BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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In order to create and monitor an investment portfolio for personal or institutional use, the physician executive, financial advisor, wealth manager, or healthcare institutional endowment fund manager, should ask three questions:
How much do we have invested?
How much did we make on our investments?
How much risk did we take to get that rate of return?
Introduction to the IPS
Most doctors, and hospital endowment fund executives, know how much money they have invested. If they don’t, they can add a few statements together to obtain a total. But, few can answers the questions above or actually know the rate of return achieved last year; or so far this year. Everyone can get this number by simply subtracting the ending balance from the beginning balance and dividing the difference. But, few take the time to do it. Why? A typical response to the question is, “We’re doing fine.”
Now, ask how much risk is in the portfolio and help is needed [risk adjusted rate of return]. In fact, Nobel laureate Harry Markowitz, Ph.D. said, “If you take more risk, you deserve more return.” Using standard deviation, he referred to the “variability of returns;” in other words, how much the portfolio goes up and down, its volatility [Markowitz, H: Portfolio Selection. Journal of Finance, March, 1952].
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
ORGANIZATIONAL BEHAVIOR ANDCLASSIFICATION OF RISKS
DEFINITION EMOTIONAL INTELLIGENCE: Emotional intelligence [EI] refers to the ability to identify and manage one’s own emotions, as well as the emotions of others. Emotional intelligence is generally said to include a few skills: namely emotional awareness, or the ability to identify and name one’s own emotions; the ability to harness those emotions and apply them to tasks like thinking and problem solving; and the ability to manage emotions, which includes both regulating one’s own emotions when necessary and helping others to do the same.
DEFINITIONAL ORGANIZATIONAL BEHAVIOR: Organizational behavior (OB) is the study of how individuals, groups, and organizations interact and influence one another. Though it is largely used within the field of business management as means to understand–and more effectively manage–groups of people. The reason businesses look to OB is because it can help organizations increase employee performance, while also creating a positive working environment.
CITE: Eugene Schmuckler; PhD MBA MEd CTS®
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And so, as we review the concept of Emotional Intelligence and Organizational Behavior, it is possible to set up five EI/OB risk classes, based on the economic consequences of the occurrence of specific individual risks:
1. Prevented risks: Risks whose cost of occurrence is higher than their cost of management and whose occurrence may invoke additional legal sanctions. This class would include intentional torts and injuries caused by gross negligence.
2. Normally prevented risks: Risks whose cost of occurrence is greater than the cost of their management but whose occurrence will be considered only as negligent. This class includes most negligent injuries and most types of product liability actions.
3. Managed risks: Risks whose cost of occurrence is only slightly greater than their cost of management. The plaintiff usually has the burden of showing that the defendant owed the plaintiff a special duty to recover for one of these risks.
4. Un-Prevented risks: Risks whose cost of occurrence is less than their cost of management. The classic example of this class is the cost of railroad crossing barriers compared to the cost of people being hit by trains.
5. Un-Preventable risks: Risks whose occurrence is unmanageable. The assignment of a risk to one of these classes is a major problem in medical and healthcare quality control, because the class of a risk determines how much effort must be expended to prevent the risk. The misclassification of a prevented or normally prevented risk as a managed or un-prevented risk can result in large financial losses.
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For example: A medical clinic that does not update obsolete equipment, such as inaccurate oxygen monitors, would be liable for any injuries attributable to the obsolete equipment. The classifications of risk must be reviewed periodically to determine if the cost of the risk-taking behavior has changed, thereby altering the classification.
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For example: A small hospital in a rural area would not be expected to have the sophisticated equipment as a major hospital in a city. If an accident victim is brought into the rural facility, the hospital’s duty may be to transfer the patient to a better-equipped facility. The patient will face the risk of dying because of the delay in treatment, but the risk of insufficient treatments outweighs the risk of transfer. If the same victim were brought into a hospital in a major metropolitan center, the duty would be to treat the patient without a transfer. The risk of transfer has not changed, but the risk of insufficient treatment has disappeared.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR-http://www.MarcinkoAssociates.com
It’s hard to believe that just 30 years ago, physician investors had only two primary asset classes from which to choose: U.S. equities and U.S. bonds.
Today, the marketplace offers a daunting array of investment choices. Rapid market globalization, technology advancements and investor sophistication have spawned a host of new asset classes, from the mundane to the mysterious.
Even neophyte medical investors can now buy and sell international equities, emerging market debt, mortgage securities, commodities, derivatives, indexes and currencies, offering infinitely more opportunities to make, or lose, money.
Amidst this ongoing proliferation, a unique asset class has emerged, one that is complex, non-traditional and not easily understood like stocks or bonds. It does, however, offer one invaluable advantage; its returns are virtually uncorrelated with any other asset class. When this asset class is introduced into a traditional investment portfolio, a wonderful thing occurs; the risk-return profile of the overall portfolio improves dramatically.
This asset class is known as a Market-Neutral strategy. The reason few medical professionals have heard of market neutral strategies is that most of them are offered by private investment partnerships otherwise known as hedge funds.
To the uninitiated, “hedge fund” means risky, volatile or speculative. With a market-neutral strategy however, just the opposite is true. Funds utilizing market-neutral strategies typically emphasize the disciplined use of investment and risk control processes. As a result, they have consistently generated returns that display both low volatility and a low correlation with traditional equity or fixed income markets.
Definition of Market-Neutral
All market-neutral funds share a common objective: to achieve positive returns regardless of market direction. Of course, they are not without risk; these funds can and do lose money. But a key to their performance is that it is independent of the behavior of the markets at large, and this feature can add tremendous value to the rest of a portfolio.
A typical market-neutral strategy focuses on the spread relationship between related securities, which is what makes them virtually independent of underlying debt or equity markets. When two related securities are mispriced in relation to one another, the disparity will eventually disappear as the result of some external event. This event is called convergence and may take the form of a bond maturity, completion of a merger, option exercise, or simply a market recognizing the inefficiency and eliminating it through supply and demand.
Here’s how it might work
When two companies announce a merger, there is an intended future convergence, when the shares of both companies will converge and become one. At the time of the announcement, there is typically a trading spread between two shares. A shrewd trader, seeing the probability of the successful merger, will simultaneously buy the relatively cheaper share and sell short the relatively more expensive share, thus locking in the future gain.
Another example of convergence would be the relationship between a convertible bond and its underlying stock. At the time of convergence, such as bond maturity, the two securities will be at parity. However, the market forces of supply and demand make the bond underpriced relative to the underlying stock. This mispricing will disappear upon convergence, so simultaneously buying the convertible bond and selling short an equivalent amount of underlying stock, locks in the relative spread between the two.
Yet another example would be two bonds of the same company – one junior and one senior. For various reasons, the senior bond may become cheaper relative to the junior bond and thus display a temporary inefficiency that would disappear once arbitrageurs bought the cheaper bond and sold the more expensive bond.
While these examples involve different types of securities, scenarios and market factors, they are all examples of a market-neutral strategy. Locking a spread between two related securities and waiting for the convergence to take place is a great way to make money without ever taking a view on the direction of the market.
How large are these spreads, you may ask? Typically, they are tiny. The markets are not quite fully efficient, but they are efficient enough to not allow large price discrepancies to occur.
In order to make a meaningful profit, a market-neutral fund manager needs sophisticated technology to help identify opportunities, the agility to rapidly seize those opportunities, and have adequate financing resources to conduct hundreds of transactions annually.
The universe of market-neutral strategies is vast, spanning virtually every asset class, country and market sector. The spectrum varies in risk from highly volatile to ultra conservative. Some market-neutral strategies are more volatile than risky low-cap equity strategies, while others offer better stability than U.S Treasuries.
One unifying factor across this vast ocean of seemingly disparate strategies is that they all attempt to take advantage of a relative mispricing between various securities, and all offer a high degree of “market neutrality,” that is, a low correlation with underlying markets.
[A] Convertible Arbitrage
Convertible arbitrage is the oldest market-neutral strategy. Designed to capitalize on the relative mispricing between a convertible security (e.g. convertible bond or preferred stock) and the underlying equity, convertible arbitrage was employed as early as the 1950s.
Since then, convertible arbitrage has evolved into a sophisticated, model-intensive strategy, designed to capture the difference between the income earned by a convertible security (which is held long) and the dividend of the underlying stock (which is sold short). The resulting net positive income of the hedged position is independent of any market fluctuations. The trick is to assemble a portfolio wherein the long and short positions, responding to equity fluctuations, interest rate shifts, credit spreads and other market events offset each other.
A convertible arbitrage strategy involves taking long positions in convertible securities and hedging those positions by selling short the underlying common stock. A manager will, in an effort to capitalize on relative pricing inefficiencies, purchase long positions in convertible securities, generally convertible bonds, convertible preferred stock or warrants, and hedge a portion of the equity risk by selling short the underlying common stock. Timing may be linked to a specific event relative to the underlying company, or a belief that a relative mispricing exists between the corresponding securities.
Convertible securities and warrants are priced as a function of the price of the underlying stock, expected future volatility of returns, risk free interest rates, call provisions, supply and demand for specific issues and, in the case of convertible bonds, the issue-specific corporate/Treasury yield spread.
Thus, there is ample room for relative misvaluations.Because a large part of this strategy’s gain is generated by cash flow, it is a relatively low-risk strategy.
[B] Fixed-Income Arbitrage
Fixed-income arbitrage managers seek to exploit pricing inefficiencies across global markets.
Examples of these anomalies would be arbitrage between similar bonds of the same company, pricing inefficiencies of asset-backed securities and yield curve arbitrage (price differentials between government bonds of different maturities). Because the prices of fixed-income instruments are based on interest rates, expected cash flows, credit spreads, and related factors, fixed-income arbitrageurs use sophisticated quantitative models to identify pricing discrepancies.
Similarly to convertible arbitrageurs, fixed-income arbitrageurs rely on investors less sophisticated than themselves to misprice a complex security.
[C] Equity Market-Neutral Arbitrage
This strategy attempts to offset equity risk by holding long and short equity positions. Ideally, these positions are related to each other, as in holding a basket of S&P500 stocks and selling S&P500 futures against the basket. If the manager, presumably through stock-picking skill, is able to assemble a basket cheaper than the index, a market-neutral gain will be realized.
A related strategy is identifying a closed-end mutual fund trading at a significant discount to its net asset value. Purchasing shares of the fund gains access to a portfolio of securities valued significantly higher. In order to capture this mispricing, one needs only to sell short every holding in the fund’s portfolio and then force (by means of a proxy fight, perhaps) conversion of the fund from a closed-end to an open-end (creating convergence).
Sounds easy, right?
In considering equity market-neutral, you must be careful to differentiate between true market-neutral strategies (where long and short positions are related) and the recently popular long/short equity strategies.
In a long/short strategy, the manager is essentially a stock-picker, hopefully purchasing stocks expected to go up, and selling short stocks expected to depreciate. While the dollar value of long and short positions may be equivalent, there is often little relationship between the two, and the risk of both bets going the wrong way is always present.
[D] Merger Arbitrage (a.k.a. Risk Arbitrage)
Merger arbitrage, while a subset of a larger strategy called event-driven arbitrage, represents a sufficient portion of the market-neutral universe to warrant separate discussion.
Merger arbitrage earned a bad reputation in the 1980s when Ivan Boesky and others like him came to regard insider trading as a valid investment strategy. That notwithstanding, merger arbitrage is a respected stratagey, and when executed properly, can be highly profitable. It bets on the outcomes of mergers, takeovers and other corporate events involving two stocks which may become one.
A textbook example was the acquisition of SDL Inc (SDLI), by JDS Uniphase Corp (JDSU). On July 10, 2000 JDSU announced its intent to acquire SDLI by offering to exchange 3.8 shares of its own shares for one share of SDLI.
At that time, the JDSU shares traded at $101 and SDLI at $320.5. It was apparent that there was almost 20 percent profit to be realized if the deal went through (3.8 JDSU shares at $101 are worth $383 while SDLI was worth just $320.5). This apparent mispricing reflected the market’s expectation about the deal’s outcome. Since the deal was subject to the approval of the U.S. Justice Department and shareholders, there was some doubt about its successful completion. Risk arbitrageurs who did their homework and properly estimated the probability of success bought shares of SDLI and simultaneously sold short shares of JDSU on a 3.8 to 1 ratio, thus locking in the future profit.
Convergence took place about eight months later, in February 2001, when the deal was finally approved and the two stocks began trading at exact parity, eliminating the mispricing and allowing arbitrageurs to realize a profit.
Merger Arbitrage, also known as risk arbitrage, involves investing in securities of companies that are the subject of some form of extraordinary corporate transaction, including acquisition or merger proposals, exchange offers, cash tender offers and leveraged buy-outs. These transactions will generally involve the exchange of securities for cash, other securities or a combination of cash and other securities.
Typically, a manager purchases the stock of a company being acquired or merging with another company, and sells short the stock of the acquiring company. A manager engaged in merger arbitrage transactions will derive profit (or loss) by realizing the price differential between the price of the securities purchased and the value ultimately realized when the deal is consummated. The success of this strategy usually is dependent upon the proposed merger, tender offer or exchange offer being consummated.
When a tender or exchange offer or a proposal for a merger is publicly announced, the offer price or the value of the securities of the acquiring company to be received is typically greater than the current market price of the securities of the target company.
Normally, the stock of an acquisition target appreciates while the acquiring company’s stock decreases in value. If a manager determines that it is probable that the transaction will be consummated, it may purchase shares of the target company and in most instances, sell short the stock of the acquiring company. Managers may employ the use of equity options as a low-risk alternative to the outright purchase or sale of common stock. Many managers will hedge against market risk by purchasing S&P put options or put option spreads.
[E] Event-Driven Arbitrage
Funds often use event-driven arbitrage to augment their primary market-neutral strategy. Generally, any convergence which is produced by a future corporate event would fall into this category.
Accordingly,Event-Driven investment strategies or “corporate life cycle investing” involves investments in opportunities created by significant transactional events, such as spin-offs, mergers and acquisitions, liquidations, reorganizations, bankruptcies, recapitalizations and share buybacks and other extraordinary corporate transactions.
Event-Driven strategies involve attempting to predict the outcome of a particular transaction as well as the optimal time at which to commit capital to it. The uncertainty about the outcome of these events creates investment opportunities for managers who can correctly anticipate their outcomes.
As such, Event-Driven trading embraces merger arbitrage, distressed securities and special situations investing. Event-Driven managers do not generally rely on market direction for results; however, major market declines, which would cause transactions to be repriced or break, may have a negative impact on the strategy.
Event-driven strategies are research-intensive, requiring a manager to do extensive fundamental research to assess the probability of a certain corporate event, and in some cases, to take an active role in determining the event’s outcome.
