Understanding Whole Life Insurance for Medical Professionals

Insurance Basics for Medical Professionals

By Jeffrey H. Rattiner, CPA, CFP®, MBA via iMBA, Inc.

After determining the need for insurance and the amount to purchase, the doctor-client and financial planner’s next task is to match those needs to the client’s objectives to determine what type of policy the client should purchase. The life insurance industry features more products today than ever before. One reason for this change is that, clearly, the insurance industry has expanded its product base to become more competitive. Another reason is that clients’ needs are constantly changing and the insurance companies must keep up with those needs or run the risk of having funds withdrawn from their companies. New and different types of life insurance products are here to stay. Since life insurance represents a significant part of a client’s risk-management program, planners have to be versed in the specifics of the varied product base.

Term Insurance Alternative

Whole life insurance was introduced as an alternative to term insurance. Whole life is often called cash value insurance or permanent insurance to distinguish it from term insurance. The cash value in whole life insurance arises because of the level premium system and the need to account for prepaid premiums. Whole life insurance offers permanent protection at a level premium for the entire lifetime of the insured. Premiums remain fixed and are paid throughout the insured’s entire lifetime. The premium level can remain constant throughout the life of the policy because premiums are higher during the early years. The excess charge in the early years makes it possible to build up a reserve, which will be needed, together with interest earned, to keep premiums level throughout the life of the policy. Older clients then pay the same premium in later years as they did when they were younger.

Cash Value

The cash value of a whole life policy serves a variety of purposes:

• It can be used for collateral for an insurance company loan.

• If the insured decides to terminate the policy, he or she can elect to receive the policy’s cash value at that time.

• The cash value balance can be remitted to the insurance company to purchase a reduced paid-up insurance policy. This will provide coverage until the funds are insufficient to pay the premiums. This cancellation feature is also referred to as a non-forfeiture value.

• If the policy is not canceled, the accumulated cash value becomes part of the death benefit paid upon the insured’s death (which makes this type of policy similar to a decreasing term policy). It can reduce cash flow by taking some of the investment results out of the contract either through dividends or through policy loans.

General Accounts

With a whole life policy, the insured does not control the investment vehicle. Policies are invested in the insurance company’s general account through the purchase of long-term bonds and mortgages. As a result, during a period of decreasing interest rates, whole life products can be expected to produce superior results since rates can be locked in when interest rates in general are higher. In contrast, rates in an increasing environment are locked in to their portfolios until maturity. There is no flexibility within a whole life policy. Premium payments, type of investment vehicle, and change in death benefit are all fixed. The safety of cash value is high, but the potential rate of return is low to moderate. If interest rates are rising, the price of the policy is declining, and you may want to suggest replacing the policy. (See Planning Issue 10.)

If the premiums paid to the insurance company turn out to be more than the company needs because expenses are lower than expected, the company’s portfolio investment return will be larger than the company expected. As a result, the company will then return some of the excess premium to the policyholder as a dividend or excess interest. Life insurance dividends are not taxable as income because they represent an excess of premium.

Premium Payments

The premium consists of mortality charge, policy expense, and a cash value. When the insured reaches 100 years of age, the policy endows with the face amount of the policy collectible by the insured. Since mortality tables end at age 100, the insurer considers the client dead and pays the face amount of the policy.

Whole life policies are packaged in a variety of ways. One policy, a limited-pay whole life policy, is a whole life policy with a death benefit continuing through age 100. The only difference between this and the traditional whole life policy is that premiums are paid only for a specified period, for example, seven years. In other words, the policyholder prepays the policy. A policy is considered to be fully paid up when the cash value of the basic contract plus the value of the dividend additions or deposits equals the net single premium for the policy in question at the insured’s attained age. The premium-paying period influences the cash value buildup in the policy. This is accomplished by using part of the investment return or dividends from long-term bonds and mortgages to pay the mortality and the expense charges on the policy for the rest of the policyholder’s life.

Advantages and DisAdvantages

Advantages of a whole life policy include lifetime coverage for the insured, a forced savings element, loan privileges, and a variety of premium payment plans. Over time, the cost is lower than term, the rate of return if the policy is kept until death is quite reasonable, and the policy will do a better job than universal life in keeping up with inflation. Disadvantages include a higher cost of death protection, a low rate of return, lack of flexibility, and incompatibility with inflation.

Assessment

Whole life policies are most appropriate for people who want or need a forced savings arrangement and for people who want lifetime coverage. As interest rates increased during the late 1970s, the returns received from insurance companies on long-term bonds and mortgage portfolios of whole life portfolios declined. As a result, in order to prevent policyholders from borrowing their cash reserves and investing these funds in other financial products, the insurance industry offered the following incentives:

• Existing policyholders were given the option to have their policies upgraded to reflect current market rates. Policies were upgraded through higher interest rates on cash values and higher future dividends and rates on policy loans.

• New types of policies were introduced—such as universal life, which tied cash value to short-term money market rates.

• Variable life insurance and universal variable life insurance were introduced, which segregated policy assets into a separate account.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Product DetailsProduct DetailsProduct Details

Product Details  Product Details

   Product Details 

MEDICAL SCHOOLS: What They Do Not Teach About Money!

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

***

WARNING! WARNING! All DOCTORS

What Medical School Didn’t Teach Doctors About Money

Medical school is designed to mold students into competent, compassionate physicians. It teaches anatomy, pathology, pharmacology, and clinical skills with precision and rigor. Yet, despite the depth of medical knowledge imparted, one critical area is often overlooked: financial literacy. For many doctors, the transition from student to professional comes with a steep learning curve—not in medicine, but in money. From managing debt to understanding taxes, investing, and retirement planning, medical school leaves a financial education gap that can have long-term consequences.

The Debt Dilemma

One of the most glaring omissions in medical education is how to manage student loan debt. The average medical student graduates with over $200,000 in debt, yet few are taught how to navigate repayment options, interest accrual, or loan forgiveness programs. Many doctors enter residency with little understanding of income-driven repayment plans or Public Service Loan Forgiveness (PSLF), missing opportunities to reduce their financial burden. Without guidance, some make costly mistakes—such as refinancing federal loans prematurely or choosing repayment plans that don’t align with their career trajectory.

Income ≠ Wealth

Medical students often assume that a high salary will automatically lead to financial security. While physicians do earn more than most professionals, income alone doesn’t guarantee wealth. Medical school rarely addresses the importance of budgeting, saving, and investing. As a result, many doctors fall into the “HENRY” trap—High Earner, Not Rich Yet. They spend lavishly, assuming their income will always cover expenses, only to find themselves living paycheck to paycheck. Without a solid financial foundation, even high earners can struggle to build net worth.

***

***

Taxes and Business Skills

Doctors are also unprepared for the complexities of taxes. Whether employed by a hospital or running a private practice, physicians face unique tax challenges. Medical school doesn’t teach how to track deductible expenses, optimize retirement contributions, or navigate self-employment taxes. For those who open their own clinics, the lack of business education is even more pronounced. Understanding profit margins, payroll, insurance billing, and compliance regulations is essential—but rarely covered in medical training.

Investing and Retirement Planning

Another blind spot is investing. Medical students are rarely taught the basics of compound interest, asset allocation, or retirement accounts. Many don’t know the difference between a Roth IRA and a traditional 401(k), or how to evaluate mutual funds and index funds. This lack of knowledge delays retirement planning and can lead to missed opportunities for long-term growth. Some doctors rely on financial advisors without understanding the fees or conflicts of interest involved, putting their wealth at risk.

Insurance and Risk Management

Medical school also fails to educate students on insurance—life, disability, malpractice, and health. Doctors need robust coverage to protect their income and assets, but many don’t know how to evaluate policies or understand terms like “own occupation” or “elimination period.” Inadequate coverage can leave physicians vulnerable to financial disaster in the event of illness, injury, or litigation.

Emotional and Behavioral Finance

Beyond technical knowledge, medical school overlooks the emotional side of money. Physicians often face pressure to maintain a certain lifestyle, especially after years of sacrifice. The desire to “catch up” can lead to impulsive spending, luxury purchases, and financial stress. Without tools to manage money mindset and behavioral habits, doctors may struggle with guilt, anxiety, or burnout related to finances.

The Case for Financial Education

Fortunately, awareness of this gap is growing. Organizations like Medics’ Money and podcasts such as “Docs Outside the Box” are working to fill the void by offering financial education tailored to physicians.

These resources cover everything from budgeting and debt management to investing and entrepreneurship. Some medical schools are beginning to incorporate financial literacy into their curricula, but progress is slow and inconsistent.

Conclusion

Medical school equips doctors to save lives, but it doesn’t prepare them to secure their own financial future. The lack of financial education leaves many physicians vulnerable to debt, poor investment decisions, and lifestyle inflation. To thrive both professionally and personally, doctors must seek out financial knowledge beyond the classroom. Whether through self-study, mentorship, or professional guidance, understanding money is as essential as understanding medicine. After all, financial health is a cornerstone of overall well-being—and every doctor deserves to master both.

COMMENTS APPRECIATED

EDUCATION: Books

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

Like, Refer and Subscribe

***

***

Critical Risk Management for Physicians Today

More Difficult than Ever Before

By Brian J. Knabe MD, Certified Medical Planner

www.SavantCapital.com

Historically, the term “risk management” has brought to mind one subject for the practicing physician – medical malpractice.  Unfortunately, physicians today face a multitude of other risks which may be more insidious and daunting than malpractice.  It is important to recognize these risks, and to have the appropriate procedures and policies in place to mitigate the risks.  These risks come from the federal government, state government, insurance companies, patients, employees, and even prospective employees.  Some risks, many unique to small businesses and medical practices, include the following:

  • Medicare recoupment risk – challenges to coding and subsequent billing by the physician.
  • Medicare fraud.  Numerous laws can be used by the federal government to go after the physician, including the Medicare and Medicaid Anti-Fraud and Abuse Statute, the RICO statute, and the Federal False Claims Act.  The recently enacted Patient Protection & Affordable Care Act aims to save money by increasing funding for anti-fraud efforts.
  • Insurance fraud.  An inquiry from Medicare to look for fraud in a physician’s practice is often followed by similar efforts by insurance companies.
  • The HIPPA Act of 1996 creates new definitions and penalties to use against the physician.
  • Self referral risks.  Federal regulations in this area include the Medicare Anti-Fraud and Abuse Statute, the Medicare Safe Harbor Regulations, and the Stark Amendment.
  • Federal agency risks.  These include regulations from the Occupational Health and Safety Agency (OSHA), Health and Human Services (HHS), the Drug Enforcement agency (DEA), and even the Environmental Protection Agency (EPA).
  • Anti-trust risks.  The Department of Justice (DOJ) and Federal Trade Commission (FTC) formulate regulations in this arena.
  • Managed care contractual risks.  Most managed care contracts require the individual physician rather than the professional corporation to sign the contract, thus placing the physician’s personal assets at risk.
  • Medical malpractice risks.  Although the vast majority of claims are paid by the insurance carrier, there can be other adverse consequences for the physician.  These include the risk of increased premiums, non-renewal of policies, and difficulty in getting replacement insurance.
  • Loss of income due to death or disability.  Most physicians recognize the importance of life insurance, but the medical professional is actually much more likely to lose income due to disability at some point in his or her career.

http://www.amazon.com/Insurance-Management-Strategies-Physicians-Advisors/dp/0763733423/ref=sr_1_6?ie=UTF8&qid=1375149801&sr=8-6&keywords=marcinko+david

The practicing physician should seek the advice of professionals with expertise in these areas.  Every practice should have an experienced attorney on retainer.  It is very important to seek advice from fiduciaries – experts who have no conflicts of interest and who can therefore act in the best interest of the client.  A Certified Medical Planner is such a fiduciary with training and expertise in these areas.

http://www.CertifiedMedicalPlanner.org

It can be particularly challenging to find an insurance advisor with no conflicts of interest, as this industry is built upon product sales and commissions.  One such insurance advisor is Scott Witt, a fee-only insurance advisor with Witt Actuarial Services (www.wittactuarialservices.com).

Others can be found with an internet search for “fee only insurance advisor”.

Conclusion

Your comments on this ME-P are appreciated. How do you select an advisor? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. 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

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.

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

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

Product Details

Product DetailsProduct Details

***

Understanding Medical Office Cancellation Fees

By Dr. David Edward Marcinko MBA MEd

***

***

Can a physician medical provider charge an office cancellation fee?

According to the American Medical Association’s Code of Medical Ethics, physicians can charge fees for “missed appointments or appointments not cancelled in advance in keeping with the published policy of the practice”, and they should “clearly notify patients in advance of fees charge” (Opinion 11.3. 2) [28].

And so, if you miss a doctor’s appointment these days, you could get hit with a “no-show” fee of up to $150 — or more for some specialties.

Is it legal for an insurance company to charge a cancellation fee?

These practices are typically legal. They help businesses ensure they can recoup the lost revenue due to no-shows or last-minute cancellations.

Cancellation fees are permitted, but seldom collected absent unusual circumstances, such as a great deal of work having been provided.

QUESTION: As a doctor [MD, DO, DPM or DDS], do you charge an office cancellation fee? If so, how much is it?

COMMENTS APPRECIATED

EDUCATION: Books

Like, Refer and Subscribe

***

***

Exploring the Dark Web: Myths & Realities

By Staff Reporter and and A.I.

***

***

The Dark Web: A Hidden Layer of the Internet

The internet is often described as an iceberg. The surface—what most users interact with daily—is the “surface web,” consisting of indexed websites accessible through standard search engines like Google or Bing. Beneath this lies the “deep web,” which includes content not indexed by search engines, such as private databases, academic journals, and password-protected sites. But even deeper still is the “dark web,” a hidden realm of the internet that requires special software to access and is often shrouded in mystery and controversy.

The dark web is accessible only through anonymizing networks like Tor (The Onion Router), which mask users’ identities and locations. This anonymity is both its greatest strength and most significant risk. Originally developed by the U.S. Navy to protect sensitive communications, Tor now serves as a gateway to a decentralized network where users can operate beyond the reach of traditional surveillance and censorship.

