Credit Rating Agency – Defined

Posted on June 20, 2026 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko; MBA MEd

SPONSOR: http://www.CertifiedMedicalPlanner.org

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A credit rating agency (CRA) plays a central role in modern financial markets by evaluating the creditworthiness of governments, corporations, and financial instruments. At its core, a CRA provides an independent judgment about the likelihood that a borrower will repay its debts in full and on time. These ratings—expressed through standardized letter grades—shape how capital flows across the global economy, influence interest rates, and affect the financial stability of entire nations. Although CRAs operate behind the scenes, their assessments carry enormous weight, making them both indispensable and frequently scrutinized.

The primary function of a CRA is to reduce information asymmetry between borrowers and lenders. Investors often lack the resources to conduct deep financial analysis on every bond issuer or security they consider. CRAs fill this gap by performing extensive evaluations of financial statements, market conditions, governance structures, and macroeconomic factors. Their ratings serve as a shorthand signal of risk. A high rating suggests strong financial health and low default probability, while a low rating signals vulnerability. This system allows markets to operate more efficiently, enabling investors to make informed decisions without conducting exhaustive research themselves.

CRAs also influence the cost of borrowing. When a company or government receives a strong rating, it can typically access capital at lower interest rates because lenders perceive less risk. Conversely, a downgrade can raise borrowing costs significantly, sometimes triggering financial distress. This dynamic gives CRAs considerable power. Their assessments can shape national budgets, corporate strategies, and investor confidence. For example, a downgrade of a sovereign government can ripple through its entire economy, affecting everything from public services to private-sector credit availability.

Despite their importance, CRAs have faced substantial criticism, particularly in the aftermath of major financial crises. One major concern is the issuer‑pays model, where the entity seeking a rating pays the agency to produce it. Critics argue that this structure creates a conflict of interest: agencies may feel pressured to assign favorable ratings to retain clients. This issue became especially visible during the 2008 financial crisis, when highly rated mortgage‑backed securities later collapsed, contributing to global economic turmoil. The failure of CRAs to accurately assess risk in these cases raised questions about their methodologies, incentives, and accountability.

Another criticism centers on the outsized influence of a small number of dominant agencies. The global market is largely controlled by three major firms—often referred to as the “Big Three.” Their ratings are embedded in regulatory frameworks, investment guidelines, and financial contracts. Because of this, their decisions can have immediate and far‑reaching consequences. Some argue that this concentration of power limits competition and innovation, while others worry that it creates systemic vulnerabilities if these agencies make errors or rely on flawed assumptions.

Regulators worldwide have attempted to address these concerns through reforms aimed at increasing transparency, reducing conflicts of interest, and encouraging competition. Measures include requiring agencies to disclose their methodologies, strengthening oversight, and limiting the use of ratings in certain regulatory contexts. While these reforms have improved accountability, debates continue about whether they go far enough. Some propose alternative models, such as investor‑pays systems or public credit rating institutions, though each approach carries its own challenges.

Despite their flaws, CRAs remain deeply embedded in the global financial system. Their evaluations help maintain order in complex markets by providing consistent, comparable assessments of credit risk. They enable investors to navigate uncertainty, support efficient capital allocation, and contribute to financial stability when functioning effectively. At the same time, their influence demands ongoing scrutiny. Ensuring that CRAs operate with integrity, independence, and transparency is essential for maintaining trust in the financial system.

COMMENTS APPRECIATED

EDUCATION: Books

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

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731

CLINICS: http://www.crcpress.com/product/isbn/9781439879900

ADVISORS: www.CertifiedMedicalPlanner.org

FINANCE:Financial Planning for Physicians and Advisors

INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Dictionary of Health Economics and Finance

Dictionary of Health Information Technology and Security

Dictionary of Health Insurance and Managed Care

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FICO Score – Defined

Posted on June 14, 2026 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko; MBA MEd

SPONSOR: http://www.CertifiedMedicalPlanner.org

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A FICO score is one of the most influential tools in modern consumer finance, shaping how individuals access credit, the cost of borrowing, and even broader life opportunities. Developed by the Fair Isaac Corporation, the score condenses a person’s credit history into a three‑digit number ranging from 300 to 850. While deceptively simple on the surface, this number reflects a complex evaluation of financial behavior and risk. Over time, the FICO score has become a central mechanism through which lenders make decisions, and its influence extends into housing, employment, insurance, and beyond.

