On Cultural Sensitivity in Education and Medicine

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A Modern Integral Component of Healthcare Training

[By Render S. Davis MHA CHE]

[By Dr. David Edward Marcinko MBA]

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While America has often been called a “nation of immigrants,” it has never been more true than today. Consequently, the challenge for physicians and other health care providers, in both large cities and small communities, is meeting the health care needs of increasingly diverse and multi-cultural populations who speak different languages and have social norms, traditions, and values that may substantially differ from their own. Problems arise when clinicians expect, even demand, that patients and their families discard their cultural foundations and adhere to the health care provider’s view of the care and decision-making process.

Instead, the health care team should be more aware of and sensitive to the values and beliefs of patients who come from other cultures; working within to assure that the patient’s individual rights are supported and wishes honored to the fullest extent possible.

In her award-winning book, The Spirit Catches You and You Fall Down, Ann Fadiman chronicled this tragic clash of two cultures in medical care for a child of the traditional Hmong people of Laos, transplanted to California after the Vietnam War.

In the book, Fadiman recounts a conversation with Professor Arthur Kleinman of Harvard University, a highly regarded expert in multicultural relations and conflict, who noted that “If you cannot see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?”

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Former U.S. Surgeon General David Satcher, M.D., Ph.D., now Director of the Satcher Health Leadership Institute at Morehouse College of Medicine in Atlanta, Georgia, helped develop a special curriculum designed to foster greater cultural competence among physicians and health care providers.

Called the “CRASH Course,” the program emphasizes:

  1. Cultural Awareness. Acknowledging the diversity and legitimacy of the many cultures that make up the fabric of American Society;
  2. Respect. Valuing other cultural norms, even if they differ or conflict with your own;
  3. Assess and affirm. Understanding the points of both congruence and difference among cultural approaches to decision-making; learning how to achieve the best outcomes within the cultural framework of the patient and family unit;
  4. Sensitivity and self awareness. Being secure in your own values; while willing to be flexible in working through cultural differences with others;
  5. Humility. Recognizing that every culture has legitimacy and that no one is an expert in what is best for others; being willing to subordinate your values for those of another to achieve the goals of treatment.

There is little doubt that multi-cultural sensitivity will continue to grow as an increasingly integral component of medical education and risk management in health care practice.

Dr. Marcinko Teaching Philosophy

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About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.  

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

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Physician Medical Risk Management and Insurance Planning Practices of Leading CERTIFIED MEDICAL PLANNERS®

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

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“BY DOCTORS – FOR DOCTORS – PEER REVIEWED – FIDUCIARY FOCUSED”

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FINANCIAL PLANNING: Strategies for Doctors and their Advisors

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BY DR. DAVID E. MARCINKO MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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REVIEWS:

Written by doctors and healthcare professionals, this textbook should be mandatory reading for all medical school students—highly recommended for both young and veteran physicians—and an eliminating factor for any financial advisor who has not read it. The book uses jargon like ‘innovative,’ ‘transformational,’ and ‘disruptive’—all rightly so! It is the type of definitive financial lifestyle planning book we often seek, but seldom find.
LeRoy Howard MA CMPTM,Candidate and Financial Advisor, Fayetteville, North Carolina

I taught diagnostic radiology for over a decade. The physician-focused niche information, balanced perspectives, and insider industry transparency in this book may help save your financial life.
Dr. William P. Scherer MS, Barry University, Ft. Lauderdale, Florida

This book was crafted in response to the frustration felt by doctors who dealt with top financial, brokerage, and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized for few, despite ever-changing needs. It is a must-read to learn why brokerage sales pitches or Internet resources will never replace the knowledge and deep advice of a physician-focused financial advisor, medical consultant, or collegial Certified Medical Planner™ financial professional.
—Parin Khotari MBA,Whitman School of Management, Syracuse University, New York

In today’s healthcare environment, in order for providers to survive, they need to understand their current and future market trends, finances, operations, and impact of federal and state regulations. As a healthcare consulting professional for over 30 years supporting both the private and public sector, I recommend that providers understand and utilize the wealth of knowledge that is being conveyed in these chapters. Without this guidance providers will have a hard time navigating the supporting system which may impact their future revenue stream. I strongly endorse the contents of this book.
—Carol S. Miller BSN MBA PMP,President, Miller Consulting Group, ACT IAC Executive Committee Vice-Chair at-Large, HIMSS NCA Board Member

This is an excellent book on financial planning for physicians and health professionals. It is all inclusive yet very easy to read with much valuable information. And, I have been expanding my business knowledge with all of Dr. Marcinko’s prior books. I highly recommend this one, too. It is a fine educational tool for all doctors.
—Dr. David B. Lumsden MD MS MA,Orthopedic Surgeon, Baltimore, Maryland

There is no other comprehensive book like it to help doctors, nurses, and other medical providers accumulate and preserve the wealth that their years of education and hard work have earned them.
—Dr. Jason Dyken MD MBA,Dyken Wealth Strategies, Gulf Shores, Alabama

I plan to give a copy of this book written
by doctors and for doctors’ to all my prospects, physician, and nurse clients. It may be the definitive text on this important topic.
—Alexander Naruska CPA,Orlando, Florida

Health professionals are small business owners who need to apply their self-discipline tactics in establishing and operating successful practices. Talented trainees are leaving the medical profession because they fail to balance the cost of attendance against a realistic business and financial plan. Principles like budgeting, saving, and living below one’s means, in order to make future investments for future growth, asset protection, and retirement possible are often lacking. This textbook guides the medical professional in his/her financial planning life journey from start to finish. It ranks a place in all medical school libraries and on each of our bookshelves.
—Dr. Thomas M. DeLauro DPM,Professor and Chairman – Division of Medical Sciences, New York College of Podiatric Medicine

Physicians are notoriously excellent at diagnosing and treating medical conditions. However, they are also notoriously deficient in managing the business aspects of their medical practices. Most will earn $20-30 million in their medical lifetime, but few know how to create wealth for themselves and their families. This book will help fill the void in physicians’ financial education. I have two recommendations: 1) every physician, young and old, should read this book; and 2) read it a second time!
—Dr. Neil Baum MD,Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, Louisiana

I worked with a Certified Medical Planner™ on several occasions in the past, and will do so again in the future. This book codified the vast body of knowledge that helped in all facets of my financial life and professional medical practice.
Dr. James E. Williams DABPS, Foot and Ankle Surgeon, Conyers, Georgia

This is a constantly changing field for rules, regulations, taxes, insurance, compliance, and investments. This book assists readers, and their financial advisors, in keeping up with what’s going on in the healthcare field that all doctors need to know.
Patricia Raskob CFP® EA ATA, Raskob Kambourian Financial Advisors, Tucson, Arizona

I particularly enjoyed reading the specific examples in this book which pointed out the perils of risk … something with which I am too familiar and have learned (the hard way) to avoid like the Black Death. It is a pleasure to come across this kind of wisdom, in print, that other colleagues may learn before it’s too late— many, many years down the road.
Dr. Robert S. Park MD, Robert Park and Associates Insurance, Seattle, Washington

Although this book targets physicians, I was pleased to see that it also addressed the financial planning and employment benefit needs of nurses; physical, respiratory, and occupational therapists; CRNAs, hospitalists, and other members of the health care team….highly readable, practical, and understandable.
Nurse Cecelia T. Perez RN, Hospital Operating Room Manager, Ellicott City, Maryland

Personal financial success in the PP-ACA era will be more difficult to achieve than ever before. It requires the next generation of doctors to rethink frugality, delay gratification, and redefine the very definition of success and work–life balance. And, they will surely need the subject matter medical specificity and new-wave professional guidance offered in this book. This book is a ‘must-read’ for all health care professionals, and their financial advisors, who wish to take an active role in creating a new subset of informed and pioneering professionals known as Certified Medical Planners™.
—Dr. Mark D. Dollard FACFAS, Private Practice, Tyson Corner, Virginia

As healthcare professionals, it is our Hippocratic duty to avoid preventable harm by paying attention. On the other hand, some of us are guilty of being reckless with our own financial health—delaying serious consideration of investments, taxation, retirement income, estate planning, and inheritances until the worry keeps one awake at night. So, if you have avoided planning for the future for far too long, perhaps it is time to take that first step toward preparedness. This in-depth textbook is an excellent starting point—not only because of its readability, but because of his team’s expertise and thoroughness in addressing the intricacies of modern investments—and from the point of view of not only gifted financial experts, but as healthcare providers, as well … a rare combination.
Dr. Darrell K. Pruitt DDS, Private Practice Dentist, Fort Worth, Texas

This text should be on the bookshelf of all contemporary physicians. The book is physician-focused with unique topics applicable to all medical professionals. But, it also offers helpful insights into the new tax and estate laws, fiduciary accountability for advisors and insurance agents, with investing, asset protection and risk management, and retirement planning strategies with updates for the brave new world of global payments of the Patient Protection and Affordable Care Act. Starting out by encouraging readers to examine their personal ‘money blueprint’ beliefs and habits, the book is divided into four sections offering holistic life cycle financial information and economic education directed to new, mid-career, and mature physicians.

