BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
[Click on Image to Enlarge]
ME-P Free Advertising Consultation
The “Medical Executive-Post” is about connecting doctors, health care executives and modern consulting advisors. It’s about free-enterprise, business, practice, policy, personal financial planning and wealth building capitalism. We have an attitude that’s independent, outspoken, intelligent and so Next-Gen; often edgy, usually controversial. And, our consultants “got fly”, just like U. Read it! Write it! Post it! “Medical Executive-Post”. Call or email us for your FREE advertising and sales consultation TODAY [678.779.8597] Email: MarcinkoAdvisors@outlook.com
Medical & Surgical e-Consent Forms
ePodiatryConsentForms.com
iMBA Inc., OFFICES
Suite #5901 Wilbanks Drive, Norcross, Georgia, 30092 USA [1.678.779.8597]. Our location is real and we are now virtually enabled to assist new long distance clients and out-of-town colleagues.
ME-P Publishing
SEEKING INDUSTRY INFO PARTNERS?
If you want the opportunity to work with leading health care industry insiders, innovators and watchers, the “ME-P” may be right for you? We are unbiased and operate at the nexus of theoretical and applied R&D. Collaborate with us and you’ll put your brand in front of a smart & tightly focused demographic; one at the forefront of our emerging healthcare free marketplace of informed and professional “movers and shakers.” Our Ad Rate Card is available upon request [678-779-8597].
Posted on March 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
By Staff Reporters
***
***
1035 Exchange
DEFINITION: A method of exchanging insurance-related assets without triggering a taxable event. Cash-value life insurance policies and annuity contracts are two products that may qualify for a 1035 exchange.
***
A 1035 exchange is a feature in the tax code that permits individuals to transfer funds from an existing life insurance endowment, or annuity policy to a new one without tax consequences.
These transactions are not subject to tax deductions or tax credits but rather tax deferrals, meaning that individuals would only pay taxes on any earnings once they receive money from the policy later.
Without this provision, policyholders would have to close their previous accounts and be subjected to both taxes and surrender charges before they could open a new account.
Posted on March 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and IRS
***
***
Straddles: A straddle is any set of offsetting positions on personal property. For example, a straddle may consist of a purchased option to buy and a purchased option to sell on the same number of shares of the security, with the same exercise price and period.
Personal property.
This is any actively traded property. It includes stock options and contracts to buy stock but generally does not include stock.
Straddle rules for stock.
Although stock is generally excluded from the definition of personal property when applying the straddle rules, it is included in the following two situations.
The stock is of a type that is actively traded, and at least one of the offsetting positions is a position on that stock or substantially similar or related property.
The stock is in a corporation formed or availed of to take positions in personal property that offset positions taken by any shareholder.
Note
For positions established before October 22, 2004, condition 1 above does not apply. Instead, personal property includes stock if condition 2 above applies or the stock was part of a straddle in which at least one of the offsetting positions was:
An option to buy or sell the stock or substantially identical stock or securities,
A securities futures contract on the stock or substantially identical stock or securities, or
A position on substantially similar or related property (other than stock).
Position
A position is an interest in personal property. A position can be a forward or futures contract or an option.
An interest in a loan denominated in a foreign currency is treated as a position in that currency. For the straddle rules, foreign currency for which there is an active inter bank market is considered to be actively traded personal property.
Offsetting position
This is a position that substantially reduces any risk of loss you may have from holding another position. However, if a position is part of a straddle that is not an identified straddle, do not treat it as offsetting to a position that is part of an identified straddle.
Presumed offsetting positions
Two or more positions will be presumed to be offsetting if:
The positions are established in the same personal property (or in a contract for this property), and the value of one or more positions varies inversely with the value of one or more of the other positions;
The positions are in the same personal property, even if this property is in a substantially changed form, and the positions’ values vary inversely as described in the first condition;
The positions are in debt instruments with a similar maturity, and the positions’ values vary inversely as described in the first condition;
The positions are sold or marketed as offsetting positions, whether or not the positions are called a straddle, spread, butterfly, or any similar name; or
The aggregate margin requirement for the positions is lower than the sum of the margin requirements for each position if held separately.
Related persons
To determine if two or more positions are offsetting, you will be treated as holding any position your spouse holds during the same period. If you take into account part or all of the gain or loss for a position held by a flow-through entity, such as a partnership or trust, you are also considered to hold that position.
RISK MANAGEMENT, LIABILITY INSURANCE AND ASSET PROTECTION ABBREVIATIONS
[Glossary of Important Acronyms]
Much has been written and much has been opined on the topic of medical risk management, insurance, asset protection and professional liability for physicians and healthcare providers in this textbook; and elsewhere.
But occasionally, we all still get lost in a wide array of abbreviations, acronyms, and initialisms that are constantly changing in this ecosystem.
And so, this glossary serves as a ready reference for those who want to know about these medical risk management definitions in a quick and ready fashion.
Acronyms and Abbreviations
AAASC American Association of Ambulatory Surgery Centers
AAHP American Association of Health Plans
ABN advance beneficiary notice
ABQAUR American Board of Quality Assurance and Utilization Review
ACE acute care episode
ACHCE American College of Health Care Executives
ACS American College of Surgeons
ADA Americans with Disabilities Act
ADC average daily census
ADL activities of daily living
ADT Admission/Discharge/Transfer
AHA American Hospital Association
AHIMA American Health Information Management Association
AHRQ Agency for Healthcare Research and Quality
AI average inventory
AIMR Association for Investment Management and Research
AIR assumed interest rate
ALE annualized loss expectancy
ALF assisted living facility
ALOS average length of stay
AMA American Medical Association
AMBAC AMBAC Indemnity Corporation
AMGA American Medical Group Association
ANSI American National Standards Institute
AP accounts payable
APA American Psychiatric Association
APC ambulatory payment classification
APG ambulatory payment group
APR annual percentage rate
AR accounts receivable
ASA American Society of Appraisers
ASC ambulatory surgery centers; also Accredited Standards Committee
ASHA American Surgical Hospital Association
ASO administrative services only
ASTC ancillary service technical component
ATM asynchronous transfer mode
AVG ambulatory visit group
BANTA best alternative to negotiated agreement
BBA Balanced Budget Act of 1997
BBRA Balanced Budget Refinement Act [1999]
BCP business continuity planning
BEA break-even analysis
BEP break-even point
BIPA Benefits Improvement and Protection Act [2000]
BLS Bureau of Labor Statistics
BPD border protection device
BS balance sheet
BSA Bank Secrecy Act
BVS business valuation standard
CA certificate authority
CAC Carrier Advisory Committee
CAS cost accounting standards
CASB Cost Accounting Standards Board
CC common criteria [for IT Security Evaluation —ISO/IEC 15408]; complication or comorbidity [for MS-DRGs]
CCA certified cost accountant
CCC cash conversion cycle
CCEVS common criteria evaluation and validation scheme
CCHIT Certification Commission for Healthcare Information Technology
CCU critical care unit
CDC Centers for Disease Control and Prevention
CDH consumer-directed healthcare
CDHP consumer-directed healthcare plan
CDPM Clinical Data Project Manager
CDSS clinical decision support system
CEO Chief Executive Officer
CF conversion factor
CFA Chartered Financial Analyst
CFO Chief Financial Officer
CFR Code of Federal Regulations
CHAMP Children’s Health and Medicare Protection Act of 2007
CHAMPUS Civilian Health and Medical Program of the Uniformed Services
CHE Certified Healthcare Executive
CHIPS Center for Healthcare Industry Performance Studies
CIA Corporate Integrity Agreement
CIO Chief Information Officer
CIP Customer Identification Program
CIS computer information systems
CLIA Clinical Laboratory Improvement Act
CLT capitation liability theory
CME continuing medical education
CMI case mix index
CMIO Chief Medical Information Officer
CMIS contribution margin income statement
CMN Certificate of Medical Necessity
CMP Certified Medical Planner ™
CMS Centers for Medicare and Medicaid Services [formerly HCFA]
COD cash on delivery
COGME Council of Graduate Medical Education
COH cash on hand
COLA cost of living allowance
CON Certificate of Need
COO Chief Operating Officer
COSO Committee of Sponsoring Organizations
COTS commercial off-the-shelf
CPHQ Certified Physician in Healthcare Quality
CPIM Certificate in Production and Inventory Management
CPI-U Consumer Price Index—urban
CPM critical (clinical) path method
CPOE computerized physician order entry [system]
CPR computer-based patient record
CPT current procedural terminology
CQI continuous quality improvement
CRL Certification Revocation List
CRM customer relationship management
CRVS California Relative Value Studies
CSO Chief Security Officer
CT scan computed tomography scan [also called CAT scan]
CUSIP Committee on Uniform Security Identification Procedures
Candid CIO: Will Weider, CIO of Ministry Health Care and Affinity Health System, offers his perspectives on administration issues in this blog.
Christina’s Considerations: Christina Thielst is a hospital and healthcare administrator and entrepreneur with a deep desire for continually improving the health of the community being served. This is her blog.
Healing Hospitals — Formerly Ask a Hospital President: F. Nicholas “Nick” Jacobs has more than 20 years experience in hospital management, with an acknowledged reputation for innovation and consumer-centered leadership.
