PODCAST: Start-Ups & Healthcare Venture Capital in the COVID-19 Recession

By Eric Bricker MD

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: Hedge Fund Manager Michael Burry MD

In The Subprime of His Life – My Story

By Dr. David Edward Marcinko MBA, CMP™

[Editor-in-Chief]

I am a long time fan of financial industry journalist Michael Lewis [Liars’ Poker, Moneyball and others] who just released a new book. The Big Short is a chronicle of four players in the subprime mortgage market who had the foresight [and testosterone] to short the diciest mortgage deals: Steve Eisner of FrontPoint, Greg Lippmann at Deutsche Bank, the three partners at Cornwall Capital, and most indelibly, Wall Street outsider Michael Burry MD of Scion Capital.

They all walked away from the disaster with pockets full of money and reputations as geniuses.

About Mike

Now, I do not know the first three folks, but I do know a little something about my colleague Michael Burry MD; he is indeed a very smart guy. Mike is a nice guy too, who also has a natural writing style that I envy [just request and read his quarterly reports for a stylized sample]. He gave me encouragement and insight early in my career transformation – from doctor to “other”.

And, he confirmed my disdain for the traditional financial services [retail sales] industry, Wall Street and their registered representatives and ‘training’ system, and sad broker-dealer ethos [suitability versus fiduciary accountability] despite being a hedge fund manager himself.

I mentioned him in my book: “Insurance and Risk Management Strategies” [For Physicians and their Advisors].

http://www.amazon.com/Insurance-Management-Strategies-Physicians-Advisors/dp/0763733423/ref=sr_1_2?ie=UTF8&s=books&qid=1269254153&sr=1-2

He ultimately helped me eschew financial services organizations, “certifications”, “designations” and ”colleges”, and their related SEO rules, SEC regulations and policy wonks; and above all to go with my gut … and go it alone!

And so, I rejected my certified financial planner [marketing] designation status as useless for me, and launched the www.CertifiedMedicalPlanner.org on-line educational program for physician focused financial advisors and management consultants interested in the healthcare space … who wish to be fiduciaries.

And I thank Mike for the collegial good will. By the way, Mike is not a CPA, nor does he posses an MBA or related advanced degree or designation. He is not a middle-man FA. He is a physician. Unlike far too many other industry “financial advisors” he is not a lemming.

IOW: We are not salesman. We are out-of-the-box thinkers, innovators and contrarians by nature. www.MedicalBusinessAdvisors.com

From a Book Review

According to book reviewer Michael Osinski, writing in the March 22-29 issue of Businessweek.com, Lewis is at his best working with characters and Burry is rendered most vividly.

A loner from a young age, in part because he has a glass eye that made it difficult to look people in the face, Burry excelled at topics that required intense and isolated concentration. Originally, investing was just a hobby while he pursued a career in medicine. As a resident neurosurgeon at Stanford Hospital in the late 1990s, Burry often stayed up half the night typing his ideas onto a message board. Unbeknownst to him, professional money managers began to read and profit from his freely dispensed insight, and a hedge fund eventually offered him $1 million for a quarter of his investment firm, which consisted of a few thousand dollars from his parents and siblings. Another fund later sent him $10 million”.

“Burry’s obsession with finding undervalued companies eventually led him to realize that his own home in San Jose, Calif., was grossly overpriced, along with houses all over the country. He wrote to a friend: “A large portion of the current [housing] demand at current prices would disappear if only people became convinced that prices weren’t rising. The collateral damage is likely to be orders of magnitude worse than anyone now considers.” This was in 2003.

“Through exhaustive research, Burry understood that subprime mortgages would be the fuse and that the bonds based on these mortgages would start to blow up within as little as two years, when the original “teaser” rates expired. But Burry did something that separated him from all the other housing bears—he found an efficient way to short the market by persuading Goldman Sachs (GS) to sell him a CDS against subprime deals he saw as doomed. A unique feature of these swaps was that he did not have to own the asset to insure it, and over time, the trade in these contracts overwhelmed the actual market in the underlying bonds”.

“By June 2005, Goldman was writing Burry CDS contracts in $100 million lots, “insane” amounts, according to Burry. In November, Lippmann contacted Burry and tried to buy back billions of dollars of swaps that his bank had sold. Lippmann had noticed a growing wave of subprime defaults showing up in monthly remittance reports and wanted to protect Deutsche Bank from potentially massive losses. All it would take to cause major pain, Lippmann and his analysts deduced, was a halt in price appreciation for homes. An actual fall in prices would bring a catastrophe. By that time, Burry was sure he held winning tickets; he politely declined Lippmann’s offer”

And the rest, as they say, is history.

Link: http://www.businessweek.com/magazine/content/10_12/b4171094664065.htm

My Story … Being a Bit like Mike

I first contacted Mike, by phone and email, more than a decade ago. His hedge fund, Scion Capital, had no employees at the time and he outsourced most of the front and back office activities to concentrate on position selection and management. Early investors were relatives and a few physicians and professors from his medical residency days. Asset gathering was a slosh, indeed. And, in a phone conversation, I remember him confirming my impressions that doctors were not particularly astute investors. For him, they generally had sparse funds to invest as SEC “accredited investors” and were better suited for emerging tax advantaged mutual funds. ETFs were not significantly on the radar screen, back then, and index funds were considered unglamorous. No, his target hedge-fund audience was Silicon Valley.

And, much like his value-hero Warren Buffett [also a Ben Graham and David Dodd devotee], his start while from the doctor space, did not derive its success because of them.

Moreover, like me, he lionized the terms “value investing”, “margin of safety” and “intrinsic value”.

Co-incidentally, as a champion of the visually impaired, I was referred to him by author, attorney and blogger Jay Adkisson www.jayadkisson.com Jay is an avid private pilot having earned his private pilot’s license after losing an eye to cancer.

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Mike again re-entered my cognitive space while doing research for the first edition of our successful print book: “Financial Planning Handbook for Physicians and Advisors” and while searching for physicians who left medicine for alternate careers!

In fact, he wrote the chapter on hedge funds in our print journal and thru the third book edition before becoming too successful for such mundane stuff. We are now in our fourth edition, with a fifth in progress once the Obama administration stuff [healthcare and financial services industry “reform” and new tax laws] has been resolved

http://www.amazon.com/Financial-Planning-Handbook-Physicians-Advisors/dp/0763745790/ref=sr_1_1?ie=UTF8&s=books&qid=1269211056&sr=1-1

Assessment

News: Dr. Burry appeared on 60 Minutes Sunday March 14th, 2010. His activities with Scion Capital are portrayed in Michael Lewis’s newest book, The Big Short.  An excerpt is available in the April 2010 issue of Vanity Fair magazine, and at VanityFair.com 

Video of Dr. Burry: http://www.cbsnews.com/video/watch/?id=6298040n&tag=contentBody;housing

Video of Dr. Burry: http://www.cbsnews.com/video/watch/?id=6298038n&tag=contentBody;housing

PS: Michael Osinski retired from Wall Street and now runs Widow’s Hole Oyster Co. in Greenport, NY http://www.widowsholeoysters.com

And, our www.MedicalBusinessAdvisors.com related books can be reviewed here: http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dstripbooks&field-keywords=david+marcinko

Assessment

Visit Scion Capital LLC and tell us what you think http://www.scioncapital.com.

And to Mike himself, I say “Mazel Tov” and congratulations? I am sure you will be a good and faithful steward. The greatest legacy one can have is in how they treated the “little people.” You are a champ. Call me – let’s do lunch. And, I am still writing: www.BusinessofMedicalPractice.com for the conjoined space we both LOVE.

Conclusion

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

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

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

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[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

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

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

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AT YOUR SERVICE: Invite Dr. Marcinko to Your Next Event, Video Conference or Blog-Cast in 2022

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ABOUT | DAVID EDWARD MARCINKO

BY ANN MILLER RN CPHQ

Dr. Dave Marcinko at YOUR Service in 2021

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

MORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

PODCAST: Physicians Need to Be Trained as Entrepreneurs and Encouraged to Innovate!

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By Kevin Pho MD

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“Teaching medical students entrepreneurial and business skills is invaluable as the need for leadership in medicine grows in every single sector. Many physicians already engage in managerial and entrepreneurial-like practices without labeling these skills. By formalizing these skills into medical education, physicians will be able to take their ambitions and ideas about how to best run existing health care institutions and translate them into innovations for the future of the field.”

Sofia Yunez is a medical student.

She shares her story and discusses her KevinMD article, “To be effective leaders, physicians need to be trained as entrepreneurs and encouraged to innovate.”

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PODCAST: https://kevinmd.libsyn.com/physicians-need-to-be-trained-as-entrepreneurs-and-encouraged-to-innovate

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?s=books&ie=UTF8&qid=1287563112&sr=1-9

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PODCASTS: 36 Blue Cross / Blue Shield Organizations Explained

By Eric Bricker MD

By Laurence Baker MD

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PODCAST: Charter Communications Stock [Value Investing]

By Vitaliy Katsenelson CFA

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Charter Communications (CHTR) is a significantly undervalued stock today. But are competition, 5G, and satellite internet significant threats to its business? How does its management compare to AT&T and Verizon? Read and/or listen to the analysis below.

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A Doctor – Economist’s Solution for Health Reform

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

As President Obama spoke, prodded and cajoled for Congress to pass HR 3200-3400 in 2008, I believe that for any healthcare reform effort to work successfully for the American people – for the long term – we need to consider the following in no particular prioritized order:

  • Insurance portability uncoupled from patient employment
  • Health insurance regional exchanges with inter-state purchase competition
  • Doctor, drug, DME and hospital pricing and payment transparency for HSAs, and all of us
  • Modifying or eliminating AMA owned CPT Codes®; a huge money maker for them
  • Abandoning ala’ carte medicine for values-based outcomes
  • Reduce JCAHO influence; encourage competition from Norwegian Det Norske Veritas [DNV]
  • Reduce big-pharma influence thru-out the entire medical education, career and care pipeline
  • End DTC advertising from big-pharma
  • Promote wholesale drug purchase competition, MC bidding and generic drugs
  • Encourage evidence-based medicine, not expert-based medicine
  • Less pay for medical specialists with a  re-evaluation of the hospitalist concept
  • Advance the dying art of physical diagnosis, teach and embrace Paretto’s 80/20 rule for clinic issues
  • Reduce lab test, diagnostic imaging and testing
  • Encourage private 24/7/365 medical offices and clinics; and on-site and retail clinics
  • Abandon P4P, medical homes and disease management ideas
  • Give more economic skin-in-game to patients relative to health benchmarks
  • Concretize the “never-event” prohibitions and include a list of patient health responsibilities
  • More pay for primary care docs and internists
  • Adopt digital records and cloud computing for patients
  • Phase in true eHRs incrementally; and abandon CCHIT for open source SaaS
  • Promote Health 2.0 social media.
  • Augmented scope of practice, numbers and pay for NPs and DNPs, etc
  • Reduce pay for CRNAs and increase it for staff RNs
  • Develop step down triage and treatment units to reduce the number of full service ERs
  • Increase medical, osteopathic, dental, optometric and podiatric medical school classes
  • Increased practice scope for dentists, podiatrists and optometrists
  • Make some sort of catastrophic HI mandatory, much like auto insurance for all
  • End pre-existing conditon health insurance contract clauses
  • More choice  and end of life control for the terminally ill patient
  • Increase marketplace competition with fewer political and financial “externalities”.
  • Teach basic healthcare topics in school and encourage physical exercise
  • Health and insurance education should be, but is not, the “answer” for Americans
  • Protect borders and discourage undocumented illegals
  • Adopt medical malpractice tort reform
  • Make all stakeholders fiduciaries
  • No public “option” unless you like food stamps, Section 8 housing, public transportation and schools
  • Budget deficit neutrality
  • Slow down!

Assessment

Recently, while in the Baltimore/Washing area, I was asked by several reporters to opine on the healthcare debate; which I did so freely having never been known as the shy type. And, regular readers will note that many of these items have been used as posts or comments on this ME-P. Unfortunately, my “laundry list” interview was pre-empted by two local but boisterous town-hall meetings with respective passionate politicians. It was redacted no doubt, but never broadcast. Thus, I missed the potential for my “five minutes” of fame. C’est la vive!

Conclusion

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

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Healthcare Organizations: www.HealthcareFinancials.com

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Physician Advisors: www.CertifiedMedicalPlanner.com

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Professor VERSUS Entrepreneur

Teaching / Educating

Bill Hennessey, M.D.

Bill Hennessey, M.D.