At its core, a FICO score attempts to answer a single question: How likely is a borrower to repay a loan on time? To estimate this, the scoring model analyzes several categories of credit information. The most significant factor is payment history, which accounts for a substantial portion of the score. Late payments, defaults, and collections signal higher risk, while consistent on‑time payments demonstrate reliability. The second major factor is credit utilization, or the percentage of available revolving credit that a person is currently using. High utilization suggests financial strain, while low utilization indicates stability. Other components include the length of credit history, the mix of credit types, and recent credit inquiries. Together, these elements form a predictive model that lenders rely on to assess risk quickly and consistently.

The importance of the FICO score lies in its widespread adoption. Banks, credit unions, mortgage lenders, auto lenders, and credit card issuers all use it as a primary decision‑making tool. A higher score typically leads to lower interest rates, better loan terms, and greater access to credit products. Conversely, a lower score can result in higher borrowing costs or outright denial of credit. This dynamic creates a powerful incentive for consumers to understand and manage their credit behavior carefully. In many ways, the FICO score functions as a financial reputation — a shorthand that follows individuals throughout their economic lives.

Beyond lending, the FICO score has expanded into other domains. Landlords often use credit scores to evaluate rental applicants, viewing them as indicators of reliability. Some employers, particularly in financial sectors, review credit reports (though not always the score itself) as part of background checks. Insurance companies may use credit‑based insurance scores to set premiums. These broader applications mean that a person’s credit behavior can influence not only their financial opportunities but also their housing stability, employment prospects, and cost of living. The score’s reach underscores its role as a structural component of economic mobility.

Despite its usefulness, the FICO score is not without criticism. One major concern is that it can reinforce existing inequalities. Individuals with limited credit histories — often young adults, immigrants, or those from low‑income backgrounds — may struggle to achieve high scores, not because they are irresponsible, but because they lack access to traditional credit products. Negative financial events, such as medical debt or job loss, can disproportionately affect vulnerable populations and depress scores for years. Critics argue that the model does not fully account for context, such as systemic barriers or unexpected hardships. As a result, the score can sometimes reflect circumstances rather than character or capability.

Another critique centers on transparency. While the general factors influencing a FICO score are publicly known, the exact algorithms are proprietary. This opacity can make it difficult for consumers to understand precisely how their actions will affect their score. Although educational tools and credit monitoring services have become more common, many people still find the system confusing or intimidating. The complexity of the scoring model can lead to misconceptions, such as the belief that carrying a balance improves a score or that checking one’s own credit is harmful. These misunderstandings can hinder effective credit management.

Despite these challenges, the FICO score remains deeply embedded in the financial system. Efforts to improve credit scoring have emerged, including models that incorporate alternative data such as rent payments, utility bills, or banking activity. These innovations aim to create a more inclusive and accurate picture of financial behavior. However, the traditional FICO score continues to dominate lending decisions, and its influence is unlikely to diminish in the near future.

Ultimately, the FICO score is both a practical tool and a symbol of the broader credit system. It rewards consistent, responsible financial behavior, but it also reflects structural realities that can advantage some individuals over others. Understanding how the score works empowers consumers to navigate the financial landscape more effectively. By managing payment history, keeping credit utilization low, maintaining long‑standing accounts, and avoiding unnecessary credit inquiries, individuals can strengthen their financial profile and expand their opportunities.

In a society where credit access plays a central role in economic life, the FICO score functions as a key determinant of financial possibility. It is a number that can open doors or close them, shape futures, and influence the trajectory of a person’s financial journey. While not perfect, it remains a powerful indicator of creditworthiness and a critical component of modern financial identity.

