions.  The recent launches of Apple Health and Google Fit have stirred a lot of interest in health application development.  It is important that hospitals and providers understand the laws around PHI and HIPAA compliance for any healthcare-focused mobile application or software.  While not all healthcare applications fall under HIPAA rules, those that collect, store, or share personally identifiable health information with covered entities (such as hospitals and providers) must be HIPAA-compliant. 

For years, hospitals have wanted to bring computers into exam rooms, waiting rooms, and treatment rooms to eliminate hard-to-read patient charts, making sure everyone treating the patient was seeing the same information, assuring that everything was recorded as it occurred, and enabling doctors, nurses, and technicians to stay connected to vital information and services wherever they were throughout the hospital.  Many hospitals have adopted Computer on Wheels (COWs) or tablets but many of these were hard to use, had poor touchscreen interface and did not last long on a battery.  Ipads seem to be the logical replacement as long as the iPad can comply with HIPAA rules.

HIPAA was written nearly 30 years ago, before mobile health applications were ever envisioned.  Because of this, some areas of the law make it hard to determine which applications must be HIPAA- compliant and which are exempt.  Considering the numerous ways security breaches can occur with a mobile device, it is not wonder that HHS is very leery about how PHI is handled on smartphones, wearables, and portable devices.

If the applications are going to send or share health data to a hospital, doctor or other covered entity, it MUST be HIPAA-compliant.  Adhering to the Privacy and Security Rules of HIPAA is essential, especially considering the dangers that come with handling protected health data on a device.  Examples include:

  • Phones, tablets, and wearables can be easily stolen and lost, meaning PHI could be compromised
  • Social media and email are easily accessible by the device, making it easy for users to post information that breaches HIPAA privacy laws.
  • Push notifications and other user communications can violate HIPAA laws if they contain PHI
  • Users may intentionally or unintentionally share personally identifiable information, even if the application’s intended use doesn’t account for it
  • Not all users take advanage of the password-protected screen-lock feature, making data visible and accessible to anyone who comes in contact with the device
  • Devices like the iPhone do not include physical keyboards, so users are more likely to use basic passwords that are not as safe as complex options.

This protected health information can include everything from medical records and images to scheduled appointment dates.  Regardless of the device, it is important to take all the steps possible to comply with HIPAA guidelines.

MOBILE HIPAA: https://medicalexecutivepost.com/2016/02/06/mobile-hipaa-solutions-for-hospital-health-systems/

Texting. Text (or SMS) messaging has become nearly ubiquitous on mobile devices. According to one survey, approximately 72 percent of mobile phone users send text messages. Clinical care is not immune from the trend, and in fact physicians appear to be embracing texting on par with the general population. Another survey found that 73 percent of physicians text other physicians about work. 

(Source:  Journal of AHIMA, “HIPAA Compliance for Clinician Texting”, by Adam Green, April 2012)

Texting can offer providers numerous advantages for clinical care. It may be the fastest and most efficient means of sending information in a given situation, especially with factors such as background noise, spotty wireless network coverage, lack of access to a desktop or laptop, and a flood of e-mails clogging inboxes. Further, texting is device neutral—it will work on personal or provider-supplied devices of all shapes and sizes. Because of these advantages, physicians may utilize texting to communicate clinical information, whether authorized to do so or not.

All forms of communication involve some level of risk. Text messaging merely represents a different set of risks that, like other communication technologies, needs to be managed appropriately to ensure both privacy and security of the information exchanged.

Text messages may reside on a mobile device indefinitely, where the information can be exposed to unauthorized third parties due to theft, loss, or recycling of the device. Text messages often can be accessed without any level of authentication, meaning that anyone who has access to the mobile phone may have access to all text messages on the device without the need to enter a password.

Texts also are generally not subject to central monitoring by the IT department. Although text messages communicated wirelessly are usually encrypted by the carrier, interception and decryption of such messages can be done with inexpensive equipment and freely available software (although a substantial level of sophistication is needed.  If text messages are used to make decisions about patient care, then they may be subject to the rights of access and amendment. There is a risk of noncompliance with the privacy rule if the covered entity cannot provide patients with access to or amend such text messages.

According to 2012 data from CTIA–The Wireless Association, U.S. citizens alone exchange nearly 200 billion text messages every month. So it’s not surprising that an increasing number of clinicians are using text messaging to exchange clinical information, along with a wide range of other modes — smartphones, pagers, computerized physician order entry, emails, etc. Electronic communication is certainly faster, can be more efficient, enhances clinical collaboration and enables clinicians to focus on patient care. But with these benefits comes an increased risk of security breaches.

HIPAA TEXTING: https://medicalexecutivepost.com/2016/11/22/hipaa-cloud-solutions/

(Source:  Clarifying the Confusion about HIPAA – Compliant Texting, by Megan Hardiman and Terry Edwards, May 2013)

Unfortunately, vendor hype about the Health Insurance Portability and Accountability Act is causing many hospitals and health systems to implement stop-gap measures that address part — but not all — of a problem. To identify all vulnerabilities, health care leaders need to consider not only text messaging, but all mechanisms by which protected health information in electronic form is transmitted — as well as the security of those mechanisms.

Mobile device-to-mobile device SMS text messages are generally not secure because they lack encryption.  The sender does not know with certainty that his or her message is indeed received by the intended recipient.  In addition, telecommunications vendor/wireless carrier may store the text messages.  Recent HHS guidance indicates text messaging, as a means of communicating PHI, can be permissible under HIPAA depending in large part on the adequacy of the controls used.  A hospital or provider may be approved for texting after performing a risk analysis or implementing a third-party messaging solution that incorporates measures to establish a secure communication platform that will allow texting on approved mobile devices.

A study reported in Computer World in May 2013 by the Ponemon Institute with 577 healthcare and It professional in facilities that ranged from fewer than 100 beds to over 500 beds stated that fifty-one percent of the respondents felt HIPAA compliance requirements can be a barrier to providing effective patient care.  Specifically HIPAA reduces time available for patient care (85% of the respondents), makes access to electronic patient information difficult (79% of the respondents) and restricts the use of electronic mobile communications (56% of the respondents).  The study stated “respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. “ They also stated “they recognized the value of implementing smartphones, text messaging and other modern forms of communications, but cited overly restrictive security policies as a primary reason why these technologies were not used.”  Clinicians in the survey stated that only 45% of each workday is spent with patients; the remaining 55% is spent communicating and collaborating with other clinicians and using the electronic medical record and other clinical IT systems. 

Several other statements made were:

  • Because of the need for security, hospitals and other healthcare organizations continue to use older, outdate technology such as pagers, email and facsimile machines.  The use of older technology can also delay patient discharges – now taking an average of 102 minutes.
  • The Ponemon Institute estimated that the lengthy discharge process costs the U.S. hospital industry more than $3.189 billion a year in lost revenue, with another $5 billion lost through decrease doctor productivity and use of outdated technology.  Secure text messaging could cut discharge time by 50 minutes.   

(Source:  Computer World, “HIPAA rules, outdate tech cost U.S. hospitals $3.38 B a year”, by Lucas Mearian, May, 2013)

Several suggestions offered for these preferred mobile devises are:  1) ensure encryption and access to individuals who need to have access; 2) use secure texting applications; and 3) even consider alerting employees with warnings before they send an email or share files that lets them know they are liable for the information sent.

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EDUCATION: Books

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DOCTORS: Early Investing Needed for Retirement

NEW FINANCIAL STRATEGIES?

By A.I. and Dr. David Edward Marcinko; MBA MEd CMP

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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Starting early is key to saving for retirement

Although 97% of people aren’t yet millionaires, many could eventually meet that target if they start investing sooner rather than later; especially doctors [MD, DO, DPM, DDS or DMD].

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

A 20-year-old, for instance, needs to invest just $330 a month into an asset class that delivers a 7% to 8% annual return to reach $1.26 million by the time s/he turns 65 years old. The luxury of time significantly boosts your chances of becoming a millionaire.

This doesn’t mean it’s too late for middle-aged savers to reach that millionaire milestone, but it will take a significantly greater investment. If a 50-year-old doctor hasn’t started saving for retirement, s/he would need to invest $3,958 a month at a steady 7% return to reach $1.26 million by retirement.

MONEY ADDICTION: https://medicalexecutivepost.com/2025/08/07/moiney-addicted-physicians-the-investing-and-trading-personality-of-doctors/

However, according to one Goldman Sachs report, investors could expect the S&P 500 to deliver just 3% annualized nominal returns over the next 10 years.

After an average 13% yearly return for the past decade, a new strategy outside of the stock market may be needed for that level of outsized gain, especially if you’re late to investing.

RETIREMENT VISION: https://medicalexecutivepost.com/2025/08/04/physicians-determine-your-retirement-vision/

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EDUCATION: Books

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

AI/HIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PHYSICIANS: Alimony V. Palimony

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What is Alimony

According to Hello Divorce, alimony, often referred to as spousal support, is a court-ordered payment from one spouse to the other following a divorce or legal separation. Its existence is tied to the legal status of marriage. The underlying principle is that both spouses contributed to the marital standard of living, and the dissolution of the marriage should not cause an inequitable economic outcome for the lower-earning spouse. This support is not intended as a punishment but as a means of mitigating the financial impact of divorce.

The purpose of alimony can vary. In some cases, it is rehabilitative, providing temporary support while one spouse obtains education or job training to become self-sufficient. For longer marriages, it might serve to help maintain the standard of living established during the partnership. Alimony is a legal tool derived from family law statutes to address the financial interdependence created by marriage.

