BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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According to Wikipedia, selling away in the U.S. securities brokerage industry is the inappropriate practice of an investment professional who sells, or solicits the sale of, securities not held or offered by the brokerage firm with which he is associated.
An example of the term expressed in a sentence is, “The broker was selling investments away from the firm.” Brokers marketing securities must have obtained the appropriate securities licenses for various types of investments. Brokers in the U.S. may be “associated” with one or more Brokerage firms and must obtain licenses by passing standardized Financial Industry Regulatory Authority exams such as the Series 6 or Series 7 exam.
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In the past I’ve held these as well as a Series 63 and 65 license [SEC].
Posted on October 11, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Book Marcinko for your Next Financial Planning Seminar, Meeting or Medical Business Event
By Ann Miller RN MHA
Professor and physician executive David Edward Marcinko MBBS DPM MBA MEd BSc CMP® is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; Oglethorpe University, and Atlanta Hospital & Medical Center in GA; and the Aachen City University Hospital, Koln-Germany. He is one of the most innovative global thought leaders in health care business and entrepreneurship today.
Dr. Marcinko is a multi-degreed educator, board certified physician, surgical fellow, hospital medical staff President, Chief Education Officer and philanthropist with more than 400 published papers; 5,150 op-ed pieces and over 125+ international presentations to his credit; including the top 10 biggest pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].
Dr. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner®, who was named “Health Economist of the Year” in 2001. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, management and trade publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News].
As a licensed insurance agent, RIA and SEC registered endowment fund manager, Dr. Marcinko is Founding Dean of the fiduciary focused CERTIFIED MEDICAL PLANNER® chartered designation education program; as well as Chief Editor of the HEALTH DICTIONARY SERIES® Wiki Project. His professional memberships include: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA and HIMSS.
Dr. Marcinko is a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.
A Dividend Aristocrat is a stock that has exhibited a remarkable level of consistency, measured by the fact that only those S&P 500 companies that have increased their annual dividend for 25 straight years — or more — can be called one. The name was coined by cable TV personality and investor Jim Cramer
These companies have raised their dividends through good times and bad, including recessions, crashes, and pandemics. Being able to continue doing so is a tribute to their stability and strength. Now, the past 18 months have been a particularly difficult economic environment to operate in, and some companies were forced to slash or hold the line on their dividends as a result.
But others are just fine, like investment manager T. Rowe Price (NASDAQ: TROW), which increased its dividend for the 35th straight year in 2022. It is located in Baltimore Maryland not far from where I grew up. In fact, I used to play stick ball, as a kid, in the parking lot.
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies provides that blueprint. ―David B. Nash, MD, MBA, Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizations that physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
Posted on September 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Everyone wants to be a doctor – or get paid like one!
[By Dr. David Edward Marcinko MBA CMP™]
Most regular ME-P readers and subscribers know that I am a Jaguar automobile fan. Except perhaps for a Bentley or Rolls Royce, I think that Jags are the finest mass produced luxury vehicles on the planet.
Backstory
My regular car guy, Jimmie the mechanic, was removing a cylinder head from a late model Jaguar sedan when he spotted a world-famous heart surgeon in his garage; we have many such dignitaries on this side of town.
In fact, it is called “pill-hill” around here, for the many hospitals, medical clinics and physician offices. The heart surgeon was waiting for the service manager to come and take a look at his car.
The Query
Jimmie shouted across the garage, ‘Hey Doc can I ask you a question?’
The famous surgeon, a bit surprised, walked over to him. Jimmie straightened up, wiped his hands on a rag and asked, ‘So Doc, look at this engine. I also can open hearts, take valves out, fix’em, put in new parts and when I finish this Jaguar will work just like a new one.’
Salary Comparisons
“So how come I work for a pittance and you get the really big money, when you and I are doing basically the same work?”
The MD’s Answer
The surgeon paused, smiled and leaned over and whispered into Jimmie’s ear: ‘Try doing it with the engine running.’
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Assessment
Of course this story is a classic; oft repeated ad nauseam.
Conclusion
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Universal Precautions refer to the medical practice of avoiding contact with patients’ bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields.
The infection control techniques were essentially good hygiene habits, such as hand washing and the use of gloves and other barriers, the correct handling of hypodermic needles, scalpels, and aseptic techniques.
Following the AIDS outbreak in the 1980s the US CDC formally introduced them in 1985–88. Every patient was treated as if infected and therefore precautions were taken to minimize risk.
There are more than 950,000 physicians in the United States. Yet, the brutal supply and demand, and demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. More so, going forward with the PP-ACA OR, perhaps not so much after the Trump election.
Furthermore, many large health care corporations, hospitals, and clinical and medical practices have not been market responsive to this change. Some physicians with top-down business models did not recognize the changing health care ecosystem or participatory medicine climate. Change is not inherent in the DNA of traditionalists. These entities and practitioners represented a rigid or “used-to-be” mentality, not a flexible or “want-to-be” mindset.
Yet today’s physicians and emerging Health 2.0 initiatives must possess a market nimbleness that cannot be recreated in a command-controlled or collectivist environment. Going forward, it is not difficult to imagine the following rules for the new virtual medical culture, and young physicians of the modern era.
A. Rule 1
Forget about large office suites, surgery centers, fancy equipment, larger hospitals, and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manners, or competitive advantage can outfox a slew of insurance companies, Certified Public Accountants, or the Associate Management Accountant, while still serving patients and making money. It is now a unit-of-one economy where “ME Inc.,” is the standard. Physicians must maneuver for advantages that boost their standing and credibility among patients, peers, and payers.
Examples include patient satisfaction surveys, outcomes research analysis, evidence-based-medicine, direct reimbursement compensation, physician economic credentialing, and true patient-centric medicine. Physicians should realize the power of networking, vertical integration, and the establishment of virtual offices that come together to treat a patient and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not a magnificent office suite or onsite presence.
B. Rule 2
Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus, and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking.” Do traditionalists or collective health care reform advocates react rationally or irrationally?
For example, some health care competition and career thought-leaders, such as Shirley Svorny, PhD, a professor of economics and chair of the Department of Economics at California State University, Northridge, wonder if a medical degree is a barrier—rather than enabler—of affordable health care. An expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.
Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.
C. Rule 3
Differentiate yourself among your health care peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors must create and innovate, not blindly follow entrenched medical societies into oblivion.
For example, the establishment of virtual medical schools and hospitals, where students, nurses, and doctors learn and practice their art on cyber entities that look and feel like real patients, can be generated electronically through the wonders of virtual reality units.
D. Rule 4
Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of quick change with fast, but informed decision making. Do what you love, disregard what you do not, and let the fates have their way with you.
Assessment
I receive a couple of phone calls each month from young doctors on this topic. I ask them to decide if they are of the philosophical ilk to adhere to the above rules; or become another conformist and go along … to get along? In other words, get fly!
Or, become an employed, or government doctor. Just remember … the entity that gives you a job, can also take it away.
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Posted on August 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Including Public Relations, Risk, Change and Crisis Management
By Dr. David Edward Marcinko MBA
Marketing is the business process of identifying, anticipating and satisfying customers’ needs and wants. It is your unique value proposition or strategic competitive advantage. Marketers can direct product to other businesses or directly to consumers.
Advertising is a marketing communication that employs an openly sponsored, non-personal message to promote or sell a product, service or idea. Sponsors of advertising are typically businesses wishing to promote their products or services. Advertising is communicated through various mass media, including traditional media such as newspapers, magazines, television, radio, outdoor advertising or direct mail; and new media such as search results, blogs, social media, websites or text messages. The actual presentation of the message in a medium is referred to as an advertisement, or “ad” or advert for short.
Advertising is differentiated from public relations in that an advertiser pays for and has control over the message. It differs from personal selling in that the message is non-personal, i.e., not directed to a particular individual. We pay for advertising but pray for public relations.
Sales are activities related to selling or the number of goods or services sold in a given targeted time period. The seller, or the provider of the goods or services, completes a sale in response to an acquisition, appropriation, requisition, or a direct interaction with the buyer at the point of sale. There is a passing of title (property or ownership) of the item, and the settlement of a price, in which agreement is reached on a price for which transfer of ownership of the item will occur. The seller, not the purchaser, typically executes the sale and it may be completed prior to the obligation of payment. In the case of indirect interaction, a person who sells goods or service on behalf of the owner is known as a salesman or saleswoman or salesperson, but this often refers to someone selling goods in a store/shop, in which case other terms are also common, including salesclerk, shop assistant, and retail clerk.