This structure permits one to dip into the book based on personal need to find relief, rather than to overwhelm. Given the complexity of modern domestic healthcare, and the daunting challenges faced by physicians who try to stay abreast of clinical medicine and the ever-evolving laws of personal finance, this textbook could not have come at a better time.
—Dr. Philippa Kennealy MD MPH, The Entrepreneurial MD, Los Angeles, California

Physicians have economic concerns unmatched by any other profession, arriving ten years late to the start of their earning years. This textbook goes to the core of how to level the playing field quickly, and efficaciously, by a new breed of dedicated Certified Medical Planners™. With physician-focused financial advice, each chapter is a building block to your financial fortress.
Thomas McKeon, MBA, Pharmaceutical Representative, Philadelphia, Pennsylvania

An excellent resource … this textbook is written in a manner that provides physician practice owners with a comprehensive guide to financial planning and related topics for their professional practice in a way that is easily comprehended. The style in which it breaks down the intricacies of the current physician practice landscape makes it a ‘must-read’ for those physicians (and their advisors) practicing in the volatile era of healthcare reform.
—Robert James Cimasi, MHA ASA FRICS MCBA CVA CM&AA CMP™, CEO-Health Capital Consultants, LLC, St. Louis, Missouri

Rarely can one find a full compendium of information within a single source or text, but this book communicates the new financial realities we are forced to confront; it is full of opportunities for minimizing tax liability and maximizing income potential. We’re recommending it to all our medical practice management clients across the entire healthcare spectrum.
Alan Guinn, The Guinn Consultancy Group, Inc., Cookeville, Tennessee

Dr. David Edward Marcinko MBA CMP™ and his team take a seemingly endless stream of disparate concepts and integrate them into a simple, straightforward, and understandable path to success. And, he codifies them all into a step-by-step algorithm to more efficient investing, risk management, taxation, and enhanced retirement planning for doctors and nurses. His text is a vital read—and must execute—book for all healthcare professionals and physician-focused financial advisors.
Dr. O. Kent Mercado, JD, Private Practitioner and Attorney, Naperville, Illinois

Kudos. The editors and contributing authors have compiled the most comprehensive reference book for the medical community that has ever been attempted. As you review the chapters of interest and hone in on the most important concerns you may have, realize that the best minds have been harvested for you to plan well… Live well.
Martha J. Schilling; AAMS® CRPC® ETSC CSA, Shilling Group Advisors, LLC, Philadelphia, Pennsylvania

I recommend this book to any physician or medical professional that desires an honest no-sales approach to understanding the financial planning and investing world. It is worthwhile to any financial advisor interested in this space, as well.
David K. Luke, MIM MS-PFP CMP™, Net Worth Advisory Group, Sandy, Utah

Although not a substitute for a formal business education, this book will help physicians navigate effectively through the hurdles of day-to-day financial decisions with the help of an accountant, financial and legal advisor. I highly recommend it and commend Dr. Marcinko and the Institute of Medical Business Advisors, Inc. on a job well done.
Ken Yeung MBA CMP™, Tseung Kwan O Hospital, Hong Kong

I’ve seen many ghost-written handbooks, paperbacks, and vanity-published manuals on this topic throughout my career in mental healthcare. Most were poorly written, opinionated, and cheaply produced self-aggrandizing marketing drivel for those agents selling commission-based financial products and expensive advisory services. So, I was pleasantly surprised with this comprehensive peer-reviewed academic textbook, complete with citations, case examples, and real-life integrated strategies by and for medical professionals. Although a bit late for my career, I recommend it highly to all my younger colleagues … It’s credibility and specificity stand alone.
Dr. Clarice Montgomery PhD MA,Retired Clinical Psychologist

In an industry known for one-size-fits-all templates and massively customized books, products, advice, and services, the extreme healthcare specificity of this text is both refreshing and comprehensive.
Dr. James Joseph Bartley, Columbus, Georgia

My brother was my office administrator and accountant. We both feel this is the most comprehensive textbook available on financial planning for healthcare providers.
Dr. Anthony Robert Naruska DC,Winter Park, Florida

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

Thank You

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What is a CONTENT DELIVERY NETWORK, Doctor?

CDNs and What They Mean to Physicians

BY J.M.

[Anonymous IT Expert]

DOCTOR – Do you like the internet? Do you use EMRs/EHRs? Do you like fast internet? Of course you do.

But, without a strong infrastructure of content delivery networks (CDNs), website loading times would be too slow to stream tele-health/tele-medicine visits or tela-radiology services; not to mention Netflix, or argue with Reddit strangers or your patients; etc.

CDNs are geographically distributed networks of servers that handle processing and speed up internet delivery. In practice, CDNs make website content like HTML pages, JavaScript files, style-sheets, images, and videos load faster. They also reduce bandwidth costs, handle more traffic, and provide a little security protection. 

  • CDNs don’t actually host web content, but instead keep cached versions of it at the ready in edge servers. 

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How CDN Works? How to Find the Cheapest CDN Provider?

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Fastly is one of a number of significant CDN providers that help form the infrastructure of the internet. And while the outage shows the breadth of its reach, it’s far from the biggest player—Akami, Cloudflare, and Amazon CloudFront take up 75% of revenue in CDN space, per Intricately.

But Fastly, one of the world’s largest cloud computing companies itself, just had an outage that shut down its CDN service, affecting major websites including the New York Times, HBO Max, and the British government’s homepage. 

ASSESSMENT: Were you or your clinic or hospital affected? Your thoughts and comments are appreciated.

ORDER DICTIONARY: https://healthcarefinancials.files.wordpress.com/2007/10/foreword-mata.pdf

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

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Assessment of Workplace Violence in Healthcare

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ON MEDICAL WORKPLACE VIOLENCE

By Eugene Schmuckler PhD, MBA CTA

By Dr. David E. Marcinko MBA

Chapter 07: Workplace Violence

NOTE: The ME-P can only speculate how this healthcare workplace violence information from a public safety expert, applies to the recent spate of national violence – regardless of venue – or how any lessons learned are applicable in this case; or not.

1. What Is Workplace Violence?

Workplace violence is more than physical assault — it is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence. The Registered Nurses Association of Nova Scotia defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, workplace violence includes:

  • threatening behavior — such as shaking fists, destroying property, or throwing objects;
  • verbal or written threats — any expression of intent to inflict harm;
  • harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;
  • verbal abuse — swearing, insults, or condescending language;
  • muggings — aggravated assaults, usually conducted by surprise with intent to rob; or
  • physical attacks — hitting, shoving, pushing, or kicking.

Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, or even a stranger.  The University of Iowa Injury Prevention Research Center classifies most workplace violence into one of four categories.

  • Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.
  • Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.
  • Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.
  • Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

2. Effects of Workplace Violence

The healthcare sector continues to lead all other industry sectors in incidents of non-fatal workplace assaults. In 2000, 48% of all non-fatal injuries from violent acts against workers occurred in the healthcare sector. Nurses, nurses’ aides, and orderlies suffer the highest proportion of these injuries. Non-fatal assaults on healthcare workers include assaults, bruises, lacerations, broken bones, and concussions. These reported incidents include only injuries severe enough to result in lost time from work. Of significance is that the median time away from work as a result of an assault or other violent act is 5 days. Almost 25% of these injuries result in longer than 20 days away from work. Obviously, this is quite costly to the facility as well as to the victim.

A study undertaken in Canada found that 46% of 8,780 staff nurses experienced one or more types of violence in the last five shifts worked. Physical assault was defined as being spit on, bitten, hit, or pushed.

Both Canadian and U.S. researchers have described the prevalence of verbal threats and physical assaults in intensive care, emergency departments, and general wards. A study in Florida reported that 100% of emergency department nurses experience verbal threats and 82% reported being physically assaulted. Similar results were found in a study undertaken in a Canadian hospital. Possible reasons for the high incidence of violence in emergency departments include presence of weapons, frustration with long waits for medical care, dissatisfaction with hospital policies, and the levels of violence in the community served by the emergency department.

Similar findings have been reported in studies of mental health professionals, nursing home and long-term care employees, as well as providers of service in home and community health.

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients, long waits for service, inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. Finally, lack of staff training and the absence of violence prevention programming are associated with elevated risk of assault in hospitals. Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk. Other hospital personnel at increased risk of violence include emergency response personnel, hospital safety officers, and all healthcare providers. Personnel working in large medical practices fall into this category as well. Although no area is totally immune from acts of violence it most frequently occurs in psychiatric wards, emergency rooms, waiting rooms, and geriatric settings.

Many medical facilities mistakenly focus on systems, operations, infrastructure, and public relations when planning for crisis management and emergency response: they tend to overlook the people. Obviously, no medical facility can operate without employees who are healthy enough to return to work and to be productive. Individuals who have been exposed to a violent incident need to be assured of their safety.

The costs associated with workplace violence crises are not limited to healthcare dollars, absenteeism rates, legal battles, or increased insurance rates. If mishandled, traumatic events can severely impair trust between patients, employees, their peers, and their managers. Without proper planning, an act of violence can disrupt normal group processes, interfere with the delivery of crucial information, and temporarily impair management effectiveness. It may also lead to other negative outcomes such as low employee morale, increased job stress, increased work turnover, reduced trust of management and co-workers, and a hostile working environment.

Data collected by the U.S. Department of Justice shows workplace violence to be the fastest growing category of murder in the country. Homicide, including domestic homicides, is the leading cause of on-the-job death for women, and is the second leading cause for men. The National Institute of Occupational Safety and Health (NIOSH) found that an average of 20 workers is murdered each week in the U.S. In addition, an estimated 1 million workers — 28,000 per week — are victims of non-fatal workplace assaults each year. Workplace attacks, threats, or harassment can include the following monetary costs:

  • $13.5 billion in medical costs per year;
  • 500,000 employees missing 1,750,000 days of work per year; with a 41% increase in stress levels with the concomitant related costs!

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More links: 

Racism in Medicine:

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About the Author

Dr. Eugene Schmuckler was Coordinator of Behavioral Sciences at a Public Training Center before accepting his current position as Academic Dean for iMBA, Inc. He is an international expert on personal re-engineering and coaching whose publications have been translated into Dutch and Russian. He now focuses on career development, change management, coaching and stress reduction for physicians and financial professionals. Behavioral finance, life planning and economic risk tolerance assessments are additional areas of focus. Formerly, Dr. Schmuckler was a senior adjunct faculty member at the Keller Graduate School of Management, Atlanta. He taught courses in Organizational Behavior and Leadership, Strategic Staffing, Training and Development, and the capstone course in human resources management. He is a member of a number of professional organizations including the American Psychological Association, the Academy of Management, and the Society for Human Resource Management. A native of Brooklyn New York, he received his BS degree in Psychology from Brooklyn College. He earned his MBA and PhD degrees in Industrial and Organizational Psychology from Louisiana State University. Currently, he serves on the executive BOD for:  www.MedicalBusinessAdvisors.com  and is the Dean of Admissions for www.CertifiedMedicalPlanner.org

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

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

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UPDATE: SPACS, Markets and Covid-19 Fraud

By Staff Reporters

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Chamath Palihapitiya, the billionaire investor who once claimed to be the next Warren Buffett, is winding down two of his special purpose acquisition companies (SPACs) and returning $1.5 billion to investors. It marks the symbolic end to the SPAC bubble that Palihapitiya is credited with instigating.

