PODCAST: Nursing Home Care

Residents disproportionately affected by COVID-19

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New Covid-19 death data reveals 'hidden' crisis in care ...

BY JAMES BLUMENSTOCK MA

Residents of nursing homes have been disproportionately affected by COVID-19. The nature of this coronavirus—which is particularly harmful to older adults and people with multiple chronic conditions—has left residents vulnerable.

Additionally, the pandemic has exacerbated existing challenges in our fragmented long-term care system, which is financed, regulated, and administered by states, the federal government, and private care facilities.

During this webinar, panelists discussed policy options to support high quality care for nursing home residents during the COVID-19 pandemic.

NOTE: This webinar is a project of the Alliance for Health Policy and NIHCM Foundation, in collaboration with The Commonwealth Fund.

PODCAST: https://nihcm.org/publications/nursing-home-care

Your thoughts are appreciated

THANK YOU

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PODCAST: Novartis Drug Company Settlement with the USA

Why SOME Doctors Take Money from Pharmaceutical Companies

Q&A: Eric Bricker, chief medical officer of Compass patient advocacy service - Dallas Business ...

BY ERIC BRICKER MD

MAssive Global Drug Company Novartis Paid $678M to Settle Charges from the US Federal Government.

The Charges Were Regarding Illegal Payments and Kickbacks to Doctors that Were Thinly-Veiled as ‘Speaker Fees’ and Fancy Dinners.

Why Where the Doctors Not Held Accountable and What Does This Say About a Doctor’s Mentality on Money?

Learn the Psychology of Doctors and Money.

Understand How It Leads to Counterproductive Relationships Between Physicians and Drug Companies, Which Can Compromise the #1 Rule in Medicine: The Patient Comes First, Always.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health

YOUR THOUGHTS ARE APPRECIATED

Thank You

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Are Today’s Doctors Desperate?

Emotions Rise with Healthcare Reform

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

NOTE:  I penned this essay more than a decade ago.dem2

Managed care is a prospective payment method where medical care is delivered regardless of the quantity or frequency of service, for a fixed payment, in the aggregate. It is not traditional fee-for-service medicine or the individual personal care of the past, but is essentially utilitarian in nature and collective in intent. Will new-age healthcare reform be even more draconian?

Unhappy Physicians

There are many reasons why doctors are professionally and financially unhappy, some might even say desperate, because of managed care; not to mention the specter of healthcare reform from the Obama administration. For example:

  • A staggering medical student loan debt burden of $100,000-250,000 is not unusual for new practitioners. The federal Health Education Assistance Loan (HEAL) program reported that for the Year 2000, it squeezed significant repayment settlements from its Top 5 list of deadbeat doctor debtors. This included a $303,000 settlement from a New York dentist, $186,000 from a Florida osteopath, $158,000 from a New Jersey podiatrist, $128,000 from a Virginia podiatrist, and $120,000 from a Virginia dentist. The agency also excluded 303 practitioners from Medicare, Medicaid, and other federal healthcare programs and had their cases referred for nonpayment of debt.
  • Because of the flagging economy, medical school applications nationwide have risen. “Previously, there were a lot of different opportunities out there for young bright people”; according to Rachel Pentin-Maki; RN, MHA”; not so today. In fact, Physicians Practice Digest recently stated, “Medicine is fast becoming a job in which you work like a slave, eke out a middle class existence, and have patients, malpractice insurers, and payers questioning your motives.” Remarkably, the Cornell University School of Continuing Education has designed a program to give prospective medical school students a real-world peek, both good and bad.

The Ripple Effects of Managed Care and Reform

“Many people who are currently making a great effort and investment to become doctors may be heading for a role and a way of life that are fundamentally different from what they expect and desire,” according to Stephen Scheidt, MD, director of the $1,000 Cornell fee program; why?

  • Fewer fee-for-service patients and more discounted patients.
  • More paperwork and scrutiny of decisions with lost independence and morale.
  • Reputation equivalency (i.e., all doctors in the plan must be good), or commoditization (i.e., a doctor is a doctor is a doctor).
  • The provider is at risk for (a) utilization and acuity, (b) actuarial accuracy, (c) cost of delivering medical care, and (d) adverse patient selection.
  • Practice costs are increasing beyond the core rate of inflation.
  • Medicare reimbursements are continually cut.

Mad Obama

Early Opinions

Richard Corlin MD, opined back in 2002 that “these are circumstances that cannot continue because we are going to see medical groups disappearing.” Furthermore, he stated, “This is an emergency that lawmakers have to address.” Such cuts also stand to hurt physicians with private payers since commercial insurers often tie their reimbursement schedules to Medicare’s resources. “That’s the ripple effect here,” says Anders Gilberg, the Washington lobbyist for the Medical Group Management Associations (MGMA).

Assessment

And so, some desperate doctors are pursing these sources of relief, among many others:

  • A growing number of doctors are abandoning traditional medicine to start “boutique” practices that are restricted to patients who pay an annual retainer of $1,500 and up for preferred services and special attention. Franchises for the model are also available.
  • Regardless of location, the profession of medicine is no longer ego-enhancing or satisfying; some MDs retire early or leave the profession all together. Few recommend it, as a career anymore.

Assessment

To compound the situation, it is well known that doctors are notoriously poor investors and do not attend to their own personal financial well being, as they expertly minister to their patients’ physical illnesses.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think? Are you a desperate doctor? 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 

References:

  1. www.managedcaremagazine.com/archives/9809/9809/.qna_dickey.shtml
  2. www.hrsa.dhhs.gov/news-pa/heal.htm
  3. www.bhpr.hrsa.gov/dsa/sfag/health-professions/bk1prt4.htm
  4. Pamela L. Moore, “Can We All Just Get Along: Bridging the Generation Gap, Physicians Practice Digest (May/June 2001).

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™

PODCAST: Established Sales Strategies That Are Effective When Applied to Healthcare

HEALTHCARE SALES TECHNIQUES

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Learn Established Sales Strategies That Are Effective When Applied to Healthcare:

1) Prospecting: The Strategy of Aaron Ross in Dividing Prospecting into Seeds, Nets and Spears Was Effective in Generating Leads at Compass Professional Health Services.

2) Pitching: The Miller-Heiman Strategy of Identifying Economic, Outcome and Technical Buyers Allows for Effective Pitching to a Buying Team.

3) Closing: The Model of ‘Fit-Risk-Price’ is Essential To Understanding How and When to Close a Sale.

Image result for eric bricker

BY ERIC BRICKER MD

THANK YOU

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The Next-Generation of “Anti-Millionaire” Doctors

“$1 Million Mistake: Becoming a Doctor”

See the source image

BY DR. DAVID E. MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

CBS Moneywatch published an article entitled “$1 Million Mistake: Becoming a Doctor” Aside from the possibility that devoting one’s life to helping others might be considered a mistake, medical student Dan Coleman was struck by the “$1 million” figure.

Before medical school, he worked in the pharmaceutical industry and even turned down a hefty promotion to his education as soon as possible, rather than defer for a year or two. But, his financial calculations made it fairly obvious that, including benefits, bonuses, and potential promotions, his medical decision was not a $1 million mistake, but was more like a $1.3 million dollar disaster. Still; he opined:

Yet, even today, as we stare down the barrel of the Affordable Care Act, being a doctor is a very desirable job. We may not be famous, but we will be well-respected. We may not be rich, but we will certainly live comfortably. We may work a lot, but we will never be out of work. To future doctors, the young and impecunious, the anti-millionaires, tuition is a mere afterthought. All that matters is the MD.

Source: http://in-training.org/medical-students-the-anti-millionaires-4361

Millionaire Interview 81 - ESI Money

OVER HEARD IN THE MEDICAL STUDENT’S LOUNGE

“We are medical students.
We are young, proud, and righteous.
We have made the hard choice (medicine), but we have cleared the high hurdle (getting into school).


We know healthcare is a difficult, imperfect art, but we are devoted.
We arm ourselves with the weapons of knowledge and compassion, prepared to defend against the onslaught of trauma, disease, and time.
We are here to the bitter end, for our patients and ourselves.
And above all, we know the cost of our choice.

And if we’re lucky, it will stay under 6% interest through graduation”.

Daniel Coleman

[Georgetown University School of Medicine]

First-year Student

Your thoughts are appreciated,

THANK YOU

***

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

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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

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

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PODCAST: The Future of Healthcare Looks to Medicare’s Past?

See the Future of Healthcare By Looking to Medicare’s Past

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Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY DR. ERIC BRICKER MD

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Desire for a Healthcare ‘Safety Net’ Goes Back Almost 100 years to President F.D.R. and His “New Deal

FDR Was Able to Pass Social Security, but He Also Wanted a Healthcare Safety Net Too.

Presidents Truman and Kennedy Also Wanted a Federally-Funded Healthcare Safety Net.

LBJ Carried the Torch of the Healthcare Safety Net. He Was Able to Have Medicare Legislation Passed in 1965 by Combining 3 Separate Proposals and Acts:

1) Hospital Insurance

2) Doctor Insurance That Was Voluntary

3) the State-Administered Kerr-Mills Act 

Hospital Insurance Became Medicare Part A. Doctor Insurance Became Medicare Part B. The Kerr-Mills Act Became Medicaid.

Presidents Carter and Clinton Also Wanted to Expand the Healthcare Safety Net. President Obama Expanded the Healthcare Safety Net with Passage of Obamacare. President Biden is Seeking to Expand the Healthcare Safety Net Too.

The Arc of Government-Funded Healthcare Stretches Back Almost 100 Years and Will Inevitably Result in the Full Government Payment for Healthcare in America.

It’s Not a Question of If, But When.

Implication: United Health Group is Making Many Acquisitions to Become a Vertically Integrated Healthcare Company to Position Itself as a Major Government Contractor for the Eventual Federal Takeover.

PODCAST: https://www.youtube.com/watch?v=OAh7Rl7w1wM

Your thoughts are appreciated.

THANK YOU

***

PODCAST: “Real ACOs Haven’t Been Tried Yet!”

What is an Accountable Care Organization?

DEFINITION: ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings.

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

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QUESTION: What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? 

ANSWER: You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory. I kid you not.  This is exactly what happens.

Thankfully, Anish Koka is vigilant and explains the blatant obfuscations and manipulations that the central planners engage in to have their way.

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And so, In this video, Anish and colleague Michel Accad, MD, will reveal the machinations, take the culprits to task, and discuss pertinent questions regarding health care organization: 

  • Does “capitation” reduce costs? 
  • Do employed physicians necessarily utilize fewer resources? 
  • What happens when a HMO and a traditional fee-for-service health system operate side-by-side in a community?
BMC and Accountable Care - Boston Medical Center

Enjoy!

PODCAST: http://alertandoriented.com/real-acos-havent-been-tried-yet/

Your thoughts are appreciated.

THANK YOU

***

INFLATION Is Here!

But for How Long?

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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

Your thoughts are appreciated.

THANK YOU

***
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MEDICAL ETHICS: Managing Risk is a Component of Caring

Demanding High Moral Standards of Self … and Economic HEALTHCARE Organizations

Dr. David Edward Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy. 

Experts Speak

In his book Medicine at the Crossroads, colleague and Emory University professor Melvin Konnor, MD noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He lays significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.” 

In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.

Evolution

In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.  While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar. 

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.” 

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.  Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care. 

Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise”. 

ASSESSMENT

Health care is indeed grounded in caring. And, managing risk is a component of caring. It arises from a sympathetic response to the suffering of others.

YOUR THOUGHTS ARE APPRECIATED

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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™

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***

FORM ADV is a Must Read for Selecting a Financial “Advisor”

Form ADV – The Essential Document

Dr. David Edward Marcinko MBA - WEGO Health Awards Nominee

By Dr. David Edward Marcinko MBA CMP©

SPONSOR: http://www.CertifiedMedicalPlanner.org

CMP logo

Under law, financial advisors and planners must provide you with a form ADV Part II or a brochure that covers the same information.  Even if a brochure is provided, ask for the ADV.  While it is acceptable, even desirable, for the brochure to be easier to read than the ADV, the ADV is what is filed with the appropriate state or SEC.  If the brochure reads more like a slick sales brochure or the information in the brochure glosses over the items on the ADV to a high degree, one should consider eliminating the advisor from consideration.

FIDUCIARY: https://medicalexecutivepost.com/2020/06/15/the-new-fiduciary-rule/

Registering with a state or SEC gives an advisor a fiduciary duty to the client.  This is a high standard under the law. 

There are several types of advisors who are exempt from registering and filing an ADV. 

First, there are registered representatives (brokers).  Brokers have a fiduciary responsibility to their firms regardless of whether they are statutory employees or independent contractors. Not the client.