DIVORCE: https://medicalexecutivepost.com/2025/08/14/physician-divorce-within-the-medical-profession/

Note: The federal tax treatment for alimony changed with the Tax Cuts and Jobs Act of 2017. For any divorce or separation agreement executed after December 31st, 2018, alimony payments are no longer tax-deductible for the person paying them. The recipient of the support does not report the payments as taxable income. This change is permanent and does not expire with other provisions of the act.

What is Palimony

According to Wikipedia, Palimony refers to financial support that may be awarded after an unmarried couple separates. Unlike alimony, palimony is not rooted in family law but is a concept derived from contract law. An award depends on the existence of an agreement between the partners. This agreement can be a formal written contract or an oral or implied agreement for support in exchange for services, such as managing the household.

The legal basis for palimony was established by the 1976 California Supreme Court case, Marvin v. Marvin. In that case, the court ruled that unmarried cohabitants could make enforceable contracts for support, as long as the agreement was not based on sexual services. Because it is a contract claim, a palimony case is pursued in civil court, not family court. Palimony is not available in all states and is only recognized in a minority of jurisdictions.

MEDIATION: https://medicalexecutivepost.com/2023/08/12/a-step-wise-approach-to-the-divorce-mediation-process-for-doctors/

Note: The tax implications of palimony are less defined than alimony because the IRS does not have a specific rule for it. How palimony is treated depends on the nature of the underlying claim. If the payments are a settlement for services rendered, they may be considered taxable income to the recipient. If the payments are characterized as a gift, they are not considered taxable income for the recipient.

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HAPPY: Labor Day 2025

Dear Medical Executive-Post Readers and Subscribers

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HISTORY OF LABOR DAY

The first Labor Day holiday was celebrated on Sept. 5th, 1882, in New York City, in accordance with the plans of the Central Labor Union. President Grover Cleveland signed a law on June 28th, 1894, that made the first Monday in September of each year a national holiday, according to the Department of Labor.

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MY SEPTEMBER HEALTH RE-SET

To give my health a boost after Labor Day, I’m taking a complete break from alcohol, sugar, cookies, ice cream, coffee and tea for the entire month of September. Besides that, I’ll also prioritize sleep and increase my exercise from 7 to at least 10 times [hours] a week. This will allow me to focus on my diet and mental well-being. It’s essentially a month of health and wellness rejuvenation.

I’ve chosen to focus on alcohol and sugar because I want to challenge the idea that moderate drinking is part of a healthy lifestyle. In reality, only those who maintain a healthy lifestyle can afford to enjoy alcohol in moderation. But, sugar is everywhere and must be minimized for Type II diabetes and weight control.

Moreover, the long-term and excessive intake of sugary beverages and refined sugars can negatively impact your overall caloric intake and create a domino effect on your health. For example, excess sugar in the body can turn into fat deposits and lead to fatty liver disease.

A low sugar diet can help you lose weight and also help you manage and/or prevent diabetes, heart disease and stroke, reduce inflammation, and even improve your mood and the health of your skin. That’s why the low sugar approach is a key tenet of other well-known healthy eating patterns, such as the Mediterranean diet and the DASH diet.

QUESTION: And so, do you also commit to such “factory resets” now and then? Please comments.

Do, enjoy the Labor Day Weekend, Bar-B-Ques with friends, family and colleagues. And, I hope you continue to find the Medical Executive-Post useful!

Many thanks for your likes and referrals.
Dr. David Edward Marcinko MBA MEd CMP
[Editor and Chief]

EDUCATION: Books

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

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PHYSICIANS: Why Salary is Down?

MEDICAL PROVIDER PAYMENTS LOWERED

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Statistic: $2.8+ billion dollars

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

COMMENTS APPRECIATED

EDUCATION: Books

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

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

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A SPECIAL MEDICAL-EXECUTIVE-POST GUEST PRESENTATION

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What Is a Special Purpose Vehicle (SPV)?

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

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

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Ophthalmologist V. Optometrist V. Optician V. Ocularist

A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Difference-between-Optometrist-and-Ophthalmologist

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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:

  • Perform eye exams and vision tests
  • Prescribe and fit eyeglasses and contact lenses
  • 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.

A former term for this medical branch is oculism.

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PHARMACEUTICALS: Trump Tariff Plans

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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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.

PBMs: https://medicalexecutivepost.com/2019/01/18/on-pbms-pharmacy-benefits-management/

It would start with a “small” tariff, Trump said, before rising to 150% in a year to a year and a half, and eventually to 250%.

Pharma companies have argued that tariffs could drive up costs and threaten their ability to fund research for new medicines.

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MENTAL HEALTH: Artificial Intelligence Regulated

By A.I and Staff Reporters

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Illinois just became the first US state to regulate AI mental health services this week when Gov. JB Pritzker signed a law banning AI therapy.

The law forbids chatbots from acting as therapists and limits how human mental health professionals can use AI to aid their work. Companies face up to $10,000 in fines if they violate the law, according to Morning Brew.

The move comes as ChatGPT users—particularly younger ones—increasingly turn to the app for what amounts to free therapy. OpenAI recently made updates to its model to encourage users to use ChatGPT in a healthier way.

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HOSPITALS: Understanding Different Types

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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HOSPITAL TYPES DEFINED FOR MODERNITY

Acute Care Inpatient Hospital

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:

  1. Rate of admissions per 1000 patients.
  2. Average length of stay per admission.
  3. 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:

  1. Type A rural hospital—small and remote, has fewer than 50 beds, and is more than 30
    miles from the nearest hospital
  2. Type B rural hospital—small and rural, has fewer than 50 beds, and is 30 miles or less from
    the nearest hospital
  3. Type C rural hospital—considered rural and has 50 or more beds

COMMENTS APPRECIATED

EDUCATION: Books

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

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Why Your Startup Needs to be a C-Corporation

A SPECIAL MEDICAL EXECUTIVE-POST PRESENTATION

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SPONSOR: http://www.MarcinkoAssociates.com

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PHYSICIANS: Determine Your Retirement Vision

By Dr. David Edward Marcinko; MBA MEd CMP™

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Determining Retirement Vision

There’s an aspect to retirement that many physicians do not plan for … the transition from work and practice to retirement.  Your work has been an important part of your life.  That’s why the emotional adjustments of retirement may be some of the most difficult ones.

For example, what would you like to do in retirement? Your retirement vision will be unique to you. You are retiring to something not from something that you envisioned. When you have more time, you would like to do more traveling, play golf or visit more often, family and friends. Would you relocate closer to your kids?  Learn a new art or take a new class? Fund your grandchildren’s education? Do you have philanthropic goals? Perhaps you would like to help your church, school or favorite charity? If your net worth is above certain limits, it would be wise to take a serious look at these goals. With proper planning, there might be some tax benefits too. Then you have to figure how much each goal is going to cost you.

If you have a list of retirement goals, you need to prioritize which goal is most important. You can rate them on a scale of 1 to 10; 10 being the most important. Then, you can differentiate between wants and needs. Needs are things that are absolutely necessary for you to retire; while wants are things that still allow retirement but would just be nice to have.

RETIREMENT SCAMS: https://medicalexecutivepost.com/2025/04/15/online-scams-retirement-accounts/

Recent studies indicate there are three phases in retirement, each with a different spending pattern [Richard Greenberg CFP®, Gardena CA, personal communication]. The three phases are:

  1. The Early Retirement Years. There is a pent-up demand to take advantage of all the free time retirement affords. You can travel to exotic places, buy an RV and explore forty-nine states, go on month-long sailing vacations. It’s possible during these years that after-tax expenses increase during these initial years, especially if the mortgage hasn’t been paid off yet. Usually the early years last about ten years until most retirees are in their 70’s.
  • Middle Years. People decide to slow down on the exploration.  This is when people start simplifying their life.  They may sell their house and downsize to a condo or townhouse.  They may relocate to an area they discovered during their travels, or to an area close to family and friends, to an area with a warm climate or to an area with low or no state taxes.  People also do their most important estate planning during these years.  They are concerned about leaving a legacy, taking care of their children and grandchildren and fulfilling charitable intent. This a time when people spend more time in the local area.  They may start taking extension or college classes.  They spend more time volunteering at various non-profits and helping out older and less healthy retirees. People often spend less during these years. This period starts when a retiree is in his or her mid to late 70’s and can last up to 20 years, usually to mid to late-80’s.
  • Late Years. This is when you may need assistance in our daily activities.  You may receive care at home, in a nursing home or an assisted care facility.  Most of the care options are very expensive.  It’s possible that these years might be more expensive than your pre-retirement expenses.  This is especially true if both spouses need some sort of assisted care. This period usually starts when the retiree is their 80’s; however they can sometimes start in the middle to the late 70’s.

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[A] Planning issues – early career

Most retirement lifestyle issues do not have to be addressed at this point.  Keeping a healthy, balanced lifestyle will help to ensure a more productive retirement.  This is the time to focus on the financial aspects of retirement planning.

[B] Planning issues – mid career

If early retirement is a major objective, start thinking about activities that will fill up your time during retirement.  Maintaining your health is more critical, since your health habits at this time will often dictate how healthy you will be in retirement

 [C] Planning issues – late career

Three to five years before you retire, start making the transition from work to retirement. 

  • Try out different hobbies;
  • Find activities that will give you a purpose in retirement;
  • Establish friendships outside of the office or hospital;
  • Discuss retirement plans with your spouse.
  • If you plan to relocate to a new place, it is important to rent a place in that area and stay for few months and see if you like it. Making a drastic change like relocating and then finding you don’t like the new town or state might be very costly mistake. The key is to gradually make the transition.