COMMENTS APPRECIATED

EDUCATION: Books

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

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731

CLINICS: http://www.crcpress.com/product/isbn/9781439879900

ADVISORS: www.CertifiedMedicalPlanner.org

FINANCE:Financial Planning for Physicians and Advisors

INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Dictionary of Health Economics and Finance

Dictionary of Health Information Technology and Security

Dictionary of Health Insurance and Managed Care

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Financial Self-Discovery for Medical Professionals

Posted on September 25, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko; MBA MEd CMP™

PHYSICIAN COACHING: https://marcinkoassociates.com/process-what-we-do/

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SPONSOR: http://www.CertifiedMedicalPlanner.org

A Financial Self Discovery Questionnaire for Medical Professionals

For understanding your relationship with money, it is important to be aware of yourself in the contexts of culture, family, value systems and experience.  These questions will help you.  This is a process of self-discovery.  To fully benefit from this exploration, please address them in writing.  You will simply not get the full value from it if you just breeze through and give mental answers.  While it is recommended that you first answer these questions by yourself, many people relate that they have enjoyed the experience of sharing them with others who are important to them. 

As you answer these questions, be conscious of your feelings, actually describing them in writing as part of your process. 

Childhood

  • What is your first memory of money?
  • What is your happiest moment with Money? Your most unhappy?
  • Name the miscellaneous money messages you received as a child.
  • How were you confronted with the knowledge of differing economic circumstances among people, that there were people “richer” than you and people “poorer” than you?

Cultural heritage

  • What is your cultural heritage and how has it interfaced with money?
  • To the best of your knowledge, how has it been impacted by the money forces?  Be specific.  
  • To the best of your knowledge, does this circumstance have any motive related to Money?
  • Speculate about the manners in which your forebears’ money decisions continue to affect you today? 

Family

  • How is/was the subject of money addressed by your church or the religious traditions of your forebears?
  • What happened to your parents or grandparents during the Depression?
  • How did your family communicate about money?
  • How?  Be as specific as you can be, but remember that we are more concerned about impacts upon you than historical veracity.
  • When did your family migrate to America (or its current location)?
  • What else do you know about your family’s economic circumstances historically?

Your parents

  • How did your mother and father address money?
  • How did they differ in their money attitudes?
  • How did they address money in their relationship?
  • Did they argue or maintain strict silence?
  • How do you feel about that today?

Please do your best to answer the same questions regarding your life or business partner(s) and their parents.

Childhood: Revisited

  • How did you relate to money as a child?  Did you feel “poor” or “rich”? 
    Relatively?  Or, absolutely?  Why?
  • Were you anxious about money?
    Did you receive an allowance?  If so, describe amounts and responsibilities.
  • Did you have household responsibilities?
  • Did you get paid regardless of performance?
  • Did you work for money?

If not, please describe your thoughts and feelings about that.

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Same questions, as a teenager, young adult, older adult.

Credit

  • When did you first acquire something on credit?
  • When did you first acquire a credit card?
  • What did it represent to you when you first held it in your hands?
  • Describe your feelings about credit.
  • Do you have trouble living within your means?
  • Do you have debt?

Adulthood

  • Have your attitudes shifted during your adult life?  Describe.

Why did you choose your personal path? 
a)      Would you do it again?
b)      Describe your feelings about credit.

Adult attitudes

  • Are you money motivated? 
    If so, please explain why?  If not, why not? 
    How do you feel about your present financial situation? 
    Are you financially fearful or resentful?  How do you feel about that?
  • Will you inherit money?  How does that make you feel?
  • If you are well off today, how do you feel about the money situations of others? 
    If you feel poor, same question. 
  • How do you feel about begging?  Welfare?
    If you are well off today, why are you working?
  • Do you worry about your financial future?
  • Are you generous or stingy?  Do you treat?  Do you tip?
  • Do you give more than you receive or the reverse?  Would others agree?
  • Could you ask a close relative for a business loan?  For rent/grocery money?
  • Could you subsidize a non-related friend?  How would you feel if that friend bought something you deemed frivolous? 
  • Do you judge others by how you perceive they deal with their Money?
    Do you feel guilty about your prosperity?
    Are your siblings prosperous?
  • What part does money play in your spiritual life?
  • Do you “live” your Money values?

Conclusion

There may be other questions that would be useful to you.  Others may occur to you as you progress in your life’s journey. The point is to know your personal money issues and their ramifications for your life, work, and personal mission. 

This will be a “work-in-process” with answers both complex and incomplete.  Don’t worry. 