Second are attorneys and accountants whose advice is “incidental” to their legal or accounting practices. But, why would one hire someone whose advice is “incidental” to his primary profession?  A top-notch advisor is a full-time professional and should be registered.  One should insist that their advisor be registered.

CFP: https://medicalexecutivepost.com/2016/11/18/why-we-cannot-assume-cfp-equals-fiduciary/

The ADV will describe the advisor’s background and employment history, including any prior disciplinary issues.  It will describe the ownership of the firm and outline how the firm and advisor are compensated.  Any referral arrangements will be described.  If an advisor has an interest in any of the investments to be recommended, it must be listed as well as the fee schedule.  There is also a description of the types of investments recommended and the types of research information that is used.

ASSESSMENT: A review of the ADV should result in an alignment of what the advisor said during the interview and what is filed with the regulators.  If there is a clear discrepancy, choose another advisor.  If it is unclear, discuss the issue with the advisor.

Your thoughts and comments are appreciated.

Form ADV | Moneygrow.com | Registered Investment Advisor ...

SEC Headquarters
100 F Street, NE
Washington, DC 20549
(202) 942-8088

TEXTBOOK ORDER: ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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

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***

The CERTIFIED MEDICAL PLANNER® Online Designation Program is Now Automated

[By Staff Reporters]

The concept of a self-taught and student motivated, but automated outcomes driven classroom may seem like a nightmare scenario for those who are not comfortable with computers.

Now everyone can breathe a sigh of relief, because the Institute of Medical Business Advisors just launched an “automated” final examination review protocol that requires no programming skill whatsoever.

Enter the CMPs

cmp

In fact, everything is designed to be very simple and easy to use. Once a student’s examination “blue-book” is received, computerized “robotic reviewers” correct student assignments and quarterly test answers. This automated examination model lets the robots correct tests and exams, while the students concentrate on guided self-learning.

SplitShire-

http://www.CertifiedMedicalPlanner.org

Assessment

According to Eugene Schmuckler PhD MBA MEd, Dean of the CERTIFIED MEDICAL PLANNER® professional designation and certification program,

“This option allows the modern adult-learner save both time and money as s/he progresses toward the ultimate goal of board certification as a CMP® mark holder.”

The trend is growing and iMBA, Inc., is leading the way.

imba inc

THANK YOU

TEXTBOOK LINK: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

***

REAL ESTATE Investing for Physicians?

OVER HEARD IN THE ADVISOR’S LOUNGE

Real Estate and Physicians

What I see in my accounting practice is that significant accumulation in younger physician portfolio growth is not happening as it once did. This is partially because confidence in the equity markets is still not what it was; but that doctors are also looking for better solutions to support their reduced incomes.

For example, I see older doctors with about 25 percent of their wealth in the market, and even in retirement years, do not rely much on that accumulation to live on. Of this 25 percent, about 80 percent is in their retirement plan, as tax breaks for funding are just too good to ignore.

What I do see is that about 50 percent of senior physician wealth is in rental real estate, both in a private residence that has a rental component, and mixed-use properties. It is this that provides a good portion of income in retirement.

So; could I add dialog about real estate as a long term solution for retirement?

Yes, as I believe a real estate concentration in the amount of 5 percent is optimal for a diversified portfolio, but in a very passive way through mutual or index funds that are invested in real estate holdings and not directly owning properties.

Today, as an option, we have the ability to take pension plan assets and transfer marketable securities for rental property to be held inside the plan collecting rents instead of dividends.

Real estate holdings never vary very much, tend to go up modestly, and have preferential tax treatment due to depreciation of the property against income.

YOUR THOUGHTS ARE APPRECIATED.

GLEASONS GIVE A KID A DREAM | gleasonsgiveakidadream

Perry D’Alessio, CPA
[D’Alessio Tocci & Pell LLP]

THANK YOU

***

In Defense of Employed Physicians

The History of Managed Care

Episode 91: Dr. Michel Accad - How Did Medicine Go Wrong?

By Michel Accad, MD

EDITOR’S NOTE: Dr. Accad practices internal medicine and cardiology in San Francisco.

***

I wish to make one clarification and one prediction regarding employed physicians.

The clarification is this:  There is a common misconception that if healthcare operated under free market conditions, it would primarily be a cottage industry of solo practices and of small physician-owned hospitals.  Such operations would not develop the capabilities of large healthcare entities that we commonly associate with central planning.

See the source image

ASSESSMENT: In reality, however, the opposite would be the case.

LINK: http://alertandoriented.com/in-defense-of-the-employed-physician/

[Related article: One hundred years of managed care]

Your thoughts are appreciated.

THANK YOU

***

Clue-Less Physicians and Taxes

OVER HEARD IN THE DOCTOR’S LOUNGE

Dr.s' Lounge دكتورز لونج - Identity Design by YaStudio

A PHYSICIAN POLL

[IRS Tax Day – May 17, 2021]

“I read a poll on SERMO (a doctor-only web forum) asking what percentage of income was paid in taxes. The lowest option was <20%.  I thought it ridiculous since I make about an average salary and paid about 8% in Federal tax, 3.5% in payroll tax, and 4% in state income taxes. So, I spoke up about it. 

After a few days of correspondence, it became evident that most doctors have no idea what they pay in taxes, or that they pay far too much in taxes.  For example, of 58 responses on the poll, I was the only one who paid less than 20% in taxes.  Keep in mind that more than half of doctors make less money than I do.

I found it hilarious that 4 doctors thought they paid more than 50% in taxes.  I can’t quite figure out how to pull that off; even if you are single, make a ton of money, take a standard deduction, are self-employed, and pay ridiculous state and local income taxes. Really … more than 50%!  You’re either mistaken or stupid … hopefully; just mistaken.

Or is the problem simply that doctor’s have no idea what their effective tax rate is”?

DJ. Morgane DO

[Internal Medicine]

Your thoughts are appreciated.

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THANK YOU

***

Physician Recruitment and Executive Search Firms

Facts about Physician Recruiters and Executive Search Firms

May Launches the Busy Season

By Dr. David E. Marcinko MBA CMP®

CMP logo

Sponsored: http://www.CertifiedMedicalPlanner.org

1) If you are job hunting, you should send your resume to recruiters

Different recruiters know about different positions. They do not usually know about the same ones. This is particularly true with retained firms. By sending your resume out widely, you will be placed in many different confidential databases and be alerted of many different positions. If you send your resume to only a few, it may be that none you send to will be working with positions which are suited for you. Throw your net widely.

If you change jobs, it is also wise to send follow-up letters to the recruiters and alert them of your new career move. Many search firms follow people throughout their careers and enjoy being kept up-to-date. It is a good idea to have your resume formatted in plain text so you can copy and paste it into email messages when requested to do so. Then, follow up with a nicely formatted copy on paper by postal mail.

Some estimate that only 1% to 3% of all resumes sent will result in actual job interviews. So, if you only send 50 resumes, you may only have less than 2 interviews, if that many. Send your resume to as many recruiters as you can. It is worth the postage or email time. Generally, recruiters will not share your resume with any employer or give your name to anyone else without obtaining your specific permission to do so. The recruiter will call first, talk to you about a particular position and then ask your permission to share your resume with that employer.

2) Your resume will be kept strictly confidential by the executive search firm.

It is safe to submit your resume to a search firm and not worry that the search firm will let it leak out that you are job hunting. Recruiters will call you each and every time they wish to present you to an employer in order to gain your permission. Only after they have gained your permission will they submit your name or resume to the identified employer. The wonderful aspect of working with search firms is that you can manage your career and your job search in confidence and privacy.

3) Fees are always paid by the employer, not the job candidate.

Recruiters and search firms work for the employer or hiring entity. The employer pays them a fee for locating the right physician for the job opening. This is important to remember, in that when you interact with executive recruiters, you are essentially interacting with an agent or representative of the employer. Recruiters are more loyal to employers than they are to job candidates because they work for the employer. This should not present a problem, but, should cause you to develop your relationship with the recruiter with the same integrity and professionalism that you would with the employer.

Recruiters are paid fees in one of two ways – retainer fees or contingency fees. This is an important distinction and will affect your process with both the employer and the recruiter. Some employers prefer working with contingency firms and some with retained firms. Both are respected by employers and useful in your job search, but, the two types of firms will not be handling the same positions with the same employers simultaneously.

A “retained recruiter” has entered an exclusive contract with an employer to fill a particular position. The retained recruiter, then, is likely to advertise a position, sharing the specifics of the position, location and employer openly. The retained firm feels a great obligation to fulfill the contract by finding the best person for the job.

A “contingency recruiter” on the other hand, usually does not have an exclusive relationship with the employer, and is only paid a fee if the job search is successful. Often, if the employer uses contingency firms, there will be more than one contingency firm competing to fill a certain position. As a job hunter, if you are sent to an interview by a contingency firm, you may find that you are competing with a larger number of applicants for a position. Generally, retained firms only send in from 3 to 5 candidates for a position.

Recruiters will be paid fees equal to about 25% to 35% of the resulting salary of the successful candidate plus expenses. This does not come out of the job candidate’s salary. This is paid to the recruiter through a separate relationship between the employer and the search firm. This may seem like a large fee, but, keep in mind that recruiters incur a great many expenses when searching for successful job candidates. They spend enormous amounts of money on computer systems, long distance calls, mail-outs, travel and interviews. Recruiters work very hard for these fees. Employers recognize the value of using recruiters and are more than willing to pay recruiters the fees. All you have to do is contact the recruiter to get the process moving. 

4) Not all medical recruiters work only with physicians.

Some search firms work exclusively with physicians or in healthcare, while others may work in several fields at once. Some of the larger generalist firms will have one or more search consultants that specialize in healthcare. It is important for you, as a job hunter, to assess the recruiters’ knowledge of your field. If you use industry or medical specialty buzz words in describing your skills, experience or career aspirations, you may or may not be talking a language the recruiter understands fully. It is wise to explore fully with the recruiter his understanding of your field and area of specialization.

5) Recruiters and search consultants move around.

Recruiters, like many professionals, move to new firms during their careers. Often you will find that recruiters will work at several firms during their careers. Since it is much more effective to address your letters to a person rather than “to whom it may concern”, it is smart for job hunters to have accurate and up-to-date information about who is who and where, since this can change frequently. Search firms also move their offices, sometimes to another suite, street or state. If you have a list of recruiters that is over one year old, you will certainly waste some postage in mailing your resumes and cover letters. Many of your mail-outs will be returned to you stamped “non-deliverable”, unless you obtain an up-to-date list. A resource, like the Directory of Healthcare Recruiters is updated very frequently, usually monthly [www.pohly.com/dir3.html].

6) Most search firms work with positions all over the country.

If you are from a particular state, and want to remain in that state, don’t make the mistake of only sending your resume to recruiters in your state. Often the recruiters in your state are working on positions in other states, and recruiters in other states are working on positions in your state. This is usually the case. Very few recruiters work only in their local area, most work all around the US and some internationally. Regardless of your geographic preference, you should still send your resume to all the healthcare recruiters. If you really only want to remain in your area, you can specify that preference in your cover letter.

7) Recruiters primarily work with hard to fill positions or executive positions.

Some recruiters specialize in clinical positions for physicians, managed care executive positions, healthcare financial positions or health administration positions. Others may specialize in finding doctors, nurses or physical therapists. Generally, an employer does not engage a recruiter’s assistance in filling a position unless it is hard to fill. Sometimes employers will engage search firms to save them the valuable time of advertising or combing through dozens of resumes.

A Career in Medical Recruiting - The Campus Career Coach

ASSESSMENT

Contingency recruiters tend to work with more mid-level management and professional positions, but, this is not always the case. Retained firms generally work with the higher level clinical or administrative positions.

One thing you will be assured of is that if a recruiter is working on a position that means that the employer is willing to pay a fee. That usually means that the position is a valued position and one worth closer inspection on your part. Even in healthcare, with certain exceptions, our economy is an “employer’s market”. This means that employers receive a deluge of resumes for their open positions. Increasingly, employers are using recruitment firms to handle their openings and schedule the interviews because employers simply do not have the manpower or time to handle the many resumes they receive.

Therefore, if a job hunter is submitted by a recruiter, that job hunter has a great advantage over all other applicants.

Your thoughts are appreciated.

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***

A Treatise on Disabled Physicians

The disabled doctors not believed by their colleagues

[By Miranda Schreiber]

FACT: People often feel nervous when they visit a doctor with some fearing their symptoms may not be believed.

QUERY: But what if you are the doctor, and your colleagues dismiss your disabilities and mental health difficulties?

Three Ways to Improve Care for Patients With Disabilities ...