Change management is the discipline that guides how we prepare, equip and support individuals to successfully adopt change in order to drive organizational success and outcomes.
Crisis management is the identification of threats to an organization and its stakeholders, and the methods used by the organization to deal with these threats.
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Risk management is the identification, evaluation, and prioritization of risks (defined in ISO 31000 as the effect of uncertainty on objectives) followed by coordinated and economical application of resources to minimize, monitor, and control the probability or impact of unfortunate events or to maximize the realization of opportunities.
Assessment: Your thoughts are appreciated from a healthcare perspective.
QUESTION: We are in near bear market correction territory – especially for tech stocks – so what are the 2 major types of valuation approaches for common stock?
ANSWER: There are basically two different approaches for common stock valuation; top-down and bottom-up. Under either of the two fundamental approaches, a physician investor will have to work with individual company data. In reality, each of these approaches is used by investors and security analysts when doing fundamental analysis.
With the bottom-up approach, investors focus directly on a company’s prospects. Analysis of such information as the company’s products, its competitive position, and its financial status leads to an estimate of the company’s earnings potential, and, ultimately, its value in the market. Considerable time and effort are required to produce the type of detailed financial analysis needed to understand a firm’s standing. The emphasis in this approach is on finding companies with good long-term growth prospects, and making accurate earnings estimates.
The top-down approach is the opposite of the bottom-up approach. Investors begin with the economy and the overall market, considering such important factors as interest rates and inflation. They next consider likely industry prospects, or sectors of the economy that are likely to do particularly well (or particularly poorly). Finally, having decided that factors are favorable for investing, and having determined which parts of the overall economy are likely to perform well, individual companies are analyzed.
The concept of a self-taught and student motivated, but automated outcomes driven classroom may seem like a nightmare scenario for those who are not comfortable with computers. Now everyone can breathe a sigh of relief, because the Institute of Medical Business Advisors just launched an “automated” final examination review protocol that requires no programming skill whatsoever.
In fact, everything is designed to be very simple and easy to use. Once a student’s examination “blue-book” is received, computerized “robotic reviewers” correct student assignments and quarterly test answers. This automated examination model lets the robots correct tests and exams, while the students concentrate on guided self-learning.
According to Eugene Schmuckler PhD MBA MEd, Academic Provost of the CERTIFIED MEDICAL PLANNER® professional designation and certification program,
“This option allows the modern adult-learner save both time and money as s/he progresses toward the ultimate goal of board certification as a CMP® mark holder.”
The trend is growing and iMBA, Inc., is leading the way.
Posted on June 19, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
REALLY?
By Dr. David Edward Marcinko MBA
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The business cycle is also known as the economic cycle and reflects the expansion or contraction in economic activity. Understanding the business cycle and the indicators used to determine its phases may influence investment or economic business decisions and financial or medical planning expectations.
Although often depicted as the regular rising and falling of an episodic curve, the business cycle is very irregular in terms of amplitude and duration. Moreover, many elements move together during the cycle and individual elements seldom carry enough momentum to cause the cycle to move.
However, elements may have a domino effect on one another, and this is ultimately drives the cycle, too. We can also have a large positive cycle, coincident with a smaller but still negative cycle, as may be seen in the current healthcare climate of today.
First Phase: Trough to Recovery (service and production driven)
Scenario: A depressed GNP leads to declining industrial production and capacity utilization. Decreased workloads result in improved labor productivity and reduced labor (unit) costs until actual producer (wholesale) prices decline.
Second Phase: Recovery to Expansion (patient and consumer driven)
Scenario: CPI declines (due to reduced wholesale prices) and consumer real income rises, improving consumer sentiment and actual demand for consumer goods.
Third Phase: Expansion to Peak (service and production driven)
Scenario: GNP raises leading to increased industrial production and capacity utilization. But, labor productivity declines and unit labor costs and producer (wholesale) prices rise.
Fourth Phase: Peak to Contraction (patient and consumer driven)
Scenario: CPI rises making consumer real income and sentiment erode until consumer demand, and ultimately purchases, shrink dramatically. Recessions may occur and economists have an alphabet used to describe them.
For example, with a “V” graph shape, the drop and recovery is quick. For a “U” shaped graph, the economy moves up more sluggishly from the bottom. A “W” is what you would expect: repeated recoveries and declines. An “L” shaped recession describes a prolonged dry economic spell or even depression.
Posted on June 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
About the SoPE
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By Dr. David Edward Marcinko MBA
The Society of Physician Entrepreneurs (SoPE) was established as a community of interest in 2008 by several members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), including Dr. Arlen Meyers, the President & CEO. SoPE became a separate and independent legal entity; incorporating in Washington, D.C. in January 2011.
It is a 501 (c) 6 member organization with the stated purpose of providing support; idea stage through funding, for physician entrepreneurs with ideas on how to improve healthcare. Currently there are over 1,000 members included in their LinkedIn site.
Vision
SoPE’s vision is to accelerate physician originated biomedical innovation.
Mission
The mission of SoPE is to foster scholarship in biomedical entrepreneurship and provide education, training and support; idea stage through funding, to primarily community-based physician entrepreneurs in the interest of better healthcare.
Membership
SoPE membership is open to all physicians and also accepts individuals as associate members; representatives of medical device, legal, venture capital, and other firms with an interest in serving and/or supporting physician entrepreneurs.
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:
Posted on May 19, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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As part of its Mental Health initiative, MTV’s second-annual Mental Health Action Day – an open-source movement of brands, organizations, government agencies, and cultural leaders to drive culture of mental health from awareness to action – will bring together more than 1,600 organizations in cities across the country to encourage and empower people to take action for mental health on Thursday, May 19, 2022.
Posted on May 10, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Altered and Poorly Written Rx for Vicodin
By Dr. David Edward Marcinko MBA
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Poorly-written Rx for vicodin
Drug: Rx Vicodin
Disp: # 10
Sig: Take I, as needed for pain.
Refills: 1 2 3 4 or 5
AM2685591
David Edward Marcinko, MBBS DPMMBA
The patient abuser may change drug quantity numbers, copy or remember the doctors’ DEA number, or take extra Rx pads. For this reason, a physician’s Rx pad should contain his/her name, address and telephone number. The doctor’s DEA number should not be pre-printed on the pad, for fear of mis-use.
Example:
Increase the quantity 10, to 100, by adding a zero, so that the additional capsules can be used, sold or bartered with on the street.
Change the directions to take 2 capsules, rather than 1 in order to produce greater euphoria.
Increase the Rx refills, from one to two, by extending the underline, or checking an additional quantity box.
Pre-printed DEA number can be stolen, sold or reused.
Pre-printed (not original) physician signature can be reproduced and widely distributed for more prescriptions.
Altered Rx for vicodin
Drug: Rx Vicodin
Disp: # 100
Sig: Take II, as needed for pain.
Refills: 1 2 3 4 or 5
AM2675591
David Edward Marcinko, MDBBS DPM MBA
The doctor drug addict, or a doc in need of funds, may write for more narcotic agent than needed, and receive the additional pills back from the patient-shill for personal consumption, sell them on the street himself for money, or receive a monetary kickback from the patient-shill.
A pharmacist may also indirectly alter a prescription using the above methods, or simply short-change the patient with fewer narcotic capsules than the prescription intends. This is more difficult to do with pills or tablets in the out patient setting, but easy to do in the in-patient setting when liquid IV drugs are used, by dilution and placing less than the full amount in IV bottles or bags. The harm to patients, of course, may be fatal.
Well-written Rx for vicodin
Drug: Rx Vicodin
Disp: # 10 (ten) capsules
Sig: Take one or two capsules, po, prn pain.
Refills: 1 2 3 4 or 5
AM2685591
David Edward Marcinko, MBBS DPM MBA
Example:
Drug quantity can-not be changed.
Directions can-not be changed. Route of administration (by mouth) indicated.
Rx refills clearly indicated.
Handwritten, not pre-printed, DEA number.
Original physician signature, only.
Doctor Rx prescription abuse foibles are legendary in the DEA and include a Maryland podiatrist who wrote prescriptions for more than 1,235 Mepergan Fortis capsules ostensibly for his wife following minor foot surgery. Or, the Florida physician who prescribed more than 2,150 Vicodin capsules for a patient with whom he was having an extra-marital affair in order that his consort not disclose the fling to his wife. Or, the osteopath from New Jersey who wrote more than 100 narcotic prescriptions every 8 hour day, for more than a year, to any patient standing in a line in front of his office. And, finally the California dentist whose excuse for writing more than 1,845 narcotic tablet prescriptions in a six month period for the same patient was that they would be needed in his next reincarnation. Yes, all of these incidents are laughable if not for their serious consequences to the involved individuals, and society, alike. The bastards!