Hospital Impact: Part of the Fierce network of health sites, this site is becoming popular among healthcare administrators for its news updates, tips and opinions on health care matters.
Leading the Way to Medical Excellence: the president of McLeod Health non-profit institutions provides weekly insights into his facilities and health care in general.
Let’s Talk Health Care: Bruce Bullen, Interim Chief Executive Officer at Harvard Pilgrim in Massachusetts, provides and open and ongoing conversation about health care administration.
Life as a Healthcare CIO: Dr. John Halamka records his experiences with infrastructure, applications, policies, management, and governance as he supports 3,000 doctors, 18,000 faculty and about three million patients.
Managed Care Matters: Joe Paduda shares his knowledge on managed care for group health, health policy, health research, and medical news for insurers, employers, and healthcare providers.
More than Medicine: Tom Quinn, president and CEO of Community General Hospital in Syracuse, New York, began his career as a hospital kitchen worker. His perspective on administration reflects his knowledge on how hospitals work from every angle.
Running a Hospital: A CEO of a large Boston hospital shares thoughts on hospitals, medicine and health care issues.
St. Joseph Medical Center: Chief Executive Officer at St. Joseph Medical Center in Missouri, Mr. Kashman, provides personal insight into administrative matters and general topics.
Todd’s Perspective: Todd Linden, president and CEO of Grinnell Regional Medical Center, offers insights into medical administration and guest bloggers provide insight into various departments.
Wachter’s World: This blog focuses on hospitals, hospitalists, quality, safety, policy and much more from Robert M. Wachter, MD, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco.
Legal Matters
Drug and Device Law: This blog contains an attorney’s personal views (and those of several other Dechert attorneys) on topics that arise in the defense of pharmaceutical and medical device product liability litigation.
Drug Injury Watch: Learn more about drug injury lawsuits from an attorney who represents patients and their families.
FDA Law Blog: Hyman, Phelps & McNamara, P.C. is the largest dedicated food and drug law firm in the country. Their knowledge about laws and regulations governing drugs, medical devices, foods, dietary supplements, and cosmetics is helpful to anyone interested in these topics.
Health Care Law Blog: Bob Coffield’s expertise lies in helping businesses and health care providers weave through a variety of state and federal health care regulations and assisting them in business transactions.
Health Plan Law: This site contains information about group health plans, claims administration and related ERISA fiduciary issues. This site also contains tutorials.
HealthBlawg: this is David Harlow’s popular health care law blog, offering expert insights and easy-to-understand analysis.
Healthcare Law Blog: Holland & Hart’s healthcare practice provides insight into this arena, including HIPAA, Stark law, the Anti-kickback Statute and more.
HIPAA Blog: Join in on this discussion of medical privacy issues often buried in “political arcana.”
HIPAA, HiTech & HIT: This updated blog brings insight into legal issues, developments and other pertinent information that relates to the creation, use and exchange of electronic health records.
HIT Blawg: This blog is focused on national health information technology legal trends and current news on this topic.
Home Care Law Blog: Learn more about legal and policy issues in the home health care, private duty and hospice industries from Gilliland & Markette LLP.
Med Law Blog: This law blog focuses on topics that range from compliance to contracts and from employee benefits to HIPAA and HIT.
Physician Law: This blog provides and easy way to stay on top of current news, updates and useful tips relating to legal issues that affect physicians and non-institutional providers.
eHealth and Health IT
Chilmark Research: This blog provides perspectives on key IT trends in the healthcare sector.
davidrothman.net: David is the Information Services Specialist at the Community General Hospital Medical Library, but he also provides great ideas for 2.0 tools and tips for healthcare industry professionals on this blog.
e-CareManagement blog: Vince Kuraitis, owner of Better Health Technologies, LLC, has a passion for disease management and care coordination that dates back to 1995.
e-HealthExpert: A non-profit organization provides a free and open forum to support the development of expertise in the field of eHealth, Healthcare Information Systems, and Health IT (Clinical IT).
eHealth: John Sharp is an IT Manager for a major medical center in Northeast Ohio, with a focus on ehealth, personal health records, Web 2.0 technologies, Windows Sharepoint Services and project management.
Found In Cache: If you would prefer a professional’s take on social media matters, Web sites and all things technological, then follow Ed Bennett, a technology expert for a Maryland medical care system.
Future Health IT: A health IT and EPR advocate from the UK provides a format to discuss the future of health care and IT.
Informaticopia: This UK blogger provides eclectic news and views on health informatics and elearning.
MedGadget: Stay ahead of the gadget curve with this site, which offers information about the newest health care gadgets on the market as well as emerging medical technologies.
Neil Versel’s Healthcare IT Blog: A healthcare journalist’s provides his views on the major segment of the industry he covers — and, he provides a ton of links to other sites as well.
Schwartz Healthcare IT Blog: A variety of authors from Schwartz Communications provide insights into ways to use IT effectively within healthcare facilities.
The Health IT Channel: For a different perspective on IT and EHR as well as other health care issues, watch a few videos at this site.
The Healthcare IT Guy: The CEO of Netspective, a Java/.NET consultancy that specializes in healthcare IT with an emphasis on e-health, EMRs, data integration, and legacy modernization, supplies tips and information for physicians and healthcare administration.
ACKNOWLEDGEMENTS: To Mackenzie H. Marcinko PhD of iMBA Inc., Perry D’Alessio CPA CMP™ [Hon] New York, NY; and Daniel B. Moisand CFP®, Principal for Moisand Fitzgerald Tamayo, Melbourne, FL.
You can also listen to a professional narration of this article on iTunes & online.
ENCORE: March 22, 2004
A basic property of religion is that the believer takes a leap of faith: to believe without expecting proof. Often you find this property of religion in other, unexpected places – for example, in the stock market. It takes a while for a company to develop a “religious” following: only a few high-quality, well-respected companies with long track records ever become worshipped by millions of investors. My partner, Michael Conn, calls these “religion stocks.” The stock has to make a lot of shareholders happy for a long period of time to form this psychological link.
The stories (which are often true) of relatives or friends buying few hundred shares of the company and becoming millionaires have to fester a while for a stock to become a religion. Little by little, the past success of the company turns into an absolute – and eternal – truth. Investors’ belief becomes set: the past success paints a clear picture of the future.
Gradually, investors turn from cautious shareholders into loud cheerleaders. Management is praised as visionary. The stock becomes a one-decision stock: buy. This euphoria is not created overnight. It takes a long time to build it, and a lot of healthy pessimists have to become converted into believers before a stock becomes a “religion.”
Once a stock is lifted up to “religion” status, beware: Logic is out the window. Analysts start using T-bills to discount the company’s cash flows in order to justify extraordinary valuations. Why, they ask, would you use any other discount rate if there is no risk? When a T-bill doesn’t do the trick, suddenly new and “more appropriate” valuation metrics are discovered.
Other investors don’t even try to justify the valuation – the stock did well for me in the past, why would it stop working in the future? Faith has taken over the stock. Fundamentals became a casualty of “stock religion.” These stocks are widely held. The common perception is that they are not risky.
The general public loves these companies because they can relate to the companies’ brands. A dying husband would tell his wife, “Never sell _______ (fill in the blank with the company name).” Whenever a problem surfaces at a “religion stock,” it is brushed away with the comment that “it’s not like the company is going to go out of business.” True, a “religion stock” company is a solid leader in almost every market segment where it competes and the company’s products carry a strong brand name. However, one should always remember to distinguish between good companies and good stocks.
Coca-Cola is a classic example of a “religion stock.” There are very few companies that have delivered such consistent performance for so long and have such a strong international brand name as Coca-Cola. It is hard not to admire the company.
But admiration of Coca-Cola achieved an unbelievable level in the late nineties. In the ten years leading up to 1999, Coca-Cola grew earnings at 14.5% a year, very impressive for a 103-year-old company. It had very little debt, great cash flow and a top-tier management. This admiration came at a steep price: Coca-Cola commanded a P/E of 47.5. That P/E was 2.7 times the market P/E. Even after T-bills could no longer justify Coke’s valuation, analysts started to price “hidden” assets – Coke’s worldwide brand. No money manager ever got fired for owning Coca-Cola.
The company may not have had a lot of business risk. But in 1999, the high valuation was pricing in expectations that were impossible for any mature company to meet. “The future ain’t what it used to be” – Yogi Berra never lets us down. Success over a prolonged period of time brings a problem to any company – the law of large numbers.
Enormous domestic and international market share, combined with maturity of the soft drink market, has made it very difficult for Coca-Cola to grow earnings and sales at rates comparable to the pre-1999 years. In the past five years, earnings and sales have grown 2.5% and 1.5% respectively. After Roberto C. Goizueta’s death, Coke struggled to find a good replacement – which it acutely needed.
Old age and arthritis eventually catch up with “religion stocks.” No company can grow at a fast pace forever. Growth in earnings and sales eventually decelerates. That leads to a gradual deflation of the “religion” premium. For Coke, the descent from its “religious” status resulted in a drop of nearly 20% in the share price – versus an increase of 65% in the broad market over the same time. And at current prices, the stock still is not cheap by any means. It trades at 25 times December 2004 earnings, despite expectations for sales growth in the mid single digits and EPS growth in the low double digits.