LINK: https://www.bbc.com/news/disability-56244376?utm_source=pocket-newtab

EDITOR’S NOTE: I had a classmate in both high school and medical school with Charctot-MarieTooth disease so I am aware of this phenomenon: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Charcot-Marie-Tooth-Disease-Fact-Sheet

Dr. David Edward Marcinko MBA

[Editor-in-Chief]

ASSESSMENT: Your thoughts are appreciated

THANK YOU

***

What Exactly is a D.O.?

DOCTOR OF OSTEOPATHIC MEDICINE

See the source image

By Dr. David Edward Marcinko MBA CMP®

[Editor-in-Chief]

OK; I admit it. I have a formal educational background in allopathic, podiatric and osteopathic medicine. I also have both earned and conferred medical degrees from the States as well as Europe. I even dropped out of dental and law school back in the day … Such the protean dilettante!

Now, today there are about 950,000 allopathic physicians, 20,000 podiatrists, 150,000 dentists and 50,000 osteopaths. And, from this cohort of medical professionals, the Doctor of Osteopathic Medicine [DO] seems to be the least well understood practitioner.

And so, I thought this essay from Very Well Health might be helpful to all our Medical Executive-Post readers and subscribers [Differences Between a DO Physician and an MD – Comparing Osteopathic and Allopathic Medical Training].

LINK: https://www.verywellhealth.com/do-doctors-vs-md-doctors-whats-the-difference-3157310

ASSESSMENT: Your thoughts are appreciated.

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THANK YOU

***

What is Your Teaching Philosophy?

 Here is My Teaching Philosophy

[By Dr. David Edward Marcinko MBA]

Although any learner-centered teaching philosophy, or Boyer Model of scholarship, is constantly in flux, the mission of a public or private educator is: [1] to promote positive learning; [2] to motivate students, staff and graduates; [3] to provide a strong foundation for lifelong learning; and in modernity [4] to enhance career and life-work opportunities; to [5] improve bottom-line financial metrics, and [6] to collaborate on a national and global basis.

However, because we are specifically operating in the rapidly changing healthcare, business management, investing, finance, economics and education milieu, even deeper experiential insight is needed.

Developing NEW Teaching AND Education Skills FOR Business and Healthcare 2.0

Medicine and healthcare business today is different than a generation ago, and all educators and healthcare professionals need new skills to be successful.

Traditionally, the physician – like the classroom professor – was viewed as the “captain of the ship”. Today, their role may be more akin to a ship’s navigator, utilizing clinical, teaching skills and knowledge to chart the patient’s, or student’s, course through a confusing morass of requirements, choices, rules and regulations to achieve the best attainable clinical or didactic outcomes.

This new teaching paradigm includes many classic business school principles, now modified to fit the PP-ACA, the era of health reform, and modern technical connectivity. Thus, a Professor, Chair or Dean must be a subtle guide on the side; not bombastic sage on the stage.

These, newer teaching philosophies must include:

  • Negotiation – working to optimize appropriate curricula, services and materials;
  • Team play – working in concert with others to coordinate education delivery within a clinically appropriate and cost-effective framework;
  • Working within the limits of competence – avoiding the pitfalls of the generalist teacher versus the subject matter expert that may restrict access to professors, texts and facilities by clearly acknowledging when a higher degree of didactic service is needed on behalf of the student;
  • Respecting different cultures and values – inherent in the support of the academic Principle of Autonomy is the acceptance of values that may differ from one’s own. As the US becomes more culturally heterogeneous, educators and medical providers are called upon to work within, and respect, the socio-cultural and/or spiritual framework of patients, students and their families; 
  • Seeking clarity on what constitutes marginal education – within a system of finite resources; providers and professors are called upon to openly communicate with students and patients regarding access to marginal education and/or treatments.
  • Supporting evidence-based practice – educators, like healthcare providers, should utilize outcomes data to reduce variation in treatments and curriculum to achieve higher academic efficiencies and improved care delivery;
  • Fostering transparency and openness in communications – teachers and healthcare professionals should be willing, and prepared, to discuss all aspects of care and academic andragogy; especially when disclosing problems or issues that arise;
  • Exercising decision-making flexibility – treatment algorithms, templates and teaching pathways are useful tools when used within their scope; but providers and professors must have the authority to adjust the plan if circumstances warrant;
  • Becoming skilled in the art of listening and interpretingIn her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD PhD, a professor at Columbia University, writes of the extraordinary value of using the patient’s personal story in the treatment plan. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases; convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship. The educational analog to this book is, The Ethics of Teaching [A Casebook], co-edited by my teacher and colleague Deborah Ware Balogh PhD of the University of Indianapolis.

***

The Ohio State University
 Photo by Kevin Fitzsimons

***

Assessment

Finally, these thoughts represent only a handful of examples to illustrate the myriad of new skills that tomorrow’s healthcare professionals, and modern educators, must master in order to meet their timeless professional obligations of compassionate patient care and contemporary teaching effectiveness.

Dr. Marcinko Teaching Philosophy

CHAIR: Chair 3.0 Philosophy Dr. Marcinko

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.

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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

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***

Product DetailsProduct Details

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Keeping the CORONA VIRUS Out of Dental Offices?

Opinion-Editorial

[By Darrell K. Pruitt DDS]

The ONLY way to protect dentists, staff, patients and their families from the risk of fatal COVID-19 infections is to keep the virus out of dental offices. (See graph from the New York Times).

***

Prediction: If quick and reliable testing is not available soon, within weeks after dental offices re-open for routine dental care – creating aerosols with high speed hand pieces, air/water syringes and ultrasonic scalers – dental offices will justifiably become known as reliable sources of COVID-19 infections, before being closed down again by the state.

Assessment: Your thoughts are appreciated.

***

Product Details

 

Investing in Financial Counseling

Investing in Financial Counseling

By Rick Kahker MSFS CFP

As a long-time advocate of blending financial planning with counseling, I’ve had years of seeing the benefit for clients. I have come to see financial counseling as an investment: one that can pay greater dividends than investments in a home, retirement account, or college education.

How can this be the case?

Mostly because making good financial decisions is the foundation of financial and emotional well-being. Most financial and many emotional problems result from disordered and dysfunctional money beliefs and behaviors. Money disorders can impair people’s functioning and disrupt their well-being just as significantly as disorders like alcoholism or other addictions.

Some common disordered money behaviors include the following:

• Compulsive Spending is a consuming focus on buying. It can include buying things you can’t afford as well as “retail therapy” shopping where no money is actually spent. It can mean you underfund emergency reserves and don’t adequately set aside enough for retirement.

• Financial Enabling is an attempt to meet your emotional needs by “helping” others, which usually does more harm than good. A pattern of bailing kids out financially is a good example. Enabling can financially harm the parent by diverting resources from other needs and sabotage the child by rewarding dependency and entitlement thinking.

• Hoarding is compulsively buying and storing things that you don’t need or will never use.

• Financial Infidelity is keeping money secrets (such as spending, saving, or investment mistakes) from your partner because you would be ashamed to have them find out.

• Inappropriate Financial Boundaries is sharing of worries or financial details in ways that violate the boundaries between children and adults.

• Workaholism is a consuming focus on work or earning to a point of damaging your relationships.

• Underspending is frugality taken to extremes, such as inadequate spending on health care, nutrition, shelter, or clothing even when you can afford them.

All these disordered financial behaviors have one thing in common: fundamentally, they aren’t about the money. They are often an unconscious response to emotional pain, in the same way addiction or anger might be. The disordered financial behavior may be a medicator that works to deaden deep emotional stress and painful emotions. While one person may find relief in alcohol or drugs and another may find it in work, someone else might use shopping, saving, or financial enabling as a way to feel better and function in the world.

Just like addictions, however, disordered financial behaviors only relieve pain for a short time. Eventually, the pain returns, sometimes even stronger. The result is an escalating cycle of destructive behavior that has many negative consequences, including financial.

To see the link between emotional health and financial health, just read a celebrity magazine or observe people you know. I’ve seen high-earning professionals who have a negative net worth because they can’t control their spending. You probably know people who bounce from one financial mess to another, never seeming to learn from their money mistakes. Some very capable and intelligent people struggle financially and in their careers because of emotional issues.

For most people experiencing financial problems, financial counseling to resolve emotional issues is a low-priority expense that comes far down the list after basic needs like housing, food, and transportation. Yet for anyone who struggles to overcome destructive patterns of behavior—even those that aren’t directly about money—counseling can pay off in very real monetary ways.

***

mind-investing-behavioral-finance

***

Assessment

Emotionally healthy and confident people make better choices about relationships, careers, and other major aspects of their lives. They also make better choices about money. This is why financial counseling is more than an investment in your emotional health. It can also make a measurable difference in your financial wealth.

Your thoughts 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

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InVesting Temperament and Tolerance Shenanigans

Financial Advisors Evaluating Malarkey

cropped-dem

By Dr. David E. Marcinko MBA

Courtesy: www.CertifiedMedicalPlanner.org

Evaluating “Sham” Risk Aversion Determination Methodologies

BACK STORY: You visit a local financial advisor as a prospective client. S/he gives you a form to complete that purports to discern your investing risk tolerance?

FORM: It says: “Please indicate by ranking the items below from 1 to 4, with 1 being the most descriptive and 4 being the least descriptive”.

LINK: https://medicalexecutivepost.com/2009/12/28/risk-aversion-and-investment-alternatives/

EPIPHANY: After reviewing the form, you realize it is a superfluous one-size-fits-all risk reduction mechanism for the advisor. You identify the sheer malarkey of the exercise and leave in disgust. You ruminate to yourself – “there must be a better way,”

MORE: https://medicalexecutivepost.com/2017/10/24/on-investing-risk-tolerance/

And so, colleague Rick Kahler MSFS CFP® suggests alternative methods.

MORE: https://medicalexecutivepost.com/2017/10/18/on-retirement-planning-risks/

Your thoughts are appreciated.

***

***

BUSINESS, FINANCE AND ECONOMICS TEXTBOOKS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

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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Kentucky Derby Day 2020 on September 5th!

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Readers, Visitors, Clients and Friends 

Sean G. Todd[By Sean G. Todd; Esq. M. Tax, CFP©, CPA]

Greetings … This ME-P will have nothing to do with finances / money / taxes / healthcare / the economy … or all the other things you are hearing about 24/7 – don’t stop reading though.  It’s merely about the most exciting 2 minutes in sports; always held on the 1st Saturday in May … a tradition lasting 145 years … can you think of what it is?

Kentucky Derby

You’re right! — 146th running of the Kentucky Derby. The “Run for the Roses” is set for [today] Sept 5th, 2020.  Here are several reasons why the Kentucky Derby is such a tradition.

Twin Spires

Throughout the world, the Twin Spires are a recognized landmark that has become symbolic to Churchill Downs.  Constructed in 1895, the Spires were the creation of a twenty-four-year-old draftsman, Joseph Dominic Baldez. Surpassing a century after being built, the Twin Spires continue to greet the winner of the Kentucky Derby and stand as a familiar beacon to horse racing enthusiasts everywhere.

The Trophy

Since the 50th running of the Kentucky Derby in 1924, Churchill Downs has annually presented a gold trophy to the winning owner of the famed “Run for the Roses.” History is unclear if a trophy was presented in 1875 to the winner of the first Kentucky Derby, and trophy presentations were sporadically made in following years. Finally, in 1924, legendary Churchill Downs President Matt Winn commissioned that a standard design be developed for the “Golden Anniversary” of the Derby.

To commemorate Derby 125 a change was made and the horseshoe was turned 180 degrees so that its ends pointed up. The trophy now annually incorporates the horseshoe with the ends pointing up. Racing superstition decrees that if the horseshoe is turned down all the luck will run out.

Since 1975, the trophy has been created by New England Serling located in North Attleboro, MA. The trophy, which is topped by an 18-karat gold horse and rider, includes horseshoe shaped handles, is 22 inches tall and weighs 56 ounces, excluding its jade base. The entire trophy is handcrafted with the exception of the horse and rider that are both cast from a mold.

To complete the trophy by April, craftsmen begin the process during the fall of the previous year and literally work hundreds of hours. The trophy is believed to be the only solid gold trophy that is annually awarded the winner of a major American sporting event.

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MORE: https://bleacherreport.com/articles/2834432-kentucky-derby-2019-lineup-full-race-guide-for-all-horses-and-jockeys

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Mint Julep

The Mint Julep has been the traditional beverage of Churchill Downs and the Kentucky Derby for nearly a century. Each year; almost 120,000 Early Times Mint Juleps are served over the two-day period of the Kentucky Oaks and Kentucky Derby.