Risk and Reward Characteristics
To help understand market-neutral performance and risk, let’s take a look at the distribution of returns of individual strategies and compare it to that of traditional asset classes.
Table 1: Average Return / Volatility of Market Neutral Strategies And Selected Traditional Asset Classes
Strategy
Average Return
Annualized Volatility
Convertible Arbitrage
11.95%
3.57%
Fixed Income Arbitrage
8.33%
4.90%
Equity Market-Neutral
11.62%
4.95%
Merger Arbitrage
13.29%
3.51%
Relative Value Arbitrage
15.69%
4.31%
Traditional Asset Classes:
S&P 500
12.62%
13.72%
MSCI World
8.57%
13.05%
High Grade U.S. Corp. Bonds
7.26%
3.73%
World Government Bonds
5.91%
5.96%
The most important observation about this chart is that the Market Neutral funds exhibits considerably lower risk than most traditional asset classes.
While market-neutral strategies vary greatly and involve all types of securities, the risk-adjusted returns are amazingly stable across all strategies. The annualized volatility – a standard measure of performance risk – varies between 3.5 and 5 percent, comparable to a conservative fixed-income strategy.
Another interesting statistics is the correlation between Market Neutral strategies and traditional asset classes and traditional asset classes
Table 2: Correlation between Market Neutral Strategies and Traditional Asset Classes
Asset Class/Strategy
S&P500
MSCI World
GovBonds
CorpBonds
The correlation of all market neutral strategies to traditional assets is quite low, or negative in some cases. This suggests that these strategies would indeed play a useful role in the ultimate goal of efficient portfolio diversification.
To test the “market neutrality” of these strategies, we asked, “How well, on average, did these strategies perform during bad, as well as good, market months?”
It turns out, in good times and bad, these strategies displayed consistent solid performance.From 12/31/91, in months when S&P 500 was down, the average down month was 3.03 percent. Market Neutral strategies performed as follows:
Strategy
Average Monthly Return
Convertible Arbitrage
+ 0.65%
Fixed Income Arbitrage
+ 0.50%
Equity Market-Neutral
+ 1.19%
Merger Arbitrage
+ 0.88%
Relative Value Arbitrage
+ 0.81%
In months when S&P 500 was up, the average up month was +3.24 percent. Market Neutral strategies performed as follows:
Strategy
Average Monthly Return
Convertible Arbitrage
+1.17%
Fixed Income Arbitrage
+1.20%
Equity Market-Neutral
+1.37%
Merger Arbitrage
+0.60%
Relative Value Arbitrage
+1.25%
Clearly, a compelling picture emerges. While these strategies, on average, underperform during good times, they show a positive average return during both good and bad markets.
Inclusion of Market-Neutral in a Long-term Investment Portfolio
A critical concern for any medical investor considering a foray into a new asset class is how it will alter the long-term risk/reward profile of the overall portfolio. To better understand this, we constructed several hypothetical portfolios consisting of traditional asset classes:
·US Blue chip equities (Dow Jones Industrial Average)
·US mid-cap equities (S&P 400 Midcap Index)
·US small-cap equities (S&P 600 Smallcap Index)
Portfolios varied in the level of risk from 100 percent U.S Treasuries (least risky) to 100 percent small-cap equities (most risky), and are ranked from 1 to 10, 1 representing the least risky portfolio.Each portfolio was analyzed on a Risk/Return basis using monthly return data since December 1991. The results are shown in Chart 1.Predictably, the least risky portfolio produced the smallest return, while the riskiest produced the highest return. This is perfectly understandable – you would expect to be compensated for taking a higher level of risk.
Chart 1: Risk/Return characteristics of traditional portfolios vs. Market Neutral strategies
Clearly, the risk-return picture offered by Market Neutral strategies is much more compelling (lower risk, higher return) than that offered by portfolios of traditional assets. What happens if we introduce these market-neutral strategies into traditional portfolios? Let’s take 20 percent of the traditional investments in our portfolio and reinvest them in market-neutral strategies.
The change is dramatic: the new portfolios (denoted 1a through 10a) offer significantly less risk for the same return. The riskiest portfolio, for instance (number 10) offered 20 percent less risk for a similar return of a new portfolio containing market-neutral strategies (number 10a).
Chart 2: Result of inclusion of 20% of Market Neutral strategies in traditional portfolios
This is quite a difference. Everything else being equal, anyone would choose the new, “improved” portfolios over the traditional ones.
How to invest
The mutual fund world does not offer a great choice of market neutral strategies.
Currently, there are only a handful of good mutual funds that label themselves market-neutral (AXA Rosenberg Market Netural fund and Calamos Market Neutral fund are two examples).
Mutual fund offerings are slim due to excessive regulations imposed by the SEC with respect to short selling and leverage, and consequently these funds lack flexibility in constructing truly hedged portfolios. The dearth of market-neutral offerings among mutual funds is offset by a vast array of choices in the hedge fund universe. Approximately 400 market-neutral funds, managing $60 billion, represent roughly 25% of all hedge funds.
Therefore, further focus will relate to the hedge fund universe, rather than the limited number of market-neutral mutual funds.
Direct investing in a market-neutral hedge fund is restricted to qualifying individuals who must meet high net worth and/or income requirements, and institutional investors, such as corporations, qualifying pension plans, endowments, foundations, banks, insurance companies, etc.
This does not mean that retail investors cannot get access to hedge fund exposure. Various private banking institutions offer funds of funds with exposure to hedge funds. Maaket-neutral funds are nontraditional investments. They are part of a larger subset of strategies known as alternative investments, and there is nothing traditional in the way doctors invest in them.
Hedge funds are private partnerships, which gives them maximum flexibility in constructing and managing portfolios, but also requires medical investors to do a little extra work.
[A] Lockup Periods
One of the main differences between mutual funds and hedge funds is liquidity. Market-neutral strategies have less liquidity than traditional portfolios. Quarterly redemption policies with 45- or 60-days notice are common. Many funds allow redemptions only once a year and some also have lock-up periods. In addition, few of these funds pay dividends or make distributions. These investments should be regarded strictly as long-term strategies.
[B] Managerial Risks
Success of a market-neutral strategy depends much less on the market direction than on the manager’s skill in identifying arbitrage opportunities and capitalizing on them.
Thus, there is significantly more risk with the manager than with the market. It’s vital for investors to understand a manager’s style and to monitor any deviations from it due to growth, personnel changes, bad decisions, or other factors.
[C] Fees
If you are accustomed to mutual fund fees, brace yourself; market-neutral investing does not come cheap.
Typical management fees range from 1 to 2 percent per year, plus a performance fee averaging 20 percent of net profits. Most managers have a “high watermark” provision; they cannot collect the performance fees until investors recoup any previous losses. Look for this provision in the funds’ prospectus and avoid any fund that lacks it. Even with higher fees, market-neutral investing is superior to most traditional mutual fund investing on a risk-adjusted return basis.
[D] Transparency
Mutual funds report their positions to the public regularly. This is not the case with market-neutral hedge funds. Full transparency could jeopardize accumulation of a specific position. It also generates front running: buying or selling securities before the fund is able to do so. While you should not expect to see individual portfolio positions, many hedge fund managers do provide a certain level of transparency by indicating their geographical or sector exposures, level of leverage and extent of hedging.
It does take a bit of education to understand these numbers, but the effort is definitely worthwhile.
[E] Taxation
The issue of hedge fund taxation is quite complex and is often dependent on the fund and the personal situation of the investor. Advice from a competent accountant, specialized financial advisor, tax attorney with relevant experience is worthwhile. The bottom line is that investing in market-neutral funds is not a tax-planning exercise and it will not minimize your taxes.
On the other hand, it should not generate any more or fewer taxes than if you invested in more traditional funds.
From the medical investor’s perspective, the principal advantages of market-neutral investing are attractive risk-adjusted returns and enhanced diversification.
Ten years of data indicate that market-neutral portfolios have produced risk-adjusted returns superior to traditional investments. In addition, the correlation between the returns of market-neutral funds and traditional asset classes has been historically negligible.
Adding exposure of market-neutral return strategies to the asset mix within a consistent, long-term investment program offers a medical investor the opportunity to improve overall returns, as well as achieving some protection against negative market movements.
Now, after all of the above, has your impression of hedge funds in general or MN funds in particular, changed?
APPENDIX:
Asset class weighting in traditional portfolios:
Portfolio
US Treasuries
US High Grade Corp Bonds
US Low Grade Corp Bonds
Large Cap Stocks
Mid Cap Stocks
Small Cap Stocks
1
50%
50%
2
50%
50%
3
10%
30%
50%
40%
4
50%
50%
5
10%
10%
50%
30%
6
10%
50%
20%
20%
7
10%
30%
20%
40%
8
20%
20%
60%
9
20%
80%
10
100%
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Posted on July 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEd
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Happy Fourth of July! It’s a good day to avoid the emergency department, so leave the fireworks shows to the pros—and perhaps use your extra hands to double-fist some BBQ instead.
Posted on July 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
The Complete Guide to July 4th Fireworks
Gather your novelty flag apparel and preheat your grills: Independence Day 2024 is upon us. And, what’s a July 4th celebration without some explosions in the sky?
Assessment
This info-graphic takes a closer look at the less glamorous side of fireworks — from the dollars that go up in smoke to the fingers we burn.
Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.
Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.
CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com
Posted on June 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By AI
CBOE Volatility Index
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There’s a lot of confidence in markets these days, and nowhere is that more apparent than in the VIX, aka the CBOE Volatility Index, aka aka the Fear Index.
According to Brew Markets, the VIX literally measures the market’s expectation of volatility based on S&P 500 index options, but it’s become a shorthand way of quantifying investors’ fear or confidence. Any time the VIX rises above 30, it’s taken as a sign of some serious trepidation in the market—but anytime it falls below 20, the market is calm, cool, and collected.
The VIX skyrocketed to over 50 on Liberation Day as investors fretted over what tariffs meant for their portfolios, but it’s been gradually falling ever since. As the chart above shows, the VIX just fell below its key support level of 17—a mark it has failed to break below recently, and a move that underlines investors’ confidence that the good times will keep rolling.
Posted on June 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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Markets: That feeling when you have a $10 trillion rally. To wit:
The S&P 500 closed at a record high this week despite a brief dip as trade tensions with Canada ratcheted up. That puts the index about 20% up from its April low, when the broad tariff announcement sent it spiraling, and up ~5% for the year.
NVIDIA also hit an all-time high, and it keeps edging closer to becoming the first company to hit a $4 trillion valuation.
Posted on June 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By A.I.
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Deals: The US and China revealed the details of their trade deal framework, easing restrictions on rare earth metals and semiconductor chips. Commerce Secretary Howard Lutnick promised up to 10 more deals are on their way ahead of the July 9th tariff-pause deadline, but that probably won’t include Canada: President Trump ended all trade discussions with the country thanks to a dispute over the digital services tax.
Stocks: Indexes climbed at the open thanks to the deal with China, but they tumbled on news of a fallout with Canada. Still, the S&P 500 managed to post its 1,245th new all-time high, while the NASDAQ booked its own record close. The Dow trundled higher as well, though it’s still about 1,600 points below its previous record.
If you’re looking at this tab, chances are you are fed up with your financial brokerage accounts, thinking of finances, investing, retirement or all of the above.
And so, we can help
An investment portfolio second opinion, also called a “ portfolio review,” is an analysis of your financial holdings and associated strategies, allocations, fees and performance to determine whether the most effective instruments and methodologies are being utilized to reach your goals.
No Worries! You may have come to the right place.
E-Mail Ann Miller RN MHA CPHQ for an Initial Appointment: MarcinkoAdvisors@outlook.com
The purpose of this initial appointment is for you to ask a lot of questions to make sure you are comfortable with potentially working with us. It also helps if you are prepared to provide a verbal summary of your current situation.
Here are some questions to consider asking us during your first meeting:
1) Can you tell us about your financial qualifications, experience, education and training; if any?
2) Can you provide some information about your current financial advisory team?
3) On what type of investments do you typically purchase and own?
5) How much do pay your financial management firm?
6) How long have you been working with your current financial management firm?
8) What other services does your financial team provide?
Assets under management (AUM) is a significant parameter in the financial world. It answers financial questions like – how many investments does a company manage? What is the net value of the investments that the company manages? Finally, how many investors have trusted their assets with the company? The higher the answer to these three questions, the more glory to the company.
A wealthy investor who is not concerned by higher fees but wants maximum returns of their asset will probably choose an asset manager based on its AUM. Thus, the AUM indicates the financial performance of the firm. Also, based on the funds under management, the firm collects fees from other clients.
So, what are the investments which qualify as AUM? Any liquid asset of the investor they have entrusted the asset manager with monitoring and control. For example, bank deposits, cash balances, equity shares, bonds, mutual funds, and other investments.
What are the services an asset manager provides to their clients? The most important function is decision-making. With the constant fluctuations and rapid movements in the market, an asset manager has to make decisions about holding or selling an investment. The firm communicates with the investors and advises them about the necessary action.
Once the decision is taken, the firm acts on the decision, i.e., the investor does not have to enter the field. In addition, the asset management company will buy, sell, and make any other transactions on behalf of the investor. Finally, the firm also renders services like accounting, tax reporting, proxy voting (equity shares), client reporting, and other financial services.
What are Assets Under Advisement?
Assets under advisement refer to assets on which your firm provides advice or consultation but for which your firm does either does not have discretionary authority or does not arrange or effectuate the transaction. Such services would include financial planning or other consulting services where the assets are used for the informational purpose of gaining a full perspective of the client’s financial situation, but you are not actually placing the trade.
Assets under advisement could also be those which you monitor for a client on a non-discretionary basis, where you may make recommendations but where the client is the party responsible for arranging or effecting the purchase or sale. A common example of this scenario is when an adviser reviews a participant’s 401(k) allocations. If the adviser does not have the authority or ability to effect changes in the portfolio, these assets are likely considered assets under advisement rather than regulatory assets under management.
Assets under advisement are permitted to be disclosed on Form ADV Part 2A as a separate asset figure from the assets under management. There is no requirement to disclose the assets under advisement figure, but some advisers opt to include the figure to give prospective clients a more complete picture of the firm’s responsibilities. If you choose to report your assets under advisement, be sure to make a clear distinction between this figure and your regulatory assets under management.
Much has been written and much has been opined on the topic of health information technology, electronic health records and medical security liability for physicians and healthcare providers in this textbook. But occasionally, we all still get lost in a wide array of acronyms, jargon and terms that are constantly changing in this ecosystem. And so, this brief glossary serves as a ready reference for those who want to know about these definitions in a quick and ready fashion.