Fortunately, unlike drug local domestic drug kingpins or international narco-traffickers who ply their trade virtually undetected, these naive white-collared nerds, always get caught by the Drug Enforcement Agency. Their Rx abuse tactics are so amateurish!
Posted on May 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Dr. David Edwarrd Marcinko MBA
Rx DRUG ABUSE
Traditional medicinal agents come in a variety of ways, known as dispensing vehicles. Drugs may be in liquid, pill or inject able form, they may be compounded in capsules, caplets, gelatin tablets, powders or suppositories, or they may come in creams or ointments for the eye, anus and vagina. They may be ingested into the stomach, placed and dissolved under the tongue, put into the eyes, popped, injected or smeared and transported through the human skin from patches.
A valid drug prescription is a written order, by a doctor, to a pharmacist. In this country, prescriptions are written by physicians, podiatrists, osteopaths, dentists. and some optometrists, physician assistants and nurse practitioners. In addition to the name of the patient and that of the medical prescriber, the prescription contains the name of the drug (not necessarily a narcotic), its quantity, instructions to the pharmacist, and directions to the patient. Narcotic prescriptions may not be prescribed to a drug addict to prevent withdrawal symptoms, as there must be some other therapeutic purpose for such an order.
The art of medicinal prescription writing, and pharmaceutical compounding, has declined in modern medicine for several reasons. Most drugs are made by pharmaceutical companies, and the role of the pharmacist, in most cases, consists only of compounding and error prevention. Many drugs are even automatically dispensed, and tracked, in the hospital setting with bar coding technology and modern inventory tracking mechanisms. Also, the practice of writing long and complicated prescriptions, containing many active ingredients, adjuvants, correctives, and elegant vehicles, has been abandoned in favor of using pure compounds.
Drugs may be prescribed by their official names, which were first given by the United States Pharmacopeia (USP), in 1920, or by the National Formulary (NF), since 1906. Unofficial or generic names may be used, known as New and Non-Official Drugs (NND) or by the United States Adopted Names (USAN), or by the manufactures trade name. For example, the generic narcotic meperidine or pithidine, is also known by the trade named, demerol. The designation USAN does not imply endorsement by the American Medical Association (AMA) Council on Drugs (CODs), or by the USP.
Of course, there is an advantage and disadvantages to prescribing drugs by their trade name, or generic names. Advantages of generics include economies of scale for both the patient and pharmacist, and although the active ingredient in generics are identical to trade drugs, they are often less expensive since research and development costs are absent, and various binders, colorizing agents, preservatives or dispersing agents are of an inferior quality, and hence cheaper for the patient. Appearance, size and taste issues are common. For the pharmacist, generics are cheaper since a multiplicity of very similar drugs need not be shelved.
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For example, the tablet or capsular form of many drugs contains inactive ingredients, such as: ammonio methacrylate copolymer, hydroxypropyl methylcellulose, lactose, magnesium stearate, povidone, redironoxide, stearyl alcohol, talc, titanium dioxide, triacetin, yellowironoxide, yellowironoxide with FD&C blue No.2 (80 mgstrengthtablet only), FD&C blue No.2 and other ingredients. And yes, I’ve seen an addict do into shock, or die from acute anaphylaxis, after taking drugs containing ingredient he was highly allergic to.
Shock is a life-threatening condition where blood pressure falls too low to sustain life. It occurs when low blood volume (due to severe bleeding, excessive fluid loss or inadequate fluid uptake), inadequate pumping action of the heart or excessive dilation of the blood vessel walls (vasodilation) causes low blood pressure. This in turn results in inadequate blood supply to body cells, which can quickly die or be irreversibly damaged.
Anaphylactic shock is the severest form of allergy that is a medical emergency. It is a Type I reaction according to the Gell and Coombs medical classification, and is often severe and sometimes fatal systemic reaction in a susceptible individual upon exposure to a specific antigen (such as wasp venom or penicillin) following previous sensitization, or drug use. Characterized especially by respiratory symptoms, fainting, itching, itching and swelling of the throat or other mucous membranes and a sudden decline in blood pressure! The victim literally cannot breathe and drowns in its own congested and fluid filled lungs
So, patients in need of routine drugs for acute or chronic conditions like arthritis, high blood pressure, asthma, acne, hay fever, performance enhancing steroids or, so called life style drugs, like Viagra for a limp woody, or hair growth stimulator Rogaine, may get a good deal by going to Canada or Mexico for generics. But for important drugs, like nitroglycerine fro your heart, blood thinner coumadin, birth control pills or various anti-cancer agents, stick with brand names.
The main disadvantage of trade drugs is increased cost, due to R & D, patents, trademarks, marketing and company advertising expenses. Of course, trade drug are first to market, and hence may be beneficial as a new treatment modality, or injurious if significant side affects or other complications arise.
Today, the prime source for drug information is probably the well known, Physicians Desk Reference (PDR). Now, in its 58th edition, the PDR® provides the latest information on prescription, but not illegal street drugs. It is considered the standard reference that can be found in virtually every physician’s office, hospital and pharmacy in the United States. The current edition is over 3,000 pages long, and is where you can find data on more than 4,000 drugs, by brand and generic name, manufacturer and product categories. The PDR also provides usage information and warnings, drug interactions, plus full-size, full-color photos cross-referenced to specific drugs. For the layman, it also includes: phonetic spelling for each listing, a key to controlled substances, adverse reactions and contraindications, pregnancy ratings, dosages and all other FDA-required information. Of course, on the street, or in Mexico, none of this information matters.
Latin abbreviations, sometimes still used by doctors on prescription blanks include:
Rx = take thou (receipe)
po = by mouth (para orbis)
prn = as needed (pro re’nata)
hs = at bed time (hora somnae)
BID = twice daily
TID = three times daily
QID = four times daily
M = Mix
Traditionally, a medical prescription is written in a certain order, well known to drug abusers, and DEA agents, and consist of six basic parts:
Superscription: This is the Rx, or recipe. In Latin it means take thou.
Inscription: Represents the ingredients and amounts.
Subscription: Represent the description for drug dispensing, and may be represented by the letter M, for mix.
Signature: Often abbreviated as Sig, and contains the directions for patient use.
Refill Status: Indicates the number of refills allowed.
DEA Number: This is nine-character alpha-numeric sequence, used by all licensed physicians who prescribe narcotic agents. An example is AM2685591. The second letter is the first letter of the doctor’s last name, (ie, Marcinko) and the first two digits add up to the third (ie, 2+6=8).
Finally, in addition to the basic parts of a prescription, it should have the patient’s name, and physician signature written in ink, followed by degree designation, such as MD, DPM, DO or DDS, etc.
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Perhaps the most egregious narcotic prescribing habits recently encountered by DEA agents have been by doctors of all degrees and medical designations. Reasons are generally two-fold. First, the doctor may become a drug addict himself, either by accident or through initial legitimate therapeutic use, and over-prescribe the narcotics. Or, increasing office costs, and decreased reimbursement fee reductions of many managed medical care have so economically destabilized the medical community, that economically impoverished doctors desperately sell prescriptions to finance their personal lifestyles, automobiles, clothes, fancy vacations or own addictions.
For example, a staggering medical student loan debt burden of $100,000-$250,000 is not unusual for new practitioners. In fact, the federal Health Education Assistance Loan (HEAL) program reported that for the Year 2001, it squeezed significant repayment settlements from its Top 5 list of deadbeat doctor debtors. This included a $303,000 settlement from a New York dentist, $186,000 from a Florida osteopath, $158,000 from a New Jersey podiatrist, $128,000 from a Virginia podiatrist, and $120 from a Virginia dentist. The agency also excluded 303 practitioners from Medicare, Medicaid and other federal healthcare programs and had their cases referred for non-payment of debt.
These facts indicate that the current healthcare reimbursement climate has caused more pain and tumult to doctors than the pubic realizes. Older medical practitioners are retiring prematurely, mature providers are frustrated and in despair, and young physicians have no concept of the economic servitude to which they are about to be subjected. Frustration is high and physician suicides have been documented. Many doctors get divorced at the start of their careers. Even the U.S. Inspector General has declared healthcare providers to be public enemy #2,behind international narco-traffickers, for their federal drug, fraud and abuse initiatives. Still, the statistic above lends itself to narcotic drug prescription abuse, either on the part of the doctor or patient, since only these two parties that can directly alter a prescription for illicit drug use, as illustrated by this poorly written prescription for a narcotic pain killer, vicodin.