Hit Parade

The second most entertaining parade next to the Kentucky Derby post parade is the parade of hats on display at Churchill Downs. From the fantastic to the sublime, there are no rules or limits.  Does a Derby hat improve one’s luck at picking winners? Some say; “yes, it certainly helps.”

Assessment

Be sure to take a moment out of your day and participate in the running of 145th Kentucky Derby. As always, make the most of each day!

MORE: https://www.nytimes.com/2018/05/01/sports/kentucky-derby-draw-odds.html

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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The Emerging Role of University CHIEF STRATEGY OFFICER

Common in Industry – Still Not so Much in Academe’

By Dr. David Edward Marcinko MBA

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http://www.CertifiedMedicalPlanner.org

A Chief Strategy Officer [CSO], or chief strategist, is the senior  executive responsible for assisting the Chief Executive Officer [CEO] with developing, communicating, executing, and sustaining corporate strategic initiatives. Some companies give the title Chief Business Officer [CBO] to its’ senior executives who are holding the top strategy role.

My opinion in academia

A few decades ago, the role of university Chief Strategy Officer [CSO] did not exist or marginally existed as a mid-level project manager in the communications department. It may have consisted of a formal background in teaching and education exhibited by the BA and/or B.Ed degrees or HR certification.

A first generation didactic CSO 1.0; if you will.

Then, as academic competition and granularity increased along with new technology information exchange, the need for deeper subject matter expertise arose. Next – generation business, under/graduate LAs, HUMANITIES, modern culture, psychology / sociology and STEM expertise arose to create and explore new – real or perceived – strategic advantages for university public relations in the form of the M.Ed, MA or MBA degrees in marketing, advertising, sales or competitive analysis.

THINK: Michal Porter PhD, known for his theories on economics, business strategy, and social causes. He is the Bishop William Lawrence University Professor at Harvard Business School, and a social impact consultant. He is credited for creating Porter’s five forces analysis, which is instrumental in business strategy development today.

Also, consider traditional S.W.O.T analysis, as well. SWOT analysis (alternatively SWOT matrix) is an initialism for strengths, weaknesses, opportunities, and threats—and is a structured planning method that evaluates those four elements of a project or business venture. A SWOT analysis can be carried out for a product, place, industry, university or person.

So, let’s call this a second generation expert CSO 2.0

However, as the complex business of running any college or university is ever changing, the ideal profile of CSO is still morphing to face modern business and management challenges like: physical and cyber security; culture and organizational behavior; gender differences, racial disparities and workplace violence issues; enrollment and international expansion; corporatization and competition; online and e-learning initiatives; with accounting, financial and economic pressures, etc.

Consequently, BODs are now seeking and embracing a new kind of CSO with advanced PhD or DBA degrees; and college and university experience. In fact, the role of contemporary CSO is emerging and becoming closer to that of an experienced corporate Chief Executive Officer, than the mere educator, academician or manager of the past.

Definitions: https://www.amazon.com/Dictionary-Health-Economics-Finance-Marcinko/dp/0826102549/ref=sr_1_6?ie=UTF8&s=books&qid=1254413315&sr=1-6

Universities and colleges  today

Insightful academic search committees are now seeking a new type of modern CSO who can build university and college rankings, maintain relationships with stakeholders, and project a positive image as a “celebrity university”.

This means shepherding students and attracting qualified youth, and faculty, for matriculation as areas of particular importance. This new entrepreneurial CSO must focus on business management, economics and finance – operational, marketing, advertising and consultative sales strategies to attract a qualified, protean and diverse student / professional staff that sets it apart from the competition; as well as more meaningfully interacting within [research and development], and without the university [outreach].

Accordingly, this  modern CSO must be a combination and protean surrogate for the university  CEO / CFO / CMO / COO / CAO and leader – NOT just a teacher or manager – who will help run it like a matrix business unit that makes a profit to generate needed capital and ROI.

Multiple lines of business – tuition; certifications; worker-placement; grants and endowments; CEUs and non-degree program fees; as well as for-profit R&D, publications, patents, copyrights and trade-marks; and applied business incubators – must ALL be created and managed as a diversified portfolio. S/he must lead in the implementation, planning and operations of systemic community responsive programs, as well as policy interventions requiring advocacy, political action and public analysis.

I prefer the moniker – CSO 3.0

Assessment

This academic CSO 3.0 must be a change-agent, crisis manager, corporate strategist, Machiavellian devotee and/or seasoned C-suite executive with the required inter – disciplinary skills outlined for this important position.

Above all – the modern CSO 3.0 must be pro-active, flexible and market responsive. This is not the place for tenure tracking.

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MEDICAL PRACTICE AND HOSPITAL OPERATIONS, STRATEGIC DEVELOPMENT, ORGANIZATIONAL BEHAVIOR AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET

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[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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.

imageproxy5

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My Pragmatic Philosophy of Education

It is NOT the Boyer Model

[By Dr. David E. Marcinko MBA]

The Boyer Model of Education and Scholarship

OK – I may subscribe to the Boyer Model but with several specific personal variations which I will keep propriety and not disclose here. But, I will discuss my teaching pragmatism, below.

Definition

Boyer’s Model of scholarship and education is an academic model advocating expansion of the traditional definition of scholarship and research into four types of scholarship. It was introduced in 1990 by Ernest Boyer.

According to Boyer, traditional research, or the scholarship of discovery, had been the center of academic life and crucial to an institution’s advancement but it needed to be broadened and made more flexible to include not only the new social and environmental challenges beyond the campus but also the reality of contemporary life.

His vision was to change the research mission of universities by introducing the idea that scholarship needed to be redefined.

MORE: https://en.wikipedia.org/wiki/Boyer%27s_model_of_scholarship

ME: Dr. Marcinko Teaching Philosophy

ENTER MY PRAGMATISM

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DEAN: Dean 3.0 Philosophy

Assessment

So, what do you think?

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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

***

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. Dave Marcinko at YOUR Service in 2021

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Book Marcinko for your next Seminar, Meeting or Medical Business Event 

By Ann Miller RN MHA

Professor and physician executive David Edward Marcinko MBBS DPM MBA MEd BSc CMP® is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; Oglethorpe University, and Atlanta Hospital & Medical Center in GA; and the Aachen City University Hospital, Koln-Germany. He is one of the most innovative global thought leaders in health care business and entrepreneurship today.

Dr. Marcinko is a multi-degreed educator, board certified physician, surgical fellow, hospital medical staff President, Chief Education Officer and philanthropist with more than 400 published papers; 5,150 op-ed pieces and over 125+ international presentations to his credit; including the top 10 biggest pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

Dr. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner®, who was named “Health Economist of the Year” in 2001. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, management and trade publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News].

As a licensed insurance agent, RIA and SEC registered endowment fund manager, Dr. Marcinko is Founding Dean of the fiduciary focused CERTIFIED MEDICAL PLANNER® chartered designation education program; as well as Chief Editor of the HEALTH DICTIONARY SERIES® Wiki Project. His professional memberships include: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA and HIMSS.

Dr. Marcinko is a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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Popular Pre-Halloween Content for 2019

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Aggregating Content – Disseminating Knowledge

By Dr. David Edward Marcinko MBA [Editor-in-Chief]

Nathaniel Potter MD

Halloween (also spelled Hallowe’en) is an annual holiday celebrated on October 31st.  It has roots in the Celtic festival of Samhain and the Christian holy day of All Saints.

Today, it is largely a secular celebration but some have expressed strong feelings about perceived religious overtones.

Here are two interesting and popular ME-P articles for this Halloween season.

Poe: https://healthcarefinancials.wordpress.com/2009/08/27/off-road-touring-with-dr-marcinko-part-vi/

Potter: https://medicalexecutivepost.com/2009/08/27/off-road-touring-with-dr-marcinko-part-vi/

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thumbnail_IMG_0487_edit2

“DANCE OF DEATH”

[Copyright 2018 iMBA Inc., All rights reserved. USA]

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

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Are You a Continuing Education Pioneer?

More on Lifelong Learning

[By Dr. David Marcinko MBA]

Today, it is increasingly imperative for colleges and universities to expand the universe of targeted adult-learners. This is for aspiring professionals, managers, executives and leaders, or those already in the workforce. The tuition gathering universe is thus expanded beyond graduation.

I developed and launched several such successful CE programs that were merged or sold to private investors, colleges and hedge funds

SAMPLE: www.PodiatryPrep.org

Also known as Executive Service Line [ESL] education, this business model refers to academic programs for adults that are generally non-credit and non-degree-granting, but may lead to professional certifications.

Estimates by Business Week magazine suggest that executive education in the United States is a $900 million annual business with approximately 80 percent provided by university schools.

SAMPLE: www.CertifiedMedicalPlanner.org

In addition to the educational benefits, monetary dividends are reaped as enrollment eases matriculation access. Similar programs at the Wharton School, Darden, Harvard, Duke, Yale and the Goizueta Business School at Emory University charge premium rates for the implied institutional moniker.

***

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ASSESSMENT: Your thoughts are appreciated. Are you a continuing education pioneer?

MORE BUSINESS AND INVESTING FOR 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

THANK YOU

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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Why 75 Years of American Finance Should Matter to Physician Investors

A Graphic Presentation [1861-1935] with Commentary from the Publisher

By Dr. David Edward Marcinko FACFAS MBA CPHQ CMP™

http://www.CertifiedMedicalPlanner.org

As our private iMBA Inc clients, ME-P subscribers, textbook and dictionary purchasers, seminar attendees and most ME-P readers know, Ken Arrow is my favorite economist. Why?

About Kenneth J. Arrow, PhD

Well, in 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked Academe’ by identifying health economics as a separate and distinct field. Yet, the seemingly disparate insurance, asset allocation, econometric, statistical and portfolio management principles that he studied have been transparent to most financial professionals and wealth management advisors for years; at least until now.

Nevertheless, to informed cognoscenti, they served as predecessors to the modern healthcare advisory era. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views. And, we envisioned the ME-P at that time to present these increasingly integrated topics to our audience.

Healthcare Economics Today

Today – as 2019 nears – savvy medical professionals, management consultants and financial advisors are realizing that the healthcare industrial complex is in flux; and this dynamic may be reflected in the overall economy.

Like many laymen seeking employment, for example, physicians are frantically searching for new ways to improve office revenues and grow personal assets, because of the economic dislocation that is Managed Care, Medi Care and Obama Care [ACA], the depressed business cycle, etc.

Moreover, the largest transfer of wealth in US history is – or was – taking place as our lay elders and mature doctors sell their practices or inherit parents’ estates. Increasingly, the artificial academic boundary between the traditional domestic economy, financial planning and contemporaneous medical practice management is blurring.

I’m Not a Cassandra

Yet, I am no gloom and doom Cassandra like I have been accused, of late. I am not cut from the same cloth as a Jason Zweig, Jeremy Grantham or Nouriel Roubini PhD, for example.

However, I do subscribe to the philosophy of Hope for the Best – Plan for the Worst.

And so dear colleagues, I ask you, “Are the latest swings in the economic, healthcare and financial headlines making you wonder when it will ever stop?”

The short answer is: “It will never stop” because what’s been happening isn’t any “new normal”; it’s just the old normal playing out before a new audience.

What audience?

The next-generation of investors, FAs, management consultants and the medical professionals of Health 2.0.

How do I know all this?

History tells me so! Just read this work, and opine otherwise, or reach a different conclusion.

Evidence from the American Financial Scene, circa 1861-1935

The work was created by L. Merle Hostetler in 1936, while he was at Cleveland College of Western Reserve University (now known as Case Western Reserve University). I learned of him while in B-School, back in the day.

At some point after it was printed, he added the years 1936-1938. Mr. Hostetler became a Financial Economist at the Federal Reserve Bank of Cleveland in 1943. In 1953 he was made Director of Research. He resigned from the Bank in 1962 to work for Union Commerce Bank in Cleveland. He died in 1990.

The volume appears to be self published and consists of a chart, approximately 85′ long, fan-folded into 40 pages with additional years attached to the last page. It also includes a “topical index” to the chart and some questions of technical interest which can be answered by the chart.

Link: http://fraser.stlouisfed.org/75years

Assessment

And so, as with Sir John Templeton’s [whose son is an MD] four most dangerous words in investing (It’s different this time), Hostetler effectively illustrates that it wasn’t so different in his era, and maybe—just maybe—it isn’t so different today for all these conjoined fields.

Conclusion      

Your thoughts and comments on this ME-P are appreciated. While not exactly a “sacred cow,” there is a current theory that investors will experience higher volatility and lower global returns for the foreseeable future.

In fact, it has gained widespread acceptance, from the above noted Cassandra’s and others, as problems in Europe persist and threats of a double-dip recession loom. But, how true is this notion; really?

Is Hostetler correct, or not; and why?