As a teacher educating is your job. It’s what you enjoy. There’s a fairly lax time schedule and resources are already built in the equation. Little accountability because the ultimate burden and measure of success is placed on the student to pass a test. If they don’t do well, it’s the student not directly the teacher who pays the price.

Now, I work with first year students who don’t know what a red blood cell looks like (biconcave disc, you thought I forgot, didn’t you) all the way to a chief resident who can probably do some surgeries better than me. It’s my job to take that first year student and turn them into a chief resident.

As an entrepreneur with limited resources, time, and energy, you don’t have the luxury to continuously teach, develop, and convince. You need people who simply get it especially in strategic positions. You don’t have the luxury of time or resources. You also are directly accountable if they don’t understand because you have a burn rate that probably just got worse. So how much “oxygen” do you allocate when trying to build your team?

Different story for Apple, Boeing and others that can create academies and educational tracks to teach and develop internally.

ASSESSMENT: Your thoughts are appreciated.

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ENTREPRENEURSHIP Rising Again!

Try (or learn about) Entrepreneurship

BY DR. DAVID EDWARD MARCINKO MBA CMP®

One of the greatest things about the virtual economy is the expanded opportunity for people to branch out on their own and create something using their own expertise. Related to this is the growing societal desire to have more free time and a more balanced, efficient life overall. 

In fact, years ago when I was in business school, I learned that during a recession when jobs were sparse – folks would either go back to school to re-engineer and re-educate OR start their own business.

Today – If the pandemic taught us anything, it’s that we need to be able to pivot when circumstances call for it. In the years ahead, there will be a premium on flexibility, portability, and improvisation; knowing how to earn income outside the traditional employer-employee relationship will continue to be an especially valuable skill. 

entrepreneur

ASSESSMENT: So, if you are a physician, nurse, medical professional or financial advisor in the healthcare space, think about what you’re naturally good at (or at least interested in), and determine if there’s an opportunity to monetize it in some way on your own. Your career might thank you for it!

Your thoughts and comments are appreciated.

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UPDATE: Sentient GOOGLE, Corporate Earnings, the Markets and Cryptocurrency

By Staff Reporters

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Blake Lemoine, an engineer for Google’s responsible AI organization, described an AI system that he has been working on since last fall as sentient, with a perception of, and ability to express thoughts and feelings that was equivalent to a human child. He was promptly suspended.

Earnings Are Under Threat. Companies from Target to Microsoft have warned their results will be lower than expected, while analysts have trimmed earnings forecasts across industries. Investors will get further clarity next month when companies begin reporting results for the second quarter.

The S&P is in a historic slump having fallen in nine out of the past 10 weeks for just the third time since 1980. And cryptocurrencies, which trade 24/7, tumbled following another red-hot inflation report.


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Dr. Marcinko Interviewed on Physician Retirement and Succession Planning

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                  Physicians Have Unique Challenges, Opportunities

By Ann Miller RN MHA CMP

[Executive-Director]

Medical Executive-Post Publisher-in-Chief, Dr. David Edward Marcinko MBA CMP™, and financial planner Paul Larson CFP™, were interviewed by Sharon Fitzgerald for Medical News, Inc. Here is a reprint of that interview.

Doctors Squeezed from both Ends

Physicians today “are getting squeezed from both ends” when it comes to their finances, according Paul Larson, president of Larson Financial Group. On one end, collections and reimbursements are down; on the other end, taxes are up. That’s why financial planning, including a far-sighted strategy for retirement, is a necessity.

Larson Speaks

“We help these doctors function like a CEO and help them quarterback their plan,” said Larson, a Certified Financial Planner™ whose company serves thousands of physicians and dentists exclusively. Headquartered in St. Louis, Larson Financial boasts 19 locations.

Larson launched his company after working with a few physicians and recognizing that these clients face unique financial challenges and yet have exceptional opportunities, as well.

What makes medical practitioners unique? One thing, Larson said, is because they start their jobs much later in life than most people. Physicians wrap up residency or fellowship, on average, at the age of 32 or even older. “The delayed start really changes how much money they need to be saving to accomplish these goals like retirement or college for their kids,” he said.

Another thing that puts physicians in a unique category is that most begin their careers with a student-loan debt of $175,000 or more. Larson said that there’s “an emotional component” to debt, and many physicians want to wipe that slate clean before they begin retirement saving.

Larson also said doctors are unique because they are a lawsuit target – and he wasn’t talking about medical malpractice suits. “You can amass wealth as a doctor, get sued in five years and then lose everything that you worked so hard to save,” he said. He shared the story of a client who was in a fender-bender and got out of his car wearing his white lab coat. “It was bad,” Larson said, and the suit has dogged the client for years.

The Three Mistake of Retirement Planning

Larson said he consistently sees physicians making three mistakes that may put a comfortable retirement at risk.

  1. The first is assuming that funding a retirement plan, such as a 401(k), is sufficient. It’s not. “There’s no way possible for you to save enough money that way to get to that goal,” he said. That’s primarily due to limits imposed by the Internal Revenue Service, which allows a maximum contribution of $49,000 annually if self-employed and just $16,500 annually until the age of 50. He recommends that physicians throughout their career sock away 20 percent of gross income in vehicles outside of their retirement plan.
  2. The second common mistake is making investments that are inefficient from a tax perspective. In particular, real estate or bond investments in a taxable account prompt capital gains with each dividend, and that’s no way to make money, he said.
  3. The third mistake, and it’s a big one, is paying too much to have their money managed. A stockbroker, for example, takes a fee for buying mutual funds and then the likes of Fidelity or Janus tacks on an internal fee as well. “It’s like driving a boat with an anchor hanging off the back,” Larson said.

Marcinko Speaks

Dr. David E. Marcinko MBADr. David E. Marcinko MBA MEd CPHQ, a physician and [former] certified financial planner] and founder of the more specific program for physician-focused fiduciary financial advisors and consultants www.CertifiedMedicalPlanner.org, sees another common mistake that wreaks havoc with a physician’s retirement plans – divorce.

He said clients come to him “looking to invest in the next Google or Facebook, and yet they will get divorced two or three times, and they’ll be whacked 50 percent of their net income each time. It just doesn’t make sense.”

Marcinko practiced medicine for 16 years until about 10 years ago, when he sold his practice and ambulatory surgical center to a public company, re-schooled and retired. Then, his second career in financial planning and investment advising began. “I’m a doctor who went to business school about 20 years ago, before it was in fashion. Much to my mother’s chagrin, by the way,” he quipped. Marcinko has written 27 books about practice management, hospital administration and business, physician finances, risk management, retirement planning and practice succession. He’s the founder of the Georgia-based Institute of Medical Business Advisors Inc.

ECON

Succession Planning for Doctors

Succession planning, Marcinko said, ideally should begin five years before retirement – and even earlier if possible. When assisting a client with succession, Marcinko examines two to three years of financial statements, balance sheets, cash-flow statements, statements of earnings, and profit and loss statements, yet he said “the $50,000 question” remains: How does a doctor find someone suited to take over his or her life’s work? “We are pretty much dead-set against the practice broker, the third-party intermediary, and are highly in favor of the one-on-one mentor philosophy,” Marcinko explained.

“There is more than enough opportunity to befriend or mentor several medical students or interns or residents or fellows that you might feel akin to, and then develop that relationship over the years.” He said third-party brokers “are like real-estate agents, they want to make the sale”; thus, they aren’t as concerned with finding a match that will ensure a smooth transition.

The only problem with the mentoring strategy, Marcinko acknowledged, is that mentoring takes time, and that’s a commodity most physicians have too little of. Nonetheless, succession is too important not to invest the time necessary to ensure it goes off without a hitch.

Times are different today because the economy doesn’t allow physicians to gradually bow out of a practice. “My overhead doesn’t go down if I go part-time. SO, if I want to sell my practice for a premium price, I need to keep the numbers up,” he noted.

Assessment

Dr. Marcinko’s retirement investment advice – and it’s the advice he gives to anyone – is to invest 15-20 percent of your income in an Vanguard indexed mutual fund or diversified ETF for the next 30-50 years. “We all want to make it more complicated than it really is, don’t we?” he said.

QUESTION: What makes a physician moving toward retirement different from most others employees or professionals? Marcinko’s answer was simple: “They probably had a better shot in life to have a successful retirement, and if they don’t make it, shame on them. That’s the difference.”

More:

Conclusion

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

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

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

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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On New Issues and Securities Stabilization

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A Primer for Physician Investors and Medical Professionals

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

[Editor-in-Chief] http://www.CertifiedMedicalPlanner.org

[PART 3 OF 8]

NEU Dr. Marcinko

NOTE: This is an eight part ME-P series based on a weekend lecture I gave more than a decade ago to an interested group of graduate, business and medical school students. The material is a bit dated and some facts and specifics may have changed since then. But, the overall thought-leadership information of the essay remains interesting and informative. We trust you will enjoy it.

Introduction

Some securities issues move very well, like traditional blue chips stocks (ie., Wallgreen). Some are dogs, like smaller dot.com companies (iixl.com). Then, there are issues that are former darling, but are now ice cold; like PPMCs (i.e., Phycor) and internet stocks (i.e., Dr. Koop).  How far can an underwriting manager go in nudging along an issue that’s not selling well? SEC rules do permit a certain amount of help by the manager, even if this takes on the appearance of price-fixing. This help is called stabilizing the issue.

Simply put, if shortly after a new offering begins, supply exceeds demand, there will be downward pressure on the price. But, the law requires that all purchasers of the new issue pay the official offering price on the prospectus. If public holders of the stock become willing to bail out and accept a low selling price, the investor looking to buy will find he is able to buy stock of the issuer cheaper in the open market than buying it new from the syndicate members.

To prevent such a decline in the price of a security during a public offering, SEC rules permit the manager to offer to buy shares in \ the open market at a bid price at, or just below, the official offering price of the new issue. This is referred to as stabilizing and his bid price is called the stabilizing bid. There is always the risk, in a firm commitment underwriting, that the underwriters will have difficulty selling the new issue. What they can’t sell, they’re “stuck” with. That’s where the term “sticky issue” comes from.

As a physician executive, or potential investor in a new issue, be aware that the best way to get an issue to sell is to increase the compensation to the sales force (i.e., stock broker or Registered Rep).

Another choice is through stabilization. Stabilizing is a permitted form of market manipulation which tends to protect underwriters against loss. It allows the underwriting syndicate (usually through the efforts of the syndicate manager) to stabilize (peg or fix) the secondary market trading price in a new issue at the published public offering price. It works something like this.

When a new issue is selling slowly, some of the investors who initially purchased, may be dissatisfied with the performance of the stock (if it is selling slowly and the underwriters have plenty to sell at the public offering price, this is anything but a hot issue and the security price will not have risen).

This dissatisfaction with performance leads to these investors desiring to sell the securities they have just purchased. If the underwriters are unable to sell at the public offering price, certainly an individual investor will have to take less when bailing out. As market makers begin to trade the stock in the secondary market, they would only be able to compete with the underwriters by offering the stock at a lower price than the public offering  price. This would make it difficult (if not impossible) for the underwriters to distribute the remaining new shares.

In order to prevent this from happening, the managing underwriter (who is usually the one to assume the role of stabilizing underwriter), agrees to purchase back any of the new shares at or just slightly below the public offering price. That is a higher price than any market maker could, in all practicality, bid for the shares. When the shares are repurchased by the stabilizing underwriter, it is as if the initial trade were annulled and never took place so that these new shares are now placed back into the distribution and are sold as new shares at the public offering price. SEC rules do, however, require disclosure of this practice.

Therefore, no syndicate manager may engage in stabilizing unless the following phrase appears in bold print on the inside front cover page of the prospectus:

IN CONNECTION WITH THIS OFFERING, THE UNDERWRITERS MAY OVER ALLOT OR EFFECT TRANSACTIONS WHICH STABILIZE OR MAINTAIN THE MARKET PRICE OF (XYZ COMPANY) AT A LEVEL ABOVE THAT WHICH MIGHT OTHERWISE PREVAIL IN THE OPEN MARKET. SUCH TRANSACTIONS MAY BE EFFECTED ON (NYSE) STABILIZING, IF COMMENCED, MAY BE DISCONTINUED AT ANY TIME.

Of course, it would be manipulation and, therefore, a violation of law, if this “price-pegging” activity continued after the entire new issue was sold out. This activity costs the syndicate manager money which is recouped by levying a syndicate penalty bid against those members of the syndicate whose clients turn shares in on a stabilizing bid.

One way to avoid stabilization is to over allot  to each of the syndicate members. This is the same concept as “over booking” that’s done by the airlines. Most airlines typically sell 5% to 10% more seats than the airplane has knowing that there will be last minute cancellations and no shows. This tends to ensure that the plan will fly full. In the same manner, managing under-writers frequently over allot an additional 10% to each of their syndicate members so that last minute cancellations should still leave the syndicate with sell orders for 100% of the issue. If there are no “drop outs”, one of two things may happen.