Posted on May 6, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
May 2nd to May 6th
DEALS AND FREEBIES
By Dr. David Edward Marcinko MBA
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In 1984, the National Parents Teachers Association designated the first week of May as Teacher Appreciation Week as a special time to honor the individuals who educated our children. It has become a tradition for restaurants and businesses to offer special deals during that week.
Posted on April 23, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
“Now and Then”
By Dr. David Edward Marcinko MBA
[Editor-in-Chief]
I was recently at a car show and could not help but snap a photo of the beautiful black 1955 vehicle; below.
Ambulance Defined [Wikipedia]
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient. The word is often associated with road going emergency ambulances which form part of an emergency medical service, administering emergency care to those with acute medical problems.
The term ambulance does, however, extend to a wider range of vehicles other than those with flashing warning lights and sirens. The term also includes a large number of non-urgent ambulances which are for transport of patients without an urgent acute condition (see functional types, below) and a wide range of urgent and non-urgent vehicles including trucks, vans, bicycles, motorbikes, station wagons, buses, helicopters, fixed-wing aircraft, boats, and even hospital ships (see vehicle types, also below).
The term ambulance comes from the Latin word ambulare, meaning to walk or move about which is a reference to early medical care where patients were moved by lifting or wheeling. The word originally meant a moving hospital, which follows an army in its movements. During the American Civil War vehicles for conveying the wounded off the field of battle were called ambulance wagons. Field hospitals were still called ambulances during the Franco-Prussian War of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the Crimean War.
There are other types of ambulance, with the most common being the patient transport ambulance (sometimes called an ambulette). These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. Such vehicles are called fly-cars. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.
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[The Editor in Marquette, MI]
Hearse Defined [Wikipedia]
Originally, a hearse was an elaborate framework that was erected over a coffin or tomb to which memorial verses or epitaphs were attached. It was then put on the top of horse-drawn carriages, looking much like a luggage rack. Today, the original hearse remains acknowledged by the bit of scroll work or stretched-out “S” on the side of a funeral coach, called Landau bars.
Hearses were originally horse-drawn, but silent electric motorized carts were introduced as horses began to be phased out as transportation. Examples that were used in Paris were reported in the pages of Scientific American May 1907 and petrol-driven hearses began to be produced from 1909 in the United States. Motorized hearses became more widely accepted in the 1920s.
The vast majority of hearses since then have been based on larger, more powerful car chassis, generally retaining the front end up to and possibly including the front doors but with custom bodywork to the rear to contain the coffin. Some early hearses also served as ambulances, owing to the large cargo capacity in the rear of the vehicle. A few cities experimented with funeral trolley cars and/or subway cars to carry both the casket and mourners to cemeteries, but these were not popular.
The only exception was Chicago, IL which operated 3 different funeral trolley cars over the elevated tracks in downtown Chicago to outlying cemeteries in the western suburbs. A special funeral bureau handled the funeral trains which sometimes operated 3-4 funeral trains a week over the ‘L’.
Back in 1955, this Cadillac performed double-duty for a small town in North East Georgia. Both as ambulance for the still living, as well as hearse for the newly deceased. Notice the dual red [“cherry”] light and siren on the roof A very utilitarian approach to both functions, don’t you think?
History [Wikipedia]
A combination car was a vehicle built upon a (usually Cadillac) “professional car” chassis which could be employed either as a hearse or as an ambulance, and had the capability of being swapped between those roles without much difficulty. These vehicles were upgraded by coachbuilders such as Superior, Miller-Meteor, and Cotner-Bevington, and were typical of the era when funeral homes offered emergency ambulance service in addition to their primary trade.
Even if a “combo” has no flashing lights (mounted or concealed), siren, or two-way radio installed, an experienced vehicle collector can recognize it as such by it having systems to carry either a gurney or a casket, one or more foldable seats on one side in the rear compartment where a first-aid person can sit while looking after a patient on their way to the hospital, and a cabinet where first-aid supplies can be stored.
Also, the presence of ambulance technology made combos useful in the first call role, as a gurney is also used in that function.
Some combos were equipped with rotating roof beacons that could flash either yellow lights in processional mode, or both red and yellow lights in emergency response mode. Alternately, a hole on the roof was often supplied where a beacon could be bolted on an intermittent basis, a wire passing through to the driver’s compartment where it could be plugged in when needed.
Combos employed more often or exclusively as ambulances were often fitted with ambulance markings and additional lighting. However, usage of passenger car or station wagon derived vehicles as ambulances became impractical in the US after c. 1980 due to upgraded equipment and interior measurement requirements imposed by US government regulators. Many such vehicles were donated or otherwise found their way to developing nations.
The Cadillac combination unit was made famous in Ghostbusters as the Ecto-1, a modified 1959 Miller-Meteor coach.
Note: The Hess & Eisenhardt company also produced luxury Jaguar automobiles; my favorites.
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[My vintage 2000 Jaguar XJ-V8L Touring Sedan]
Conclusion
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DEFINITION: A centenarian is a person who has reached the age of 100 years. Because life expectancy worldwide are below 100 years, the term is invariably associated with longevity. In 2012, the United Nations estimated that there were 316,600 living centenarians worldwide.
Sto Lat (One Hundred Years) is a traditional Polish song that is sung to express good wishes, good health and long life to a person. It is also a common way of wishing someone a happy birthday in Polish. Sto lat is used in the Spring, many birthdays and on international days of language.
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What Percentage of the Population Lives to 100?
According to the Social Security Administration, the overall chances of living to 100 aren’t actually that great. And, according to the World Economic Forum, there are over 500,000 centenarians among the 7.9 billion people worldwide. That means that only a 0.006% of the population is 100 or more.
Here are a few additional facts from the most recently available information from the Society of Actuaries and the Social Security Administration:
One out of three males and one out of two females who are in their mid-50s today will live to be 90.
For a couple who is 65 today, there is a 50% chance that one person will be alive at 92.
If you have lived to be 65, you will likely live another 20 years, on average.
If you live to be 75, the average life expectancy is 88.
If you live to be 85, the average life expectancy is 92.
And, if you live to be 95, the average life expectancy is 98.
Hospitals, a local family practice office, a pharmaceutical company, all likely have one thing in common. Somewhere within these companies or partnerships, there are key employees or profit makers. Due to their expertise, management skills, knowledge, or “history of why,” they have become indispensable to their employers.
If this key employee were to die prematurely, what would potentially happen to the company? In many cases, especially in smaller companies, it would have a devastating effect on the bottom line, or even precipitate a bankruptcy. In these circumstances, a form of business insurance, called key person coverage, is recommended in order to alleviate the potential financial problems resulting from the death of that employee.
The business would purchase and own a life insurance policy on the key person. Upon the death of the employee, the life insurance proceeds could be used to:
Pay off bank loans.
Replace the lost profits of the company.
Establish a reserve for the search, hiring and training of a replacement.
[B] Business Continuation Funding
See the chapters on buy-sell agreements and asset protection planning.
[C] Executive Bonus Plan
An executive bonus plan (or § 162 plan) is an effective way for a company to provide valued, select employees an additional employment benefit. One of the main advantages to an executive bonus plan, when compared to other benefits, is its simplicity. In a typical executive bonus plan, an agreement is made between the employer and employee, whereby the employer agrees to pay for the cost of a life insurance policy, in the form of a bonus, on the life of the employee.
The major benefits of such a plan to the employee are that he or she is the immediate owner of the cash values and the death benefit provided. The only cost to the employee is the payment of income tax on any bonus received. The employer receives a tax deduction for providing the benefit, improves the morale of its selected employees, and can use the plan as a tool to attract additional talent.
[D] Non-Qualified Salary Continuation
Commonly referred to as deferred compensation, this is a legally binding promise by an employer to pay a salary continuation benefit at a specific point in the future, in exchange for the current and continued performance of its employee. These plans are normally used to supplement existing retirement plans.
Although there are different variations of deferred compensation, in a typical deferred compensation agreement, the employer will purchase and own a life insurance policy on the life of the employee. The cash value of the policy grows tax deferred during the employee’s working years. After retirement, these cash values can be withdrawn from the policy to reimburse the company for its after-tax retirement payments to the employee.
Upon the death of the employee, any remaining death benefit would likely be received income tax free by the employer (Alternative Minimum Taxes could apply to any benefit received by certain larger C corporations). The death benefit could then be used to pay any required survivor benefits to the employee’s spouse, or provide partial or total cost recovery to the employer.