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:

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

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed. Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

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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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The Next Big [Investment] Thing?

Or, NOT!

By Rick Kahler CFP®

How do you spot the investment opportunity that will become the next Apple, Facebook, or Microsoft? Certainly they are out there. Someone is going to discover them and be set for life, so why shouldn’t it be you?

Here’s why it shouldn’t

As with all Registered Investment Advisors, the amount of money I manage for clients is publicly disclosed information that anyone with an Internet connection can find.

Because of that, I am seen as the gatekeeper of a source of funding for every under funded business opportunity that is sure to become the next Apple. I get to see a lot of proposals. Many have promise at first glance. But the promise usually fades the more I dig into the proposal, ask questions, and do the math.

After hours and hours of investigation, every few years I see that one proposal that looks really good. One that calls to me to invest, that really has the promise of being a winner. When all the stars and the planets align, I know I now have a 90% chance of not making a dime on the venture.

That’s why I have learned to save my time and my money when I am approached with “the next big thing.” I just don’t have time to investigate every project and cull hundreds of opportunities down to the one that has a 10% chance of succeeding. I see it as looking for the proverbial needle in the haystack. Certainly, there’s a needle in there somewhere. But examining every piece of hay in order to find it has a significant monetary cost.

To succeed, I would need a lot of time, even more money, and exponentially more intuition and intellect. Not to mention a fair amount of luck. The probability that I will go bankrupt before I ever find the needle is staggering.

Most of the “next big things” are discovered by driven entrepreneurs who bank everything they have on an idea and find the financing to shoestring it together. It usually isn’t the armchair investor who cashes in.

My experience

Over my 40 years of real estate and investment experience, I have seen people lose millions investing in lumber mills, emu farms, highly leveraged real estate, futures contracts, day trading, restaurants, multi-level-marketing companies, rare earth minerals, Iraqi currency, and the newest ones—marijuana farms and crypto-currencies.

As a result, for my money and the money of my clients, I’ll play the odds for success by saying “no” to every opportunity that comes across my desk. I don’t take the time to investigate them. I don’t read the offering circulars. I don’t attend presentations. The answer is “no” to the great odds of losing my money and “yes” to the staggering odds of keeping money growing conservatively for me and for my clients.

What do I say “yes” to? I say yes to investing in mutual funds that own or loan money to 12,000 successful companies around the globe and thousands of real estate properties. I say yes to well-diversified portfolios. I say yes to proven investment strategies with 25-year track records. I say yes to having enough cash reserves to fund two to five years of retirement income.

Boring

I know, it’s not very sexy, is it? In fact, the way I invest my money and the money of those who have entrusted their investments to me is downright boring.

***

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

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Assessment

So here is my hot tip when it comes to finding investment opportunities to secure your future: forget about the “next big thing.” Instead, stay with the “next boring thing.” The odds are overwhelming that this will make you a long-term winner.

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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

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Don’t let Population Health Demographic Trends Guide “Investment” Decisions

A Different Perspective on Population Health

By Dr. David Edward Marcinko MBA CMP®
http://www.CertifiedMedicalPlanner.org

Definition

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. It is an approach to health that aims to improve the health of an entire human population or cohort. http://www.HealthDictionarySeries.org

History

In fact, the nominal “father of population health” is colleague and Dean David B. Nash MD MBA of Jefferson Medical School in Philadelphia. And, although I attended Temple University down the street, David still wrote the Foreword to my textbook years later; Financial Management Strategies for Hospitals and Healthcare Organizations [Tools, Techniques, Checklists and Case Studies].

Factors

Now age, income, location, race, gender  and education are just a few characteristics that differentiate the world’s population. These are called ”disparities” and they have a major impact on people’s lives; especially their healthcare. And, I’ve written about them before.  Perform a ME-P “search” for more.

So, it’s only natural that we’re keeping an eye on two major demographic trends: aging baby boomers and maturing Millennials [1982-2002 approximately].

Why it’s important

The impact of large population shifts propagate throughout an economy benefitting certain sectors more than others and influencing a country’s growth prospects; tantalizing investing ideas?

Example:

For example, as baby boomers retire, we’ll likely see higher spending on health care, but less on education and raising children. Likewise, tech-savvy Millennials will likely prioritize consumption on experiences over cars and houses [leading economic indicator].

So, can we profit from these trends?

Assessment

Well maybe – maybe not! Overall economic prospects may not be completely affected by these trends. Spending habits on combined goods and services will shift, rather than rise or decline.

So, be careful. What matters most for your investment success is your demographics and investing according to your personal circumstances and goals [paradox-of-thrift].

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

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

***

APPLE and the iPhone X

Now Apple must show what’s next after iPhone X

By  Vitaliy Katsenelson CFA

The iPhone X is likely to be a phenomenal success for Apple. But its success will not be driven by anything new that the new phone packs inside. Instead, its success will be based on the phone’s screen size. Essentially, iPhone X provides the same screen real-estate as an iPhone Plus, but with the sleeker form factor of the iPhone 7 or 8.

Apple has done a great job at changing the paradigm of our thinking about the iPhone. If you only care about making phone calls, then an iPhone 4 is good enough. Why pay for more? You probably don’t even need to upgrade your phone for years, as long as the battery keeps holding its charge. However, for most, the actual “phone” function is the least important of the iPhone.

Earnings

From an earnings perspective, iPhone X will be a tremendous boost. It will increase the average selling price per unit by a few hundred dollars, which should help not just sales, but profit margins as well. This is actually healthy for both Apple and the entire iPhone ecosystem (including DRAM and solid state drive makers — for example, we still have a large position in Micron Technology). People were also postponing buying new iPhones while waiting for the iPhone X; thus, the number of units sold will probably exceed most optimistic expectations.

What is next?

Then the question becomes, What is next? Higher-priced iPhones will also change the dynamics of the upgrade cycle. Apple is going to have a harder time convincing iFanatics to shell out $1,000-$1,200 every year (or even every two years). The upgrade cycle will likely be elongating to three or four years.

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Thus, any blow-out success of iPhone X in 2017 and early 2018 will be coming at the expense of future years. Even if you are a loyal Apple shareholder, you have to be prepared for this.

Assessment

Absent a new category of products, Apple is turning into a fully ripe stock. Yes, it will look statistically cheap based on 2018 earnings, but that will not be the case if you look at 2019 or 2020 earnings.

As all the excitement subsides, Apple stock will have to answer an extremely important question: What is next? After all, the value of any business is a lot more than the earnings generated next year, but far beyond that.

Conclusion

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Did ADA Leaders Mislead Congress about EDR Security?

 Electronic Dental Records [EDR] Security?

By Darrell K. Pruitt DDS

“Terrifying Truth: Ransomware is Everywhere – At its basest level, ransomware is a form of kidnapping. Hackers effectively ‘kidnap’ a business’s data and information systems and threaten to destroy it unless the business pays a ransom for its safe return.”

Todd Lewis for Nibletz [October 24, 2017]
http://www.nibletz.com/security/ransomware

Lewis: “Healthcare and hospital networks are prime targets for these attacks. A patient whose medical service provider is unable to access critical patient information can be in a life-or-death situation unless the healthcare network is rapidly recovered and brought back on line. Cyberattackers take advantage of this urgency and realize that hospitals have greater incentives to pay a ransom to recover their systems and operations. Moreover, hospital networks operate on a 24-hour basis and are rarely taken down for maintenance and updating that might include patches for security holes. Ransomware attacks frequently take advantage of holes in networks that have not been patched with regular updates, and hospitals and medical centers are more likely than businesses in other industries to have failed to close those holes.”

ADA: “Dentists will have a more complete data set of the patient they are treating, enabling better care.”

Dr. Robert H. Ahlstrom, representing the American Dental Association and by default, all US dentists, in testimony before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry. His testimony is featured in an official document titled “Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007.”

Click to access 070731p08.pdf

Insightful or clueless dentist?

Conclusion

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Just Say “NO” to Hospitals!

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Just Say No to Hospitals!

Hospitals are examples and metaphors for the iatrogenesis of our entire provision of health care.

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Product DetailsProduct Details

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EHRs, ADA Leaders and Conflict of Interest

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A decade later ….?


By D. Kellus Pruitt DDS

In July 2007, Dr. Robert H. Ahlstrom, representing the American Dental Association and by default, all US dentists, testified before the National Committee on Vital and Health Statistics (NCVHS) on the benefits of EHRs in dentistry.

His testimony is featured in an official document titled:

“Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security July 31, 2007

http://www.ncvhs.hhs.gov/070731p08.pdf

Here are the ADA’s 11 selling points which Dr. Ahlstrom presented to HHS in support of electronic dental records:

  1. Dental office computer systems will be compatible with those of the hospitals and plans they conduct business with. Referral inquiries will be handled easily.
  2. Vendors will be able to supply low-cost software solutions to physicians/dentists who support standards-based electronic data interchange. Costs associated with mailing, faxing and telephoning will decrease.
  3. All administrative tasks can be accomplished electronically. Dentists will have more time to devote to direct care.
  4. Dentists will have a more complete data set of the patient they are treating, enabling better care.
  5. Patients seeking information on enrollment status or health care benefits will be given more accurate, complete and easier-to-understand information.
  6. Consumer documents will be more uniform and easier to read.
  7. Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.
  8. Patients will save postage and telephone costs incurred in claims follow-up.
  9. Patients will have the ability to see what is contained in their medical and dental records and who has accessed them. Patient records will be adequately protected through organizational policies and technical security controls.
  10. Visits to dentists and other health care providers will be shorter without the burden of filling out forms.
  11. Consumer correspondence with insurers about problems with claims will be reduced.

Not one of Ahlstrom’s 11 promises has been fulfilled. None …. Total failure!

A decade later, it has become clear that the nation was misled by ambitious leaders of the American Dental Association who have since enjoyed power and/or profit from members’ misinformed adoption of digital records.

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 In my opinion, the grandest deception in the history of dentistry is clearly a result of a secretive not-for-profit corporation’s conflict of interest. This very important business lesson would have been lost to history if I hadn’t been documenting the true progress of EHRs in dentistry.

I (alone?) recognized very early that paperless was doomed simply because the needs of dentists and their patients was secondary to implementation of third-parties’ half-baked, selfish ideas. And I got spanked for that by the same ADA leadership behind Ahlstrom’s tainted testimony to Congress.

My ADA membership was suspended, and I still have not been told why. All the President of the Texas Dental Association would tell me is, “You know what you did.”

Assessment 

To this day, dental EHRs are both increasingly less secure than paper dental records as well as increasingly more expensive. What’s more, they offer no tangible benefits for the patients. ADA leadership failed my profession.

Transparency is accountability.

Conclusion

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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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The Crypto-future through Bitcoin, Ethereum, Ripple XRP and IOTA

Peering into the Crypto-Future 

By Phil Baumann RN

In order to gain a clearer view of the impacts of the incoming future of technologies and their economic, behavioral, cultural, political and other impacts, categorization can perform useful veil-lifting.

I’ll let the reader do the deep-dive research into the technologies underlying each of these currencies, but here is a peeled-away breakdown of their respective categories:

Whether these specific “coins” succeed the slaughtering rapidity of techno-culture shocks remains to be seen.

Yes, they are traded assets that can make you rich or poor. That’s certainly interesting. What matters much more than their capital markets is that each has attempted to confront crucial problems that can liberate the ramifying “potential energies” of other technologies that can plug in to them.

Their premises spur economy-generating economies.

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Don’t feel bad if you missed the Bitcoin gold-rush. That’s in the past. Sometimes understanding the world confers its own wealth (insert Latin aphorism here). If you run the currency of knowledge through the circuitry of imagination you gain the power of foresight.

Assessment:

That’s my two cents: take them and spread the wealth.

Disclosure: I hold Bitcoin (BTC), Ethereum (ETH), Ripple XRP and IOTA (MIOTA). But this post is not about finance per se nor is it about promoting these currencies as investments. Rather this post is about envisioning the four kinds of markets that the respective technologies underlying each of these four cryptocoins can help grow and power. These aren’t simply currencies and stores of monetary value – they are technologies.

Conclusion

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HITECH: A politically-correct Scam?

Update on HITECH

By Kellus Pruitt DDS

“How bad science can lead to bad science journalism — and bad policy – This is what happens when news organizations don’t catch lousy studies.”

By Stephen Soumerai and Ross Koppel for The Washington Post, June 7, 2017/

Https://www.washingtonpost.com/posteverything/wp/2017/06/07/how-bad-science-can-lead-to-bad-science-journalism-and-bad-policy/?Utm_term=.631e0a2d022c#comments

Soumerai and Koppel:  “As researchers who focus on health care, we see news coverage of badly designed studies constantly. And we’re concerned that breathless reporting on bad science can result in costly, ineffective and even harmful national policies.”