Just incorporate fine-tuning into your life’s process.

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PHYSICIANS: Beware “Zombie” Debt and “Phantom” Debt Collectors

Posted on August 13, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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According to Wikipedia, Phantom debt or zombie debt is a debt that is old, defaulted, or not owed and is somehow still being pursued for collection to be paid by the presumed debtor. It generally refers to debt that is more than 3 years old, is long forgotten about or belonged to someone else – like someone with the same name or a deceased parent. The amount owed can grow to hundreds or thousands of dollars more than what was originally owed.

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

An example of this is from George Miller. George missed an 11 cent Verizon bill and seven years later it had grown to $4,000.00.

Sometimes it was never owed, was owed by a deceased parent, or that was previously owed by the presumed debtor, but was previously paid in full, settled, discharged via bankruptcy or a dismissed court case, is beyond the statute of limitations, or is otherwise not legally collectible, but that a collection agency or other similar service is aggressively attempting to collect, often fraudulently.

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MONEY ADDICTED PHYSICIANS: The Investing and Stock Trading Personality of Doctors

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While the concept of phantom debt is quite old, it has gotten a lot of attention since the 1990s.

Very often, collectors of phantom debt use intimidating, abusive, or otherwise illegal tactics in an attempt to collect phantom debt that include frequent phone calls, calls to the victim’s place of employment, or threats of scary consequences against the victim that sometimes include arrest and/or criminal prosecution. In the USA, such tactics violate the Fair Debt Collection Practices Act [FDCPA]

The source of phantom debt may be from collectors who buy the debt from other collectors for pennies on the dollar, some of which take action that is not legal in order to collect that debt. Unlawful techniques used include suing or threatening to sue, re-aging the debt on the victim’s credit report to circumvent limits on reporting, or falsely promising to remove a negative credit report entry in exchange for a partial payment.

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

COMMENTS APPRECIATED

EDUCATION: Books

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

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Moodys, Stocks, Bonds and UnitedHealth

Posted on May 20, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Moody’s decision couldn’t dampen the mood on Wall Street yesterday; despite tariffs and credit, etc..

Stocks rose even as bond yields spiked in response to the rating agency’s decision to downgrade the US’ credit.

And, UnitedHealth popped as investors decided to buy the dip the insurer faced last week amid a slew of bad news.

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PHYSICIAN CREDIT: Ratings, Scoring, Errors and Repair Services

Posted on December 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

ALMOST ALL ABOUT CREDIT

By Staff Reporters

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Credit Rating and Scoring

The category in which a credit agency classifies you is based upon payment history.  Recently, credit reporting agencies have shifted away from ratings to a system known as credit scoring. Your score is determined by proprietary formulas that are based on your credit history, the higher the better. The practical benefits of this scoring system are numerous.

First, medical professionals do not need to be experts at deciphering credit reports since the same scoring system is used by many different companies.

Correcting Credit Report Errors

A credit bureau is not the place to get an item to be fixed on your credit report. Rather, you must take it up directly with the credit issuer. In any case, a late payment noted on a credit report by a durable medical equipment vendor, for example, has to be addressed directly with that merchant. The DME merchant then has 30 days to acknowledge your complaint and respond to you. In the meantime, you do not have to pay for the disputed items.  Most credit errors cannot be reported or kept on your credit report for more than seven years.

For legitimate late payments you should contact the credit grantor and negotiate to take one of the following steps. Be tenacious, and either remove the late payment or write a letter explaining that the problem has been resolved and you now are a good credit risk again. This letter is a powerful tool and should be saved with other permanent financial records. The industry term for it is a letter of correction.

Credit Repair Services

Credit repair services are oversold and their claims tend to be exaggerated. They do not have an inside track to the consumer reporting agencies.  Good credit repair services are experienced in communicating with creditors and can help with legitimate repairs.  They cannot restore your credit rating or your good name. 

However, realize that with some time and effort you can accomplish the same results yourself.

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

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CREDIT: All About Contractual Agreements

Posted on October 31, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

DEFINITIONS

What Is CREDIT? Credit is a contractual agreement in which a borrower receives a sum of money or something else of value and commits to repaying the lender later, typically with interest. Credit is also the creditworthiness or credit history of an individual or a company. Good credit tells lenders you have a history of reliably repaying what you owe on loans. Establishing good credit is essential to getting a loan.