In a typical plan, the terms of the agreement are negotiated as to the amount of benefit received by the employee, when retirement benefits can begin, how long retirement benefits will be paid, and if benefits will be provided for death or disability. The business has established what is commonly referred to as “golden handcuffs” for the employee. As a result, the benefit will only be received if the employee continues to work for the company until retirement. If the employee is terminated or quits prior to retirement, the plan would end and no benefits would be payed.
[E] Split Dollar Plans
Split dollar arrangements can be a complicated and confusing concept for even the most experienced insurance professional or financial advisor. This concept is, in its simplest terms, a way for a business to share the cost and benefit of a life insurance policy with a valued employee. In a normal split dollar arrangement, the employee will receive valuable life insurance coverage at little cost to them. The business pays the majority of the premium, but is usually able to recover the entire cost of providing this benefit at termination of employment, death or surrender of the policy.
Following the publication of IRS Notices 2002-8 and 2002-59, there are currently two general approaches to the ownership of business split-dollar life insurance: Employer-owned or Employee-owned.
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[1] Employer-Owned Method
In the employer-owned method the employer is the sole owner of the policy. A written split-dollar agreement usually permits the employee to name the beneficiary for most of the death proceeds. The employer owns all the cash value and has the unfettered right to borrow or withdraw it as necessary. At the end of the formal agreement, the business can generally (1) continue the policy as key person insurance, (2) transfer ownership to the insured and report the cash values as additional income to the insured, (3) sell the policy to the insured, or (4) use a combination of these methods. This is commonly referred to as “rollout.”
Practitioners should be careful not to include rollout language in the split-dollar agreement. The reason the rollout should not be included is that if the parties formally agree that after a specified number of years—or following a specific event—related only to the circumstances surrounding the policy, that the policy will be turned over to the insured, the IRS could declare that the entire transaction was a sham and that its sole purpose was to avoid taxation of the premiums to the employee, generating substantial interest and penalties in addition to the additional taxes due.
The death proceeds available to the insured employee’s beneficiary is considered a current and reportable economic benefit (REB), and it is an annually taxable event to the employee. If an individual policy is involved, the REB is calculated by multiplying the face amount times the government’s Table 2004 rates or the insurance company’s alternative term rates, using the insured’s age. If a second-to-die policy is involved, the government’s PS38 rates or the company’s alternative PS38 rates will be used. Any part of the premium actually paid by the employee is used to offset any REB dollar-for-dollar.
[2] Employee-Owned Method
With the employee-owned method, the insured-employee is generally the applicant and owner of the policy. Any premiums paid by the business are deemed to be loans to the employee and the employee reports as income an imputed interest rate on the cumulative amount of loan based on Code § 7872. A collateral assignment is made for the benefit of the business to cover the cumulative loan amount. In some cases, the assignment may allow the assignee to have access to the cash values of the policy by way of a policy loan. This method is unavailable for officers and executives of publicly- held corporations because of the current restrictions on corporate loans (the Sarbanes-Oxley Act of 2002).
The employee-owned method is somewhat similar to the older collateral assignment form of split-dollar. The benefits for the employee are both the ability to control large amounts of death proceeds as well as developing equity in the policy. Whether or not this new method catches on will depend greatly on the imputed interest rate published by the IRS every July. If set low enough, this may be an excellent opportunity for the employee to use inexpensive business dollars to pay for life insurance.
Posted on April 8, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA
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National Public Health Week is observed during the first week of April every year. That’s seven days to champion the health of all Americans. It’s a week to recognize that everyone should lead healthier lives, irrespective of where they live, work, or come from. Since its founding in 1955, the initiative has become an important movement to highlight issues that can improve the health and happiness of a nation. You could choose to crush a workout or any workout challenge today. It’s a great week to start eating healthy and stick to it. Whatever you do, remember to involve your friends, family, and the larger community. It’s also a week when we campaign for health policies that are fair, inclusive, and accessible to all communities in the United States.
The first National Public Health Week took place in April 1955 and was organized by the American Public Health Association (A.P.H.A.). Since then, the initiative has received tremendous support from civil societies and administrations across the United States. The day recognizes the long history and achievements in public health. It also serves to highlight critical issues to help people lead healthier and happier lives.
In attempting to reach these goals, National Public Health Week seeks to address the root causes of poor health, disease, and lifestyles. It starts with recognizing that healthcare is still a privilege many cannot afford. Where people are born, their neighborhoods, places of work, different lives, and backgrounds determine the quality of healthcare access.
For example, a child who goes to school hungry will not be an engaged student. People working for minimum wages sacrifice health for the sake of an income. It’s thousands of families who have no access to nutritious food in their communities. Or those without the means to travel to access quality healthcare, often located far away.
National Public Health Week is committed to making health inclusive and equitable. It hopes to foster decision-making that considers the health of all communities — irrespective of income, race, or gender. Each year, the first full week in April celebrates the power of the community in realizing this vision. The A.P.H.A. usually announces different themes for each day of the week. From fitness challenges and discussions to sharing healthy recipes — it’s seven days of committing to health as a country.
So, no matter where you are, APHA invites you to join us as we celebrate National Public Health Week! This year’s theme, Public Health Is Where You Are, celebrates what we know is true: The places where we are, physically, mentally and societally, affect our health and our lives.
Celebrate and promote health in your community by hosting your own NPHW event!
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… Here are a few ideas:
Host virtual health panels and discussions. …
Team up to reach new audiences and build community. …
Pink sheets are an over-the-counter (OTC) market that connects broker-dealers electronically. There is no trading floor and the quotations are also all done electronically. Since there is no central trading floor or stock exchange like the New York Stock Exchange (NYSE), the pink sheet-listed companies do not have the same criteria to fulfill as the companies listed on national stock exchanges. Many stocks listed on the pink sheets are low-priced penny stocks that trade for under $5 a share.
Pink sheets got their name because the original pink sheets listing the stocks were actually printed and distributed on pink pieces of paper. Trading over-the-counter (OTC) refers to the process of how securities listed on the pink sheets are traded through a broker-dealer network.
Recent advances in biomedical and health sciences—from immunotherapy to treat cancer, to the highly effective COVID-19 vaccines—demonstrate the strengths and successes of the U.S. biomedical enterprise. Such advances present an opportunity to revolutionize how to prevent, treat, and even cure a range of diseases including cancer, infectious diseases, Alzheimer’s disease, and many others that together affect a significant number of Americans.
To improve the U.S. government’s capabilities to speed research that can improve the health of all Americans, President Biden is proposing the establishment of the Advanced Research Projects Agency for Health (ARPA-H). Included in the President’s FY2022 budget as a component of the National Institutes of Health (NIH) with a requested funding level of $6.5B available for three years, ARPA-H will be tasked with building high-risk, high-reward capabilities (or platforms) to drive biomedical breakthroughs—ranging from molecular to societal—that would provide transformative solutions for all patients.
Posted on March 22, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
Managerial Accounting
By Dr. David E. Marcinko MBA
Recently, several major banking institutions have addressed the problem of escalating debt upon graduating physicians, mid-life practitioners and even seasoned healthcare providers; despite historically low rates for prime customers.
Unfortunately, one may still wonder how many clinicians truly appreciate the risks associated with usurious interest rates for homes, cars, medical equipment and other consumer items; as we offer the following review to reduce this peril.
Posted on March 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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Advancing the Science of Medicine with a Priceless, No Cost Option
Everything we know about the human body comes from studying whole body donors. At MedCure, they connect you or your loved ones to the physicians, surgeons, and researchers who are continuing this vital work. Their discoveries and innovations help people live longer, make treatments less invasive, and create new ways to prevent illness or disease.
They are constantly overwhelmed by the incredible generosity and selflessness of donors. MedCure honors their gifts by covering, upon acceptance, all expenses related to the donation process. These costs include transportation from the place of passing, cremation, and a certified copy of the death certificate, as well as the return of cremated remains to the family or a scattering of the ashes at sea. By request, they can provide a family letter that shares more detailed information on how you or your loved one contributed to medical science.
Devaluation is the deliberate downward adjustment of the value of a country’s money related to another currency, group of currencies or currency standard. It is often confused with depreciation and is the opposite of revaluation which refers to the readjustment of a currency exchange rate.
The government of a country may decide to devalue its currency and like depreciation it is not the result of non-governmental activities.
One reason a country made devalue its currency is to combat a trade imbalance. Devaluation reduces the cost of a country’s export rendering them more competitive in the Global market which is which in turn increases the cost of imports.
If imports are more expensive domestic consumers are less likely to purchase them further strengthening domestic businesses because exports increase and imports decrease there is typically a better balance of payments because the trade deficit shrinks. In short a country that devalue its currency can produce is difficult because there is a greater demand for cheaper exports.