  1. The issuer will issue the additional shares (which results in it raising more money).
  2. The issuer will not issue the additional shares and the syndicate will have to go short. Any losses suffered by the syndicate through taking of this short position are shared proportionately by the syndicate members.

Now, what if market conditions and the fervor surrounding a new issue like e-commerce company Ariba,  in 1999, remain so that the issue doesn’t cool down during the cooling off period? Such hot issues are a mixed blessing to be sure.

On the one hand, the issue is a sure sell-out. On the other hand, just how many healthcare investors are going to be told by brokers that additional shares can not be obtained.

Furthermore, the SEC and the NASD/FINRA are vigorous [or should be] in their scrutiny of  proper distribution channels for hot issues. Just what is a “proper” distribution?  It can be summed up in one sentence. Member firms have an obligation to make a “bona fide” public distribution of all the shares at the public offering price. The key to this rule lies within the definition of bona fide public distribution.

While the underwriting procedures for corporate bonds are almost identical to corporate stock, there are significant differences in the underwriting of municipal securities. Municipal securities are exempt from the registration filing requirements or the Securities Act of 1933. A state or local government, in the issuance of municipal securities, is not required to register the offering with the SEC, so there is no filing of a registration statement and there is no prospectus which would otherwise have to be given to investors.

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Municipal Underwriting

There are two main methods of financing when it comes to municipal securities. One method is known as negotiated. In the case of a negotiated sale, the municipality looking to borrow money would approach an investment bank and negotiate the terms of the offering directly with the firm. This is really not very different from the above equity discussions.

The other type of municipal underwriting is known as competitive bidding. Under the terms of competitive bidding, an issuer announces that it wishes to borrow money and is looking for syndicates to submit competitive bids. The issue will then be sold to the syndicate which submits the best bid, resulting in the municipality having the lowest net interest cost (lowest expense to the issuer).

If the issue is to be done by a competitive bid, the municipality will use a Notice of Sale to announce that fact. The notice of sale will generally include most or all of the following information.

  • Date, time, and place. This does not mean when the bonds will be sold to the public, but when the issue will be awarded (sold) to the syndicate issuing the bid.
  • Description of the issue and the manner in which the bid is to be made (sealed bid or oral). Type of bond (general obligation, revenue, etc.)
  • Semi-annual interest payment dates and the denominations in which the bonds will be printed.
  • Amount of good faith deposit required, if any.
  • Name of the law firm providing the legal opinion and where to acquire a bid form.
  • The basis upon which the bid will  e awarded, generally the lowest net interest cost.

Since municipal securities are not registered with the SEC, the municipality must hire a law firm in order to make sure that they are issuing the securities in compliance with all state, local and federal laws. This is known as the bond attorney, or independent bond counsel. Some functions are included below:

    1. Establishes the exemption from federal income tax by verifying  requirements for the exemption.
    2. Determines proper authority for the bond issuance.
    3. Identifies and monitors proper issuance procedures.
    4. Examines the physical bond  ertificates to make sure that they are proper
    5. Issues the debt and a legal opinion, since municipal bonds are the only securities that require an opinion.
    6. Does not prepare the official statement.

When medical investors purchase new issue municipal securities from syndicate or selling group members, there is no prospectus to be delivered to investors, but there is a document which is provided to purchasers very similar in nature to a prospectus. It is known as an Official Statement. The Official Statement contains all of the information an investor needs to make a prudent decision regarding a proposed municipal bond purchase.

The formation of a municipal underwriting syndicate is very similar to that for a corporate  issue. When there is a negotiated underwriting, an Agreement Among Underwriters (AAU) is used. When the issue is competitive bid, the agreement is known as a Syndicate Letter. In the syndicate letter, the managing underwriter details all of the underwriting agreements among members of the syndicate. Eastern (undivided) and Western (divided) accounts are also used, but there are  several different types of orders in a municipal underwriting. The traditional types of orders, in priority order, are:

Pre-Sale Order: Made before the syndicate actually offers the bonds. They have first priority over any other order turned in.

Syndicate (group net) Order: Made once the offering is under way at the public offering price. The purchase is credited to each syndicate member in proportion to its allotment. An institutional buyer will frequently purchase” group net”, since many of the firms in the syndicate may consider this buyer to be their client and he wishes to please all of them.

Designated Order: Sales to medical investors (usually healthcare institutions) at the public offering price where the investor designates which member or members of the syndicate are to be given credit.

Member Orders: Purchased  by members of  the syndicate at the take-down price (spread). The syndicate member keeps the full take-down if the bonds are sold to investors, or earns the take-down less the concession if the sale is made to a member of the selling group. Should the offering be over-subscribed, and the demand for the new bonds exceeds the supply, the first orders to be filled are the pre-sale orders. Those are followed by the syndicate (sometimes called group net) orders, the designated orders, and the last orders filled are the member’s.

Finally, be aware that the term bond scale, is a listing of coupon rates, maturity dates, and yield or price at which the syndicate is re-offering the bonds to the public. The scale is usually found in the center of a tombstone ad and on the front cover of the official statement.

One of the reasons why the word “scale” is used is, that like the scale on a piano, it normally goes up. A regular or positive scale is one in which the yield to maturity is lowest on the near term maturities and highest on the long term maturities. This is also known as a positive yield curve, since the longer the maturity, the higher the yield. In times of very tight money, such as in 1980-81, one might find a bond offering with a negative scale.

A negative (sometimes called inverted) scale is just the opposite of a positive one, with, yields on the short term maturities are higher than those on the long term maturities.

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RECAST: An Interview with Fiduciary Bennett Aikin AIF®

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On Financial Fiduciary Accountability

[By Dr. David E. Marcinko MBA & Prof. Hope Rachel Hetico; RN, MHA, CMP™]

[By Ann Miller; RN, MHA]

Currently, there is a growing dilemma in the financial sales and services industry. It goes something like this:

  • What is a financial fiduciary?
  • Who is a financial fiduciary?
  • How can I tell if my financial advisor is a fiduciary?

Now, in as much as this controversy affects laymen and physician-investors alike, we went right to the source for up-to-date information regarding this often contentious topic, for an email interview and Q-A session, with Ben Aikin.ben-aikin

About Bennett Aikin AIF® and fi360.com

Bennett [Ben] Aikin is the Communications Coordinator for fi360.com. He oversees all communications for fi360. His responsibilities include messaging, brand management, copyrights and trademarks, and publications. Mr. Aikin received his BA in English from Virginia Tech in 2003 and is currently an MS candidate in Journalism from Ohio University.

Q. Medical Executive Post 

You have been very helpful and gracious to us. So, let’s get right to it, Ben. In the view of many; attorneys, doctors, CPAs and the clergy are fiduciaries; most all others who retain this title seem poseurs; sans documentation otherwise.

A. Mr. Aikin

You are correct. Attorneys, doctors and clergy are the prototype fiduciaries. They have a clear duty to put the best interests of their clients, patients, congregation, etc., above their own. [The duty of a CPA isn’t as clear to me, although I believe you are correct]. Furthermore, this is one of the first topics we address in our AIF training programs, and what we call the difference between a profession and an industry.  The three professions you name have three common characteristics that elevate them from an industry to a profession:

  1. Recognized body of knowledge
  2. Society depends upon practitioners to provide trustworthy advice
  3. Code of conduct that places the clients’ best interests first

Q. Medical Executive Post 

It seems that Certified Financial Planner®, Chartered Financial Analysts, Registered Investment Advisors and their representatives, Registered Representative [stock-brokers] and AIF® holders, etc, are not really financial fiduciaries, either by legal statute or organizational charter. Are we correct, or not? Of course, we are not talking ethics or morality here. That’s for the theologians to discuss.

A. Mr. Aikin

One of the reasons for the “alphabet soup”, as you put it in one of your white papers [books, dictionaries and posts] on financial designations, is that while there is a large body of knowledge, there is no one recognized body of knowledge that one must acquire to enter the financial services industry.  The different designations serve to provide a distinguisher for how much and what parts of that body of knowledge you do possess.  However, being a fiduciary is exclusively a matter of function. 

In other words, regardless of what designations are held, there are five things that will make one a fiduciary in a given relationship:

  1. You are “named” in plan or trust documents; the appointment can be by “name” or by “title,” such as CFO or Head of Human Resources
  2. You are serving as a trustee; often times this applies to directed trustees as well
  3. Your function or role equates to a professional providing comprehensive and continuous investment advice
  4. You have discretion to buy or sell investable assets
  5. You are a corporate officer or director who has authority to appoint other fiduciaries

So, if you are a fiduciary according to one of these definitions, you can be held accountable for a breach in fiduciary duty, regardless of any expertise you do, or do not have. This underscores the critical nature of understanding the fiduciary standard and delegating certain duties to qualified “professionals” who can fulfill the parts of the process that a non-qualified fiduciary cannot.

Q. Medical Executive Post 

How about some of the specific designations mentioned on our site, and elsewhere. I believe that you may be familiar with the well-known financial planner, Ed Morrow, who often opines that there are more than 98 of these “designations”? In fact, he is the founder of the Registered Financial Consultants [RFC] designation. And, he wrote a Foreword for one of our e-books; back-in-the-day. His son, an attorney, also wrote as a tax expert for us, as well. So, what gives?

A. Mr. Aikin

As for the specific designations you list above, and elsewhere, they each signify something different that may, or may not, lend itself to being a fiduciary: For example:

• CFP®: The act of financial planning does very much imply fiduciary responsibility.  And, the recently updated CFP® rules of conduct does now include a fiduciary mandate:

• 1.4 A certificant shall at all times place the interest of the client ahead of his or her own. When the certificant provides financial planning or material elements of the financial planning process, the certificant owes to the client the duty of care of a fiduciary as defined by CFP Board. [from http://www.cfp.net/Downloads/2008Standards.pdf]

•  CFA: Very dependent on what work the individual is doing.  Their code of ethics does have a provision to place the interests of clients above their own and their Standards of Practice handbook makes clear that when they are working in a fiduciary capacity that they understand and abide by the legally mandated fiduciary standard.

• FA [Financial Advisor]: This is a generic term that you may find being used by a non-fiduciary, such as a broker, or a fiduciary, such as an RIA.

• RIA: Are fiduciaries.  Registered Investment Advisors are registered with the SEC and have obligations under the Investment Advisers Act of 1940 to provide services that meet a fiduciary standard of care.

• RR: Registered Reps, or stock-brokers, are not fiduciaries if they are doing what they are supposed to be doing.  If they give investment advice that crosses the line into “comprehensive and continuous investment advice” (see above), their function would make them a fiduciary and they would be subject to meeting a fiduciary standard in that advice (even though they may not be properly registered to give advice as an RIA).

• AIF designees: Have received training on a process that meets, and in some places exceeds, the fiduciary standard of care.  We do not require an AIF® to always function as a fiduciary. For example, we allow registered reps to gain and use the AIF® designation. In many cases, AIF designees are acting as fiduciaries, and the designation is an indicator that they have the full understanding of what that really means in terms of the level of service they provide.  We do expect our designees to clearly disclose whether they accept fiduciary responsibility for their services or not and advocate such disclosure for all financial service representatives.

Q. Medical Executive Post 

Your website, http://www.fi360.com, seems to suggest, for example, that banks/bankers are fiduciaries. We have found this not to be the case, of course, as they work for the best interests of the bank and stockholders. What definitional understanding are we missing?

A. Mr. Aikin

Banks cannot generally be considered fiduciaries.  Again, it is a matter of function. A bank may be a named trustee, in which case a fiduciary standard would generally apply.  Banks that sell products are doing so according to their governing regulations and are “prudent experts” under ERISA, but not necessarily held to a fiduciary standard in any broader sense.

Q. Medical Executive Post 

And so, how do we rectify the [seemingly intentional] industry obfuscation on this topic. We mean, our readers, subscribers, book and dictionary purchasers, clients and colleagues are all confused on this topic. The recent financial meltdown only stresses the importance of understanding same.

For example, everyone in the industry seems to say they are the “f” word. But, our outreach efforts to contact traditional “financial services” industry pundits, CFP® practitioners and other certification organizations are continually met with resounding silence; or worse yet; they offer an abundance of parsed words and obfuscation but no confirming paperwork, or deep subject-matter knowledge as you have kindly done. We get the impression that some FAs honesty do-not have a clue; while others are intentionally vague.