While the dark web is often associated with illegal activity—such as drug trafficking, weapons sales, and identity theft—it also serves legitimate purposes. Journalists, whistleblowers, and political dissidents in oppressive regimes use it to communicate safely and share information without fear of retaliation. Platforms like SecureDrop allow sources to submit documents anonymously to media outlets, helping expose corruption and injustice.

However, the dark web’s reputation is largely shaped by its criminal underbelly. Marketplaces like Silk Road, AlphaBay, and Hansa have been notorious for facilitating illicit trade. These platforms often use cryptocurrencies like Bitcoin to enable anonymous transactions. Law enforcement agencies around the world have responded with crackdowns, leading to arrests and shutdowns, but new sites frequently emerge to take their place.

The dual nature of the dark web presents a complex ethical dilemma. On one hand, it offers a haven for free speech and privacy in an increasingly monitored digital world. On the other, it enables activities that threaten public safety and national security. Governments and cybersecurity experts continue to grapple with how to regulate this space without infringing on civil liberties.

Understanding the dark web requires a nuanced perspective. It is not inherently evil, nor is it entirely virtuous. Like any tool, its impact depends on how it is used. As technology evolves, so too will the dark web, and society must remain vigilant in balancing the need for privacy with the imperative to prevent harm.

TOR: https://www.torproject.org/about/history/

In conclusion, the dark web is a multifaceted component of the internet that challenges our notions of freedom, security, and ethics. It serves as both a refuge for the vulnerable and a playground for the unscrupulous. As we navigate this hidden frontier, education and awareness are key to ensuring that its potential is harnessed responsibly.

COMMENTS APPRECIATED

EDUCATION: Books

Like, Refer and Subscribe

***

***

How Dark Patterns Manipulate Your Online Choices

Physicians and All Web Surfers Beware!

By Staff Reporters

***

Dark Patterns are tricks used in websites and apps that make you do things that you didn’t mean to, like buying or signing up for something. The purpose of this site is to spread awareness and to shame companies that use them.

****

WTF is dark pattern design? | TechCrunch

***

PODCAST: https://www.darkpatterns.org/

YOUR COMMENTS ARE APPRECIATED.

***

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

Thank You

***

***

Understanding Investment Fees: A Guide for Physicians

SPONSOR: http://www.MarcinkoAssociates.com

By Dr. David Edward Marcinko MBA MEd CMP™

***

***

MEDICAL COLLEAGUES BEWARE!

Investment fees still matter for physicians and all of us, despite dropping dramatically over the past several decades due to computer automation, algorithms and artificial intelligence, etc. And, they can make a big difference to your financial health. So, before buying any investment thru a financial advisor, planner, manager, stock broker, etc., it’s vital to understand these two often confusing costs.

***

***

Fee Only: Paid directly by clients for their services and can’t receive other sources of compensation, such as payments from fund providers. Act as a fiduciary, meaning they are obligated to put their clients’ interests first

Fee Based: Paid by clients but also via other sources, such as commissions from financial products that clients purchase. Brokers and dealers (registered representatives) are simply required to sell products that are “suitable” for their clients. Not a fiduciary.

EDUCATION: Books

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

COMMENTS APPRECIATED

Refer, Like and Subscribe

***

***

Understanding Workplace Violence: Types and Impact

Subscribe to continue reading

Subscribe to get access to the rest of this post and other subscriber-only content.

PALACE FALLACY: Memory Loss

SPONSOR: http://www.CertifiedMedicalPlanner.org

By Staff Reporters and A.I.

***

***

The Memory Palace Fallacy – Learning Styles Don’t Actually Exist

Remember being told you’re a “visual learner” or an “auditory learner”? Well, turns out that whole learning styles theory is pretty much bunk.

Common Learning Myths have been thoroughly debunked by modern educational research, and this is a big one. Studies consistently show that matching teaching methods to supposed learning styles doesn’t improve outcomes at all.

What actually matters is matching the teaching method to the content itself – you learn geography better with maps because geography is visual, not because you’re a “visual person.” It’s like trying to learn piano by reading about it versus actually playing keys. The activity should match what you’re trying to learn, not some made-up category about how your brain supposedly works.

COMMENTS APPRECIATED

EDUCATION: Books

Like and Subscribe

***

***

RISK MANAGEMENT TERMS: All Financial Advisors Should Know

By Staff Reporters

***

***

Authentication:

The verification of the identity of an individual, system, machine, or any other unique entity

Authorization:

The process of allowing access to specific areas of a system based on the role and needs of the user

Committee Charter:

A document that defines the purposes and responsibilities of the oversight committee

Compliance Risk Profile:

The current and prospective risk to earnings or capital arising from violations of or nonconformance with laws, rules, regulations, prescribed practices, internal policies and procedures, or ethical standards

Control Assessment:

A high-level review and analysis of controls relating to a process; should encompass both current and missing controls

Controls:

Methods that preserve the integrity of important information, meet operational or financial targets, and/or communicate management policies (See also: Key Control, Secondary Control, Tertiary Control)

ERM Policy Statement:

Defines an organization’s approach to and method of enterprise risk management

Governance:

Processes and structures implemented to communicate, manage, and monitor organizational activities

Impact:

The influence and effect of a risk

Inherent Risk:

Risk that is inherent to a process, taking into consideration the likelihood and impact of a risk

Key Control:

A primary control that is essential for a business process; typically takes place during the process it applies to

Key Indicators:

Measurements that are important for organizations to monitor for potential issues; examples include key performance indicators (KPIs) and key risk indicators (KRIs)

Key Performance Indicator (KPI):

A measurement with a defined set of goals and tolerances that gauges the performance of an important business activity

Key Risk Indicator (KRI):

A proactive measurement for future and emerging risks that indicates the possibility of an event that adversely affects business activities

Likelihood:

The probability of a risk occurring

Mitigation Actions:

The necessary steps, or action items, to reduce the likelihood and/or impact of a potential risk

Operation Risk Profile:

1) The risk arising from the execution of an organization’s business processes;
2) The risk of loss resulting from failed or inadequate internal processes, systems, people, or other entities

Price Risk Profile:

The risk to earning or capital arising from adverse changes in portfolio values

Process:

1) The principle elements of essential business functions within work groups or business units;
2) A set of tasks completed by business continuity plan owners within a department

Reputation Risk Profile:

The current and prospective risk to earnings or capital arising from negative public opinion or perception

Residual Risk:

Risk remaining after considering the existing control environment

Risk:

A potential event or action that would have an adverse effect on the organization

Risk Appetite:

A statement that broadly considers the risk levels that management deems acceptable

Risk Assessment:

The prioritization of potential business disruptions based on the impact and likelihood of occurrence; includes an analysis of threats based on the impact to the organization, its customers, and financial markets

Risk Tolerance:

A metric that sets the acceptable level of variation around organizational objectives and provides assurance that the organization remains within its risk appetite

Secondary Control:

An important control that typically takes place after the process it applies to (i.e., reporting or ongoing monitoring)

Strategic Risk Profile:

The current and prospective risk to earnings or capital raising from adverse business decisions, improperly implemented decisions, or lack of responsiveness to industry changes

Tertiary Control:

A non-essential control that can still be applied effectively to a business process

Velocity:

The time it takes a risk event to manifest itself

Vulnerability:

An entity’s susceptibility to a risk event as determined by the entity’s preparedness, agility, and adaptability

COMMENTS APPRECIATED

EDUCATION: Books

Refer and Subscribe

***

***

PURE: Absolute Risks of Physicians

By Dr. David Edward Marcinko MBA MEd

***

***

What Is Pure Risk?

Pure risk is a category of risk that cannot be controlled and has two outcomes: complete loss or no loss at all. There are no opportunities for gain or profit when pure risk is involved. Pure risk is generally prevalent in situations such as natural disasters, fires, or death. These situations cannot be predicted and are beyond anyone’s control. Pure risk is also referred to as absolute risk.

***

1. Personal Risks

Now, there are basically 3 types of pure risks that concern individual physicians. These incur losses like loss of income, additional expenses and devaluation of property. There are 4 risk factors affecting them:

  • Premature death. This is death of a breadwinner who leaves behind financial responsibilities.
  • Old age / retirement. The risk of being retired without sufficient savings to support retirement years.
  • Health crisis. Individual with health problem may face a potential loss of income and increase in medical expenditures.
  • Unemployment. Jobless individual may have to live on their savings. If savings are depleted, a bigger crisis is awaiting.

2. Property Risks

This means the possibility of damage or loss to the property owned due to some cause. There are two types of losses involved.

  • Direct loss which means financial loss as a result of property damage.
  • Consequential loss which means financial loss due to the happenings of direct loss of the property.

For instance, a medical practice that burned down may incur repair costs as the direct loss. The consequential loss is being unable to run the practice business to generate income.

3. Liability Risks

A doctor is legally liable to his wrongful act that cause damage to a third party; physically, by reputation or property. S/he can be legally sued with no maximum in the compensation amount if found guilty.

Knowing how risks are classified, and the types of pure risks an individual is exposed to, will provide a fundamental overview on these risk topics and prepare you to further acquire the knowledge of how to deal with and manage them as a physician executive, leader, or manager.

COMMENTS APPRECIATED

EDUCATION: Books

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

Like, Refer and Subscribe

***

***

PHYSICIANS BEWARE: The APR Car Lease “Money Factor”

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

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

What is it?

The so-called money factor (abbreviated as MF on invoices) is a number in a decimal form that dealers use to calculate the APR of a car lease. It’s a major part of your monthly payment and dealers are known to jack up the money factor to pad their profits.

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

How it works

Most doctors don’t ask to see it because they’re not aware of it or don’t know how to calculate it. Ask to see the money factor, then multiply it by 2,400.

For example, if the money factor is .00150, you multiply it by 2,400 to get 3.6%. If that’s higher than the prevailing rate, you have room to talk them down.

How to reduce it

So how do you get a good interest rate when you lease a vehicle? The same way you do when borrowing for any other reason, whether it’s buying a home or applying for a personal loan: by having good credit. This may reduce your interest rate because you’ll represent a lower risk to a lender.

A high residual value on the car could also help you get a better interest rate. A higher residual value means you’d have lower monthly payments because there would be less depreciation on the vehicle. Since interest is applied to your monthly payment, a lower monthly payment would equate to reduced interest charges.

MONEY DOCTORS: https://medicalexecutivepost.com/2025/04/08/psychology-a-money-relationship-questionnaire-for-doctors/

Financial implications

The money factor is one of the many numbers you may want to learn about when leasing a car. It’s one of the transactional costs that come with leasing, and allows dealers and finance companies to make a profit on every lease they execute. As a consumer, it’s a smart idea to learn the financial implications of this number and how it’ll affect your overall costs over the course of a multi-year lease.

***

***

If the interest rate is too high, you may need to shop around for a better rate, negotiate with the dealer or lender to lower the money factor, or consider leasing another vehicle that’s more in line with your budget. Either way, make sure you explore all your financial options before taking a car off the lot.

SALARY NEGOTIATIONS: https://medicalexecutivepost.com/2016/08/21/salary-negotiations-skills-for-doctors-hospitalists/

COMMENTS APPRECIATED

EDUCATION: Books

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

Like and Subscribe

***

***

EQ: Emotional Intelligence Defined

LEADERSHIP versus MANAGEMENT

***

***

By Dr. David Edward Marcinko MBA MEd

By Professor Gary A. Cook PhD

By Professor Eugene Schmuckler PhD MBA MEd CTS

Many of us have encountered a person who may intellectually be at upper levels, but whose ability to interact with others appears to that of one who is highly immature. This is the individual who is prone to becoming angry easily, verbally attacks co-workers, is perceived as lacking in compassion and empathy, and cannot understand why it is difficult to get others to cooperate with them and their agendas.

THINK: Sheldon Cooper PhD D.Sc MA BA of the The Big Bank Theory TV show.

The concept of Emotional Intelligence [EQ] was brought into the public domain when Daniel Goleman authored a book entitled, Emotional Intelligence.” According to Goleman, emotional intelligence consists of four basic non-cognitive competencies: self awareness, social awareness, self management and social skills. These are skills which influence the manner in which people handle themselves and their relationships with others.  Goleman’s position was that these competencies play a bigger role than cognitive intelligence in determining success in life and in the workplace.  He and others contend that emotional intelligence involves abilities that may be categorized into five domains:

  1. Self awareness: Observing and recognizing a feeling as it happens.
  2. Managing emotions: Handling feelings so that they are appropriate; realizing what is behind a feeling; finding ways to handle fears and anxieties, anger and sadness.
  3. Motivating oneself; Channeling emotions in the service of a goal; emotional self control; delaying gratification and stifling impulses.
  4. Empathy: Sensitivity to others’ feelings and concerns and taking their perspective appreciating the differences in how people feel about things.
  5. Handling relationships: Managing emotions in others; social competence & social skills. 

In 1995, Goleman then expanded on the works of Howard Gardner, Peter Salovey and John Mayer. He further defined Emotional Intelligence as a set of competencies demonstrating the ability one has to recognize his or her behaviors, moods and impulses and to manage them best, according to the situation. Mike Poskey, in “The Importance of Emotional Intelligence in the Workplace.” continued this definition by stating that emotional intelligence is considered to involve emotional empathy; attention to, and discrimination of one’s emotions; accurate recognition of one’s own and others’ moods; mood management or control over emotions; response with appropriate emotions and behaviors in various life situations (especially to stress and difficult situations); and balancing of honest expression of emotions against courtesy, consideration, and respect. 

Source: Emotional Intelligence: what is and why it matters” – Cary Cherniss, PhD, presented at the annual conference of the Society of Industrial and Organizational Psychology, April 2000.

EQ differs from what has generally been considered intelligence which is described in terms of one’s IQ.

Traditional views of intelligence focused on cognition, memory and problem solving. Even today individuals are evaluated on the basis of cognitive skills. Entrance tests for medical, law, business, undergraduate and graduate schools base admissions in large part on the scores of the SAT, GMAT, LSAT, MCAT, etc. Without question, cognitive ability is critical but has been demonstrated, it is not a very good predictor of future direct job performance and indirect liability management. In fact, in 1940, David Wechsler the developer of a widely used intelligence test made reference to “non-intellective” elements. By this Wechsler meant affective, personal and social factors.

Source: Non-Intellective factors in intelligence. Psychological Bulletin, 37, 444-445.  