It takes a while for the religion premium to be totally deflated because faith is a very strong emotion. A lot of frustration with sub-par performance has to come to the surface.
Disappointment chips away at faith one day at a time. “Religion” stocks are not safe stocks. The leap of faith and perception of safety come at a large cost: the hidden risk of reduction in the “religion premium.” The risk is hidden because it never showed itself in the past. “Religion” stocks by definition have had an incredibly consistent track record. Risk was rarely observed.
However, this hidden risk is unique because it is not a question of if it will show up but a question of when. It is very hard to predict how far the premium will inflate before it deflates – but it will deflate eventually. When it does, the damage to the portfolio can be huge.
Religion stocks generally have a disproportionate weight in portfolios because they are never sold – exposing the trying-to-be-cautious investor to even greater risks. Coca-Cola is not alone in this exclusive club. General Electric, Gillette, Berkshire Hathaway are all proud members of the “religion stock” club as well. Past members would include: Polaroid – bankrupt; Eastman Kodak – in a major restructuring; AT&T – struggling to keep its head above water. That stock is down from over $80 in 1999 to $18 today.
Emotions have no place in investing. Faith, love, hate, and disgust should be left for other aspects of our life. More often than not, emotions guide us to do the opposite of what we need to do to be successful. Investors need to be agnostic towards “religion stocks.” The comfort and false sense of certainty that those stocks bring to the portfolio come at a huge cost: prolonged under performance.
My thoughts today (20+ years later)
This is one of the first investment articles I ever wrote. I had just started writing for TheStreet.com. It’s interesting to read this article more than 20 years later. I am surprised my writing was not as bad as I had feared (though in many cases it was worse than I feared when I read my other early articles).
So much has happened since then – I am a different person today than I was back then. I have two more kids; I have written three more books and a thousand articles. The last two decades were my formative years as an investor and adult.
The goal of the article was not to make predictions but to warn readers that the long-term success of certain companies creates a cult-like following and deforms thinking. In fact, my original article – the one I submitted to TheStreet.com – did not mention any companies other than Coke. The editors wanted me to include more names so that the article would show up on more pages of Yahoo! Finance.
With the exception of Berkshire Hathaway, all of these companies have produced mediocre or horrible returns. In the best case, their fundamental returns in their old age were only a fraction of what they were when these companies were younger and the world was their oyster.
To my surprise, Coke’s stock is still trading at a high valuation. Its business has performed like the old-timer it is, with revenue and earnings growing by only 3–4% a year. The days of double-digit revenue and earnings growth were left in the 80s and 90s, though the high valuation remained.
Posted on March 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
Electronic Data Gathering, Analysis, and Retrieval
By Staff Reporters
***
***
EDGAR (Electronic Data Gathering, Analysis, and Retrieval) is an internal database system operated by the U.S. Securities and Exchange Commission (SEC) that performs automated collection, validation, indexing, and accepted forwarding of submissions by companies and others who are required by law to file forms with the SEC. The database contains a wealth of information about the commission and the securities industry which is freely available to the public via the Internet.
In September 2017, SEC Chairman Jay Clayton revealed the database had been hacked and that companies’ data may have been used by criminals for insider trading.
Posted on March 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
What is Honeypot?
A Honeypot is a network-attached system used as a trap for cyber-attackers to detect and study the tricks and types of attacks used by hackers. It acts as a potential target on the internet and informs the defenders about any unauthorized attempt at the information system.
Honeypots are mostly used by large companies and organizations involved in cybersecurity. It helps cybersecurity researchers to learn about the different types of attacks used by attackers. It is suspected that even cyber criminals use these honeypots to decoy researchers and spread wrong information. The cost of a honeypot is generally high because it requires specialized skills and resources to implement a system such that it appears to provide an organization’s resources while still preventing attacks at the back end and access to any production system.
Advantages of Honeypot
Acts as a rich source of information and helps collect real-time data.
Identifies malicious activity even if encryption is used.
Wastes hackers’ time and resources.
Improves security.
Disadvantages of Honeypot
Being distinguishable from production systems, it can be easily identified by experienced attackers.
Having a narrow field of view, it can only identify direct attacks.
A honeypot once attacked can be used to attack other systems.
Fingerprinting(an attacker can identify the true identity of a honeypot ).
What is Honeynet?
A honeynet is made up of two or more honeypots connected via a network. Having a linked network of honeypots can be beneficial. It allows organizations to trace how an attacker interacts with a single resource or network point while also monitoring how a hacker moves between network points and interacts with numerous points at the same time.
The goal is to induce hackers to believe that they have successfully breached the network. Having more false network destinations makes the arrangement appear more realistic.
Posted on February 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
VIRAL AUDIO DEBATES
By Staff Reporters
***
***
Auditory Illusions are like magic tricks for your ears. They make you hear things that aren’t there or misinterpret sounds. Think of the famous “Yanny or Laurel” debate – two people hear completely different words from the same audio clip.
NOTE: Yanny or Laurel is an auditory illusion that became popular in May 2018, in which a short audio recording of speech can be heard as one of two words. 53 percent of over 500,000 respondents to a Twitter poll reported hearing a man saying the word “Laurel”, while 47 percent of people reported hearing a voice saying the name “Yanny”. Analysis of the sound frequencies has confirmed that both sets of sounds are present in the mixed recording, but some users focus on the higher-frequency sounds in “Yanny” and cannot seem to hear the lower sounds of the word “Laurel”. When the audio clip is slowed to lower frequencies, the word “Yanny” is heard by more listeners, while faster playback loudens “Laurel.”
According to colleague Dan Ariely PhD, our brains love patterns, sometimes too much, leading us to hear phantom sounds or misinterpret music lyrics. It’s a reminder that our senses are easily fooled, so don’t believe everything you hear.
While health care is not “do-it-yourself,” an informed patient can be an asset. A poorly informed patient, on the other hand, clearly complicates treatment. Assume the responsibility of being the primary information source and educator for your patient. To help deal with a self-diagnosing patient, consider the following as suggested by: David B. Troxel, MD, Medical Consultant to The Doctors Company:
Encourage patients to always check with you about the accuracy of information obtained from external sources. Use the intake time to find out what Internet information the patient has found.
Directly discuss what the patient has read, even if the patient’s external source is a good one in your professional opinion. The exchange enhances your relationship with the patient and can increase treatment compliance. Welcome questions, and help put the patient’s information in the appropriate context.
Provide your patient with a list of Web sites that provide accurate information, such as the Centers for Disease Control and Prevention (www.cdc.gov). Make sure the patient understands the limitations of the Internet.
Document in the patient’s chart your diagnosis, your treatment management plan, and medication prescribed, as well as the reasons behind your decisions.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Posted on February 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
“Show Me the Money”
By Staff Reporters
***
***
In some situations, an inheritance might complicate an estate and add to the estate tax burden. If there are sufficient assets and income to accomplish financial goals, more assets are not needed. A disclaimer may be useful. This is an unqualified refusal to accept a gift or inheritance, that is, when you “just say no”. You have decided not to accept a sizable gift made under a will, trust or other document.
When you disclaim the property, certain requirements must be met:
The disclaimer must be irrevocable;
The refusal must be in writing;
The refusal must be received within nine months;
You must not have accepted any interest in the property; and
As a result of the refusal, the property will pass to someone else.
The property passes under the terms of the decedents will, as if you had predeceased the decedent. If the filer of the disclaimer has control, the property will be included in the disclaimant’s estate and can only be passed to another as a gift for as an inheritance. The intent of the disclaimer is to renounce and never take control of the property.
Posted on February 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
ORIGINAL: May 2021 | Matt Cohlmia
As the future of healthcare becomes digitized, the threat of disruption to health systems has never been greater. Despite their best intentions, the flood of new competitors and ever-proliferating modalities of care each compete for patient attention, creating the potential for a fragmented, confusing, and impersonal patient experience. At the same time, health systems possess the breadth of care, the access to data, and the patient trust to become their community’s preferred partner in care.
But to achieve success, they must leverage these resources to create easy to navigate and personalized experiences for their patients, and for the first time ever, those are within reach.
Scambaiters pose as potential victims to waste the time and resources of scammers, gather information useful to authorities, and publicly expose scammers. They may document scammers’ tools and methods, warn potential victims, provide discussion forums, disrupt scammers’ devices and systems using remote access trojans and computer viruses, or take down fraudulent webpages, while some scam baiters simply call scammers to annoy them and waste their time dealing with a scam baiter, therefore allowing scammers less time to scam potential victims.
Some scambaiters are motivated by a sense of civic duty, some simply engage for their own amusement, or a combination of both.
9. We act with honesty, integrity and are always straightforward. 8. We strive to be innovative, creative, iconoclastic, and flexible. 7. We admit and learn from mistakes and don’t repeat them. 6. We work hard always as competitors are trying to catch up. 5. We treat others with dignity and respect. 4. We are the onus of consulting advice for the well being of others. 3. We fight complacency as former success is in the past. 2. The best management styles are timeless, not timely. 1. Our clients are colleagues and always come first.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Posted on February 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
LEGIT or NOT?
