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    Later, Dr. Marcinko was a vital and recruited BOD  member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

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ANOSMIA, HYPERSOMIA, AGEUSIA, HYPOGEUSIA, DYSGEUSIA and the CORONA VIRUS?

WHAT IS “ANOSMIA”

By Darrell Pruitt DDS and David E. Marcinko MBBS, MBA

Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from Hyposmia which is a decreased sensitivity to some or all smells.

According to Wikipedia, Anosmia can be due to a number of factors, including an inflammation of the nasal mucosa, blockage of nasal passages or a destruction of one temporal lobe. Inflammation is due to chronic mucosa changes in the lining of the paranasal sinus and in the middle and superior turbinates. When anosmia is caused by inflammatory changes in the nasal passageways, it is treated simply by reducing inflammation. It can be caused by chronic meningitis and neurosyphilis that would increase intracranial pressure over a long period of time, and in some cases by ciliopathy, including ciliopathy due to primary ciliary dyskinesia. The term derives from the New Latin anosmia, based on Ancient Greek ἀν- (an-) + ὀσμή (osmḗ, “smell”; another related term, hyperosmia, refers to an increased ability to smell). Some people may be anosmic for one particular odor, a condition known as “specific anosmia”. The absence of the sense of smell from birth is known as congenital anosmia.

Ageusia is the loss of taste functions of the tongue, particularly the inability to detect sweetness, sourness, bitterness, saltiness, and umami. It is sometimes confused with anosmia – a loss of the sense of smell. Because the tongue can only indicate texture and differentiate between sweet, sour, bitter, salty, and umami, most of what is perceived as the sense of taste is actually derived from smell. True Ageusia is relatively rare compared to Hypogeusia – a partial loss of taste – and Dysgeusia – a distortion or alteration of taste.

ASSESSMENT:

If you should suddenly lose your sense of smell (anosmia), you might want to get tested for COVID-19 – even without the presence of other symptoms.

“A majority of COVID-19 patients experience some level of anosmia, most often temporary. Analyses of electronic health records indicate that COVID-19 patients are 27 times more likely to have smell loss but are only around 2.2 to 2.6 times more likely to have fever, cough or respiratory difficulty, compared to patients without COVID-19.”

See: “How COVID-19 Causes Loss of Smell – Olfactory support cells, not neurons, are vulnerable to novel coronavirus infection.” By Kevin Jiang for Harvard Medical School, July 24, 2020.

https://hms.harvard.edu/news/how-covid-19-causes-loss-smell

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Happy New Year 2019

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What is Risk Adjusted Stock Market Performance?

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Update on Some Interesting and Important Financial Calculations

By Timothy J. McIntosh MBA CFP® MPH

By Dr. David Edward Marcinko MBA CMP™

By Jeffery S. Coons PhD CFA

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-INTRODUCTION-

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

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

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

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

[a] The Treynor Ratio

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

[b] The Sharpe Ratio

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

***

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[c] The Jensen Alpha Measure

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

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

[d] Database Ratings

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

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

***

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

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Assessment

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

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

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

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ABOUT

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

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

Conclusion

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Understanding Hobson’s Choice in Medicine

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Hobson’s choice  in Public Health

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By Dr. David Edward Marcinko MBA

[From Wikipedia, the free encyclopedia]

A Hobson’s choice is a free choice in which only one thing is offered. Because a person may refuse to accept what is offered, the two options are taking it or taking nothing. In other words, one may “take it or leave it.”

The phrase is said to have originated with Thomas Hobson (1544–1631), a livery stable owner in Cambridge, England, who offered customers the choice of either taking the horse in his stall nearest the door or taking none at all.

***

An oil portrait of Thomas Hobson, in the National Portrait Gallery, London. He looks straight to the artist and is dressed in typical Tudor dress, with a heavy coat, a ruff, and tie tails

[Thomas Hobson, the National Portrait Gallery, London]

***

In Medicine

One of the first examples that springs readily to mind in trying to look for examples of Hobson’s Choice in Medicine is the issue of defensive medicine. While the physician actually has the option of not “shotgunning” a patient (that is, shooting randomly large number of tests in order to cover legal liability and prevent medicolegal backlashes), the risk of missing a diagnosis and the fall outs thereof are so large, that it basically degenerates into a Hobson’s Choice.

The idiosyncrasies of medicine and the way the body reacts to them always leaves us open to the risk of working within the constraints of Hobson’s Choice.

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For example, antibiotics have saved more lives than we can count, yet, an idiosyncratic, unpredictable reaction may just be waiting for us around the corner.

In Public Health

In the Indian Public Health scenario, all that the patients are offered in a primarily paternalistic system is the choice Hobson had offered all those years ago. Much like Henry Ford, who told customers lining up to buy his revolutionary Ford Model T that they could have their cars in “any color so long as it is black”, the Indian system, hobbled by the lack of an empowered public, and a patient choice scheme, functions on the basis of Hobson’s choice.

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Assessment

Even in the clinical sciences, with shared decision making and user driven healthcare still in their infancy in the nation, a paternalistic physician offers naught but “this or none” choice to their patients. While one can say that the lack of general awareness of the public tends to spawn this issue, we cannot shake off our personal stake in this matter just by hiding behind the façade of moral determinism!

Conclusion

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More on Cognitive Bias

In the “Mind of the Beholder”

By Dr. David Edward Marcinko MBA CMP™

http://www.HealthDictionarySeries.org

Definition

A cognitive bias refers to a systematic pattern of deviation from norm or rationality in judgment, whereby inferences about other people and situations may be drawn in an illogical fashion. Individuals create their own “subjective social reality” from their perception of the input. It is a  re-emerging topic in investing and financial planning, today! Here are some examples.
***

Conclusion

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

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

Contact: MarcinkoAdvisors@msn.com

***

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

Don’t let Population Health Demographic Trends Guide “Investment” Decisions

A Different Perspective on Population Health

By Dr. David Edward Marcinko MBA CMP®
http://www.CertifiedMedicalPlanner.org

Definition

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. It is an approach to health that aims to improve the health of an entire human population or cohort. http://www.HealthDictionarySeries.org

History

In fact, the nominal “father of population health” is colleague and Dean David B. Nash MD MBA of Jefferson Medical School in Philadelphia. And, although I attended Temple University down the street, David still wrote the Foreword to my textbook years later; Financial Management Strategies for Hospitals and Healthcare Organizations [Tools, Techniques, Checklists and Case Studies].