You mean like HITECH?

Since the HITECH Act was passed in 2009, it has been well-documented that not only were the premises of the law fiction, but the law itself has always favored healthcare stakeholders like Cerner at the expense of patients and their doctors – the healthcare principals.

The grandest blunder in medical history gained traction in 1999 with an Institute of Medicine (IOM) report titled, “To Err is Human,” which promises that EHRs should have already saved 100,000 lives a year … Not even close. Not unlike the dangerous research bias described in Soumerai and Koppel’s article that was posted recently, several researchers have also pointed out that the studies cited in the IOM report did not show that people were dying from medical errors that health information technology could detect or correct.

The questionable IOM report was followed in 2005 by a tainted RAND Corporation report which promised savings of $77 billion annually… Wrong again!

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Shortly after the report was published, rumors quickly spread that the data for the study were cherry-picked by those with software to sell. By 2011, the passage of time revealed that RAND had clearly made a vendor-friendly mistake, forcing RAND to disown their study – but not before its optimistic conclusion was instrumental in the successful passage of the HITECH Act in 2009 (two years after Minnesota lawmakers had already passed the doomed EHR mandate based on the same tainted RAND results).

Political Fiat

Then presidential candidate Hillary Clinton was only one of many lawmakers to quote the RAND study. Almost everyone the nation was suckered in. Ultimately, it was revealed that the study’s vendor-friendly conclusion was largely financed by software giant Cerner, who continues to profit from years of misinformation.

(See: “In 2nd Look, Few Savings From Digital Records,” by Reed Abelson and Julie Creswell, New York Times, Jan. 10, 2013).

Http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html

In fact, it was announced last Monday that Cerner, which is responsible for the most dishonest research in the history of health information technology, has been awarded the Department of Veterans Affairs contract for the VA’s next-generation electronic health records system.

Assessment

Dishonesty wins.

Conclusion

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Why Cognizant Shines Brighter as a Stock Pick

Why Cognizant Shines Brighter as a Stock Pick

By Vitaliy Katsenelson, CFA

Originally written for Institutional Investor Magazine

Conclusion

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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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R.I.P. Richard Wagner JD CFP®

On the Life of “Dick” Wagner


By Rick Kahler CFP®

The financial planning profession lost one of its most significant figures this past week. Richard Wagner, my friend and mentor, died suddenly.

Dick, a longtime financial planner in Colorado, was one of the pioneers and thought leaders of personal financial planning. His visionary leadership and commentary were closely followed and highly respected by financial planners worldwide.

Dick’s influence on financial planning was profound. He was one of the early leaders to understand the emotional impact that money has on our lives and to believe that financial planning must include that emotional component in order to fully serve clients’ needs. We each have an individual relationship with money, which affects everyone in all facets of our lives. For this reason, Dick called money “the most powerful and pervasive secular force on the planet.”

He served as the President of the Institute of Certified Financial Planners and received the Financial Planning Association’s (FPA) highest honor, the P. Kemp Fain, Jr. He was a co-founder of the Nazrudin Project, a leaderless brain trust of 100 of the more forward-thinking planners, therapists, and coaches in financial planning. From this group emerged many FPA presidents, as well as scores of influential books and white papers. For its size, Nazrudin has had a disproportionate and continuing impact on the financial planning profession.

Dick also served on the founding board of the Financial Therapy Association. His keynote address at the group’s first conference eloquently laid the foundation for this embryonic movement of blending psychology and financial planning.

Dick’s life work, the beloved passion he carried for decades, was to see financial planning become a profession. In fact, he envisioned financial planning as the most important 21st century profession because of its focus on money. He challenged financial planners to give their best to their clients and their profession. Even further, he urged us to build an authentic profession—one he saw as dedicated to helping people manage intangible but essential functions, maintaining a responsibility to put clients’ interest first, and serving not only individuals but humanity and the greater good. One of Dick’s last contributions to the profession was the publication of the book he labored for 20 years to write, Financial Planning 3.0.

Anyone who knew Dick for more than a minute knew that he told it like it was—with gusto, clarity, and passion. He characteristically would sum up the essence of financial planning as:

“Save more, spend less, and don’t do anything stupid.”

Most importantly, I knew him as an immensely caring, passionate, wise, and conscientious soul. He was one of my valued mentors. The scope of his ideas and the depth of his creative vision challenged me to question my assumptions and expand my own views of what my chosen profession could become.

I had the privilege of spending many weekends with Dick as a member of a small group of financial planning pioneers who were trying to make sense of this union of emotions and money. I often equated listening to Dick’s visions of “what could be” to flying a commercial airliner at 45,000 feet. While he was soaring, I would spend most of my time trying to figure out if and where we could land the plane.

Wherever he may be now, I believe Dick is still soaring—once again, far higher and farther than those of us left behind. His passing leaves me shocked and saddened, with a sense of grief not yet eased by the gratitude I feel for having known him. The financial planning profession to which he devoted so much of his life was vastly enriched by his ideas and his work. 

Publisher’s Note:

Although I never personally met Dick, I do consider him a friend and colleague. We emailed and spoke on the phone, often. In fact, he contributed to the first edition of our book: Financial Planning Handbook For Physicians And Advisors; now in it’s fourth iteration: Comprehensive Financial Planning Strategies for Doctors

Rest in peace my friend. Robert Pine said it well when he noted,

“What we have done for ourselves is soon forgotten but what we have done for others remains and is immortal.”

-Dr. David Marcinko MBA

Conclusion

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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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Pharmaceutical Stocks in the Post-Trump Era?

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By Vitaliy Katsenelson CFA

vitaly

Trumps Hates Them – We Love Them

 Originally written for Institutional Investor Magazine
 A few weeks after Donald Trump was elected president of the United States, he was asked about pharmaceuticals prices. With typical rhetorical gusto, he declared, “Pharmaceutical companies are getting away with murder.” Well, my firm has been increasing our allocation to those “murderers,” and despite Mr. Trump’s comments, we are very comfortable with our positions in the long run (which lies beyond what may end up being a very volatile short run).

Big Pharma

Pharmaceuticals companies check off a lot of boxes in our quality and growth dimensions. They are usually monopolies or oligopolies when it comes to their specific drugs; they have high recurrence of revenue; their business is not cyclic and thus marches to its own drummer; they have strong balance sheets and a high return on capital, and generate a lot of cash flow; they benefit from a significant growth tailwind as the global population ages (I aged just while writing this); and they enjoy pricing power (more on that later). Yet the pharmaceuticals sector as a whole has been decimated over the past eight months due to perceived political risk — first by pharma pricing critic Hillary Clinton’s “It’s in the bag” expectation of victory and then by Trump’s “They get away with murder” comments. We view the carnage created by the political risk as an opportunity to increase our exposure to this sector. Here is why.

President Trump mentioned that he wants the U.S. government — mainly, its Medicare program — to negotiate directly with drug-makers on price. His remark may create the impression that pharmaceuticals companies today charge the government whatever prices they want. That is not the case. Medicare covers prescription drug costs through a program known as Medicare Part D. Medicare basically outsources the negotiation of drug prices to pharmacy benefit management (PBM) companies such as CVS, Express Scripts, and UnitedHealth Group (a health insurance company that owns its own PBM). In fact, less than a handful of PBMs control this market and so exercise tremendous pricing power; thus the government is already negotiating with pharmaceuticals companies.

The Stats

Here are some useful stats about this market: As of the end of 2015, 290 million Americans had health insurance. Among them, 214 million had private insurance and 52 million were insured by Medicare. Medicare insures a lot of people; however, UnitedHealth — a company whose business model relies on paying as little as possible for prescriptions — insures 70 million Americans and thus already has greater bargaining power than Medicare.

But let’s say President Trump gets his wish, the law is changed, and the government bypasses PBMs and starts bargaining with Gilead Sciences, Amgen, and Allergan directly — the Trump take-no-prisoners approach. Let’s even assume that President Trump’s ingenious negotiating techniques result in a 20 percent concession on price. Since Medicare represents only 18 percent of the total insured population, the net impact on pharmaceuticals companies’ revenue would be 3.6 percent. That’s a small pimple that they’d be able to cover up by raising prices 4 percent on the remaining 82 percent of payers.

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Europeans and Canadians

The reality is that the reason Europeans and Canadians are paying much lower prices for their prescriptions is that they have a single-payer system, and thus pharmaceuticals companies are bargaining not with four or five entities but with one: the government. At this stage, however, it is very unlikely that a Republican president and Republican-controlled Congress will move this country to a single-payer system.

If the U.S. starts allowing re-importation of pharmaceuticals from Canada and Europe — another threat made by our president — then American companies will simply start raising prices outside of the United States.

Finally, let’s remember an important but often forgotten fact: Donald Trump is the president of the U.S.; he is not its king and doesn’t have the powers of one. Although we expect his tweets and other remarks to create additional volatility, they will not necessarily have a symmetrical impact on pharmaceuticals companies or whatever other businesses he tweets about.

Assessment

We have taken advantage of price weakness and added to our positions in Amgen (analysis here), Allergan (analysis here), and Gilead (analysis here). We also bought some new positions. Stay tuned for next week, when I’ll reveal those names.

Conclusion

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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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Unrecognized Corporate Psychopathy in the Medical Profession

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Langan MD

By Michael Lawrence Langan MD

In his book Without Conscience, Dr. Robert Hare notes: “If we can’t spot them, we are doomed to be their victims, both as individuals and as a society. ”

Dr. Clive Boddy in Corporate Psychopaths observes that “unethical leaders create unethical followers, which in turn create unethical companies and society suffers as a result.”

And more […]

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 Snakes in Smocks: Unrecognized Corporate Psychopathy in the Medical ProfessionDisrupted Physician

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Conclusion

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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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The Emerging Role of Chief Diversity Officer [CDO] 2.0

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dem-2

By Dr. David Edward Marcinko MBA MEd

http://www.CertifiedMedicalPlanner.org

My history

I came of age on the mean inner city streets of Baltimore, Maryland and developed a special interest in diversity, inclusion and urban renewal at a young age.

Today, I resonate with the identity of human capital educational leadership; small classes or teams; engaged students and stakeholders; parents and teachers; research and development; and a motivated staff inculcating life-long learning initiatives and critical thinking skills.

Career

Yet, I am not a career opportunist seeking incremental advancement through the halls of academia. Rather, I am a culturally sensitive and bi-racial physician-executive who senses there are deep, but often untapped, human resources embedded within many universities. If true; they are best released by an externally recruited champion of diversity and inclusion.

A Chief Diversity Officer [CDO]; if you will.

This includes a respect for values that celebrate the unique attributes, characteristics and perspectives that make each person who they are; ethnicity; gender; gender identity; language differences; nationality; parental status; physical, mental and developmental abilities; race; religion; sexual orientation; skin color; socio-economic status; work and behavioral styles; the perspectives of each individual DNA shaped by their nation, experiences and culture—and more.

Even when people appear the same on the outside, they are different.

Importantly, such inclusion includes a strategy to leverage diversity.

  • Diversity always exists in social systems.
  • Inclusion, on the other hand, must be created.

In order to leverage diversity, an environment must be created where people feel supported, listened to and able to do their personal best; for example:

The BAKKE DECISION

Historically, and for me, an important ruling on affirmative action by the Supreme Court in 1978 was the BAKKE Case. Allan Bakke, a white man, was denied admission to a medical school that had admitted black candidates with weaker academic credentials. Bakke contended that he was a victim of racial discrimination. The Court ruled Bakke had been illegally denied admission to the medical school, but also that medical schools were entitled to consider race as an admission factor.

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My story

As Department Chair and Residency Director at a local hospital, I was credited with accepting the first women residents and African Americans into our post-graduate education and surgical training program.

So, at this level of blended pedagogy, andragogy and heutagogy, my mission is to be a modern guide on the side; not bombastic sage on the stage. Moreover, this CDO 2.0 position holds special gravitas in order to set the tone for the future growth of inclusion and diversity thru example; in words and deeds.

Assessment

Frankly, I don’t see the CDO role as a mere “job”. It is a calling that requires a “hands-on” ambassador — helping to advise and lead in all related matters. As the sage once opined:

There is no limit to what you can accomplish if you don’t care who gets the credit!

Conclusion

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Ethics in Modern Healthcare

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The Access to Medical Care Dilemma

By David E. Marcinko MBA

By Render S. Davis; MHA, CHE

[Certified Healthcare Executive]

Crawford Long Hospital at Emory University

Atlanta, Georgia, USA

biz-book

In his book, “Back to Reform”, author Charles Dougherty writes that “cost containment is the goal for the healthy.  Access is the goal for the sick.” 