A. Mr. Aikin

All of the evidence you cite is correct.  But that does not mean it is impossible to find an investment advisor who will manage to a fiduciary standard of care and acknowledge the same. The best way to rectify confusion as it pertains to choosing appropriate investment professionals is to get fiduciary status acknowledged in writing and go over with them all of the necessary steps in a fiduciary process to ensure they are being fulfilled. There also are great resources out there for understanding the fiduciary process and for choosing professionals, such as the Department of Labor, the SEC, FINRA, the AICPA’s Personal Financial Planning division, the Financial Planning Association, and, of course, Fiduciary360.

We realize the confusion this must cause to those coming from the health care arena, where MD/DO clearly defines the individual in question; as do other degrees [optometrist, clinical psychologist, podiatrist, etc] and medical designations [fellow, board certification, etc.]. But, unfortunately, it is the state of the financial services industry as it stands now.

Q. Medical Executive Post 

It is as confusing for the medical community, as it is for the lay community. And, after some research, we believe retail financial services industry participants are also confused. So, what is the bottom line?

A. Mr. Aikin

The bottom line is that lay, physician and all clients have a right to expect and demand a fiduciary standard of care in the managing of investments. And, there are qualified professionals out there who are providing those services.  Again, the best way to ensure you are getting it is to have fiduciary status acknowledged in writing, and go over the necessary steps in a fiduciary process with them to ensure it is being fulfilled.

Q. Medical Executive Post 

The “parole-evidence” rule, of contract law, applies, right? In dealing with medical liability situations, the medics and malpractice attorneys have a rule: “if it wasn’t written down, it didn’t happen.”  

A. Mr. Aikin

An engagement contract accepting fiduciary status should trump a subsequent attempt to claim the fiduciary standard didn’t apply. But, to reiterate an earlier point, if someone acts in one of the five functional fiduciary roles, they are a fiduciary whether they choose to acknowledge it or not.  I have attached a sample acknowledgement of fiduciary status letter with copies of our handbook, which details the fiduciary process we instruct in our programs, and our SAFE, which is basically a checklist that a fiduciary should be able to answer “Yes” to every question to ensure the entire fiduciary process is being covered.

Q. Medical Executive Post 

It is curious that you mention checklists. We have a post arguing that very theme for doctors and hospitals as they pursue their medial error reduction, and quality improvement, endeavors. And, we applaud your integrity, and wish only for clarification on this simple fiduciary query?

A. Mr. Aikin

Simple definition: A fiduciary is someone who is managing the assets of another person and stands in a special relationship of trust, confidence, and/or legal responsibility.

Q. Medical Executive Post 

Who is a financial fiduciary and what, if any, financial designation indicates same?

A. Mr. Aikin

Functional definition: See above for the five items that make you a fiduciary.

Financial designations that unequivocally indicate fiduciary duty: Short answer is none, only function can determine who is a fiduciary. 

Q. Medical Executive Post 

Please repeat that?

A. Mr. Aikin

Financial designations that indicate fiduciary duty: none. It is the function that determines who is a fiduciary.  Now, having said that, the CFP® certification comes close by demanding their certificants who are engaged in financial planning do so to a fiduciary standard. Similarly, other designations may certify the holder’s ability to perform a role that would be held to a fiduciary standard of care.  The point is that you are owed a fiduciary standard of care when you engage a professional to fill that role or they functionally become one.  And, if you engage a professional to fill a non-fiduciary role, they will not be held to a fiduciary standard simply because they have a particular designation.  One of the purposes the designations serve is to inform you what roles the designation holder is capable of fulfilling.

It is also worth keeping in mind that just being a fiduciary doesn’t equate to a full knowledge of the fiduciary standard. The AIF® designation indicates having been fully trained on the standard.

Q. Medical Executive Post 

Yes, your website mentions something about fiduciaries that are not aware of same! How can this be? Since our business model mimics a medical model, isn’t that like saying “the doctor doesn’t know he is doctor?” Very specious, with all due respect!

A. Mr. Aikin

I think it is first important to note that this statement is referring not just to investment professionals.  Part of the audience fi360 serves is investment stewards, the non-professionals who, due to facts and circumstances, still owe a fiduciary duty to another.  Examples of this include investment committee members, trustees to a foundation, small business owners who start 401k plans, etc.  This is a group of non-sophisticated investors who may not be aware of the full array of responsibilities they have. 

However, even on the professional side I believe the statement isn’t as absurd as it sounds.  This is basically a protection from both ignorant and unscrupulous professionals.  Imagine a registered representative who, either through ignorance or design, begins offering comprehensive and continuous investment advice.  Though they may deny or be unaware of the fact, they have opened themselves up to fiduciary liability. 

Q. Medical Executive Post 

Please clarify the use of arbitration clauses in brokerage account contracts for us. Do these disclaim fiduciary responsibility? If so, does the client even know same?

A. Mr. Aikin

By definition, an engagement with a broker is a non-fiduciary relationship.  So, unless other services beyond the scope of a typical brokerage account contract are specified, fiduciary responsibility is inherently not applicable.  Unfortunately, I do imagine there are clients who don’t understand this. Furthermore, AIF® designees are not prohibited from signing such an agreement and there are some important points to understand the reasoning.

First, by definition, if you are entering into such an agreement, you are entering into a non-fiduciary relationship. So, any fiduciary requirement wouldn’t apply in this scenario.

Second, if this same question were applied into a scenario of a fiduciary relationship, such as with an RIA, this would be a method of dispute resolution, not a practice method. So, in the event of dispute, the advisor and investor would be free to agree to the method of resolution of their choosing. In this scenario, however, typically the method would not be discussed until the dispute itself arose.

Finally, it is important to know that AIF/AIFA designees are not required to be a fiduciary. It is symbolic of the individuals training, knowledge and ongoing development in fiduciary processes, but does not mean they will always be acting as a fiduciary.

Q. Medical Executive Post 

Don’t the vast majority of arbitration hearings find in favor of the FA; as the arbitrators are insiders, often paid by the very same industry itself?

A. Mr. Aikin

Actual percentages are reported here: http://www.finra.org/ArbitrationMediation/AboutFINRADR/Statistics/index.htm However, brokerage arbitration agreements are a dispute resolution method for disputes that arise within the context of the securities brokerage industry and are not the only means of resolving differences for all types of financial advisors.  Investment advisers, for example, are subject to respond to disputes in a variety of forums including state and federal courts.  Clients should look at their brokerage or advisory agreement to see what they have agreed to. If you wanted to go into further depth on this question, we would recommend contacting Brian Hamburger, who is a lawyer with experience in this area and an AIFA designee. Bio page: http://www.hamburgerlaw.com/attorneys/BSH.htm.

Q. Medical Executive Post 

What about our related Certified Medical Planner® designation, and online educational program for financial advisors and medical management consultants? Is it a good idea – reasonable – for the sponsor to demand fiduciary accountability of these charter-holders? Cleary, this would not only be a strategic competitive advantage, but advance the CMP™ mission to put medical colleagues first and champion their cause www.CertifiedMedicalPlanner.org above all else. 

A. Mr. Aikin

I think it is a good idea for any plan sponsor to demand fiduciary status be acknowledged from anyone engaged to provide comprehensive and continuous investment advice.  I also think it is a good idea to be proactive in verifying that the fiduciary process is being followed.

Q. Medical Executive Post 

Is there anything else that we should know about this topic?

A. Mr. Aikin

Yes, a further note about fi360’s standards. I wrote generically about the fiduciary standard, because there is one that is defined by multiple sources of regulation, legislation and case law.  The process defined in our handbooks, we call a Fiduciary Standard of Excellence, because it covers that minimum standard and also best practice standards that go above and beyond.  All of our Practices, which comprise that standard, are legally substantiated in our Legal Memoranda handbook, which was written by Fred Reish’s law firm, who is considered a leading ERISA attorney.

Additional resources:

Q. Medical Executive Post 

Thank you so much for your knowledge and willingness to frankly share it with the Medical-Executive-Post.

Assessment

All are invited to continue the conversation with Mr. Aikin, asynchronously online, or thru this contact information:

fi360.com
438 Division Street
Sewickley, PA 15143
412-741-8140 Phone
866-390-5080 Toll-free phone
412-741-8142 Fax

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

LEXICONS: http://www.springerpub.com/Search/marcinko
PRACTICES: www.BusinessofMedicalPractice.com
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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
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BLOG: www.MedicalExecutivePost.com

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PODCAST: Mental Health Interview with Milton L. Mack Jr.

RIP NAOMI JUDD

[Original Rebroadcast]

The Common Bridge by Rick Helppie

Mental Health, Jury Bias, and Judicial Reform, with the Honorable Milton L. Mack Jr.
Rich brings back the Honorable Milton L. Mack, Jr. for a discussion on Mental Health, Jury Bias, and Judicial Reform. Judge Mack has been a leading voice on how mental health issues affect over half of the court cases in the US and how this needs to be addressed in judicial reform. He has also been on the forefront of bringing cutting edge technology into the courtroom.

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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STO LOT Spring Greetings = Life to 100 Hundred Years?

About Centenarians

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By Dr. David Edward Marcinko MBA CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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DEFINITION: A centenarian is a person who has reached the age of 100 years. Because life expectancy worldwide are below 100 years, the term is invariably associated with longevity. In 2012, the United Nations estimated that there were 316,600 living centenarians worldwide.

CITE: https://www.r2library.com/Resource/Title/082610254

Sto Lat (One Hundred Years) is a traditional Polish song that is sung to express good wishes, good health and long life to a person. It is also a common way of wishing someone a happy birthday in Polish. Sto lat is used in the Spring, many birthdays and on international days of language.

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What Percentage of the Population Lives to 100?

According to the Social Security Administration, the overall chances of living to 100 aren’t actually that great. And, according to the World Economic Forum, there are over 500,000 centenarians among the 7.9 billion people worldwide. That means that only a 0.006% of the population is 100 or more.

Here are a few additional facts from the most recently available information from the Society of Actuaries and the Social Security Administration:

  • One out of three males and one out of two females who are in their mid-50s today will live to be 90.
  • For a couple who is 65 today, there is a 50% chance that one person will be alive at 92.
  • If you have lived to be 65, you will likely live another 20 years, on average.
  • If you live to be 75, the average life expectancy is 88.
  • If you live to be 85, the average life expectancy is 92.
  • And, if you live to be 95, the average life expectancy is 98.

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COVID, Inflation and Value Investing [Millennial Interview]

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By Vitaliy Katsenelson CFA

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COVID, Inflation, and Value Investing: Millennial Investing Interview
I was recently interviewed by Millennial Investors podcast. They sent me questions ahead of time that they wanted to ask me “on the air”. I found some of the questions very interesting and wanted to explore deeper. Thus, I ended up writing answers to them (I think through writing). You can listen to the podcast here

By the way, I often get asked how I find time to write. Do I even do investment research? Considering how much content I’ve been spewing out lately, I can understand these questions. In short – I write two hours a day, early in the morning (usually from 5–7am), every single day. I don’t have time-draining hobbies like golf. I rarely watch sports. I have a great team at IMA, and I delegate a lot. I spend the bulk of my day on research because I love doing it. 

This is not the first time I was asked these questions. If you’d like to adapt some of my daily hacks in your life, read this essay.

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CITE: https://www.r2library.com/Resource/Title/082610254

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On Immigrant Entrepreneurs and the USA

Shape the Start-Up Economy

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COMMENTS APPRECIATED

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Common Entrepreneurial Mistakes

BY JONATHAN MASE R.N.

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Being an entrepreneur is not necessarily easy, and many people that try to become entrepreneurs wind up failing. It’s important to recognize the risk of failure before you decide to walk down this path. Being an entrepreneur is very rewarding, and you can find success if you can do things right.

Keep reading to learn about common entrepreneurial mistakes that you can avoid to give yourself a better chance of realizing your entrepreneurial goals. 

READ: https://jonathanmase.wordpress.com/2021/08/06/common-entrepreneurial-mistakes/

Your comments are appreciated.

THANK YOU

MD Entrepreneurs: https://medicalexecutivepost.com/2021/07/29/minnovation-for-physician-entrepreneurs/

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BUSINESS PLAN CONSTRUCTION: For Health Industry Modernity

FOR MEDICAL AND HEALTHCARE ENTREPRENEURS AND INNOVATORS

By Dr. David Edward Marcinko MBA MEd CMP®

I was asked by business schools and medical colleagues – and their bankers, CPAs and advisors – to speak about this topic several times last year before the pandemic.

Now, with the specter of M-4-A etc; it certainly is a vital concern to all young entrepreneurs, doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.