Factors

Now age, income, location, race, gender  and education are just a few characteristics that differentiate the world’s population. These are called ”disparities” and they have a major impact on people’s lives; especially their healthcare. And, I’ve written about them before.  Perform a ME-P “search” for more.

So, it’s only natural that we’re keeping an eye on two major demographic trends: aging baby boomers and maturing Millennials [1982-2002 approximately].

Why it’s important

The impact of large population shifts propagate throughout an economy benefitting certain sectors more than others and influencing a country’s growth prospects; tantalizing investing ideas?

Example:

For example, as baby boomers retire, we’ll likely see higher spending on health care, but less on education and raising children. Likewise, tech-savvy Millennials will likely prioritize consumption on experiences over cars and houses [leading economic indicator].

So, can we profit from these trends?

Assessment

Well maybe – maybe not! Overall economic prospects may not be completely affected by these trends. Spending habits on combined goods and services will shift, rather than rise or decline.

So, be careful. What matters most for your investment success is your demographics and investing according to your personal circumstances and goals [paradox-of-thrift].

Conclusion

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The Home Office Tax Deduction Explained

What it is – How it works?

By Dr. David Edward Marcinko MBA CMP™
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A taxpayer’s business use of his or her home may give rise to a deduction for the business portion of expenses related to operating the home.

The basic requirement:

1. There must be a specific room or area that is set aside for and used exclusively on a regular basis as:
a. The principal place of any business, or
b. A place where the taxpayer meets with patients, clients or customers in the normal course of their trade or business, or
c. A separate structure that is used in the taxpayer’s trade or business and is not attached to their house or residence.

2. An employee can take a home office deduction if he or she meets the regular and exclusive use test and the use is for the convenience of the employer.

Deductions

Deductible expenses include business portions of mortgage interest, property taxes, depreciation, repairs and maintenance to the overall home that help the business use area, janitorial services or maid, utilities, insurance as well as other expenses directly related to the operating the remainder of the home.

***

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Conclusion

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DR. MARCINKO SEEKING UNIVERSITY FACULTY APPOINTMENT

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Crowd Sourcing My Job Search – An Academic Social Media Experiment?

Dr. David Edward Marcinko MBBS DPM MBA MEd BSc CMP®

Any New Year typically brings to mind the passage of Father Time.

And, as a former endowed chairman and distinguished Business School professor of capitalism, health economics, policy and management; it’s hard to believe that I’ll be finishing up my current visiting scholar-on-sabbatical tenure after this Spring semester.

So, I am crowd-sourcing my next university job search as an emerging trend. It’s the career development equivalent of my just launched WIKI health dictionary project.

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Regardless of the job search, check it out and tell me what you think!

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On a NEW economic hybrid medical reimbursement system

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Enter Hybrid Reimbursement!

dem-2By Dr. David Edward Marcinko MBA CMP®

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As we know – not withstanding ACOs or bundled care reimbursement models – current medical reimbursement structures involve the submission and payment of medical CPT® coded claims.

Still, some doctors feel they need to “up-code” to maximize revenue or even “down-code” for fear of having a claim denied.

The Outcome

The upshot is that contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.

Enter Hybrid Reimbursement Models

This hybrid reimbursement system might use a two-payment structure.

  1. For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.
  2. The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.

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Flag MOney

***

Assessment

Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar. 

Conclusion

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What is Population Health?

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DEM white shirtBy David Edward Marcinko MBBS DPM MBA MEd

http://www.DavidEdwardMarcinko.com

What is population health?

In its most fundamental sense, population health seeks to improve or manage the health of a specific population. It is a systematic, holistic approach that aims to prevent disease by keeping people healthy and improving the quality of care.

HDS

http://www.HealthDictionarySeries.org

In fact, according to my colleague David B. Nash MD MBA, Founding Dean and Endowed Chair at the Jefferson College of Population Health, population health programs and interventions work to:

  • Connect prevention, wellness and behavioral health with traditional health care delivery
  • Focus on improving the quality and safety of care, improving access to healthcare services and helping to prevent/manage chronic diseases in the service of a specific population
  • Advance policies and solutions to address socio-economic and cultural factors (social determinants of health) that have an impact on health outcomes
  • Leverage technology and information systems to design social and community interventions and new models of health care delivery that facilitate care coordination and access

WHITE-PAPER: Population and Public Health

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Was the San Bernardino CA Massacre Work Place Violence?

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ASSESSMENT OF WORKPLACE VIOLENCE … A HEALTHCARE P.O.V.

  • By Eugene Schmuckler PhD MBA MEd CTS
  • By Dr. David Edward Marcinko MBA MBBS

What Really Is Workplace Violence?

Workplace violence is more than physical assault — it is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence.

Registered Nurses Association of Nova Scotia

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

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

 Non-work Related Situations

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

University of Iowa Injury Prevention Research Center

The University of Iowa Injury Prevention Research Center classifies most workplace violence into one of four categories.[1]

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

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workplace-violence

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Assessment

And so, was San Bernardino workplace violence – or not; please opine?

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ABOUT

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

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[1]   Cal/OSHA, 1995; UIIPRC, 2001. 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

***

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

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 2nd Opinions

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Telephonic or electronic advice for medical professionals that is:

  • Objective, affordable, medically focused and personalized
  • Rendered by a prescreened financial consultant or medical management advisor
  • Offered on a pay-as-you-go basis, by phone or secure e-mail transmission.