A Meaningless Distinction

So, for an increasing number of Americans, the concerns experienced in-vitro, in-vivo, or described on this Medical Executive-Post blog, are almost meaningless because they are, for the most part, outside the structure of the current health care system. Why?

  • Employers are downsizing staff or cutting out health insurance benefits in an effort to be financially successful in a global economy.
  • Demands for greater government accountability in the expenditure of tax dollars have brought about increasingly more stringent eligibility requirements for safety-net programs like Medicaid. 
  • As insurance becomes more expensive or government programs undergo budget cuts, people are being excised from the system.
  • New competitive demands have fostered unprecedented consolidations, mergers, and closures of healthcare facilities.

This shake-out may have served to greatly reduce the overcapacity that plagued the system, but it has been done with greater emphasis on cutting costs than on fostering efficiency and effectiveness in creating a true system of care delivery. 

The Healthcare Commodity Issue

Those who view health care as little different from any other commodity available through the free market see the present access concerns as simply a byproduct of the inevitable restructuring of the system. While they argue that we must adhere to market solutions to solve our health care access problems, others demand a different approach calling for governmental national health insurance or some form of subsidized care providing at least a basic level of treatment for all citizens. 

Moreover, while Americans continue to proudly tout that we do not explicitly ration care as do some other countries (notably Great Britain and Canada); we tacitly accept a health care system that implicitly excludes citizens who are unable to overcome financial barriers to access.

Care Access Issues

Access to care represents the most visible issue at the very foundation of the ethical principle of justice. 

In their text, “Principles of Biomedical Ethics”, authors Thomas Beauchamp, Ph.D. and James F. Childress, Ph.D. point out that “justice” is subject to interpretation and may even be evoked to support the positions of parties in direct opposition.

A Philosophical Mixed Bag

For example, those who support the predominant principle of distributive justice – the fair allocation of resources based on laws or cultural rules – still must decide on what basis these resources will be used. 

On the other hand, this mix-ed bad of philosophical thoughts include among others:

  • Utilitarians, who argue for resource distribution based on achieving the “greatest good for the greatest number.”
  • Libertarians, who believe that recipients of resources should be those who have made the greatest contributions to the production of those resources – a free market approach to distribution.
  • Egalitarians, that support the distribution of resources based on the greatest need, irrespective of contribution or other considerations. 

Consequently, developing a system of access based on “justice” will be fraught with enormous difficulty.

The Current System

In the current health care environment, access to medical care is approaching crisis levels as increasing malpractice insurance premiums are driving physicians from high-risk specialties such as obstetrics, emergency medicine, and surgery in record numbers. 

The impact is most dramatic in rural and under-served areas of the country where sole-practitioners and small group practices are discontinuing services, leaving local citizens with no choice but to forego care or travel greater distances to regional medical centers to find necessary treatment. 

At the same time, significant budget cuts at both the federal and state levels have seriously eroded funding for Medicaid, leaving this especially-vulnerable segment of the population with even fewer options than before.

Issues Moving to the Forefront

Two areas of the medical care access dilemma are moving to the forefront.

1. The first is in emergency medicine.

An initial study by the Federal Centers for Disease Control and Prevention, cited statistics showing that in the decade ending in 2001, emergency room visits increased 20 percent, while the number of emergency departments shrank 15 percent. Increasingly, hospitals have closed emergency departments due to increasing costs, staffing shortages, and declining payments for services. This crisis comes at a time when post 9/11 fears of terrorism and global disease outbreaks like Severe Acute Respiratory Syndrome (SARS) have placed an even greater burden on the delivery of emergency services.  It continues and is exacerbated, even today.

For example, Arthur Kellerman, MD, former director of emergency services at Atlanta’s Grady Memorial Hospital, the city’s only level one trauma center, writes that “the situation is alarming and has been for some time… It’s unconscionable that we are not coming to terms with the Achilles’ heel of our health care system.”

2. The second area that will grow in significance is in the area of genetic testing.

As technological capabilities improve, medicine’s ability to examine an individual’s genetic makeup will open up remarkable opportunities to predict a person’s susceptibility to certain diseases or handicapping conditions. From a scientific standpoint, we are on the threshold of an extraordinary new era in medicine, where identifications of and treatments for potential illnesses may begin before the person is even born.

“Medicine’s Iceberg”

However, there is a more troubling access side to the potential of genetic testing as noted by Johns Hopkins University president, Dr. William R. Brody. He described genetic testing as “medicine’s iceberg,” where serious dangers for access to care are lurking beneath the surface. 

According to Brody, heated debate has already begun regarding the value of genetic information to insurance companies who could use the information to determine premium levels, even the overall insurability, for individuals and/or families with a member identified through testing as predisposed to a catastrophic and/or potentially expensive medical condition.

In this scenario, infants manifesting a genetic predisposition to certain illnesses or potential behavior disorders may find themselves faced with lifelong un-insurability based on the results of prenatal genetic testing.

Assessment

Furthermore, Brody persuasively argues that the potential of this technology, regardless of the incredible scientific potential it offers, could lead to dramatically diminished access to health insurance for tens of thousands of individuals and families and bring about an “end to private health insurance as we know it.”  He suggests that some form of community-rated, universal health insurance may be the only reasonable alternative to assure that Americans at all levels, from indigent and working poor, to the most affluent, may receive needed, basic medical care. 

CONCLUSION

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MARCINKO’s Upcoming WEBINARS from MentorHealth

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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.

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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

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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

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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.

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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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Government Medicine is Killing Us!

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By Bob Murphy

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Bob Murphy: Government Medicine is Killing Us

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About

Bob Murphy is our re-posting guest today as he wraps up a three-part series on the anti-market healthcare system in the US.

Conclusion

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On Wall Street’s Suitability, Prudence and Fiduciary Accountability

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Financial Advisor’s are Not Doctors!

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Dr. David E. Marcinko FACFAS MBA CMP™ MBBS

THRIVE-BECOME A CMP™ Physician Focused Fiduciary

http://www.CertifiedMedicalPlanner.org

Financial advisors don’t ascribe to the Hippocratic Oath.  People don’t go to work on “Wall Street” for the same reasons other people become firemen and teachers.  There are no essays where they attempt to come up with a new way to say, “I just want to help people.”

Financial Advisor’s are Not Doctors

Some financial advisors and insurance agents like to compare themselves to CPAs, attorneys and physicians who spend years in training and pass difficult tests to get advanced degrees and certifications. We call these steps: barriers-to-entry. Most agents, financial product representatives and advisors, if they took a test at all, take one that requires little training and even less experience. There are few BTEs in the financial services industry.

For example, most insurance agent licensing tests are thirty minutes in length. The Series #7 exam for stock brokers is about 2 hours; and the formerly exalted CFP® test is about only about six [and now recently abbreviated]. All are multiple-choice [guess] and computerized. An aptitude for psychometric savvy is often as important as real knowledge; and the most rigorous of these examinations can best be compared to a college freshman biology or chemistry test in difficulty.

Yet, financial product salesman, advisors and stock-brokers still use lines such as; “You wouldn’t let just anyone operate on you, would you?” or “I’m like your family physician for your finances.  I might send you to a specialist for a few things, but I’m the one coordinating it all.”  These lines are designed to make us feel good about trusting them with our hard-earned dollars and, more importantly, to think of personal finance and investing as something that “only a professional can do.”

Unfortunately, believing those lines can cost you hundreds of thousands of dollars and years of retirement. 

More: Video on Hedge Fund Manager Michael Burry MD

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Suitability Rule

A National Association of Securities Dealers [NASD] / Financial Industry Regulatory Authority [FINRA] guideline that require stock-brokers, financial product salesman and brokerages to have reasonable grounds for believing a recommendation fits the investment needs of a client. This is a low standard of care for commissioned transactions without relationships; and for those “financial advisors” not interested in engaging clients with advice on a continuous and ongoing basis. It is governed by rules in as much as a Series #7 licensee is a Registered Representative [RR] of a broker-dealer. S/he represents best-interests of the firm; not the client.

And, a year or so ago there we two pieces of legislation for independent broker-dealers-Rule 2111 on suitability guidelines and Rule 408(b)2 on ERISA. These required a change in processes and procedures, as well as mindset change.

Note: ERISA = The Employee Retirement Income Security Act of 1974 (ERISA) codified in part a federal law that established minimum standards for pension plans in private industry and provides for extensive rules on the federal income tax effects of transactions associated with employee benefit plans. ERISA was enacted to protect the interests of employee benefit plan participants and their beneficiaries by:

  • Requiring the disclosure of financial and other information concerning the plan to beneficiaries;
  • Establishing standards of conduct for plan fiduciaries ;
  • Providing for appropriate remedies and access to the federal courts.

ERISA is sometimes used to refer to the full body of laws regulating employee benefit plans, which are found mainly in the Internal Revenue Code and ERISA itself. Responsibility for the interpretation and enforcement of ERISA is divided among the Department Labor, Treasury, IRS and the Pension Benefit Guarantee Corporation.

Yet, there is still room for commissioned based FAs. For example, some smaller physician clients might have limited funds [say under $100,000-$250,000], but still need some counsel, insight or advice.

Or, they may need some investing start up service from time to time; rather than ongoing advice on an annual basis. Thus, for new doctors, a commission based financial advisor may make some sense. 

Prudent Man Rule

This is a federal and state regulation requiring trustees, financial advisors and portfolio managers to make decisions in the manner of a prudent man – that is – with intelligence and discretion. The prudent man rule requires care in the selection of investments but does not limit investment alternatives. This standard of care is a bit higher than mere suitability for one who wants to broaden and deepen client relationships. 

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Prudent Investor Rule

The Uniform Prudent Investor Act (UPIA), adopted in 1992 by the American Law Institute’s Third Restatement of the Law of Trusts, reflects a modern portfolio theory [MPT] and total investment return approach to the exercise of fiduciary investment discretion. This approach allows fiduciary advisors to utilize modern portfolio theory to guide investment decisions and requires risk versus return analysis. Therefore, a fiduciary’s performance is measured on the performance of the entire portfolio, rather than individual investments 

Fiduciary Rule

The legal duty of a fiduciary is to act in the best interests of the client or beneficiary. A fiduciary is governed by regulations and is expected to judge wisely and objectively. This is true for Investment Advisors [IAs] and RIAs; but not necessarily stock-brokers, commission salesmen, agents or even most financial advisors. Doctors, lawyers, CPAs and the clergy are prototypical fiduciaries. 

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More formally, a financial advisor who is a fiduciary is legally bound and authorized to put the client’s interests above his or her own at all times. The Investment Advisors Act of 1940 and the laws of most states contain anti-fraud provisions that require financial advisors to act as fiduciaries in working with their clients. However, following the 2008 financial crisis, there has been substantial debate regarding the fiduciary standard and to which advisors it should apply. In July of 2010, The Dodd-Frank Wall Street Reform and Consumer Protection Act mandated increased consumer protection measures (including enhanced disclosures) and authorized the SEC to extend the fiduciary duty to include brokers rather than only advisors, as prescribed in the 1940 Act. However, as of 2014, the SEC has yet to extend a meaningful fiduciary duty to all brokers and advisors, regardless of their designation.

The Fiduciary Oath: fiduciaryoath_individual

Assessment 

Ultimately, physician focused and holistic “financial lifestyle planning” is about helping some very smart people change their behavior for the better. But, one can’t help doctors choose which opportunities to take advantage of along the way unless there is a sound base of technical knowledge to apply the best skills, tools, and techniques to achieve goals in the first place.

Most of the harms inflicted on consumers by “financial advisors” or “financial planners” occur not due to malice or greed but ignorance; as a result, better consumer protections require not only a fiduciary standard for advice, but a higher standard for competency.

The CFP® practitioner fiduciary should be the minimum standard for financial planning for retail consumers, but there is room for post CFP® studies, certifications and designations; especially those that support real medical niches and deep healthcare specialization like the Certified Medical Planner™ course of study [Michael E. Kitces; MSFS, MTax, CLU, CFP®, personal communication].

Being a financial planner entails Life-Long-Learning [LLL]. One should not be allowed to hold themselves out as an advisor, consultant, or planner unless they are held to a fiduciary standard, period. Corollary – there’s nothing wrong with a suitability standard, but those in sales should be required to hold themselves out as a salesperson, not an advisor.

The real distinction is between advisors and salespeople. And, fiduciary standards can accommodate both fee and commission compensation mechanisms. However; there must be clear standards and a process to which advisors can be held accountable to affirm that a recommendation met the fiduciary obligation despite the compensation involved.

Ultimately, being a fiduciary is about process, not compensation.