By Staff Reporters
***
***
A new pathway will result in a degree called the “Doctor of Medical Science” (DMS); this training is designed for someone—not a physician—to practice clinical medicine with all of the privileges afforded to a medical doctor in the discipline of primary care.
Lincoln Memorial University (LMU) recently announced the start of this new program. In a recent press release they stated, “Lincoln Memorial University is pleased to announce a new type of medical training with its launch of the brand new Doctor of Medical Science (DMS) degree. The only one of its kind, this program bridges the gaps between physician and physician assistant (PA) training for the development of a new type of doctoral trained provider to aid Appalacia and other health care shortage areas.”
The DMS will be for Physician Assistants who have at least three years experience in clinical practice. The curriculum will be a two year program and will consist of 50 credits. The first year will have online didactics delivered by clinical and PhD specialists on staff at LMU-DeBusk College of Osteopathic Medicine and other teaching hospitals. The second year will be more online didactics specific to a clinical specialty.
LMU has already received approval for this program from the Southern Association of Colleges and Schools Commission on Colleges.
Posted on February 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Life Insurance: A contract under which an insurance company promises, in exchange for premiums, to pay a set benefit when the policyholder dies.
Several factors will affect the cost and availability of life insurance, including age, health and the type and amount of insurance purchased. Life insurance policies have expenses, including mortality and other charges. If a policy is surrendered prematurely, the policyholder also may pay surrender charges and have income tax implications. You should consider determining whether you are insurable before implementing a strategy involving life insurance.
Any guarantees associated with a policy are dependent on the ability of the issuing insurance company to continue making claim payments.
Posted on February 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Term Insurance: Life insurance that provides coverage for a specific period. If the policyholder dies during that time, his or her beneficiaries receive the benefit from the policy. If the policyholder outlives the term of the policy, it is no longer in effect. Several factors will affect the cost and availability of life insurance, including age, health, and the type and amount of insurance purchased.
Life insurance policies have expenses, including mortality and other charges. If a policy is surrendered prematurely, the policyholder also may pay surrender charges and have income tax implications.
And, you should consider determining whether you are insurable before implementing a strategy involving life insurance. Any guarantees associated with a policy are dependent on the ability of the issuing insurance company to continue making claim payments.
A certified financial planner (CFP®) helps individuals plan their financial futures. CFPs are not focused only on investments; they help their clients achieve specific long-term financial goals, such as saving for retirement, buying a house, or starting a college fund for their children.
To become a CFP®, a person must complete a course of study and then pass a two-part examination. The exam covers wealth management, tax palnning, insurance, retirement planning, estate planning, and other basic personal finance topics. These topics are all important for someone seeking to help clients achieve financial goals.
Chartered Financial Analyst (CFA)
A CFA, on the other hand, conducts investing in larger settings, normally for large investment firms on both the buy side and the sell side, mutual funds or hedge funds. CFAs can also provide internal financial analysis for corporations that are not in the investment industry. While a CFP® focuses on wealth management and planning for individual clients, a CFA focuses on wealth management for a corporation.
To become a CFA, a person must complete a rigorous course of study and pass three examinations over the course of two or more years. In addition, the candidate must adhere to a strict code of ethics and have four years of work experience in an investment decision-making setting.
(“Informed Voice of a New Generation of Fiduciary Advisors for Healthcare”)
For most lay folks, personal financial planning typically involves creating a personal budget, planning for taxes, setting up a savings account and developing a debt management, retirement and insurance recovery plan. Medicare, Social Security and Required Minimal Distribution [RMD] analysis is typical for lay retirement. Of course, we can assist in all of these activities, but lay individuals can also create and establish their own financial plan to reach short and long-term savings and investment goals.
But, as fellow doctors, we understand better than most the more complex financial challenges doctors can face when it comes to their financial planning. Of course, most physicians ultimately make a good income, but it is the saving, asset and risk management tolerance and investing part that many of our colleagues’ struggle with. Far too often physicians receive terrible guidance, have no time to properly manage their own investments and set goals for that day when they no longer wish to practice medicine.
For the average doctor or healthcare professional, the feelings of pride and achievement at finally graduating are typically paired with the heavy burden of hundreds of thousands of dollars in student loan debt.
You dedicated countless hours to learning, studying, and training in your field. You missed birthdays and holidays, time with your families, and sacrificed vacations to provide compassionate and excellent care for your patients. Amidst all of that, there was no time to give your finances even a second thought.
Between undergraduate, medical school, and then internship and residency, most young physicians do not begin saving for retirement until late into their 20s, if not their 30s. You’ve missed an entire decade or more of allowing your money and investments to compound and work for you. When it comes to addressing your financial health and security, there’s no time to waste.
While IAs and FAs may seem the same, they are not the same. The Financial Industry Regulatory Authority (FINRA) and the Securities Exchange Commission (SEC) have clearly defined investment advisors as distinct from financial advisors.
The term financial advisor is a generic one that can encompass many different financial professionals, although it most commonly refers to stock brokers (individuals or companies that buy and sell securities).
Investment advisor, on the other hand, is a legal term and thus has a more clear-cut definition – or at least as clear as legalese is apt to be.
KEY DIFFERENCES:
Financial advisors help with all aspects of your finances, including saving, budgeting, insurance, retirement planning, and taxes.
Investment advisors focus specifically on choosing and managing investment portfolios.
Financial advisors offer broader financial guidance, while investment advisors concentrate solely on investments.
Investment advisors are held to the fiduciary standard, while financial advisors who work as brokers may operate under different rules.
Posted on January 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
According to colleague Dan Ariely PhD,Pre-Procurement Ownership is when you start to feel ownership over something before you actually have it. It’s like mentally moving into a house or car before you’ve signed the papers and moved in or driven away
This psychological quirk makes us more likely to commit to purchases because we’ve already imagined them as ours. Marketers exploit this by encouraging us to “try before you buy.”
So, next time you’re trying on a new men’s suit or woman’s skirt, be aware: your brain might already be claiming ownership.
Academic Team of Internationally Known Contributors
D. E. Marcinko & Associates is one of the most academically published authorities on the topic of financial planning and private wealth management for physicians, nurses and medical professionals. We have published 33 major peer reviewed textbooks redacted in the Library of Medicine, Institute of Health and the Library of Congress, in four languages, with over 5,025 online white papers, web-posts and related publications. These cover a range of financial planning topics from medical malpractice, risk management and insurance, to investment policy statement analysis and endowment funding management, and to taxation, retirement, estate and legacy planning.
Financial planning, business and strategic management, FMV for practice and clinics and related “hard” topics are included.
***
We also include “soft” subjects from investor psychology, ethics and lost fortunes to luxury spending, from understanding the middle-class millionaire to the political philosophies of physicians and the affluent. Our corpus of work is regularly consulted by doctors, medical, business, graduate and nursing schools, to elite advisors, private and investment bankers, wealth managers, venture capitalists, academics and the press.
Did you know that at MARCINKO & Associates, all medical colleagues throughout the United States may contact us when they are considering the sale, purchase, strategic operating improvement, merger, acquisition and/or other financial business or related personal financial planning transaction?
Our difference is “hard” knowledge and insider financial guidance that helps medical colleagues, nurses, private practitioners, clinics, ambulatory surgery, radiology and outpatient wound care centers realize their ultimate economic goals. This typically includes managerial and cost accounting, financial ratio analysis, fair market valuation business appraisals, business plan creation and personal financial planning.
Our “expert witness” business litigation support service and divorce mediation, arbitration, asset division, settlement and second opinion offerings are always available, as well.
And, our “soft” skill professional career guidance and mentoring center includes executive coaching, consulting and mentoring advisory programs for stressed, conflicted or burned-out physicians and medical practitioners.
Most importantly, our professional fees are reasonable and always transparent.
MARCINKO & Associates also serves universities, medical, business, graduate and nursing schools; physicians, dentists, podiatrists, optometrists and legal societies. This includes accountants, financial service providers, wealth and hedge fund managers, emerging entities, hospitals, CEOs and their BODs, the press, media and related organizations.
At DEMarcinko & Associates an “expert witness” possesses specialized knowledge in a particular field and is qualified to provide deposition or testimony in court and under oath. This testimony can be based on their personal experience, education, training or research. The role of an expert witness is to provide objective and unbiased opinions, analysis, and insights to help a lawyer, judge and/or jury understand technical or complex issues related to the case.
An expert witness can be called by either the prosecution or the defense in a legal case. The expert witness may be required to provide a written report or affidavit detailing their opinions, analyses and conclusions, and they may be asked to testify in court to provide oral testimony and answer questions from the judge and lawyers.
Posted on January 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Institute for Supply Management (ISM) Manufacturing Index. Now, published on a monthly basis, the ISM surveys more than 300 manufacturing firms on employment, production, new orders, supplier deliveries, and inventories.
A composite diffusion index of national manufacturing conditions is constructed, where readings above (below) 50 percent indicate an expanding (contracting) manufacturing sector.