2nd Opinions

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Typical Topics 

  • Financial Planning
  • Retirement Planning
  • Overhead Assessments
  • Income Distribution Models
  • Academic Funding Analyses
  • Insurance Planning
  • Risk Management
  • Practice Assessments
  • New Venture Business Plans
  • Hospital Based Contract Assessments
  • Practice Income Turnarounds
  • Estate Planning
  • Portfolio Analysis
  • Compensation Plans
  • Cost Accounting Implementation
  • Contract Subsidy Analyses
  • Practice Buy Sell Valuations
  • Investment Policy Statement Analysis
  • Interim Management
  • Contract Compliance Models
  • New Physician Projections
  • Productivity Measurements
  • Revenue Cycle Gap Analyses
  • Payer Rate Evaluations
  • Revenue Cycle Improvements
  • Compensation Benchmarking
  • Strategic Planning Models
  • HIT System Evaluations
  • Staffing Analyses
  • P4P – ACOs – Concierge Medicine
  • Annual Budget Development
  • Ancillary Service Modeling
  • New Practice Development
  • Medical Service Line Extensions
  • Markets, Sales and Advertising
  • Health PR and Medical Practice Crisis Management
  • Investment Management-product evaluation/selection/competitive analysis
    -investment research
    -asset allocation and risk management* Research (products, pensions, planning, risk)
    * Financial Planning (IPS process, solutions, segmentation)
    * New Product Development (pension, longevity insurance, risk management)
    * Management Consulting (effectiveness/efficiency assessment of the investment management process)* Advocacy (regulatory, pensions, new products)
    * Financial Education/Coaching (corporate, groups)

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

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

***

[HOSPITAL OPERATIONS, ORGANIZATIONAL BEHAVIOR AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET]

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[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]

***

[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd.  Edition]

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[Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

***

Investing and Economics is an Imprecise Science

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BUT … It’s still all about CONSUMERISM!

[By Dr. David Edward Marcinko MBA MBBS [Hon] CMP]

http://www.CertifiedMedicalPlanner.org

DEM 2013There is a major variable, dominant in any marketplace that pushes an economy in a forward direction. It is called consumerism.

This became apparent while I was waiting in a doctor colleague’s office one recent afternoon.

Scenario:

The front office receptionist, who appeared to be about 21 years old, was breaking for lunch and her replacement, and appeared not much older, came over to assist.

Realizing the propensity for a long wait, one was taken by the size of waiting room and the number of patients coming in and out of the office. [Americans consume healthcare and a lot of it].

There was another notable peculiarity. The sample prescription bags being carried out the door were no match for the bags under everyone’s eyes, including the doctor’s. The office staff was probably working overtime, if not two jobs, and the doctor was working harder and faster in a managed care / ACA system.

***

stock-exchange-

[Consumerism driving the Stock Market]

***

Why?

So they all could afford to buy and voraciously consume for their children and themselves. Americans indeed work longer hours than any other industrialized nation.

Assessment

Additionally, as women female medical professionals entered the workforce in unprecedented numbers, the stock markets reached an all time high in 2015, even as money was spent at a feverish pace as the Federal Reserve pumped out money in inflammatory fashion.

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Form ADV Part II [The Essential Document]

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Lifting the “Veil of Secrecy” on Selecting Financial Advisors

[By Dr. David Edward Marcinko MBA CMP™]

DEM white  shirtBy law, financial advisors must provide you with a form ADV Part II or a brochure that covers the same information. Even if a brochure is provided, ask for the ADV. Today, it may even be online.

While it is acceptable, even desirable, for the brochure to be easier to read than the ADV, the ADV is what is filed with the appropriate state or SEC. If the brochure reads more like a slick sales brochure or the information in the brochure glosses over the items on the ADV to a high degree, one should consider eliminating the advisor from consideration.

Types of Advisors

Registering with a state or SEC gives an advisor a fiduciary duty to the client. This is a high standard under the law. There are several types of advisors who are exempt from registering and filing an ADV.

First, there are registered representatives (brokers).  Brokers have a fiduciary responsibility to their firms regardless of whether they are statutory employees or independent contractors.

Second are attorneys and accountants whose advice is “incidental” to their legal or accounting practices. But, why would one hire someone whose advice is “incidental” to his primary profession?

A top-notch advisor is a full-time professional and should be registered.  One should insist that their advisor be registered.

***

Lifting veil of secrecy

[The Author in Chicago Seeking Fiduciary Transparency]

***

The ADV will describe the advisor’s background and employment history, including any prior disciplinary issues. It will describe the ownership of the firm and outline how the firm and advisor are compensated. Any referral arrangements will be described. If an advisor has an interest in any of the investments to be recommended, it must be listed as well as the fee schedule. There is also a description of the types of investments recommended and the types of research information that is used.

Assessment

A review of the ADV should result in an alignment of what the advisor said during the interview and what is filed with the regulators. If there is a clear discrepancy, choose another advisor. If it is unclear, discuss the issue with the advisor.

  • SEC Headquarters
  • 100 F Street, NE Washington, DC 20549
  • (202) 942-8088

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Rapid Learning Health Systems and PCMC

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Emerging Competitive Trends in Modern Healthcare Today

http://www.CertifiedMedicalPlanner.org

imba inc

By Dr. David Edward Marcinko MBA CMP

By Hope Rachel Hetico RN MHA CMP

SOAR

dave-and-hope10Several trends are affecting the healthcare industry today. These trends are, in turn, having an impact on the financial performance of the entire healthcare ecosystem [patients, payers and providers], alike.

The ability of physicians, allied healthcare providers and the entire industry to respond to these trends is determined by the willingness to adapt, ability to re-train, and overall business flexibility. Central, of course, is the level of leadership in making the changes.

Perhaps the foremost trend, due to the PP-ACA, HSAs and Value Based Health Care, etc., is Patient Centered Medical Care [PCMC].

***

1

[Rapid Learning Health System in a PCHC Model]

***

Patient-Focused Healthcare

Patient-Centered, or Patient-Focused or Holistic Health Care has several names. It focuses on patient needs, attempting to humanize patient care. Patient-Centered healthcare therefore incorporates the following:

  • patient education;
  • active participation of the patient;
  • involvement of the family;
  • nutrition;
  • art; and
  • music.

These are thought to improve patient outcomes [1]. Furthermore, some think that patients will benefit from learning how to cope with healthcare processes before they enter into those processes and that this knowledge will result in better outcomes [2].

***

two

[The Current Healthcare Ecosystem]

***

An example of this would be classes to prepare couples for childbirth. These classes teach prospective parents the different stages of labor and strategies for dealing with the challenges associated with each stage. They cover options for pain management such as breathing and relaxation techniques and/or analgesics. The classes also provide education about clinical options such as induced labor and caesarian sections, and they cover practical issues such as what to wear and what kind of car seat to buy to transport the newborn home.

In fact, we know from personal experience that this type of education is enormously beneficial in reducing stress and improving the decision-making ability of patients who are involved in healthcare processes.