Now, with the specter of tele-health, tele-medicine, M-4-A etc; it certainly is a vital concern to all young doctors & medical professionals whether live, audio recorded or in podcast form. And so, here is a written transcript of a recent presentation for your review.

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New Product Business Plan Sample [2021 Updated] | OGScapital

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READ: https://healthcarefinancials.files.wordpress.com/2017/08/mba-business-plan-capstone-outline.pdf

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PODCAST: Ray Dalio on How the Healthcare Economy Works

Economy Works’ Applied to Healthcare … Credit Cycles and Healthcare Policy

By Eric Bricker MD

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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

RICARDIAN DEMAND HEALTH ECONOMICS: https://medicalexecutivepost.com/2021/12/14/ricardian-derived-demand-economics-in-medicine/

RISING HEALTH CARE COSTS: https://medicalexecutivepost.com/2018/03/11/medical-treatment-costs-becoming-expensive-25-factors/

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INFLATION Is Here – UPDATE?

But for How Long?

See the source image

Vitaliy N. Katsenelson, CFA

[CEO & Chief Investment Officer]

READERS

DEFINITION: In economics, inflation (or less frequently, price inflation) is a general rise in the price level of an economy over a period of time. When the general price level rises, each unit of currency buys fewer goods and services; consequently, inflation reflects a reduction in the purchasing power per unit of money – a loss of real value in the medium of exchange and unit of account within the economy. The opposite of inflation is deflation, a sustained decrease in the general price level of goods and services. The common measure of inflation is the inflation rate, the annualized percentage change in a general price index, usually the consumer price index, over time.

CITATION: https://www.r2library.com/Resource/Title/0826102549

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See the source image

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DEAR READERS

This essay is going to be long.
I blame inflation, be it transitory or not, for inflating its length. 

The number one question I am asked by clients, friends, readers, and random strangers is, are we going to have inflation? 

I think about inflation on three timelines: short, medium, and long-term

The pandemic disrupted a well-tuned but perhaps overly optimized global economy and time-shifted the production and consumption of various goods. For instance, in the early days of the pandemic automakers cut their orders for semiconductors. As orders for new cars have come rolling back, it is taking time for semiconductor manufacturers, who, like the rest of the economy, run with little slack and inventory, to produce enough chips to keep up with demand. A $20 device the size of a quarter that goes into a $40,000 car may have caused a significant decline in the production of cars and thus higher prices for new and used cars. (Or, as I explained to my mother-in-law, all the microchips that used to go into cars went into a new COVID vaccine, so now Bill Gates can track our whereabouts.)

Here is another example. The increase in new home construction and spike in remodeling drove demand for lumber while social distancing at sawmills reduced lumber production – lumber prices spiked 300%. Costlier lumber added $36,000 to the construction cost of a house, and the median price of a new house in the US is now about $350,000.

The semiconductor shortage will get resolved by 2022, car production will come back to normal, and supply and demand in the car market will return to the pre-pandemic equilibrium. High prices in commodities are cured by high prices. High lumber prices will incentivize lumber mills to run triple shifts. Increased supply will meet demand, and lumber prices will settle at the pre-pandemic level in a relatively short period of time. That is the beauty of capitalism! 

Most high prices caused by the time-shift in demand and supply fall into the short-term basket, but not all. It takes a considerable amount of time to increase production of industrial commodities that are deep in the ground – oil, for instance. Low oil prices preceding the pandemic were already coiling the spring under oil prices, and COVID coiled it further. It will take a few years and increased production for high oil prices to cure high oil prices. Oil prices may also stay high because of the weaker dollar, but we’ll come back to that.

Federal Reserve officials have told us repeatedly they are not worried about inflation; they believe it is transitory, for the reasons I described above. We are a bit less dismissive of inflation, and the two factors that worry us the most in the longer term are labor costs and interest rates. 

Let’s start with labor costs 

During a garden-variety recession, companies discover that their productive capacity exceeds demand. To reduce current and future output they lay off workers and cut capital spending on equipment and inventory. The social safety net (unemployment benefits) kicks in, but not enough to fully offset the loss of consumer income; thus demand for goods is further reduced, worsening the economic slowdown. Through millions of selfish transactions (microeconomics), the supply of goods and services readjusts to a new (lower) demand level. At some point this readjustment goes too far, demand outstrips supply, and the economy starts growing again.

This pandemic was not a garden-variety recession 

The government manually turned the switch of the economy to the “off” position. Economic output collapsed. The government sent checks to anyone with a checking account, even to those who still had jobs, putting trillions of dollars into consumer pockets. Though output of the economy was reduced, demand was not. It mostly shifted between different sectors within the economy (home improvement was substituted for travel spending). Unlike in a garden-variety recession, despite the decline in economic activity (we produced fewer widgets), our consumption has remained virtually unchanged. Today we have too much money chasing too few goods– that is what inflation is. This will get resolved, too, as our economic activity comes back to normal.

But …

Today, though the CDC says it is safe to be inside or outside without masks, the government is still paying people not to work. Companies have plenty of jobs open, but they cannot fill them. Many people have to make a tough choice between watching TV while receiving a paycheck from big-hearted Uncle Sam and working. Zero judgement here on my part – if I was not in love with what I do and had to choose between stacking boxes in Amazon’s warehouse or watching Amazon Prime while collecting a paycheck from a kind uncle, I’d be watching Sopranos for the third time. 

To entice people to put down the TV remote and get off the couch, employers are raising wages. For instance, Amazon has already increased minimum pay from $15 to $17 per hour. Bank of America announced that they’ll be raising the minimum wage in their branches from $20 to $25 over the next few years. The Biden administration may not need to waste political capital passing a Federal minimum wage increase; the distorted labor market did it for them. 

These higher wages don’t just impact new employees, they help existing employees get a pay boost, too. Labor is by far the biggest expense item in the economy. This expense matters exponentially more from the perspective of the total economy than lumber prices do. We are going to start seeing higher labor costs gradually make their way into higher prices for the goods and services around us, from the cost of tomatoes in the grocery store to the cost of haircuts.

Only investors and economists look at higher wages as a bad thing. These increases will boost the (nominal) earnings of workers; however, higher prices of everything around us will negate (at least) some of the purchasing power. 

Wages, unlike timber prices, rarely decline. It is hard to tell someone “I now value you less.” Employers usually just tell you they need less of your valuable time (they cut your hours) or they don’t need you at all (they lay you off and replace you with a machine or cheap overseas labor). It seems that we are likely going to see a one-time reset to higher wages across lower-paying jobs. However, once the government stops paying people not to work, the labor market should normalize; and inflation caused by labor disbalance should come back to normal, though increased higher wages will stick around.

There is another trend that may prove to be inflationary in the long-term: de-globalization.  Even before the pandemic the US set plans to bring manufacturing of semiconductors, an industry deemed strategic to its national interests, to its shores. Taiwan Semiconductor and Samsung are going to be spending tens of billions of dollars on factories in Arizona.  

The pandemic exposed the weaknesses inherent in just-in-time manufacturing but also in over reliance on the kindness of other countries to manufacture basic necessities such as masks or chemicals that are used to make pharmaceuticals.  Companies will likely carry more inventory going forward, at least for a while.  But more importantly more manufacturing will likely come back to the US. This will bring jobs and a lot of automation, but also higher wages and thus higher costs.  

If globalization was deflationary, de-globalization is inflationary  

We are not drawing straight-line conclusions, just yet. A lot of manufacturing may just move away from China to other low-cost countries that we consider friendlier to the US; India and Mexico come to mind.  

And then we have the elephant in the economy – interest rates, the price of money. It’s the most important variable in determining asset prices in the short term and especially in the long term. The government intervention in the economy came at a significant cost, which we have not felt yet: a much bigger government debt pile. This pile will be there long after we have forgotten how to spell social distancing
 
The US government’s debt increased by $5 trillion to $28 trillion in 2020 – more than a 20% increase in one year! At the same time the laws of economics went into hibernation: The more we borrow the less we pay for our debt, because ultra-low interest rates dropped our interest payments from $570 billion in 2019 to $520 billion in 2020. 

That is what we’ve learned over the last decade and especially in 2020: The more we borrow the lower interest we pay. I should ask for my money back for all the economics classes I took in undergraduate and graduate school.

This broken link between higher borrowing and near-zero interest rates is very dangerous. It tells our government that how much you borrow doesn’t matter; you can spend (after you borrow) as much as your Republican or Democratic heart desires. 

However, by looking superficially at the numbers I cited above we may learn the wrong lesson. If we dig a bit deeper, we learn a very different lesson: Foreigners don’t want our (not so) fine debt. It seems that foreign investors have wised up: They were not the incremental buyer of our new debt – most of the debt the US issued in 2020 was bought by Uncle Fed. Try explaining to your kids that our government issued debt and then bought it itself. Good luck.

Let me make this point clear: Neither the Federal Reserve, nor I, nor a well-spoken guest on your business TV knows where interest rates are going to be (the total global bond market is bigger even than the mighty Fed, and it may not be able to control over interest rates in the long run). But the impact of what higher interest rates will do the economy increases with every trillion we borrow. There is no end in sight for this borrowing and spending spree (by the time you read this, the administration will have announced another trillion in spending). 

Let me provide you some context about our financial situation 


The US gross domestic product (GDP) – the revenue of the economy – is about $22 trillion, and in 2019 our tax receipts were about $3.5 trillion. Historically, the-10 year Treasury has yielded about 2% more than inflation. Consumer prices (inflation) went up 4.2% in April. Today the 10-year Treasury pays 1.6%; thus the World Reserve Currency debt has a negative 2.6% real interest rate (1.6% – 4.2%). 

These negative real (after inflation) interest rates are unlikely to persist while we are issuing trillions of dollars of debt. But let’s assume that half of the increase is temporary and that 2% inflation is here to stay. Let’s imagine the unimaginable. Our interest rate goes up to the historical norm to cover the loss of purchasing power caused by inflation. Thus it goes to 4% (2 percentage points above 2% “normal” inflation). In this scenario our federal interest payments will be over $1.2 trillion (I am using vaguely right math here). A third of our tax revenue will have to go to pay for interest expense. Something has to give. It is not going to be education or defense, which are about $230 billion and $730 billion, respectively. You don’t want to be known as a politician who cut education; this doesn’t play well in the opponent’s TV ads. The world is less safe today than at any time since the end of the Cold War, so our defense spending is not going down (this is why we own a lot of defense stocks). 

The government that borrows in its own currency and owns a printing press will not default on its debt, at least not in the traditional sense. It defaults a little bit every year through inflation by printing more and more money. Unfortunately, the average maturity of our debt is about five years, so it would not take long for higher interest expense to show up in budget deficits. 

Money printing will bring higher inflation and thus even higher interest rates

If things were not confusing enough, higher interest rates are also deflationary 

We’ve observed significant inflation in asset prices over the last decade; however, until this pandemic we had seen nothing yet. Median home prices are up 17% in one year. The wild, speculative animal spirits reached a new high during the pandemic. Flush with cash (thanks to kind Uncle Sam), bored due to social distancing, and borrowing on the margin (margin debt is hitting a 20-year high), consumers rushed into the stock market, turning this respectable institution (okay, wishful thinking on my part) into a giant casino. 

It is becoming more difficult to find undervalued assets. I am a value investor, and believe me, I’ve looked (we are finding some, but the pickings are spare). The stock market is very expensive. Its expensiveness is setting 100-year records. Except, bonds are even more expensive than stocks – they have negative real (after inflation) yields.

But stocks, bonds, and homes were not enough – too slow, too little octane for restless investors and speculators. Enter cryptocurrencies (note: plural). Cryptocurrencies make Pets.com of the 1999 era look like a conservative investment (at least it had a cute sock commercial). There are hundreds if not thousands of crypto “currencies,” with dozens created every week. (I use the word currency loosely here. Just because someone gives bits and bytes a name, and you can buy these bits and bytes, doesn’t automatically make what you’re buying a currency.)

“The definition of a bubble is when people are making money all out of proportion to their intelligence or work ethic.”

By Mike Burry MD
[The Big Short]

I keep reading articles about millennials borrowing money from their relatives and pouring their life savings into cryptocurrencies with weird names, and then suddenly turning into millionaires after a celebrity CEO tweets about the thing he bought. Much ink is spilled to celebrate these gamblers, praising them for their ingenious insight, thus creating ever more FOMO (fear of missing out) and spreading the bad behavior.

Unfortunately, at some point they will be writing about destitute millennials who lost all of their and their friends’ life savings, but this is down the road. Part of me wants to call this a crypto craziness a bubble, but then I think, Why that’s disrespectful to the word bubble, because something has to be worth something to be overpriced. At least tulips were worth something and had a social utility. (I’ll come back to this topic later in the letter).