Access control: The process of controlling the access of a user
Access security: To allow computer or healthcare network entry using ID / password / secure socket layer (SSL) encryption / biometrics, etc; unique identification and password assignments are usually made to medical staff members for access to medical information on a need-to-know basis, and only upon written authority of the owner of the data.
Access level authorization: Establishes a procedure to determine the computer or network access level granted to individuals working on or near protected health information, medical data or secure health data.
Accredited standards committee: Organization that helps develop American National Standards (ANS) for computer and health information technology; accredited by ANSI for the development of American National Standards; ASC X12N develops medical electronic business exchange controls like 835-Health Care Claim Payment/Advice and 837-Health Care Claim.
Accountability: The security goal that generates the requirement for actions of an entity to be traced uniquely to that entity. This supports nonrepudiation, deterrence, fault isolation, intrusion detection and prevention, and after-action recovery and legal action.
Accounting: Creating an historical record of who was authenticated, at what time, and how long they accessed the computer system.
Administrative simplification: The use of electronic standard code sets for health information exchange; Title II, Subtitle F of HIPAA gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care and medical information.
Alternative backup sites: Off-site locations that are used for transferring computer operations in the event of an emergency.
American Health Information Management Association: A large trade association of health information and medical data management professionals.
American Medical Informatics Association: An organization that promotes the use of electronic medical management and healthcare informatics for clinical and administrative endeavors.
American Telemedicine Association: Established in 1993 as a leading resource and advocate promoting access to medical care for patients and health professionals via telecommunications technology; membership open to individuals, companies, and other organizations with an interest in promoting the deployment of telemedicine throughout the world.
Anti-virus software: A software package or subscription service used to thwart malicious computer or network attacks, such as: Symantec®, McAfee®, Trend Micro®, Panda Software®, Sunbelt Software®, Computer Associates®, AVG® or MS-FF ®, etc.
ASC X12N: HIPAA transmission standards, specifications and implementation guides from the Washington Publishing Company; or the National Council of Prescription Drug Programs.
Assurance: Grounds for confidence that the other four security goals (integrity, availability, confidentiality, and accountability) have been adequately met by a specific implementation. “Adequately met” includes (1) functionality that performs correctly, (2) sufficient protection against unintentional errors (by users or software), and (3) sufficient resistance to intentional penetration or bypass.
Asymmetric cryptology: The use of two different but mathematically related electronic keys for secure health data and medical information storage, transmission and manipulation.
Asymmetric encryption: Encryption and decryption performed using two different keys, one of which is referred to as the public key and one of which is referred to as the private key; also known as public-key encryption.
Asymmetric key: A half of a key pair used in an asymmetric “public-key” encryption system with two important properties: (1) the key used for encryption is different from the one used for decryption, (2) neither key can feasibly be derived from the other.
Attack tree: An inverted tree diagram that provides a visual image of the attacks that may occur against an asset.
Audio teleconferencing: A multi-simultaneous dual voice communications between two parties at remote locations; two way communications between physician and patient at various locations.
Authentication: The process of verifying and confirming the identity of a user.
Availability: The security goal that generates the requirement for protection against – Intentional or accidental attempts to (1) perform unauthorized deletion of data or (2) otherwise cause a denial of service or data.
Back door: A means to access to a computer program that bypasses security mechanisms, sometimes installed by a programmer so that the program can be accessed for troubleshooting or other purposes.
Back door trojans or bots: Currently, the biggest threat to healthcare and all PC users worldwide according to the MSFT Corporation.®
Bandwidth: The amount of information that can be carried over a communications link.
Bar coding systems: Final FDA ruling issued in February 2004 that required bar codes on most prescription and non-prescription medications used in hospitals and dispensed based on a physician’s order; the bar code must contain at least the National Drug Code (NDC) number, which specifically identifies the drug; although hospitals are not required at this time to have a bar code reading system on the wards, this ruling has heightened the priority of implementing hospital-wide systems for patient-drug matching using bar codes.
Baud: A unit of digital transmission that indicates the speed of information flow. The rate indicates the number of events able to be processed in one second and is expressed as bits per second (bps). The baud rate is the standard unit of measure for data transmission capability; typical older rates were 1200, 2400, 9600, and 14,400 baud; the signaling rate of a telephone line in the number of transitions made in a second; 1/300 sec = 300 baud.
Beta test: The secondary or final stress examination of newly developed computer hardware, software or peripheral devices; site, etc.
Bibliographic database: Indexed computer or printed source of citations of journal articles and other reports in the literature; typically include author, title, source, abstract, and/or related information; MEDLINE® and EMBASE®.
Bioinformatics: The application of medical and biological science to the health information management field.
Biological Information technology: Cross industry alliance of the Microsoft Corporation to enhance the ability to use and share digital health and biomedical data.
Biometric: Personal security identity characteristics, such as a signature, fingerprints, voice, iris or retinal scan, hand or foot vein geometry, facial characteristics, hair analysis, eye, blood vessel or DNA; uses the unique human characteristics of a person as a means of authenticating.
Biometric identification: Secure identification using biometrics that identifies a human from a measurement of a physical feature or repeatable action of the individual (for example, hand geometry, retinal scan, iris scan, fingerprint patterns, facial characteristics, DNA sequence characteristics, voice prints, and hand written signature).
Biopassword: Start-up healthcare IT security pioneer of keyboarding patterns to boost online security through neural network patterns.
Bluetooth® device: Machines, like cell phone with headset, transmitting across communications channels 1 to 14, over time.
Bluetooth® technology: Wireless mobile technology standard built into millions of mobile phones, headsets, portable computers, desktops and notebooks; named after Harold Bluetooth, a 10th century Viking king; healthcare telemetry and rural data transmissions; the Bluetooth Special Interest Group (BSIG) advocates measures aimed at pushing healthcare interoperability for wireless devices and other computers designed for use in the medical field; other wireless stands include: Wi-Fi, ZigBe®, IrDA and RFID.
Buffer: A temporary storage area.
Buffer overflow: A security breach that occurs when a computer program attempts to stuff more data into a temporary storage area than it can hold
Business continuity plan: A plan that outlines the procedures to follow after a business experiences an attack on its security.
California Database Security Breach Act: A state act that requires disclosure to California residents if a breach of personal information has or is believed to have occurred.
Certification authority: An independent third-party organization that assigns digital certificates.
Chain of custody: A process that documents everyone who has had contact with or direct possession of the evidence.
Chain of trust: Suggestion that each and every covered entity and business associate share responsibility and accountability for confidential PHI.
Chain of trust agreement: Contract entered into by two business partners in which it is agreed to exchange data and that the first party will transmit information to the second party, where the data transmitted is agreed to be protected between the partners; sender and receiver depend upon each other to maintain the integrity and confidentiality of the transmitted information; multiple two-party contracts may be involved in moving information from the originator to the ultimate recipient; for example, a provider may contract with a clearing house to transmit claims to the clearing house; the clearing house, in turn, may contract with another clearing house or with a payer for the further transmittal of those same claims.
Children’s Online Privacy Protection Act: A federal act that requires operators of online services or Web sites directed at children under the age of 13 to obtain parental consent prior to the collection, use, disclosure, or display of a child’s personal information.
Cipher lock: A combination lock that uses buttons that must be pushed in the proper sequence in order to open the door.
Clearing house: HIPAA medical invoice, healthcare data transaction exchange and medical data implementation service center that that meets or exceeds Federally-mandated standardized Electronic Data Interchange (EDI) transaction requirements.
Clinger-Cohen Act: Public Law 104-106; Information Technology Management Reform Act (ITMRA) of 1996.
Clinical data: Protected Health Information (PHI) from patient, physician, laboratory, clinic, hospital and/or payer, etc; identifiable patient medical information.
Clinical data information systems: Automatic and securely connected system of integrated computers, central severs and the Internet that transmits Protected Health Information (PHI) from patient, physician, laboratory, clinic, hospital and/or payer, etc.
Clinical data repository: Electronic storehouse of encrypted patient medical information; clinical data storage.
Clinical informatics: The management of medical and clinical data; the use of computers, networks and IT for patient care and health administration.
Clinical information: All the related medical information about a patient; Protected Health Information (PHI) from patients, providers, laboratories, clinics, hospitals and/or payers or other stakeholders, etc.
Clinical information system: A computer network systems that supports patient care; relating exclusively to the information regarding the care of a patient, rather than administrative data, this hospital-based information system is designed to collect and organize data.
Clinical regional health information system: Electronic entity committed to securely share private patient health information among entities like medical providers, clinics, laboratories, hospitals, outpatient centers, hospice and other healthcare facilities; Community Health Management Information Systems (CHMIS), Enterprise Information Networks (EINs), Regional Health Information Networks (RHINs) and Health Information Networks (HINs).
Cold site: An alternative backup site that provides the basic computing infrastructure, such as wiring and ventilation, but very little equipment.
Compact disc – read only memory (CD-ROM): A computer drive that can read CD-R and CD-RW discs.
Compact disc – recordable (CD-R): An optical disc that contains up to 650 megabytes of data and cannot be changed once recorded.
Compact disc – rewriteable (CD-RW): An optical disc that can be used to record data, erase it, and re-record again.
Computer security: A computer or network that is free from threats against it.
Computerized Physician Order Entry System: Automatic medical provider electronic medical chart ordering system that usually includes seven features: medication analysis, system order clarity, increased work efficiency, point of care utilization, benchmarking and performance tracking, on-line alerts and regulatory reporting.
Confidential health information: Protected Health Information (PHI) that is prohibited from free-use and secured from unauthorized dissemination or use; patient specific medical data.
Counter signature: The ability to prove the order of application of signatures; analogous to the normal business practice of signing a document which has already been signed by another party (ASTM E 1762 -95); part of a digital signature.
Covered entity: 42 CFR § 164.504(e)(2)(i)(B). Any of three broadly defined entities that deal with protected health information (PHI): providers, individuals or group health plans, and clearinghouses.
Cracker: A person who breaks into or otherwise violates the system security with a malicious intent.
Cryptography: The science of transforming information so that it is secure while it is being transmitted or stored.
Cyber-terrorism: Attacks by a terrorist group using computer technology and the Internet to cripple or disable a nation’s electronic infrastructure.
Data backup: The process of copying data to another media and storing it in a secure location.
Data encryption standard: An older health or medical data private key cryptology federal protocol for secure information exchange; replaced by AES.
Data interchange standard: X12 HIPAA health data transmission standard format.
Data interchange standard association: The organization that provides X12 HIPAA transmission standards and formats.
Deadbolt lock: A lock that extends a solid metal bar into the door frame for extra security.
Decision support system: Computer tools or applications to assist physicians in clinical decisions by providing evidence-based knowledge in the context of patient-specific data; examples include drug interaction alerts at the time medication is prescribed and reminders for specific guideline-based interventions during the care of patients with chronic disease; information should be presented in a patient-centric view of individual care and also in a population or aggregate view to support population management and quality improvement.
Decryption: Changing an encrypted message back to its original form.
Definition files: Files that contain updated antivirus information.
De-identified health information: Protected health information that is no longer individually identifiable health information; a covered entity may determine that health information is not individually identifiable health information only if: (1) a person with appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable determines that the risk is very small that the information could be used, alone or in combination with other available information, to identify an individual, and documents the methods and results of the analysis; or (2) the following identifiers of the individual, relatives, employers or household members of the individual are removed.
Denial of service: The prevention of authorized access to resources or the delaying of time critical operations.
Designated record set: Contains medical and billing records and any other records that a physician and/or medical practice utilizes for making decisions about a patient; a hospital, emerging healthcare organization, or other healthcare organization is to define which set of information comprises “protected health information” and which set does not; contains medical or mixed billing records, and any other information that a physician and/or medical practice utilizes for making decisions about a patient. It is up to the hospital, EHO, or healthcare organization to define which set of information comprises “protected health information” and which does not though logically this should not differ from locale to locale. The patient has the right to know who in the lengthy data chain has seen their PHI. This sets up an audit challenge for the medical organization, especially if the accountability is programmed, and other examiners view the document without cause.
Designated standard: HIPAA standard as assigned by the department of HHS
Device lock: A steel cable and a lock used to secure a notebook computer.
Digital certificate: A certificate that binds a specific person to a public key.
Digital imaging and communications in medicine: Technology broadband transmission imaging standards for X-rays, MRIs, CT and PET scans, etc; health IT standard transmissions platform aimed at enabling different computing platforms to share image data without compatibility problems; a set of protocols describing how radiology images are identified and formatted that is vendor-independent and developed by the American College of Radiology and the National Electronic Manufacturers Association.
Digital radiology: Medical digital imaging applied to x-rays, CT, PET scans and related non-invasive and invasive technology; broadband intensive imaging telemedicine.
Digital rights management: The control and protection of digital intellectual property.
Digital signature: Encrypted electronic authorization with verification and security protection; private and public key infrastructure; based upon cryptographic methods of originator authentication, computed by using a set of rules and a set of parameters so that the identity of the signer and the integrity of medical or other data can be verified.
Digital signature standard: Encryption technology to ensure electronic medical data transmission integrity and authentication of both sender and receiver; date and time stamps; public and private key infrastructure.
Digital versatile disc – recordable (DVD-R): An optical disc technology that can record once up to 3.95 gigabytes of data on a single-sided disc and 7.9 GB on a double-sided disc.
Digital versatile disc – rewriteable (DVD-RAM): An optical disc technology that can record, erase, and re-record data and has a capacity of 2.6 GB (single side) or 5.2 GB (double side).
Digital versatile disc (DVD): A technology that permits large amounts of data to be stored on an optical disc.
Disaster recovery plan: A process to restore vital health and/or critical healthcare technology systems in the event of a medical practice, clinic, hospital or healthcare business interruption from human, technical or natural causes; focuses mainly on technology systems, encompassing critical hardware, operating and application software, and any tertiary elements required to support the operating environment; must support the process requirements to restore vital company data inside the defined business requirements; does not take into consideration the overall operating environment; an emergency mode operation plan is still necessary.
Disclosure: Release of PHI outside a covered entity or business agreement space, under HIPAA; the release, transfer, provision of access to or divulging of medical information outside the entity holding the information.
Disc – rewriteable (DVD-RW): An optical disc technology that allows data to be recorded, erased, and re-recorded.
Due care: Managers and their organizations have a duty to provide for information security to ensure that the type of control, the cost of control, and the deployment of control are appropriate for the system being managed.
e-health: Emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies; characterizes not only a technical development, but also a state-of-mind, attitude, and a commitment for networked, global thinking, to improve health care worldwide by using information and communication technology.