Goleman became aware of the work of Salovey and Mayer having trained under David McClelland and was influenced by McClelland’s concern with how little traditional tests of cognitive intelligence predicted success in life. In fact, a study of 80 PhDs in science underwent a battery of personality tests, IQ tests and interviews in the 1950s while they were graduate students at Berkeley. Forty years later they were re-evaluated and it turned out that social and emotional abilities were four times more important than IQ in determining professional success and prestige.

Source: Feist & Barron: Emotional Intelligence and academic intelligence in career and life success. Paper presented at the Annual Convention of the American Psychological Society, San Francisco, 1996.

Undoubtedly, we want to have individuals work with us who have persistence which enables to them have the energy, drive, and thick skin to develop and close new business, or to work with the patients and other members of the staff. It is important to note that working alongside one with a “good” personality may be fun, energetic, and outgoing.

However, a “good personality does not necessarily equate to success. An individual with a high EQ can manage his or her own impulses, communicate effectively, manage change well, solve problems, and use humor to build rapport in tense situations. This clarity in thinking and composure in stressful and chaotic situations is what separates top performers from weak performers. 

INVESTOR’S EQ: https://medicalexecutivepost.com/2025/04/06/emotional-intelligence-how-eq-can-make-you-a-better-investor/

Poskey outlined a set of five emotional intelligence competencies that have proven to contribute more to workplace achievement than technical skills, cognitive ability, and standard personality traits combined.

***

***

A. Social Competencies: Competencies that Determine How We Handle Relationships

Intuition and Empathy – Our awareness of others’ feelings, needs, and concern. He suggested that this competency is important in the workplace for the following reasons:

  1. Understanding others: an intuitive sense of others’ feelings and perspectives, and showing an active interest in their concerns and interests
  2. Patient service orientation: the ability to anticipate, recognize and meet customer’s’ (patients) needs
  3. People development: ability to sense what others need in order to grow, develop, and master their strengths
  4. Leveraging diversity: cultivating opportunities through diverse people.

B. Political Acumen and Social Skills: Our adeptness at inducing desirable responses in others. This competency is important for the following reasons:

  1. Influencing: using effective tactics and techniques for persuasion and desired results.
  2. Communication: sending clear and convincing messages that are understood by others
  3. Leadership: inspiring and guiding groups of people
  4. Change catalyst: initiating and/or managing change in the workplace
  5. Conflict resolution: negotiating and resolving disagreements with people
  6. Collaboration and cooperation: working with coworkers and business partners toward shared goals
  7. Team capabilities: creating group synergy in pursuing collective goals.

C. Personal Competencies: Competencies that determine how we manage ourselves

D. Self Awareness: Knowing out internal states, preferences, resources, and intuitions. This competency is important for the following reasons.

  1. Emotional awareness: recognizing one’s emotions and their effects and impact on those around us
  2. Accurate self-assessment: knowing one’s strengths and limits
  3. Self-confidence: certainty about one’s self worth and capabilities
  4. Self-Regulation: managing one’s internal states, impulses, and resources. This competency is important in  the workplace for the following reasons.
  5. Self-control: managing disruptive emotions and impulses
  6. Trustworthiness: maintaining standards of honesty and integrity
  7. Conscientiousness: taking responsibility and being accountable for personal performance
  8. Adaptability: flexibility in handling change
  9. Innovation: being comfortable with an openness to novel ideas, approaches, and new information.

E. Self-Expectations and Motivation: Emotional tendencies that guide or facilitate reaching goals. This competency is important in the workplace for the following reasons.

  1. Achievement drive: striving to improve or meet a standard of excellence we impose on ourselves
  2. Commitment: aligning with the goals of the group or the organization
  3. Initiative: readiness to act on opportunities without having to be told
  4. Optimism: Persistence in pursuing goals despite obstacles and setbacks

A note of caution is necessary. Goleman and Salovey both stated that emotional intelligence on its own is not a strong predictor of job performance. Instead they contend that it provides the bedrock for competencies that are predictors. 

Obviously, EQ is an important attribute and it behooves each of us to promote emotional intelligence in the workplace. A number of guidelines have been developed for the Consortium for Research on Emotional Intelligence in Organizations by Goleman and Cherniss. The guidelines cover 21 phases which include preparation, training, transfer and evaluation.

  1. Assess the organization’s needs: Determine the competencies that are most critical for effective job performance in a particular type of job. In doing so, us a valid method, such as the comparison of the behavioral interviews of superior performs and average performers. Also make sure the competencies to be developed are congruent with the organization’s culture and overall strategy.
  2.  Assess the individual: This assessment should be based on the key competencies needed for a particular job, and the data should come from multiple sources using multiple methods to maximize credibility and validity.
  3.  Deliver assessments with care: Give the individual information on his/her strengths and weaknesses. In doing so, try to be accurate and clear. Also, allow plenty of time for the person to digest and integrate the information.  Provide feedback in a safe and supportive environment in order to minimize resistance and defensiveness. Avoid making excuses or downplaying the seriousness of deficiencies.
  4.  Maximize choice: People are motivated to change when they freely choose to do so. As much as possible, allow people to decide whether or not they will participate in the development process, and have them change goals themselves.
  5.  Encourage people to participate: People will be more likely to participate in development efforts if they perceive them to be worthwhile and effective. Organizational policies and procedures should encourage people to participate in development activity, and supervisors should provide encouragement and the necessary support. Motivation will be enhanced if people trust the credibility of those who encourage them to undertake the training.
  6.  Link learning goals to personal values: People are most motivated to pursue change that fits with their values and hopes. If a change matters little to people, they won’t pursue it. Help people understand whether a given change fits with what matters most to them.
  7.  Adjust expectations: Builds positive expectations by showing learners that social and emotional competence can be improved and that such improvement will lead to valued outcomes. Also, make sure that the learner has a realistic expectation of what the training process will involve.
  8.  Gauge readiness: Assess whether the individual is ready for training. If the person is not ready because of insufficient motivation or other reasons, make readiness the focus of intervention efforts.
  9.  Foster a positive relationship between the trainers and learners: Trainers who are warm, genuine, and empathic our best able to engage the learners in the change process. Select trainers who have these qualities, and make sure that they use them when working with the learners.
  10.  Make change self-directed: Learning is more effective when people direct their own learning program, tailoring it to their unique needs and circumstances. In addition to allowing people to set their own learning goals, let them continue to be in charge of their learning throughout the program, and tailor the training approach to the individual’s learning style.
  11.  Set clear goals: People need to be clear about what the competence is, how to acquire it, and how to show it on the job. Spell out the specific behaviors and skills that make up the target competence. Make sure that the goals are clear, specific, and optimally challenging.
  12.  Break goals into manageable steps: change. That is more likely to occur if the change process is divided into manageable steps. Encourage both trainers and trainees to avoid being overly ambitious.
  13.  Provide opportunities to practice: Lasting change requires sustained practice on the job and elsewhere in life. An automatic habit is being unlearned and different responses are replacing it. Use naturally occurring opportunities for practice at work, and in life. Encourage the trainees to try the new behaviors repeatedly and consistently over a period of months.
  14.  Give performance feedback: Ongoing feedback encourages people and direct change. Provide focused and sustained feedback as the learners practice new behaviors. Make sure that supervisors, peers, friends, family members-or some combination of these- give periodic feedback on progress.
  15.  Rely on experiential methods: Active, concrete, experiential methods tend to work best for learning social and emotional competencies. Development activities that engage all the senses and our dramatic and powerful can be especially effective.
  16.  Build in support: Change is facilitated through ongoing support of others who are going through similar changes. Programs should encourage the formation of groups where people give each other support, throughout the change effort. Coaches and mentors also can be valuable in helping support the desired change.
  17.  Use models: Use modern webinars, patient portals, live or videotaped models that clearly show how the competency can be used in realistic situations. Encourage learners to study, analyze, and emulate the models.
  18.  Enhance insight: Self-Awareness is the cornerstone of emotional and social competence. Help learners acquire greater understanding about how their thoughts, feelings, and behavior affect themselves and others.
  19.  Prevent relapse: Use relapse prevention, which helps people use lapses and mistakes as lessons to prepare themselves for further efforts.

Moreover:

  • Encourage use of skills on the job: Supervisors, peers and subordinates should reinforce and reward learners for using their new skills on the job. Coaches and mentors also can serve this function. Also, provide prompts and cues, such as through periodic follow-ups. Change also is more likely to indoor. When high status persons, such as supervisors and upper-level management model it.
  •  Develop an organizational culture that supports learning: Change will be more enduring if the organization’s culture and tone support the change and offer a safe atmosphere for experimentation.

Finally, see if the development effort has lasting effects evaluated. When possible, find a true set of measures of the competence or skill, as shown on the job, before and after training, and also at least two months later. One-year follow-ups also are highly desirable. In addition to charting progress on the acquisition of competencies, also assess the impact on important job related outcomes, such as performance measures, and indicators of adjustments such as absenteeism, grievances, health status, etc.

Managers V. Leaders

These abilities are important for one to be successful as a manager and even more so as a leader, or physician executive. But, before we begin an examination of strategic leadership, it is necessary to make a deeper distinction between a manager and a leader. There are many different definitions as well as descriptions regarding leadership and management.

BRAND MANAGEMENT: https://medicalexecutivepost.com/2025/07/07/brand-management-7-approaches-for-doctors-and-financial-advisors/

Many people talk as though leadership and management is the same thing. Fundamentally, they are quite different. Management focuses on work. We manage work activities such as money, time, paperwork, materials, equipment, and personnel, among other things.  As can be found in any basic book on management, management focuses on planning, organizing, controlling, coordinating, budgeting, finance and money management as well as decision making. In effect, managers are generally those individuals who have been given their authority by virtue of their role. It is the function of a manager to ensure that the work gets done as well as to oversee the activities of others. In many healthcare organizations we find that those individuals elevated to a managerial position occur as a result of being a high performer on their previous assignment. A manager receives authority on the basis of role; while a leader’ authority is more innate in nature.

HEALTHCARE LEADERSHIP: https://medicalexecutivepost.com/2025/05/01/healthcare-leadership-on-the-brink-executives-eyeing-the-exits/

COMMENTS APPRECIATED

***

***

EDUCATION: Books

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

Like, Subscribe and Refer

***

ESSENTIALITY: Hospital Credit Analysis

By Dr. David Edward Marcinko MBA MEd

***

SPONSOR: http://www.MarcinkoAssociates.com

Why Hospital Essentiality?

An important component of hospital credit analysis is essentiality. Hospitals are unusual businesses that many times possess some form of essentiality to their communities. Health care is important to the economic vitality of every community. Many hospitals have served their communities for many years; it is not uncommon to find hospitals that have been continuously operating for more than 100 years in the same community.

Most hospitals are not-for-profit. In not-for-profit hospitals, no private party actually “owns” the hospital; control is vested in various boards, but no one explicitly owns a not-for-profit hospital. In a broad sense, communities own not-for-profit hospitals. They are considered “charities” with a “charitable purpose.” Though a not-for-profit hospital may not have owners, it has many “stakehold-ers,” parties that have vested interests in the continuing success of the hospital.

HOSPITAL TYPES: https://medicalexecutivepost.com/2025/08/06/hospitals-understanding-different-types/

***

***

Many hospitals have broad and vast webs of stakeholders. Stakeholders are why hospitals rarely close or are shut down. Too many stakeholders have interests in the continuing successful operation of hospitals.

Another dimension of the essentiality analysis is service analysis. How significant are the hospital’s services? If the hospital shuts down, what population segments would suffer? How significant is the population that would suffer? How much would they suffer?

HOSPITAL ROI: https://medicalexecutivepost.com/2024/10/09/the-dupont-decomposition-equation-for-roi/

Assessment

And so, hospital stakeholder relationships need to be considered in the analysis of essentiality. How strong are these relations? How many are there? How important is the continuing success of this hospital to these stakeholders?

Analysis of hospital’s stakeholders and services should provide a credible view of the degree of essentiality associated with a hospital. Higher degrees of essentiality suggest higher likelihoods that hospitals, one way or another, will meet their commitments, particularly their payment
commitments.

***

***

COMMENTS APPRECIATED

EDUCATION: Books

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

Like and Subscribe

EMOTIONAL INTELLIGENCE & ORGANIZATIONAL BEHAVIOR: Economic Risk Management Classification for Medical Professionals

BY DR. DAVID EDWARD MARCINKO, MBA MEd CMP®

***

SPONSOR: http://www.MarcinkoAssociates.com

ORGANIZATIONAL BEHAVIOR AND CLASSIFICATION OF RISKS

DEFINITION EMOTIONAL INTELLIGENCE: Emotional intelligence [EI] refers to the ability to identify and manage one’s own emotions, as well as the emotions of others. Emotional intelligence is generally said to include a few skills: namely emotional awareness, or the ability to identify and name one’s own emotions; the ability to harness those emotions and apply them to tasks like thinking and problem solving; and the ability to manage emotions, which includes both regulating one’s own emotions when necessary and helping others to do the same.

DEFINITIONAL ORGANIZATIONAL BEHAVIOR: Organizational behavior (OB) is the study of how individuals, groups, and organizations interact and influence one another. Though it is largely used within the field of business management as means to understand–and more effectively manage–groups of people. The reason businesses look to OB is because it can help organizations increase employee performance, while also creating a positive working environment.

CITE: Eugene Schmuckler; PhD MBA MEd CTS®

***

***

And so, as we review the concept of Emotional Intelligence and Organizational Behavior, it is possible to set up five EI/OB risk classes, based on the economic consequences of the occurrence of specific individual risks:

1. Prevented risks: Risks whose cost of occurrence is higher than their cost of management and whose occurrence may invoke additional legal sanctions. This class would include intentional torts and injuries caused by gross negligence.

2. Normally prevented risks: Risks whose cost of occurrence is greater than the cost of their management but whose occurrence will be considered only as negligent. This class includes most negligent injuries
and most types of product liability actions.

3. Managed risks: Risks whose cost of occurrence is only slightly greater than their cost of management. The plaintiff usually has the burden of showing that the defendant owed the plaintiff a special duty to recover for one of these risks.

4. Un-Prevented risks: Risks whose cost of occurrence is less than their cost of management. The classic example of this class is the cost of railroad crossing barriers compared to the cost of people being hit by
trains.