But ….

When interest rates are zero or negative, stocks of sci-fi-novel companies that are going to colonize and build five-star hotels on Mars are priced as if El Al (the Israeli airline) has regular flights to the Red Planet every day of the week except on Friday (it doesn’t fly on Shabbos). Rising interest rates are good defusers of mass delusions and rich imaginations. 

In the real economy, higher interest rates will reduce the affordability of financed assets. They will increase the cost of capital for businesses, which will be making fewer capital investments. No more 2% car loans or 3% business loans. Most importantly, higher rates will impact the housing market. 

Up to this point, declining interest rates increased the affordability of housing, though in a perverse way: The same house with white picket fences (and a dog) is selling for 17% more in 2021 than a year before, but due to lower interest rates the mortgage payments have remained the same. Consumers are paying more for the same asset, but interest rates have made it affordable.

At higher interest rates housing prices will not be making new highs but revisiting past lows. Declining housing prices reduce consumers’ willingness to improve their depreciating dwellings (fewer trips to Home Depot). Many homeowners will be upside down in their homes, mortgage defaults will go up… well, we’ve seen this movie before in the not-so-distant past. Higher interest rates will expose a lot of weaknesses that have been built up in the economy. We’ll be finding fault lines in unexpected places – low interest has covered up a lot of financial sins.

And then there is the US dollar, the world’s reserve currency. Power corrupts, but the unchallenged and unconstrained the power of being the world’s reserve currency corrupts absolutely. It seems that our multitrillion-dollar budget deficits will not suddenly stop in 2021. With every trillion dollars we borrow, we chip away at our reserve currency status (I’ve written about this topic in great detail, and things have only gotten worse since). And as I mentioned above, we’ve already seen signs that foreigners are not willing to support our debt addiction. 

A question comes to mind.
Am I yelling fire where there is not even any smoke? 

Higher interest rates is anything but a consensus view today. Anyone who called for higher rates during the last 20 years is either in hiding or has lost his voice, or both. However, before you dismiss the possibility of higher rates as an unlikely plot for a sci-fi novel, think about this. 

In the fifty years preceding 2008, housing prices never declined nationwide. This became an unquestioned assumption by the Federal Reserve and all financial players. Trillions of dollars of mortgage securities were priced as if “Housing shall never decline nationwide” was the Eleventh Commandment, delivered at Temple Sinai to Goldman Sachs. Or, if you were not a religious type, it was a mathematical axiom or an immutable law of physics. The Great Financial Crisis showed us that confusing the lack of recent observations of a phenomenon for an axiom may have grave consequences. 

Today everyone (consumers, corporations, and especially governments) behaves as if interest rates can only decline, but what if… I know it’s unimaginable, but what if ballooning government debt leads to higher interest rates? And higher interest rates lead to even more runaway money printing and inflation? 

This will bring a weaker dollar 

A weaker US dollar will only increase inflation, as import prices for goods will go up in dollar terms. This will create an additional tailwind for commodity prices. 

If your head isn’t spinning from reading this, I promise mine is from having written it. 

To sum up: A lot of the inflation caused by supply chain disruption that we see today is temporary. But some of it, particularly in industrial commodities, will linger longer, for at least a few years. Wages will be inflationary in the short-term and will reset prices higher, but once the government stops paying people not to work, wage growth should slow down. Finally, in the long term a true inflationary risk comes from growing government borrowing and budget deficits, which will bring higher interest rates and a weaker dollar with them, which will only make inflation worse and will also deflate away a lot of assets.

THE END
UPDATE: https://www.msn.com/en-us/news/us/how-us-inflation-rate-is-impacting-americans-wallets-before-the-holiday-season/vi-AAROG5J

CURRENT: https://www.msn.com/en-us/money/markets/us-treasury-yields-tick-lower-on-fears-omicron-will-dent-recovery/ar-AARYSKy?li=BBnbfcL

Your thoughts are appreciated.

THANK YOU

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See the source image

Doctors Living With Higher Stock Market Volatility

Join Our Mailing List 

Change is afoot in the market, the rally of which lulled many into complacency

DG

By David Gratke

DOW DJI 34,899.34 at close
-905.04 (‎-2.53%)

Volatility, on vacation for most of the past few years, is back this fall for physician investors and us all. It hit a new 52-week high in mid-October, double the level of August. That means change is afoot in the market, whose rally lulled many into complacency. So. this is a good time to see where your portfolio stands in risk terms.

The last time volatility really spiked, as measured by the Standard & Poor’s 500 volatility index, or VIX, was the fall of 2011 when the market last corrected by 20%. Then, the VIX level was twice as high as now. Volatility is market price fluctuation, and it signals greater risk.

Financial Risk

financial risk

The root cause of higher volatility is that the world’s major central banks, including our Federal Reserve, have flooded markets with liquidity – printing money, if you will. In other words, in an effort to jump-start local economies, they have kept rates so low that stocks are artificially higher, and thus ripe for a price-churning correction. The insidious side-effect of this money printing has been to greatly reduce, if not extinguish, historical, and normal, market price fluctuations.

As David Kotok, chairman and chief investment officer of Cumberland Advisors, puts it: “An era is ending: for over half a decade, nearly worldwide, zero interest rates suppressed volatilities. That is over.” The initial indication of this, Kotok says, was when then Fed-Chairman Ben Bernanke indicated that his bond-buying stimulus program was coming to an end. Well, now it’s over and the market fears interest rates are on the way up.

Investor Sentiment

Transferrable  Emotions

Stock market volatility can be measured and is used to gauge investor thinking, or what we call investor sentiment.

The VIX gauges investor sentiment. When volatility is low, the implication is that investors are complacent. Said differently, they are not paying attention to the underlying risks in the marketplace. Also during times of low volatility, markets are often fully valued, or even overvalued due to investor contentment.

When the VIX is high, as it was during the 2008-09 financial crisis, investors exhibited great amounts of fear. They sell out of their investments, and markets are typically undervalued.

Volatility was low prior to 2008, hovering around its historical average of 20. The index then zoomed to 90 during the 2008-09 stock market slide. In recent months, however, most notably June and July, we witnessed a historic low in this index, hovering near 10. Sure enough, there were high levels of margin balances and bullish investor sentiments, along with above-average stock valuations, as seen by lofty price/earnings ratios.

Now, the VIX is slightly below average, at about 15.

Since August, volatility rose from its sleepy historic mid-summer lows for many reasons: Middle East tensions, the Ebola outbreak, low gross domestic product growth, central bank stimulus slowing down, corporate stock buybacks, high P/E ratios, just to highlight a few.

Stock_Market

A New Normal?

Assuming this higher volatility is the new normal, what can you do about it? One alternative is to do nothing and ride this out. Another is to trade options, betting on which way the market will cut. But this is very risky and best done by professionals. Kotok says a volatility surge is a good time to examine your portfolio’s risk profile: His firm’s largest positions are in defensive stocks, like utilities and telecoms – ones that don’t tend to rocket around when the market gyrates.

During a recent volatility boost to the current level, in 2013, a Wall Street Journal story offered some market pros’ tips. Examples: putting money in a balanced fund, where stocks and bonds are in roughly equal proportion. Another warned that whenever stock holdings were over 70% of a portfolio, or under 30%, you are most vulnerable.

Regardless, Kotok cautions that “more and exciting volatilities lie ahead.”

Follow AdviceIQ on Twitter at @adviceiq.

About the Author

David Gratke is chief executive officer of Gratke Wealth LLC in Beaverton, Ore.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

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

PODCAST: The RIGHT To REPAIR Electronics Movement

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The right to repair electronics refers to proposed legislation that would provide the practical means for equipment owners to repair their devices, and not a new legal right. The implications for medicine are huge.

Advocates observe that while repair is legal under copyright law and patent law, owners are often prohibited from making their own repairs or hiring technicians they trust to help by manufacturer limitations on access to repair materials such as parts, tools, diagnostics, documentation and firmware.

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See the source image

R2R ASSOCIATION: https://www.repair.org/stand-up/#:~:text=Right%20to%20Repair%20or%20%22Fair%20Repair%22%20legislation%20is,-%20not%20their%20distributors%2C%20retailers%2C%20or%20even%20franchisees.

MICROSOFT: https://www.digitaltrends.com/mobile/microsoft-expands-right-to-repair/

STEVE WOZNIAK PODCAST: https://lynnwoodtimes.com/2021/07/25/right-to-repair-wozniak/

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What is CHROMETOPHOBIA?

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A great question to ponder during National Financial Planning Month!

About the “FEAR OF MONEY”

By Charles Patrick Davis, MD, PhD

Fear of money: An abnormal and persistent fear of money. Sufferers experience undue anxiety even though they realize their fear is irrational. They worry that they might mismanage money or that money might live up to its reputation as “the root of all evil.” Perhaps they remember well the ill fortune that befell the mythical King Midas. His wish that everything he touched be turned to gold was fulfilled, and even his food was transformed into gold.

The fear of money is termed chrometophobia or chrematophobia, from the Greek “chrimata” (money) and “phobos” (fear). The “chrome” in “chrometophobia” may also be related to the Greek word “chroma” (color) because of the brilliant colors of ancient coins — for example, gold, silver, bronze and copper.

CITE: https://www.r2library.com/Resource/Title/0826102549

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

FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PHYSICIAN FINANCIAL ADVISORS: https://medicalexecutivepost.com/2021/10/11/

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GE Update for Physicians and Investors

BY STEVE WINOKER

Hi David,

I hope this note finds you well. Here at GE, September was an important month for us. We concluded our annual strategy reviews with each business, complementing the quarterly operating reviews with a longer-term focus. I had the opportunity to participate in many of the review processes and came away impressed with our progress, leadership team, and the growth opportunities that lie ahead as we innovate for the future of flight, precision health, and energy transition.

In my last investor update, I shared the exciting news that GE announced an agreement to acquire BK Medical, and in the spirit of growth and innovation, I’d like to share a few more recent business highlights that illustrate how our teams are delivering for our customers:

  • At Aviation, Bamboo Airways signed a Memorandum of Understanding agreement to purchase GEnx engines for its Boeing 787-9 aircraft. This order of 10 firm and 20 options, valued at a list price of approximately $2 billion, will help the airline expand its transcontinental flight network. Dang Tat Thang, CEO of Bamboo Airways, said, “The selection of the GEnx engines for our Boeing 787-9 aircraft will help increase the operational efficiency and service quality of Bamboo Airways on Vietnam-U.S. nonstop flights as well as many potential international routes.”
  • Renewable Energy announced today that it received an order to supply Haliade-X turbines for Massachusetts’s Vineyard Wind 1, the first utility-scale offshore wind installation in the U.S. Additionally, our Haliade-X offshore wind prototype turbine recently became the first in the industry to operate at 14 MW, increasing our customers’ ability to produce more power from a single turbine.
  • Gas Power announced the delivery, installation, and commissioning of four TM2500 aeroderivative gas turbines in only 42 days to supplement renewable power generation for the State of California’s Department of Water Resources during peak demand season. GE’s TM2500s start and ramp up quickly in just minutes and will help enhance the reliability and sustainability of California’s grid.

See the source image

We’re excited about what the future holds, as our teams are highly focused on executing for our customers, leveraging lean to drive meaningful progress and innovating for a more sustainable world.

We look forward to sharing more on our 3Q’21 earnings call on Tuesday, October 26. As always, I welcome your feedback.

Best,
Steve

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

MORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: Warren Buffett’s Thoughts on Healthcare

BY ERIC BRICKER MD

CITE: https://www.r2library.com/Resource/Title/0826102549

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In Response to a Question Regarding the Ending of Haven Healthcare–the Joint Venture Among Berkshire Hathaway, JP Morgan Chase and Amazon to Improve Healthcare for their Employee Health Plan Members–Warren Buffett Made the Following Statement:

“Healthcare is the Tapeworm of the US Economy and the TAPEWORM WON.”

Additionally, Warren Buffett Goes on to Say that ‘Prestigious‘ People in the Community Run Hospital Boards and These People Are ‘Fairly Happy‘ with the Healthcare System the Way It Currently Is.

It is Likely that Warren Buffett Formed Some of This Opinion in Speaking About Healthcare with the Vice Chairman of Berkshire Hathaway, Charlie Munger, and Berkshire Board Member and Famous CEO, Tom Murphy.

Charlie Munger Has Served on the Board of a Los Angeles Hospital for 31 Years and Tom Murphy Currently Serves on the NYU Langone Hospital System Board of Directors.

The Support of the Status Quo by ‘Prestigious,’ ‘Fairly Happy’ Hospital Board Members Cannot Be Understated… It Blocks Change and Warren Buffett Appears to Think Similarly.