Electronic data interchange: Inter healthcare organization computer-to-computer transmission of business or health information in a standard format; direct transmission from the originating application program to the receiving, or processing, application program; an EDI transmission consists only of business or health data, not any accompanying verbiage or free-form messages; a standard format is one that is approved by a national or international standards organization, as opposed to formats developed by health industry groups, medical practices, clinics or companies; the electronic transmission of secure medical and financial data in the healthcare industrial complex; X12 and similar variable-length formats for the electronic exchange of structured health data. The Centers for Medicare and Medicaid Services (CMS) regulates security and Electronic Data Interchange (EDI).
Electronic data interchange standards: The American National Standards Institute (ANSI) set of EDI standards known as the X12 standards. These standards have been developed by private sector standards development organizations (SDOs) and are maintained by the Accredited Standards Committee (ASC) X12. ANSI ASC X12N standards, Version 4010, were chosen for all of the transactions except retail pharmacy transactions, which continue to use the standard maintained by the National Council for Prescription Drug Programs (NCPDP) because it is already in widespread use. The NCPDP Telecommunications Standard Format Version 5.1 and equivalent NCPDP Batch Standard Version 1.0 have been adopted in this rule (health plans will be required to support one of these two NCPDP formats). The standards are designed to work across industry and company boundaries. Changes and updates to the standards are made by consensus, reflecting the needs of the entire base of standards users, rather than those of a single organization or business sector. Specifically, the following nine healthcare transactions were required to use X12N standard electronic claim formats by October 16, 2003.
Electronic health record: A real-time patient health record with access to evidence-based decision support tools that can be used to aid clinicians in decision-making; the EHR can automate and streamline a clinician’s workflow, ensuring that all clinical information is communicated; prevents delays in response that result in gaps in care; can also support the collection of data for uses other than clinical care, such as billing, quality management, outcome reporting, and public health disease surveillance and reporting; electronic medical record.
Electronic medication administrative record: Electrical file keeping computerized system for tracking clinical medication dispensation and use; integrated with TPAs, PBMs, robotic dispensing devices and CPOEs, etc.
Electronic medical (media) claims: Usually refers to a flat file format used to transmit or transport medical claims, such as the 192-byte UB-92 Institutional EMC format and the 320-byte Professional EMC-NSF.
Electronic prescribing: A type of computer technology whereby physicians use handheld or personal computer devices to review drug and formulary coverage and to transmit prescriptions to a printer or to a local pharmacy; e-prescribing software can be integrated into existing clinical information systems to allow physician access to patient-specific information to screen for drug interactions and allergies.
Electronic preventive services selector: A digital tool for primary care clinicians to use when recommending preventive services for their patients unveiled by the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), in November 2006; designed for use on a personal digital assistant (PDA) or desktop computer to allow clinicians to access the latest recommendations from the AHRQ-sponsored U.S. Preventive Services Task Force; designed to serve as an aid to clinical decision-making at the point of care and contains 110 recommendations for specific populations covering 59 separate preventive services topics; a real time search function allows a clinician to input a patient’s age, gender, and selected behavioral risk factors, such as whether or not they smoke, in the appropriate fields, while the software cross-references the patient characteristics entered with the applicable Task Force recommendations and generates a report specifically tailored for that patient.
Electronic signature: Various date and time stamped electronic security verification systems, such as passwords, encryption, ID numbers, biometrics identifiers, etc; electrical transmission and authentication of real signatories; signatory attribute that is affixed to an electronic health document to bind it to a particular entity; an electronic signature process secures the user authentication (proof of claimed health identity, such as by biometrics (fingerprints, retinal scans, hand written signature verification, etc.), tokens or passwords) at the time the signature is generated; creates the logical manifestation of signature (including the possibility for multiple parties to sign a medical document and have the order of application recognized and proven) and supplies additional information such as time stamp and signature purpose specific to that user; and ensures the integrity of the signed document to enable transportability, interoperability, independent verifiability, and continuity of signature capability; verifying a signature on a document verifies the integrity of the document and associated attributes and verifies the identity of the signer; there are several technologies available for user authentication, including passwords, cryptography, and biometrics (ASTM 1762-95).
Encryption: Changing the original text to a secret message.
Gigabytes (GB): Billions of bytes of data.
Gramm-Leach-Bliley Act: A federal act that requires private data be protected by banks and financial institutions.
Hacker: A person who possesses advanced computer skills and is adept at exploring computers and networks in order to break into them.
HEALTH 1.0: This is the dying healthcare system of yesterday and today. Information is communicated from doctors to patients. It is a basic B2C [business-to-consumer] website as the internet became one big encyclopedia by aggregating knowledge silos. Some doctors maintain websites, others do not. Nevertheless, Health 1.0 has a command and control hierarchy; doctors on top of the pyramid, patients on the bottom.
HEALTH 2.0:According to Matthew Holt [personal communication] Healthcare 2.0 may be defined as: “The foundation of healthcare 2.0 is information exchange plus technology. It employs user-generated content, social networks and decision support tools to address the problems of inaccessible, fragmentary or unusable health care information. Healthcare 2.0 connects users to new kinds of information, fundamentally changing the consumer experience (e.g., buying insurance or deciding on/managing treatment), clinical decision-making (e.g., risk identification or use of best practices) and business processes (e.g., supply-chain management or business analytics)”.
And so, if Health 1.0 was a static book, Health 2.0 is a dynamic discussion
Example: The power of the internet is illustrated in the phenomenon of “crowd-sourcing.” In this context, the term means to harvest the reach of social networking [wisdom of crowds] to solve a problem. A knowledge seeker asks a question and participants respond. For example, readers can participate on the www.MedicalExecutivePost.com or www.BusinessofMedicalPractice.com sites to improve the administration of any medical practice. And, www.PodiatryPrep.com is an example of how podiatrists connect for global board certification assistance.
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HEALTH 2.0 Plus:The Dictionary of Health Insurance and Managed Care defines this emerging hybrid as a bridge uniting the philosophy of contemporary Health 2.0 with futuristic Health 3.0 technologies. Cisco System’s HealthPresence is one example developed in 2010, by Dr. T. Warner Hudson. Using the network as a platform, HealthPresence combines video, audio and information to create an environment similar to what patients experience when they visit their own doctor.
HEALTH 3.0: Soon, patients will not only be seeking information; but actionable intelligence – whether it is artificial or real. Patients will communicate almost as with another patient or doctor. The internet won’t just blindly do what we tell it to do – it will think and represent some amazing opportunities. For example, imagine your toilet running a SMAC 20 and then being instantly notified of the results by your smart phone? Or; use your iPhone to send pictures and streaming videos of conditions for a second opinion www.KnockingLive.com
Health information technology: The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, medical data, and knowledge for communication and decision making.
Health information technology auditor: An expert who evaluate a health organization’s computer systems to ensure the proper safeguards are in place to protect and maintain the integrity of the firm’s data; While the position has existed since the mid-1960s, companies that previously employed just a handful of HIT auditors are now significantly adding to their ranks, sometimes doubling, tripling or quadrupling current staff levels; much current demand is due to the Sarbanes-Oxley Act and other legislation aimed at improving corporate governance in the wake of major accounting scandals earlier in the decade; publicly traded hospital systems require the expertise of HIT auditors to meet ongoing compliance requirements; the Gramm-Leach-Bliley Act and the Health Insurance Portability and Accountability Act (HIPAA), among other regulations, also are fueling the need for HIT auditors. Health IT auditors must have a general understanding of accounting principles and the strategic vision to ensure a health organization’s HIT systems allow it to achieve its short- and long-term objectives. Many hospitals promote from within for this role. Health facilities who look outside the organization for these professionals usually seek candidates with experience, knowledge of healthcare of emerging technologies and issues, and increasingly, certifications such as the certified information systems auditor (CISA) designation.
Health information technology promotion act: Legislation to accelerate the adoption of interoperable electronic health records by ensuring uniform standards, championed by Rep. Nancy Johnson, R-Conn, (H.R. 4157) which would: codify the Office of the National Coordinator for Health Information Technology in statute and delineate its ongoing responsibilities; create exceptions to the fraud and abuse statutes to allow certain providers to fund health information technology equipment and services for other providers; and provide for a study of federal and state health privacy policies.
Health Insurance Portability and Accountability Act (HIPAA): A federal act that requires enterprises in the health sector to guard protected health information and implement policies and procedures to safeguard it.
Health level seven: An international community of healthcare subject matter experts and information technology physicians and scientists collaborating to create standards for the exchange, management and integration of protected electronic healthcare information; the Ann Arbor, Mich.-based Health Level Seven (HL7) standards developing organization has evolved Version 3 of its standard, which includes the Reference Information Model (RIM) and Data Type Specification (both ANSI standards); HL7 Version 3 is the only standard that specifically deals with creation of semantically interoperable healthcare information, essential to building the national infrastructure; HL7 promotes the use of standards within and among healthcare organizations to increase the effectiveness and efficiency of healthcare delivery for the benefit of all patient, payers, and third parties; uses an Open System Interconnection (OSI) and high level seven healthcare electronic communication protocol that is unique in the medical information management technology space and modeled after the International Standards Organization (ISO) and American National Standards Institute (ANSI); each has a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven’s domain is clinical and administrative data.
Hot site: An alternative backup site that contains the same equipment as found in the organization’s actual IT center.
Human firewall: An employee who practices good security techniques to prevent any security attacks from passing through them.
Incident response team: An employee team charged with gathering and handling the digital evidence of an attack.
Individually identifiable health information: Medical information that is created or received by a covered entity; relates to the physical or mental health condition of an individual, provision of health care or the payment for the provision of health care; identifies the individual or there is reasonable belief that the information can be used to identify the individual.
Information security: A computer or network that is free from threats against it.
Integrity: The security goal that generates the requirement for protection against either intentional or accidental attempts to violate data integrity (the property that data has when it has not been altered in an unauthorized manner) or system integrity (the quality that a system has when it performs its intended function in an unimpaired manner, free from unauthorized manipulation).
Intellectual property: Works created by others such as books, music, plays, paintings, and photographs.
IT-related risk: The net mission impact considering (1) the probability that a particular threat-source will exercise (accidentally trigger or intentionally exploit) system vulnerability and (2) the resulting impact if this should occur. IT-related risks arise from legal liability or mission loss due to:
* Unauthorized (malicious or accidental) disclosure, modification, or destruction of information
* Unintentional errors and omissions
* IT disruptions due to natural or man-made disasters
* Failure to exercise due care and diligence in the implementation and operation of the IT system.
Key-in-knob lock: A basic lock that has the lock mechanism embedded in the knob or handle.
Keystroke logger: A type of hardware spyware that captures keystrokes as they are typed.
Logic bombs: A computer program that lies dormant until it is triggered by a specific event.
Lossless: To compress electronic digital data.
Malicious code: Programs that are intentionally created to break into secure computers or to create havoc after the computers are accessed.
Master patient index: Healthcare facility composite that links and assists in tracking patient, person, or member activity within an organization (or health enterprise) and across patient care settings; hardcopy or electronic identification of all patients treated in a facility or enterprise and lists the medical record or identification number associated with the name; can be maintained manually or as part of a computerized system; typically, those for healthcare facilities are retained permanently, while those for insurers, registries, or others may have different retention periods; a database of all the patients ever registered (within reason) at a facility; name, demographics, insurance, next of kin, spouse, etc.
Medically unbelievablE event: Implemented on Jan. 1, 2007, the CMS blockage of payments for medical services that make no sense based on “anatomic considerations” or medical reasonableness when the same patient, date of service, HCPCS code or provider is involved; unlike other National Correct Coding Initiative (NCCI) edits, MUEs can’t be overridden by a modifier because there will never be a scenario where the physician had a good reason to submit a claim for removing a second appendix from the same person; etc.
Megabytes (MB): Millions of bytes of storage.
Memory stick: USB flash or non-volatile storage device; Sony CompactFlash®, pen or mini-drive; flash card, smart media, slang terms.
Mesh: Medical Subject Headings, the controlled vocabulary of about 16,000 terms used for MEDLINE and certain other MEDLARS databases.
Minimum necessary: The amount of protected health information shared among internal or external parties determined to me the smallest amount needed to accomplish its purpose for Use or Disclosure; the amount of health information or medical data needed to accomplish a purpose varies by job title, CE or job classification.
Minimum necessary rule: HIPAA regulation that suggests any PHI used to identify a patient, such as a social security number, home address or phone number; divulge only essential elements for use in transferring information from patient record to anyone else that requires the information; especially important with financial information; changes the way software is written and vendor access is provided. The “Minimum Necessary” Rule states the minimum use of PHI that can be used to identify a person, such as a social security number, home address or phone number. Only the essential elements are to be used in transferring information from the patient record to anyone else that needs this information. This is especially important when financial information is being addressed. Only the minimum codes necessary to determine the cost should be provided to the financial department. No other information should be accessed by that department. Many institutions have systems where a registration or accounting clerk can pull up as much information as a doctor or nurse, but this is now against HIPAA policy and subject to penalties. The “minimum necessary” rule is also changing the way software is set up and vendor access is provided.
Mirror site: A secondary location identical to the primary IT site that constantly receives a copy of data from the primary site.
National health information network: The technologies, standards, laws, policies, programs and practices that enable health information to be shared among health decision makers, including consumers and patients, to promote improvements in health and healthcare; vision for the NHII began more than a decade ago with publication of an Institute of Medicine report, The Computer-Based Patient Record. The path to a national network of healthcare information is through the successful establishment of Regional Health Information Organizations (RHIO).
National provider identifier: Originally was an eight-digit alphanumeric identifier. However, the healthcare industry widely criticized this format, claiming that major information systems incompatibilities would make it too expensive and difficult to implement. DHHS therefore revised its recommendation, instead specifying a 10-position numeric identifier with a check digit in the last position to help detect keying errors. The NPI carries no intelligence; in other words, its characters will not in themselves provide information about the provider. More recently, CMS announced that HIPAA-covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the NPI to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008. The proposal for a Standard Unique National Health Plan (Payer) Identifier was withdrawn on February, 2006. (According to CMS, “withdrawn” simply means that there is not a specific publication date at this time. Development of the rule has been delayed; however, when the exact date is determined, the rule will be put back on the agenda.)
Network: A group of interconnected computers.
Notebook safe: A special safe secured to a wall or the trunk of a car used for storing a notebook computer.
Operating system hardening: Steps that can be taken to make a personal computer operating system more secure.
Optical disc: A disc that uses laser technology to record data.
Password: A secret combination of words or numbers that authenticates or identifies the user.
Patch: A software update to correct a problem.
Patch management: Tools, utilities, and processes for keeping computers up to date with new software updates that are developed after a software product is released.
Pharmacy information system: Drug tracking and dispensation related health management information system for hospitals and healthcare organizations.