5. Un-Preventable risks: Risks whose occurrence is unmanageable. The assignment of a risk to one of these classes is a major problem in medical and healthcare quality control, because the class of a risk determines how much effort must be expended to prevent the risk. The misclassification of a prevented or normally prevented risk as a managed or un-prevented risk can result in large financial losses.

***

For example: A medical clinic that does not update obsolete equipment, such as inaccurate oxygen monitors, would be liable for any injuries attributable to the obsolete equipment. The classifications of risk must be reviewed periodically to determine if the cost of the risk-taking behavior has changed, thereby altering the classification.

***

***

For example: A small hospital in a rural area would not be expected to have the sophisticated equipment as a major hospital in a city. If an accident victim is brought into the rural facility, the hospital’s duty may be to transfer the patient to a better-equipped facility. The patient will face the risk of dying because of the delay in treatment, but the risk of insufficient treatments outweighs the risk of transfer. If the same victim were brought into a hospital in a major metropolitan center, the duty would be to treat the patient without a transfer. The risk of transfer has not changed, but the risk of insufficient treatment has disappeared.

COMMENTS APPRECIATED

EDUCATION: Books

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

Like, Refer and Subscribe

***

***

Stocks, the FOMC and Trade Deals

SPONSOR: http://www.CertifiedMedicalPlanner.org

By A.I.

***

***

  • Stocks: The multi-day rally wavered this afternoon as investors turned their attention to big tech earnings tomorrow. The S&P 500 closed at a record high, while the NASDAQ finally broke its hot streak.
  • FOMC: Treasury Secretary Scott Bessent sees no reason for Jerome Powell to step down, while President Trump tempered his outrage against the Fed chair. Instead, well-known economist Mohamed El-Erian took up the gauntlet.
  • Trade: Bessent said China may get an extension to make a true trade deal, while promising a “rash of trade deals” in the coming days. Speaking of, Trump declared the US has made a deal with the Philippines capping import levies at 19%.

COMMENTS APPRECIATED

Like and Refer

***

***

Beware of Borrowing That Helps Your Advisor – Not You

By Rick Kahler MSFP CFP

***

***

When Maria needed $400,000 for a down payment on a new home, her broker at a large Wall Street firm offered a solution: “Don’t sell investments and trigger capital gains. Just take out a margin loan.”

A margin loan is a line of credit from a brokerage firm, secured by the client’s investment portfolio. It offers quick access to cash with no immediate tax consequences and minimal paperwork. But the convenience comes at a cost. As of mid-2025, margin loan interest rates range from 6.25% to over 11%.

Margin loan recommendations are often presented by brokers as tax-savvy strategies that allow clients to access “tax-free” cash while keeping their portfolios intact. In many cases, however, the math benefits the advisor more than the investor. The cost of borrowing often exceeds what an investor is likely to earn by holding on.

For example, let’s assume an interest rate of 7.5% on Maria’s $400,000 margin loan. While borrowing delayed the payment of $20,000 in capital gains tax, she will eventually have to pay that tax anyway unless she holds the investments until her death. Two years later, with portfolio returns of 4% annually, she had earned around $32,000 from the $400,000 in investments she might have sold. Meanwhile, she had paid $60,000 in interest—leaving her some $28,000 worse off. That’s without factoring in ongoing interest payments, or the risks of a margin call if the investments securing the loan drop in value.

Why do advisors keep recommending margin loans? Because selling investments reduces the portfolio size and the advisor’s fee. Borrowing keeps the portfolio intact and the compensation unchanged—while the firm receives additional income from interest on the loan. In some cases, advisors suggest using margin loans to buy more investments, increasing both the portfolio and the fee they collect.

None of this is illegal. But when the borrowing cost is higher than expected returns and the advisor benefits financially, the ethics are questionable. The client takes the risk, while the advisor keeps the revenue.

This kind of conflict appears more often in portfolios where compensation is tied to asset volume and the company’s primary culture rewards gathering assets over delivering unbiased advice. By contrast, fee-only financial planning and investment advisors typically operate on simpler hourly, flat, or tiered fee structures. Their compensation doesn’t depend on whether a client borrows, sells, or holds. The culture of the firm focuses on conflict-free advice aligned with the client’s best interest.

Wall Street brokers are often held to a fiduciary standard, but structure still matters. In 2024 the SEC reported their examinations of brokers would continue to focus on advisor recommendations unduly influenced by the company’s compensation and incentives.

There are rare situations where a margin loan may be appropriate. A client with large unrealized gains might use a short-term margin loan to minimize taxes. An elderly investor might borrow tax-free rather than sell assets that will receive a step-up in basis at their death. Even in those cases, the math must be exact and the client must clearly understand the risks, including the possibility of a margin call.

If your advisor recommends a margin loan, especially to buy more investments, ask strong questions. What’s the interest rate? What return is realistic? What are the tax consequences of selling? How does this affect the advisor’s income?

If you don’t get direct answers, that’s a warning sign.

In a high-rate, low-return environment, margin loans rarely favor the client. The exceptions are narrow. The risks are significant. And the conflict of interest is measurable.

Sometimes the smartest move is the simplest: sell what you need, pay the tax, and leave leverage out of your plan.

COMMENTS APPRECIATED

Like and Subscribe

***

***

PARADOXES: Beware Financial and Investing Contradictions

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

***

***

As we plan for our financial future, I think it’s helpful to be cognizant of these paradoxes. While there’s nothing we can do to control or change them, there is great value in being aware of them, so we can approach them with the right tools and the right mindset.

Here are just seven of the paradoxes that can bedevil financial planning and investment decision-making:

  • There’s the paradox that all of the greatest fortunes—Carnegie, Rockefeller, Buffett, Gates—have been made by owning just one stock. And yet the best advice for individual investors is to do the opposite: to own broadly diversified index funds.
  • There’s the paradox that the stock market may appear overvalued and yet it could become even more overvalued before it eventually declines. And when it does decline, it may be to a level that is even higher than where it is today.
  • There’s the paradox that we make plans based on our understanding of the rules—and yet Congress can change the rules on us at any time, as it did just a few weeks ago.
  • There’s the paradox that we base our plans on historical averages—average stock market returns, average interest rates, average inflation rates and so on—and yet we only lead one life, so none of us will experience the average.
  • There’s the paradox that we continue to be attracted to the prestige of high-cost colleges, even though a rational analysis that looks at return on investment tells us that lower-cost state schools are usually the better bet.
  • There’s the paradox that early retirement seems so appealing—and has even turned into a movement—and yet the reality of early retirement suggests that we might be better off staying at our desks.
  • There’s the paradox that retirees’ worst fear is outliving their money and yet few choose the financial product that is purpose-built to solve that problem: the single-premium immediate annuity.

Assessment

QUESTION: How should you respond to these paradoxes? As you plan for your financial future, embrace the concept of “loosely held views.” In other words, make financial plans, but continuously update your views, question your assumptions and rethink your priorities.

COMMENTS APPRECIATED

Refer and Subscribe

***

***

Stocks, Crypto & Stock Markets

SPONSOR: http://www.CertifiedMedicalPlanner.org

By A.I.

***

***

  • The Fed Drama: A White House official said President Trump will likely fire Jerome Powell soon. Stocks sank at the thought of the Fed head being shown the door, offsetting the pleasant surprise of a flat wholesale inflation reading.
  • Markets: Stocks managed to recoup their losses after Trump said it’s “highly unlikely” that he will fire Powell, but bonds remained shaken.
  • Crypto: Bitcoin bounced higher after the crypto bills currently under consideration in the House of Representatives cleared a key hurdle.

COMMENTS APPRECIATED

Like and Subscribe

***

***

What is a “Market-Neutral” Fund?

Market Neutral Funds Demystified

[A Special Report]

By Dimitri Sogoloff MD MBA & Dr. David E. Marcinko MBA MEd CMP

***

Introduction

SPONSOR: https://marcinkoassociates.com/

It’s hard to believe that just 30 years ago, physician investors had only two primary asset classes from which to choose: U.S. equities and U.S. bonds.

Today, the marketplace offers a daunting array of investment choices. Rapid market globalization, technology advancements and investor sophistication have spawned a host of new asset classes, from the mundane to the mysterious.

Even neophyte medical investors can now buy and sell international equities, emerging market debt, mortgage securities, commodities, derivatives, indexes and currencies, offering infinitely more opportunities to make, or lose, money.

Amidst this ongoing proliferation, a unique asset class has emerged, one that is complex, non-traditional and not easily understood like stocks or bonds. It does, however, offer one invaluable advantage; its returns are virtually uncorrelated with any other asset class. When this asset class is introduced into a traditional investment portfolio, a wonderful thing occurs; the risk-return profile of the overall portfolio improves dramatically.

This asset class is known as a Market-Neutral strategy. The reason few medical professionals have heard of market neutral strategies is that most of them are offered by private investment partnerships otherwise known as hedge funds.

To the uninitiated, “hedge fund” means risky, volatile or speculative. With a market-neutral strategy however, just the opposite is true. Funds utilizing market-neutral strategies typically emphasize the disciplined use of investment and risk control processes. As a result, they have consistently generated returns that display both low volatility and a low correlation with traditional equity or fixed income markets. 

Definition of Market-Neutral

All market-neutral funds share a common objective: to achieve positive returns regardless of market direction. Of course, they are not without risk; these funds can and do lose money. But a key to their performance is that it is independent of the behavior of the markets at large, and this feature can add tremendous value to the rest of a portfolio.

A typical market-neutral strategy focuses on the spread relationship between related securities, which is what makes them virtually independent of underlying debt or equity markets. When two related securities are mispriced in relation to one another, the disparity will eventually disappear as the result of some external event. This event is called convergence and may take the form of a bond maturity, completion of a merger, option exercise, or simply a market recognizing the inefficiency and eliminating it through supply and demand.

Here’s how it might work

When two companies announce a merger, there is an intended future convergence, when the shares of both companies will converge and become one. At the time of the announcement, there is typically a trading spread between two shares. A shrewd trader, seeing the probability of the successful merger, will simultaneously buy the relatively cheaper share and sell short the relatively more expensive share, thus locking in the future gain.

Another example of convergence would be the relationship between a convertible bond and its underlying stock. At the time of convergence, such as bond maturity, the two securities will be at parity. However, the market forces of supply and demand make the bond underpriced relative to the underlying stock. This mispricing will disappear upon convergence, so simultaneously buying the convertible bond and selling short an equivalent amount of underlying stock, locks in the relative spread between the two.  

Yet another example would be two bonds of the same company – one junior and one senior. For various reasons, the senior bond may become cheaper relative to the junior bond and thus display a temporary inefficiency that would disappear once arbitrageurs bought the cheaper bond and sold the more expensive bond.

While these examples involve different types of securities, scenarios and market factors, they are all examples of a market-neutral strategy. Locking a spread between two related securities and waiting for the convergence to take place is a great way to make money without ever taking a view on the direction of the market.

How large are these spreads, you may ask? Typically, they are tiny. The markets are not quite fully efficient, but they are efficient enough to not allow large price discrepancies to occur.

In order to make a meaningful profit, a market-neutral fund manager needs sophisticated technology to help identify opportunities, the agility to rapidly seize those opportunities, and have adequate financing resources to conduct hundreds of transactions annually.  

Brief Description of Strategies

SPONSOR: http://www.CertifiedMedicalPlanner.org

The universe of market-neutral strategies is vast, spanning virtually every asset class, country and market sector. The spectrum varies in risk from highly volatile to ultra conservative. Some market-neutral strategies are more volatile than risky low-cap equity strategies, while others offer better stability than U.S Treasuries.

One unifying factor across this vast ocean of seemingly disparate strategies is that they all attempt to take advantage of a relative mispricing between various securities, and all offer a high degree of “market neutrality,” that is, a low correlation with underlying markets.

[A] Convertible Arbitrage

Convertible arbitrage is the oldest market-neutral strategy. Designed to capitalize on the relative mispricing between a convertible security (e.g. convertible bond or preferred stock) and the underlying equity, convertible arbitrage was employed as early as the 1950s.

Since then, convertible arbitrage has evolved into a sophisticated, model-intensive strategy, designed to capture the difference between the income earned by a convertible security (which is held long) and the dividend of the underlying stock (which is sold short). The resulting net positive income of the hedged position is independent of any market fluctuations. The trick is to assemble a portfolio wherein the long and short positions, responding to equity fluctuations, interest rate shifts, credit spreads and other market events offset each other.  

A convertible arbitrage strategy involves taking long positions in convertible securities and hedging those positions by selling short the underlying common stock. A manager will, in an effort to capitalize on relative pricing inefficiencies, purchase long positions in convertible securities, generally convertible bonds, convertible preferred stock or warrants, and hedge a portion of the equity risk by selling short the underlying common stock. Timing may be linked to a specific event relative to the underlying company, or a belief that a relative mispricing exists between the corresponding securities.

Convertible securities and warrants are priced as a function of the price of the underlying stock, expected future volatility of returns, risk free interest rates, call provisions, supply and demand for specific issues and, in the case of convertible bonds, the issue-specific corporate/Treasury yield spread.

Thus, there is ample room for relative misvaluations. Because a large part of this strategy’s gain is generated by cash flow, it is a relatively low-risk strategy. 

[B] Fixed-Income Arbitrage

Fixed-income arbitrage managers seek to exploit pricing inefficiencies across global markets.

Examples of these anomalies would be arbitrage between similar bonds of the same company, pricing inefficiencies of asset-backed securities and yield curve arbitrage (price differentials between government bonds of different maturities). Because the prices of fixed-income instruments are based on interest rates, expected cash flows, credit spreads, and related factors, fixed-income arbitrageurs use sophisticated quantitative models to identify pricing discrepancies.

Similarly to convertible arbitrageurs, fixed-income arbitrageurs rely on investors less sophisticated than themselves to misprice a complex security.

[C] Equity Market-Neutral Arbitrage

This strategy attempts to offset equity risk by holding long and short equity positions. Ideally, these positions are related to each other, as in holding a basket of S&P500 stocks and selling S&P500 futures against the basket. If the manager, presumably through stock-picking skill, is able to assemble a basket cheaper than the index, a market-neutral gain will be realized.