RETIREMENT INCOME: https://medicalexecutivepost.com/2024/10/18/fast-facts-retirement-income-in-the-usa/

Conclusion

For physicians, like most folks, retirement is the stage in life when one chooses to leave the workforce and live off sources of income or savings that do not require active work. The age at which a person retires, their lifestyle during retirement, and the way they fund that lifestyle, will vary from one person to the next, depending on individual preferences and financial planning. Usually it is age 65.

Some doctors may opt for early retirement to enjoy their hobbies and travel, while others may continue working part-time to stay engaged and supplement their income. Effective retirement planning often involves a combination of savings, investments, and possibly pension benefits to ensure a comfortable and secure post-work life.

COMMENTS APPRECIATED

EDUCATION: Books

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

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Stock Markets, Commodities and International Trade

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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  • Trade: President Trump signed an executive order late Friday unleashing a wave of new tariffs on 69 US trading partners that will go into effect on August 7th. Here’s a handy list of tariffs and their economic effects for readers of this ME-P.
  • Markets: Stocks opened lower Friday and kept falling thanks to a double whammy of new tariff rates and a shocking slowdown in the labor market, while bond yields tumbled.
  • Commodities: Gold jumped as the likelihood of a rate cut rose due to the latest jobs report, while oil sank on reports that OPEC+ may announce a crude production boost as soon as this weekend.
  • More Markets: Stocks may want to stop reading the news for a while after tanking Friday in response to President Trump laying out sweeping new global tariffs, as well as a jobs report that showed the labor market has been cooling down more than we realized. The dip left all three major averages down for the week.
  • Stock spotlight: Reddit, that platform that has once again been propping up meme stocks, managed to buck the trend and soar, following its report of better-than-expected quarterly earnings results.
  • INCENTIVE OPTIONS: https://medicalexecutivepost.com/2025/07/15/incentive-stock-options-defined/

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DIRECT TO PHYSICIAN [D-2-P] INVESTOR ADVISORY PLATFORMS

Enter Artificial Intelligence and the “Robo-Advisors”

By Dr. David Edward Marcinko; MBA MED CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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DIRECT TO INVESTOR ONLINE ADVISORY PLATFORMS

Since the financial crisis in 2008, several start-up companies from Silicon Valley and Boston [Learn Vest, Betterment, Financial Guard, Quovo, WealthFront, Nest Egg Wealth. Wealth-Front and Personal Capital] have emerged with the mantra that individual investors, younger and informed clients will receive portfolio strategies, financial advice and performance metrics directly from various internet and online advisory platforms. Termed “robo-advisors” by some, their existence heralds the doom of financial advisors; or at least drives down the value of Financial Advisory guidance; reduces fees and holds them more accountable to clients.

STOCK MARKET HELL: https://medicalexecutivepost.com/2025/01/30/escaping-stock-market-double-hell/

On the other hand, detractors say the financial advice may not be as good because the personalization will not be there; but pricing fees will be more competitive, at least initially. Going forward price will get even lower and service better. And ultimately, as consumers get more information on line, product and service will improve and be delivered to them faster than thru traditional human channels of distribution. The era of quarterly client meetings with TAMPs is fading. Clients will have access to their portfolios; in real time, all the time.

Turnkey Asset Management Program (TAMP) Defined

A turnkey asset management program offers a fee-account technology platform that financial advisers, broker-dealers, insurance companies, banks, law firms, and CPA firms can use to oversee their clients’ investment accounts.

Turnkey asset management programs are designed to help financial professionals save time and allow them to focus on providing clients with service in their areas of expertise, which may not include asset management tasks like investment research and portfolio allocation. In other words, TAMPs let financial professionals and firms delegate asset management and research responsibilities to another party that specializes in those areas.

Conclusion

The growth of more traditional direct to investment platforms like E-Trade and Schwab has outpaced Financial Advisors and recently human advisors must have the technology and niche space specificity to survive in the future. Realistically, robo-advisors, Artificial Intelligence and traditional flesh-and-blood FAs will seamlessly merge into a hybrid platform indistinguishable to most all.

COMMENTS APPRECIATED

EDUCATION: Books

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

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PHYSICIANS: Do You Use A Financial Planner?

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TO: All Physicians and Dentists

QUESTION?

Do you use a financial advisor?

What has been your experience with him or her?

THANK YOU

EDUCATION: Books

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

When Economic Facts Become Political Opinions: A Financial Advisor’s Dilemma

By Rick Kahler MSFP CFP

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QUESTION: “How will this administration’s trade policies affect my retirement savings?” “What does it mean for our plans to travel internationally if the value of the dollar declines?” “Is it wise to borrow right now to expand my business?”

Clients who ask questions like these expect and deserve honest answers from their financial advisors. Their financial and retirement planning depend on accurate information. Yet in the current polarized and chaotic climate, every economic explanation carries potential political interpretations.

Historically, political parties and administrations debated policies on taxes, spending, and regulation. Yet they shared a basic understanding of core mechanisms. Both parties recognized that central banks fight inflation, that tariffs raise prices, and that court rulings are binding. Disagreements focused on applications and political philosophies, not fundamental aspects of our governmental system and the rule of law.

That consensus has collapsed.

This distortion creates a professional bind for advisors. To fulfill their fiduciary duty to clients, advisors must explain economic realities like the link between tariffs and increased consumer costs. They owe it to clients to consider the impact on the U.S. dollar when a president threatens the independence of the Federal Reserve. They should be aware of information such as a CNBC survey that found 66% of small business owners reported being or expecting to be impacted by tariffs. They cannot ignore the difficulties of making business and investment decisions when policies change almost daily and legal rulings are delayed or ignored.

Considering the ramifications of political decisions on clients’ affairs is not an abstract concern. When international confidence in American institutions is wavering and U.S. business owners are uncertain, the consequences affect real money in the accounts of real people.

Yet talking about such issues may trigger accusations of partisanship. Many people get the bulk of their political and economic information from social media and from competitive news outlets that may be as much entertainment as journalism. The biases in some of these sources go so far beyond partisan leanings that they offer conflicting information purporting to be factual. What was once a neutral middle ground where essential facts were agreed upon has become harder to find, particularly when reporting covers politics and the economy.

That neutral territory is exactly where responsible financial advisors need to get the facts on which they base their advice. It’s challenging to stay there if clients are getting their news from outlets that are strongly biased toward either end of the political spectrum. Nuanced explanations can be interpreted as bias or context seen as spin. For the advisor whose information is questioned, remaining silent fails the client. Speaking truthfully risks the relationship with the client.

I have seen advisors lose clients, on both ends of the political spectrum, when advisors and clients held different views. The professional cost of maintaining standards has become substantial.

The financial planning profession faces an unprecedented challenge. Our traditional advisory principles assume a shared understanding of economic fundamentals. That foundation is no longer solid, and trust in advisors’ expertise is eroding.

These disruptions raise a core question. Should financial advisors prioritize economic truth over client comfort or client retention? Or should they accommodate clients’ political sensitivity and compromise the integrity of the advice they provide? Either path risks the loss of clients and revenue.

The choice is not theoretical. It defines the advisor’s professional identity and the quality of financial guidance itself. When economic mechanisms are politicized, the profession’s standards weaken and client service suffers.

The stakes are clear. This is a conflict over whether facts still function as the basis of financial advice.

The resolution will determine whether financial planning remains a profession or becomes another form of political posturing.

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Goldman Sachs and Bitcoin

SPONSOR: http://www.CertifiedMedicalPlanner.org

By A.I.

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

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

COMMENTS APPRECIATED

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

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BRAND MANAGEMENT: 7 Approaches For Doctors and Financial Advisors

By A.I.

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Any extensive analysis of numerous papers published on brand management leads to the seven approaches mentioned below. This included 300+ articles from Journal of Marketing, Journal of Marketing Research, Journal of Consumer Research, Harvard Business Review and European Journal of Marketing.

So, it can be safe to claim that no matter which framework or model one follows it must have originated via one of the seven approaches listed below.

The Seven Branding Approaches are:

  • The economic approach: the brand as part of the traditional marketing mix.
  • The identity approach: the brand as linked to corporate identity.
  • The consumer-based approach: the brand as linked to consumer associations.
  • The personality approach: the brand as a human-like character.
  • The relational approach: the brand as a viable relationship partner.
  • The community approach: the brand as the pivotal point of social interaction.
  • The cultural approach: the brand as part of the broader cultural fabric.

There are multiple theories and model to be followed in the area of brand management with their own school of thought and have been proven to work.

These include the Aaker’s brand identity model, Kapferer’s brand prism or Keller’s customer-based brand equity pyramid. All of them will enhance the brand equity of the product or service but may have evolved from different school of thoughts. Though everyone talks about the different models, rarely we find text on the school of thought rather then the actual model in practice.

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And, you will find the Brand Asset Valuator Model in many books but you might never come to know the author’s perspective.

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BEWARE: July Fourth Fireworks PLUS Helpful Weekend Reading List

By Dr. David Edward Marcinko MBA MEd

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Happy Fourth of July! It’s a good day to avoid the emergency department, so leave the fireworks shows to the pros—and perhaps use your extra hands to double-fist some BBQ instead.

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COMMENTS APPRECIATED

WEEKEND READING LIST: EDUCATION: Books

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PHYSICIANS ONLY: Career Coaching and Development

MARCINKO ASSOCIATES, Inc.