As a result of this movement, some healthcare organizations have tried to re-engineer the processes by which care is delivered in order to make it more patient focused. This is accomplished, in large part, by bringing the therapy to the patient rather than bringing the patient to the therapy.

***

3

[A Life-Long Continuous Learning System]

***

For example, storing more supplies and equipment in the patient’s hospital room means that more services can be performed in the room. Obviously, this trend has significant implications for the operations management function in healthcare organizations in the areas of layout and human resources management. Supplies and equipment may be arranged differently to facilitate patient-focused care.

Considerable staffing changes and cross training may be in order, to provide this type of service. Changes in facility layout to implement patient-focused care and reduce nonproductive movement of patients and personnel should be considered, especially when a facility is contemplating expansion or renovation of facilities.

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Citations and References

[1]  See Mang, A.L. “Implementation Strategies of Patient-Focused Care.” Hospital and Health Services Administration. 40:3 (1995): 426-525; and Kremitske, D.L. and West, D.L. “Patient-Focused Primary Care: A Model.” Hospital Topics. 75:4 (1997): 22-28.

[2]  Douglass, K. “No Pain; Big Gain.” Hospitals and Health Networks. 72:20 (1998): 38-39.

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More on “Passive Investing” for Physicians

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Basic Financial Concepts

tim

By Timothy J. McIntosh; CFPMBA MPH CMP [hon]

By Jeffery S. Coons; PhD CFA

By Dr. David E. Marcinko; MBA CMP™

Passive investing is a monetary plan in which an investor invests in accordance with a pre-determined strategy that doesn’t necessitate any forecasting of the economy or an individual company’s prospects.

Premise

The primary premise is to minimize investing fees and to avoid the unpleasant consequences of failing to correctly predict the future. The most accepted method to invest passively is to mimic the performance of a particular index. Investors typically do this today by purchasing one or more ‘index funds’. By tracking an index, an investor will achieve solid diversification with low expenses.  Thus, a physician-investor could potentially earn a higher rate of return than an investor paying higher management fees.

Passive management is most widespread in the stock markets.  But; with the explosion of exchange traded funds on the major exchanges, index investing has become more popular in other categories of investing. There are now literally hundreds of different index funds.

***

Bull Markets

[Domestic Bull Markets – Historical USA]

***

Passive management is based upon the Efficient Market Hypothesis theory.  The Efficient Market Hypothesis (EMH) states that securities are fairly priced based on information regarding their underlying cash flows and that investors should not anticipate to consistently out-perform the market over the long-term.

The Efficient Market Hypothesis evolved in the 1960s from the Ph.D. dissertation of Eugene Fama.  Fama persuasively made the case that in an active market that includes many well-informed and intelligent investors, securities will be appropriately priced and reflect all available information. If a market is efficient [even emerging and/or world markets], no information or analysis can be expected to result in outperformance of an appropriate benchmark.

***

World Markets

[USA versus World Index]

***

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The Author

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

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On Cultural Sensitivity in Education and Medicine

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A Modern Integral Component of Healthcare Training

[By Render S. Davis MHA CHE]

[By Dr. David Edward Marcinko MBA]

[By Hope R. Hetico RN MHA]

***

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

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

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

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

***

anatomy-254129_640

***

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

Called the “CRASH Course,” the program emphasizes:

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

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

Dr. Marcinko Teaching Philosophy

***

anatomy-254120_640

**

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About the Author

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

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“Vesalius on the Verge”

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The Book and the Body

[By Dr. David Edward Marcinko MBA]

DEM blue

“Vesalius on the Verge: The Book and the Body” explores the groundbreaking work of 16th century professor and physician Andreas Vesalius, who changed the way that human anatomy was taught forever with “De humani corporis fabrica (On the fabric of the human body)”.

The book did two things not seen before: it corrected errors in the conception of the human body that existed for over a millennia, and it combined text with artistic illustration, which enabled interactive learning.

Where else can you see a first edition of the 1543 published text, a desiccated body juxtaposed with a full skeleton, and a contemporary recreation of Vesalius’ dissection table?

Plan your visit today! #muttermuseum #vesalius #anatomy #medicine #rarebooks” By muttermuseum on Instagram

***

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***

anatomy

Source: tumblr_inline_nhs0feL7wW1qzgziy

***

Assessment:

I went to medical school in Philadelphia PA, and visited the Mutter Museum many times. If you’ve never been there – I urge you to check it out!

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Beware Dubious Insurance Policies for Doctors

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Careful Consideration is Required

[By Dr. David Edward Marcinko MBA MBBS] http://www.CertifiedMedicalPlanner.org

Dr. David E. Marcinko MBAThe following insurance policies should be carefully considered before purchase, since they may be unnecessary, too expensive, provide only minimal benefits, or be duplicated in your other policies.

The Culprits

Disclosure: I was a licensed insurance agent for more than a decade.

So, the culprits include: credit life or home mortgage insurance  (decreasing term), life insurance for children, accident policies for students, hospital indemnity policies, dread disease insurance, credit card insurance, pet health insurance, life insurance for the elderly, funeral insurance, flight insurance, pre-paid legal insurance and most extended warranties on automobiles, televisions, stereos, home computers; other gadgets and the like.

New wave Health 2.0 culprits include: terrorist insurance, cyber security insurance and reputation management policies.

Assessment

On the other hand, the following types of coverage may be important, for some medical professionals, and in selected cases: trip cancellation insurance, termite insurance and flood and earthquake insurance.

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***

Insurance

***

Conclusion

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About the INSTITUTE OF MEDICAL BUSINESS ADVISORS, Inc.

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The Institute of Medical Business Advisors, Inc provides a team of experienced, senior level consultants led by iMBA Chief Executive Officer Dr. David Edward Marcinko MBA CMPMBBS [Hon] and President Hope Rachel Hetico RN MHA CMP™ to provide going contact with our clients throughout all phases of each project, with most of the communications between iMBA and the key client participants flowing through this Senior Team.

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iMBA Inc., and its skilled staff of certified professionals have many years of significant experience, enjoy a national reputation in the healthcare consulting field, and are supported by an unsurpassed research and support staff of CPAs, MBAs, MPHs, PhDs, CMPs™, CFPs® and JDs to maintain a thorough and extensive knowledge of the healthcare environment.