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  • Markets: Investors pre-gamed the Fed’s big interest rate decision coming this afternoon by sending stocks lower and Treasury yields higher; they’re sweating what’s expected to be the central bank’s third 75-basis-point hike in a row to tamp down inflation. Speaking of inflation, Ford’s stock had its worst day in 11 years after warning of $1 billion in extra supplier costs.

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Finally, the Justice Department charged 47 people for allegedly carrying out the single largest Covid relief fraud scheme to date. Feds say that by exploiting a program meant to feed needy Minnesota children, the defendants stole $250 million. Prosecutors say the fraud was committed by a network of individuals connected to the nonprofit Feeding Our Future and was overseen by the nonprofit’s founder, Aimee Bock. Feeding Our Future was one of a handful of organizations Minnesota trusted to oversee the distribution of meals to children in low-income families during the pandemic. Instead, prosecutors allege, the organization operated a “pay-to-play scheme” in which individuals submitted fake meal sites and children’s names, raking in government money with fraudulent invoices.

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AMA Joins Class-Action Suit Against CIGNA

By Paige Minemyer

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The AMA and 2 State Medical Societies Join Class-Action Suit Against CIGNA

The American Medical Association (AMA) has joined a class-action lawsuit against Cigna, alleging the insurer underpaid for claims filed by providers in the contracted MultiPlan network. MultiPlan is the country’s largest third-party network, and Cigna contracts with it to access providers. According to the lawsuit, which was initially filed in June, Cigna reimbursed for claims from providers in MultiPlan’s network at its non-participating providers rate rather than at the rate expected for a MultiPlan contract.

As such, the insurer “significantly underpaid claims, and put patients at risk of balance billing,” the plaintiffs claim. “It also breached its fiduciary duties, including its duty to honor written plan terms and its duty of loyalty, because its conduct serves Cigna’s own economic self-interest and elevates Cigna’s interests above the interests of plan member patients,” according to the lawsuit.

Paige Minemyer, Fierce Healthcare [9/13/22]

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

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Malpractice Allegations Alter Practice Patterns of Emergency Department Doctors

Malpractice Allegations Alter Practice Patterns of Emergency Department Doctors

QUERY: When physicians are accused of malpractice, how does this experience affect their practice of medicine?

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Researchers Caitlin Carroll, David M. Cutler and Anupam Jena use administrative data on all emergency medicine physicians in Florida to answer this question in How Do Physicians Respond to Malpractice Allegations? Evidence from Florida Emergency Departments (NBER Working Paper 28330).

WHITE PAPER: https://www.nber.org/system/files/working_papers/w28330/w28330.pdf

ASSESSMENT: Your thoughts and comments are appreciated.

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

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PODCAST: Google Starts a Health Insurance Stop-Loss Company

By Eric Bricker MD

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COMMENTS APPRECIATED

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INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: A Block Chain Video

What it is – How it works

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PODCAST: http://www.realitysharesadvisors.com/indexes/blockchain-index/

Conclusion

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

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

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

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

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PODCAST: A Full Course on Bio-Statistics

BY Quinnipiac University

Biostatistics are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experiments and the interpretation of the results.

The following topics of #biostatistics are discussed in this course

⭐️ Table of Contents ⭐️ 0:00

Module 1 – Introduction to Statistics 29:13 Module 2 – Describing Data: Shape 45:44 Module 3 – Describing Data: Central Tendency 1:03:34 Module 4 – Describing Data: Variability 1:34:51 Module 5 – Describing Data: Z-scores 1:43:25 Module 6 – Probability (part I) 2:09:21 Module 6 – Probability (part II) 2:26:22 Module 7 – Distribution of Sample Means 2:41:24 Module 9 – Estimation & Confidence Intervals & Effect Size 2:56:59 Module 10 – Misleading with Statistics 3:17:43 Module 11 – Biostatistics in Medical Decision-making 4:13:36 Module 11b – Biostatistics in Medical Decision-Making: Clinical Application 4:56:51 Module 12 – Biostatistics in Epidemiology 5:05:16 Module 13 – Asking Questions: Research Study Design 5:10:15 Module 14 – Bias & Confounders 5:39:20 Module 16 – Correlation & Regression 6:06:19 Module 17 – Non-parametric Tests ⭐️

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

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PODCAST: 0:00

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

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

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The DENTAL Witness Stand

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By Darrell Pruitt DDS

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Today I was on the witness stand in a Dallas County courthouse for 2 hours testifying as an expert witness in an injury case involving a dentist who failed to pay attention to a patient’s safety. The three year old girl was brought into the dental operatory while hugging her mom, face-to-face. The mom and child were in that same position when they were seated in the dental chair – with the child’s legs straddling her mom’s waist, and extending a few inches beyond the back of the chair.

The dentist entered the operatory and reclined the chair by pushing a button on the control module. The hinge mechanism severely pinched the child’s right foot, breaking all 5 metatarsals. She will have problems with her foot the rest of her life.

The lesson, Doc: Never ever recline a dental chair unless all limbs are visibly clear of pinch points.

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

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On Wall Street’s Suitability, Prudence and Fiduciary Accountability

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Financial Advisor’s are Not Doctors!

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Dr. David E. Marcinko FACFAS MBA CMP™ MBBS

THRIVE-BECOME A CMP™ Physician Focused Fiduciary

http://www.CertifiedMedicalPlanner.org

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

Financial Advisor’s are Not Doctors

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

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

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

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

More: Video on Hedge Fund Manager Michael Burry MD

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Suitability Rule

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

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

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

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

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

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

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

Prudent Man Rule

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

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Prudent Investor Rule

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

Fiduciary Rule

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

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

The Fiduciary Oath: fiduciaryoath_individual

Assessment 

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

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

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

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

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

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

More: Deception in the Financial Service Industry

Full Disclosure:

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

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

More: Enter the CMPs

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

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

Conclusion

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

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HOW: The ME-P Helps Your Financial Advisory Business or Medical Practice Grow?

All about the Medical Executive-Post Business Model

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One of the questions we receive most often from readers of the Medical Executive-Post is how can we “afford” to give away so much content for free. Or stated another way, “how do we get paid for all of this?”

The simple answer is that we know many (or even most) of you will simply take the ideas that we share and implement them yourself. Do-It-YourSelfers can always simply purchase our texts, books and peer reviewed handbooks redacted in more than a thousand, medical, law, business and graduate schools, as well as the Library of Congress, Institute of Health and Library of Congress.

LINK: https://medicalexecutivepost.com/2021/10/22/why-are-certified-medical-planner-textbooks-so-darn-popular/

On the other hand, some of you will realize you need some additional help.

For example:

Maybe as a financial advisor you’re “stuck” in your financial planning business and recognize that some outside assistance is necessary to help you get to the next level of niche specificity thru our Certified Medical Planner™ chartered certification program designation. Helping physicians of all specialty types in a fiduciary focused manner is the proverbial Win-Win for all concerned.

LINK: http://www.CertifiedMedicalPlanner.org

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OR, perhaps you are seeking a glossary of terms and definitions in heath economics, finance, accounting, insurance, managed care, health information technology and security; found in our Health Dictionary Series Wiki Project? Free and print versions are available.

LINK: http://www.HealthDictionarySeries.org

LINK: https://medicalexecutivepost.com/2011/09/17/order-our-three-newest-best-selling-dictionaries/

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OR, as a doctor maybe your medical practice is growing so much you just hit a wall where you don’t have time to do it all for your patients. After all, with only “so much” time available every day and week, it’s vital to delegate or outsource anything that isn’t really core to your practice and management skill set.

LINK: http://www.MedicalBusinessAdvisors.com

OR, maybe you are even starting, buying or selling your medical practice and need our financial and valuation services. Part (1) – Part (2) – Part (3) Financial, estate, investing and retirement planning services are also available.

OR, you may just need a second informed opinion about a topic not listed; there are a myriad of issues to consider in the competitive ecosystem today.

LINK: https://medicalexecutivepost.com/schedule-a-consultation/

Regardless, we may have solutions to help!


So, in the meantime, I hope that the ME-P content continues to be helpful food for thought, and perhaps we’ll have an opportunity to cross paths soon at a future conferences or podcasts. Feel free to invite us to speak at your own seminar/podcast online V-log, as well.

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

With warm regards.

Fraternally.
Ann Miller RN MHA CMP

[Managing Director]

email: MarcinkoAdvisors@msn.com

Phone: 770-448-0769

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A Fiduciary Comes with Responsibilities to the Client

By Stephen Kelley, CSA

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As a Registered Investment Adviser (RIA) with a Series #65 securities license, we hold a fiduciary duty to you. This means that we are legally bound to put your interests above those of anyone else, including ourselves.

Now you might reasonably think that anyone offering financial advice or services to clients is required to be a fiduciary. Sadly, if you thought that, you’d be wrong. Some estimates claim that only 15 percent of advisors have a fiduciary duty to their clients. The Paladin Registry puts the number even lower, estimating that just one in 12 (8.3 percent) advisors have a fiduciary responsibility.

For the most part, stockbrokers (also called “Registered Representatives,” “Account Executives,” “Financial Advisors,” or “Wealth Managers”) are not fiduciaries, even though they are allowed to portray themselves as full-service investment advisors. If your stockbroker/registered representative/account executive/financial advisor/wealth manager holds a series seven [#7] securities license, then it’s probable that they aren’t a fiduciary.

This was made amply clear in the movie, “The Wolf of Wall Street,” a biopic about Jordan Belfort, a stockbroker who made his fortune selling junk stocks and bonds to middle-class investors: in other words, by cheating them. Much of it was perfectly legal. The SEC went after Belfort’s company, Stratton Oakmont, for nearly a decade before it was able to shut it down. The point being that even in the face of egregious wrongdoing, theft, fraud and a virtual sea of drugs and blatant hedonism, the securities laws in this country are so loose that it took billions in theft and a decade of suspected and known fraud to step in and stop the abuse. And this movie was based on a true story.