SPONSOR: http://www.MarcinkoAssociates.com

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Did you Know?

Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.

Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.

CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].

NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686971/

THANK YOU

CONTACT US: https://marcinkoassociates.com/process-what-we-do/

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EDUCATION: Books

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

ASSETS UNDER ADVISEMENT: Doctors Only

By Dr. David Edward Marcinko; MBA MEd CMP

A.U.A IS ALL WE DO!

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SPONSOR: http://www.MarcinkoAssociates.com

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

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

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

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D. E. Marcinko & Associates Core Operating Values

9.   We act with honesty, integrity and are always straightforward.
8.   We strive to be innovative, creative, iconoclastic, and flexible.
7.   We admit and learn from mistakes and don’t repeat them.
6.   We work hard always as competitors are trying to catch up.
5.   We treat others with dignity and respect.
4.   We are the onus of consulting advice for the fiduciary well being of others.
3.   We fight complacency as former success is in the past.
2.   The best management styles are timeless, not timely.
1.   Our clients are colleagues and always come first.

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COMMENTS APPRECIATED

EDUCATION: Books

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

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CORRELATION: Diversification in Finance and Investments

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

DEFINITION

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

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

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

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

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ETFs: Alternatively Weighted Investments

DEFINITION

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Alternatively Weighted Exchange Traded Funds are designed to track an index that is constructed based on criteria other than market capitalization (the methodology used for most traditional indexes).

Instead, alternatively weighted indexes select and weight securities based on other factors, such as growth, valuation, and price momentum, among others. Examples include:

  • Invesco S&P 500 Equal Weight ETF (NYSEARCA: RSP)
  • SPDR Technology ETF (NYSEARCA: XNTK)
  • First Trust NYSE Arca Biotechnology Index Fund (NYSEARCA: FBT)
  • Amplify Online Retail ETF (NASDAQ: IBUY)
  • iShares MSCI USA Equal Weighted ETF (NYSEARCA: EUSA)
  • ALPS Equal Sector Weight ETF (NYSEARCA: EQL)

These may also be known as “smart beta” funds.

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REVERSAL OF FORTUNE: For E.S.G. Investors?

Environmental, Social and Governance Investing

SPONSOR: http://www.MarcinkoAssociates.com

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An Informed Op-Ed Piece

By Dr. David Edward Marcinko; MBA MEd

As many medical, dental and podiatric colleagues are aware, Environmental, Social and Governance (ESG) investing refers to a set of standards for a company’s behavior used by socially conscious investors to screen potential investments. Over the last decade, or so, I have seen many investors pursing this laudable aim.

Yet, more than 80% of private equity fund managers have now stepped away from at least one deal due to ESG concerns, according to the 2023 BDO Private Capital Survey. The reasons are complex, and point towards fund managers’ sentiment towards risk-reward in the current economic environment.

This retreat from ESG is due to backlash from conservatives who are critical of the idea that mutual fund managers should be considering any other factor but a company’s share holders in their investment decisions. Accusations of “Greenwashing” have also plagued many ESG funds, which is when an asset management firm charging higher fees or a specific thematic fund without actually delivering a unique investment strategic competitive advantage.

Greenwashing is the process of conveying a false impression or misleading information about how a company’s products are environmentally sound. Greenwashing involves making an unsubstantiated claim to deceive consumers and / or investors into believing that a company’s products are environmentally friendly or have a greater positive environmental impact than they actually do. Greenwashing may also occur when a company attempts to emphasize sustainable aspects of a product to overshadow the company’s involvement in environmentally damaging practices.

ESG: https://medicalexecutivepost.com/2023/09/23/mas-and-esg-profit/

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According to internationally known linguistics and cognitive science Professor, Mackenzie Hope Marcinko PhD of the University of Delaware, greenwashing is performed through the use of environmental imagery, misleading labels, cognitive biases and tendencies hiding tradeoffs. Greenwashing is also a play on the term “Whitewashing,” which means using false information to intentionally hide wrongdoing, errors or an unpleasant situation in an attempt to make it seem less bad than it really is.

To be sure, uncertainty around ESG regulations in the USA is leading financial deal makers to tread carefully. For example, Jim Clayton MBA, a private equity advisor also from the University of Delaware recently stated:

  • We’re a year past when the SEC said they were going to issue ESG reporting standards for public filers which has created more noise in the system.”
  • “People are nervous about what I would call ESG-intense exposed industries, in other words, those with “heavy carbon footprints”.

MORE ESG: https://medicalexecutivepost.com/2023/03/27/on-socially-responsible-investing-2/

And, a federal judge in Texas said that American Airlines violated federal law by basing investment decisions for its employee retirement plan on environmental, social, and other non-financial factors. The ruling in January 2025 by US District Judge Reed O’Connor appeared to be the first of its kind amid growing backlash by conservatives to an uptick in socially-conscious investing. O’Connor said American had breached its legal duty to make investment decisions based solely on the financial interests of 401(k) plan beneficiaries by allowing BlackRock, its asset manager and a major shareholder, to focus on environmental, social and corporate governance (ESG) factors.

Even the State of Florida pulled $2 billion from the investment management firm BlackRock in the largest divestment ever made. Florida Governor Ron DeSantis claimed that by taking ESG standards into account when making investment decisions, the firm isn’t prioritizing the financial bottom line for Floridians.

Assessment

But, for a few years at least, things were indeed good. In 2020 and 2021, ESG funds outperformed the market by ~4.3%.

Conclusion

So, always remember [caveat emptor]: let the buyer beware!

References and Readings:

1. 2023 BDO Private Capital Survey: https://insights.bdo.com/2023-BDO-Private-Capital-Survey.html

2. Marcinko, DE; Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017 

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

4. Zymeri, Jeff: ‘Not Going to Fly Here’ [DeSantis Signs Far-Reaching Anti-ESG Bill into Law]. 2023: https://www.yahoo.com/news/not-going-fly-desantis-signs-121648679.html

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EDUCATION: Books

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

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FINANCIAL LIFE PLANNING? For Physicians and Medical Professionals

SPONSOR: http://www.MarcinkoAssociates.com

By Dr. David Edward Marcinko; MBA MEd CMP

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Life planning and behavioral finance as proposed for physicians and integrated by the Institute of Medical Business Advisors Inc., is unique in that it emanates from a holistic union of personal financial planning, human physiology and medical practice management, solely for the healthcare space.  Unlike pure life planning, pure financial planning, or pure management theory, it is both a quantitative and qualitative “hard and soft” science, with an ambitious economic, psychological and managerial niche value proposition never before proposed and codified, while still representing an evolving philosophy. Its’ first-mover practitioners are called Certified Medical Planners™.

Life planning, in general, has many detractors and defenders. Formally, it has been defined by Mitch Anthony, Gene R. Lawrence, AAMS, CFP© and Roy T. Diliberto, ChFC, CFP© of the Financial Life Institute, in the following trinitarian way.

Financial Life Planning is an approach to financial planning that places the history, transitions, goals, and principles of the client at the center of the planning process.  For the financial advisor or planner, the life of the client becomes the axis around which financial planning develops and evolves.

Financial Life Planning is about coming to the right answers by asking the right questions. This involves broadening the conversation beyond investment selection and asset management to exploring life issues as they relate to money.

Financial Life Planning is a process that helps advisors move their practice from financial transaction thinking, to life transition thinking. The first step is aimed to help clients “see” the connection between their financial lives and the challenges and opportunities inherent in each life transition.

But, for informed physicians, life planning’s quasi-professional and informal approach to the largely isolate disciplines of financial planning and medical practice management is inadequate. Today’s practice environment is incredibly complex, as compressed economic stress from HMOs managed care, financial insecurity from insurance companies, ACOs and VBC, Washington DC and Wall Street; liability fears from attorneys, criminal scrutiny from government agencies, and IT mischief from malicious electronic medical record [eMR] hackers. And economic bench marking from hospital employers; lost confidence from patients; and the Patient Protection and Affordable Care Act [PP-ACA] more than a decade ago. All promote “burnout” and converge to inspire a robust new financial planning approach for physicians and most all medical professionals. 

The iMBA Inc., approach to financial planning, as championed by the Certified Medical Planner™ professional certification designation program, integrates the traditional concepts of financial life planning, with the increasing complex business concepts of medical practice management. The former topics are presented in this textbook, the later in our recent companion text: The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors].

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For example, views of medical practice, personal lifestyle, investing and retirement, both what they are and how they may look in the future, are rapidly changing as the retail mentality of medicine is replaced with a wholesale and governmental philosophy. Or, how views on maximizing current practice income might be more profitably sacrificed for the potential of greater wealth upon eventual practice sale and disposition. 

Or, how the ultimate fear represented by Yale University economist Robert J. Shiller, in The New Financial Order: Risk in the 21st Century, warns that the risk for choosing the wrong profession or specialty, might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics. OR, if a medical degree is even needed for future physicians?

Say, what medical license?

Dr. Shirley Svorny, chair of the economics department at California State University, Northridge, holds a PhD in economics from UCLA. She is an expert on the regulation of health care professionals who participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that medical licensure not only fails to protect patients from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible. Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

Yet, the opportunity to revise the future at any age through personal re-engineering, exists for all of us, and allows a joint exploration of the meaning and purpose in life. To allow this deeper and more realistic approach, the informed transformation advisor and the doctor client, must build relationships based on trust, greater self-knowledge and true medical business management and personal financial planning acumen.