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Understanding the Scientific Publication “H” Index, and others

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How to evaluate the academic performance of individual scientists

[By Dr. David Edward Marcinko MBA]

Dr. MarcinkoThe “h-index” was introduced in 2005 as a metric for estimating “the importance, significance and broad impact of a scientist’s cumulative contributions.” It takes into account both the number of an individual’s publications and their impact on peers, as indicated by citation counts.

Origination

Its creator, Jorge Hirsch (UC-San Diego) asserts that a “successful scientist” will have an h-index of 20 after 20 years; an “outstanding scientist” will have an index of 40 after 20 years; and a “truly unique individual” will have an index of 60 after 20 years or 90 after 30 years. You can read more about it in Nature and PhysicsWeb.

Web of Science

Curious to know your own h-index? You can easily determine it using Web of Science. Select “Science Citation Index Expanded.” Click “General Search” category and search for your name as author (e.g., SMITH J*). Use “Refine Your Results” by Institution to differentiate yourself from other scientists with the same initial(s). (This is an important step, otherwise your publications will be intermingled with unrelated papers and your h-index will be inaccurate.) Click on “Citation Report” in the box on the right side. Your h-index will be calculated automatically.

An alternative method is to sort your citations by “Times Cited”, using sort box on the right side. Scan down the list until the number of the paper exceeds the number of citations to that paper. For example, your h-index is 20 if your 21st paper has been cited 20 or fewer times, but your 20th paper has been cited 20 or more times.

Critique

Although effective and simple, the h-index suffers from some drawbacks that limit its use in accurately and fairly comparing the scientific output of different researchers. These drawbacks include information loss and low resolution: the former refers to the fact that in addition to h2 citations for papers in the h-core, excess citations are completely ignored, whereas the latter means that it is common for a group of researchers to have an identical h-index.

***

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Fixing the Bias

To solve these problems, Chun-Ting Zhang proposed the “e-index“, where e2 represents the ignored excess citations, in addition to the h2 citations for h-core papers. Citation information can be completely depicted by using the h-index together with the e-index, which are independent of each other. Some other h-type indices, such as a and R, are h-dependent, have information redundancy with h, and therefore, when used together with h, mask the real differences in excess citations of different researchers.

Link: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0005429

Assessment

Google Scholar is another useful source of citation data.  A.-W. Harzing’s Publish or Perish software is a free application for Windows, Mac OS, and GNU/Linux that uses Google Scholar to compute citation counts, h-indexes, journal impact factors, and many other citation metrics.

Conclusion

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The Danger of Groupthink with Endowment Fund Portfolio Managers

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A Historical Look-Back to the Future?

wayne-firebaugh

By Wayne Firebaugh CPA CFP® CMP™

www.CertifiedMedicalPlanner.org

It is not unusual for endowment fund managers to compare their endowment allocations to those of peer institutions and that as a result, endowment allocations are often similar to the “average” as reported by one or more survey/consulting firms.

One endowment fund manager expanded this thought by presciently noting that expecting materially different performance with substantially the same allocation is unreasonable [personal communication]. It is anecdotally interesting to wonder whether the seminal study “proving” the importance of asset allocation could have even had a substantially different conclusion. It seems likely that the pensions surveyed in the study had very similar allocations given the human tendency to measure one’s self against peers and to use peers for guidance.

Peer Comparison

Although peer comparisons can be useful in evaluating your institution’s own processes, groupthink can be highly contagious and dangerous.

For example, in the first quarter of 2000, net flows into equity mutual funds were $140.4 billion as compared to net inflows of $187.7 billion for all of 1999. February’s equity fund inflows were a staggering $55.6 billion, the record for single month investments. For all of 1999, total net mutual fund investments were $169.8 billion[1] meaning that investors “rebalanced” out of asset classes such as bonds just in time for the market’s March 24, 2000 peak (as measured by the S&P 500).

Of course, investors are not immune to poor decision making in upward trending markets. In 2001, investors withdrew a then-record amount of $30 billion[2] in September, presumably in response to the September 11th terrorist attacks. These investors managed to skillfully “rebalance” their ways out of markets that declined approximately 11.5% during the first several trading sessions after the market reopened, only to reach September 10th levels again after only 19 trading days. In 2002, investors revealed their relentless pursuit of self-destruction when they withdrew a net $27.7 billion from equity funds[3] just before the S&P 500’s 29.9% 2003 growth.

The Travails

Although it is easy to dismiss the travails of mutual fund investors as representing only the performance of amateurs, it is important to remember that institutions are not automatically immune by virtue of being managed by investment professionals.

For example, in the 1960s and early 1970s, common wisdom stipulated that portfolios include the Nifty Fifty stocks that were viewed to be complete companies.  These stocks were considered “one-decision” stocks for which the only decision was how much to buy. Even institutions got caught up in purchasing such current corporate stalwarts as Joe Schlitz Brewing, Simplicity Patterns, and Louisiana Home & Exploration.

Collective market groupthink pushed these stocks to such prices that Price Earnings ratios routinely exceeded 50. Subsequent disappointing performance of this strategy only revealed that common wisdom is often neither common nor wisdom.

Senate house conference committee meets wall street reform

[Wall Street Reform?]

More Current Examples

More recently, the New York Times reported on June 21, 2007, that Bear Stearns had managed to forestall the demise of the Bear Stearns High Grade Structured Credit Strategies and the related Enhanced Leveraged Fund.

The two funds held mortgage-backed debt securities of almost $2 billion many of which were in the sub-prime market.  To compound the problem, the funds borrowed much of the money used to purchase these securities.

The firms who had provided the loans to make these purchases represent some of the smartest names on Wall Street, including  JP Morgan, Goldman Sachs, Bank of America, Merrill Lynch, and Deutsche Bank.[4]

Assessment

Despite its efforts Bear Stearns had to inform investors less than a week later on June 27th that these two funds had collapsed.

Conclusion

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

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[1]   2001 Fact Book, Investment Company Institute.

[2]   Id.

[3]   2003 Fact Book, Investment Company Institute.

[4]    Bajaj, Vikas and Creswell, Julie. “Bear Stearns Staves off Collapse of 2 Hedge Funds.”
New York Times, June 21, 2007.