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In accountancy, depreciation refers to two aspects of the same concept: first, the actual decrease of fair value of an asset, such as the decrease in value of factory equipment each year as it is used and wear, and second, the allocation in accounting statements of the original cost of the assets to periods in which the assets are used (depreciation with the matching principle).
Depreciation is thus the decrease in the value of assets and the method used to reallocate, or “write down” the cost of a tangible asset (such as equipment) over its useful life span. Businesses depreciate long-term assets for both accounting and tax purposes. The decrease in value of the asset affects the balance sheet of a business or entity, and the method of depreciating the asset, accounting-wise, affects the net income, and thus the income statement that they report.
Paul Edward Farmer (October 26, 1959 – February 21, 2022) was an American medical anthropologist and physician. Farmer held an MD and PhD from Harvard University, where he was the Kolokotrones University Professor and the chair of the Department of Global Health and Social Medicine at Harvard Medical School. He was the co-founder and chief strategist of Partners In Health (PIH), an international non-profit organization that since 1987 has provided direct health care services and undertaken research and advocacy activities on behalf of those who are sick and living in poverty. He was professor of medicine and chief of the Division of Global Health Equity at Brigham and Women’s Hospital.
Dr. Farmer had written extensively on health and human rights, the role of social inequalities in the distribution and outcome of infectious diseases, and global health.
The Physician Executive Summary is always included at the beginning of a formal business plan and represents a brief synopsis of the medical prarctice entire plan. Its appearance, grammar and style should be sharp and crisp as it represents an enticement for the reader to maintain interest and contribute intelligent or economic input into the new venture.
It should contain information about the practice, advertising and marketing opportunities, physician management, proposed financing with four Pro Forma financial statements, business operations and exit strategy. This last point, while unpleasant is often overlooked by naive practitioners. Business experts however, look favorably upon an escape plan and view it as the mark of mature professional that realizes the possibility of success as well as failure.
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Ultimately, the plan must explain to potential investors how you will make the practice profitable and produce the required Return on Investment (ROI) for them. It must describe medical services, patient acceptance and benefits, provider qualifications and accomplishments, the amount of capital required, market size, potential practice growth rate, and market niche.
Additional information may include office location, proximity to labor, transportation, license requirements, business entity status, proprietary technology and potential working agreements with various insurance, managed care, ACA and HMO plans. If all of the above seems bewildering to the uninitiated, you are correct.
Remember however, that if you do not have, or can’t borrow the funds to begin a private practice, you will just have to become an employed practitioner until you can. It is therefore imperative to start off on the right foot, with a sound business plan, as you begin your medical career.
People really love money since it is needed to buy just about everything. In fact, we actually published a formal print dictionary on health economics and finance terms that is very popular with physician investors and medical colleagues; it is a favorite of economic students as well!
And, money is by far one of those words that has more slang or terms for it than any others. This proves that cash or money, does not have be boring when speaking about it. Just keep in mind that these slang synonyms are in plural form. They are also words mostly used for US currency.
Perhaps the fact that money is so important may help to explain why there are so many different ways to say it. These 95 slang words for money and their meanings are really worth taking a look at. This list not only contains the countless ways to speak, write or say the word money, but also what are the meanings behind each phrase or term.
The International Franchise Association (IFA) estimates that that about $1 trillion in sales, or 40% of all retail sales, were made through franchised establishment last year. On the positive side, franchises offer a branded practice concept with management training and access to proprietary methods, marketing and advertising campaigns and a host of support.
Moreover, there are franchises available for virtually every healthcare product or service, including: diet, weight loss and fitness; vein care and laser surgery; vitamins, nutriceuticals and pharmaceuticals; plastic and cosmetic surgery; dermatology, tanning and skin care; home healthcare and extended, etc. Some well know established healthcare and medical franchises are: Doctors Express, Being There Senior Care, Home Care Assistance, Personal Training Institute, Inches-A-Weigh, Remedy Intelligent Staffing, Visiting Angels, Unlimited MedSearch, prnYourHealth and Any Lab Test Now, etc.
On the downside, franchises incur high start-up costs, rules and obligations, payment of franchise percentages and many contractual obligations. Questions to consider when contemplating this business entity include:
Franchise stability, track record, licensing and costs.
Training, support and proximity of other franchises.
Independence, ownership laws, contracts and dispute resolutions,
Screening methods, market size and potential market share.
Replacement cost and transferability?
For more information on Uniform Franchise Offerings Circulars (UFOCs) contact www.FranChoice.com or:
The business cycle is also known as the economic cycle and reflects the expansion or contraction in economic activity. Understanding the business cycle and the indicators used to determine its phases may influence investment or economic business decisions and financial or medical planning expectations. Although often depicted as the regular rising and falling of an episodic curve, the business cycle is very irregular in terms of amplitude and duration.
Moreover, many elements move together during the cycle and individual elements seldom carry enough momentum to cause the cycle to move. However, elements may have a domino effect on one another, and this is ultimately drives the cycle. We can also have a large positive cycle, coincident with a smaller but still negative cycle, as seen in the current healthcare climate of today.
First Phase: Trough to Recovery (production driven)
Scenario: A depressed GNP leads to declining industrial production and capacity utilization. Decreased workloads result in improved labor productivity and reduced labor (unit) costs until actual producer (wholesale) prices decline.
Second Phase: Recovery to Expansion (consumer driven)
Scenario: CPI declines (due to reduced wholesale prices) and consumer real income rises, improving consumer sentiment and actual demand for consumer goods.
Third Phase: Expansion to Peak (production driven)
Scenario: GNP rises leading to increased industrial production and capacity utilization. But, labor productivity declines and unit labor costs and producer (wholesale) prices rise.
Fourth Phase: Peak to Contraction (consumer driven)
Scenario: CPI rises making consumer real income and sentiment erode until consumer demand, and ultimately purchases, shrink dramatically. Recessions may occur and economists have an alphabet used to describe them.
For example, with a V, the drop and recovery is quick. For U, the economy moves up more sluggishly from the bottom. A W is what you would expect: repeated recoveries and declines. An L shaper recession describes a prolonged dry economic spell or even depression.
NOTE: Historically, contractions have had a shorter duration than expansions.
Bull and Bear Markets for Medical Professionals
A bull market is generally one of rising stock prices, while a bear market is the opposite. There are usually two bulls for every one bear market over the long term.
More specifically, a bear market is defined as a drop of twenty percent or more in a market index from its high, and can vary in duration and severity. While a bull market has no such threshold requirement to exist, other than they exist between these two periods of sharp decline.
Whither the Bear?
As a doctor, your action plan in a bear market depends on many variables, with perhaps your age being the most important:
In your 30s:
Pay off debts, school or practice loans.
Invest in safe money market mutual funds, cash or CDs.
Start retirement plan or 401-K account.
In your 40s:
Increase your pension plan or 401-K contributions.
Stay weighted more toward equity investments.
Review your goals, risk tolerance and portfolio.
In your 50s:
Position assets for ready cash instruments.
Diversify into stock, bonds and cash.
Retirement:
Maintain 3 years of ready cash living expenses.
Reduce, but still maintain your exposure to equities.
ASSESSMENT: So, where are we right now in the economic business cycle? Your thoughts are appreciated.
Whether you do contract work or have your own small business, tax deductions for the self-employed physician consultant and/or medical executive or nurse consultant, etc., can add up to substantial tax savings.
With self-employment comes freedom, responsibility, and a lot of expense. While most self-employed people celebrate the first two, they cringe at the latter, especially at tax time. They might not be aware of some of the tax write-offs to which they are entitled.
When it comes time to file your returns, don’t hesitate to claim the benefits you get for being the boss. As a self-employed success story, you’ve earned them.
FORM 1099NEC: Form 1099 NEC is one of several IRS tax forms used in the United States to prepare and file an information return to report various types of income other than wages, salaries, and tips. The term information return is used in contrast to the term tax return although the latter term is sometimes used colloquially to describe both kinds of returns.
“Many times an overlooked deduction is educational expenses. If one is taking courses or buying research material to be more effective in their work, this can be deductible.”
Individual Retirement Plans (IRAs)
One of the best tax write-offs for the self-employed physician consultant is a retirement plan. A person with no employees can set up an individual 401 (k). “You can contribute $19,500 in 2021 as a 401(k) deferral, plus 25 percent of net income.”