That’s why a fiduciary duty is so important to a client. Being a fiduciary is a legal distinction. A Registered Investment Advisor (RIA) or Investment Advisor Representative (IAR) who holds a Series #65 securities license, subject to the Investment Advisers Act of 1940, is a fiduciary. The legal investment advising standards that govern a non-fiduciary stockbroker and a fiduciary Registered Investment Advisor are very different.

A Registered Investment Advisor is legally required to follow the “trust” standard — the highest known in law — which requires it to place the interests of its clients ahead of its own and fulfill critical fiduciary duties of trust and confidence. Under the fiduciary trust standard, a Registered Investment Advisor must provide its “best advice” to a client. A non-fiduciary stockbroker (like the coveted Series #7 of “The Wolf of Wall Street”) follows only the “suitability” standard, which doesn’t require a stockbroker to place the interests of his clients ahead of its own. Under the non-fiduciary suitability standard, a stockbroker need provide only “suitable advice” to his clients — even if the stockbroker knows that the advice is not the best advice for the client.

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The table below helps summarize which professionals are fiduciaries.

Type of ProfessionalAre They A Fiduciary?
PhysicianYes
LawyerYES/Maybe
CPANo
Trust OfficerYes
Stock BrokerNo
Insurance AgentNo
Registered RepresentativeNo
CFP PractitionerMaybe
Financial PlannerMaybe
Registered Investment AdviserYes
NAFPA-Registered Financial AdvisorYes

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MORE: https://medicalexecutivepost.com/2022/05/21/an-interview-with-bennett-aikin-aif/

RELATED: https://www.kitces.com/blog/the-4-different-types-of-financial-advisor-fiduciaries/

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

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On Psychology, Financial Planning and Investing Bias

Psychological Biases Affecting Financial Planning and Investing

Dr. Marcinko at Johns Hopkins University

By Dr. David Edward Marcinko MBA CMP®

[Editor-in-Chief]

Sponsored: http://www.CertifiedMedicalPlanner.org

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The following are some of the most common psychological biases.  Some are learned while others are genetically determined (and often socially reinforced).  While this essay focuses on the financial implications of these biases, they are prevalent in most areas in life.

[A] Incentives

It is broadly accepted that incenting someone to do something is effective, whether it be paying office staff a commissions to sell more healthcare products, or giving bonuses to office employees if they work efficiently to see more HMO patients.  What is not well understood is that the incentives cause a sub-conscious distortion of decision-making ability in the incented person.  This distortion causes the affected person – whether it is yourself or someone else – to truly believe in a certain decision, even if it is the wrong choice when viewed objectively.  Service professionals, including financial advisors and lawyers, are affected by this bias, and it causes them to honestly offer recommendations that may be inappropriate, and that they would recognize as being inappropriate if they did not have this bias.  The existence of this bias makes it important for each one of us to examine our incentive biases and take extra care when advising physician clients, or to make sure we are appropriately considering non-incented alternatives.

[B] Denial

Denial is a well known, but under-appreciated, psychological force.  Physicians, clients and professionals (like everyone else) are prone to the mistake of ignoring a painful reality, like putting off an unpleasant call (thus prolonging a problematic situation and potentially making it worse) or not opening account statements because of the desire not to see quantitative proof of losses.  Denial also manifests itself by causing human beings to ignore evidence that a mistake has been made.  If you think of yourself as a smart person (and what professional doesn’t?), then evidence pointing to the conclusion that a mistake has been made will call into question that belief, causing cognitive dissonance.  Our brains function to either avoid cognitive dissonance or to resolve it quickly, usually by discounting or rationalizing the disconfirming evidence. Not surprisingly, colleagues at Kansas State University and elsewhere, found that financial denial, including attempts to avoid thinking about or dealing with money, is associated with lower income, lower net worth, and higher levels of revolving credit.

[C] Consistency and Commitment Tendency

Human beings have evolved – probably both genetically and socially – to be consistent.  It is easier and safer to deal with others if they honor their commitments and if they behave in a consistent and predictable manner over time. This allows people to work together and build trust that is needed for repeat dealings and to accomplish complex tasks.  In the jungle, this trust was necessary to for humans to successfully work as a team to catch animals for dinner, or fight common threats.  In business and life it is preferable to work with others who exhibit these tendencies.  Unfortunately, the downside of these traits is that people make errors in judgment because of the strong desire not to change, or be different (“lemming effect” or “group-think”).  So the result is that most people will seek out data that supports a prior stated belief or decision and ignore negative data, by not “thinking outside the box”.  Additionally, future decisions will be unduly influenced by the desire to appear consistent with prior decisions, thus decreasing the ability to be rational and objective.  The more people state their beliefs or decisions, the less likely they are to change even in the face of strong evidence that they should do so.  This bias results in a strong force in most people causing them to avoid or quickly resolve the cognitive dissonance that occurs when a person who thinks of themselves as being consistent and committed to prior statements and actions encounters evidence that indicates that prior actions may have been a mistake.  It is particularly important therefore for advisors to be aware that their communications with clients and the press clouds the advisor’s ability to seek out and process information that may prove current beliefs incorrect.  Since this is obviously irrational, one must actively seek out negative information, and be very careful about what is said and written, being aware that the more you shout it out, the more you pound it in.

[D] Pattern Recognition

On a biological level, the human brain has evolved to seek out patterns and to work on stimuli-response patterns, both native and learned.  What this means is that we all react to something based on our prior experiences that had shared characteristics with the current stimuli.  Many situations have so many possible inputs that our brains need to take mental short cuts using pattern recognition we would not gain the benefit from having faced a certain type of problem in the past.  This often-helpful mechanism of decision-making fails us when past correlations or patterns do not accurately represent the current reality, and thus the mental shortcuts impair our ability to analyze a new situation.  This biologic and social need to seek out patterns that can be used to program stimuli-response mechanisms is especially harmful to rational decision-making when the pattern is not a good predictor of the desired outcome (like short term moves in the stock market not being predictive of long term equity portfolio performance), or when past correlations do not apply anymore.

[E] Social Proof

It is a subtle but powerful reality that having others agree with a decision one makes, gives that person more conviction in the decision, and having others disagree decreases one’s confidence in that decision.  This bias is even more exaggerated when the other parties providing the validating/questioning opinions are perceived to be experts in a relevant field, or are authority figures, like people on television.  In many ways, the short term moves in the stock market are the ultimate expression of social proof – the price of a stock one owns going up is proof that a lot of other people agree with the decision to buy, and a dropping stock price means a stock should be sold.  When these stressors become extreme, it is of paramount importance that all participants in the financial planning process have a clear understanding of what the long-term goals are, and what processes are in place to monitor the progress towards these goals.  Without these mechanisms it is very hard to resist the enormous pressure to follow the crowd; think social media.

[F] Contrast

Sensation, emotion and cognition work by contrast.  Perception is not only on an absolute scale, it also functions relative to prior stimuli.  This is why room temperature water feels hot when experienced after being exposed to the cold.  It is also why the cessation of negative emotions “feels” so good.  Cognitive functioning also works on this principle.  So one’s ability to analyze information and draw conclusions is very much related to the context with in which the analysis takes place, and to what information was originally available.  This is why it is so important to manage one’s own expectations as well as those of clients.  A client is much more likely to be satisfied with a 10% portfolio return if they were expecting 7% than if they were hoping for 15%.

[G] Scarcity

Things that are scarce have more impact and perceived value than things present in abundance.  Biologically, this bias is demonstrated by the decreasing response to constant stimuli (contrast bias) and socially it is widely believed that scarcity equals value.  People who feel an opportunity may “pass them by” and thus be unavailable are much more likely to make a hasty, poorly reasoned decision than they otherwise would.  Investment fads and rising security prices elicit this bias (along with social proof and others) and need to be resisted.  Understanding that analysis in the face of perceived scarcity is often inadequate and biased may help professionals make more rational choices, and keep clients from chasing fads.

[H] Envy / Jealousy

This bias also relates to the contrast and social proof biases.  Prudent financial and business planning and related decision-making are based on real needs followed by desires.  People’s happiness and satisfaction is often based more on one’s position relative to perceived peers rather than an ability to meet absolute needs.  The strong desire to “keep up with the Jones” can lead people to risk what they have and need for what they want.  These actions can have a disastrous impact on important long-term financial goals.  Clear communication and vivid examples of risks is often needed to keep people focused on important financial goals rather than spurious ones, or simply money alone, for its own sake.

[I] Fear

Financial fear is probably the most common emotion among physicians and all clients. The fear of being wrong – as well as the fear of being correct! It can be debilitating, as in the corollary expression on fear: the paralysis of analysis.

According to Paul Karasik, there are four common investor and physician fears, which can be addressed by financial advisors in the following manner:

  • Fear of making the wrong decision: ameliorated by being a teacher and educator.
  • Fear of change: ameliorated by providing an agenda, outline and/or plan.
  • Fear of giving up control: ameliorated by asking for permission and agreement.
  • Fear of losing self-esteem: ameliorated by serving the client first and communicating that sentiment in a positive manner.

https://images.routledge.com/common/jackets/crclarge/978148224/9781482240283.jpg

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

Psychological Traps

Now, as human beings, our brains are booby-trapped with psychological barriers that stand between making smart financial decisions and making dumb ones. The good news is that once you realize your own mental weaknesses, it’s not impossible to overcome them. 