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YOUR COMMENTS ARE APPRECIATED.

Thank You

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ANNUAL FINANCIAL STATEMENT REPORTS: Health Insurance Companies

FOR PHYSICIAN INVESTORS

By David Belk MD

Health Insurance Company Financial Index

Below is a listing of the Nine largest for-profit health insurance Companies. The Annual financial statements are linked to the year for each Company and a four page summary report is linked to the name of the health insurance company at the top of the listing.

CITE: https://www.r2library.com/Resource/Title/0826102549

The relevant pages in each financial statement I used to prepare my summaries are listed next to each year’s statement. Aetna and Coventry’s summaries are combined because they merged in 2012. Health Net also Merged with Centene in 2016 leaving only seven major health insurance companies.

A composite summary for the data for all eight companies is here

Composite Data Table

Click on the name of the health insurance company to open the accordion and view the financial statements.

LINK: https://truecostofhealthcare.org/health-insurance-financial-index/

YOUR COMMENTS ARE APPRECIATED.

Thank You

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PODCAST: How Health Care Can Win by Adapting to Changes in Consumer Behavior

LESSONS FROM THE RETAIL SECTOR

See the source image

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Discover how ProMedica uses customer feedback and a digital-first approach to consumers to achieve stellar results across more than 400 facilities in 28 states.

PODCAST: https://www.youtube.com/watch?v=861em_pJfVM&t=3070s

YOUR THOUGHTS AND COMMENTS ARE APPRECIATED.

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Thank You

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PODCAST: Lessons for [physician] Investors: The Trial of Theranos Founder ELIZABETH HOLMES

By Bertalan Meskó, MD PhD

Wofür R&D Jahre benötigt, braucht künstliche Intelligenz wenige Minuten“

Elizabeth Holmes has no idea how much damage she has done with Theranos. As I often wrote, for digital technologies to gain ground and become part of our everyday lives, we need not only technological solutions but a cultural paradigm shift. Holmes rolled a massive rock in front of it.

Similarly, Facebook’s data privacy practices do not increase people’s confidence in the company’s products. All the scandals that have surrounded the social network could backfire when Facebook wants to step into healthcare – and this is exactly what we wrote about in our latest article, Is There A Place For Facebook In Healthcare? In it, we looked at what Facebook currently does in medicine and evaluated whether those are viable ways to follow in the future.

Take care,
Berci
Bertalan Meskó, MD PhD
The Medical Futurist

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MORE: https://www.cnbc.com/2021/09/10/the-lessons-for-investors-from-the-trial-of-theranos-founder-elizabeth-holmes.html?utm_source=The+Medical+Futurist+Newsletter&utm_campaign=f5b0ff1b6b-EMAIL_CAMPAIGN_2021_9_14&utm_medium=email&utm_term=0_efd6a3cd08-f5b0ff1b6b-399696053&mc_cid=f5b0ff1b6b&mc_eid=40fee31c25

YOUR COMMENTS ARE APPRECIATED.

Thank You

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PODCAST: The State of Mental Health

IN THE USA

By Eric Bricker MD

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YOUR COMMENTS AND THOUGHTS ARE APPRECIATED.

MORE: https://medicalexecutivepost.com/2021/07/28/mental-health-entrepreneurial-start-up/

Thank You

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PODCAST: Confessions of a Hospital Chief Financial Officer

HOSPITAL FINANCES REVEALED

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

YOUR THOUGHTS AND COMMENTS ARE APPRECIATED

Thank You

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PODCAST: Private Equity Firms Are Making Partial Purchases of Physician Practices.

Older Doctors Sell Out to Private Equity

Private Equity Firms Are Making Partial Purchases of Physician Practices

BY ERIC BRICKER MD

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The Deals Are Frequently Structured as Follows:

–The Private Equity Firm Offers an Up Front Lump Sum of Money and Administrative Services Such as Billing and Collections for the Practice.

–In Return, the Doctors in the Practice Agree to Have 30-40% of All Future Revenue Go to the Private Equity Firm.

The Up Front Lump Sum Can Be Equal to as Much as 10 – 20 Years of Income for a Physician.

The Older Doctors in the Practice Who Are Usually the Partners Frequently Take This Deal, Resulting in the Younger Partners Making Less Take-Home Pay.

Implication for Employers:

Private Equity Firms Create Larger Group Practices to Have Better Negotiating Leverage with Commercial Insurance Carriers and Obtain Higher Fee-for-Service Reimbursement.

Overall Healthcare Costs for Physician Services Go Up, While the Take-Home Pay for Doctors Goes Down… and the Private Equity Firm Keeps the Difference.

NOTE: The Older Doctors Who Are Paid the Lump Sum Are Still Required to Stay at the Practice for a Certain Number of Years After the Transaction.

YOUR THOUGHTS AND COMMENTS ARE APPRECIATED

***

DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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ON THE ROAD AGAIN: Public Speaking, Opining and Assigning

Dr. David Edward Marcinko is Speaking Up

Dr. David Edward Marcinko MBA CMP® enjoys personal coaching and public speaking and gives as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.

These have included lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.

His talks tend to be engaging, iconoclastic, and humorous. His most popular presentations include a diverse variety of topics and typically include those in all iMBA, Inc’s textbooks, handbooks, white-papers and most topics covered on this blog.

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Recognizing the Differences between Healthcare and Other ...

INVITATIONS: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

CONTACT: Ann Miller RN MHA

MarcinkoAdvisors@msn.com

Ph: 770-448-0769

Second Opinions: https://medicalexecutivepost.com/schedule-a-consultation/

DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

THANK YOU

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Invite Professor Marcinko to Your Next Seminar or Event

See You Soon

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

Colleagues know that I enjoy personal coaching and public speaking and give as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world. All in a Corona safe environment.

Avatar of Dr. Marcinko Speaking as MSL

These include lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, end-note lectures at city and statewide financial coalitions, and annual lectures for a variety of internal yearly meetings.

LIVE or PODCAST enabled, as well.

Topics Link: imba-inc-firm-services

Teleconference: https://medicalexecutivepost.com/2020/10/14/me-marcinko-and-my-avatar/

My Fond Farewell to Tuskegee University

And so, we appreciate your consideration.

Invite Dr. Marcinko

CONTACT: ANN MILLER RN MHA CMP®

[ME-P Executive-Director]

PH: 770-448-0769

EM: MarcinkoAdvisors@msn.com

THANK YOU

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PODCAST: How are Hospitals Doing after the Pandemic?

The Pandemic is Ending?

How Are Hospitals Doing?

Interview with Brian Peters 

Rich Helppie brings back Brian Peters, the CEO of The Michigan Health and Hospital Association to talk about the current state of Covid-19; what we may have gotten right, what we may have gotten wrong and how to move forward.

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EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.
-Dr. David E. Marcinko MBA CMP®

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PODCAST: https://richardhelppie.com/brian-peters/

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

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OVER HEARD IN THE FINANCIAL ADVISOR’S LOUNGE

center

“TAKE THE FIDUCIARY PLEDGE”

FINANCIAL ADVISORS LOUNGE AT iMBA, Inc.

CMP logo

SPONSORED: http://www.CertifiedMedicalPlanner.org

DEFINITION: A fiduciary is a person who holds a legal or ethical relationship of trust with one or more other parties (person or group of persons).

Typically, a fiduciary prudently takes care of money or other assets for another person. One party, for example, a corporate trust company or the trust department of a bank, acts in a fiduciary capacity to another party, who, for example, has entrusted funds to the fiduciary for safekeeping or investment. Likewise, financial advisers, financial planners, and asset managers, including managers of pension plans, endowments, and other tax-exempt assets, are considered fiduciaries under applicable statutes and laws.

In a fiduciary relationship, one person, in a position of vulnerability, justifiably vests confidence, good faith, reliance, and trust in another whose aid, advice, or protection is sought in some matter. In such a relation good conscience requires the fiduciary to act at all times for the sole benefit and interest of the one who trusts.

CITATION: https://www.r2library.com/Resource/Title/0826102549

See the source image

[Fiduciary Pledge]*

I, the undersigned, ___________________________ (“financial advisor”), pledge to always put the best interests of _______________________________ (“client”) first, no matter what.

As such, I will disclose in writing the following material facts and any conflicts of interest (actual and/or perceived) that may arise in our business relationship:

  • All commission, fees, loads, and expenses, in advance, client will pay as a result of my advice and recommendations;
  • All commission and commissions I receive as a result of my advice and recommendations;
  • The maximum fee discount allowed by my firm and the largest fee discount I give to other customers;
  • The fee discount client is receiving;
  • Any recruitment bonuses and other recruitment compensation I have or will receive from my firm;
  • Fees I paid to others for the referral of client to me;
  • Fees I have or will receive for referring client to any third-parties; and
  • Any other financial conflicts of interest that could reasonably compromise the impartiality of my advice and recommendations.

Jeff Kuest MBA CFA CFP®

[CounterPoint Capital Advisors]

*© 2011-2015. All rights reserved. Courtesy permission with personal communication from Jeff Kuest, MBA, CFA, CFP®

ASSESSMENT: Your thoughts are appreciated.

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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PE Ratio versus PEG Ratio

PE versus PEG

By staff reporters

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“Medical Management and Health Economics Education for Financial Advisors”

CMP® CURRICULUM: https://lnkd.in/eDTRHex
CMP® WEB SITE: https://lnkd.in/guWSApq

Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

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MID-YEAR FINANCIAL ROUND-UP: 2020

MID-YEAR ROUND-UP

DR. DAVID EDWARD MARCINKO MBA MEd CMP® 

STOCKS: A global stock market crash on March 12 set the worst single-day decline for stocks since 1987. But in Q2, major indexes clawed their way back on the promise of economic reopenings. Filled to the brim with tech companies, the Nasdaq has distanced itself from the Dow and the S&P.

FED: The Fed slashed interest rates in March to stem the economic bleeding, and in early June said it would hold rates near zero through 2022.

OIL: In late April, oil prices crashed below -$37 a barrel as plummeting demand from lockdowns left traders with nowhere to put their oil. Following an agreement by OPEC+ to reduce supply by 9.7 million barrels a day, prices are slowly rebounding back to March’s highs.

MORE: https://www.msn.com/en-us/money/markets/wall-street-is-wrapping-up-its-best-quarter-in-decades/ar-BB166FUU?li=BBnbfcN

“Medical Management and Health Economics Education for Financial Advisors”

CMP® CURRICULUM: https://lnkd.in/eDTRHex
CMP® WEB SITE: https://lnkd.in/guWSApq

Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

Another CERTIFIED MEDICAL PLANNER® “In The News”

ANOTHER CERTIFIED MEDICAL PLANNER® “IN THE NEWS”

Courtesy: https://lnkd.in/eVGcji5

“Informed Voice and Next-Gen of Physician Fiduciary Advisors”

AMAURY CIFUENTES CFP® CMP®

“The extensive experience of our professional team allows us to implement a rigorous process to identify ‘Best in Class’ opportunities in our focus areas. We assist in providing capital, innovative solutions and strategic expertise to our portfolio throughout the investment cycle.”

LINK: https://lnkd.in/eBf-4vY

AMAURY has 30 years of experience in banking and finance; financial planning and investments with an emphasis on business lending, real estate and private investments. He is a licensed CERTIFIED MEDICAL PLANNER® giving him an enhanced knowledge of the medical industry’s specific needs.

PRESS RELEASE: https://lnkd.in/ecMbEsQ

CURRICULUM: https://lnkd.in/eMMbbVp

AUTOMATION: https://lnkd.in/eVp9Cji

BUSINESS, FINANCE, INVESTING & INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

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

THANK YOU

Fifty Shades of Warren Buffet -OR- New Year in Omaha

A POD-Cast

By Vitaliy Katsenelson CFA

50 Shades of Warren Buffet or Next Year In Omaha

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

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Some Value-Focused Investing Interviews and Podcasts

By Vitaliy Katsenelson CFA

Dear ME-P Readers,

You might want to listen to some great interviews by Roben on investment topics (his shows cover a wide variety of themes).

  1. An interview with an acquaintance of mine, Saurabh Madaan, who went from working for Google to Markel (which is often called the “Baby Berkshire Hathaway”).
  2. Speaking of Markel, here Roben interviews Tom Gayner, Markel’s CIO. I have had the privilege of sharing a stage with Tom once a year for the last seven years in Omaha at the YPO event.
  3. Here Roben interviews my friend Jim Chanos –brilliant short seller and incredible human being. 