If you have employees, consider a SIMPLE (Savings Incentive Match Plan for Employees) IRA—an IRA-based plan that gives small employers a simplified method to make contributions to their employees’ retirement. As of 2021, an employee may defer up to $13,500 and employees over 50 may contribute an additional $3,000.
“A third retirement plan is Simplified Employee Pension IRA (SEP IRA).” The employer may contribute the lesser of 25 percent of income or $58,000 in 2021. If the employer has eligible employees, an equal percentage of their income must be contributed.
Recall that retirement plans are “absolutely the No. 1 tax deduction. The government is helping fund retirement.”
Business use of home or dwelling
Now, most self-employed taxpayers’ businesses start as home-based businesses. These people need to know portions of business costs are deductible and so “It is very important that you keep track of expenses relating to your housing costs.”
If your gross income from your business exceeds your total expenses, then you can deduct all of your expenses related to the business use of your home. If your gross income is less than your total expenses, your deduction will be limited to the difference between your gross income and the sum of all business expenses you would pay if the business was not in your home. Those expenses could include telephone lines, the Internet, and other costs to do business.
You must also have a home office that is truly used for work and the Internal Revenue Service may require you to document this.
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Deducting automobile expenses
If you travel for business, even short distances within your own city, you may deduct the dollar value of business miles traveled on your tax return. The taxpayer may file the actual expense s/he incurred, or use the standard mileage rate prescribed by the IRS, which is 56 cents as of 2021. The IRS allowable mileage rates should be checked every year as they can change.
“If you decide to use actual car expenses, be sure to include payments, depreciation, registration, insurance, garage rent, licenses, repairs and maintenance, and parking and toll fees.” AND, “If you decide to use the standard mileage rate, it would be in your best interest to keep a log—daily, weekly or monthly—of miles driven to distinguish personal use from business use.”
Depreciation of property and equipment
Some self-employed people may purchase property and equipment for a business. If they expect that property to last longer than one year, it should be depreciated on the tax return.
Claims regarding property, according to the IRS, must meet the following criteria: You must own the property and it must be used or held to generate income. The property should have an estimated useful life, meaning you should be able to guess how long you can generate income with it. It may not have a useful life of one year or less, and may not be purchased and disposed of in the same year.
Certain repairs on property used for business may also be deducted.
Educational expenses
Any educational expense is potentially tax-deductible.
“Many times an overlooked deduction is educational expenses. “If one is taking courses or buying research material to be more effective in their work, this can be deductible.”
Think about any books, web courses, local college courses, or other classes or materials that you have purchased to improve your job or business. It’s easy to forget a work-related webinar or business e-book that was purchased online, so remember to save e-receipts.
Also recall that subscriptions to trade or professional publications and donations to business organizations, both of which are frequently necessary for the continuation and growth of your business.
Other areas to explore
Other deductions that can be easily missed are advertising and promotional expenses, banking fees, and air, bus, or train fare. Restaurant meals and other entertainment costs may be written off as long as they are necessary business expenses.
And, consider health insurance premiums, which in most cases represent a credit rather than a tax deduction. “A credit goes directly against one’s taxes, rather than a reduction of income.”
Regardless of which expenses you discover that you may write off, the most important thing is to keep accurate records throughout the year. Save receipts, including e-mail receipts, and file or log them so you have easy access to them at tax time. Not only does keeping receipts, mileage logs, and other expense records make filing taxes easier, but it also facilitates a system that allows you to track changes from year to year.
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Long-term tax-saving strategies
Don’t just look at last-minute write-offs when considering self-employment tax deductions. Think about laying down some long-term strategies for money savings from year to year—particularly if you are a high earner.
“Accountants typically tell you what you have to pay but they don’t always tell you strategies to reduce your payments.”
To reduce your gross taxable income, consider setting up a defined-benefit pension plan. This plan is based on your age and income: The older you are and the higher your earnings, the more you are allowed to contribute. An alternative plan is an age-weighted profit-sharing plan, which is similar and can benefit those who have several employees.
Another strategy for high-earning business owners who own their own building through a limited liability company or similar business structure is to pay themselves rent. This rent is used to pay down the mortgage, but it is also considered a business expense for tax purposes.
Self-employed professionals required to have liability insurance should consider setting up their own insurance company. A captive insurance company is one that insures the risks of the business—or businesses, in the case of a cooperative. Its premiums can be tax-deductible.
But, if money accumulates and claims are minimal, the money taken out is taxable under capital gains. This is not a retirement strategy, but that it can save you money by allowing you to “pay yourself” instead of an insurance company and still deduct the premiums.
Assessment
With any of these more complicated, long-term strategies, consult with a business attorney, CPA/EA or financial planner to ensure you have the best plan possible for your business.
The modes of persuasion, modes of appeal or rhetorical appeals (Greek: pisteis) are strategies of rhetoric that classify a speaker’s or writer’s appeal to their audience. These include ethos, pathos, and logos.
Rhetorical appeal with persuasion elements are often key attributes for doctors, medical professionals, lawyers, CPAs, and all sorts of financial advisors and medical management consultants, etc.
Just like real estate, butter has been around for thousands of years. Sometime in the 1800’s someone decided that there was a need for something that looked like butter, tasted similar to butter, but wasn’t butter. Along came margarine. Real estate investment trusts (REITs) are the margarine of the real estate investing world.
NAREIT, the National Association of Real Estate Investment Trusts, answers the question
“What is a REIT?” in the following way:
“A REIT, or Real Estate Investment Trust, is a type of real estate company modeled after mutual funds. REITs were created by Congress in 1960 to give all Americans – not just the affluent – the opportunity to invest in income producing real estate in a manner similar to how many Americans invest in stocks and bonds through mutual funds. Income-producing real estate refers to land and the improvements on it – such as apartments, offices or hotels. REITs may invest in the properties themselves, generating income through the collection of rent or they may invest in mortgages or mortgage securities tied to the properties, helping to finance the properties and generating interest income.”
While REITs typically own real estate, investors in REITs do not. REITs are paper assets that represent interest in a company that owns and operates income producing properties. In essence they are real estate flavored stock. As such, REITs are generally highly correlated with the stock market.
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TERMINOLOGY
When discussing REITs, you encounter the following terminology – public, private, traded, and non-traded. Public REITs can be designated as non-traded or traded depending on whether or not they are traded on a stock exchange.
Since traded REITs are traded on the stock exchange, they enjoy a high degree of liquidity just like any other stock. Unfortunately, traded REITs tend to follow the economic cycles and can closely correlate with the stock market. This can lead to a higher degree of volatility than what is usually seen with physical real estate. Additionally, they do not afford the investor the tax-advantages that come with investments in physical real estate.
Private REITs and non-traded public REITs are not traded on an exchange. These are usually offered to accredited investors through broker-dealer networks. These REITs are illiquid and generally have high fees. They have been plagued with transparency issues as well as conflicts of interest. Valuation of this stock is difficult and can be misleading to the investor. Due diligence is very important as the quality of non-traded REITs can vary widely.
A Pandemic (from Greek πᾶν pan “all” and δῆμος demos “people”) is an epidemic of disease that has spread across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic.
Further, flu pandemics generally exclude recurrences of seasonal flu. Throughout history, there have been a number of pandemics, such as smallpox and tuberculosis. One of the most devastating pandemics was the Black Death, which killed an estimated 100 million people in the 14th century. Some recent pandemics include: HIV, Spanish flu, 2009 flu pandemic and H1N1.
An Epidemic is the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less.
For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.
Epidemics is the outbreak of the disease in a community while pandemic is the outbreak of the disease globally.
SARS was an epidemic while AIDS was an pandemic.
Pandemic disease has the same origin or source where so ever it gets spread while the same disease is spreading with different sources in each country, it refers to epidemic.
Epidemic when extending to greater levels becomes a pandemic.
ENDEMIC: If you translate it literally, endemic means “in the population.” It derives from the Greek endēmos, which joins en, meaning “in,” and dēmos, meaning “population.” “Endemic” is often used to characterize diseases that are generally found in a particular area; malaria, for example, is said to be endemic to tropical and subtropical regions. This use differs from that of the related word epidemic in that it indicates a more or less constant presence in a particular population or area rather than a sudden, severe outbreak within that region or group.
DEFINITION: Stablecoins are blockchain-based digital currencies that have been created with the aim to have a stable value. Stablecoins achieve price-stability through various different methods such as a peg against a fiat currency or a commodity, through collateralization against other cryptocurrencies or through algorithmic coin supply management.
Every stable coin includes a specific set of mechanisms that mostly behave in the same way. In general, stable coins keep collateral of the asset and manage the supply. In this way, they incentivize the market, which allows trade of the coin for no more or less than $1.