PhisHing: An attempt to fraudulent gather confidential information by masquerading as a trustworthy entity, person or business in an apparently official email, text message or website; carding or spoofing; video vishing; phish-tank; vish-tank; slang terms.
Physical security: The process of protecting the computer itself.
Port scanning: Sending a flood of information to all of the possible network connections on a computer.
Ports: The network connections on a computer.
Preset lock: A basic lock that has the lock mechanism embedded in the knob or handle.
Privacy: The quality or state of being hidden, encrypted, obscure, or undisclosed; especially medical data or PHI.
Privacy act: Federal legislature of 1974 which required giving patient some control over their PHI.
Privacy enhanced mail: Email message standard protocol for enhanced medical, health data or other security.
Privacy officer: A medical entity’s protected client information and security officer; required by each covered entity, to be responsible for “the development and implementation of the policies and procedures” necessary for compliance.
Privacy rule: The Federal privacy regulations promulgated under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 that created national standards to protect medical records and other protected health information. The Office of Civil Rights (OCR) within the Department of Health and Human Services (DHHS) regulates the privacy rules.
Privacy standards: Any protocol to ensure the confidentiality of PHI.
Private key system: A means of cryptography where the same key is used to both encrypt and decrypt a message.
Public key system: A means of cryptography where two keys are used.
* Psychotherapy notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual’s medical record; excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.
* Public health authority means an agency or authority of the United States, a State, a territory, a political subdivision of a State or territory, or an Indian tribe, or a person or entity acting under a grant of authority from or contract with such public agency, including the employees or agents of such public agency or its contractors or persons or entities to whom it has granted authority, that is responsible for public health matters as part of its official mandate.
* Required by law means a mandate contained in law that compels a covered entity to make a use or disclosure of protected health information and that is enforceable in a court of law; includes but is not limited to, court orders and court-ordered warrants; subpoenas or summons issued by a court, grand jury, a governmental or tribal inspector general, or an administrative body authorized to require the production of information; a civil or an authorized investigative demand; Medicare conditions of participation with respect to health care providers participating in the program; and statutes or regulations that require the production of information, including statutes or regulations that require such information if payment is sought under a government program providing public benefits.
Regional health information organization: A multi-stakeholder organization that enables the exchange and use of health information, in a secure manner, for the purpose of promoting the improvement of health quality, safety and efficiency; the U.S. Department of Health and Human Services see RHIOs as the building blocks for the national health information network (NHIN) that will provide universal access to electronic health records; other experts maintain that RHIOs will help eliminate some administrative costs associated with paper-based patient records, provide quick access to automated test results and offer a consolidated view of a patient’s history.
Risk assessment: The process of identifying the risks to system security and determining the probability of occurrence, the resulting impact, and additional safeguards that would mitigate this impact.
Risk management: The total process of identifying, controlling, and mitigating information system–related risks. It includes risk assessment; cost-benefit analysis; and the selection, implementation, test, and security evaluation of safeguards. This overall system security review considers both effectiveness and efficiency, including impact on the mission and constraints due to policy, regulations, and laws.
Royalties: Payment to the owner or creator of intellectual property for their work.
Sarbanes-Oxley Act (Sarbox): A federal act that enforces reporting requirements and internal controls on electronic financial reporting systems.
Scanning: Locating a computer that can be broken into.
Script kiddies: Younger and less sophisticated users who break into a computer with malicious intent.
Secure virtual private network: Cryptographic tunneling protocols to provide the necessary health data confidentiality (preventing snooping), sender authentication (preventing identity spoofing), and message integrity (preventing message alteration) to achieve the medical privacy intended. When properly chosen, implemented, and used, such techniques can provide secure communications over unsecured networks.
Security: A set of healthcare information technology system characteristic and mechanisms which span the system both logically and physically; electronic access control against unauthorized intervention, both friendly or malicious; encompasses all of the safeguards in an information system, including hardware, software, personnel policies, information practice policies, disaster preparedness, and the oversight of all these areas; the purpose of health information security is to protect both the system and the information it contains from unauthorized access from without and from misuse from within; through various security measures, a health information system can shield confidential information from unauthorized access, disclosure and misuse, thus protecting privacy of the individuals who are the subjects of the stored data; security life cycle.
Security administration: The physical and electrical protection features of an IT health system needed to be managed in order to meet the needs of a specific installation and to account for changes in the healthcare entities operational environment.
Security compromise: Physical or electronic data, file, program or transmission error due to malicious miscreants or software interventions; health data confidentiality breach.
Security configuration: Measures, practices, and procedures for the safety of information systems that must be coordinated and integrated with each other and other methods, practices, and procedures of the organization established in order to credential safekeeping policy; provides written security plans, rules, procedures, and instructions concerning all components of a healthcare entity’s security; procedures must give instructions on how to report breaches and how those breaches are to be handled within the organization.
Security configuration management: The measurement of practices and procedures for the security of information systems that is coordinated and integrated with each other and other measures, practices and procedures of the organization so as to create a coherent system of health data security (NIST Pub 800-14).
Security domain: A set of subjects, their information objects, and a common security policy; foundation for IT security is the concept of security domains and enforcement of data and process flow restrictions within and between these domains.
Security goals: The five security goals are integrity, availability, confidentiality, accountability, and assurance.
Security information system: security is a system characteristic and a set of mechanisms that span the system both logically and physically.
Security policy: A formal written policy that outlines the importance of security to the organization and establishes how the security program is organized.
Share: An object that is shared with others over a computer network.
Signature files: Files that contain updated antivirus information.
Smart card: A device that contains a chip that stores the user’s private key, login information, and public key digital certificate.
Sniffing: Listening to the traffic on a computer network and then analyzing it.
Social engineering: Relying on trickery and deceit to break security and gain access to computers.
Spam: Unsolicited e-mail messages.
Spy: A person who has been hired to break into a computer and steal data.
Spyware: Hardware or software that “spies” on what the user is doing and captures that activity without their knowledge.
Stealth signal transmitter: Software installed on a notebook computer that sends a signal that can be traced.
Threat analysis: The examination of threat-sources against system vulnerabilities to determine the threats for a particular system in a particular operational environment.
Threat modeling: A process of constructing scenarios of the types of threats that assets face.
Threat: The potential for a threat-source to exercise (accidentally trigger or intentionally exploit) a specific vulnerability.
Threat-source: Either (1) intent and method targeted at the intentional exploitation of a vulnerability or (2) a situation and method that may accidentally trigger a vulnerability.
Token: A security device used to authenticate the user by having the appropriate permission (like a password) embedded into the device.
USA Patriot Act: A federal act designed to broaden the surveillance of law enforcement agencies to enhance the detection and suppression of terrorism.
Username: A unique identifier of a person used to access a computer system.
Virus: A program that secretly attaches itself to other programs and when executed causes harm to a computer.
Vulnerability: A flaw or weakness in system security procedures, design, implementation, or internal controls that could be exercised (accidentally triggered or intentionally exploited) and result in a security breach or a violation of the system’s security policy.
Vulnerability assessment: A process to determine what vulnerabilities exist in the current system against these attacks.
Vulnerability assessment managed services: Agencies that use scanning devices connected to probe an organization’s security to look for vulnerabilities.
War driving: A technique used to locate wireless local area networks (WLANs).
WiMax: A more powerful version of Wi-Fi that can provide wireless Internet access over wider geographic location such as a city; an acronym that stands for Worldwide Interoperability for Microwave Access, and is a certification mark for products that pass conformity and interoperability tests for the IEEE 802.16 standards. IEEE 802.16 is working group number 16 of IEEE 802, specializing in point-to-multipoint broadband wireless access.
Wireless hot spot: Specific geographic location in which an access point provides public wireless broadband network services; security is risky for PHI; hotspot.
Wireless local area networks: A computer network that uses radio waves instead of wires to connect computers.
Worm: A program that does not attach itself to other programs or need user intervention to execute.
Posted on June 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
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By Dr. David Edward Marcinko MBA MED CMP™
SPONSOR: wwwCertifiedMedicalPlanner.org
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Crisis Management is the precautions and identification of threats to an organization and its stakeholders, and the methods used by the organization to deal with these threats.
For example, recall in 1982, that Tylenol™ commanded 35 percent of the over-the-counter analgesic market in America and it represented nearly 17 percent of Johnson & Johnson’s profits. But, when seven people died from consuming the tainted drug, a national panic ensued. Moreover, Americans started to question the safety of all over-the-counter medications.
Fortunately, J&J commenced the proto-typical good crisis response in the following way:
J&J acted quickly, with complete candidness about what happened and within hours of learning of the deaths, J&J installed toll-free numbers for consumers, sent alerts to healthcare providers nationwide, and stopped advertising the product. J&J recalled 31 million bottles of Tylenol™ capsules and offered replacement products free of charge. J&J did not wait for evidence to see whether the contamination might be more widespread.
J&J’s leadership was in the lead and seemed in full control throughout the crisis. The chairman was admired for his leadership to pull Tylenol™ capsules off the market and his forthrightness in dealing with the media. The Tylenol™ crisis led the news every night on every station for six weeks.
J&J placed consumers first. J&J spent more than $100 million for the recall and re-launch of Tylenol™. The stock had been trading near a 52-week high just before the tragedy, dropped for a time, but recovered to its highs only two months later.
J&J accepted responsibility. The disaster could have been described in many different ways: as an assault on the company, as a problem somewhere in the process of getting Tylenol™ from J&J factories to retail stores, or as the acts of a crazed criminal.
J&J sought to ensure that measures were taken to prevent a recurrence of the problem. J&J introduced tamper-proof packaging that would make it much more difficult for a similar incident to occur in the future.
J&J presented itself prepared to handle the short-term damage in the name of consumer safety. Within a year of the disaster, J&J’s share of the analgesic market, which had fallen to 7 percent from 37 percent following the poisoning, had climbed back to 30 percent.
This wildly successful response in now the stuff of graduate and business school case models for excellence in teaching!
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
here are many ways for a doctor, osteopath, podiatrist or dentist to financially invest. Traditionally, this meant picking individual stocks and bonds. Today, there are many other ways to purchase securities en mass. For example:
MUTUAL FUND: A regulated investment company that manages a portfolio of securities for its shareholders.
Open End Mutual Funds: An investment company that invests money in accordance with specific objectives on behalf of investors. Fund assets expand or contract based on investment performance, new investments and redemptions. Trade at Net Asset Value or the price the fund shares scheduled with the US Securities and Exchange Commission (SEC) trade. NAV can change on a daily basis. Therefore, per-share NAV can, as well.
Closed End Mutual Funds: Older than open end mutual funds and more complex. A CEMF is an investment company that registers shares SEC regulations and is traded in securities markets at prices determined by investments. Shares of closed-end funds can be purchased and sold anytime during stock market hours. CEMF managers don’t need to maintain a cash reserve to redeem or / repurchase shares from investors. This can reduce performance drag that may otherwise be attributable to holding cash. CEMFs may be able to offer higher returns due to the heavier use of leverage [debt]. They are subject to volatility, less liquid than open-end funds, available only through brokers and may sells at a heavily discount or premium to [NAV] determined by subtracting its liabilities from its assets. The fund’s per-share NAV is then obtained by dividing NAV by the number of shares outstanding. .
Sector Mutual Funds: Sector funds are a type of mutual fund or Exchange-Traded Fund (ETF) that invests in a specific sector or industry such as technology, healthcare, energy, finance, consumer goods, or real estate. Sector funds focus on a particular industry, allowing investors to gain targeted exposure to specific market areas. The goal is to outperform the overall market by investing in companies within a specific sector that is expected to perform well. However, they are also more susceptible to market fluctuations and specific sector risks, making them a more specialized and potentially higher-risk investment option.
EXCHANGE TRADED FUNDS: ETFs are a type of fund that owns various kinds of securities, often of one type. For example, a stock ETF holds stocks, while a bond ETF holds bonds. One share of the ETF gives buyers ownership of all the stocks or bonds in the fund. If an ETF held 100 stocks, then those who owned the fund would own a stake – albeit a very tiny one – in each of those 100 stocks.
ETFs are typically passively managed, meaning that the fund usually holds a fixed number of securities based on a specific preset index of investments. These are tax efficient. In contrast, many mutual funds are actively managed, with professional investors trying to select the investments that will rise and fall.
The Standard & Poor’s 500 Index is perhaps the world’s best-known index, and it forms the basis of many ETFs. Other popular indexes include the Dow Jones Industrial Average and the National Association of Securities Dealers Automated Quotations [NASDAQ] Composite Index.
ETFs based on these funds are called Index Funds and just buy and hold whatever is in the index and make no active trading decisions. ETFs trade on a stock exchange during the day, unlike mutual funds that trade only after the market closes. With an ETF you can place a trade whenever the market is open and know exactly the price you’re paying for the fund.
INDEX FUNDS: Index funds mirror the performance of benchmarks like the DJIA. These passive investments are an unimaginative way to invest. Passive index funds tracking market benchmarks accounted for just 21% of the U.S. equity fund market in 2012. By 2024, passive index funds had grown to about half of all U.S. fund assets. This rise of passive funds has come as they often outperform their actively managed peers. According to the widely followed S&P Indices Versus Active (SPIVA) scorecards, about 9 out of 10 actively managed funds didn’t match the returns of the S&P 500 benchmark in the past 15 years.
ASSESSMENT
Investing in individual stocks is psychologically and academically different than investing in the above funds, according to psychiatrist and colleague Ken Shubin-Stein MD, MPH, MS, CFA who is a professor of finance at the Columbia University Graduate School of Business When you buy shares of a company, you are putting all your eggs in one basket. If the company does well, your investment will go up in value. If the company does poorly, your investment will go down. Fund diversification helps reduce this risk.
CONCLUSION
Investing in the above fund types will help mitigate single company security risk.
References:
1. Fenton, Charles, F: Non-Disclosure Agreements and Physician Restrictive Covenants. In, Marcinko, DE and Hetico, HR: Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™]. Productivity Press, New York, 2015.
Readings:
1. Marcinko, DE and Hetico, HR; Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017
2. Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, NY 2006
4. Shubin-Stein, Kenneth: Unifying the Psychological and Financial Planning Divide [Holistic Life Planning, Behavioral Economics, Trading Addiction and the Art of Money]. Marcinko, DE and Hetico, HR; Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
We make second investment portfolio opinions affordable
Approximately 1 million allopathic physicians, 150,000 dentists, 200,000 osteopaths, 15,000 podiatrists and 6 million nurses often find it difficult to get an unbiased and fiduciary second opinion on their retirement or brokerage accounts. By offering second opinions for a flat fee, the monetary barriers that prevented colleagues from receiving a second opinion in the past have been removed.