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Credit Analysis is a form of financial analysis used primarily to determine the financial strength of the issuer of a security, and the ability of that issuer to provide timely payment of interest and principal to investors in the issuer’s debt securities. Credit analysis is typically an important component of security analysis and selection in credit-sensitive bond sectors such as the corporate bond market and the municipal bond market.

Credit Default Swap Index (CDX) is a credit derivative, based on a basket of CDS, which can be used to hedge credit risk or speculate on changes in credit quality.

Credit Default Swaps (CDS) are credit derivative contracts between two counter parties that can be used to hedge credit risk or speculate on changes in the credit quality of a corporation or government entity.

Credit Quality reflects the financial strength of the issuer of a security, and the ability of that issuer to provide timely payment of interest and principal to investors in the issuer’s securities. Common measurements of credit quality include the credit ratings provided by credit rating agencies such as Standard & Poor’s and Moody’s. Credit quality and credit quality perceptions are a key component of the daily market pricing of fixed-income securities, along with maturity, inflation expectations and interest rate levels.

Credit Rating Agency (CRA) is a company that assigns credit ratings for issuers of certain types of debt obligations as well as the debt instruments themselves. In the United States, the Securities and Exchange Commission (SEC) permits investment banks and broker-dealers to use credit ratings from “Nationally Recognized Statistical Rating Organizations” (NRSRO) for similar purposes. As of January 2012, nine organizations were designated as NRSROs, including the “Big Three” which are Standard and Poor’s, Moody’s Investor Services and Fitch Ratings.

A Credit Rating Downgrade by a credit rating agency (such as Standard & Poor’s, Moody’s or Fitch), of reducing its credit rating for a debt issuer and/or security. This is based on the agency’s evaluation, indicating, to the agency, a decline in the issuer’s financial stability, increasing the possibility of default (defined below). A downgrade should not to be confused with a default; a debt security can be downgraded without defaulting. (And, conversely, a debt issuer can suddenly default without being downgraded first–credit ratings and credit rating agencies are not infallible.)

Credit Ratings are measurements of credit quality provided by credit rating agencies). Those provided by Standard & Poor’s typically are the most widely quoted and distributed, and range from AAA (highest quality; perceived as least likely to default) down to D (in default). Securities and issuers rated AAA to BBB are considered/perceived to be “investment-grade”; those below BBB are considered/perceived to be non-investment-grade or more speculative.

Credit Risk is the risk that the inability or perceived inability of the issuers of debt securities to make interest and principal payments will cause the value of those securities to decrease. Changes in the credit ratings of debt securities could have a similar effect.

Credit Risk Transfer Securities (CRTS) are the unsecured obligations of the GSEs (Government Sponsored Enterprises). Although cash flows are linked to prepays and defaults of the reference mortgage loans, the securities are unsecured loans, backed by general credit rather than by specified assets.

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

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US Credit Card Balances & Microsoft Stock Both Jump

Posted on November 8, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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US credit card balances have jumped to a record $1.08 trillion, according to the New York Federal Reserve.

Nevertheless, Stocks rose for the seventh straight day on Tuesday, giving the NASDAQ and S&P 500 their longest winning streaks since 2021. The surge was fueled by a rally in Big Tech and a growing consensus that the Federal Reserve Bank is done raising interest rates. Chief among the tech revelers was Microsoft, which finished the day at an all-time high amid strong demand for its cloud computing services.

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

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PODCAST: Ray Dalio on How the Economy Works in Healthcare

Posted on September 5, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

Ray Dalio’s ‘How the Economy Works’ Applied to Healthcare … Credit Cycles and Healthcare Policy

By Eric Bricker MD

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

RELATED: https://www.msn.com/en-us/money/savingandinvesting/ray-dalio-warns-stagflation-will-send-america-back-to-the-1970s/ar-AAVSYgF

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

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Tax Deductions versus Tax Credits

Posted on April 10, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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What is a tax deduction?

A deduction reduces the amount of income you pay taxes on, which means you could pay less in taxes. You subtract deductions from your income before calculating how much taxes you owe. How much a deduction saves you depends on your income tax bracket.