A stable coin can be considered the best depending on several factors: It should be stable. PAX is one the most stable stablecoin. It should be liquid and available on most exchanges. It should be backed by FIAT. PAX is 100% collateralized in US bank accounts. It should be regulated. It should be redeemable.
The physician, nurse, or other medical professional should easily recognize that there are a vast array of opportunities, obstacles, and pitfalls when it comes to managing one’s finances. Still, with some modicum of effort, the basic aspects of insurance, investments, taxes, accounting, portfolio management, retirement and estate planning, debt reduction, asset protection and practice management can be largely self-taught. Yet, it is realized that nuances and subtleties can make a well-intentioned financial plan fall short. The devil truly is in the details. Moreover, none of these areas can be addressed in isolation. It is common for a solution in one area to cause a new set of problems in another.
Accordingly, most health care practitioners would be well served to hire [independent, hourly compensated and prn] financial help. Unlike some medical problems, financial issues may not cause any “pain” or other obvious symptoms. Medical professionals tend to have far more complex financial situations than most lay people. Despite the complexities of the new world of health reform, far too many either do nothing; or give up all control totally, to an external advisor. This either/or mistake can be costly in many ways, and should be avoided.
In reality, and at various time in their careers, the medical professional needs a team comprised of at least a financial analyst, lawyer, management consultant, risk manager [actuary, mathematician or insurance counselor] and accountant. At various points in time, each member of the team, or significant others, will properly assume a role of more or less importance, but the doctor must usually remain the “quarterback” or leader; in the absence of a truly informed other, or Certified Medical Planner™.
This is necessary because only the doctor has the personal self-mandate with skin in the game, to take a big picture view. And, rightly or wrongly, investments dominate the information available regarding personal finance and the attention of most physicians. One is much more likely to need or want to discuss the financial markets with their financial advisor than private letter rulings by the IRS, or with their estate planning attorney or tax accountant. While hiring for expertise is a good idea, there is sinister way advisors goad doctors into using all their retail services; all of the time. That artifice is – the value of time.
True integrated physician focused and financial planning is at its core a service business, not a product or sales endeavor. And, increasingly money is more likely to be at the top of the list for providers as the healthcare environment is contracting.
So, eschewing the quarterback model of advice, and choosing to self-educate thru this book and elsewhere, may be one of the best efforts a smart physician can make.
Posted on November 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
TO H.R. RECRUITERS, UNIVERSITY HIRING MANAGERS & SEARCH COMMITTEES
Sooth My Academic Teaching and Classroom Withdrawal Pangs! “MY TEACHING PHILOSOPHY”
I’m screening for my next university Dean, Chair or teaching Professorship opportunity.
Currently, an endowed Resident-Scholar completing a text book production assignment complete with aligned case models, tests, quizzes, rubrics, curriculum teaching portfolio, and accreditation review.
Two-decades of domestic and international teaching experience and credentials in health economics, finance, investing, business, policy, risk management, IT and administration. Hundreds of peer-reviewed and trade publications [TNTC] with 30 major textbooks redacted in more than a thousand university libraries [NIH, Library Congress and National Institute Health, etc]. Public and population health global speaker and thought leader. Wall Street experience as start-up founder, entrepreneur and CXO.
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Although standard definitions will tell you that it is a ‘monetary policy’ used by central banks to stimulate the national economy, in reality it is more as follows:
– A cleverly disguised word that simply means ‘money printing’.
Once you do retire, and put your physician or medical career behind you, it’s important to realize that, at some point, the IRS expects you to draw down your 401(k) balance. Starting at age 72, you need to take required minimum distributions (RMDs).
Your annual RMD amount depends on the balance of your 401(k) and a formula that determines your life expectancy.
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QUERY: But – What happens if you don’t take your RMD for the year?
ANSWER: Well, you could end up paying a penalty. In fact, it’s a pretty hefty penalty of up to 50% of the amount you were supposed to withdraw. Paying that penalty can be pretty costly for someone living in retirement. As long as you’re vigilant and stay on top of the situation, though, you can avoid the penalty as well as these other costly 401(k) mistakes.
Posted on November 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
For Doctors and Advisors
BOOK REVIEWS WITH FOREWORD
Reviews
Written by doctors and healthcare professionals, this textbook should be mandatory reading for all medical school students―highly recommended for both young and veteran physicians―and an eliminating factor for any financial advisor who has not read it. The book uses jargon like ‘innovative,’ ‘transformational,’ and ‘disruptive’―all rightly so! It is the type of definitive financial lifestyle planning book we often seek, but seldom find. ―LeRoy Howard MA CMPTM,Candidate and Financial Advisor, Fayetteville, North Carolina I taught diagnostic radiology for over a decade. The physician-focused niche information, balanced perspectives, and insider industry transparency in this book may help save your financial life. ―Dr. William P. Scherer MS, Barry University, Ft. Lauderdale, Florida This book was crafted in response to the frustration felt by doctors who dealt with top financial, brokerage, and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized for few, despite ever-changing needs. It is a must-read to learn why brokerage sales pitches or Internet resources will never replace the knowledge and deep advice of a physician-focused financial advisor, medical consultant, or collegial Certified Medical Planner™ financial professional. ―Parin Khotari MBA,Whitman School of Management, Syracuse University, New York In today’s healthcare environment, in order for providers to survive, they need to understand their current and future market trends, finances, operations, and impact of federal and state regulations. As a healthcare consulting professional for over 30 years supporting both the private and public sector, I recommend that providers understand and utilize the wealth of knowledge that is being conveyed in these chapters. Without this guidance providers will have a hard time navigating the supporting system which may impact their future revenue stream. I strongly endorse the contents of this book.
―Carol S. Miller BSN MBA PMP,President, Miller Consulting Group, ACT IAC Executive Committee Vice-Chair at-Large, HIMSS NCA Board Member This is an excellent book on financial planning for physicians and health professionals. It is all inclusive yet very easy to read with much valuable information. And, I have been expanding my business knowledge with all of Dr. Marcinko’s prior books. I highly recommend this one, too. It is a fine educational tool for all doctors.
―Dr. David B. Lumsden MD MS MA,Orthopedic Surgeon, Baltimore, Maryland There is no other comprehensive book like it to help doctors, nurses, and other medical providers accumulate and preserve the wealth that their years of education and hard work have earned them. ―Dr. Jason Dyken MD MBA, Dyken Wealth Strategies, Gulf Shores, Alabama I plan to give a copy of this book written ‘by doctors and for doctors’ to all my prospects, physician, and nurse clients. It may be the definitive text on this important topic. ―Alexander Naruska CPA, Orlando, Florida
Health professionals are small business owners who need to apply their self-discipline tactics in establishing and operating successful practices. Talented trainees are leaving the medical profession because they fail to balance the cost of attendance against a realistic business and financial plan. Principles like budgeting, saving, and living below one’s means, in order to make future investments for future growth, asset protection, and retirement possible are often lacking. This textbook guides the medical professional in his/her financial planning life journey from start to finish. It ranks a place in all medical school libraries and on each of our bookshelves. ―Dr. Thomas M. DeLauro DPM, Professor and Chairman – Division of Medical Sciences, New York College of Podiatric Medicine
Physicians are notoriously excellent at diagnosing and treating medical conditions. However, they are also notoriously deficient in managing the business aspects of their medical practices. Most will earn $20-30 million in their medical lifetime, but few know how to create wealth for themselves and their families. This book will help fill the void in physicians’ financial education. I have two recommendations: 1) every physician, young and old, should read this book; and 2) read it a second time! ―Dr. Neil Baum MD, Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, Louisiana
I worked with a Certified Medical Planner™ on several occasions in the past, and will do so again in the future. This book codified the vast body of knowledge that helped in all facets of my financial life and professional medical practice. ―Dr. James E. Williams DABPS, Foot and Ankle Surgeon, Conyers, Georgia
Almost everything you own and use for personal or investment purposes is a capital asset. Examples include a home, personal-use items like household furnishings, and stocks or bonds held as investments. When you sell a capital asset, the difference between the adjusted basis in the asset and the amount you realized from the sale is a capital gain or a capital loss.
Generally, an asset’s basis is its cost to the owner, but if you received the asset as a gift or inheritance, refer to Topic No. 703 for information about your basis.
For information on calculating adjusted basis, refer to Publication 551, Basis of Assets. You have a capital gain if you sell the asset for more than your adjusted basis. You have a capital loss if you sell the asset for less than your adjusted basis. Losses from the sale of personal-use property, such as your home or car, aren’t tax deductible.
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