In fact, Mandi Woodruff, a financial reporter whose work has appeared in Yahoo! Finance, Daily Finance, The Wall Street Journal, The Fiscal Times and the Financial Times among others; related the following mind-traps in a September 2013 essay for the finance vertical Business Insider; as these impediments are now entering the lay-public zeitgeist:

  • Anchoring happens when we place too much emphasis on the first piece of information we receive regarding a given subject. For instance, when shopping for a wedding ring a salesman might tell us to spend three months’ salary. After hearing this, we may feel like we are doing something wrong if we stray from this advice, even though the guideline provided may cause us to spend more than we can afford.
  • Myopia makes it hard for us to imagine what our lives might be like in the future. For example, because we are young, healthy, and in our prime earning years now, it may be hard for us to picture what life will be like when our health depletes and we know longer have the earnings necessary to support our standard of living. This short-sightedness makes it hard to save adequately when we are young, when saving does the most good.
  • Gambler’s fallacy occurs when we subconsciously believe we can use past events to predict the future. It is common for the hottest sector during one calendar year to attract the most investors the following year. Of course, just because an investment did well last year doesn’t mean it will continue to do well this year. In fact, it is more likely to lag the market.
  • Avoidance is simply procrastination. Even though you may only have the opportunity to adjust your health care plan through your employer once per year, researching alternative health plans is too much work and too boring for us to get around to it. Consequently, we stick with a plan that may not be best for us.
  • Loss aversion affected many investors during the stock market crash of 2008. During the crash, many people decided they couldn’t afford to lose more and sold their investments. Of course, this caused the investors to sell at market troughs and miss the quick, dramatic recovery.
  • Overconfident investing happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. Data convincingly shows that people who trade most often under-perform the market by a significant margin over time.
  • Mental accounting takes place when we assign different values to money depending on where we get it from. For instance, even though we may have an aggressive saving goal for the year, it is likely easier for us to save money that we worked for than money that was given to us as a gift.
  • Herd mentality makes it very hard for humans to not take action when everyone around us does. For example, we may hear stories of people making significant profits buying, fixing up, and flipping homes and have the desire to get in on the action, even though we have no experience in real estate.
https://images.routledge.com/common/jackets/crclarge/978149872/9781498725989.jpg

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

Your thoughts are appreciated.

THANK YOU

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STOP-LOSS Health Insurance?

What is stop-loss insurance AND how does it work?

By Staff Reporters

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A stop-loss health insurance policy covers claims above a health insurance plan’s retained claims. The claims fund of a self-funded employer will pay claims up to the predetermined deductible for each of the company’s covered employees. The role of the stop-loss is to cover all claims above these deductible levels.

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

According to RoundStone Insurance, aggregate stop-loss insurance is designed to protect an employer who self-funds their employee health plan from higher-than-anticipated payouts for claims. Stop-loss insurance is similar to high-deductible insurance, and the employer remains responsible for claims below the deductible amount.

An individual stop-loss insurance carrier determines the average expected monthly claims per employee / per month PEPM based on the employer’s history. Then, this figure is multiplied by a percentage ranging from 110%-150%. That determined amount is then multiplied by the enrollment on a monthly basis to establish the aggregate deductible.

DHIMA: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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

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New Medical Informed Consent Dilemma

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Emerging Problems

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem21

According to the Dictionary of Health Insurance and Managed Care, informed consent is the oral and written communication process between a patient and physician that results in the agreement to undergo a particular procedure, surgical intervention or medical treatment.

Unfortunately, a lack of standardization surrounding this process represents a major risk for patients and surgeons, and may lead to inaccurate patient expectations, lost or incomplete consent forms, missing encounter documentation and delays in critical surgeries and procedures.

History: Render S. Davis of Emory University [2008 recipient of the Health Care Ethics Consortium’s Heroes in Healthcare Ethics Award] writes for us in the Business of Medical Practice www.MedicalBusinessAdvisors.com that the concept of informed consent is rooted in medical ethics and codified as a legal principle. It is based on the assertion that a competent person has the right to determine what is done to him or her [self-regulated autonomy].

Rationale: The American Medical Association recommends that its members disclose and discuss the following with their patients:  

  • The patient’s diagnosis, if known,
  • The nature and purpose of a proposed treatment or procedure,
  • The risks and benefits of a proposed treatment or procedure,
  • Alternatives (regardless of cost or health insurance coverage),
  • The risks and benefits of the alternative treatments and,
  • The risks and benefits of not the procedure.

The requirements for informed consent are spelled out in statutes and case law in all 50 states. It is a necessary protocol for all hospitals, medical clinics, podiatry practices and ASCs.

Inadequacy of Traditional Consent Forms-to-Date

The typical informed consent process, particularly one that relies solely on traditional generic consent forms, is often inadequate, incomplete or offers the potential for not fully explaining and documenting a particular procedure to a given patient. 

Traditional consent forms are subject to errors and omissions, such as missing signatures (patient, provider or witness), missing procedure(s), and missing dates that place the validity of consent at risk. Lost or misplaced forms may result in delayed or postponed procedures often at the expensive of costly operating room time. Moreover, far too many forms are generic in nature and wholly unsuited for a specific patient or increasingly sophisticated medical procedure.

Patient Safety Background

According to the Institute of Medicine’s [IOM] repot, To Err is Human, more than 1 million injuries and nearly 100,000 deaths occur annually in the United States due to mistakes in medical care. Wrong patient, wrong-side, wrong-procedure and wrong-toe surgery are particularly egregious. In fact, these are among several other “never-events” that Medicare, and an increasing number of private insurance companies are refusing to reimburse.

Based on the need to make healthcare safer, the Agency for Healthcare Research and Quality (AHRQ) undertook a study to identify patient safety issues and develop recommendations for “best practices”.

AHRQ Evidence Report

The AHRQ report identified the challenge of addressing shortcomings such as missed, incomplete or not fully comprehended informed consent, as a significant patient safety opportunity for improvement.

The authors of the AHRQ report hypothesized that better informed patients “are less likely to experience errors by acting as another layer of protection.” And, the AHRQ study ranked a more interactive informed consent process among the top 11 practices supporting more widespread implementation.

General Accounting Office report found that malpractice insurance premiums were relatively flat for most of the 1990’s, but projections began to increase dramatically to 2010.

Results of Improper Informed Consent

Failure to obtain adequate informed consent, depending on state law, may place surgeons, resident, fellows, ambulatory and office surgery centers, medical clinics and hospitals at risk for litigation ranging from medical negligence to assault and battery.

Proceedings Involving Informed Consent

Informed consent is often a factor in medical malpractice litigation. Some attorneys note that physicians are liable, and that plaintiffs may be able to recover damages, in cases involving improper informed consent, even if the procedure is successful. Inadequate informed consent is often cited as a secondary cause in malpractice complaints and anecdotal evidence suggests this strategy may be especially pursued in podiatric malpractices cases.

Avoiding Litigation

The AMA advises its membership of the following regarding informed consent:  

“To protect yourself in litigation, in addition to carrying adequate liability insurance, it is important that the communications process itself be documented. Good documentation can serve as evidence in a court of the law that the process indeed took place. A timely and thorough documentation in the patient’s chart by the physician providing the treatment and/or performing the procedure can be a strong piece of evidence that the physician engaged the patient in an appropriate discussion.”

Impact of Comprehensive Informed Consent Forms

Another study found that providing informed consent information to patients in written form increased comprehension of the procedure. It was also hypothesized that: 

  • Better informed patients are more compliant with medical advice and recover faster.
  • Informed consent discussions strengthen physician-patient relationships and increase patients’ confidence in their doctor.
  • Well informed patients are more engaged in their own care, and are thus less likely to experience surgical errors than more passive, or less informed patients. 

Medical Ethics

The ethical foundation of informed consent is based on the creation of an environment that supports respect for patients and protects their right to autonomous, informed participation in all collaborative Healthcare 2.0 decisions. 

Assessment 

Thus, the essence of the informed consent problems of modern medicine today!

More: http://www.ePodiatryConsentForms.com 

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New Wave FIN-TECH Business Models?

FINANCIAL SERVICES:

New business models and big opportunities

By MIT Technology Review

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Courtesy: http://www.CertifiedMedicalPlanner.org

The financial services industry is turning to bold initiatives to propel from pandemic response to business growth. And, among financial services institutions, 62% are looking to ramp up tech investments, and another 62% expect to move IT and business functions to the cloud, compared with 46% across industries.

For example, in a recent report, Nucleus Research found that cloud deployments deliver four times the return on investment as on-premises deployments do.

Link: https://www.technologyreview.com/2021/04/29/1023266/new-business-models-big-opportunity-financial-services/?mc_cid=3ae91e4c2b&mc_eid=72aee829ad

INDUSTRY RELATED: https://medicalexecutivepost.com/2014/09/24/is-the-financial-services-industry-all-fed-up/

TRANSFORMATION: https://medicalexecutivepost.com/2016/12/28/the-most-transformational-era-in-financial-services-since-the-1980s/

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Don’t be a “Fireworks Fourth Fool” [Video]

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By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

Graphic video image warning!

Back in the day, when I was a surgical resident and fellow, I treated my fair share of electrical, thermal and chemical burn injuries. Some were life, eyeball and limb threatening; but fortunately most were not! Treatment was with local wound care, followed by full, split thickness or postage stamp skin grafts, flaps, or various plastic surgery techniques, etc.

And, many were accidental of course, but a few were simply ill-conceived ideas from dumb or inebriated patients seen through the emergency room of the old Emory University – Northlake Regional Medical Center, in Tucker, GA.

So, for you medical types, here is a recap on the way we doctors classify burns, as referenced in several of my surgical textbooks and related medical publications.

Classification of Burn Depths

A. Superficial burn injury

1st degree burn

  • Limited to the epidermis
  • Presents with erythema and minimal swelling
  • Mild discomfort
  • Commonly treated on outpatient basis

B. Superficial partial-thickness burns

Second Degree Burn

  • Superficial 2nd degree burns
  • Involves the epidermis and superficial portion of the dermis
  • Often seen with scalding injuries
  • Presents with blister formation and typically blanches with pressure
  • Sensitive to light touch or pinprick
  • Commonly treated on outpatient basis; heal in 1-3 wks.

C. Deep partial-thickness burns

Deep 2nd degree burns

  • Involves the epidermis and most of the dermis
  • Patients often require excision of the wound and skin grafting
  • Appears white or poorly vascularized; may not blister
  • Less sensitivity to light touch and pinprick than superficial form
  • Extensive time to heal (3-4 wks)

D. Full-thickness burns

Third Degree Burn

  • Involves epidermis, and all layers of dermis, extending down to subcutaneous tissue
  • Appears dry, leathery, and insensate, often without blisters
  • Can be difficult to differentiate from deep partial-thickness burns
  • Commonly seen when patient’s clothes caught on fire/skin directly exposed to flame
  • Usually require referral to burn surgeon; need skin grafting to heal.