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Investment Policy Statement Benchmark Construction for Hospital Endowment Fund Management

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Financial Management of Hospitals and Healthcare Organizations

[By Perry D’Alessio CPA]

[By David Edward Marcinko MBA CMP]

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Introduction

Dr.  Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that … our hospitals are now involved in the worst financial crisis they have ever   experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing   hospitals in the future … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel   and salaries; many economies have been effected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect. [1]

Many health administration and endowment managers would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. Although they might be startled to learn that Dr. MacEachern made these observations in 1932, there is the old truism that there is nothing new under the sun.

Current healthcare statistics after the November 7th, 2012 presidential election and Patient Protection-Affordable Care Act confirmation, suggest that the financial crises are much the same for today’s hospitals as they were for hospitals during the Great Depression.

The AHA

The American Hospital Association (AHA) recently reported a number of gloomy statistics for hospitals: [2]

  • Hospitals provided $39 billion in uncompensated   care to patients in 2010 representing 5.8% of their expenses.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for   $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million, that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic   scalpels costing $30,000.

Daunting Numbers

A further review added more daunting numbers:[3]

  • In 2010, 22.4% of hospitals reported a negative total margin.
  • From 1997 through 2009, hospitals saw a small net surplus from government payments from sources such as Medicare and Medicaid deteriorate into a deficit approaching $35 billion.
  • Emergency departments in 47% of all hospitals report operating at, or over, capacity partially reflecting an approximate 10% decline in the number of emergency departments since 1991.
  • The average age of hospital plants has increased 22.5% from 8.0 years to 9.8 years in just fifteen years.
  • From 2003 through September 2007, hospital bond downgrades have outpaced hospital bond upgrades by 19%.

In a time when so much seems different yet so much seems the same, hospitals are increasingly viewing their endowments as a source of help. But what is an endowment? The same Latin words that give rise to the word “dowry” also give rise to the word endowment [4].

Interestingly, the concepts of a dowry and an endowment are in many ways similar. Both are typically viewed as gifts for continuing support or maintenance. With respect to the healthcare entity, an endowment is generally used to smooth variations in operating results and to fund extra programs or  plant purchases. Any entity that enjoys the support of an endowment also encounters the conflicting objectives between current income and future growth.

Assessment

Dean William Inge, a 19th century cleric and author, aptly noted that: “Worry is interest paid on trouble before it is due.”

When managing an endowment, it is important that the institution focus its attention on those items that it can control rather than worrying about those it cannot control. Successful endowment managers seem to agree that there are at least two major areas   subject to the endowment’s control: asset allocation (also known as investment policy) and payout policy.

###


Notes:

[1]   MacEachern, M.T., MD. “Some Economic Problems Affecting Hospitals Today and Suggestions for Their Solution.” The Bulletin of the American Hospital Association. July 1932.

[2]   Steinberg, C. Overview of the U.S. Healthcare System.  American Hospital Association (2003). Carline Steinburg is Vice President, Health Trends Analysis, for AHA.

[3]   “Trends Affecting Hospitals and Health Systems.”  TrendWatch Chartbook 2010.  American Hospital Association (2010).

[4]   Merriam-Webster Online.

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Safe Driving Tips all Doctor’s May Learn from Bus Drivers

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On Physicians Driving Safely

By Dr. David Edward Marcinko MBA

By Nalley Collision Center

Dr. MarcinkoBus drivers take their lives into their hands every day on city streets and interstate highways. Despite challenging traffic conditions and the responsibility of a large vehicle and numerous passengers, bus drivers find ways to stay safe while keeping up with demanding routes and schedules. These unsung heroes of the road universally command respect, but they also offer important lessons to ordinary drivers who share busy roads with buses every day.

So – as summer is upon us – and in the spirit of safe driving – allow our ME-P team at to share a few bus-driver inspired driving tips with you.

Distracted Driving

Modern technology has caused an addiction for many bus drivers as they struggle to communicate while safely driving a bus.

An Italian bus driver was caught on video simultaneously using two cell phones while steering his bus with his elbows. This talent showed the world that cell phone use behind the wheel might not present the extreme danger most people expect.

Seriously, bus drivers can provide some good examples of how not to drive. Although many states have laws in place restricting the use of electronic devices while driving, many states do not. All drivers, and every doctor, should avoid risking their lives and the lives of passengers by reserving cell phone use to emergencies while driving.

Road Rage

A New York City school bus driver named Juan DelValle side-swiped a car on a crowded city street and was subsequently attacked by the offended driver. DelValle was within days of his long-awaited retirement and died from severe injuries to his brain.

This one example shows how a minor traffic incident can quickly escalate into a life-changing event for unprepared drivers. Drivers should exercise extreme caution every time they have an incident with another driver. After an accident, drivers who feel threatened can call police and wait in their cars until help arrives.

Rest                                             

Bus drivers illustrate why no one should sit behind the wheel of a vehicle when fatigued.

Investigators determined that a tour bus crash in New York that killed 15 passengers was caused by a sleepy driver. The bus driver, Ophadell Williams, was charged with criminally negligent homicide. His life might never return to its previous state.

Drivers who spend time getting the sleep they need might arrive late at their destination, but they also arrive with a clear conscience, an alert mind, and living passengers.

Defensive Driving

A Transit bus in Los Osos, California rolled down an embankment after colliding with a car on a dark and wet stretch of road. Bus drivers know they cannot count on the driving skills of other motorists for safety, so they drive defensively. In the Los Osos case, the bus driver managed to stay alive after the Mercedes crossed the center line.

Although the driver of the automobile died in the wreck, all the bus passengers lived.

DEM's Jag XJ-V8-LMore

Assessment

Every driver should periodically take time to review defensive-driving tactics or to attend a defensive driving class to improve their ability to respond to unexpected circumstances on the highway.  

Conclusion

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Beware Automobile Identity Theft and Physician Focused Scams

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Check Your Driver’s License

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

DEM 2013

WARNING: Did you know that identity theft and physician targeted automobile scams are all the rage.

According to recent FBI reports, and the National Motor Vehicle License Organization [NMVLO], now you can see anyone’s driver’s license on the Internet, including your own! And, medical professionals are the targeted group of choice.

The FIA Culprit

The United States amendment to the Freedom of Information Act, enacted on September 3rd 2008, provides public access to motor vehicle driver’s information in an e-format. Under the Motor Vehicle Operator License Identification  Act (MOLIA), all US states are required  to adhere to the Driver’s statute and store an electronic copy of all valid drivers licenses in their state. And, they do their best to make all license photo’s searchable.