A related strategy is identifying a closed-end mutual fund trading at a significant discount to its net asset value. Purchasing shares of the fund gains access to a portfolio of securities valued significantly higher. In order to capture this mispricing, one needs only to sell short every holding in the fund’s portfolio and then force (by means of a proxy fight, perhaps) conversion of the fund from a closed-end to an open-end (creating convergence).

Sounds easy, right?

In considering equity market-neutral, you must be careful to differentiate between true market-neutral strategies (where long and short positions are related) and the recently popular long/short equity strategies.

In a long/short strategy, the manager is essentially a stock-picker, hopefully purchasing stocks expected to go up, and selling short stocks expected to depreciate. While the dollar value of long and short positions may be equivalent, there is often little relationship between the two, and the risk of both bets going the wrong way is always present.

[D] Merger Arbitrage (a.k.a. Risk Arbitrage)

Merger arbitrage, while a subset of a larger strategy called event-driven arbitrage, represents a sufficient portion of the market-neutral universe to warrant separate discussion.

Merger arbitrage earned a bad reputation in the 1980s when Ivan Boesky and others like him came to regard insider trading as a valid investment strategy. That notwithstanding, merger arbitrage is a respected stratagey, and when executed properly, can be highly profitable. It bets on the outcomes of mergers, takeovers and other corporate events involving two stocks which may become one.

A textbook example was the acquisition of SDL Inc (SDLI), by JDS Uniphase Corp (JDSU). On July 10, 2000 JDSU announced its intent to acquire SDLI by offering to exchange 3.8 shares of its own shares for one share of SDLI.

At that time, the JDSU shares traded at $101 and SDLI at $320.5. It was apparent that there was almost 20 percent profit to be realized if the deal went through (3.8 JDSU shares at $101 are worth $383 while SDLI was worth just $320.5). This apparent mispricing reflected the market’s expectation about the deal’s outcome. Since the deal was subject to the approval of the U.S. Justice Department and shareholders, there was some doubt about its successful completion. Risk arbitrageurs who did their homework and properly estimated the probability of success bought shares of SDLI and simultaneously sold short shares of JDSU on a 3.8 to 1 ratio, thus locking in the future profit.

Convergence took place about eight months later, in February 2001, when the deal was finally approved and the two stocks began trading at exact parity, eliminating the mispricing and allowing arbitrageurs to realize a profit. 

Merger Arbitrage, also known as risk arbitrage, involves investing in securities of companies that are the subject of some form of extraordinary corporate transaction, including acquisition or merger proposals, exchange offers, cash tender offers and leveraged buy-outs. These transactions will generally involve the exchange of securities for cash, other securities or a combination of cash and other securities.

Typically, a manager purchases the stock of a company being acquired or merging with another company, and sells short the stock of the acquiring company. A manager engaged in merger arbitrage transactions will derive profit (or loss) by realizing the price differential between the price of the securities purchased and the value ultimately realized when the deal is consummated. The success of this strategy usually is dependent upon the proposed merger, tender offer or exchange offer being consummated.  

When a tender or exchange offer or a proposal for a merger is publicly announced, the offer price or the value of the securities of the acquiring company to be received is typically greater than the current market price of the securities of the target company.

Normally, the stock of an acquisition target appreciates while the acquiring company’s stock decreases in value. If a manager determines that it is probable that the transaction will be consummated, it may purchase shares of the target company and in most instances, sell short the stock of the acquiring company. Managers may employ the use of equity options as a low-risk alternative to the outright purchase or sale of common stock. Many managers will hedge against market risk by purchasing S&P put options or put option spreads. 

[E] Event-Driven Arbitrage

Funds often use event-driven arbitrage to augment their primary market-neutral strategy. Generally, any convergence which is produced by a future corporate event would fall into this category.

Accordingly, Event-Driven investment strategies or “corporate life cycle investing” involves investments in opportunities created by significant transactional events, such as spin-offs, mergers and acquisitions, liquidations, reorganizations, bankruptcies, recapitalizations and share buybacks and other extraordinary corporate transactions.

Event-Driven strategies involve attempting to predict the outcome of a particular transaction as well as the optimal time at which to commit capital to it. The uncertainty about the outcome of these events creates investment opportunities for managers who can correctly anticipate their outcomes.

As such, Event-Driven trading embraces merger arbitrage, distressed securities and special situations investing. Event-Driven managers do not generally rely on market direction for results; however, major market declines, which would cause transactions to be repriced or break, may have a negative impact on the strategy. 

Event-driven strategies are research-intensive, requiring a manager to do extensive fundamental research to assess the probability of a certain corporate event, and in some cases, to take an active role in determining the event’s outcome. 

Risk and Reward Characteristics

To help understand market-neutral performance and risk, let’s take a look at the distribution of returns of individual strategies and compare it to that of traditional asset classes.

 Table 1:  Average Return / Volatility of Market Neutral Strategies And Selected Traditional Asset Classes 

 

Strategy Average Return Annualized Volatility
Convertible Arbitrage 11.95% 3.57%
Fixed Income Arbitrage 8.33% 4.90%
Equity Market-Neutral 11.62% 4.95%
Merger Arbitrage 13.29% 3.51%
Relative Value Arbitrage 15.69% 4.31%
   Traditional Asset Classes:    
S&P 500 12.62% 13.72%
MSCI World 8.57% 13.05%
High Grade U.S. Corp. Bonds 7.26% 3.73%
World Government Bonds 5.91% 5.96%

The most important observation about this chart is that the Market Neutral funds exhibits considerably lower risk than most traditional asset classes.

While market-neutral strategies vary greatly and involve all types of securities, the risk-adjusted returns are amazingly stable across all strategies. The annualized volatility – a standard measure of performance risk – varies between 3.5 and 5 percent, comparable to a conservative fixed-income strategy.     

Another interesting statistics is the correlation between Market Neutral strategies and traditional asset classes and traditional asset classes

Table 2: Correlation between Market Neutral Strategies and Traditional Asset Classes

 

Asset Class/Strategy S&P500 MSCI World GovBonds CorpBonds

The correlation of all market neutral strategies to traditional assets is quite low, or negative in some cases. This suggests that these strategies would indeed play a useful role in the ultimate goal of efficient portfolio diversification.

To test the “market neutrality” of these strategies, we asked, “How well, on average, did these strategies perform during bad, as well as good, market months?”

It turns out, in good times and bad, these strategies displayed consistent solid performance. From 12/31/91, in months when S&P 500 was down, the average down month was 3.03 percent. Market Neutral strategies performed as follows:

  

Strategy Average Monthly Return
Convertible Arbitrage + 0.65%
Fixed Income Arbitrage + 0.50%
Equity Market-Neutral + 1.19%
Merger Arbitrage + 0.88%
Relative Value Arbitrage + 0.81%

In months when S&P 500 was up, the average up month was +3.24 percent.  Market Neutral strategies performed as follows:

  

Strategy Average Monthly Return
Convertible Arbitrage +1.17%
Fixed Income Arbitrage +1.20%
Equity Market-Neutral +1.37%
Merger Arbitrage +0.60%
Relative Value Arbitrage +1.25%

Clearly, a compelling picture emerges. While these strategies, on average, underperform during good times, they show a positive average return during both good and bad markets.

Inclusion of Market-Neutral in a Long-term Investment Portfolio

A critical concern for any medical investor considering a foray into a new asset class is how it will alter the long-term risk/reward profile of the overall portfolio. To better understand this, we constructed several hypothetical portfolios consisting of traditional asset classes:

·  US Treasuries (Salomon Treasury Index 10yrs+)

·  High Grade Corporate Bonds  (Salomon Investment Grade Index)

·  Speculative Grade Corporate Bonds  (High Yield Index)

·  US Blue chip equities  (Dow Jones Industrial Average)

·  US mid-cap equities  (S&P 400 Midcap Index)

·  US small-cap equities (S&P 600 Smallcap Index)

Portfolios varied in the level of risk from 100 percent U.S Treasuries (least risky) to 100 percent small-cap equities (most risky), and are ranked from 1 to 10, 1 representing the least risky portfolio.Each portfolio was analyzed on a Risk/Return basis using monthly return data since December 1991. The results are shown in Chart 1.Predictably, the least risky portfolio produced the smallest return, while the riskiest produced the highest return. This is perfectly understandable – you would expect to be compensated for taking a higher level of risk.

Chart 1: Risk/Return characteristics of traditional portfolios vs. Market Neutral strategies 

Clearly, the risk-return picture offered by Market Neutral strategies is much more compelling (lower risk, higher return) than that offered by portfolios of traditional assets. What happens if we introduce these market-neutral strategies into traditional portfolios? Let’s take 20 percent of the traditional investments in our portfolio and reinvest them in market-neutral strategies.

The change is dramatic: the new portfolios (denoted 1a through 10a) offer significantly less risk for the same return. The riskiest portfolio, for instance (number 10) offered 20 percent less risk for a similar return of a new portfolio containing market-neutral strategies (number 10a).   
 
Chart 2:  Result of inclusion of 20% of Market Neutral strategies in traditional portfolios 

This is quite a difference.  Everything else being equal, anyone would choose the new, “improved” portfolios over the traditional ones.

How to invest

The mutual fund world does not offer a great choice of market neutral strategies. 

Currently, there are only a handful of good mutual funds that label themselves market-neutral (AXA Rosenberg Market Netural fund and Calamos Market Neutral fund are two examples).

Mutual fund offerings are slim due to excessive regulations imposed by the SEC with respect to short selling and leverage, and consequently these funds lack flexibility in constructing truly hedged portfolios. The dearth of market-neutral offerings among mutual funds is offset by a vast array of choices in the hedge fund universe. Approximately 400 market-neutral funds, managing $60 billion, represent roughly 25% of all hedge funds.

Therefore, further focus will relate to the hedge fund universe, rather than the limited number of market-neutral mutual funds.

Direct investing in a market-neutral hedge fund is restricted to qualifying individuals who must meet high net worth and/or income requirements, and institutional investors, such as corporations, qualifying pension plans, endowments, foundations, banks, insurance companies, etc.

This does not mean that retail investors cannot get access to hedge fund exposure. Various private banking institutions offer funds of funds with exposure to hedge funds. Maaket-neutral funds are nontraditional investments. They are part of a larger subset of strategies known as alternative investments, and there is nothing traditional in the way doctors invest in them.

Hedge funds are private partnerships, which gives them maximum flexibility in constructing and managing portfolios, but also requires medical investors to do a little extra work.

[A] Lockup Periods

One of the main differences between mutual funds and hedge funds is liquidity. Market-neutral strategies have less liquidity than traditional portfolios. Quarterly redemption policies with 45- or 60-days notice are common. Many funds allow redemptions only once a year and some also have lock-up periods. In addition, few of these funds pay dividends or make distributions. These investments should be regarded strictly as long-term strategies.

[B] Managerial Risks

Success of a market-neutral strategy depends much less on the market direction than on the manager’s skill in identifying arbitrage opportunities and capitalizing on them.

Thus, there is significantly more risk with the manager than with the market. It’s vital for investors to understand a manager’s style and to monitor any deviations from it due to growth, personnel changes, bad decisions, or other factors.

[C] Fees

If you are accustomed to mutual fund fees, brace yourself; market-neutral investing does not come cheap.

Typical management fees range from 1 to 2 percent per year, plus a performance fee averaging 20 percent of net profits. Most managers have a “high watermark” provision; they cannot collect the performance fees until investors recoup any previous losses. Look for this provision in the funds’ prospectus and avoid any fund that lacks it. Even with higher fees, market-neutral investing is superior to most traditional mutual fund investing on a risk-adjusted return basis.

[D] Transparency

Mutual funds report their positions to the public regularly. This is not the case with market-neutral hedge funds. Full transparency could jeopardize accumulation of a specific position. It also generates front running: buying or selling securities before the fund is able to do so. While you should not expect to see individual portfolio positions, many hedge fund managers do provide a certain level of transparency by indicating their geographical or sector exposures, level of leverage and extent of hedging.

It does take a bit of education to understand these numbers, but the effort is definitely worthwhile. 

[E] Taxation

The issue of hedge fund taxation is quite complex and is often dependent on the fund and the personal situation of the investor. Advice from a competent accountant, specialized financial advisor, tax attorney with relevant experience is worthwhile. The bottom line is that investing in market-neutral funds is not a tax-planning exercise and it will not minimize your taxes.

On the other hand, it should not generate any more or fewer taxes than if you invested in more traditional funds.

From the medical investor’s perspective, the principal advantages of market-neutral investing are attractive risk-adjusted returns and enhanced diversification.

Ten years of data indicate that market-neutral portfolios have produced risk-adjusted returns superior to traditional investments. In addition, the correlation between the returns of market-neutral funds and traditional asset classes has been historically negligible.

Adding exposure of market-neutral return strategies to the asset mix within a consistent, long-term investment program offers a medical investor the opportunity to improve overall returns, as well as achieving some protection against negative market movements.

Now, after all of the above, has your impression of hedge funds in general or MN funds in particular, changed?

APPENDIX:  

Asset class weighting in traditional portfolios:
Portfolio US Treasuries US High Grade Corp Bonds US Low Grade Corp Bonds Large Cap Stocks Mid Cap Stocks Small Cap Stocks
1 50% 50%        
2   50% 50%      
3 10% 30% 50% 40%    
4   50%   50%    
5   10% 10% 50% 30%  
6     10% 50% 20% 20%
7     10% 30% 20% 40%
8       20% 20% 60%
9         20% 80%
10           100%

 

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Product DetailsProduct DetailsProduct Details

Product Details  Product Details

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

BEWARE FIREWORKS: Money to Burn on the Fourth of July

The Complete Guide to July 4th Fireworks

Gather your novelty flag apparel and preheat your grills: Independence Day 2024 is upon us. And, what’s a July 4th celebration without some explosions in the sky?

Assessment

This info-graphic takes a closer look at the less glamorous side of fireworks — from the dollars that go up in smoke to the fingers we burn.

***

[via MedPub]

Happy Fourth ME-P readers; please light responsibly!