[A] The iMBA Philosophy

As you read this ME-P website, we hope you will embrace the opportunity to receive the focused and best thinking of some very smart people. Hopefully, along the way you will self-saturate with concrete information that proves valuable in your own medical practice and personal money journey. Maybe, you will even learn something that is so valuable and so powerful, that future reflection will reveal it to be of critical importance to your life.  The contributing authors certainly hope so.

At the Institute of Medical Business Advisors, and thru the Certified Medical Planner™ program, we suggest that such an epiphany can be realized only if you have extraordinary clarity regarding your personal, economic and [financial advisory or medical] practice goals, your money, and your relationship with it. Money is, after only, no more or less than what we make of it. 

Ultimately, your relationship with it, and to others, is the most important component of how well it will serve you. 

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EDUCATION: Books

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

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FINANCIAL ADVISORS: Usually Aren’t Millionaires

THE TRUTH MUST BE TOLD!

By Dr. David Edward Marcinko MBA MEd CMP

http://www.MarcinkoAssociates.com

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Financial Advisors and Financial Planners Usually Aren’t Millionaires

According to the most recent data from the Bureau of Labor Statistics (BLS), financial advisors had a median annual salary of $99,580 in 2023, which is significantly higher than the national average of $65,470. Of course, salaries of financial advisors can differ significantly by their location and level of expertise. The client’s profile may also have an impact on their compensation. But, many are not rich.

REPLACE FINANCIAL PLANNERS: https://medicalexecutivepost.com/2023/03/15/why-your-financial-planner-may-be-replaced/

This is unfortunate. Financial advisors and Financial planners don’t rank among the millionaire professions in Thomas J. Stanley and William D. Danko’s book The Millionaire Next Door. Many work as salaried employees rather than entrepreneurs, lacking the scalable income potential of business owners who reinvest profits.

Certified Medical Planner: https://medicalexecutivepost.com/2024/12/17/certified-medical-planner-niche-advisors-thrive/

Stanley and Danko also stressed frugality, a challenge for advisors pressured to flaunt success—think luxury cars or upscale offices—making them “income-statement affluent” rather than “balance-sheet affluent.”

BEST DOG FINANCIAL ADVISOR: https://medicalexecutivepost.com/2025/03/23/dog-nearly-fetches-prestigious-financial-advisor-honor/

CONCLUSION

The truth is that a Financial Advisors’ success isn’t measured in client returns. Instead it is measured in their ability to gather assets and retain clients. In other words; Financial Advisors do not need to be good with money.

Financial Advisors need to be good with marketing, advertising, sales and people.

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EDUCATION: Books

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

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OMADA: Digital Health Company Files for IPO

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Virtual chronic care provider Omada Health has filed to go public in the United States, the latest in a string of healthcare listings expected this year. Omada did not disclose the details as to how much it plans to raise from its IPO.

IPO: https://medicalexecutivepost.com/2025/03/02/ipo-road-show-with-pros-and-cons/

The San Francisco, California-based company, which last raised $192 million in a Series E funding round in 2022, reported a 38% increase in revenue to $169.8 million for 2024, according to its IPO paperwork. For the first quarter of 2025, the company posted a 56.6% year-on-year jump in revenue to $55 million. Omada has applied to list its common stock on the NASDAQ under the symbol “OMDA”.

Healthcare IPOs on U.S. exchanges have fetched $7.1 billion in 2024, compared with $2.8 billion a year earlier, according to data compiled by LSEG.

Invite Dr. Marcinko

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2 Fast 2 Furious: HHS Cuts on the Horizon

By Health Capital Consultants LLC

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During the first 90 days of the Republican Party’s government trifecta (controlling the White House, Senate, and House of Representatives), both the Trump Administration and Congress have laid the groundwork for seismic change to the U.S. healthcare industry.

In an attempt to track the latest actions of the federal government’s legislative and executive branches affecting the healthcare industry since the first installment in our February issue, this Health Capital Topics article summarizes recent events in Washington and the impact of these changes on providers and patients. (Read more…)

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BERKSHIRE HATHAWAY: Warren Buffett to Retire

BREAKING NEWS

By Staff Reporters

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According to the Washington Post, legendary investor Warren Buffett said Saturday that he plans to step down from his role leading Berkshire Hathaway. Warren, 94, serves as the conglomerate’s chairman and chief executive. He said Saturday that he will recommend to the Berkshire Hathaway board that Greg Abel become CEO at the end of 2025.

“I think the time has arrived where Greg should become the chief executive officer of the company at year end,” Buffett said at Berkshire Hathaway’s annual meeting in Omaha.

Abel is chairman and CEO of Berkshire Hathaway Energy. Buffett has previously signaled that Abel would be in line to succeed him as CEO.

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UPDATE: Berkshire Hathaway (NYSE:BRK.A)(NYSE:BRK.B) on Saturday reported its worst drop in quarterly operating earnings since 2020, and noted “considerable uncertainty” around international trade policies and tariffs. 

The sprawling conglomerate’s Q1 operating earnings slipped 14.1% Y/Y to $9.64B. This was the steepest fall in operating earnings since a 32.1% decrease logged in the third quarter of 2020

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LIAR-LIAR: The Physician Paradox?

By Staff Reporters

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Classic Definition: Suppose someone tells you “I am lying.” If what he/she tells you is true, then he/she is lying, in which case what he/she tells you are false. On the other hand, if what he/she tells you is false, then he/she is not lying, in which case what he/she tells you is true.

Modern Circumstance: In short: if “I am lying” is true then it is false, and if it is false then it is true. 

Paradox Example: The paradox arises for any sentence that says or implies of itself that it is false (the simplest example being “This sentence is false”). It is attributed to the ancient Greek seer Epimenides (fl. c. 6th century BCE), an inhabitant of Crete, who famously declared that “All Cretans are liars” (consider what follows if the declaration is true). The paradox is important in part because it creates severe difficulties for logically rigorous theories of truth; it was not adequately addressed (which is not to say solved) until the 20th century.

Paradox Example: Doctors lie because, as caretakers, our role is to improve the lives of their patients. Re-assuring patients during some of the most difficult times of their lives counts as improving their well being! This is an acceptable practice because it does not cause harm.

Paradox Example: Cultural differences may make a lie of omission or the practice of withholding information from the patient, prudent. For instance, some cultures and religions dictate that the husband or head male family members make all medical decisions for women.

Paradox Example: Many physicians don’t report “near misses” to their patients. But, concealing serious medical errors is something we recommend against.

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The Medical Executive-Post is a  news and information aggregator and social media professional network for medical and financial service professionals.

Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.

Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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ANNUITIES: Three Types of Insurance Products

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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An annuity is a contract between you and an insurance company.  When you purchase an annuity, you make a lump-sum contribution or a series of contributions, generally each month.  In return, the insurance company makes periodic payments to you beginning immediately or at a pre-determined date in the future.  These periodic payments may last for a finite period, such as 20 years, or an indefinite period, such as until both you and your spouse are deceased.  Annuities may also include a death benefit that will pay your beneficiary a specified minimum amount, such as the total amount of your contributions.

The growth of earnings in your annuity is typically tax-deferred; this could be beneficial as you may be in a lower tax bracket when you begin taking distributions from the annuity. 

Warning: A word of caution: Annuities are intended as long-term investments. If you withdraw your money early from an annuity, you may pay substantial surrender charges to the insurance company as well as tax penalties to the IRS and state.

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There are three basic types of annuities — fixed, indexed, and variable

1. With a fixed annuity, the insurance company agrees to pay you no less than a specified (fixed) rate of interest during the time that your account is growing. The insurance company also agrees that the periodic payments will be a specified (fixed) amount per dollar in your account.

2. With an indexed annuity, your return is based on changes in an index, such as the S&P. Indexed annuity contracts also state that the contract value will be no less than a specified minimum, regardless of index performance.

3. A variable annuity allows you to choose from among a range of different investment options, typically mutual funds. The rate of return and the amount of the periodic payments you eventually receive will vary depending on the performance of the investment options you select. 

READ: SEC’s publication, Variable Annuities: What You Should Know.

COMMENTS APPRECIATED

The Medical Executive-Post is a  news and information aggregator and social media professional network for medical and financial service professionals.

Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.

Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

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SEX: Bereavement Style

By Staff Reporters

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According to colleague Dan Ariely PhD, Bereavement Sex is one of those coping mechanisms that sounds strange but makes sense when you think about it. In the face of loss, our brains crave connection and comfort.

Engaging in sex after a significant loss can be a way to feel alive and regain a sense of control. It’s a testament to our complex emotional wiring, where grief and intimacy intertwine.

Psychology Today: https://www.psychologytoday.com/us/blog/all-about-sex/201911/myths-and-the-truth-about-sex-after-grieving?msockid=2d99b4712dfb6dde0d66a1522c226c4e

So, while it might seem odd, it’s just another way our brains handle the roller coaster of emotions.

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IPOs: Delayed

By Staff Reporters

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Initial Public Offering Defined

IPO stands for initial public offering. It is when a company takes a portion of their shares and makes them available for the general public to buy on the open market. It is a way for the company to raise money by selling those shares to the general public. You can usually access shares from an IPO by working directly with an investment bank.

Paused IPOs

Private companies StubHub and Klarna each paused their imminent plans to go public.

Klarna, which was set to IPO on this Monday, was expected to jump-start the frozen IPO market this year with an expected ~$15 billion valuation.

StubHub, meanwhile, reportedly wants to wait for the market to calm down before resuming its plans to go public.

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Registered Investment Advisor VERSUS Hedge Fund Manager

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters

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A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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The Hedge Fund manager I am considering is a Registered Investment Adviser [RIA]

QUESTION: What is a Registered Investment Advisor?