E. Fourth degree burns

Fourth Degree Burn

  • Full-thickness burn extending to muscle or bone
  • Common result of high-voltage electric injury or severe thermal burns
  • Requires hospital admission

Assessment

So, why do we review this clinical material on Independence Day? It is to remind our readers not to drink and shoot fireworks today; or to stop and re-think before proceeding with same. Don’t be like the fool in this YouTube video. I don’t want to see you in any ER; any where today! GOMER.

***

ME-P and Independence Day 2010

LINK:

http://www.bing.com/videos/search?q=fireworks+accidents&FORM=HDRSC3#view=detail&mid=D3AA2608DA10E002C8B4D3AA2608DA10E002C8B4

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On Death Talk, Risk Management and Financial Planning

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A financial planning challenge

Rick Kahler MS CFP

By Rick Kahler MS CFP®

One of the challenges in financial planning is the strong taboo in our society against talking about money. Another powerful taboo is talking about death when someone has a serious illness.

When someone is diagnosed with cancer, for example, the focus is almost always on treatment and recovery. Rarely is there any discussion of what happens if the treatment doesn’t work. There seems to be an unspoken belief that if we don’t talk about it, it won’t happen.

Not talking about death isn’t limited to family and friends, according to Dr. Carol McClanahan, MD, CFP®

For example, in a recent presentation to financial advisors at the Insiders Forum in Phoenix, she pointed out that many doctors shy away from talking about dying until the very end.

Given this strong reluctance to talk about both money and dying, how can you work with a financial advisor to deal with the financial and emotional issues that go along with a family member’s serious illness?

Here are some suggestions based on Dr. McClanahan’s talk:

Don’t expect someone facing a serious illness to give you an accurate prognosis of their disease, as they are often in denial. McClanahan suggests turning to “Dr. Google” for accurate information. Specifically, she recommends the National Institutes of Health (www.nih.gov), which has statistics on every disease imaginable.

  1. Learn to interpret what doctors say. For example, when a cancer patient is told chemotherapy has a 25% chance of working, the average patient hears “working” as “being cured.” “Working” actually means there is a 25% chance of the tumor shrinking. Often the chances of being cured are far less than 25%, and the physical effects of chemotherapy can be devastating to one’s remaining quality of life. McClanahan says, “Most of what we do to people at the end of life is unnecessary torture.”
  2. Find out early about options for palliative care. This is multidisciplinary care focused on treating the symptoms of treatment, relieving suffering, and improving the quality of life. Because of denial and unwillingness to talk about what happens if they don’t get better, many patients never get into palliative care or get into it way too late. Similarly, most patients wait too long to get into hospice care. The average time in hospice care, according to McClanahan, is just 19 days.
  3. Share your money concerns with the advisor. McClanahan says that anxiety over having enough money to pay for their care and the resulting effect on the family finances are two of the top concerns patients have. Interestingly, most financial advisors focus instead on whether advance directives, estate documents, and funeral plans are in place.
  4. Call the advisor’s attention to signs that a person’s illness is advancing. These can include a shortened attention span, not remembering details of conversations, word-finding difficulties, inability to multitask, mental fuzziness, and depression. Ask advisors to deal with these symptoms: meet early in the day, address the most important issues first, keep meetings short, include family members as appropriate, and put action items in writing.
  5. Realize that sharing your emotions is part of financial planning. Serious illness affects people in many different ways, but the underlying concerns are always emotional. Discuss those concerns with the advisor, and work together to create a comprehensive plan addressing both death and recovery. Remember that, as McClanahan put it, “preparation for a negative outcome does not reduce the risk of cure.”

***

halloween

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The role of the financial planner

The role of a financial planner is to help clients prepare for the future, including the end of life. When that future becomes “now,” don’t hesitate to ask for the planner’s emotional support as well as financial advice. 

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PODCAST: In-Patient Psychiatric Care

By Eric Bricker MD

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Dr. Marcinko Interviewed on Physician Retirement and Succession Planning

imba inc

                  Physicians Have Unique Challenges, Opportunities

By Ann Miller RN MHA CMP

[Executive-Director]

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

Doctors Squeezed from both Ends

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

Larson Speaks

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

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

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

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

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

The Three Mistake of Retirement Planning

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

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

Marcinko Speaks

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

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

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

ECON

Succession Planning for Doctors

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

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

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

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

Assessment

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

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

More:

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Of Financial Certifications and Designations

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The “Too Numerous to Count” Syndrome

[By Dr. David Edward Marcinko; MBA, CMP™]

Dr. MarcinkoThe following list of certifications enumerates only a partial exposure of the often nebulous field of “financial planning credentials” that presently exist in the market place. 

Good … and Not So

Some of these professional designations are awarded to individuals in the financial planning or financial “advisory” space after [some] diligent study and [often not so] arduous testing; others not so.

Disclaimer: I am a reformed Certified Financial Planner®, Series 7 [stock-broker], 63 and 65 license holder, and RIA representative who also held all applicable insurance and security licenses.

The individuals hold not only proper education [some only reguire a HS diploma or GED] as evidenced by the credential; the holders are often people of ethics [hopefully] and competence [usually]. But, not all credentials are the same. Some credentialing bodies have higher educational requirements that also require years of experience and a thorough background search. Others are awarded after only a few hours of study and, most all, remain non-fiduciary in nature.

Too Many To Count – Syndrome

In medicine, the abbreviation TNTC is well known. Sometime, I think this term is better applicable to the plethora of “credentials” in the financial services industry.

dhimc-book1

The Designation Line-up

A brief description for some of these financial designations [not degrees] follows:

  • AAMS – Accredited Asset Management Specialist
  • AEP – Accredited Estate Planner
  • AFC – Accredited Financial Counselor
  • AIF – Accredited Investment Fiduciary
  • AIFA – Accredited Investment Fiduciary Auditor
  • APP – Asset Protection Planner
  • BCA – Board Certified in Annuities
  • BCAA – Board Certified in Asset Allocation
  • BCE – Board Certified in Estate Planning
  • BCM – Board Certified in Mutual Funds
  • BCS – Board Certified in Securities
  • C3DWP – 3 Dimensional Wealth Practitioners
  • CAA – Certified Annuity Advisor
  • CAC – Certified Annuity Consultant
  • CAIA – Chartered Alternative Investment Analyst
  • CAM – Chartered Asset Manager
  • CAS – Chartered Annuity Specialist
  • CCPS – Certified College Planning Specialist
  • CDFA – Certified Divorce Financial Analyst
  • CEA – Certified Estate Advisor
  • CEBS – Certified Employee Benefit Specialist
  • CEP – Certified Estate Planner
  • CEPP – Chartered Estate Planning Practitioner
  • CFA – Chartered Financial Analyst
  • CFE – Certified Financial Educator
  • CFG – Certified Financial Gerontologist
  • CFP – Certified Financial Planner
  • CFPN – Christian Financial Professionals Network 
  • CFS – Certified Fund Specialist
  • CIC – Chartered Investment Counselor
  • CIMA – Certified Investment Analyst
  • CIMC – Certified Investment Management Consultant
  • CLTC – Certified in Long Term Care
  • CMFC – Chartered Mutual Fund Counselor
  • CMP – Certified Medical Planner™
  • CPC – Certified Pension Consultant
  • CPHQ – Certified Professional in Healthcare Quality
  • CPHQ – Certified Physician in Healthcare Quality
  • CPM – Chartered Portfolio Manager
  • CRA – Certified Retirement Administrator
  • CRC – Certified Retirement Counselor
  • CRFA – Certified Retirement Financial Advisor
  • CRP – Certified Risk Professional
  • CRPC – Chartered Retirement Planning Counselor
  • CRPS – Chartered Retirement Plan Specialist
  • CSA – Certified Senior Advisor
  • CSC – Certified Senior Consultant
  • CSFP – Certified Senior Financial Planner
  • CSS – Certified Senior Specialist
  • CTEP – Chartered Trust and Estate Planner
  • CTFA – Certified Trust and Financial Advisor
  • CWC – Certified Wealth Counselor
  • CWM – Chartered Wealth Manager
  • CWPP – Certified Wealth Preservation Planner
  • ECS –  Elder Care Specialist
  • FAD – financial Analyst Designate
  • FIC – Fraternal Insurance Counselor
  • FLMI – Fellow Life Management Institute
  • FRM – Financial Risk Manager
  • FSS – Financial Services Specialist
  • LIFA – Licensed Insurance Financial Analyst
  • MFP – Master Financial Professional
  • MSFS – Masters of Science Financial Service Degree
  • PFS – Personal Financial Specialist
  • PPC – Professional Plan Consultant
  • QFP – Qualified Financial Planner
  • REBC – Registered Employee Benefits Consultant
  • RFA – Registered Financial Associate
  • RFC – Registered Financial Consultant
  • RFG – Registered Financial Gerontologist
  • RFP – Registered Financial Planner
  • RFS – Registered Financial Specialist
  • RHU – Registered Health Underwriter
  • RPA – Registered Plans Associate
  • WMS – Wealth Management Specialist

This list is intentionally incomplete and it is not intended to be an endorsement of any credential by the Institute of Medical Business Advisors, Inc www.MedicalBusinessAdvisors.com

Alphabet Soup

Obviously, these “professional” designations spread across multiple industries. For example there is an alphabet of designations in the brokerage and securities field, another alphabet in the insurance industry and within the insurance industry, designations exist for those who meet face to face with prospective customers, another for those who provide client service and yet another in underwriting the various insurance products. Certainly when the designations are complied in a list such as that above, they present a dizzying array of apparent qualifications.

Assessment

While in general, education for the financial service [and medical] professional is good for everybody, there are certain things that you should do as proper due diligence to protect your family and your financial assets. What are they?

Disclaimer: I am also founder of the Certified Medical Planner™ online educational program in health economics for financial advisors and medical management consultants. www.CertifiedMedicalPlanner.org

Conclusion

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About Medical Workplace Violence

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UPDATE

At least three people are dead and multiple people are injured following a shooting at the Natalie Building at St. Francis Hospital in Tulsa, Oklahoma.

Link: https://www.msn.com/en-us/news/crime/at-least-3-dead-multiple-people-injured-in-shooting-at-oklahoma-medical-office/ar-AAXYITO?li=BBnb7Kz

More than Physical Assault

[By Staff Reporters and Dr. David E. Marcinko MBA]

Business Med PracticeWorkplace violence is more than physical assault.