Want Proof?

I just searched for my driver’s license and there it was … picture and all. Thanks Homeland Security!

Go to the web site, and check it out. It’s unbelievable. Just enter your name, city and state to see if your license is on file. After your license comes on the screen, click the box marked “Please Remove.” This will remove it from public viewing, but not from law enforcement.

###

Classic XJ-V8-WB Jaguar

My vintage British 2000 Jaguar XJ-V8-LWB touring sedan 

Jaguar Touring sedan XJ-V8-LWB###

Assessment

As an auto [Jaguar] enthusiast, I am appalled at this situation. Please notify all your friends and ME-P colleagues so they can protect themselves, too.  Believe me – they will thank you for it. Here is the link.

Linkhttp://www.license.shorturl.com/>http://www.license.shorturl.com/

Conclusion

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Update on Physician SOAP Notes

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An Encore Presentation

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

www.BusinessofMedicalPractice.com

DEM 2013I wrote on this topic previously. Both as primary paper driven SOAP notes, and as next-gen electronic SOAPier notes, to much acclaim and derision.

  • Why? Because, now more than ever, inadequately documented medical charts can mean civil and criminal liability to the sloppy and/or unwary practitioner. And, medical records were previously used to aid in the quality of medical care.

Today, they are also the basis for payment for services, not as a record or reflection of the care that was actually provided, but as a separate justification for billing.

What is a SOAP Note?

SOAP notes

Assessment

SOAP[IER] eMRs [Beware the Alphabet Soup Switcher-Roo]

Conclusion

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A New Test For Alzheimers Disease [Video Humor]?

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A MOVING PUZZLE

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

DEM at Univ of PittsburghLast month, I had the opportunity to visit and tour the University of Pittsburgh and the Tower of Learning.

While there, I was given this brain teaser by one of the graduate students. I was told that if you can put this moving puzzle together; you may just be able to say goodbye to Alzheimer’s Disease!

Now, this is really clever and a bit challenging. So, much as we middle-aged folks are concerned with Alzheimer’s disease, this puzzle may help dispel some fear. Give it a try. Just remember, I was told that if you can put this puzzle together … you probably do not have to fear Alzheimer’s!

CLICK BELOW:

http://www.brl.ntt.co.jp/people/hara/fly.swf

Hint: you can move the puzzle pieces outside of the box to separate them to get a better look. Use left clicker to move the pieces around.

Assessment

It took me about 5 minutes to put it together. What about you?

Conclusion

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Letter from the Editor on Sandy Hook Elementary School

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A Painful Op-Ed Piece

By Dr. David Edward Marcinko FACFAS, MBA, CMP™

[Publisher and Editor-in-Chief]

Dr David E Marcinko MBAThe tragedy which struck the Sandy Hook Elementary School in Newtown, Connecticut last Friday left this Medical Executive-Post, and the entire nation, stunned. So many deaths of far too young victims! It is difficult to comprehend, explain or manage. It is not so difficult to feel some of the enormous loss of the parents, families and friends of the victims.

And, I’m sure it is unnecessary for me to encourage you to keep them in your thoughts and prayers. You, like me, have probably thought of little else since Friday.

At the ME-P, we will remember the people and families in Newtown, CT. Like the rest of the nation, our home-page flag will be at half-staff through this week.

If you have children of elementary school age, you may need some opportunities to process their reactions to this tragedy. Perhaps all they need is someone to listen, or to reassure them that these tragedies are rare events. We trust your local clergy, pediatricians and counselors are available to assist you or your child if that would be helpful.

More: www.CertifiedMedicalPlanner.org

In closing, I would like to share with you a Judeo-Christian reading which might bring some comfort during these difficult days:

A Prayer

The Spirit of the Lord God is upon me, because the Lord has anointed me to bring good news to the poor …  to comfort all who mourn; to grant to those who mourn in Zion— to give them a beautiful headdress instead of ashes, the oil of gladness instead of mourning, the garment of praise instead of a faint spirit; that they may be called oaks of righteousness, the planting of the Lord, that he may be glorified.

Assessment

ME-P Textbook: Chapter 07: Workplace Violence

We trust the deep knowledge and expertise on this topic by ME-P thought-leader Gene Schmuckler is available to you, as needed.

Fraternally,

David Edward Marcinko

Conclusion

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Do Clients Trust Financial Advisors More than Doctors or CPAs?

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I Think … Not in My Universe

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Survey after survey has shown that the public does not trust the financial services industry; it was – in fact, the least trusted industry in a recent Rick Edelman survey.

John Hancock?

But, perhaps they were looking at the wrong industries, or maybe investors just don’t trust your firm. A new survey by John Hancock shows that investors with assets of $200,000 or more, trust their financial advisor [FA] more than their primary doctor, accountant, contractor/handyman, boss and real estate agent. It was penned by one young staff writer named Diana Britton.

Link: http://wealthmanagement.com/blog/clients-trust-you-more-doctors-cpas?NL=WM-04&Issue=WM-04_20120611_WM-04_597&YM_RID=marcinkoadvisors%40msn.com&YM_MID=1318408

My View Point is Pretty Unique

Now, I am a doctor and board certified surgeon who held Series #7, #63 and #65 securities licenses, and was a Certified Financial Planner® for more than a decade. I was registered with a BD, SEC and NASD/FINRA, and held life, health and PC insurance licenses. This is the so-called “dual registration” to earn commissions and fees.

And, I’ve got a current partner who is a doctor-CPA who has a Master’s Degree in Accounting.  So, I know from whence I speak.

An Insurance Company!

Now, I resigned all of the above financial services monikers because of their lack of education and fiduciary accountability. These are sales licenses, certifications to hold a certification, and related gimmicks, all. Insurance agents have a duty to the company, not the client. Always ask them to put your best interests ahead of their own – in writing before hire – and watch them run.

Assessment

I suspect this study from an insurance company is less than accurate. How do I know? My gut heuristics tell me. Agency law tells me. No surveys needed or damn statistics for me. How about you? OR, are the marketing and PR gurus winning the public opinion battle with their insurance company advertising chicanery? ie., Hancock’s the future is yours!

If really so, here is my razzy for them.

 
Note: It is for the above reasons, and more, that we started the www.CertifiedMedicalPlanner.org online education program for financial advisors and management consultants that truly want to be trusted.