If the fund manager is an entity, then any individual you deal with will be a registered investment adviser representative. If the fund manager is an individual, then that individual is a registered investment adviser. In either case, the designation implies several steps have been taken.

In order to become a registered investment adviser, an individual must register for and pass the Series 65 Uniform Investment Adviser Law Exam, a three-hour, 130-question computer-based exam administered by the North American Securities Administrators Association. Topics covered include economics and analysis, investment vehicles, investment recommendations and strategies, and ethics and legal guidelines. A passing score is 70 percent or higher.

Once an individual has passed the Series 65, he or she must then apply via Form ADV to become a registered investment adviser. This application is made to either a state authority or to the SEC, depending on the adviser’s assets under management. If assets under management exceed $30 million, then the adviser must register with the SEC.

Form ADV consists of two parts. Part I provides general information to the regulatory authority. Part II is designed to be distributed to potential clients, and includes disclosure of a decent amount of information about the adviser. If the manager is a registered investment adviser, then you should expect to receive as part of the offering documentation either a current copy of Part II of the adviser’s Form ADV or a brochure that contains all the current information in Part II of Form ADV.

In addition to filing Form ADV and paying a small fee, the registered investment adviser becomes subject to extra administrative/regulatory burden as well as capital adequacy requirements that state the Adviser must maintain certain net worth levels.

By and large, because of the extra administrative burden as well as restrictions on certain activities, hedge fund managers attempt to avoid registering as investment advisers. Whether such managers can or cannot avoid such registration is largely dependent upon the state in which the manager operates. In California, for instance, hedge fund managers must register as investment advisers. In New York, such registration is not necessary. Not surprisingly, hedge fund managers located in California are rare, while they are quite plentiful in New York. 

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OBTAIN: An Unbiased Second Financial Planning Opinion

By Ann Miller RN MHA CPHQ CMP

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Finally … Fiduciary second investing and financial planning opinions right here!

Telephonic or electronic advice for medical professionals that is:

  • Objective, affordable, medically focused and financially personalized
  • Rendered by a pre-screened financial consultant for doctors and medical professionals
  • Offered on a pay-as-you-go basis, by phone or secure e-mail transmission

The iMBA Discussion Forum™ is a physician-to-financial advisor telephone or e-mail portal that connects independent financial professionals to doctors, nurses or healthcare executives desiring affordable and unbiased financial planning advice.

Medical professionals and healthcare executives can now receive direct access to pre-screened iMBA professionals in the areas of Investing, Financial Planning, Asset Allocation, Portfolio Management, Insurance, Mortgage and Lending, Human Resources, Retirement Planning and Employee Benefits. To assist our medical professional and healthcare executive members, we can be contracted with per-minute or per-project fees, and contacted by client phone, email or secure instant messaging.

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http://www.MARCINKOASSOCIATES.com

E-mail CONTACT: MarcinkoAdvisors@outlook.com

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Thank You

HEDGE FUNDS: In Individual Retirement Accounts?

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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QUESTION: What is a Hedge Fund?

A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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SPONSOR: http://www.MARCINKOASSOCIATES.com

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QUESTION: Can I invest my Individual Retirement Account [IRA] in a Hedge Fund?

This is up to the manager, but there is no legal restriction on a hedge fund accepting individual retirement account (IRA) assets. IRA accounts are not well suited for funds that make extensive use of leverage, however. In such cases, the fund is likely to generate significant amounts of unrelated business taxable income (UBTI) – profits of the fund attributable to the use of leverage. The holder of an IRA account must pay taxes on UBTI, even if the UBTI was generated in an IRA account.

But, today’s hedge funds may or may not use leverage. Many hedge funds are not hedged at all, but rather are just specialized versions of regular long stock portfolios. If such funds do not use much leverage, IRA investors will not encounter much difficulty with UBTI and should not hesitate in considering these funds.

In considering whether to accept IRA money, hedge fund managers must consider several factors. If the only type of retirement money accepted by the hedge funds is IRA money, then the manager has no limit on how much retirement money the fund can accept. If, however, there are other types of retirement money invested in the fund, such as pension funds, IRA money will be counted towards a total of 25 percent of fund assets that can be invested in retirement accounts before the fund becomes subject to the Employment Retirement Income Security Act of 1974 (ERISA). Funds subject to ERISA regulations face a heavy administrative burden and more restrictions than most fund managers like.

Finally, IRA distributions from a hedge fund are subject to the standard 20 percent withholding unless the funds are directly rolled over to other qualified plans.

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ACCOUNTABLE CARE ORGANIZATION: A Financially Toxic Contract Example for Physicians

SPONSOR: http://www.MarcinkoAssociates.com

By. Dr. David Edward Marcinko; MBA MEd CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

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WARNING – DISASTROUS ACO EXAMPLE – WARNING

GIVEN CASH FLOW MODEL

Suppose that in a new Accountable Care Organization [ACO] contract, a certain medical practice was awarded a new global payment or capitation styled contract that increased revenues by $100,000 for the next fiscal year. The practice had a gross margin of 35% that was not expected to change because of the new business. However, $10,000 was added to medical overhead expenses for another assistant and all Account’s Receivable (AR) are paid at the end of the year, upon completion of the contract.

Cost of Medical Services Provided (COMSP):

The Costs of Medical Services Provided (COMSP) for the ACO business contract represents the amount of money needed to service the patients provided by the contract.  Since gross margin is 35% of revenues, the COMSP is 65% or $65,000.  Adding the extra overhead results in $75,000 of new spending money (cash flow) needed to treat the patients. Therefore, divide the $75,000 total by the number of days the contract extends (one year) and realize the new contract requires about $ 205.50 per day of free cash flows.

Assumptions

Financial cash flow forecasting from operating activities allows a reasonable projection of future cash needs and enables the doctor to err on the side of fiscal prudence. It is an inexact science, by definition, and entails the following assumptions:

  • All income tax, salaries and Accounts Payable (AP) are paid at once.
  • Durable medical equipment inventory and pre-paid advertising remain constant.
  • Gains/losses on sale of equipment and depreciation expenses remain stable.
  • Gross margins remain constant.
  • The office is efficient so major new marginal costs will not be incurred.

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Physician Reactions:

Since many physicians are still not entirely comfortable with global reimbursement, fixed payments, capitation or ACO reimbursement contracts; practices may be loath to turn away short-term business in the ACA era.  Physician-executives must then determine other methods to generate the additional cash, which include the following general suggestions:

1. Extend Account’s Payable

Discuss your cash flow difficulties with vendors and emphasize their short-term nature. A doctor and her practice still has considerable cache’ value, especially in local communities, and many vendors are willing to work them to retain their business

2. Reduce Accounts Receivable

According to most cost surveys, about 30% of multi-specialty group’s accounts receivable (ARs) are unpaid at 120 days. In addition, multi-specialty groups are able to collect on only about 69% of charges. The rest was written off as bad debt expenses or as a result of discounted payments from Medicare and other managed care companies. In a study by Wisconsin based Zimmerman and Associates, the percentages of ARs unpaid at more than 90 days is now at an all time high of more than 40%. Therefore, multi-specialty groups should aim to keep the percentage of ARs unpaid for more than 120 days, down to less than 20% of the total practice. The safest place to be for a single specialty physician is probably in the 30-35% range as anything over that is just not affordable.

The slowest paid specialties (ARs greater than 120 days) are: multi-specialty group practices; family practices; cardiology groups; anesthesiology groups; and gastroenterologists, respectively. So work hard to get your money, faster. Factoring, or selling the ARs to a third party for an immediate discounted amount is not usually recommended.

3. Borrow with Short-Term Bridge Loans

Obtain a line of credit from your local bank, credit union or other private sources, if possible in an economically constrained environment. Beware the time value of money, personal loan guarantees, and onerous usury rates. Also, beware that lenders can reduce or eliminate credit lines to a medical practice, often at the most inopportune time.

4. Cut Expenses

While this is often possible, it has to be done without demoralizing the practice’s staff.

5.  Reduce Supply Inventories

If prudently possible; remember things like minimal shipping fees, loss of revenue if you run short, etc.

6. Taxes

Do not stop paying withholding taxes in favor of cash flow because it is illegal.

Hyper-Growth Model:

Now, let us again suppose that the practice has attracted nine more similar medical contracts. If we multiple the above example tenfold, the serious nature of potential cash flow problem becomes apparent. In other words, the practice has increased revenues to one million dollars, with the same 35% margin, 65% COMSP and $100,000 increase in operating overhead expenses. 

Using identical mathematical calculations, we determine that $750,000 / 365days equals $2,055.00 per day of needed new free cash flows!  Hence, indiscriminate growth without careful contract evaluation and cash flow analysis is a prescription for potential financial disaster.

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EDUCATION: Books

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

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COGNITIVE BIAS: Negativity V. Pessimism

By Staff Reporters

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Negativity bias is not totally separate from pessimism bias, but it is subtly and importantly distinct. In fact, it works according to similar mechanics as the sunk cost fallacy in that it reflects our profound aversion to losing. We like to win, but we hate to lose even more.

And so, according to cognitive scientist Mackenzie Marcinko PhD, when we make a decision, we generally think in terms of outcomes—either positive or negative. The bias comes into play when we irrationally weigh the potential for a negative outcome as more important than that of a positive outcome.

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Pessimism bias on the other hand, is a cognitive bias that causes people to overestimate the likelihood of negative things and underestimate the likelihood of positive things, especially when it comes to assuming that future events will have a bad outcome.