Posted on January 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
US stocks largely rose on Monday as chip names popped and investors awaited the release of key monthly jobs data later this week.
The S&P 500 (^GSPC) was up about 0.5%, while the Dow Jones Industrial Average (^DJI) fell about 0.1% after being higher for most of the session. The tech-heavy NASDAQ Composite (^IXIC) led the gains, adding about 1.2%, after a tech-led rally on Friday.
LAS VEGAS (AP) — A vehicle caught fire and exploded Wednesday outside the lobby of President-elect Donald Trump’s hotel in Las Vegas, authorities said.
Las Vegas police said they are investigating the fire and explosion, but neither they nor the Clark County Fire Department immediately provided more details. A county spokeswoman said in a statement that the fire was in the hotel’s valet area and was reported at 8:40 a.m.
Posted on December 29, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Habituation is your brain’s way of tuning out repetitive stimuli. It’s like background noise – after a while, you stop noticing it. This mental autopilot helps us focus on new and important information, but it can also make us overlook the familiar. It’s why you might not notice a smell in your house that’s obvious to a visitor.
To combat habituation, according to colleague Dan Ariely PhD, try changing up your routine and environment. Fresh experiences keep your brain engaged and alert.
Posted on December 23, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
DEFINED
***
***
Witness Stress is caused by witnessing a traumatic event and can lead to memory issues and confusion, affecting how accurately we remember details. This stress makes eyewitness testimonies more prone to error.
According to colleague Dan Ariily PhD, it highlights the role of stress in memory distortion and why additional support is often necessary for witnesses.
Posted on December 21, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Ann Miller RN MHACMP™
INTRODUCING OUR NEXT GENERATION e-BOOK LIBRARYFROM iMBA, Inc.
An e-book is an electronic or digital book that can be read on a computer or a handheld device.
Our new e-books consists of text, images, and are fixed to a specific spot on the page.
And, our e-books are a data files similar in content and structure to a word-processing document that comes in a PDF format. To use our e-books, you need to purchase and download it to a device that has a .pdf file reader app, such as ADOBE® or similar on a smartphone, tablet or computer. A PDF, also known as a portable document format, is the format most people are familiar with and used in our e-books. PDFs are known for their ease of use and ability to hold custom layouts. They are the most commonly used e-Book formats, especially by professionals and adult-learners.
You can then access the e-book and read it, or highlight pages and even take side notes.
e-Books Save Money
With no manufacturing, printing, binding or shipping costs, e-Books are cheaper than traditional hard or paper back books.The price of each specialized and highly niche focused e-Book [50-100 pages] is only $25, whereas similar paperback printed books of this type generally cost $145, or more!
Posted on December 21, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
An Oft Neglected Chore
[By Dr. David Edward Marcinko MBA MEd]
Hello ME-P Readers!
Doctors and Colleagues – You have probably noticed the weather is getting colder, and you’ve made some changes, right? Thanksgiving is past and X-mass day is nigh! Have you started wearing jackets, packed up the flip-flops, and replaced the A/C with heat?
If you have, that is great, but what have you done to prepare your car for the cold winter months?
Betchya didn’t know that, much like your patients, your car needs to be equally prepared for the colder seasons! It’s a fact—your car reacts to the colder weather in many of the same ways us humans do. Sure, we have blood and skin, where cars have oil and metal, but stay with me here.
There are a few simple things you can do to make sure your trusted car is ready to battle the elements. So; let’s take a quick look at my classic 2000 Jaguar XJ-V8-XL touring sedan; and those pesky winter car tasks.
The List
First of all, your car’s electrical system can take a beating in the cold. The battery has a Cold Cranking Amps (CCA) rating, which should help you determine if it’s powerful enough for those snowy days. The higher the number, the better you’re protected from being stranded. An inspection of your electrical system is always a good idea, though.
Second, you should also consider inspecting the windshield wipers on your vehicle. It’s an easy thing to forget about until you really need them, and then of course they’re worn out. Winter weather, with frost, ice, snow, and dry air can really deteriorate the rubber in wipers.
Third, though it may seem backwards, your vehicle’s cooling system should be in good working condition as well. If the coolant mixture and levels aren’t correct, you could have some very, very expensive repairs waiting for you. Overheating is less of an issue, but your engine actually freezing when not running is a very real, and expensive, danger. And, did you know that your engine’s cooling system also controls your heat inside! A cooling system malfunction could also mean some very cold commutes for you.
Next, headlights are often ignored, too, until you get caught out one night with burnt-out bulbs. With the days getting shorter, and the nights getting much longer and darker, it’s not a bad idea to replace your headlights. Why not upgrade them while you’re at it? The price difference is minimal, and the difference in visibility will make night driving a true joy.
Finally, let’s talk about tires. Some tires are much more suited to winter weather than others! Some tires, especially on performance cars, are rated for summer use only, while others might be “three season” tires. Of course, many cars come standard with all-season tires as well. For those that encounter frequent winter conditions, though, a set of full-winter tires is the best option.
Assessment
Now, just like the patients in your waiting room …. NEXT!
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@outlook.com
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Posted on December 15, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Pro hac vice is Law Latin that means “for this time [only]” (literally, “for this turn”). When a lawyer is admitted to a case pro hac vice, a court has granted them a limited license to practice in a jurisdiction where they otherwise would not be licensed to do so.
For example, a lawyer licensed only to practice in California may nonetheless practice in a New York case once a court has granted them admission pro hac vice, so long as the lawyer practices only within the limited scope of their pro hac vice admission. In almost all U.S. jurisdictions, lawyers who practice pro hac vice must do so in conjunction with a local lawyer acting as local counsel. Local counsel typically acts as an anchor to the bar of a foreign jurisdiction, exposing local counsel to liability for the acts or omissions of the lawyer admitted pro hac vice. Local counsel therefore usually assumes, at a minimum, a role of monitoring the lawyer admitted pro hac vice.
Posted on December 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
ALMOST ALL ABOUT CREDIT
By Staff Reporters
***
***
Credit Rating and Scoring
The category in which a credit agency classifies you is based upon payment history. Recently, credit reporting agencies have shifted away from ratings to a system known as credit scoring. Your score is determined by proprietary formulas that are based on your credit history, the higher the better. The practical benefits of this scoring system are numerous.
First, medical professionals do not need to be experts at deciphering credit reports since the same scoring system is used by many different companies.
Correcting Credit Report Errors
A credit bureau is not the place to get an item to be fixed on your credit report. Rather, you must take it up directly with the credit issuer. In any case, a late payment noted on a credit report by a durable medical equipment vendor, for example, has to be addressed directly with that merchant. The DME merchant then has 30 days to acknowledge your complaint and respond to you. In the meantime, you do not have to pay for the disputed items. Most credit errors cannot be reported or kept on your credit report for more than seven years.
For legitimate late payments you should contact the credit grantor and negotiate to take one of the following steps. Be tenacious, and either remove the late payment or write a letter explaining that the problem has been resolved and you now are a good credit risk again. This letter is a powerful tool and should be saved with other permanent financial records. The industry term for it is a letter of correction.
Credit Repair Services
Credit repair services are oversold and their claims tend to be exaggerated. They do not have an inside track to the consumer reporting agencies. Good credit repair services are experienced in communicating with creditors and can help with legitimate repairs. They cannot restore your credit rating or your good name.
However, realize that with some time and effort you can accomplish the same results yourself.
Achieving your financial, wealth and medical practice management goals is important, but handling everything on your own can be overwhelming. That’s where we come in. At D. E. Marcinko & Associates, our team of dual degree experienced physician advisors and medical consultants is here to guide you every step of the way. We believe in providing unbiased, high-quality financial and business advice.
For example, we offer a one-time written financial plan with oral evaluation for a flat fee with no ongoing sales or assets under management fees or commissions. Together, we can create a personalized financial plan tailored to your unique goals, empowering you to make confident, informed decisions as you navigate your financial future.
Other Services Include:
Estate Planning We have a network of qualified legal professionals that we can refer you to for state specific estate planning needs.
Tax Strategy We can work alongside your CPA for tax planning purposes. If needed, we can refer you to a qualified tax professional.
Investment Analysis If you have investments, we review your accounts to make sure they are aligned with your long-term goals.
401-k Allocations We evaluate your 401(k) allocations and provide recommendations that align with your goals.
Education Savings We help you explore the various ways to plan and save for education expenses.
Insurance & Risk Management We assess your insurance coverage to ensure it adequately protects you against potential risks; as well as evaluate and provide expert litigation witnesses, as needed.
Medical Practice Management We evaluate your current or potential medical practice to determine value and/or private equity offers or physician practice management formats [PPMC] for new, mid-career or retiring physicians, nurses and dentists.
D. E. Marcinko & Associates is unique and fully committed to all phases of a medical professionals personal and business life cycle. We are at your service 24/7: Email MarcinkoAdvisors@outlook.com
Think of synthetic equity as a communal garden. You don’t own the plot, and you don’t necessarily have a say in what’s planted, but you’re guaranteed a share of the crops that are harvested.
Synthetic equity is a form of deferred compensation that mirrors some of the benefits of real stock ownership without granting actual shares. It’s a contractual agreement between you and your employer that entitles you to a payout upon certain events—such as an IPO, acquisition, or surpassing earnings milestones.