According to trauma specialist Eugene Schmuckler; PhD, MBA, CTS opining and writing in www.BusinessofMedicalPractice.com; workplace violence is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence.

The RNANS

The Registered Nurses Association of Nova Scotia [RNANS], a leading study group, defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, medical workplace violence includes:

· threatening behavior — such as shaking fists, destroying property, or throwing objects;

· verbal or written threats — any expression of intent to inflict harm;

· harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;

· verbal abuse — swearing, insults, or condescending language;

· muggings — aggravated assaults, usually conducted by surprise and with intent to rob; or

· physical attacks — hitting, shoving, pushing, or kicking.

Cause and Affect

Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, patient, physician, nurse, or even a stranger.

The UI-IPRC 

The University of Iowa – Injury Prevention Research Center [UI-IPRC] classifies most workplace violence into one of four categories.

· Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.

· Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.

· Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.

· Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

Conclusion

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

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

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

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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PODCAST: Health Insurance Carrier Stock Market Performance

By Eric Bricker MD

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

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MEDICARE Fraud and Abuse Scams

REPORTING SCAMS

By Staff Reporters

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LINK: https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse

BLOG: https://www.medicare.gov/blog/how-to-protect-medicare-card

SPOOFS: https://www.bing.com/videos/search?q=medicare+phone+scams&&view=detail&mid=147902000F772B221DC9147902000F772B221DC9&&FORM=VRDGAR&ru=%2Fvideos%2Fsearch%3Fq%3Dmedicare%2Bphone%2Bscams%26FORM%3DHDRSC3

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RISK MANAGEMENT: https://www.amazon.com/Management-Liability-Insurance-Protection-Strategies-ebook/dp/B01A8TCDES/ref=sr_1_1?keywords=david+marcinko&qid=1652959760&sr=8-1

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MEDICAL RISK MANAGEMENT, Liability Insurance and Asset Protection Strategies

FOR PHYSICIANS AND THEIR FINANCIAL ADVISORS

SPONSOR: http://www.CertifiedMedicalPlanner.org

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REVIEWS:

“Physicians who don’t understand modern risk management, insurance, business, and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko and his co-authors will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”
Dr. James M. Dahle, MD, FACEP, Editor of The White Coat Investor, Salt Lake City, Utah, USA


“With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”
—Dr. J. Wesley Boyd, MD, PhD, MA, Harvard Medical School, Boston, Massachusetts, USA

ASSESSMENT: Your thoughts are appreciated.

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

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THANK YOU

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Happy Friday 13th

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Triskaidekaphobia

Triskaidekaphobia (/ˌtrɪskaɪˌdɛkəˈfoʊbiə/ TRIS-kye-DEK-ə-FOH-bee-ə, TRIS-kə-; from Ancient Greek τρεισκαίδεκα (treiskaídeka) ‘thirteen’, and Ancient Greek φόβος (phóbos) ‘fear’) is fear or avoidance of the number 13.

It is also a reason for the fear of Friday the 13th, called paraskevidekatriaphobia (from Greek Παρασκευή (Paraskevi) ‘Friday’, Greek δεκατρείς (dekatreís) ‘thirteen’, and Ancient Greek φόβος (phóbos) ‘fear’) or friggatriskaidekaphobia (from Old Norse Frigg ‘Frigg’, Ancient Greek τρεισκαίδεκα (treiskaídeka) ‘thirteen’, and Ancient Greek φόβος (phóbos) ‘fear’).

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

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The BUSINESS of Medical Practice

“NO MARGIN – NO MISSION”

Within Reason

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BY DR. DAVID E. MARCINKO MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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

Your thoughts are appreciated.

THANK YOU

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

RIP NAOMI JUDD

[Original Rebroadcast]

The Common Bridge by Rick Helppie

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

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PODCAST: https://richardhelppie.com/podcasts/

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COMMENTS APPRECIATED.

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

Thank You

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Stress Testing your Investment Portfolio

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What is Your Risk Number?

DG

[By David Gratke]

Are your current investments aligned with YOUR investment goals and expectations in 2022?

As we all know, the global financial markets have responded tremendously to the past seven years of Global Central Bank monetary polices. i.e. asset prices, stocks, bonds and real estate have all gone up in price as a result. But now, we have the pandemic and Ukraine war to consider.

So, when have you last ‘stress-tested’ your portfolio to see how durable it may through various market cycles? And, how do you determine if your current investment holdings are right for you? Maybe they are too conservative, or just the opposite, still too aggressive?  Maybe they are right where they need to be, but how do you know, how do you measure that?

  • Capture you Risk Tolerance
  • See if your portfolio fits you.
  • OK, How do I Start?

By simply answering a few questions, and spending 10 minutes of your time, based upon the size of your investment portfolio, you will quickly determine your own tolerance for risk.

Comparing your Risk Number to your Portfolio

Now that you have calculated your Risk Number, how does that number compare to your actual portfolio holdings? Is the portfolio you have today, the one you started with some time ago regarding risk and return? Is it still in alignment with your original expectations?

Does your portfolio have?

  • Too much risk?
  • Is it too conservative?
  • Or, is it just right
  • What if the market drops significantly? Instead, what if the market goes up significantly? See how your current portfolio will fair in any one of these market conditions:
  • Let’s put your portfolio onto the treadmill; just like the doctor’s office.
  • How do you know, how do you measure?

Let’s Stress Test your Portfolio

  1. Bull Market (Prices generally rise)
  2. Bear Market (Prices generally fall)
  3. Financial Crisis
  4. Rising Interest Rates

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ScreenShot2015-06-01at11_34_02AM_113439

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  • Are the results in alignment with your expectations?
  • Any ‘hot spots’ you need to know about?
  • Are there any individual holdings that will cause you loss of sleep over?
  • Maybe investments don’t generate enough income?
  • Maybe investments fluctuate too much in price?
  • Now you can have a look and see if there are any ‘hot spots’ where you may need to re-balance a portion of your holdings based upon these findings.

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2

Yes! That feels like me

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Congratulations. Once you have determined your Risk Number, and perhaps re-aligned your current portfolio to your Risk Number, then yes, you DO have the portfolio that is right for you, one that ‘feels like you’.

ABOUT

David Gratke is chief executive officer of Gratke Wealth LLC in Beaverton, Ore. A Registered Investment Advisory Firm.

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Conclusion

Your thoughts and comments on this ME-P are appreciated. How does the current market tumult affect this ME-P or your own investing strategy? 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.

***

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

“Physicians who don’t understand modern risk management, insurance, business and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko, and his co-authors, will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”

Dr. James M. Dahle MD FACEP [Editor of The White Coat Investor, Salt Lake City, Utah]

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USA “With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”

Dr. J. Wesley Boyd MD PhD MA [Harvard Medical School, Boston, Massachusetts, USA]

PODCAST: 50% of Medical Treatments Have Unknown Effectiveness

By Eric Bricker MD

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COMMENTS APPRECIATED

Thank You

Subscribe to the Medical Executive-Post

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

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RENEWED: US Covid-19 Public Health Emergency

By Ahmed Aboulenein

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WASHINGTON (Reuters) – The United States on Wednesday renewed the COVID-19 public health emergency, allowing millions of Americans to keep getting free tests, vaccines and treatments for at least three more months.

The public health emergency was initially declared in January 2020, when the coronavirus pandemic began. It has been renewed each quarter since and was due to expire on April 16.

The Department of Health and Human Services (HHS) in a statement said it was extending the public health emergency and that it will give states 60 days notice prior to termination or expiration.

This could be the last time HHS Secretary Xavier Becerra extends it, policy experts have said.

MORE: https://www.msn.com/en-us/news/us/us-renews-covid-19-public-health-emergency/ar-AAWbaqa?li=BBnb7Kz

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COMMENTS APPRECIATED

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INDUSTRIAL ORGANIZATION: For Hospitals, Clinics and Healthcare CXOs, CEOs, CMOs and CTOs, etc.

MANAGEMENT STRATEGIES, TOOLS TEMPLATES AND CASE STUDIES

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Reviews:

Hospitals and Health Care Organizations is a must-read for any physician and other health care provider to understand the multiple, and increasingly complex, interlocking components of the U.S. health care delivery system, whether they are employed by a hospital system, or manage their own private practices.

The operational principles, methods, and examples in this book provide a framework applicable on both the large organizational and smaller private practice levels and will result in better patient care. Physicians today know they need to better understand business principles and this book by Dr. David E. Marcinko and Professor Hope Rachel Hetico provides an excellent framework and foundation to learn important principles all doctors need to know.
―Richard Berning, MD, Pediatric Cardiology

… Dr. David Edward Marcinko and Professor Hope Rachel Hetico bring their vast health care experience along with additional national experts to provide a health care model-based framework to allow health care professionals to utilize the checklists and templates to evaluate their own systems, recognize where the weak links in the system are, and, by applying the well-illustrated principles, improve the efficiency of the system without sacrificing quality patient care. … The health care delivery system is not an assembly line, but with persistence and time following the guidelines offered in this book, quality patient care can be delivered efficiently and affordably while maintaining the financial viability of institutions and practices.
―James Winston Phillips, MD, MBA, JD, LLM

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PURCHASE: https://www.amazon.com/dp/B00BC9IIUM?ref_=k4w_oembed_faGUzLlJ9ojLIx&tag=kpembed-20&linkCode=kpd

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Doctors “Pay Up” OR ELSE “Don’t Work”

Physicians Suspected of Mental Health Issues

J. Wesley Boyd M.D., Ph.D.

I used to be an Associate Director in a state physician health program (PHP) and I served as a consultant when the state of North Carolina audited its PHP. Now, roughly twice a month I am contacted by a physician somewhere in the U.S. who is, effectively, being extorted.

How are they being extorted? These physicians are forced to either pay tens of thousands of dollars to for-profit evaluation/treatment centers or else lose their ability to practice medicine.