***

STOCK PERFORMANCE: Growth v. Value Investing for Physicians

BY DR. DAVID EDWARD MARCINKO: MBA MEd CMP™

***

SPONSOR: http://www.MarcinkoAssociates.com

***

Performance of Growth & Value Stocks

Although many academics argue that value stocks outperform growth stocks, the returns for individuals investing through mutual funds demonstrate a near match. 

Introduction

A 2005 study Do Investors Capture the Value Premium? written by Todd Houge at The University of Iowa and Tim Loughran at The University of Notre Dame found that large company mutual funds in both the value and growth styles returned just over 11 percent for the period of 1975 to 2002. This paper contradicted many studies that demonstrated owning value stocks offers better long-term performance than growth stocks. 

The studies, led by Eugene Fama PhD and Kenneth French PhD, established the current consensus that the value style of investing does indeed offer a return premium. There are several theories as to why this has been the case, among the most persuasive being a series of behavioral arguments put forth by leading researchers. The studies suggest that the out performance of value stocks may result from investors’ tendency toward common behavioral traits, including the belief that the future will be similar to the past, overreaction to unexpected events, “herding” behavior which leads at times to overemphasis of a particular style or sector, overconfidence, and aversion to regret. All of these behaviors can cause price anomalies which create buying opportunities for value investors.

Another key ingredient argued for value out performance is lower business appraisals. Value stocks are plainly confined to a P/E range, whereas growth stocks have an upper limit that is infinite.  When growth stocks reach a high plateau in regard to P/E ratios, the ensuing returns are generally much lower than the category average over time. 

Moreover, growth stocks tend to lose more in bear markets.  In the last two major bear markets, growth stocks fared far worse than value.  From January 1973 until late 1974, large growth stocks lost 45 percent of their value, while large value stocks lost 26 percent. Similarly, from April 2000 to September 2002, large growth stocks lost 46 percent versus only 27 percent for large value stocks. These losses, academics insist, dramatically reduce the long-term investment returns of growth stocks.

***

***

However, the study by Houge and Loughran reasoned that although a premium may exist, investors have not been able to capture the excess return through mutual funds.  The study also maintained that any potential value premium is generated outside the securities held by most mutual funds.  Simply put, being growth or value had no material impact on a mutual fund’s performance.

Listed below in the table are the annualized returns and standard deviations for return data from January 1975 through December 2002.

Index                              Return                         SD      

S&P 500                            11.53%                     14.88%

Large Growth Funds         11.30%                     16.65%

Large Value Funds             11.41%                    15.39%

 Source:  Hough/Loughran Study

The Hough/Loughran study also found that the returns by style also varied over time.  From 1965-1983, a period widely known to favor the value style, large value funds averaged a 9.92 percent annual return, compared to 8.73 percent for large growth funds. This performance differential reverses over 1984-2001, as large growth funds generated a 14.1 percent average return compared to 12.9 percent for large value funds.  Thus, one style can outperform in any time period.

However, although the long-term returns are nearly identical, large differences between value and growth returns happen over time.   This is especially the case over the last ten years as growth and value have had extraordinary return differences – sometimes over 30 percentage points of under performance. 

This table indicates the return differential between the value and growth styles since 1992.

YEARLY RETURNS OF GROWTH/VALUE STOCKS

YearGrowthValue
19925.1%10.5%
19931.7%18.6%
19943.1%-0.6%
199538.1%37.1%
199624.0%22.0%
199736.5%30.6%
199842.2%14.7%
199928.2% 3.2%
2000-22.1%6.1%
2001-26.7%7.1%
2002-25.2%-20.5%
200328.2%27.7%
2004 6.3%16.5%
2005 3.6%6.1%
2006 10.8%20.6%
20078.8%1.5%
2008-38.43%-36.84%
200937.2%19.69%
201016.71%15.5%
20112.64%0.39%
201215.25%17.50%

Source:  Ibbottson.

Between the third quarter of 1994 and the second quarter of 2000, the S&P Growth Index produced annualized total returns of 30 percent, versus only about 18 percent for the S&P Value Index.  Since 2000, value has turned the tables and dramatically outperformed growth.  Growth has only outperformed value in two of the past eight years.  Since the two styles are successful at different times, combining them in one portfolio can create a buffer against dramatic swings, reducing volatility and the subsequent drag on returns. 

Assessment

In our analysis, the surest way to maximize the benefits of style investing is to combine growth and value in a single portfolio, and maintain the proportions evenly in a 50/50 split through regular rebalancing.  Research from Standard & Poor’s showed that since 1980, a 50/50 portfolio of value and growth stocks beats the market 75 percent of the time.

Conclusion

Due to the fact that both styles have near equal performance and either style can outperform for a significant time period, a medical professional might consider a blending of styles.  Rather than attempt to second-guess the market by switching in and out of styles as they roll with the cycle, it might be prudent to maintain an equal balance your investment between the two.

EDUCATION: Books

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

COMMENTS APPRECIATED

Refer, Subscribe and Like

***

***

INVESTING: Wrap-Up

By Staff Reporters and Brew Markets

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

COMMENTS APPRECIATED

Like and Refer

***

RISK MANAGEMENT FOR PHYSICIANS

https://www.amazon.sa/-/en/Risk-Management-Liability-Insurance-Asset/dp/1032917636

SPOT A STROKE: Warning Signs and Impulse Urges

By Staff Reporters

***

Stroke emergency awareness & recognition signs [medical procedure infographic]

Stroke Impulses are sudden, intense urges that can result from neurological conditions like those following a stroke. It’s like having your brain’s impulse control dial turned way down. These impulses can be surprising and out of character, driven by changes in brain function. Understanding and managing these impulses requires patience and support.

STROKE: https://medicalexecutivepost.com/2021/03/31/stroke/

These changes in personality and mood after stroke are common. Impulsiveness, apathy, pseudobulbar affect, anger, frustration and depression can affect a stroke survivor’s quality of life.

AGE: https://medicalexecutivepost.com/2025/03/03/signs-aging-check-up/

So, according to psychologist and colleague Dan Ariely PhD, if you or someone you know is dealing with stroke impulses, remember: it’s a brain thing, not a willpower thing.

COMMENTS APPRECIATED

Subscribe Today!

***

***

ASSET PROTECTION: Records Verification

By Rick Kahler MSFP CFP®

***

***

OVER HEARD IN THE FINANCIAl ADVISOR’S LOUNGE

A basic strategy for asset protection is to hold various assets in different entities. Putting real estate, small businesses, and other assets into trusts, corporations, or limited liability companies (LLCs) is effective protection that is relatively easy to put into practice. Not only do I recommend this strategy to clients, I use it myself. Recently, however, I discovered a potential downside.

About 25 years ago, I invested in some rare coins in a corporation I owned and put them into a safe deposit box owned by the corporation. When my business relocated 12 years ago, the safe deposit box billing was not forwarded to the new address and was never paid again. Last year I went to retrieve the coins from the safe deposit box, which I had not visited in 25 years. I discovered the box had been drilled open three years earlier and my collection turned over to the unclaimed property division of the State Treasurer’s office.

I was told getting the coins back would be simple enough. I just needed to verify that I owned the company which owned them by providing the corporation’s tax ID number. However, the corporation no longer existed. I didn’t have a record of its tax ID number. The IRS wouldn’t verify the number without my giving them the address the company had used. That address was a post office box number that I no longer used and couldn’t remember. The state’s position was “no tax ID, no coins.” The only verification of my identity as owner of the corporation was my signature on the bank’s safe deposit box application. Eventually, with the support of bank officers who were willing to swear that I was who I claimed to be, I got my coin collection back.  The hassle involved in this process was a reminder of an important component of asset protection. Maintain accurate records so you don’t end up hiding assets from yourself.

***

***

A good start is to create a master file of all the entities that hold your assets. This can be any system that’s easy for you to use: a computer spreadsheet, a set of file folders, or a single paper list. Share it as appropriate with your CPA, attorney, or financial planner. The master list should include the name of each company, its date of incorporation, tax ID number, address, and other relevant information like phone or bank account numbers. Also keep an inventory of the assets each company owns.

Once you’ve created a master list, it’s essential to keep it up to date as you buy or sell assets, close companies, or transfer ownership. Set up a system, as well, to remind yourself of tasks like filing tax returns, completing minutes of annual meetings, and paying the annual safe deposit box rent. Make your record-keeping easier by eliminating unnecessary complications.

For example, you probably don’t need a separate address for each trust, corporation, or LLC. Instead of creating a separate company for each asset, you might consider grouping smaller assets within one entity. I’d suggest first discussing the pros and cons with an attorney or financial planner. For larger assets like real estate, I do recommend holding each one separately.

When I talk to clients about asset protection, I mention that part of the price we pay for it is an increase in paperwork. It’s easy to accept that idea with casual good intentions. The case of my reclaimed coin investment is a good reminder of the importance of keeping up with that paperwork. If we don’t, we might protect ourselves right out of access to our own assets.

COMMENTS APPRECIATED

Subscribe, Refer and Like

***

***

VACCINES: The Paradox?

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

***

 Vaccines cause the flu and autism

Classic Definition: Although the human body can develop a low-grade fever, muscular aches and pains in response to any vaccine, rumors that a flu shot can cause the flu are not true.

Modern Circumstance: Flu shots do contain dead flu viruses, but they are indeed dead. As for vaccines causing autism, this myth was started in 1998 with an article in the journal The Lancet.

Paradox Examples: In the study, the parents of eight children with autism said they believed their children acquired the condition after they received a vaccination against measles, mumps and rubella (the MMR vaccine). Since then, rumors have run rampant despite the results of many studies.

Oxymoron: https://medicalexecutivepost.com/2025/05/11/paradox-v-oxymoron-2/

And, a 2002 study in The New England Journal of Medicine of 530,000 children found no link between vaccinations and the risk of a child developing autism.

Choice Paradox: https://medicalexecutivepost.com/2025/02/23/healthcare-paradox-of-choice/

Unfortunately, the endurance of this paradoxical myth continues to eat up time and funding dollars that could be used to make advances in autism, rather than proving, over and over again, that vaccinations do not cause the condition.

Cite: Dr. Rachel Vreeman, St. Martin’s Griffin 2009.

COMMENTS APPRECIATED

The Medical Executive-Post is a  news and information aggregator and social media professional network for medical and financial service professionals. Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed. Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.

Like and Refer

***

***

“Sell in May” – Maybe Not?

By Staff Reporters and ChatGPT

SPONSOR: http://www.MarcinkoAssociates.com

***

***

The phrase “sell in May and go away” suggests that investors should sell their stocks in May and avoid the market during the summer months, as historical data indicates poorer stock performance during this period.

***

It’s Friday morning, so you’re probably clocking out once you’re done reading this ME-P. And who could blame you, after such a wild month of watching your portfolio zig & zag with every headline.

In fact, why not just sell all your stocks and walk away entirely? You’ve got to admit, it’s tempting. After all, markets have completed an incredible round trip since Liberation Day—you could just call it even, start celebrating Cinco de Mayo a bit late, and maybe check your portfolio again sometime around August.

“Sell in May and go away” might sound like appealing advice these days, especially considering that the market usually spends the next six months under-performing: The S&P 500 gains just 1.8% on average from May through October, the worst-performing stretch of the year historically.

But Carson Research Chief Market Strategist Ryan Detrick says that would be a mistake. “

These ‘worst six months’ have gained in eight of the last 10 years,” he recently wrote. He continued: “Not to mention the month of May has been higher nine of the past 10 years, so maybe we should call it,

“Sell in June and go Away?”

***

Invite Dr. Marcinko

COMMENTS APPRECIATED

Like and Refer

***

***

OSTRICH BIAS: Negative Information

SPONSOR: http://www.CertifiedMedicalPlanner.org

Financial Advisor, Planner and Insurance Agent Information

By Staff Reporters

***

***

Ostrich Bias is a behavioral phenomenon describing the tendency of individuals to avoid or ignore information that they perceive as negative or threatening. This term is derived from the popular but inaccurate belief that ostriches bury their heads in the sand when faced with danger, even though they do not exhibit such behavior.

Evidence: There is neuro-scientific evidence of the ostrich effect. Sharot et al. (2012) investigated the differences in positive and negative information when updating existing beliefs. Consistent with the ostrich effect, participants presented with negative information were more likely to avoid updating their beliefs; wills, estate plans, investment portfolios, and insurance policies, etc..

Moreover, they found that the part of the brain responsible for this cognitive bias was the left IFG – inferior frontal gyrus – by disrupting this part of the brain with TMS – transcranial magnetic stimulation – participants were more likely to accept the negative information provided.

EXAMPLE: The Ostrich Bias can cause someone to avoid looking at their bills, because they’re worried about seeing how far behind they are on home mortgage payments, credit cards, education or auto loans, etc.

COMMENTS APPRECIATED

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

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

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

Invite Dr. Marcinko

Refer and Like

***

***

AI “Demolition Man” ID

By Staff Reporters

***

***

If getting answers from ChatGPT makes you feel dystopian, you may not want to hear about OpenAI CEO Sam Altman’s other co-founded venture, now rolling out stateside. It scans your eyeballs in exchange for cryptocurrency.

What in the Demolition Man? The device, which creates a unique user ID for your scan, is meant to address a problem that Altman had a hand in creating: how to verify identities and confirm humanity in a world full of artificial intelligence.

The project, called World (formerly Worldcoin), went live in other countries in 2023. Its US expansion, announced this week, featured retail outlets in five cities where you can get your eyes scanned:

  • Tools for Humanity, the company behind the orbs, says 12+ million people around the world have participated so far.
  • It claims to keep your data private, but authorities in more than a dozen places have suspended World’s operations or investigated its data practices, per the WSJ.

COMMENTS APPRECIATED

Like and Refer

***

***

INTRA-DAY: Stock Markets Crash!