Companies use synthetic equity plans to motivate their personnel through growth-related incentives. In other words, it grants employees a sense of ownership without issuing shares or altering the business’s ownership structure. As the company succeeds and appreciates in value, so does your potential payout. Although you don’t own actual shares of company stock, you are compensated as if you did.
According to Carla McCabe, synthetic equity programs also have a significant tax advantage to both business owners and the key employees.
For example, when a key employee receives shares under the firm’s synthetic equity program, the IRS does not recognize that receipt as taxable income to the employee until he or she actually receives the money. This usually occurs when the firm is sold or when the employee retires and is cashed out (assuming the employee’s synthetic shares are vested). This is very attractive considering that regular shares are taxed as ordinary income and the employee basically has to pay the associated tax even though he or she didn’t receive any cash.
Of course, all this begs the question: Why would a company offer synthetic equity instead of actual equity?
Two years ago, prior to the 2022 election, mental health experts alerted the medical world to their version of an assessment scale for yet another new condition – “doomscrolling.”
As defined by the National Library of Medicine in the article, “Constant exposure to negative news on social media and news feeds could take the form of ‘doomscrolling’ which is commonly defined as a habit of scrolling through social media and news feeds where users obsessively seek for depressing and negative information.”
And so, formally Doomscrolling or doomsurfing is the act of spending an excessive amount of time reading large quantities of news, particularly negative news, on the web and social media. Doomscrolling can also be defined as the excessive consumption of short-form videos or social media content for an excessive period of time without stopping. The concept was coined around 2020, particularly in the context of the COVID pandemic.
Surveys and studies suggest doomscrolling is predominant among youth. It can be considered a form of internet addiction disorder. In 2019, a study by the National Academy of Sciences found that it can be linked to a decline in mental and physical health. Numerous reasons for doomscrolling have been cited, including negativity bias and FOMO [fear of missing out], and attempts at gaining control over uncertainty.
QUERY: What about the roaring stock market, post the 2024 presidential election. Fundamental analysis or FOMO?
Posted on November 24, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
According to some studies, as much as 10 percent of our thoughts involve comparisons of some kind. Social comparison theory is the idea that individuals determine their own social and personal worth based on how they stack up against others. The theory was developed in 1954 by psychologist Leon Festinger. Later research has shown that people who regularly compare themselves to others may find motivation to improve, but may also experience feelings of deep dissatisfaction, guilt or remorse, and engage in destructive behaviors like lying or disordered eating.
***
Downward Comparison is the act of comparing oneself to others who are worse off to feel better about one’s situation. It’s like looking at someone else’s messy desk to feel better about your clutter.
On the other hand, Upward Comparison is the act of comparing oneself to others who are better off to feel bad about one’s situation. It’s like looking at someone else’s neat desk and feel worse about your own clutter.
Finally, according to Dan Ariely PhD, these coping mechanisms boosts self-esteem or depress us with a sense of relief or dread. While helpful in moderation, relying too much on upward or downward comparisons can help hinder personal growth and/or depress growth or empathy; etc.
So, them sparingly and remember: upward comparisons can inspire you to improve and strive for better; while downward comparisons have the opposite effects.
Posted on November 23, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
The proposed Credit Card Competition Act (CCCA) could devastate credit card rewards at the national level if passed. Now, states are getting involved too Read on.
Ross Stores rose 2.19% after beating earnings estimates but missing sales forecasts last quarter, with shoppers spending less thanks to inflation.
MicroStrategy tumbled big time yesterday after a short seller report highlighted the risk inherent in betting it all on bitcoin, but the stock recovered 6.19% today.
Super Micro Computer continues to recover from the brink of defeat, rising another 11.62% as investors beg the tech company’s forgiveness for ever doubting it.
Data analytics company Elastic sprang 14.77% higher today on a strong earnings report highlighted by rising demand from customers building AI applications.
STOCKS DOWN
Tax-filing company Intuit sank 5.68% after reporting strong earnings last quarter but forecasting weaker results this quarter.
Reddit dropped 7.18% after a one-two punch from shareholders: Tencent Holdings sold a chunk of its stake in the social media company, while Advance Magazine Publishers is selling its stake but, through some financial trickery, is keeping control of the shares.
Palo Alto Networks may have beaten earnings expectations yesterday afternoon, but the cybersecurity stock fell 3.61% after shareholders weren’t impressed by its full-year guidance.
The S&P 500® index (SPX) rose 20.63 points (0.35%) to 5,969.34 to end the week up 1.68%; the $DJI gained 426.16 points (0.97%) to 44,296.51 to end the week up 1.96%; and the NASDAQ Composite®($COMP) added 31.23 points (0.16%) to 19,003.65 to end the week up 1.73%.
The 10-year Treasury note yield fell two basis points to 4.41% and is down two basis points for the week, while the 2-year note yield rose seven basis points this week as rate cut odds fell.
The CBOE Volatility Index® (VIX)fell sharply to 15.31 and finished slightly lower for the week.
Posted on November 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
Robert F Kennedy Jr, who was selected by Donald Trump to run the U.S. health and human services department, is working on plans to rid the American Medical Association from its role in drawing up Medicare’s billing codes, which sets doctors’ fees for more than 10,000 procedures, Oliver Barnes of The Financial Times reports.
The plan would result in an upheaval of a system that has been in place for decades. Publicly traded companies in the healthcare space include CVS Health (CVS), Centene (CNC), Cigna (CI), Elevance Health (ELV), Humana (HUM), Molina Healthcare (MOH) and UnitedHealth (UNH).
Posted on November 17, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
***
***
The number of people living with Alzheimer’s disease is growing. The ripple effect is straining families, communities, and the healthcare system, yet talking about the disease on a personal level can be difficult.
November is Alzheimer’s Awareness Month because it can happen in any family, and because it’s worth talking about the challenges of living with or caring for someone with this disease.
You may notice splashes of teal and purple sprouting up this November, as both colors are associated with Alzheimer’s awareness. Teal is the color of the Alzheimer’s Foundation of America, chosen for its calming effect. Purple is the signature color of the Alzheimer’s Foundation, which stands for strength in the fight against Alzheimer’s disease.
Posted on November 17, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
***
***
George Boole, an English mathematician from the 19th century, developed an algebraic method that he first described in his 1847 book, The Mathematical Analysis of Logic and expounded upon in his An Investigation of the Laws of Thought (1854).
Boolean algebra is fundamental to modern computing, and all major programming languages include it. It also figures heavily in statistical methods and set theory.
Today’s database searches are largely based on Boolean logic, which allows us to specify parameters in detail — for example, combining terms to include while excluding others. A Boolean search, in the context of a search engine, is a type of search where you can use special words or symbols to limit, widen, or define your search.
This is possible through Boolean operators such as AND, OR, and NOT, plus symbols like + (add) and – (subtract).
When you include an operator in a Boolean search, you’re either introducing flexibility to get a wider range of results, or you’re defining limitations to reduce the number of unrelated results.
Posted on November 16, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
***
***
The Stereotype Curse is the negative impact of stereotypes on an individual’s performance or behavior. It’s like a self-fulfilling prophecy where being aware of a stereotype makes you more likely to conform to it.
For example, if you’re told you’re bad at math because of your gender, that stress can affect your performance. Breaking free from stereotypes requires awareness and effort.
So, next time you feel boxed in by a stereotype, remind yourself: you’re more than a cliché.
Posted on October 22, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
COGNITIVE BIASES
By Staff Reporters
***
***
According to colleague Dan Ariely PhD,anchoring is the mental trick your brain plays when it latches onto the first piece of information it gets, no matter how irrelevant. You might know this as ‘ first impressions ’ – when someone relies on their own first idea of a person or situation.
Imagine you’re buying a car, and the salesperson starts with a high price. That number sticks in your mind and influences all your subsequent negotiations. Anchoring can skew our decisions and perceptions, making us think the first offer is more important than it is. Or, subsequent offers lower than they really are.
So, the next time you’re haggling or making a big decision, be aware of that initial anchor dragging you down.
Although some might view a budget as unnecessarily restrictive, sticking to a spending plan can be a useful tool in enhancing the wealth of a medical practice. So, I will emphasize keys to smart budgeting and how to track spending and savings in these tough economic times.
There is an aphorism that suggests, “Money cannot buy happiness.” Well, this may be true enough but there is also a corollary that states, “Having a little sure reduces the unhappiness.”
Unfortunately, today there is more than a little financial unhappiness in all medical specialties. The challenges range from the commoditization of medicine, aging demographics, Medicare reimbursement cutbacks and increased competition to floundering equity markets, the home mortgage crisis, the squeeze on credit and declines in the value of a practice. Few doctors seem immune to this “perfect storm” of economic woes.
Far too many physicians are hurting and it is not limited to above-average earning professionals. However, one can strive to reduce the pain by following some basic budgeting principles. By adhering to these principles, physicians can eliminate the “too many days at the end of the month” syndrome and instead develop a foundation for building real wealth and security, even in difficult economic climates like we face today.