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Fiduciary and non-sales orientated second opinions have the power to change financial lives in the long term. We’ve seen it happen many times. What characterizes a good second opinion? Three things: the opinion must be individualized to your investment portfolio[s], informed and results-oriented. That’s the informed fiduciary approach we take. We are colleagues and look forward to working with you.
As many medical, dental and podiatric colleagues are aware, Environmental, Social and Governance (ESG) investing refers to a set of standards for a company’s behavior used by socially conscious investors to screen potential investments. Over the last decade, or so, I have seen many investors pursing this laudable aim.
Yet, more than 80% of private equity fund managers have now stepped away from at least one deal due to ESG concerns, according to the 2023 BDO Private Capital Survey. The reasons are complex, and point towards fund managers’ sentiment towards risk-reward in the current economic environment.
This retreat from ESG is due to backlash from conservatives who are critical of the idea that mutual fund managers should be considering any other factor but a company’s share holders in their investment decisions. Accusations of “Greenwashing” have also plagued many ESG funds, which is when an asset management firm charging higher fees or a specific thematic fund without actually delivering a unique investment strategic competitive advantage.
Greenwashing is the process of conveying a false impression or misleading information about how a company’s products are environmentally sound. Greenwashing involves making an unsubstantiated claim to deceive consumers and / or investors into believing that a company’s products are environmentally friendly or have a greater positive environmental impact than they actually do. Greenwashing may also occur when a company attempts to emphasize sustainable aspects of a product to overshadow the company’s involvement in environmentally damaging practices.
According to internationally known linguistics and cognitive science Professor,Mackenzie Hope Marcinko PhD of the University of Delaware, greenwashing is performed through the use of environmental imagery, misleading labels, cognitive biases and tendencies hiding tradeoffs. Greenwashing is also a play on the term “Whitewashing,” which means using false information to intentionally hide wrongdoing, errors or an unpleasant situation in an attempt to make it seem less bad than it really is.
To be sure, uncertainty around ESG regulations in the USA is leading financial deal makers to tread carefully. For example, Jim ClaytonMBA, aprivate equity advisor also from the University of Delaware recently stated:
“We’re a year past when the SEC said they were going to issue ESG reporting standards for public filers which has created more noise in the system.”
“People are nervous about what I would call ESG-intense exposed industries, in other words, those with “heavy carbon footprints”.
And, a federal judge in Texas said that American Airlines violated federal law by basing investment decisions for its employee retirement plan on environmental, social, and other non-financial factors. The ruling in January 2025 by US District Judge Reed O’Connor appeared to be the first of its kind amid growing backlash by conservatives to an uptick in socially-conscious investing. O’Connor said American had breached its legal duty to make investment decisions based solely on the financial interests of 401(k) plan beneficiaries by allowing BlackRock, its asset manager and a major shareholder, to focus on environmental, social and corporate governance (ESG) factors.
Even the State of Florida pulled $2 billion from the investment management firm BlackRock in the largest divestment ever made. Florida Governor Ron DeSantis claimed that by taking ESG standards into account when making investment decisions, the firm isn’t prioritizing the financial bottom line for Floridians.
Assessment
But, for a few years at least, things were indeed good. In 2020 and 2021, ESG funds outperformed the market by ~4.3%.
Conclusion
So, always remember [caveat emptor]: let the buyer beware!
2. Marcinko, DE; Comprehensive Financial Planning Strategies for Doctors and Advisors [Best Practices from Leading Consultants and Certified Medical Planners™] Productivity Press, New York, 2017
3. Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, NY 2006.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Life planning and behavioral finance as proposed for physicians and integrated by the Institute of Medical Business Advisors Inc., is unique in that it emanates from a holistic union of personal financial planning, human physiology and medical practice management, solely for the healthcare space. Unlike pure life planning, pure financial planning, or pure management theory, it is both a quantitative and qualitative “hard and soft” science, with an ambitious economic, psychological and managerial niche value proposition never before proposed and codified, while still representing an evolving philosophy. Its’ first-mover practitioners are called Certified Medical Planners™.
Financial Life Planning is an approach to financial planning that places the history, transitions, goals, and principles of the client at the center of the planning process. For the financial advisor or planner, the life of the client becomes the axis around which financial planning develops and evolves.
Financial Life Planning is about coming to the right answers by asking the right questions. This involves broadening the conversation beyond investment selection and asset management to exploring life issues as they relate to money.
Financial Life Planning is a process that helps advisors move their practice from financial transaction thinking, to life transition thinking. The first step is aimed to help clients “see” the connection between their financial lives and the challenges and opportunities inherent in each life transition.
But, for informed physicians, life planning’s quasi-professional and informal approach to the largely isolate disciplines of financial planning and medical practice management is inadequate. Today’s practice environment is incredibly complex, as compressed economic stress from HMOs managed care, financial insecurity from insurance companies, ACOs and VBC, Washington DC and Wall Street; liability fears from attorneys, criminal scrutiny from government agencies, and IT mischief from malicious electronic medical record [eMR] hackers. And economic bench marking from hospital employers; lost confidence from patients; and the Patient Protection and Affordable Care Act [PP-ACA] more than a decade ago. All promote “burnout” and converge to inspire a robust new financial planning approach for physicians and most all medical professionals.
The iMBA Inc., approach to financial planning, as championed by the Certified Medical Planner™ professional certification designation program, integrates the traditional concepts of financial life planning, with the increasing complex business concepts of medical practice management. The former topics are presented in this textbook, the later in our recent companion text: The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors].
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For example, views of medical practice, personal lifestyle, investing and retirement, both what they are and how they may look in the future, are rapidly changing as the retail mentality of medicine is replaced with a wholesale and governmental philosophy. Or, how views on maximizing current practice income might be more profitably sacrificed for the potential of greater wealth upon eventual practice sale and disposition.
Or, how the ultimate fear represented by Yale University economist Robert J. Shiller, in The New Financial Order: Risk in the 21st Century, warns that the risk for choosing the wrong profession or specialty, might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics. OR, if a medical degree is even needed for future physicians?
Say, what medical license?
Dr. Shirley Svorny, chair of the economics department at California State University, Northridge, holds a PhD in economics from UCLA. She is an expert on the regulation of health care professionals who participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that medical licensure not only fails to protect patients 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.
Yet, the opportunity to revise the future at any age through personal re-engineering, exists for all of us, and allows a joint exploration of the meaning and purpose in life. To allow this deeper and more realistic approach, the informed transformation advisor and the doctor client, must build relationships based on trust, greater self-knowledge and true medical business management and personal financial planning acumen.
[A] The iMBA Philosophy
As you read this ME-P website, we hope you will embrace the opportunity to receive the focused and best thinking of some very smart people. Hopefully, along the way you will self-saturate with concrete information that proves valuable in your own medical practice and personal money journey. Maybe, you will even learn something that is so valuable and so powerful, that future reflection will reveal it to be of critical importance to your life. The contributing authors certainly hope so.
At the Institute of Medical Business Advisors, and thru the Certified Medical Planner™ program, we suggest that such an epiphany can be realized only if you have extraordinary clarity regarding your personal, economic and [financial advisory or medical] practice goals, your money, and your relationship with it. Money is, after only, no more or less than what we make of it.
Ultimately, your relationship with it, and to others, is the most important component of how well it will serve you.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com
Most individual physician portfolios are simply a list of stocks. Doctors with such lists usually know the cost of each position and when they acquired it. It is not unusual to find inherited low cost stocks in the account that have been held for many years.
When you inherit securities, a new cost basis is established (the price of the stock on the date of death or six months later—the executor of the estate makes this determination). Even though there would be no capital gain liability if the stock were sold immediately after date of death, most people simply don’t do anything, just hold the stock. Of course taxes should be considered when selling securities but the investment merit should be the overriding factor.
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Doctor and Accountant Opinions
In a personal communication, Mr. L. Eddie Dutton, CPA said, “First make an investment decision and if it fits into the tax plan, so much the better. Doctors often wonder where they will get the money to pay the taxes. I say to get it from the sale of the appreciated stock and cry all the way to the bank with your profit.”
Dr. Ernest Duty MD, a very successful private investor advises “Ask yourself this question: If you had the money instead of the stock, would you buy the stock? If your answer is ‘Yes’ then, hold on to the stock but if you say ‘No, I wouldn’t buy that stock today’ then, sell it” [personal communication].
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: E-MAILCONTACT: MarcinkoAdvisors@outlook.com
Posted on May 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION
By Staff Reporters
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Meta-analysis is a quantitative, formal, epidemiological study design used to systematically assess previous research studies to derive conclusions about that body of research. Outcomes from a meta-analysis may include a more precise estimate of the effect of treatment or risk factor for disease, or other outcomes, than any individual study contributing to the pooled analysis. The examination of variability or heterogeneity in study results is also a critical outcome.
The benefits of meta-analysis include a consolidated and quantitative review of a large, and often complex, sometimes apparently conflicting, body of literature. The specification of the outcome and hypotheses that are tested is critical to the conduct of meta-analyses, as is a sensitive literature search. A failure to identify the majority of existing studies can lead to erroneous conclusions; however, there are methods of examining data to identify the potential for studies to be missing; for example, by the use of funnel plots.
Rigorously conducted meta-analyses are useful tools in evidence-based medicine. The need to integrate findings from many studies ensures that meta-analytic research is desirable and the large body of research now generated makes the conduct of this research feasible.
Cognitive science is the interdisciplinary study of the mind and cognition. According to linguistics Professor Mackenzie H. Marcinko PhD, it combines various aspects from neuroscience, computer science, psychology, philosophy, linguistics, anthropology, and other fields, into a comprehensive study on the nature of intelligence.
Linguistics is the scientific study of language and its structure, including the study of morphology, syntax, phonetics, and semantics. Specific branches of linguistics include sociolinguistics, dialectology, psycholinguistics, computational linguistics, historical-comparative linguistics and applied linguistics.
Now, language and linguistics are closely related fields of study but they have distinct focuses.
Language refers to the system of communication used by humans, encompassing spoken, written, and signed forms. It is a means of expressing thoughts, ideas, and emotions.
On the other hand, linguistics is the scientific study of language itself. It examines the structure, sounds, meaning, and evolution of languages, as well as how they are acquired and used by individuals and communities.
While language is a broader concept that encompasses various forms of communication, linguistics delves into the intricate details and mechanics of language, aiming to understand its underlying principles and patterns.
Every year on May 10th, the world comes together to observe World Lupus Day.
Lupus is a disease that occurs when your body’s immune system attacks your own tissues and organs (autoimmune disease). Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments. The most distinctive sign of lupus — a facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but not all cases of lupus. Some people are born with a tendency toward developing lupus, which may be triggered by infections, certain drugs or even sunlight. While there’s no cure for lupus, treatments can help control symptoms.
In 2025, this important day continues its mission of raising awareness about lupus, supporting those affected, and promoting further research into this complex autoimmune condition.
The phrase “sell in May and go away” suggests that investors should sell their stocks in May and avoid the market during the summer months, as historical data indicates poorer stock performance during this period.
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It’s Friday morning, so you’re probably clocking out once you’re done reading this ME-P. And who could blame you, after such a wild month of watching your portfolio zig & zag with every headline.
In fact, why not just sell all your stocks and walk away entirely? You’ve got to admit, it’s tempting. After all, markets have completed an incredible round trip since Liberation Day—you could just call it even, start celebrating Cinco de Mayo a bit late, and maybe check your portfolio again sometime around August.
“Sell in May and go away” might sound like appealing advice these days, especially considering that the market usually spends the next six months under-performing: The S&P 500 gains just 1.8% on average from May through October, the worst-performing stretch of the year historically.
These ‘worst six months’ have gained in eight of the last 10 years,” he recently wrote. He continued: “Not to mention the month of May has been higher nine of the past 10 years, so maybe we should call it,
Financial Advisor, Planner and Insurance Agent Information
By Staff Reporters
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Ostrich Bias is a behavioral phenomenon describing the tendency of individuals to avoid or ignore information that they perceive as negative or threatening. This term is derived from the popular but inaccurate belief that ostriches bury their heads in the sand when faced with danger, even though they do not exhibit such behavior.
Evidence: There is neuro-scientific evidence of the ostrich effect. Sharot et al. (2012) investigated the differences in positive and negative information when updating existing beliefs. Consistent with the ostrich effect, participants presented with negative information were more likely to avoid updating their beliefs; wills, estate plans, investment portfolios, and insurance policies, etc..
Moreover, they found that the part of the brain responsible for this cognitive bias was the left IFG – inferior frontal gyrus – by disrupting this part of the brain with TMS – transcranial magnetic stimulation – participants were more likely to accept the negative information provided.
EXAMPLE: The Ostrich Bias can cause someone to avoid looking at their bills, because they’re worried about seeing how far behind they are on home mortgage payments, credit cards, education or auto loans, etc.
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Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.
Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.
Posted on May 6, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Doctor David Edward Marcinko; MBA MEd
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National Teachers’ Day is observed on the first Tuesday of the first full week of May (May 6th) and we’re more than ready to show our appreciation to those who have taught us. Everyone has had that favorite teacher that has helped inspire them. This day meant to honor them was actually made by a teacher.
None other than First Lady Eleanor Roosevelt herself. Eleanor Roosevelt was more than Franklin D. Roosevelt’s wife, she has a history of civic duty and was an advocate for fellow teachers. Her love for education began at a young age when she was privately tutored and encouraged by her aunt Anna “Barnie” Roosevelt. No matter how high she rose on the social ladder, she never forgot where she came from.
Much like a springy inflatable structure often resembling a four-sided building and used by children for jumping for sport and fun, stocks staged a much-needed bounce-house back week on hopes that the trade war would de-escalate, with the S&P 500 climbing for four straight days to close 4.6% higher.
Whether the rally continues this week may depend on the Magnificent Seven earnings on tap—each of those Big Tech stocks has fallen at least 6.5% this year, shedding a combined $2.5 trillion in market value, per the Wall Street Journal.
A Certified Public Accountant (CPA) is a licensed professional who has passed an examination administered by a state’s Board of Accountancy. State CPA exams are created under guidelines issued by The American Institute of Certified Public Accountants (AICPA). The Uniform CPA Exam can only be taken by accountants who already have professional experience in the field and a bachelor’s degree.CPAs are not fiduciaries.
Not all accountants are CPAs. Accountants who are CPAs are licensed by their state’s Board of Accountancy after passing the Uniform CPA Exam. CPAs prepare reports that accurately reflect the business dealings of the companies and individuals that hire them. Many prepare tax returns for individuals or businesses and advise them on ways to minimize taxes. Obtaining the CPA designation requires a bachelor’s degree, typically with a major in business administration, finance, or accounting. Other majors are acceptable if the applicant meets the minimum requirements for accounting courses.