To calculate how much a deduction could reduce your taxes, you multiply the amount of the deduction by your marginal tax rate. For example, if a deduction is worth $5,000 and you are in the 10% tax bracket (the lowest), the deduction would reduce your taxes by $500.

A deduction’s value to you is tied to your tax rate. So if you’re paying a higher tax rate, you can reap more of a deduction’s benefit. The lower your tax rate, the less benefit a deduction will have for you. Imagine that you take a $5,000 deduction, but you’re in the 35% tax bracket — the second highest. Now you’re saving $1,750 in taxes.

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

What is a tax credit?

On the other hand, a credit is a dollar-for-dollar reduction in the amount of tax you owe. For example, if you qualify for a $1,000 tax credit of some kind and owe $5,000 in taxes, that credit will reduce your tax burden to $4,000.

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But – Do Not Claim Too Many Tax Deductions

Deductions are enticing to taxpayers because they can reduce the amount of your income before you calculate the tax you owe, which in turn might significantly lower how much you have to pay in taxes or increase your refund. But that doesn’t mean you should go wild writing things off on your tax returns, as experts say claiming too many deductions is the most common reason people end up getting audited by the IRS.

Don’t try writing off deductions that are no longer accepted by the IRS. The tax code has changed over the years, and there are some things the tax agency no longer recognizes. You should remember that some of the tax write-offs were terminated by the IRS, including deductions on alimony, moving expenses, and any expenses related to investing, hobbies, and tax preparation.

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PODCAST: Ray Dalio on How the Healthcare Economy Works

Posted on January 2, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

Economy Works’ Applied to Healthcare … Credit Cycles and Healthcare Policy

By Eric Bricker MD

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

RICARDIAN DEMAND HEALTH ECONOMICS: https://medicalexecutivepost.com/2021/12/14/ricardian-derived-demand-economics-in-medicine/

RISING HEALTH CARE COSTS: https://medicalexecutivepost.com/2018/03/11/medical-treatment-costs-becoming-expensive-25-factors/

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Dr. Marcinko Interviewed on the Physician Credit Crunch

Posted on May 6, 2018 by Dr. David Edward Marcinko MBA MEd CMP™

Financial Experts Share Tips on Obtaining Loans to Start or Expand a Medical Practice

By Michael Gibbons

Editor: ADVANCE Newsmagazines

Maybe you’re a young dermatologist or plastic surgeon who dreams of starting your own practice. Or maybe you’re an established professional but want to expand your palette of anti-aging services. Either way, you’ve probably made an unpleasant discovery: Banks are leery about lending today. Global recessions with seemingly no end in sight tend to give loan officers sticky fingers.HO-JFMS-CD-ROM

Dermatologists and Plastic Surgeons

We have it on good authority that dermatologists and plastic surgeons as a group are less affected by this problem than physicians in some other branches of medicine. Still, there’s no better time than now to absorb some sound advice on how to approach banks for loans—whether you’re a fresh-faced newcomer to the fresh-face business or a wrinkled veteran at eliminating wrinkles.

Start Small

There’s no soft-soaping it: Starting a healthy aging practice is much harder than expanding an existing practice, even in the flushest of times.

“For young dermatologists starting out, I recommend you start small,” advises Jerome Potozkin, MD, who offers facial rejuvenation, liposuction, body contouring and dermatological care through his practice in Walnut Creek, CA. “You can always expand. Keep your overhead low. Know what your credit score is and do everything you can to improve it. Pay your bills on time.”

Lasers aren’t cheap. Besides the initial acquisition costs, a service contract can cost $7,000 to $12,000 a year, according to Dr. Potozkin. “Don’t feel you have to buy every new laser under the sun,” he says. “In fact, renting rather than purchasing is an option many companies offer. When your volume is low you can rent and schedule laser days—although the pitfall there is you don’t have lasers available whenever patients come in.”

Also, young dermatologists “will probably have an easier time getting a loan if they go to a relatively underserved area, as opposed to an area that has a large number of dermatologists per capita,” says Dr. Potozkin, who began practicing 10 years ago. “There are two schools of thought on this: Go where you want to live to start a practice or go to where there’s a need and be instantly successful. I chose the former. It took me longer to get started but I’m very happy where I am.”