LINK: https://www.psychologytoday.com/us/blog/almost-addicted/201912/doctors-pay-or-else-dont-work#=

MD Mental CARE: https://www.psychologytoday.com/us/blog/almost-addicted/201904/why-physicians-who-need-psychiatric-care-go-kansas

MEDICAL BOARDS: https://medicalexecutivepost.com/2016/07/14/a-brief-history-of-medical-boards/

EDITOR’S NOTE: Colleague J. Wesley Boyd, M.D., Ph.D., is a professor of psychiatry and medical ethics at Baylor College of Medicine. He is also a lecturer on global health and social medicine at Harvard Medical School. He writes on issues of social justice, human rights, immigration and asylum, access to care, and substance use disorders. And, he is the author of the book, Almost Addicted, which won the Will Solemine Award for Excellence in Medical Writing from the New England American Medical Writer’s Association. Dr. Boyd also contributed to our major textbook on Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors. We appreciate his work and contributions.

Dr. David E. Marcinko MBA

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

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

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Dr. Dave Marcinko at YOUR Service in 2022

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Book Marcinko for your Next Financial Planning Seminar, Meeting or Medical Business Event 

By Ann Miller RN MHA

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

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

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

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

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

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What is Risk Adjusted Stock Market Performance?

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Update on Some Interesting and Important Financial Calculations

By Timothy J. McIntosh MBA CFP® MPH

By Dr. David Edward Marcinko MBA CMP™

By Jeffery S. Coons PhD CFA

TMDr. Jeff Coons

dr-david-marcinko9

-INTRODUCTION-

Performance measurement, like an annual physical, is an important feedback loop to monitor progress towards the goals of the medical professional’s investment program.  Performance comparisons to market indices and/or peer groups are a useful part of this feedback loop, as long as they are considered in the context of the market environment and with the limitations of market index and manager database construction.

Inherent to performance comparisons is the reality that portfolios taking greater risk will tend to out-perform less risky investments during bullish phases of a market cycle, but are also more likely to under-perform during the bearish phase.  The reason for focusing on performance comparisons over a full market cycle is that the phases biasing results in favor of higher risk approaches can be balanced with less favorable environments for aggressive approaches to lessen/eliminate those biases.

So, as physicians and other investors, can we eliminate the biases of the market environment by adjusting performance for the risk assumed by the portfolio?  While several interesting calculations have been developed to measure risk-adjusted performance, the unfortunate answer is that the biases of the market environment still tend to have an impact even after adjusting returns for various measures of risk.

However, medical professionals and their advisors will have many different risk-adjusted return statistics presented to them, so understanding the Sharpe ratio, Treynor ratio, Jensen’s measure or alpha, Morningstar star ratings, etc. and their limitations should help to improve the decisions made from the performance measurement feedback loop.

[a] The Treynor Ratio

The Treynor ratio measures the excess return achieved over the risk free return per unit of systematic risk as identified by beta to the market portfolio.  In practice, the Treynor ratio is often calculated using the T-Bill return for the risk-free return and the S&P 500 for the market portfolio.

[b] The Sharpe Ratio

The Sharpe ratio, named after CAPM pioneer William F. Sharpe, was originally formulated by substituting the standard deviation of portfolio returns (i.e., systematic plus unsystematic risk) in the place of beta of the Treynor ratio.  Thus, a fully diversified portfolio with no unsystematic risk will have a Sharpe ratio equal to its Treynor ratio, while a less diversified portfolio may have significantly different Sharpe and Treynor ratios.

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8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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[c] The Jensen Alpha Measure

The Jensen measure, named after CAPM research Michael C. Jensen, takes advantage of the CAPM equation discussed in the Portfolio Management section to identify a statistically significant excess return or alpha of a portfolio.  The essential idea is that to investigate the performance of an investment manager you must look not only at the overall return of a portfolio, but also at the risk of that portfolio.

For instance, if there are two mutual funds that both have a 12 percent return, a lucid investor will want the fund that is less risky. Jensen’s gauge is one of the ways to help decide if a portfolio is earning the appropriate return for its level of risk. If the value is positive, then the portfolio is earning excess returns. In other words, a positive value for Jensen’s alpha means a fund manager has “beat the market” with his or her stock picking skills compared with the risk the manager has taken.

[d] Database Ratings

The ratings given to mutual funds by databases, such as Morningstar, and various financial magazines are another attempt to develop risk-adjusted return measures.  These ratings are generally based on a ranking system for funds calculated from return and risk statistics.

A popular example is Morningstar’s star ratings, representing a weighting of three, five and ten year risk/return ratings.  This measure uses a return score from cumulative excess monthly fund returns above T-Bills and a risk score derived from the cumulative monthly return below T-Bills, both of which are normalized by the average for the fund’s asset class.  These scores are then subtracted from each other and funds in the asset class are ranked on the difference.  The top 10 percent receive five stars, the next 22.5 percent get four stars, the subsequent 35 percent receive three stars, the next 22.5 percent receive two stars, and the remaining 10 percent get one star.

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

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Assessment

Unfortunately, these ratings systems tend to have the same problems of consistency and environmental bias seen in both non-risk adjusted comparisons over 3 and 5 year time periods and the other risk-adjusted return measures discussed above.  The bottom line on performance measurement is that the medical professional should not take the easy way out and accept independent comparisons, no matter how sophisticated, at face value.  Returning to our original rules-of-thumb, understanding the limitations of performance statistics is the key to using those statistics to monitor progress towards one’s goals.

This requires an understanding of performance numbers and comparisons in the context of the market environment and the composition/construction of the indices and peer group universes used as benchmarks.

Another important rule-of-thumb is to avoid projecting forward historical average returns, especially when it comes to strong performance in a bull market environment.  Much of an investment or manager’s performance may be environment-driven, and environments can change dramatically.

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register.

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

ABOUT

Timothy J. McIntosh is Chief Investment Officer and founder of SIPCO.  As chairman of the firm’s investment committee, he oversees all aspects of major client accounts and serves as lead portfolio manager for the firm’s equity and bond portfolios. Mr. McIntosh was a Professor of Finance at Eckerd College from 1998 to 2008. He is the author of The Bear Market Survival Guide and the The Sector Strategist.  He is featured in publications like the Wall Street Journal, New York Times, USA Today, Investment Advisor, Fortune, MD News, Tampa Doctor’s Life, and The St. Petersburg Times.  He has been recognized as a Five Star Wealth Manager in Texas Monthly magazine; and continuously named as Medical Economics’ “Best Financial Advisors for Physicians since 2004.  And, he is a contributor to SeekingAlpha.com., a premier website of investment opinion. Mr. McIntosh earned a Bachelor of Science Degree in Economics from Florida State University; Master of Business Administration (M.B.A) degree from the University of Sarasota; Master of Public Health Degree (M.P.H) from the University of South Florida and is a CERTIFIED FINANCIAL PLANNER® practitioner. His previous experience includes employment with Blue Cross/Blue Shield of Florida, Enterprise Leasing Company, and the United States Army Military Intelligence.

Dr. Jeffrey S. Coons is the Co-Director of Research at Manning & Napier Advisors, Inc. with primary responsibilities focusing on the measurement and management of portfolio risk and return relative to client objectives.  This includes providing analysis across every aspect of the investment process, from objectives setting and asset allocation to on-going monitoring of portfolio risk and return.  Dr. Coons is also member of the Investment Policy Group, which establishes and monitors secular investment trends, macroeconomic overviews, and the investment disciplines of the firm. Dr. Coons holds a doctoral degree in economics from Temple University, graduated with distinction from the University of Rochester with a B.A. in Economics, holds the designation of Chartered Financial Analyst, and is one of the employee-owners of Manning and Napier.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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PSYCHOLOGICAL “TRAPS” of Investing

MIND TRAPS PHYSICIAN INVESTORS MUST REDUCE AND AVOID AT ALL COSTS

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By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

As human beings, our brains are booby-trapped with psychological barriers that stand between making smart financial decisions and making dumb ones. The good news is that once you realize your own mental weaknesses, it’s not impossible to overcome them.

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

In fact, Mandi Woodruff, a financial reporter whose work has appeared in Yahoo! Finance, Daily Finance, The Wall Street Journal, The Fiscal Times and the Financial Times among others; related the following mind-traps in a September 2013 essay for the finance vertical Business Insider; as these impediments are now entering the lay-public zeitgeist.

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8 Psychological Traps All Stock Investors Should Avoid - YouTube

 Anchoring happens when we place too much emphasis on the first piece of information we receive regarding a given subject. For instance, when shopping for a wedding ring a salesman might tell us to spend three months’ salary. After hearing this, we may feel like we are doing something wrong if we stray from this advice, even though the guideline provided may cause us to spend more than we can afford.

 Myopia makes it hard for us to imagine what our lives might be like in the future. For example, because we are young, healthy, and in our prime earning years now, it may be hard for us to picture what life will be like when our health depletes and we know longer have the earnings necessary to support our standard of living. This short-sightedness makes it hard to save adequately when we are young, when saving does the most good.

 Gambler’s fallacy occurs when we subconsciously believe we can use past events to predict the future. It is common for the hottest sector during one calendar year to attract the most investors the following year. Of course, just because an investment did well last year doesn’t mean it will continue to do well this year. In fact, it is more likely to lag the market.

 Avoidance is simply procrastination. Even though you may only have the opportunity to adjust your health care plan through your employer once per year, researching alternative health plans is too much work and too boring for us to get around to it. Consequently, we stick with a plan that may not be best for us.

 Loss aversion affected many investors during the stock market crash of 2008. During the crash, many people decided they couldn’t afford to lose more and sold their investments. Of course, this caused the investors to sell at market troughs and miss the quick, dramatic recovery.

 Overconfident investing happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. Data convincingly shows that people who trade most often underperform the market by a significant margin over time.

 Mental accounting takes place when we assign different values to money depending on where we get it from. For instance, even though we may have an aggressive saving goal for the year, it is likely easier for us to save money that we worked for than money that was given to us as a gift.

MORE: https://medicalexecutivepost.com/2021/09/04/more-on-money-psychology/

RELATED: https://medicalexecutivepost.com/2014/12/15/on-internet-investing-psychology/

 Herd mentality makes it very hard for humans to not take action when everyone around us does. For example, we may hear stories of people making significant profits buying, fixing up, and flipping homes and have the desire to get in on the action, even though we have no experience in real estate.

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