I am just scratching the surface here. You can listen to hundreds of other shows with Roben here, or look for Full Disclosure with Roben Farzad on your podcast app – just be careful, they are very addicting. 

stocks

Conclusion

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

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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

Dr. Marcinko Interviewed on the Physician Credit Crunch

Financial Experts Share Tips on Obtaining Loans to Start or Expand a Medical Practice

By Michael Gibbons

Editor: ADVANCE Newsmagazines

Maybe you’re a young dermatologist or plastic surgeon who dreams of starting your own practice. Or maybe you’re an established professional but want to expand your palette of anti-aging services. Either way, you’ve probably made an unpleasant discovery: Banks are leery about lending today. Global recessions with seemingly no end in sight tend to give loan officers sticky fingers.HO-JFMS-CD-ROM

Dermatologists and Plastic Surgeons

We have it on good authority that dermatologists and plastic surgeons as a group are less affected by this problem than physicians in some other branches of medicine. Still, there’s no better time than now to absorb some sound advice on how to approach banks for loans—whether you’re a fresh-faced newcomer to the fresh-face business or a wrinkled veteran at eliminating wrinkles.

Start Small

There’s no soft-soaping it: Starting a healthy aging practice is much harder than expanding an existing practice, even in the flushest of times.

“For young dermatologists starting out, I recommend you start small,” advises Jerome Potozkin, MD, who offers facial rejuvenation, liposuction, body contouring and dermatological care through his practice in Walnut Creek, CA. “You can always expand. Keep your overhead low. Know what your credit score is and do everything you can to improve it. Pay your bills on time.”

Lasers aren’t cheap. Besides the initial acquisition costs, a service contract can cost $7,000 to $12,000 a year, according to Dr. Potozkin. “Don’t feel you have to buy every new laser under the sun,” he says. “In fact, renting rather than purchasing is an option many companies offer. When your volume is low you can rent and schedule laser days—although the pitfall there is you don’t have lasers available whenever patients come in.”

Also, young dermatologists “will probably have an easier time getting a loan if they go to a relatively underserved area, as opposed to an area that has a large number of dermatologists per capita,” says Dr. Potozkin, who began practicing 10 years ago. “There are two schools of thought on this: Go where you want to live to start a practice or go to where there’s a need and be instantly successful. I chose the former. It took me longer to get started but I’m very happy where I am.”

Patience, Prudence and Passiondem2

Be patient, prudent, passionate—and start with a spare office and as little debt as possible, advises Dr. David E. Marcinko MBA, a financial advisor and Certified Medical Planner™. Marcinko, a health economist,  is CEO of the Institute of Medical Business Advisors Inc., a national physician and medical practice consulting firm based in Norcross, GA www.MedicalBusinessAdvisors.com

“Patients are looking for passion from you, not lavish trappings,” Dr. Marcinko says. “When a banker or a loan officer sees $175,000 or more of debt they are loath to give a loan—and it’s hard to blame them. Purchase a home after you become a private practitioner. You need to be as close to debt-free as you can be.

Exit Strategy

“Another thing bankers want to know is, ‘If we give you a loan and you start a practice and it fails, how will we be paid back?’ They want an exit strategy.”

The good news is dermatology “remains a very lucrative specialty, and in most parts of the country they are in a shortage position, particularly with the aging population,” says Sandra McGraw, JD, MBA, principal and CEO of the Health Care Group, a financial and legal consulting firm based in Plymouth Meeting, PA., that advises the American Academy of Dermatology, among other groups.

“I would start with a realistic business plan for why you think this practice can succeed, in the specific location,” McGraw says. “How many patients do you expect to see? How will they know you are there and available? Remember that banks lend to all kinds of people, so keep your numbers realistic. Overestimating expenses is as bad as underestimating them. Then determine how you want the money—usually a fixed loan for a period of time and then a line of credit as you get your practice going and sometimes need the cash flow.”biz-book

Expanding a Practice

Established dermatologists should have an easier time getting loans to expand their practices. They have, one hopes, a track record of success and assets to put up as collateral.

Mid-career physicians “have cash flow, physician assets and equity to some degree in a house and personal assets,” Dr. Marcinko observes. “Banks can attach loans to personal assets and savings accounts. Ninety-nine percent of times you must sign a personal asset guarantee. Mid-lifers have assets young ones don’t, so mid-lifers aren’t quite the risk. They have businesses that have value and cash flow. Banks like cash flow.”

However, even veterans must do some homework before approaching a bank. “You still want to establish why you want the money and how the expansion will increase your income,” McGraw says.

Another tip: If the bank has loans out with reputable vendors, you might ask the loan officer to recommend them to you as potential contractors. “Sometimes keeping it local and supporting others with loans at the bank can be helpful,” she says.

Assessment

Dr. Marcinko adds, “Bankers today want you to come in with a well-reasoned, well-thought-out and well-written business plan. Give bankers a 30-second elevator speech on why you are different. It’s really important to ask yourself, ‘What can I offer the community as a doctor in my specialty that nobody else can?’ If you bill yourself as the first dermatologist to do laser surgery, that’s a perceived advantage. You purchased the equipment and learned to use it. But anyone can do that. If you can come up with something that nobody else has or can do, that’s how you’re successful in anything.”

Link: Dr. Marcinko Interview

Link: https://healthcarefinancials.files.wordpress.com/2009/08/dr-marcinko-interview.pdf

Conclusion

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

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

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

Sponsors Welcomed

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

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

Backward Market Business Research

Experimenting in Business

By Dan Ariely PhD

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 Part of the CAH Startup Lab Experimenting in Business Series

By Rachael Meleney and Aline Holzwarth

Missteps in business are costly—they drain time, energy, and money.

Of course, business leaders never start a project with the intention to fail—whether it’s implementing a new program, launching a new technology, or trying a new marketing campaign.

Yet, new…

Beginning at the End — Dan Ariely

Product DetailsProduct Details

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A Stock Market Top?

Happy eighth birthday of the bull market!

By Rick Kahler CFP®

March 9, 2017, was the eighth birthday of the bull market in the US S&P 500. In its lifetime it gained 314.4%, an average annual return of 19.4%. This raises a question as to how much longer it will last.

An article posted on MarketWatch.com, “Seven Signs We’re Near a Market Top and What to Do Now” gives some interesting perspective on what to look for to answer that question.

  1. Small investors begin pouring money into stock mutual funds out of fear they might miss out on another year of growth.
  2. Surveys of professional money managers show a declining number who are anticipating an imminent bear market, while more of them think the bull market will continue for a little longer.
  3. The VIX market index, which is a barometer of traders’ expectation of near term volatility (always present with a bear market), signals calm ahead.
  4. There are record price/earnings ratios, which means buyers are bidding up the price of stocks faster than earnings are rising.
  5. Investors have started to forget the pain of the last bear market and are becoming more complacent and optimistic.
  6. The Nasdaq index begins a bull run.
  7. Greed begins to outweigh fear, as investors start fearing missing out on further market gains instead of fearing future market losses.

Even to a casual observer, many of these signs look evident in the equity markets.

I’ve spoken with investors who have been on the sidelines but are thinking it’s time to get into the stock market, given its double-digit returns over the past 12 months along with the Trump rally. This is usually a reliable sign that markets are nearing a top as this new money drives the market to dizzying new highs.

When a market top looks inevitable—and we know the market will fall—what should investors do to protect their capital from being eroded away by a bear market? Selling out your stocks and moving the money to cash is always an option, but not a very good one. How do we really know this is the top and that the market won’t continue to go higher? Often the most profitable and exciting part of a bull market is the frothy run-up just before the fall.

Even more problematic, if you do get out in time to miss the crash, how will you know when it’s time to get back in? The most common answer I am given by investors to that question is, “When the economy looks good again.” That’s similar to a deer hunter saying he will load his gun when he sees a deer. By the time the economy looks good, the run up in stocks is usually nearing its end.

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Act?

The best course of action is to fasten your seat belt and get ready for some terrifying turbulence. Most bear markets drop quickly and recover quickly. Investors who get out usually do so near the bottom and completely miss the inevitable recovery. All bear markets have ended with a new bull market, although the bottom is not identified as such, but rather seen as a pause before another certain downturn.

One more thing!

Don’t feel that missing when to get out and when to get back in would make you inadequate. The majority of those who attempt to time the market for a living will miss it, too. That MarketWatch.com article that listed the seven signs of a market top? It advised investors to start edging out of the markets as soon as possible because red flags were everywhere. And it was published in March 2014—three years ago.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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MARCINKO’s Upcoming WEBINARS from MentorHealth

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MentorHealth

MentorHealth, the sponsor of these ME-P webinars, is a comprehensive training source for healthcare professionals that is high on value, but not on cost. MentorHealth is the right training solution for physicians and healthcare professionals. With MentorHealth webinars, doctors can make the best use of time, talent and treasure to benefit their continuing professional education needs.

So, it is no wonder why they partnered up with the ME-P to produce these three exciting and timely Webinars, delivered by our own Publisher-in-Chief and Distinguished Professor David Edward Marcinko.

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A Medical Malpractice Trial From The Doctor’s POV

Even among the sciences, medicine occupies a special position. Its practitioners come into direct and intimate contact with people in their daily lives they are present at the critical transitional moments of existence.

For many people, they are the only contact with a world that otherwise stands at a forbidding distance. Often in pain, fearful of death, the sick have a special thirst for reassurance and vulnerability to belief.

When this trust is violated, whether rooted in factual substance or merely a conclusion lacking in reality, American jurisprudence offers several remedies with the core being civil litigation. We have personally witnessed a spectrum of reasons that prompts a patient to seek the counsel of an attorney.

Monday, February 6, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Medical Workplace Violence Issues

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients,long waits for service,inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well.

A lack of staff training and the absence of violence prevention programming are also associated with the elevated risk of assault in hospitals.

Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk.

Wednesday, February 22, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

Romantic Patient Advances

Within the medical practice, clinic, hospital or university setting, faculty and supervisors exercise significant power and authority over others. Therefore, primary responsibility for maintaining high standards of conduct resides especially with those in faculty and supervisor positions.

Members of the medical faculty and staff, including graduate assistants, are prohibited from having “Amorous Relationships”with students over whom they have “Supervisory Responsibilities.” “Supervisory Responsibilities”are defined as teaching, evaluating, tutoring, advocating, counseling and/or advising duties performed currently and directly, whether within or outside the office, clinic or hospital setting by a faculty, staff member or graduate assistant, with respect to a medical, nursing or healthcare professional student.

Such responsibilities include the administration, provision or supervision of all academic, co-curricular or extra- curricular services and activities, opportunities, awards or benefits offered by or through the health entity or its personnel in their official capacity.

Monday, March 13, 2017

10:00 AM PST | 01:00 PM EST

60 Minutes

$139.00

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MORE:

http://www.mentorhealth.com/control/webinarsearch?speaker_id=41224

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WEBINAR NOTE: These are online interactive training courses using which, professionals from any part of the world have the opportunity to listen to and converse with some of the best-known experts in the HR Industry. These are offered in live & recorded format for single & multiple users (corporate plans ). Under recorded format each user gets unlimited access for six months. Corporate plans give you the best return on your investment as we do not have upper limit on the number of participants who can take part in webinar.

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Penthouse Interviews Murray Rothbard

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Source: A Re-Post by MICHEL ACCAD, MD

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Penthouse Interviews Murray Rothbard

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Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd.  Edition]

Product DetailsProduct Details

  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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My Interview Request from The American College of Financial Services

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By Gary Arnesto

RE: Interview Request from The American College of Financial Services

Dr. Marcinko,

I work for the content marketing company Media Shower, and I’m writing on behalf of The American College of Financial Services, a school that offers education in the financial planning field, specifically to help students achieve professional designations such as: Certified Financial Planner (CFP), Chartered Financial Consultant (ChFC), Chartered Life Underwriter (CLU), RICP (Retirement Income Certified Professional), and Financial Services Certified Professional (FSCP).

We’re starting a new Expert Interview series with important people in the financial professional industry, and we’d love to do an email interview with you to run on The American College blog!

We’ll send you a few interview questions, and we’ll turn your responses into a great article for our audience with a link back to The American College. All we ask for in return is a link posted on your site that promotes the interview to your audience.

You can see our website here: http://www.theamericancollege.edu/

If you’d like to discuss the program with someone at the company directly, feel free to contact Xand Griffin at: xgriffin@stratusinteractive.com.

Please let me know if you’d be interested in doing the email interview with us, and we’ll get moving on it right away!

Thank you,

Gary Arnesto

Assessment and RSVP

Many thanks for the invitation Gary, and yes I accept. My opinions may not always be correct; but I am never equivocal.

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DEM tie

David Edward Marcinko MBBS DPM MBA CMP®

http://www.CertifiedMedicalPlanner.org

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Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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