For example, the pessimism bias could cause someone to believe that they’re going to fail an exam, even though they’re well-prepared and are likely to get a good grade.

According to colleague Dan Ariely PhD, The pessimism bias can distort people’s thinking, including your own, in a way that leads to irrational decision-making, as well as to various issues with your mental health and emotional well being.

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PHYSICIAN NET WORTH: Versus Average Family

By Dr. David Edward Marcinko MBA MEd CMP®

SPONSOR: http://www.MarcinkoAssociates.com

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Average Net Worth of an American Family

Both median and average family net worth surged between 2019 and 2022, according to the U.S. Federal Reserve. Average net worth increased by 23% to $1,063,700, the Fed reported in October 2023, the most recent year it published the data. Median net worth, on the other hand, rose 37% over that same period to $192,900.

You might wonder why the average and median net worth figures are so different. That’s because when you take the average of something, you add together every value in a data set and then divide that figure by the number of individual values.

When calculating a median, you simply look at the middle figure within a data set. That said, an average figure can be significantly higher or lower than a median figure if there are extreme outliers – meaning a group of people with significantly more net worth than the rest of the group can bring the average higher.

Average Net Worth by Age

The average net worth of someone younger than 35 years old is $183,500, as of 2022. From there, average net worth steadily rises within each age bracket. Between 35 to 44, the average net worth is $549,600, while between 45 and 54, that number increases to $975,800. Average net worth surges above the $1 million mark between 55 to 64, reaching $1,566,900.

Average net worth again rises for those ages 65 to 74, to $1,794,600, before falling to $1,624,100 for the 75 and older group. The median net worth within every single age bracket, however, is much lower than the average net worth.

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Physicians [MD/DO] Net Worth by Specialty

A 2023 Medscape report shows the top 10 specialties with the most survey respondents saying they are worth more than $5 million.

  1. Plastic Surgery (31% of all survey respondents)
  2. Orthopedics (28%)
  3. Gastroenterology (25%)
  4. Urology (23%)
  5. Cardiology (22%)
  6. Ophthalmology (18%)
  7. Radiology (17%)
  8. Oncology (17%)
  9. Pathology (14%)
  10. Ob/Gyn (14%)

EDUCATION: Books

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

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REQUEST “PROFESSIONAL PORTFOLIO CONSTRUCTION” For Physicians [The Doctor Effect]

A FREE WHITE PAPER UPON E-MAIL REQUEST

SPONSOR: http://www.MarcinkoAssociates.com

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Several years ago we noted that far too many mid-career, mature and physician clients using traditional stock brokers, management consultants and “financial advisors”, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc,. doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.”

In fact, an informal inverse related relationship was noted, and dubbed the “Doctor Effect.” In other words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning, professional portfolio and investing continuum.

Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.” This realization was a confirmation of the industry culture which seemed to be: Bread for the advisor – Crumbs for the client!

And so, we at the the Institute of Medical Business Advisors Inc. (iMBA), and this Medical Executive-Post, formed a cadre’ of technology focused and highly educated doctors, financial advisors, attorneys, accountants, psychologists and educational visionaries who decided there must be a better way for their healthcare colleagues to receive financial planning advice, products and related management services within a culture of fiduciary responsibility.

We trust you agree with this ME Inc philosophy as illustrated in this free white paper available upon request.

PROFESSIONAL PORTFOLIO CONSTRUCTION [Investing Assets and their Management]
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The Best and Worst Investment Decisions I’ve Made

By Vitaliy Katsenelson CFA

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Today, I’m going to share stories about my best and worst investment decisions. But don’t worry, this isn’t just a brag-and-cringe session about making or losing money. These stories are about the valuable lessons learned, and how these adventures in investing helped shape my current approach. 

The Best Investment Decision

In investing, you don’t get extra points for creativity or difficulty. A million dollars earned while you are smiling buys as many potatoes as a million dollars that cost you your marriage and hair.

However, from a personal, creative satisfaction perspective, our investment in Uber was one of our best. That’s not to say that it has been the most successful decision from a financial perspective, at least not yet.

Uber doesn’t fit into the traditional value stock category. Until 2023, the third year of our ownership, it never made money. It was a stock everyone hated. After we bought it, I had clients reach out to me asking if I had been kidnapped and someone else was making these purchases of Uber.

We bought more shares very opportunistically during and after the pandemic. I wrote a long research report on it, which you can read here.

On one hand, Uber’s switchboard is a digital business, but the company also has a physical presence in thousands of cities, which incurs costs (the analog side of the business). Additionally, the availability of cheap money caused the ride-share market to go crazy and act rationally irrational, as competitors jostled in a land grab.

My thesis consisted of several insights:

  1. Unlike traditional-tech, digital-only companies, Uber is a hybrid, both digital and analog. Thus, its cost structure is much higher than that of other companies. This, in part, explains the higher losses.
  2. It has a strong brand; its name has become a verb.
  3. The rideshare market is inevitable and will only continue to grow. Uber is not just in competition with taxis, second cars, or seldomly used cars; it is also in competition with the favors we ask of friends and relatives, such as dropping us off at the mechanic or picking us up from the doctor’s office.
  4. Uber has global scale, which its competitors lack, allowing it to spread R&D across more markets.
  5. As its revenue grows, each incremental dollar comes with a very high margin, which directly drops to the bottom line. Therefore, at some point, its earnings will explode to the upside as fixed costs stop growing, allowing it to scale.

The Uber story is not over; we still own the stock. I don’t want to do a celebratory dance. But this idea came with a lot of creative satisfaction. There is another point of pride here. Despite our very tumultuous ownership of this stock, we remained rational (I have written about that here). We bought more when it became extremely undervalued, and I would be lying if I said that was psychologically easy – it was not, but we followed our research and process.

The Worst Investment Decision

My worst investments that resulted in losses had several things in common: They were low-quality companies; their financials were complex and not transparent (for instance, one-time items were labeled as “one-time” every quarter); and they had questionable management. 

However, they were all considered “cheap”… until they were not. Now, I hope you see why I am dogmatic about quality. 

However.

When you are wrong on an investment and you lose money, the most you can lose is 100%. I have learned a lot from those. But they were not my worst investments. Those were the ones where I left 300–400% on the table when I sold too soon. Let me detail two examples.

EA – Electronic Arts

We bought EA in the early 2010s. I wrote about it – you can read my investment case for it here. To sum up, games were moving from being sold in stores to being digital downloads, which would lead to higher margins (don’t have to pay for packaging and Best Buy to sell them). The market for games was exploding, as every adult and teenager had a gaming device in their hands – a smartphone. The market for video games was going to be much larger. EA was the largest player in that space, with great franchises.

The following two years of ownership were very painful. EA had a few big game flops, and the market did not care about improving fundamentals. The stock kept declining. We continued to buy more. Every time we bought more shares, the stock fell further. Fast-forward a year or two. The stock doubled from our original purchase, but I was mentally exhausted. I did a celebratory dance and sold the stock. The stock then went up another 4x within a few years after we sold it. It went up for the right reasons – its earnings exploded to the upside, in line with my original thesis.

The sale was a mistake, not because the price went up but because I let frustration over the stock-price decline (volatility) get to me. Investing is a mental game. I learned from this adventure that it is important to zoom out and not obsess over individual stocks in the portfolio. This is why we have a portfolio. It was a very costly but educational mistake. Our ownership of Uber was not a walk in the park, either – just look at the stock price over the last few years. But I had learned my lesson from EA and was able to do the analysis, update our model, and zoom out.

In investing, there is a big difference between intellectual and tactile knowledge. I am going to go PG-13 on you for a second and quote the irascible Charlie Munger: “Learning about investing through a model portfolio is like learning about sex through romantic novels.” A big part of investing is observing yourself as an investor – your thoughts and emotions as you ride the actual rollercoaster of owning a stock.

I also made an important modification to our process.

We always value every company in the portfolio on earnings (free cash flows) at least four years out. Why four years? Three seems too short. There is no magic in this number, other than it being longer than most analyst estimates. We do this for all stocks in the portfolio, and then the total return for each is calculated and annualized. If a company has strong growth potential, it may appear to be expensive based on current earnings; but in reality, it may actually be cheap based on earnings projected four years from now.

On the other side of the spectrum, a company that has no growth or dividends may seem “cheap” based on its current earnings multiple, but this cheapness may quickly dissipate once a total return is calculated using future earnings. Time is on the side of growing businesses and the enemy of the ones that stand still. Therefore, a non-growing or slow-growing business needs a much greater discount (margin of safety) to secure a spot in our portfolio.

I want to stress another point. We sometimes sell a stock and then it goes higher. If we sold it for the right fundamental reasons, this doesn’t bother me. There is very little to learn.

Twilio

I’ll give you another crazy example. We bought Twilio at $25 in 2017 or so. Our thesis was that they had built the largest digital telecommunications network, which gave them a brief competitive advantage. They were also spending 5x more on R&D than competitors to build applications around this network, which would give them long-term advantages.

The stock price went up to $60 in a few months without anything significantly changing, so we sold a third of our position. Then it went up to $90, and we sold some more. To our disbelief, we sold the rest at around $120, a bit before the pandemic.

During the pandemic, Twilio’s price hit $400. I had zero regret about not holding on to the shares. Absolutely none. Twilio’s profitability did not match the stock market’s opinion of its price. Twilio’s stock price was as crazy to me at $250 as it was at $300 or $400. After reviewing our models, we concluded that even $120 was at the extreme end of our optimistic assumptions. Fast-forward to today, where the stock is at $60 or so. We are currently sharpening our pencils, but we have not bought the stock – yet.