Enrolled Agent
Although not a CPA, an Enrolled Agent [EA] is a person who has earned the privilege of representing taxpayers before the Internal Revenue Service [IRS]. This is done by either passing a three-part comprehensive IRS test covering individual and business tax returns, or through experience as a former IRS employee. Enrolled agent status is the highest credential the IRS awards. Individuals who obtain this elite status must adhere to ethical standards and complete 72 hours of continuing education courses every three years.
Certified Managerial Accountant
A Certified Management Accountant (CMA), which is issued by the Institute of Management Accountants (IMA), builds on financial accounting proficiency by adding management skills that aid in making strategic business decisions based on financial data.
Oftentimes, the reports and analyses prepared by certified management accountants (CMAs) will go above and beyond those required by generally accepted accounting principles (GAAP).
For example, in addition to a company’s required GAAP financial statements, CMAs may prepare additional management reports that provide specific insights useful to corporate decision-makers, such as performance metrics on specific company departments, products, or even employees.
Certified Financial Analyst
A Certified Financial Analyst [CFA] is a globally-recognized professional designation offered by the CFA Institute, an organization that measures and certifies the competence and integrity of financial analysts. Candidates are required to pass three levels of exams covering areas such as accounting, economics, ethics, money management, and security analysis. From 1963 through November 2023, more than 3.7 million candidates had taken the CFA exam. The overall pass rate was 45%. From 2014 through 2023, the 10-year average pass rate was 43%.1
CFA Institute. The CFA Institute was formerly the Association for Investment Management and Research (AIMR).
The CFA charter is one of the most respected designations in finance and is widely considered to be the gold standard in the field of investment analysis. To become a charter holder, candidates must pass three difficult exams, have a bachelors degree, and have at least 4,000 hours of relevant professional experience over a minimum of three years. Passing the CFA Program exams requires strong discipline and an extensive amount of studying.
There are more than 200,000 CFA charter holders worldwide in 164 countries.The designation is handed out by the CFA Institute, which has 11 offices worldwide and 160 local member societies.
Several years ago a group of highly trusted and deeply experienced financial advisors, insurance service professionals and estate planners noted that far too many of their mature retiring physician clients, using traditional stock brokers, management consultants and financial advisors, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.”
In fact, an informal inverse related relationship was noted, and dubbed the “Doctor Effect.” In others words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning and medical practice management, continuum.
Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, dinners and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.” This realization confirmed the industry culture which seemed to be:
Bread for the advisor – Crumbs for the client!
And so, Marcinko Associates formed a cadre’ of technology focused and highly educated multi-degreed doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries who decided there must be a better way for their healthcare colleagues to receive financial planning advice, products and related advisory services within a culture of fiduciary responsibility.
We trust you agree with this specific niche knowledge, and collegial consulting philosophy, as illustrated thru our firm and these two books.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Carried interest accounts for the bulk of private equity fund managers’ compensation. It is calculated as a share of fund profits, historically 20% above a threshold rate of return for limited partners.
In contrast with most other forms of employment compensation and business income, carried interest earned from fund investments held for at least three years is taxed as a long-term capital gain at a rate below the top marginal income tax rate.
Critics of the provision contend it taxes highly compensated private equity managers at a lower rate than comparably paid providers of labor or business services.
Defenders of carried interest argue taxing it as income would be unfair because it represents capital gains even if they’re not derived from recipients’ capital.
Financial Modeling is one of the most highly valued, but thinly understood, skills in financial analysis. The objective of financial modeling is to combine accounting, finance, and business metrics to create a forecast of a company’s future results.
According to Jeff Schmidt, a financial model is simply a spreadsheet, usually built in Microsoft Excel, that forecasts a business’s financial performance into the future. The forecast is typically based on the company’s historical performance and assumptions about the future and requires preparing an income statement, balance sheet, cash flow statement, and supporting schedules (known as a three-statement model, one of many types of approaches to financial statement modeling). From there, more advanced types of models can be built such as discounted cash flow analysis (DCF model), leveraged buyout (LBO), mergers and acquisitions (M&A), and sensitivity analysis
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DEFINED TERMS
Discounted Cash Flow (DCF): A valuation method used to estimate the value of an investment based on its expected future cash flows, adjusted for the time value of money. It’s like deciding whether a treasure chest is worth diving for now, based on the gold coins you’ll be able to cash in later.
Sensitivity Analysis: This involves changing one variable at a time to see how it affects an outcome. Imagine tweaking your coffee-to-water ratio each morning to achieve the perfect brew strength.
Budget – A budget is the amount of money a department, function, or business can spend in a given period of time. Usually, but not always, finance does this annually for the upcoming year.
Rolling Forecast – A rolling forecast maintains a consistent view over a period of time (often 12 months). When one period closes, finance adds one more period to the forecast.
Topside – A topside adjustment is an overlay to a forecast. This is typically completed by the corporate or headquarter team. As individual teams submit a forecast, the consolidated result might not make sense or align with expectations. When this occurs, the high-level teams use a topside adjustment to streamline or adjust the consolidated view.
Monte Carlo Simulation: Picture yourself at the casino, but instead of gambling your savings away, you’re using this technique to predict different outcomes of your business decisions based on random variables. It’s like playing financial roulette with the odds in your favor.
What-If Analysis: Ever daydream about what would happen if you took that leap of faith with your business? This tool allows you to explore various scenarios without risking a dime. It’s like trying on outfits in a virtual dressing room before making a purchase.
Leveraged Buyout (LBO) Model: This is a bit like orchestrating a heist, but legally. It’s about acquiring a company using borrowed money, with plans to pay off the debts with the company’s own cash flows. High stakes, high rewards.
Mergers and Acquisitions (M&A) Model: Picture two puzzle pieces coming together. This model evaluates how combining companies can create a new, more valuable entity. It’s the corporate version of a matchmaker.
Three Statement Model: The holy trinity of financial modeling, linking the income statement, balance sheet, and cash flow statement. It’s like weaving a tapestry where each thread is crucial to the overall picture.
Capital Asset Pricing Model (CAPM): A formula that calculates the expected return on an investment, considering its risk compared to the market. It’s like choosing the best roller coaster in the park, balancing thrill and safety.
Cash Flow Forecasting: This is your financial weather forecast, predicting the cash flow climate of your business. It helps you plan for sunny days and save for the rainy ones.
Cost of Capital: The price of financing your business, whether through debt or equity. It’s like the interest rate on your growth engine, pushing you to maximize every dollar invested.
Debt Schedule: A timeline of your business’s debts, showing when and how much you owe. It’s your roadmap to becoming debt-free, one milestone at a time.
Equity Valuation: Determining the value of a company’s shares. It’s like assessing the worth of a rare gemstone, ensuring investors pay a fair price for a piece of the treasure.
Financial Leverage: Using debt to amplify returns on investment. It’s like using a lever to lift a heavy object, increasing force but also risk.
Forecast Model: A crystal ball for your finances, projecting future performance based on past and present data. It’s your guide through the financial wilderness, helping you navigate with confidence.
Operating Model: A detailed blueprint of how a business generates value, mapping out operational activities and their financial impact. It’s like laying out the inner workings of a clock, ensuring every gear turns smoothly.
Revenue Growth Model: This tracks potential increases in sales over time, charting a course for expansion. It’s like plotting your ascent up a mountain, anticipating the effort required to reach the summit.
Profitability ratios measure a company’s ability to generate income relative to revenue, balance sheet assets, operating costs, and equity. Common profitability financial ratios include the following:
The gross margin ratio compares the gross profit of a company to its net sales to show how much profit a company makes after paying its cost of goods sold:
Gross margin ratio = Gross profit / Net sales
The operating margin ratio, sometimes known as the return on sales ratio, compares the operating income of a company to its net sales to determine operating efficiency:
Operating margin ratio = Operating income / Net sales
The return on assets ratio measures how efficiently a company is using its assets to generate profit:
Return on assets ratio = Net income / Total assets
The return on equity ratio measures how efficiently a company is using its equity to generate profit:
Return on equity ratio = Net income / Shareholder’s equity
Posted on April 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
BREAKING US STOCK MARKET NEWS
By ME-P Staff Reporters
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Stocks in the U.S. opened sharply lower on Friday, extending a slide from the previous trading session triggered by President Trump’s announcement of sweeping new tariffs on U.S. imports earlier this week.
The S&P 500 fell 144 points, or 2.5%, to 5,252 as of 9:34 a.m. EST. The Dow Jones Industrial Average tumbled 1,006 points, or 2.5%, and the NASDAQ Composite slid 3.1%.
The indexes’ free-fall Thursday was their biggest one-day drop since 2020, with more than $2 trillion in investor wealth erased from the S&P 500. The S&P 500 and Dow each sank more than 4% yesterday, while the tech-heavy NASDAQ plunged nearly 6%.
NOTE: Drops of this magnitude aren’t unheard of on Wall Street, but they’re rare. Over the last 25 years, the S&P 500 has fallen 4% in a single day 38 times, according to Adam Turnquist, chief technical strategist for brokerage firm LPL Financial.
Posted on March 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
EDITOR-IN-CHIEF
By Dr. David Edward Marcinko; FACFAS MBA MEd
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NATIONAL PHYSICIANS WEEK
National Physicians Week sets out March 25-31 to honor the healers dedicated to the art of medicine. In 2017, National Physicians Week highlighted the shortage of physicians in the United States against a growing landscape of minorities joining the ranks.
#NationalPhysiciansWeek
“In hindsight, I am proud of what we have accomplished in a short period of time, including raising the recognition of our group and spotlighting the years of sacrifice by those in our profession to serve our patients. We are poised to initiate actionable efforts to engage and educate our physician community.”
Cite: Dr. Kimberly Funches Jackson, President
Today in 2025, let’s explore the invaluable contributions of physicians, celebrate their hard work during National Physicians Week, and highlight the essential role that locum doctors play in enhancing healthcare delivery.
A Week to Honor All Physicians
National Physicians Week is a celebration of the remarkable work that doctors do every single day. From diagnosing complex conditions to providing life-saving treatments, physicians dedicate themselves to improving the health and well-being of their patients. It’s a week for healthcare professionals, patients, and communities to come together and show appreciation for the doctors who make a difference in our lives.
Physicians work long hours, face immense pressure, and make critical decisions daily. Their contributions go beyond the walls of the hospital, as many are also involved in research, teaching, and community outreach.
So, this week, it’s important to acknowledge not only their professional expertise but also the compassion and resilience they exhibit in their work.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com
Avram Noam Chomsky is an American professor known for his traditional work in linguistics and political activism. Sometimes called “the father of modern linguistics”, Chomsky is also one of the founders of the field of cognitive science. He is a laureate professor of linguistics at the University of Arizona and an professor emeritus at MIT.
And so, modern linguists today approach their work with scientific rigor and perspective [STEM], although they use methods that were once thought to be solely an academic discipline of the humanities.
Contrary to this humanitarian belief, according to Professor Mackenzie Hope Marcinko PhD of the University of Delaware, linguistics is now multidisciplinary. It overlaps each of the human sciences including psychology, neurology, anthropology, and sociology. Linguists conduct formal studies of sound structure, grammar and meaning, but also investigate the history of language families, and research language acquisition.
A hostile takeover happens when an entity takes control of a company without the knowledge and against the wishes of the company’s management. A hostile takeover is an acquisition strategy requiring that the entity acquire and control more than 50% of the voting shares issued by the company.
In mergers and acquisitions (M&A), a hostile takeover is the acquisition of a target company by an acquiring company that goes directly to the target company’s shareholders, either by making a tender offer or through a proxy vote.
Ideally, an entity interested in acquiring a company should seek approval from the target company’s Board of Directors. The difference between a hostile and a friendly takeover is that, in a friendly takeover, the target company’s board of directors approve of the transaction and recommend shareholders vote in favor of the deal.
Defenses against a hostile takeover
These defense mechanisms can be preemptive or reactive, depending on how prepared the company is for the possibility of a hostile bid.
Poison pill is one of the most common defenses against a hostile takeover. Officially known as a “shareholder rights plan,” the poison pill allows existing shareholders to purchase additional shares at a discount, diluting the ownership interest of the acquiring company. The goal is to make it prohibitively expensive for the acquirer to complete the takeover.
A golden parachute is another defense strategy, which involves providing lucrative compensation packages (bonuses, severance pay, stock options, etc.) to key executives in the event they are terminated as a result of the takeover. This creates a financial disincentive for the acquiring company, as it would need to pay out these large sums upon completing the takeover.
In a Crown jewel defense, the target company sells or threatens to sell its most valuable assets—its “crown jewels”—if the takeover is completed. This reduces the attractiveness of the company to the acquirer, as the most desirable assets would no longer be part of the deal.
The Pac-Man defenses a more aggressive strategy in which the target company turns the tables by attempting to buy shares of the acquiring company, effectively launching a counter-takeover. While rare, this defense can deter hostile bids by making the takeover battle more costly and complex.
A White-Knight defense involves the target company seeking out a more favorable acquirer, or “white knight,” to make a friendly takeover bid. This allows the target company to avoid the hostile acquirer while still securing the benefits of a merger or acquisition.
The hostile takeover between Sanofi-Aventis and Genzyme Corp. occurred in 2010 when Sanofi, a French pharmaceutical company, wanted to buy Genzyme, a US biotech firm specializing in rare diseases. Genzyme resisted the offer, leading to conflict. Sanofi started a public campaign to pressure Genzyme’s shareholders into selling.
After months of negotiations, the two companies reached a deal in 2011. Sanofi agreed to pay $74 per share, with additional payments tied to Genzyme’s future performance, bringing the total deal value to around $20.1 billion. This acquisition allowed Sanofi to expand into the lucrative market for rare disease treatment.
The genetic testing company 23andMe went from biotech superstar to the brink of collapse. And, its most valuable asset might be its controversial customer DNA data trove.
Now, 23andMe filed for bankruptcy late Sunday night and announced the resignation of its chief executive officer Anne Wojcicki who is stepping down from her position but remains on the board of directors.
Wojcicki has so far tried unsuccessfully to rescue the business by buying it back and capping a precipitous fall for the DNA-testing company.
Absolute Return – the goal is to have a positive return, regardless of market direction. An absolute return strategy is not managed relative to a market index.
Accredited Investor – wealthy individual or well-capitalized institutions covered under Regulation D of the Securities Act of 1933.
Alpha – the return to a portfolio over and above that of an appropriate benchmark portfolio (the manager’s “value added”).
Arbitrage – any strategy that invests long in an asset, and short in a related asset, hoping the prices will converge.
Attribution – the process of “attributing” returns to their sources. For example, did the returns to a portfolio (over and above some benchmark) come from stock selection, industry/sector over- or under-weighting or factor weighting. Software programs are helpful in reporting an attribution.