There are three major budget types. A flexible budget is an expenditure cap that adjusts for changes in the volume of expense items. A fixed budget does not. Advancing to the next level of rigor, a zero-based budget starts with essential expenses and adds items until the money is gone. Regardless of type, budgets can be extremely effective if one uses them at home or the office in order to spot money troubles before they develop.
For the purpose of wealth building, doctors may think of this budget as a quantitative expression of an action plan. It is an integral part of the overall cost-control process for the individual, his or her family unit or one’s medical practice.
Preparing a net income statement (lifestyle cash flow budget) is often difficult because many doctors perceive it as punitive. Most doctors do not live a disciplined spending lifestyle and they view a budget as a compromise to it. However, a cash flow budget is designed to provide comfort when there is surplus income that can be diverted for other future needs. For example, if you treat retirement savings as just another periodic bill, you are more likely to save for it.
You may construct a personal cash budget by recording each cash receipt and cash disbursement on a spreadsheet. Only the date, amount and a brief description of the transaction are necessary. The cash budget is a simple tool that even doctors who lack accounting acumen can use. Since it is possible to track the cash-in and cash-out in the same format used for a standard check register, most doctors find that the process takes very little time. Such a budget will provide a helpful look at how well you are staying within available resources for a given period.
We then continue with an analysis of your operating checkbook and a review of various source documents such as one’s tax return, credit card statements, pay stubs and insurance policies. A typical statement will show all cash transactions that occur within one year. It is helpful to establish a monthly equivalent to all items of income and expense. For the purposes of getting started, note items of income and expense by the frequency you are accustomed to receiving or spending them.
What You Should Know About The ‘Action Plan’ Cash Budget
For a medical office, the first operations budget item might be salary for the doctor and staff. Operating assets and other big ticket items come next. Some of our doctors/clients review their office P&L statements monthly, line by line, in an effort to reduce expenses. Then they add back those discretionary business expenses they have some control over.
Now, do you still run out of money before the end of the month? If so, you had better cut back on entertainment, eating dinner out or that fancy, new but unproven piece of medical equipment. This sounds draconian until you remind yourself that your choice is either: live frugally later or live a simpler lifestyle now and invest the difference.
As a young doctor, it may be a difficult trade-off. By mid-life, however, you are staring retirement in the face. That is why the action plan depends on your actions concerning monetary scarcity, a plan that one can implement and measure using simple benchmarks or budgeting ratios. By using these statistics, perhaps on an annual basis, the doctor can spot problems, correct them and continue planning actively toward stated goals like building long-term wealth.
Useful Calculations To Assess Your Budgeting Success
In the past, generic budgeting ratios would emphasize not spending more than 15 to 20 percent of your net salary on food or 8 percent on medical care. Now these estimates have given way to more rigorous numbers. Personal budget ratios, much like medical practice financial ratios, represent comparable benchmarks for parameters such as debt, income growth and net worth. Although these ratios are still broad, the following represent some useful personal budgeting ratios for physicians.
• Basic liquidity ratio = liquid assets / average monthly expenses. Cash-on-hand should approach 12 to 24 months or more in the case of a doctor employed by a financially insecure HMO or fragile medical group practice. Yes, chances are you have heard of the standard notion of setting enough cash aside to cover three months in a rainy day scenario. However, we have decried this older laymen standard for many years in our textbooks, white papers and speaking engagements as being wholly insufficient for the competitively unstable environment of modern healthcare.
• Debt to assets ratio = total debt / total assets. This percentage is high initially but should decrease with age as the doctor approaches a debt-free existence
• Debt to gross income ratio = annual debt repayments / annual gross income. This represents the adequacy of current income for existing debt repayments. Doctors should try to keep this below 20 to 25 percent.
• Debt service ratio = annual debt repayment / annual take-home pay. Physicians should aim to keep this ratio below 25 to 30 percent or face difficulty paying down debt.
• Investment assets to net worth ratio = investment assets / net worth. This budget ratio should increase over time as retirement approaches.
• Savings to income ratio = savings / annual income. This ratio should also increase over time as one retires major obligations like medical school debt, a practice loan or a home mortgage.
• Real growth ratio = (income this year – income last year) / (income last year – inflation rate). This budget ratio should grow faster than the core rate of inflation.
• Growth of net worth ratio = (net worth this year – net worth last year) / net worth last year – inflation rate). Again, this budgeting ratio should stay ahead of inflation.
In other words, these ratios will help answer the question: “How am I doing?”
Pearls For Sticking To A Budget
Far from the burden that most doctors consider it to be, budgeting in one form or another is probably one of the greatest tools for building wealth. However, it is also one of the greatest weaknesses among physicians who tend to live a certain lifestyle.
In fact, we have found that less than one in 10 medical professionals have a personal budget. Fear, or a lack of knowledge, is a major cause of procrastination. Fortunately, the following guidelines assist in reversing this microeconomic disaster.
1. Set reasonable goals and estimate annual income. Do not keep large amounts of cash at home or office. Deposit it in an FDIC insured money-market account for safety. Do not deposit it in a money market mutual fund with net asset value (NAV) that may “break the buck” and fall below the one-dollar level. Track actual bills and expenses.
2. Do not pay bills early, do not have more taxes withheld from your salary than needed and develop spending estimates to pay fixed expenses first. Fixed expenses are usually contractual and usually include housing, utilities, food, Social Security, medical, debt repayments, homeowner’s or renter’s insurance, auto, life and disability insurance, etc. Reduce fixed expenses when possible. Ultimately, all expenses get paid and become variable in the long run.
3. Make it a priority to reduce variable expenses. Variable expenses are not contractual and may include clothing, education, recreational, travel, vacation, gas, cable TV, entertainment, gifts, furnishings, savings, investments, etc. Trim variable expenses by 5 to 20 percent.
4. Use “carve-outs or “set-asides” for big ticket items and differentiate true wants from frivolous needs.
5. Calculate both income and expenses as a percentage of your total budget. Determine if there is a better way to allocate resources. Review the budget on a monthly basis to notice any variance. Determine if the variance was avoidable, unavoidable or a result of inaccurate assumptions. Take corrective action as needed.
6. Know the difference between saving and investing. Savers tend to be risk adverse while investors understand risk and take steps to mitigate it. Watch mutual fund commissions and investment advisory fees, which cut into return-rates. Keep investments simple and diversified (stocks, bonds, cash, index, no-load mutual and exchange traded funds, etc.).
Sooner or later, despite the best of budgeting intentions, something will go awry. A doctor will be terminated or may be the victim of a reduction-in-force (RIF) because of cost containment initiatives.4 A medical practice partnership may dissolve or a local hospital or surgery center may close, hurting your practice and livelihood. Someone may file a malpractice lawsuit against you, a working spouse may be laid off or you may get divorced. Regardless of the cause, budgeting crisis management encompasses two different perspectives: awareness and execution.
First, if you become aware that you may lose your job, the following proactive steps will be helpful to your budget and overall financial condition.
• Decrease retirement contributions to the required minimum for company/practice match. • Place retirement contribution differences in an after-tax emergency fund. • Eliminate unnecessary payroll deductions and deposit the difference to cash. • Replace group term life insurance with personal term or universal life insurance. • Take your old group term life insurance policy with you if possible. • Establish a home equity line of credit to verify employment. • Borrow against your pension plan only as a last resort.
If you have lost your job or your salary has been depressed, negotiate your departure and get an attorney if you believe you lost your position through breach of contract or discrimination. Then execute the following steps to recalculate your budget and boost your wealth rebuilding activities.
• Prioritize fixed monthly bills in the following order: rent or mortgage; car payments; utility bills; minimum credit card payments; and restructured long-term debt.
• Consider liquidating assets to pay off debts in this order: emergency fund, checking accounts, investment accounts or assets held in your children’s names.
• Review insurance coverage and increase deductibles on homeowner’s and automobile insurance for needed cash.
• Then sell appreciated stocks or mutual funds; personal valuables such as furnishings, jewelry and real estate; and finally, assets not in pension or annuities if necessary.
• Keep or rollover any lump sum pension or savings plan distribution directly to a similar savings plan at your new employer, if possible, when you get rehired.
• Apply for unemployment insurance.
• Review your medical insurance and COBRA coverage after a “qualifying event” such as job loss, firing or even after quitting. It is a bit expensive due to a 2 percent administrative fee surcharge but this may be well worth it for those with preexisting conditions or who are otherwise difficult to insure. One may continue COBRA for up to 18 months.
• Consider a high deductible Health Savings Account (HSA), which allows tax-deferred dollars like a medical IRA, for a variety of costs not normally covered under traditional heath insurance plans. Self-employed doctors deduct both the cost of the premiums and the amount contributed to the HSA. Unused funds roll over until the age of 59½, when one can use the money as a supplemental retirement benefit.
• Eliminate unnecessary variable, charitable and/or discretionary expenses, and become very frugal.
Final Notes
The behavioral psychologist, Gene Schmuckler, PhD, MBA, sometimes asks exasperated doctors to recall the story of the old man who spent a day watching his physician son treating HMO patients in the office. The doctor had been working at his usual feverish pace all morning. Although he was working hard, he bitterly complained to his dad that he was not making as much money as he used to make. Finally, the old man interrupted him and said, “Son, why don’t you just treat the sick patients?” The doctor-son looked at his father with an annoyed expression and responded, “Dad, can’t you see, I do not have time to treat just the sick ones.”