BREAKING NEWS

Artificial Intelligence Enhanced

***

***

Markets drop as tariff concerns shake the market

Key takeaways (1:30 EST)

  • The Dow Jones Industrial Average experienced a significant drop of more than 1,100 points, reflecting investor anxiety over tariff policies finance. The S&P was down 150 and the NASDAQ was down 550.
  • This decline is part of a broader trend affecting the S&P 500 and NASDAQ, as geopolitical tensions and economic uncertainties weigh heavily on market sentiment finance.yahoo.com .
  • Investors are closely monitoring developments regarding trade policies and their potential impact on the economy, leading to heightened volatility in the stock market

COMMENTS APPRECIATED
Refer and Like

***

***

SEX: Bereavement Style

By Staff Reporters

***

***

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

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

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

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

COMMENTS APPRECIATED

Thank You

***

***

INSURANCE: Natural Disasters

By Staff Reporters

***

***

Natural Disaster Insurance

Protecting accumulated assets by insuring them against the wrath of Mother Nature

Most homeowners’ insurance policies do not cover damages arising from floods or earthquakes.  If a home, or any other real property like a vacation home or beach condo, is in an area subject to floods or earthquakes, consider the value of purchasing insurance that covers such catastrophes.

Take the time to review your homeowners’ policy, making sure that it will repair or replace your roof if damaged by hail, and will apply in the event of high winds, rather than only in tornadoes. The key to the maintenance of any type of insurance is to anticipate all of the possible calamities, and then to decide whether you can afford to lose the assets exposed to those calamities.

COMMENTS APPRECIATED

Read, Refer, Like and Subscribe

***

***

BENEFICIARY DESIGNATIONS: Top 10 Tips for Medical Professionals

By Staff Reporters

***

***

Beneficiary designations can provide a relatively easy way to transfer an account or insurance policy upon your death. However, if you’re not careful, missing or outdated beneficiary designations can easily cause your estate plan to go awry.

Where you can find them

Here’s a sampling of where you’ll find beneficiary designations:

  • Employer-sponsored retirement plans [401(k), 403(b), etc.]
  • IRAs
  • Life insurance policies
  • Annuities
  • Transfer-on-death (TOD) investment accounts
  • Pay-on-death (POD) bank accounts
  • Stock options and restricted stock
  • Executive deferred compensation plans
  • In several states, so-called “lady bird” deeds for real estate

***

***

10 tips about beneficiary designations

Because beneficiary designations are so important, keep these things in mind in your estate planning:

  1. Remember to name beneficiaries. If you don’t name a beneficiary, one of the following could occur:
    • The account or policy may have to go through probate. This process often results in unnecessary delays, additional costs, and unfavorable income tax treatment.
    • The agreement that controls the account or policy may provide for “default” beneficiaries. This could be helpful, but it’s possible the default beneficiaries may not be whom you intended.
  2. Name both primary and contingent beneficiaries. It’s a good practice to name a “back up” or contingent beneficiary in case the primary beneficiary dies before you. Depending on your situation, you may have only a primary beneficiary. In that case, consider whether it may make sense to name a charity (or charities) as the contingent beneficiary.
  3. Update for life events. Review your beneficiary designations regularly and update them as needed based on major life events, such as births, deaths, marriages, and divorces.
  4. Read the instructions. Beneficiary designation forms are not all alike. Don’t just fill in names — be sure to read the form carefully. If necessary, you can draft your own customized beneficiary designation, but you should do this only with the guidance of an experienced attorney or tax advisor.
  5. Coordinate with your will and trust. Whenever you change your will or trust, be sure to talk with your attorney about your beneficiary designations. Because these designations operate independently of your other estate planning documents, it’s important to understand how the different parts of your plan work as a whole.
  6. Think twice before naming individual beneficiaries for particular assets. For example, you may establish three accounts of equal value initially and name a different child as beneficiary of each account. Over the years, the accounts may grow or be depleted unevenly, so the three children end up receiving different amounts — which is not what you originally intended.
  7. Avoid naming your estate as beneficiary. If you designate a beneficiary on your 401(k), for example, it won’t have to go through probate court to be distributed to the beneficiary. If you name your estate as beneficiary, the account will have to go through probate. For IRAs and qualified retirement plans, there may also be unfavorable income tax consequences.
  8. Use caution when naming a trust as beneficiary. Consult your attorney or CPA before naming a trust as beneficiary for IRAs, qualified retirement plans, or annuities. There are situations where it makes sense to name a trust — for example if:
    • Your beneficiaries are minor children
    • You’re in a second marriage
    • You want to control access to funds
  9. Be aware of tax consequences. Many assets that transfer by beneficiary designation come with special tax consequences. It’s helpful to work with an experienced tax advisor to help provide planning ideas for your particular situation.
  10. Use disclaimers when necessary — but be careful. Sometimes a beneficiary may actually want to decline (disclaim) assets on which they’re designated as beneficiary. Keep in mind that disclaimers involve complex legal and tax issues and require careful consultation with your attorney and CPA.

COMMENTS APPRECIATED

Refer and Subscribe

***

***

CREDIT CARDS: Mistakes All Doctors Must Avoid

By Staff Reporters

***

***

Credit Card Mistakes to Avoid

No number has as far-reaching an impact on your money as your credit scores. Here are some credit card obstacles all physicians, nurses and medical professionals should dodge on the road to financial security

***

***

  • Don’t pay for a credit card repair service.
  • Don’t miss a payment.
  • Don’t max out your card.
  • Don’t take a cash-advance.
  • Don’t skip using your cards.
  • Don’t chase interest rates.
  • Don’t apply for several credit cards all at once.
  • Don’t co-sign a loan.
  • Don’t spread our car or mortgage payments.


COMMENTS APPRECIATED

Refer and Subscribe

***

***

PHYSICIAN: Financial Education Lacking in Medical School

FRANKLY SPEAKING MY MIND!

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

SPONSOR: http://www.MarcinkoAssociates.com

***

The vast majority of physicians and medical professionals major in one of the hard science while in college; biology, engineering, chemistry, mathematics, computer science or physics; etc. Few take undergraduate courses in finance, business management, securities analysis, accounting or economics; although this paradigm is changing with modernity. These course are not particularly difficult for the pre-medical baccalaureate major, they are just not on the radar screen for time compressed and highly competitive students; nor are they needed for medical or nursing school admission, or the many related allied health professional schools.

In fact, William C. Roberts MD, originally from Emory University in Atlanta, and former editor for the Baylor University Medical Center Proceedings and The American Journal of Cardiology, opined just a decade ago:

“Of the 125 medical schools in the USA, only one of them to my knowledge offers a class related to saving or investing money.”

And so, it is important to review some basic principles of economics, finance and accounting as they relate to financial planning in thees two textbooks; and this ME-P.

COMMENTS APPRECIATED

Refer and Subscribe

***

***

***

BLOGGING: All Doctors Please Beware!

WARNING – WARNING

By Dr. DavidEdwardMarcinko; MBA MEd

***

***

According to www.NPR.org, there are more than120,000 health care forums on the Internet with opinions ranging from pharmaceuticals, to sexual dysfunction, to acne. The same goes for commercial doctor blogs that promote lotions, balms and potions, diets and vitamins, minerals, herbs, drinks and elixirs, or various other ingest-ants, digest-ants or pharmaceuticals, etc.

And, to other doctors, the blogging craze is a new novelty where there are no rules, protocols, standards or precise figures on how many “medical-doctor” or related physician-blogs are “out there.” Unfortunately, too many recount gory ER scenes, or pictorially illustrate horrific medical conditions, or serious and traumatic injuries. Of course, others simply are medical practice websites, or those that entice patients into more lucrative plastic surgery or concierge medical practices. Some are from self-serving/credible plaintiff-seeking attorneys wishing to assist patients.

Not all physician blogs are geared toward practice information, marketing or medical sensationalism. In fact, just the opposite seems to be the case in extremely candid blogs, like “Ranting Docs”, “White Coat Rants,” “Grunt Docs”, “Cancer Doc,” “The Happy Hospitalist,” “Mom MD”, “Cross-Over Health”, “Angry Docs” and “M.D.O.D.,” which bills itself as “Random Thoughts from a Few Cantankerous American Physicians.”

According to some of these, they are more like personal journals, or public diaries, where doctors vent about reimbursement rates, difficult cases, medical mistakes, declining medical prestige and control, and/or what a “bummer” it is to have so many patients die; not pay, or who are indigent, noncompliant. We call these the “disgruntled doctor sites.” Some even talk about their own patients, coding issues, or various doctor-patient shenanigans.

But, according to psychiatrist and blogger Dr. Deborah Peel and others, the problem with blogging about patients is the danger that one will be able to identify themselves – the doctor – or that others who know them will be able to identify them.”  Her affiliation, Patient Privacy Rights, rightly worries that patients might track back to the individual, and adversely affect their employment, health insurance or other aspects of life.

***

***

And, according to Dr. Jay S. Grife; MA Esq., it is certainly true that if a doctor violates a patient’s privacy there could be legal consequences. Under HIPAA, physicians could face fines or even jail time. In some states, patients can file a civil lawsuit if they believe a doctor has violated their privacy. Still, internet privacy issues are an evolving gray-area that if not wrong, may still be morally and ethically questionable [personal communication].

Our colleague Robert Wachter MD, author of the blog called “Wachter’s World,” says it’s important for doctors to be able to share cases, as long as they change the facts substantially. On the other hand, the author of “Wachter’s World” and a leading expert on patient safety alternately suggests “You might say we as doctors should never be talking about experiences with our patients online or in books or in articles.” But, he says that “patients shouldn’t take all the information on blogs at face value. Taken for what they are — unedited opinions, and in some cases entertainment — blogs can give readers some useful insight into the good, the bad and the ugly of the medical profession”. Link: http://www.the-hospitalist.org/blogs

Well, fair enough! But, doctors unhappy with their current medical career choice, or its modern evolution, should probably consider counseling or even career change guidance, re-education and re-engineering. It is very inappropriate to vent career frustrations in a public venue. It’s far better for the blog to be private and/or by invitation only; if at all [Personal communication].

We believe that a hybrid mash-up of both views can be wholly appropriate, or grossly inappropriate in some cases. Of course the devil is in the details; linguistics and semantics aside. Nevertheless; what is not addressed in electronic physician “mea-culpas” are the professional liability risks and concerns that are evolving in this quasi-professional, quasi-lay, communication forum.

***

***

Example: We have seen medical mistakes, and liability admissions of all sorts, freely and glibly presented. In fact,

“Some physicians find that the act of liability blogging as a professional confession that is useful in moving past their malpractice mistakes. And, it is also a useful way to begin a commitment to a better professional life of caring in the future. It helps eliminate the toxic residue and angst of professional liability and guilt. Moreover, as they are unburdened of past acts of omission or commission, doctors should remember to also forgive those who have wronged them. This helps greatly with the process and brings additional peace.”

However, although some may say that this electronic confession is good for the soul, it may not be good for your professional liability carrier, or you, when plaintiff’s attorneys release a legion of IT focused interns, or automated bots, searching online for your self-admissions and scouring for your self-incriminations. Of course, a direct connection to a specific patient may still not be made and no HIPAA violation is involved. But, a vivid imagination is not need needed to envision this type of blind medical malpractice discovery deposition query even now.

QUESTION: “Doctor Smith, I noted all the medical errors admitted on your blog. What other mistakes did you make in the care and treatment of my client?”

And so, the question of plausible deniability, or culpability, is easily raised.  If you must journalize your thoughts for sanity or stress release; do it in print. And, don’t tell anyone about it so the diary won’t be subpoenaed. Then tear it up and throw it away. Remember, with risk management, “It is all about credibility.” Don’t trash yours! These thoughts may be especially important if you covet a medical career as a researcher, editor, educator, medical expert or something other than a working-class or employed physician.

EDUCATION: Books

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

COMMENTS APPRECIATED

Read, Like Subscribe and Refer

***

***

OBTAIN: An Unbiased Second Financial Planning Opinion

By Ann Miller RN MHA CPHQ CMP

***

***

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

Telephonic or electronic advice for medical professionals that is:

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

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

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

***

http://www.MARCINKOASSOCIATES.com

E-mail CONTACT: MarcinkoAdvisors@outlook.com

***

***

Thank You

ACCOUNTABLE CARE ORGANIZATION: A Financially Toxic Contract Example for Physicians

SPONSOR: http://www.MarcinkoAssociates.com

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

***

SPONSOR: http://www.CertifiedMedicalPlanner.org

***

WARNING – DISASTROUS ACO EXAMPLE – WARNING

GIVEN CASH FLOW MODEL

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

Cost of Medical Services Provided (COMSP):

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

Assumptions

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

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

***

***

Physician Reactions:

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

1. Extend Account’s Payable

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

2. Reduce Accounts Receivable

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

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

3. Borrow with Short-Term Bridge Loans

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

4. Cut Expenses

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

5.  Reduce Supply Inventories

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

6. Taxes

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

Hyper-Growth Model:

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

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

COMMENTS APPRECIATED

Subscribe, Read, Refer and Like

EDUCATION: Books

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

***

***

LEGAL: Expert Witness Defined

By Staff Reporters

***

***

What exactly is an Expert Witness?

At D.E. Marcinko & Associates an “expert witness” possesses specialized knowledge in a particular field and is qualified to provide deposition or testimony in court and under oath. This testimony can be based on their personal experience, education, training and/or research. The role of an expert witness is to provide objective and unbiased opinions, analysis, and insights to help a lawyer, judge and/or jury understand technical or complex issues related to the case.

EDUCATION: Books

An expert witness can be called by either the prosecution or the defense in a legal case. The expert witness may be required to provide a written report or affidavit detailing their opinions, analyses and conclusions, and they may be asked to testify in court to provide oral testimony and answer questions from the judge and lawyers.

MORE: https://marcinkoassociates.com/expert-witness/

COMMENTS APPRECIATED

Read, Refer, Like and Subscribe

***

***

SCALPING: Restaurant Reservations

DEFINITION

By Staff Reporters

***

***

Restaurant Reservation Scalping 

The unauthorized online restaurant reservation market works like this.

Third-party platforms directly secure or encourage scalpers to secure reservations at popular restaurants without the restaurants’ permission, and then they facilitate the sale of those reservations for a hefty fee on their websites and smart phone apps.

These reservation scalpers often use bots to quickly secure the reservations online and take them off the market, so the average human customer can’t get access to that reservation without paying an unauthorized third party.

COMMENTS APPRECIATED

Read, Refer, Like and Subscribe

***

***

MEDICAL OFFICE: Practice Embezzlement Schemes

DR. DAVID EDWARD MARCINKO; MBA MEd CMP®

***

SPONSOR: http://www.MarcinkoAssociates.com

***

Without proper internal accounting controls, a medical practice [MD, DO, DPM, DDS, DMD] might never reach peak profitability. Internal controls designed and implemented by the physician-owner help prevent bad things from happening.