More: Deception in the Financial Service Industry

Full Disclosure:

As a medical practitioner, Dr. Marcinko is a fiduciary at all times. He earned Series #7 (general securities), Series #63 (uniform securities state law), and Series #65 (investment advisory) licenses from the National Association of Securities Dealers (NASD-FINRA), and the Securities Exchange Commission [SEC] with a life, health, disability, variable annuity, and property-casualty license from the State of Georgia.

Dr.Marcinko was a licensee of the CERTIFIED FINANCIAL PLANNER™ Board of Standards (Denver) for a decade; now reformed, and holds the Certified Medical Planner™ designation (CMP™). He is CEO of iMBA Inc and the Founding President of: http://www.CertifiedMedicalPlanner.org

More: Enter the CMPs

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[Two Newest Books by Marcinko annd the iMBA, Inc Team]

Conclusion

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Cars and Houses Roar the Economy Back to Life?

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On cars and houses

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jvelazquez@bankingunusual.com

The US economy is roaring back to life as measured by the two largest purchases that people make: cars and houses. The interesting thing is that the uptick in sales is not being driven by artificial government incentives.

Instead, consumer demand is the main driver. It’s also interesting to note the impact of housing on your local economy.

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According to data compiled by the Bureau of Economic Analysis (BEA) and the National Association of Realtors (NAR), the value of construction as well as real estate and rental and leasing represents approximately 16.8% of the US economy, but the impact is much larger in some states.

More:

Click here to check out the impact of housing in your state.

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Conclusion

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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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Ben Bernanke: Buy One Suit, Get Three Free

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Linear thinking is dangerous

vitaly[By Vitaliy Katsenelson, CFA]

Linear thinking is dangerous. It is the easiest form of reasoning, lying on the path of least resistance. The simpler the path, the more readily people will march along it. Linear arguments are easy to make, as they require the least amount of evidence — past data points with a straight line drawn through them.However, the larger the crowd that follows the wrong line of reasoning, the more people pile in, and the greater the consequences if they are proved wrong.

A lot of things in nature, and thus in investing, are not linear. A past trend may or may not persist into the future. Events don’t happen in a vacuum; they are observed, studied and capitalized on — which in the case of investing may preclude a company’s future from resembling its past. As I write this, I think of successful companies whose achievements attracted competition, which then marginalized them.

Some things are inherently nonlinear, their behavior reminiscent of a pendulum’s: The further they swing in one direction, the harder they’ll go in the opposite direction. It is very dangerous to default to linearity with such nonlinear phenomena, as the more confident we become in the swing (the more linearity we observe), the closer we are to the pendulum’s reversing course.

Price-earnings ratios often follow a pendulum behavior. If you look at high-quality dividend-paying stocks — the Coca-Colas and Procter & Gambles of the world — they are now changing hands at more than 20 times earnings. Their recent performance has driven linear thinkers to pile into them, expecting more of the same in the future. Don’t! These stocks were beneficiaries of a swing in the P/E pendulum as it went from low to average and then to above-average levels.

Pattern recognition is an important contributor to success in investing. Mark Twain once said that history doesn’t repeat itself, but it rhymes. If you can identify a rhyme (that is, see a pattern) relating to the current situation, then you can develop a framework to analyze and forecast it. But what if the current situation is very different — if it doesn’t rhyme with anything in the past? This is where the ability to draw parallels becomes helpful. It allows you to overlay rhymes (patterns) from other companies, industries or even fields. Building analogous frameworks is a cure for linear thinking; it helps us see nonlinearity and facilitates the creation of nonlinear mental models.

Then there is pseudolinearity: things that seem to be linear but are forced into linearity by extrinsic factors. This was a subtopic of my presentation at the Valuex Vail investing conference in June. I drew a parallel between two entities that suddenly looked analogous: Jos. A. Bank Clothiers, a Hampstead, Maryland–based retailer of men’s apparel, and the Federal Reserve.

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Jos. A. Bank

Jos. A. Bank has always been a very promotional retailer. It would jack up prices, then run sales for consumers happy to be deceived — a typical American retail tale. But sometime in 2008, Jos. A. Bank went promotional on steroids. You could not watch CNBC for an hour without seeing one of its ads. The company started out by encouraging you to buy one suit and get one free. Then you got two free suits. Finally, it started giving away Android phones with suit purchases. For a while this past March, Jos. A. Bank offered consumers the opportunity to buy one suit and get three free.

There are several problems with the strategy: It does not emphasize the quality of the suits or the company’s great service, and the ads aren’t helping to build a brand but are intended just to pimp sales at Jos. A. Bank, as if it were a grocery store with USDA choice beef on sale.

This brings us to the latest quarter. Jos. A. Bank’s same-store sales dropped 8 percent, but what really piqued my interest was this explanation by its CEO, R. Neal Black, during its earnings call in June: “Since 2008, at the beginning of the financial crisis and the recession, the overall sales picture has been one of volatility, and strong promotional activity has been consistently and effectively driving our sales increases. This strategy was designed with 18 to 24 months of effectiveness in mind, and we stuck with it for more than 60 months since — as the economy remained weak. Now the strategy has become less effective.”

What Jos. A. Bank has really been doing since the financial crisis is running its own version of quantitative easing. The company had a temporary strategy that was supposed to get people into its stores during the recession — much like the Fed’s original QE, which was designed to provide liquidity in a time of crisis — but the recovery that ensued was not to Jos. A. Bank’s liking. So just as the Fed implemented QE2, and then QE3 when the economy did not improve to its satisfaction, the retailer followed with more QE.

It is understandable why Jos. A. Bank’s management did what it did. The company was being responsible to its employees — it didn’t want to close stores or have layoffs — and it had to report quarterly to shareholders. The focus shifted from building a long-term sustainable franchise to using short-term measures to grow earnings the next quarter and the quarter after that.

There are many lessons that one can draw from the parallels between Jos. A. Bank’s behavior and the Fed’s handling of our economy. First, it is very hard to challenge someone who has a linear argument. Let’s say that a year ago you talked to Jos. A. Bank’s management and raised the question of the sustainability of their advertising strategy. They’d have pointed to four years of success, and they’d have been right, at least up to that moment. They would have had four years of data points and a bulletproof linear argument, and you would have had your common sense and little else.

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Ben Bernanke

Right now Ben Bernanke looks like a genius. He can show you all the data points in the recovery, but so could Jos. A. Bank, and this leads us to a second lesson: Pain is postponable, but it is cumulative. During Jos. A. Bank’s quarterly call, its CEO also said: “The decline in traffic is because existing customers are returning slightly less frequently. . . . It makes sense when you consider the saturating effect of our intense promotional activity over the past several years.”

With every sale Jos. A. Bank stole its future purchases, because when you buy one suit and get three for free, you may not need to buy another one for a while.But there is also a snowball effect that you cannot ignore: Every ad chipped away at the company’s brand. Now when you show someone that you wear a Jos. A. Bank suit, they don’t think about its quality, just that you have two or three more suits in your closet.

There is a cost to our recovery — a bloated Federal Reserve balance sheet and our addiction to low interest rates. Of course, we spread that addiction globally.

According to Hugh Hendry, founding partner and CIO of London-based hedge fund firm Eclectica Asset Management, rising U.S. bond yields have driven global yields higher. “In Brazil for instance, the biggest emerging debt market, no company has been able to raise debt abroad since mid-May as borrowing costs soared to a four-year high in June, at 7.1 percent,” he wrote in a recent investment letter.

The Fed is betting on George Soros’ theory of reflexivity, in which people’s biases and actions can change the economy: Instead of the wagon being towed by the horse, the wagon, in expectation that it will be towed by the horse, starts moving on its own, thereby motivating the horse to start towing the wagon.Lower interest rates drive people to riskier assets, and as asset values go up, people feel confident and spend money, and the economy grows. But this policy puts us on very shaky ground, because reflexivity cuts both ways: If asset prices start to decline, confidence declines — and so will the economy. Now there are a lot more savers owning riskier assets than they otherwise would have, and their wealth is at risk of getting wiped out.

The third lesson from the parallels between the Fed and Jos. A. Bank: We are in the midst of a game of musical chairs, and when the music stops, no one wants to be left standing around holding risky assets. Everyone is focused on the Fed’s tapering, and they are right to do so. Just as we saw with Jos. A. Bank, economic promotions cannot go on forever. With every sale the company had to increase the ante, giving away more and more to get people to come into its stores. The Fed may continue to buy Treasuries and mortgage securities, but the purchases will be less and less effective. And the music may stop on its own, without the Fed doing anything about it.

Last, pseudolinearity eventually leads to high uncertainty and thus lower valuations. Put yourself in the shoes of an investor analyzing Jos. A. Bank today. Before buying the stock, you’d have to answer the following questions: What is the company’s earnings power? How much did its promotional strategy damage the brand? And how much in future sales did that strategy steal?

Assessment

In the wake of Jos. A. Bank’s own five-year, nonstop version of QE, it is difficult to answer these questions with confidence. The company’s earnings power is uncertain, and investors will be willing to pay less for a dollar of uncertain earnings, thus resulting in a lower P/E. At some point, when U.S. economic activity weakens, investors will have to answer similar questions about the U.S. and global economies. And as they look for answers, they’ll be putting a lower P/E on U.S. stocks.

ABOUT

Vitaliy N. Katsenelson CFA is Chief Investment Officer at Investment Management Associates in Denver, Colo. He is the author of Active Value Investing (Wiley 2007) and The Little Book of Sideways Markets (Wiley, 2010).  His books were translated into eight languages.  Forbes Magazine called him “The new Benjamin Graham”.  

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

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Do Commisson-Based Fiduciary Financial Advisors EVEN Exist?

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Sometimes the Case?

By Rick Kahler MS CFP http://www.KahlerFinancial.com

Rick Kahler MS CFPCan a financial advisor represent your best interests and still earn a commission? Surprisingly, this can sometimes be the case.

But … It’s up to you to find out.

Fiduciary

Being required to put the consumer’s interest first, which means representing a client rather than selling products and services to a customer is called having a fiduciary duty. While fee-only planners are inherently fiduciaries, they don’t exclusively own the fiduciary domain. The definition of a fiduciary duty does not inherently ban receiving commissions. Numerous statutes and applications of common law can require someone receiving a commission from selling a financial product to act in a fiduciary capacity.

One such circumstance was discussed in a blog post at http://www.kitces.com by Duane Thompson, president of Potomac Strategies, LLC, a legislative and public relations consulting firm.

Registered Investment Advisor

Those registered with the SEC as Registered Investment Advisors (RIA) under the Investment Advisers Act of 1940 are required to uphold a fiduciary standard of care. Advisors must register as RIAs if they, “for compensation, engage in the business of advising others” about investing in securities and as a central part of the business.

The 1940 Act has almost nothing to say about linking compensation to fiduciary responsibility. While large firms selling financial products can argue whether they must register as RIAs, it is clear that anyone registered as an RIA is held to a fiduciary standard, regardless of their compensation structure.

That said, the chances are an advisor who is compensated 100% by commissions is not an RIA and not held to a fiduciary standard. Of the 11,475 adviser firms registered with the SEC, only four are commission only, according to Thompson. Of the remainder, those that receive  a commission also charge some type of fee.

The Odds

The overwhelming odds are that, if you don’t pay a fee to a company giving investment advice or selling a financial product, they are not legally required to look after your best interests.

Even though an RIA who is totally or in part compensated by commissions has a legal obligation to put your interests first, they may still have a conflict of interest, which the SEC requires them to disclose. The size of that conflict of interest depends on the percentage of an adviser’s revenue derived from selling financial products.

Example:

For example, a RIA receiving 90% of their revenue from the sale of financial products has a large conflict of interest. The sustainability of the company and advisers’ careers depends upon sales. Arguably it’s going to be very difficult for an adviser to remain unbiased, especially if what may be in the client’s best interest is a no-load, low cost index mutual fund or variable annuity; which pay no commission.

Conversely, an advisor receiving 99% of their revenue from fees and 1% from commissions on the sale of low-cost term life insurance has almost no conflict. The sale of the insurance is most likely a convenience for clients and has an insignificant financial impact to the adviser.

face-off

[Fiduciary Advisor versus Sales Man/Woman] 

In order to find out the likelihood of advisers upholding a fiduciary standard, first ask whether they are a RIA with the SEC. If not, they owe you no fiduciary responsibility. You are a customer.

Assessment

If an adviser is an RIA, however, don’t assume there is no conflict of interest that may taint the fiduciary relationship. Ask how much of the firm’s gross revenue comes from commissions on the sale of financial products and how much comes from fees paid directly by clients. The higher the percentage of revenue that comes from fees, the lower the conflict of interest and the greater the chance you will receive unbiased, client-centered advice.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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