Always remember to add a bit of emotional sanity into your budgeting and economic endeavors.
Regardless of one’s age or lifestyle, the insightful doctor realizes that it is never too late to take control of a lost financial destiny through prudent wealth building activities. Personal and practice budgeting is always a good way to start the journey.
NOTE: Dr. Marcinko is a former Certified Financial Planner and current Certified Medical Planner™. He has been a medical management advisor for more than a decade. He is the CEO of http://www.MarcinkoAssociates.com
The authors acknowledge the assistance of Mackenzie H. Marcinko PhD in the preparation of this article.
Marcinko & Associates is financial guide. We help answer your questions in an empowering way. We educate and guide medical colleagues to understand their financial picture and to make better financial decisions. We strive to simplify everything, clear up confusion, and address specific needs and goals.
Simply put, we’re a financial services company on a mission to empower financial freedom for all healthcare professionals; only. We work with doctors, nurses, medical providers, individuals and all sizes of organizations to offer investment, wealth management and retirement solutions so everyone can have a clear and simple understanding of where their finances and career is today and where it is headed tomorrow.
Whatever your financial situation, we do not shame, criticize, or sell. We enrich, educate and empower. We work only with medical colleagues at every stage of their financial journey [students, interns, residents, practitioners, mid-career and mature physicians], through big life personal changes to annual employment reviews, in order to help them understand, invest, and protect their money and lifestyle.
Assess, develop, and align financial retirement and estate planning goals
Risk Management: Malpractice, home, life, medical, auto and personal indemnity
Life Insurance Need Reviews: whole, universal and term
Business, operations, HR, employment negotiations and medical practice management
Annuity Need Reviews: Indexed and Fixed [Pros and Cons].
***
***
At Marcinko & Associates we discuss specific needs and answer specific questions. We educate and make personalized recommendations that you are free to use, incorporate or disregard. Referrals to trusted specialists and strategic alliance partners then occur if – and as – needed [pro re nata].
According to colleague Dan Ariely PhD, a Zero Sum Bias [ZSB] is the mistaken belief that one person’s gain is another’s loss. It’s like thinking the world is a giant pie with only so many slices. This mindset fuels competition and jealousy, making us forget that collaboration can create more pie. It’s why we sometimes root against others instead of working together.
Question: Is the stock market a zero-sum game? You frequently hear media refer to games and markets as zero-sum games.
Answer: Well, yes, we define the stock market as a zero-sum game, both in the short and in the long term, although it technically is incorrect. A zero-sum game is where one person’s gain is another person’s loss – thus there is no wealth created and the overall benefit is zero. This doesn’t apply to stocks, but it’s a zero-sum game in relation to a stock market benchmark.
For example, short-term trading in stocks is theoretically not a zero-sum game, and neither is long-term investing. But short-term trading is close to a zero-sum game, and long-term investing is a zero-sum game if we use a broad index as a benchmark.
Essentially, in other words, the stock market functions as an expansive network of zero-sum transactions; each trade engages a buyer and a seller–their perspectives on a security’s future value contrasting. These opposing views propel market prices: they mirror not only risk transfer but also potential reward—a dynamic process indeed! Traders and investors must grasp the crucial zero-sum aspect; it underscores trading’s inherent competitiveness. Effectively anticipating market trends and actions from other participants: therein lies success in this environment.
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.
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.
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.
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 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.
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.”
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:
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.
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.
Posted on October 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
DUMB PHONES ANYONE?
By Anonymous Reporter[s]
***
***
Allow us [me] to suggest the use of Android and iOS shortcuts that disable bio-metric unlocking on your cell phone.
“If you use a bio-metric phone sensor [eye scan or fingerprint], you can be compelled to decrypt your device for law enforcement because a bio-metric is something you are,” lawyer Riana Pfefferkorn said in a 2019 talk at the Defcon security conference.
But, “If you use a pass-code to decrypt, typically, you can’t be compelled to unlock, because a pass-code is something that you know.” Her talk did not cover how claiming to have forgotten a pass-code would affect those issues.
In either case, if your cell phone becomes in possession of federal investigators, you may faces the risk of them determining the unlock code through other means, like using such third-party tools as Cellebrite’s unlocking kits to defeat the phone’s security.
Stay Legal! Or simply invoked your Fifth Amendment right against self-incrimination; if needed.
In conclusion: I [we] advise the awareness of cell phone privacy risks involved in having so much of your life stored on personal smart cell phone devices that you take almost everywhere. Stay Safe!
Posted on October 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
***
Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
PayPal completed its first transaction using its proprietary stablecoin to pay an invoice to Ernst & Young. It’s a milestone for the payments company’s advance into cryptocurrency.
The free IRS tax filing software, which was piloted in 12 states for the 2024 tax season, will be available in 24 states for 2025.
Your loss is our gain: Shares of airline stocks popped on the news of Spirit’s problems. Delta Air Lines ascended 3.84%, United Airlines climbed 6.47%, and Frontier Group Holdings soared 16.43%.
Albemarle popped 8.25% on the rumor that mining behemoth Rio Tinto may try to make an acquisition of the lithium miner. Other potential takeover targets rose as well, including Arcadium (up 10%) and SQM (up 3%).
Abercrombie & Fitch rose 9.10% thanks to an upgrade from JP Morgan analysts, who are bullish about the fashion retailer’s recent momentum.
Ubisoft Entertainment skyrocketed 29.87% on the news that the video game maker’s parent company and founders are considering a buyout.
Homebuilder stocks sank on today’s strong jobs report, which propelled treasury yields higher, which means that mortgage rates aren’t getting any lower. D.R. Horton dropped 2.91%, Lennar fell 2.52%, and Toll Brothers lost 2.57%.
Transportation stocks fell thanks to an agreement between port owners and longshoremen to put the recent strike on pause. Moller-Maersk lost 5.37%, while Zim IntegratedShipping Services stumbled 12.55%.
The S&P 500® index (SPX) climbed 51.13 points (0.9%) to 5,751.07 up 0.22% for the week;the Dow Jones Industrial Average® ($DJI) added 341.16 points (0.81%) to 42,352.75, up 0.09% for the week; and the NASDAQ Composite® ($COMP) rose 219.37 points (1.22%) to 18,137.85, up 0.1% for the week.
The 10-year Treasury note yield (TNX) soared 13 basis points to 3.98%, finishing the week up 23 basis points. The 2-year yield rose 37 basis points this week.
The CBOE Volatility Index® (VIX)fell to 18.58 but remains elevated from last month’s lows, likely on geopolitical concerns.
Only 2% of the homes hit by Hurricane Helene in Georgia, North Carolina, and South Carolina had a policy protecting them against catastrophic flooding, according to an analysis by Politico and E&E News.
The US Hiring Pace picked up strongly in September and the unemployment rate ticked down to 4.1%, signs the U.S. economy had continued momentum in a month the Federal Reserve delivered its first interest-rate cut in four years. U.S. employers added 254,000 jobs last month, the Labor Department said Friday.
Posted on September 27, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
What is it – How it works
[By Dr. David E. Marcinko MBA MEd and staff reporters]
The butterfly effect refers to a concept that small causes can have large effects. Initially, it was used with weather prediction but later the term became a metaphor used in and out of science.
***
[Copyright 2019 iMBA, Inc. All rights reserved. USA.]
***
The term, closely associated with the work of Edward Lorenz, is derived from the metaphorical example of the details of a tornado (the exact time of formation, the exact path taken) being influenced by minor perturbations such as the flapping of the wings of a distant butterfly several weeks earlier. Lorenz discovered the effect when he observed that runs of his weather model with initial condition data that was rounded in a seemingly inconsequential manner would fail to reproduce the results of runs with the unrounded initial condition data. A very small change in initial conditions had created a significantly different outcome.
In chaos theory, the butterfly effect is the sensitive dependence on initial conditions in which a small change in one state of a deterministic nonlinear system can result in large differences in a later state.
In Psychology / Psychiatry
Although I first learned about the Butterfly Effect is high school physics class, I also later learned that it relates to psychological/psychiatry in medical school. It seems the effect serves as a metaphor for life in a chaotic world. Specifically, it suggests that small events can have very large psychological / psychiatric effects.
In Insurance and Risk Management
As a health economist, and former financial advisor, I also know that the Butterfly Effect is related to the insurance and financial service industries; as weill as risk management theory in general.
Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds.
THE ME-P DISCLAIMER: Posts, comments and opinions do not necessarily represent iMBA, Inc., but become our property after submission. Copyright © 2006 to-date. iMBA, Inc allows colleges, universities, medical and financial professionals and related clinics, hospitals and non-profit healthcare organizations to distribute our proprietary essays, photos, videos, audios and other documents; etc. However, please review copyright and usage information for each individual asset before submission to us, and/or placement on your publication or web site. Attestation references, citations and/or back-links are required. All other assets are property of the individual copyright holder.
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 