Embezzlement protection is the classic example. However, internal controls also help ensure good things happen most of the time; according to colleague Dr. Gary Bode; MSA, CPA.

Some Common Embezzlement “Old School” Schemes

Here are some ‘old-school” embezzlement schemes to avoid; however the list is imaginative and endless.

  • The physician-owner pocketing cash “off the books”. To the IRS, this is like embezzlement to intentionally defraud it out of tax money.
  • Employee’s pocketing cash from cash transactions.  This is why you see cashiers following protocol that seems to take forever when you’re in the grocery check out line. This is also why you see signs offering a reward if he/she is not offered a receipt. This is partly why security cameras are installed.
  • Bookkeepers writing checks to themselves.  This is easiest to do in flexible software programs like QuickBooks, Peachtree Accounting and related financial software. It is one of the hardest schemes to detect. The bookkeeper self-writes and cashes the check to their own name; and then the name on the check is changed in the software program to a vendor’s name.  So a real check exists which looks legitimate on checking statements unless a picture of it is available.
  • Employees ordering personal items on practice credit cards.
  • Bookkeepers receiving patient checks and illegally depositing them in an unauthorized, pseudo practice checking account, set up by themselves in a bank different from yours. They then withdraw funds at will. If this scheme uses only a few patients, who are billed outside of the practice’s accounting software it is hard to detect.  The doctor must have a good knowledge of existing patients to catch the ones “missing” from practice records. Monitoring the bookkeeper’s lifestyle might raise suspicion, but this scheme is generally low profile and protracted. Checking the accounting software “audit trail” shows the required original invoice deletions or credit memos in a less sophisticated version of this scheme.
  • Bookkeepers writing payroll checks to non-existent employees. This scheme works well in larger practices and medical clinics with high seasonal turnover of employees, and practices with multiple locations the podiatrist-owner doesn’t visit often.
  • Bookkeepers writing inflated checks to existing employees, vendors or subcontractors. Physician-owners should beware if romantic relationships between the bookkeeper and other practice related parties.
  • Bookkeepers writing checks to false vendors. This is another low profile, protracted scheme that exploits the podiatrists-owner’s indifference to accounts payable.

Assessment

Operating efficiency, safeguarding assets, compliance with existing laws and accuracy of financial transactions are common goals of internal managerial and cost accounting in medical practice.

CONCLUSION

Hopefully, the above is a good review to prevent common practice embezzlement schemes. Unfortunately, it is a never-ending endeavor.  

References: Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, NY 2007.

Related Textbooks: https://tinyurl.com/579rex23

COMMENTS APPRECIATED

Read, Subscribe and Refer

***

***

HEALTH POLICY EDITION: Fast and Furious Pace

By Health Capital Consultants, LLC

***

***

Fast & Furious: Healthcare Policy Edition

During his first month in office, President Donald Trump’s administration has rolled out edicts calling for significant changes at a fast and furious pace, with a number of healthcare agencies and programs across the U.S. Department of Health & Human Services (HHS) targeted.

In an attempt to keep up with the latest actions of the legislative and executive branches of the federal government, this Health Capital Topics article summarizes recent events in Washington and the impact of these changes (both imminent and impending) on providers and patients. (Read more…)

COMMENTS APPRECIATED

Refer, Subscribe and Like

***

***

WORKER’S COMPENSATION: Physician Insurance

By Staff Reporters

***

***

While some medical practitioners and facilities can operate without Professional Liability Insurance coverage, one business related insurance that cannot / should not be avoided is Worker’s Compensation.  Employers in all but seven states – so-called “monopolistic” states because they have their own state funds, are under statutory obligation to provide coverage for their employees.  Historically, Worker’s Compensation pre-dates Social Security entitlements and well before the emergence of employer sponsored group benefits.

The coverage under worker’s compensation provides for lost income due to on-the-job accidents or work-related disability or death and the amount of benefits vary by state.  In some instances, the coverage will reimburse the employee for medical expenses incurred with the accident. 

The four general benefits covered under Worker’s Compensation are:

Medical Care – for expenses incurred usually without limitations on amount or period of care.

Disability Income – payable for both total and partial disability and is usually based on 66 2/3 percent of their wage base.

Death Benefits – generally fall into two categories; one a flat amount for “burial” insurance; and two, survivor benefits.  Though varying by state, these benefits are similar to the disability payment (a percentage of weekly base wages) but may be capped as to total benefit, such as $50,000 or a period, such as 10 years

Rehabilitation Benefits – includes not only medical rehabilitation, but vocational rehabilitation, vocational counseling, retraining or educational benefits, and job placement

Traditionally, the secondary purpose of Worker’s Compensation was to reduce potential litigation because employees accepting the benefits from a Worker’s Compensation claim generally waived their right to sue their employer. 

***

***

However, in our litigious society, this “protective shelter” has been severely tested and is crumbling.

Employers may provide their Worker’s Compensation three ways:

  • Private commercial insurance
  • State government funds
  • Self-insurance

Very few factors drive the premium structure – the occupation of the workers is the single most important determinant of premiums.  An office worker may have premiums as low as $.10 per hundred of wages and a coal miner may exceed $50.00 per hundred of wages.  Generally speaking, however, Worker’s Compensation premiums for the medical profession or healthcare worker are among the lowest available.

Therefore, for the medical practice, some physicians may consider self-insurance because the weekly benefits are typically below $500, thus making this decision attractive. 

Alternatively, because officers and owners can elect not to be covered by Worker’s Compensation, the decision to purchase coverage from a private insurance company may afford inexpensive assurance that the benefits will be conveniently provided, and administered, by a private insurance company for their employees.

COMMENTS APPRECIATED

Read, Refer, Like and Subscribe

***

***

LIFE INSURANCE: Split Dollar Plans

By Staff Reporters

***

***

Split-Dollar Life Insurance: An arrangement under which a life insurance policy’s premium, cash values, and death benefit are split between two parties—usually a corporation and a key employee or executive. Under such an arrangement an employer may own the policy and pay the premiums and give a key employee or executive the right to name the recipient of the death benefit.

***

***

Several factors will affect the cost and availability of life insurance, including age, health, and the type and amount of insurance purchased. Life insurance policies have expenses, including mortality and other charges. If a policy is surrendered prematurely, the policy holder also may pay surrender charges and have income tax implications. You should consider determining whether you are insurable before implementing a strategy involving life insurance.

Any guarantees associated with a policy are dependent on the ability of the issuing insurance company to continue making claim payments.

COMMENTS APPRECIATED

Refer and Subscribe

***

***

MALTA: A Hedge Fund Haven?

By Dr. David E. Marcinko MEd MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

***

***

OVER HEARD IN THE DOCTOR’S LOUNGE

“Malta has quietly leveraged the rising tide of the financial transparency imperative to attract hedge funds.

There was a time when the quaint island sought to play on the traditional terrain, offering anonymity and a “laissez-faire regulatory regime,” not to mention very low taxes, as in no capital gains taxes and no taxes on dividends; all while English speaking and USD currency denominated.

***

***

While many leading domiciles for offshore hedge funds remain in the Caribbean – notably the Cayman Islands, the British Virgin Islands, Bermuda, and the Bahamas – the island of Malta is drawing attention, especially from European funds.

COMMENTS APPRECIATED

Subscribe, Like and Refer

EDUCATION: Books

***

***

BIN Credit Card Attack?

BANK IDENTIFICATION NUMBER – DEFINED

By Staff Reporters

***

***

What Is a BIN Attack?

The BIN, or the Bank Identification Number, is the first six digits on a credit card. These are always tied to its issuing institution – usually a bank. In a BIN attack, fraudsters use these six numbers to algorithmically try to generate all the other legitimate numbers, in the hopes of generating a usable card number.  

How Does a BIN Attack Work?

Fraudsters conduct BIN attacks by generating hundreds of thousands of possible credit card numbers and testing them out.

  1. A fraudster looks up the BIN of the bank they will target. Ranging from four to six digits, this information is in the public domain and is thus easy to source.
  2. Using dedicated software such as an auto-dialer, they generate thousands, often tens of thousands, combinations of possible existing card numbers by this issuer.
  3. At this point, these credentials need to be tested. The fraudster identifies a suitable online shop or donation page.
  4. They start card testing by attempting a small payment with each generated card number.
  5. They keep track of the small percentage of card details that worked, which they are ready to use in earnest for their fraudulent pursuits. 

***

***

Remember that the fraudster will start off with only six digits, yet there are many more card details required for a successful transaction. If those are entered erroneously, the transaction will decline. This includes the CVV number, the expiration date, as well as likely address verification service (AVS) failures. Card testing transactions are executed remotely in a fast fashion, so distance checks should also be a hint as well as velocity alerts. 

Fraudsters may use bad merchant accounts directly for this purpose, or more frequently involve multiple online stores and services during a BIN attack, as their attempts keep getting blocked at most outlets.

MORE: https://seon.io/resources/dictionary/bin-attack/

COMMENTS APPRECIATED

Subscribe, Refer and Like

***

***

HEALTH ACTUARY: Medical Professions

By Dr. David Edward Marcinko MBA MEd CMP®

***

***

SPONSOR: http://www.MarcinkoAssociates.com

THE MEDICAL AND HEALTHCARE ACTUARY

Health actuaries analyze potential risks, profits and trends that will affect their employers, which are often in the health insurance, government health services and medical provider industries. They advise companies on issuing policies to consumers based on risks, calculated premiums and upcoming changes in health-care costs.

It’s common for an actuary to have a bachelor’s degree or higher in actuary studies, mathematics or statistics. Coursework on medical terminology and hierarchy of the medical field is also beneficial. In addition to academic education, certification is also necessary to reach “professional status,” which is required by most employers.

***

***

The professional organization, Society of Actuaries, certifies actuaries in the health and medical field. Their statistical work is commonly done with predictive tables, probability tables and life tables that are created on customized statistical analysis software such as Stata or XLSTAT.

The actuary field as a whole is growing faster than other fields, according to the Bureau of Labor Statistics [BLS]. In 2020, it expanded by 27 percent. The average annual salary for an actuary in 2010 was $87,650. More specifically, in the health insurance field, the salary was slightly higher at $91,000.

EDUCATION: Books

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

COMMENTS APPRECIATED

Subscribe, Refer and Like

***

***

TONTINE Funds

By Staff Reporters

DEFINITION

***

***

According to Wikipedia, a tontine (/ˈtɒntaɪn, -iːn, ˌtɒnˈtiːn/) is an investment linked to a living person which provides an income for as long as that person is alive. Such schemes originated as plans for governments to raise capital in the 17th century and became relatively widespread in the 18th and 19th centuries.

Tontines enable subscribers to share the risk of living a long life by combining features of a group annuity with a kind of mortality lottery. Each subscriber pays a sum into a trust and thereafter receives a periodical payout. As members die, their payout entitlements devolve to the other participants, and so the value of each continuing payout increases. On the death of the final member, the trust scheme is usually wound up.

Tontines are still common in France. They can be issued by European insurers under the Directive 2002/83/EC of the European Parliament. The Pan-European Pension Regulation passed by the European Commission in 2019 also contains provisions that specifically permit next-generation pension products that abide by the “tontine principle” to be offered in the 27 EU member states.

Questionable practices by U.S. life insurers in 1906 led to the Armstrong Investigation in the United States restricting some forms of tontines. Nevertheless, in March 2017, The New York Times reported that tontines were getting fresh consideration as a way for people to get steady retirement income.

MORE: http://www.tontine.com

COMMENTS APPRECIATED

Subscribe, Review and Refer

***

***

MEDICAL LABORATORY RESULTS: Direct Patient Access?

PROS and CONS

BY DR. DAVID EDWARD MARCINKO MBA MEd CMP®

***

***

SPONSOR: http://www.MarcinkoAssociates.com

§ DIRECT PATIENT ACCESS TO LABORATORY RESULTS

According to Patricia Salber MD [personal communication], there are a number of reasons why direct patient access to laboratory medical results is a good idea:

  • Between 8 and 26% of abnormal test results, including those suspicious for cancer, are not followed up in a timely manner.  Direct access could help reduce the number of times this occurs
  • Self-management, particularly of chronic illness has known benefits.  Just like the QS people, many folks with chronic illness obtain and manage to self-acquired lab results every day via gluco-meters, home pulmonary function tests, blood pressure measurements, and so forth.  Direct access to laboratory-acquired data, one could argue is a continuation of that personal responsibility
  • Patients want to be notified about their results in what they perceive as a timely fashion.  In one study, patients who received direct notification of their bone density tests results were more likely to perceive they had timely notification compared to usual care even though there was no measurable effect on actual treatment received after three months
  • Being more responsible for test results could encourage consumers to try to learn more about the meaning of the test results, conceivably increasing their health literacy. 

But, the arguments against direct access discussed include the following:

  • Patients prefer their physicians contact them directly when they have abnormal test results, although the major studies published in 2005 and 2009, preceded the extraordinary use of the internet to access health information that exists today.
  • There is concern over whether patients will know what to do when they receive the results – will they make erroneous interpretations or fail to contact their docs?  This could be, but the intent of the proposed rule is shared access to the results.  We suspect if the rule become law, docs will develop better notification mechanisms so that they reach the patient before the patient directly accesses the results or lab companies will design better lab test notifications with easy-to-understand interpretations or a whole new industry will appear that can provide instantly available individualized lab interpretation…or maybe all three of these would happen and that would be a very good thing.
  • Unknown impact of dual notification (doctors and patients) of lab test results on physician behavior…would docs simply shift responsibility for initiating follow-up care from themselves to their patients?
  • Would direct access of life-changing lab tests, such as HIV or malignancy, lead to unnecessary patient anxiety – or worse?  (Conversely, is there less anxiety, desperation, or suicidal ideation if the bad news is delivered face to face? 
  • Individuals likely may contact their physicians immediately after getting the lab results asking for a telephonic or face-to-face interpretation … it is not known how this would impact physician workload and/or potential for reimbursement [personal communication, Richard Hudson DO, Atlanta, GA].

EDUCATION: Books

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

COMMENTS APPRECIATED

Subscribe, Refer and Like

***

***