Patience, Prudence and Passiondem2

Be patient, prudent, passionate—and start with a spare office and as little debt as possible, advises Dr. David E. Marcinko MBA, a financial advisor and Certified Medical Planner™. Marcinko, a health economist,  is CEO of the Institute of Medical Business Advisors Inc., a national physician and medical practice consulting firm based in Norcross, GA www.MedicalBusinessAdvisors.com

“Patients are looking for passion from you, not lavish trappings,” Dr. Marcinko says. “When a banker or a loan officer sees $175,000 or more of debt they are loath to give a loan—and it’s hard to blame them. Purchase a home after you become a private practitioner. You need to be as close to debt-free as you can be.

Exit Strategy

“Another thing bankers want to know is, ‘If we give you a loan and you start a practice and it fails, how will we be paid back?’ They want an exit strategy.”

The good news is dermatology “remains a very lucrative specialty, and in most parts of the country they are in a shortage position, particularly with the aging population,” says Sandra McGraw, JD, MBA, principal and CEO of the Health Care Group, a financial and legal consulting firm based in Plymouth Meeting, PA., that advises the American Academy of Dermatology, among other groups.

“I would start with a realistic business plan for why you think this practice can succeed, in the specific location,” McGraw says. “How many patients do you expect to see? How will they know you are there and available? Remember that banks lend to all kinds of people, so keep your numbers realistic. Overestimating expenses is as bad as underestimating them. Then determine how you want the money—usually a fixed loan for a period of time and then a line of credit as you get your practice going and sometimes need the cash flow.”biz-book

Expanding a Practice

Established dermatologists should have an easier time getting loans to expand their practices. They have, one hopes, a track record of success and assets to put up as collateral.

Mid-career physicians “have cash flow, physician assets and equity to some degree in a house and personal assets,” Dr. Marcinko observes. “Banks can attach loans to personal assets and savings accounts. Ninety-nine percent of times you must sign a personal asset guarantee. Mid-lifers have assets young ones don’t, so mid-lifers aren’t quite the risk. They have businesses that have value and cash flow. Banks like cash flow.”

However, even veterans must do some homework before approaching a bank. “You still want to establish why you want the money and how the expansion will increase your income,” McGraw says.

Another tip: If the bank has loans out with reputable vendors, you might ask the loan officer to recommend them to you as potential contractors. “Sometimes keeping it local and supporting others with loans at the bank can be helpful,” she says.

Assessment

Dr. Marcinko adds, “Bankers today want you to come in with a well-reasoned, well-thought-out and well-written business plan. Give bankers a 30-second elevator speech on why you are different. It’s really important to ask yourself, ‘What can I offer the community as a doctor in my specialty that nobody else can?’ If you bill yourself as the first dermatologist to do laser surgery, that’s a perceived advantage. You purchased the equipment and learned to use it. But anyone can do that. If you can come up with something that nobody else has or can do, that’s how you’re successful in anything.”

Link: Dr. Marcinko Interview

Link: https://medicalexecutivepost.com/wp-content/uploads/2009/08/dr-marcinko-interview.pdf

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Understanding Managed Bond Funds

Posted on March 29, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Considerations for the Physician-Investor

By Staff Reportersdhimc-book11

Proper diversification among types of bonds is an important investment objective. The maturity schedule and the number of issuers are often very important, along with the issuers’ creditworthiness.

Individual Constraints

The constraints on purchases of individual bond issues often put the physician-investor at a disadvantage. Minimum amounts of investments are imposed by the marketplace or the issuer. Many doctor-investors find it impractical to meet these requirements and also obtain proper diversification (the amount of portfolio funds committed to debt-based securities simply is not large enough to obtain diversification and at the same time meet the other limitations). Accordingly, many investors find mutual funds devoted to debt-based securities most effective in achieving diversification.

A Large Marketplace

The mutual fund marketplace has many types of bond funds, and diversification can be obtained quite easily. The investor with a relatively reduced amount to invest in debt-based securities should consider using mutual funds.

Assessment

For more terminology information, please refer to the Dictionary of Health Economics and Finance.

www.HealthDictionarySeries.com

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