Selling EA was a mistake; selling Twilio was not.

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Key takeaways

  • My “best investment decision” with Uber wasn’t just about financial gains, but the creative satisfaction it brought. It taught me the value of sticking to our research and process, even when it’s psychologically challenging.
  • The worst investments often share common traits: low-quality companies, complex financials, questionable management, and the illusion of being “cheap.” This reinforces my dogmatic stance on prioritizing quality.
  • Sometimes, the costliest mistakes aren’t the ones where you lose money, but those where you leave significant gains on the table by selling too soon. My experience with EA taught me this lesson the hard way.
  • There’s a crucial difference between intellectual and tactile knowledge in investing. Actually owning stocks and experiencing the emotional roller coaster is invaluable for developing as an investor.
  • Selling a stock that later increases in value isn’t always a mistake if the decision was based on sound fundamental reasons. My experience with Twilio illustrates this point – sometimes it’s right to sell even if the price continues to climb.

NOTE: Please read the following important disclosure here.

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Sc.D versus Ph.D Degree

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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In the United States, the difference between a Ph.D and a Sc.D is that the former is awarded to most, if not all, disciplines, while a Sc.D is awarded to science or STEM (science, technology, engineering, mathematics) disciplines.

This means that, in the United States at least, a Ph.D and a Sc.D are equal to one another in terms of telling people about an individual’s mastery of a particular skill, training, and prestige. A Ph.D holder and a Sc.D holder are viewed as peers and equals by most, if not all, American universities.

Meanwhile in Europe, according to Emily Summer, the difference between a Ph.D and a Sc.D is that the former is awarded at the start of an academic career, while the Sc.D is awarded much later, after the individual has built up an impressive body of work.

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BEAT: Base-Erosion Anti-Abuse Tax (BEAT)

By Staff Reporters

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Base-Erosion Anti-Abuse Tax (BEAT): The 2017 tax reforms moved the U.S. from a worldwide taxation system to a quasi-territorial system, so foreign earnings are no longer included in a company’s domestic tax base.

To discourage companies operating in the U.S. from avoiding tax liability by shifting profits out of the country, Congress imposed a 10% minimum tax called Base-Erosion Anti-Abuse Tax (BEAT). The BEAT rate will increase from 10% to 12.5% in 2026. 

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PT BARNUM: Forer Bias Effect

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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As in the case of Declinism, to better understand the Forer effect (commonly known as the Barnum Effect), it’s helpful to acknowledge that people like their world to make sense. If it didn’t, we would have no pre-existing routine to fall back on and we’d have to think harder to contextualise new information.

Note: Phineas Taylor Barnum (July 5, 1810 – April 7, 1891) was an American showman, businessman, and politician remembered for promoting celebrated hoaxes and founding with Jim Bailey the Ringling Bros. and Barnum & Bailey Circus. He was also an author, publisher, and philanthropist although he said of himself: “I am a showman by profession … and all the gilding shall make nothing else of me.” According to Barnum’s critics, his personal aim was “to put money in his own coffers”. According to Wikipedia, the adage “there’s a sucker born every minute” has frequently been attributed to him, although no evidence exists that he had coined the phrase

With that, if there are gaps in our thinking of how we understand things, we will try to fill those gaps in with what we intuitively think makes sense, subsequently reinforcing our existing schema(s). As our minds make such connections to consolidate our own personal understanding of the world, it is easy to see how people can tend to process vague information and interpret it in a manner that makes it seem personal and specific to them. Given our egocentric nature (along with our desire for nice, neat little packages and patterns), when we process vague information, we hold on to what we deem meaningful to us and discard what is not. Simply, we better process information we think is specifically tailored to us, regardless of ambiguity.

More specifically, according to colleague Dan Ariely PhD, the Forer effect refers to the tendency for people to accept vague and general personality descriptions as uniquely applicable to themselves without realizing that the same description could be applied to just about everyone else (Forer, 1949). For example, when people read their horoscope, even vague, general information can seem like it’s advising something relevant and specific to them.

Remember, we make thousands of decisions every day, some more important than others. Make sure that the ones that do matter are not made based on bias, but rather on reflective judgment and critical thinking.

EDUCATION: Books

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

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STOCK DIVIDENDS: Company Earnings Distribution

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

DEFINITION

If the definition of a security is title to a stream of cash flows, then the dividends a company is expected to pay to equity shareholders on a periodic basis (e.g., quarterly) are a clear source of return for an investor.  A dividend is simply a distribution of (some portion of) the company’s earnings to equity shareholders.  Like a bond yield, a stock’s dividend yield can be used to measure the income return on the stock. 

To determine a stock’s dividend yield, the trailing year’s dividends per share paid are divided by the current stock price.  However, a key difference between a dividend yield and a bond yield is the level of certainty that can be assumed regarding future payments, since a bond’s coupon is generally predetermined and its payment is expected to be senior to the payment of dividends.

After a company has determined that it has earned a profit, management has to decide what to do with those profits.  One choice is to distribute the earnings to shareholders in the form of dividends, while another option is to reinvest the profits in the company.  A company’s management may determine that the shareholders interest is best served by using the earnings to pursue growth opportunities (e.g., capital expansion, research & development, etc.) at the corporate level.  Thus, when management believes that its investment opportunities are likely to produce a higher return than what investors’ could generate with their dividends or that reinvestment is needed to maintain its financial strength, the company will retain the earnings. 

One of the biggest myths in investing is capital appreciation accounts for the largest part of investors’ gains. Dividends, or cash payments to shareholders, actually account for a substantial part of an equity investor’s total return. In fact since 1926, dividends have accounted for more than 40% of the total return of the S&P 500 stock index. In the last decade (2000-2009), the S&P 500’s total return of -9% would have been a heftier loss of -24% had it not been for the 15% contribution from dividends.

History has shown that dividends have been a powerful source of total return in a diversified investment portfolio, especially during periods of market turbulence. In examining the prior eight decades of stock market performance, dividends often account for more than 2/3 of the total return (1930s, 1940s, 1970s, & 2000s).  If an investor avoided dividend paying stocks during these elongated time periods, most of the total gains would be lost. 

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DIVIDEND CONTRIBUTION OF S&P 500 RETURN BY DECADE   
 S&P 500 CumulativeDividendsAverage 
 Price %DividendTotal% of TotalPayout 
YearsChangeContribution*ReturnReturnRatio** 
       
1930s-41.9%56.0%14.1%>100%90.1% 
1940s34.8%100.3%135.0%74.3%59.4% 
1950s256.7%180.0%436.7%41.2%54.6% 
1960s53.7%54.2%107.9%50.2%56.0% 
1970s17.2%59.1%76.4%77.4%45.5% 
1980s227.4%143.1%370.5%38.6%48.6% 
1990s315.7%117.1%432.8%27.0%47.6% 
2000s-24.1%15.0%-9.1%>100%35.3% 
2010s27.9%8.4%36.3%23.1%28.4% 
as of 12/31/12      

Source: Strategas

During those decades such as the 2000s where the stock market struggled to advance, dividends were a significant element for investor survival.  This is not only due to the dividends alone, but also the risk element of stocks that pay dividends.  Dividend stocks have historically provided lower overall volatility and stronger downside protection when markets decline. Since 1927, dividend stocks have consistently held up better than the broader market during downturns. You can measure downside risk through a statistic known as downside capture ratio.

Downside capture ratio is a statistical measure of overall performance in a down stock market. An investment category, or investment manager, who has a down-market ratio less than 100 has outperformed the index during a falling stock market. 

For example, a down-market capture ratio of 80 indicates that the portfolio measure declined only 80% as much as the index during the period. The downside capture ratio of high-dividend-yielding stocks, since 1927, has been 81% or lower over various long-term periods.  Put a better way, during months that the S&P 500 stock index fell, dividend stocks declined by nearly 19% less than the broader market.

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DOWNSIDE AND UPSIDE CAPTURE RATIOS OF HIGH DIVIDEND STOCKS – 1927 TO 2011  
The lower the number, the better    
                                                                            Downside 
                                                                              Capture Ratio 
   
Since 192781.53 
50-year67.45 
30-year65.86 
20-year65.83 
10-year81.61 
   

Source: Kenneth French as of 12/31/11

EDUCATION: Books

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

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OPTOMETRY Doctor [OD]

By Staff Reporters

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Optometry Doctor [OD]: An optometrist has an Optometry Doctor (OD) degree and can assess overall eye health and the quality of a person’s vision through a comprehensive examination. They diagnose and treat many eye disorders that do not require surgery or further specialized care. An optometrist can also identify symptoms of other health conditions that may affect the eyes, such as diabetes. Some also specialize in a field like pediatric care.

Optometrists [OD] and ophthalmologists [MD/DO] are both eye doctors, but they have different types of training and areas of expertise. If you need an eye exam—and think you may need glasses or contact lenses—an optometrist is a good first choice. To become an optometrist, a person needs to complete four years of additional education after a bachelor’s degree. Sometimes they complete a residency as well.

Now, ODs are licensed doctors and can prescribe medication. However, optometrists have a defined scope of practice that that revolves largely around the eyes. Optometrists can not prescribe all the same medications that your family doctor or ophthalmologist can.

So, if your eye issue requires surgery, or for specific conditions related to your eyes or overall health, you’ll want to visit an ophthalmologist [MD/DO].

On average, an optometrist in the U.S. makes about $131,860 per year, according to 2023 statistics.

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