Beta – a measure of systematic (i.e., non-diversifiable) risk. The goal is to quantify how much systematic risk is being taken by the fund manager vis-à-vis different risk factors, so that one can estimate the alpha or value-added on a risk-adjusted basis.
Correlation – a measure of how strategy returns move with one another, in a range of –1 to +1. A correlation of –1 implies that the strategies move in opposite directions. In constructing a portfolio of hedge funds, one usually wants to combine a number of non-correlated strategies (with decent expected returns) to be well diversified.
Drawdown – the percentage loss from a fund’s highest value to its lowest, over a particular time frame. A fund’s “maximum drawdown” is often looked at as a measure of potential risk.
Hurdle Rate – the return where the manager begins to earn incentive fees. If the hurdle rate is 5% and the fund earns 15% for the year, then incentive fees are applied to the 10% difference.
Leverage – one uses leverage if he borrows money to increase his position in a security. If one uses leverage and makes good investment decisions, leverage can magnify the gain. However, it can also magnify a loss.
Opportunistic – a general term that describes an aggressive strategy with a goal of making money (as opposed to holding on to the money one already has).
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Pairs Trading – usually refers to a long/short strategy where one stock is bought long, and a similar stock is sold short, often within the same industry. Buying the stock of Home Depot and shorting Lowe’s in an equal amount would be an example.
Portfolio Simulation – involves testing an investment strategy by “simulating” it with a database and analytic software. Often referred to as “backtesting” a strategy. The simulated returns of the strategy are compared to those of a benchmark over a specific time frame to see if it can beat that benchmark.
Sharpe Ratio – a measure of risk-adjusted return, computed by dividing a fund’s return over the risk-free rate by the standard deviation of returns. The idea is to understand how much risk was undertaken to generate the alpha.
Short Rebate – if you borrow stock and then sell it short, you have cash in your account. The short rebate is the interest earned on that cash.
R-Squared – a measure of how closely a portfolio’s performance varies with the performance of a benchmark, and thus a measure of what portion of its performance can be explained by the performance of the overall market or index. Hedge fund investors want to know how much performance can be explained by market exposure versus manager skill.
Transportable Alpha – the alpha of one active strategy can be combined with another asset class. For example, an equity market-neutral strategy’s value-added can be “transported” to a fixed income asset class by simply buying a fixed income futures contract. The total return comes from both sources.
Value at Risk – a technique which uses the statistical analysis of historical market trends and volatilities to estimate the likelihood that a specific portfolio’s losses will exceed a certain amount.
Tax avoidance—An action taken to lessen tax liability and maximize after-tax income.
Tax evasion—The failure to pay or a deliberate underpayment of taxes.
Underground economy—Money-making activities that people don’t report to the government, including both illegal and legal activities.
Voluntary compliance—A system of compliance that relies on individual citizens to report their income freely and voluntarily, calculate their tax liability correctly, and file a tax return on time.
Posted on March 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
Rocking Financial Planning … Old School Advice!
By Dr. David E. Marcinko MBBS MBA MEd CMP®
The economic platitude of the past, such as don’t spend more than 15-20 percent of your net salary on food, or 5-10 percent on medical care, among others, have given rise to the more individualized personal financial ratio concept. Personal ratios, like business ratios, represent benchmarks to compare such parameters as debt, income growth and net worth.
According to Edward McCarthy MIB CFP® – a personal financial expert from Warwick, Rhode Island whom I interviewed about a decade ago – the following represented useful ratios for the lay as well as medical professional [personal communication].
The Ratios:
Basic Liquidity Ratio = liquid assets / average monthly expenses. Should be 4-6 months, or even longer, in the case of a medical professional employed by a financially insecure HMO. In a low interest rate environment, iMBA Inc offers 12-24 months for consideration.
Debt to Assets Ratio = total debt / total assets. A percentage which is high initially, and should decrease with age as the medical professional approaches a debt free existence
Debt to Gross Income Ratio = annual debt repayments / annual gross income. A percentage representing the adequacy of current income for existing debt repayments. Medial professionals should try to keep this below 25-30%.
Debt Service Ratio = annual debt re-payment / annual take-home pay. Medical professionals should try to keep this ratio below about 40%, or have difficulty paying down debt.
Investment Assets to Net Worth-Ratio = investment assets / net worth. This ratio should increase over time, as retirement for the medical professional approaches.
Savings to Income Ratio = savings / annual income. This ratio should also increase over time, especially as major obligations are retired.
Real Growth Ratio = (income this year – income last year) / (income last year – inflation rate). It is desirable for the medical professional to keep this ratio growing faster than the core rate f inflation.
Growth of Net-Worth Ratio = (net worth this year – net worth last year) / net worth last year – inflation rate. Again, this ratio should stay ahead of inflation.By calculating these ratios, perhaps on an annual basis, the medical professional can spot problems, correct them, and continue progressing toward stated financial goals.
Assessment
Now, after ten years, are these traditional ratios and advice still valid today: why or why not?
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Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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SPEAKING: Dr. David Edward Marcinko MBA MEd will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements.
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CONTACT: Ann Miller RN MHA at: MarcinkoAdvisors@outlook.com
“Malta has quietly leveraged the rising tide of the financial transparency imperative to attract hedge funds.“
There was a time when the quaint island sought to play on the traditional terrain, offering anonymity and a “laissez-faire regulatory regime,” not to mention very low taxes, as in no capital gains taxes and no taxes on dividends; all while English speaking and USD currency denominated.
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While many leading domiciles for offshore hedge funds remain in the Caribbean – notably the Cayman Islands, the British Virgin Islands, Bermuda, and the Bahamas – the island of Malta is drawing attention, especially from European funds.
SO – HOW MUCH IS A “FINANCIAL ADVISOR” REALLY WORTH?
This blog holds a rather uncomplimentary opinion of financial advisors, and the financial services and brokerage industry as a whole; deserved, or not? The entire site hints at this attitude as well, in favor of a going it alone or ME, Inc investing when possible. Nevertheless, it is reasonable to wonder how much boost in net-returns might an educated and informed, fee transparent and honest, fiduciary focused “financial advisor” add to a clients’ investment portfolio; all things being equal [ceteris paribus].
And, can it be quantified?
Well, according to Vanguard Brokerage Services®, perhaps as much as 3%? In a decade long paper from the Valley Forge, PA based mutual fund and ETF giant, Vanguard said financial advisors can generate returns through a framework focused on five wealth management principles:
• Being an effective behavioral coach: Helping clients maintain a long-term perspective and a disciplined approach is arguably one of the most important elements of financial advice. (Potential value added: up to 1.50%).
• Applying an asset location strategy: The allocation of assets between taxable and tax-advantaged accounts is one tool an advisor can employ that can add value each year. (Potential value added: from 0% to 0.75%).
• Employing cost-effective investments: This component of every advisor’s tool kit is based on simple math: Gross return less costs equals net return. (Potential value added: up to 0.45%).
• Maintaining the proper allocation through rebalancing: Over time, as investments produce various returns, a portfolio will likely drift from its target allocation. An advisor can add value by ensuring the portfolio’s risk/return characteristics stay consistent with a client’s preferences. (Potential value added: up to 0.35%).
• Implementing a spending strategy: As the retiree population grows, an advisor can help clients make important decisions about how to spend from their portfolios. (Potential value added: up to 0.70%).
Source: Financial Advisor Magazine, page 20, April 2014.
Assessment
However, Vanguard notes that while it’s possible all of these principles could add up to 3% in net returns for clients, it’s more likely to be an intermittent number than an annual one because some of the best opportunities to add value happen during extreme market lows and highs when angst or giddiness [fear and greed] can cause investors to bail on their well-thought-out investment plans.
And, is the study applicable to doctors and allied healthcare providers? Doe Vanguard have a vested interest in the topic. What about fee based versus fee-only financial advice?
Conclusion
Finally, recognize the plethora of other financial planning life-cycle topics addressed in this ME-P were not included in the Vanguard investment portfolio-only study a decade ago.
And what about today with contemporaneous internet advising, chat-rooms, linkedin, robo-advisors, reddit and the like?
According to Patricia Salber MD [personal communication], there are a number of reasons why direct patient access to laboratory medical results is a good idea:
Between 8 and 26% of abnormal test results, including those suspicious for cancer, are not followed up in a timely manner. Direct access could help reduce the number of times this occurs
Self-management, particularly of chronic illness has known benefits. Just like the QS people, many folks with chronic illness obtain and manage to self-acquired lab results every day via gluco-meters, home pulmonary function tests, blood pressure measurements, and so forth. Direct access to laboratory-acquired data, one could argue is a continuation of that personal responsibility
Patients want to be notified about their results in what they perceive as a timely fashion. In one study, patients who received direct notification of their bone density tests results were more likely to perceive they had timely notification compared to usual care even though there was no measurable effect on actual treatment received after three months
Being more responsible for test results could encourage consumers to try to learn more about the meaning of the test results, conceivably increasing their health literacy.
But, the arguments against direct access discussed include the following:
Patients prefer their physicians contact them directly when they have abnormal test results, although the major studies published in 2005 and 2009, preceded the extraordinary use of the internet to access health information that exists today.
There is concern over whether patients will know what to do when they receive the results – will they make erroneous interpretations or fail to contact their docs? This could be, but the intent of the proposed rule is shared access to the results. We suspect if the rule become law, docs will develop better notification mechanisms so that they reach the patient before the patient directly accesses the results or lab companies will design better lab test notifications with easy-to-understand interpretations or a whole new industry will appear that can provide instantly available individualized lab interpretation…or maybe all three of these would happen and that would be a very good thing.
Unknown impact of dual notification (doctors and patients) of lab test results on physician behavior…would docs simply shift responsibility for initiating follow-up care from themselves to their patients?
Would direct access of life-changing lab tests, such as HIV or malignancy, lead to unnecessary patient anxiety – or worse? (Conversely, is there less anxiety, desperation, or suicidal ideation if the bad news is delivered face to face?
Individuals likely may contact their physicians immediately after getting the lab results asking for a telephonic or face-to-face interpretation … it is not known how this would impact physician workload and/or potential for reimbursement [personal communication, Richard Hudson DO, Atlanta, GA].
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: CONTACT: MarcinkoAdvisors@outlook.com
Posted on March 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
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At least eight agencies are investigating a recent fire at a Bayer executive’s New Jersey home as a possible arson, authorities said. The fire happened around 7:30 a.m. March 4th “at an occupied residence on East Lane in Madison,” the Morris County Prosecutor’s Office told CNN yesterday.
US stocks bounced back sharply on Friday to cap a volatile week on Wall Street as the risk of a government shutdown eased while investors stayed on watch for the next move in an escalating trade war. The S&P 500 (^GSPC) climbed more than 2.1% after the benchmark index sank on Thursday to close in correction territory. The NASDAQ Composite (^IXIC) jumped over 2.6% as tech stocks soared. The Dow Jones Industrial Average (^DJI) moved up more than 600 points, or 1.6%.
Yesterday March 14th was Pi Day! (Yes, the mathematical constant, although we fully support celebrating with actual pie.) Put simply, Pi—aka π—is the ratio of a circle’s circumference to its diameter. It also sneaks its way into medicine. For one, it’s part of Poiseuille’s Law, an equation that helps explain how fluid flows through tubes, including arteries and IV lines. So, whether you’re crunching numbers or crunching on a slice, Pi is definitely worth celebrating
And, today is the Ides of March!
Visualize: How private equity tangled banks in a web of debt, from the Financial Times.
Posted on March 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Dr. David Edward Marcinko MBA MEdCMP®
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Your Executor or personal representative is named in your Will and is responsible for management of assets subject to probate. A basic checklist of the duties of the personal representative looks like this:
Gather all estate assets;
Collect all amounts owed the decedent;
Notify creditors and paying all valid debts;
Selling assets as needed to pay expenses or as directed by the Will;
Distribute assets to beneficiaries;
File decedents final federal income tax return;
File an estate tax return if the estate is large enough; and
File inventories and annual returns with the probate court, if required.
The position requires a lot of responsibility and involves many duties and a considerable commitment of time. The personal representative must petition the probate court for formal appointment.
Selection of your personal representative should not be made lightly, or as a favor to a friend. It requires a lot of work and very often for little or no pay. Friends and family typically will not charge the estate for their time and work. Outside advisers like attorneys and accountants will not hesitate to bill for their work effort. A few items for your selection criteria should be:
Longevity – the person should have a likelihood of being able to serve after your death;
Skill in managing legal and financial affairs;
Familiarity with your estate and wishes;
Integrity and loyalty; and
Impartiality and absence of conflicts of interest.
Alternatives to family or friends might be a corporate executor, such as a bank, an attorney, or other adviser. Similar criteria should be used in the selection of a trustee.
SPEAKING: Dr. Marcinko will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements: MarcinkoAdvisors@outlook.com
Posted on March 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Base-Erosion Anti-Abuse Tax (BEAT): The 2017 tax reforms moved the U.S. from a worldwide taxation system to a quasi-territorial system, so foreign earnings are no longer included in a company’s domestic tax base.
To discourage companies operating in the U.S. from avoiding tax liability by shifting profits out of the country, Congress imposed a 10% minimum tax called Base-Erosion Anti-Abuse Tax (BEAT). The BEAT rate will increase from 10% to 12.5% in 2026.
Leverage ratios measure the amount of capital that comes from debt. In other words, leverage financial ratios are used to evaluate a company’s debt levels. Common leverage ratios include the following:
The debt ratio measures the relative amount of a company’s assets that are provided from debt:
Debt ratio = Total liabilities / Total assets
The debt to equity ratio calculates the weight of total debt and financial liabilities against shareholders’ equity:
Debt to equity ratio = Total liabilities / Shareholder’s equity
The term seed suggests that this is a very early investment, meant to support the business until it can generate cash of its own, or until it is ready for further investments. Seed money options include friends and family funding, seed venture capital funds, angel funding, and crowdfunding.
Types of Seed funding
Friends and family funding: This type of seed funding involves raising money from friends and family members.
Angel investing: As mentioned above, angel investors are wealthy individuals who provide seed funding in exchange for equity ownership.
Seed accelerators: These are programs that provide startups with seed funding, mentorship, and resources to help them grow their businesses.
Crowdfunding: This type of funding allows startups to raise money from a large number of people, typically through an online platform.
Incubators: These are organizations that provide startups with seed funding, office space, and resources to help them grow their businesses.
Government grants: Some government agencies provide seed funding for startups working on specific projects or in specific industries.
Corporate ventures: Some big companies set up venture arms to provide seed funding to startups in their industry or complementary field.
Micro-Venture Capital: A type of venture capital that provides seed funding to new startups and early-stage companies with a small amount of money.
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