Conclusion

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Tips from a Doctor for Optimizing Automobile Fuel Efficiency to Save Money

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Here’s How I Can Afford Gasoline for My Vintage Jaguar XJ-8-LWB

Dr. Dr. David Edward Marcinko MBA CMP

[Editor-in-Chief]

Dammit Spock! I’m a doctor – not an auto mechanic!

But, as the cost of fuel increases, more and more physician drivers are thinking about ways to maximize their gas mileage. As well as reducing the cost of fuel in the doctor’s pocket, optimizing fuel efficiency helps reduce the environmental impact of driving and conserves a resource that is only getting scarcer. This is especially true when you drive a luxury European touring sedan that has been said to be one of the finest in the world – like me!

There are a number of different ways drivers can increase their gas mileage. Advice and tips on fuel efficiency fall into a number of key categories.

My Tips and Pearls 

1. The car that you drive can make a big difference when it comes to fuel efficiency. Clearly, the larger and more powerful the vehicle is, the lower its gas mileage is likely to be. Car manufacturers are increasingly looking to new technology to help improve fuel efficiency, and if your car is quite old then it might be time to consider switching to a new model. Fuel efficiency statistics are now commonly published and compared on driving websites, and you should consider this before buying a new, or used, car.

2. Ensuring that your car is well-maintained is also a significant factor in the fuel efficiency that you will experience. Something as small and innocuous as spark plugs, for example, can reduce your gas mileage by as much as 12%. Over the course a year, the cost of the gas you waste is likely to be far more than the cost of replacing the part. If you are in doubt, talk to a trusted mechanic about maintenance, and alway have your car serviced at the recommended intervals.

3. Tire pressure can also have a significant impact on fuel efficiency. Low tire pressure can affect the vehicle’s performance, reducing gas mileage markedly. At the same time, it is also worth remembering that having the pressure too high can also have a negative effect. Ensure that you check your tire pressure on a regular basis. Talk to your mechanic if you are unsure about the optimum pressure value for your tires.

4. The way you drive your car also impacts your overall gas mileage. The official U.S. government website for fuel economy recommends that you always observe the speed limit, noting that for each 5 mph that you drive over a 60-mph speed limit, you are likely to paying an additional $0.29 per gallon of gas. Aggressive driving can reduce your gas mileage by as much as 33% on the highway. Carrying unnecessary weight in your car also uses more fuel, and you should always turn off your engine when the car is idle.

5. By changing the way in which you use your car, you can also save money. By combining multiple short trips into single, multi-purpose outings, you can prevent wasted mileage. Commuters can consider car sharing schemes, whereby drivers take it in turns to provide transport for fellow workers, reducing the number of cars on the road. You may even choose to switch to public transport on certain days of the week, to reduce the burden on your car.

6. You can even improve gas mileage by being careful about where and when you purchase fuel. Gas is at its densest during the coolest times of day. That means that by purchasing fuel early in the morning, or after dark, the volume of gas that the pump dispenses per unit will be moderately higher than at other, warmer times of day. Be savvy about prices in your local area too, keeping an eye out for the cheapest gas stations, but don’t go out of your way to purchase fuel. The money that you save at the pump is likely to be wasted on the additional mileage spent driving to the station.

7. As the cost of gas fluctuates on such a frequent basis, learning to optimize your fuel efficiency is a great way to ensure that you get the most out of the money you spend on fuel. Ensure that your vehicle is as efficient as possible, moderate your driving behavior, and moderate the amount of driving that you do to see the biggest improvements in your gas mileage.

Assessment

This ME-P is a follow-up, by reader request, of a prior popular essay of mine. How Smart Doctors Can Save Big at the Pump I appreciate your interest.

More photos: https://healthcarefinancials.files.wordpress.com/2012/04/dems-jaguar.pdf

Conclusion

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Is Malta a Hedge Fund Haven?

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Island in the Mediterranean Sea – South of Sicily (Italy)

By Dr. David Edward Marcinko MBA CMP

[Editor-in-Chief]

OK; I’ve written about hedge funds before, on this ME-P and in our www.MedicalBusinessAdvisors.com print publications for various textbooks, handbooks, white papers and journal. And, we discuss the concept in our online educational www.CertifiedMedicalPlanner.org program, as well. Some medical professionals love them, and some financial advisors use them in their work; others do not.

Of course, I’ve written frequently about my colleague – the now retired and newly anointed philanthropist  and uber-hedge fund manager Mike Burry MD; ad nauseam.

Link: https://medicalexecutivepost.com/2010/03/24/video-on-hedge-fund-manager-michael-burry-md/

But, now there is a new wrinkle on the island that I first visited about ten years ago, while on a working vacation

Rising Visibility

Malta–yes, Malta–has quietly leveraged the rising 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.

Maybe back then, no more today, if this essay is to be believed.

Link: http://www.bloomberg.com/news/2012-01-05/malta-lures-connecticut-hedge-funds-with-300-days-of-sun-aided-by-eu-rules.html

Image 1

Why Malta?

Link: http://www.firstgozo.com/maltafacts.htm

Malta

Assessment

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 Mata is drawing attention, especially from European funds.

Conclusion

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

How Good Looks Lead to Higher [MD] Paychecks

Even for Medical Professionals?

DEM 2

By Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.org

[Editor-in-Chief]

Beauty seems like enough of a reward in and of itself, but a wealth of research reveals that it comes with extra perks too.

Prettier people earn more money, find higher-earning and more attractive spouses, and even get better mortgage deals!

And, now that more than 40% of young new physicians are seeking employment, do looks really matter?

Assessment

Source: www.onlinembaprograms.net

Conclusion                

Is this controversial thought true for doctors and learned medical professionals? How about publishers and editors? Do you have any real-life examples to share with the ME-P? Your thoughts and comments are appreciated.

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Content Life Cycle and Branding Management for Physicians

Freshness Also Required

By Dr. David Edward Marcinko MBA CMP™

By Eugene Schmuckler PhD, MBA

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Self-Branding in the Modern Era

In 1987 the magazine Fast Company published an article authored by Tom Peters entitled “The Brand Called You.” Although some individuals may shy away from the concept of self-branding in actuality, many of the online social network sites such as Facebook become media by which we in fact brand ourselves.

Peter’s Speaks

In his article, Peter’s stated. “Regardless of position, regardless of the business we happen to be in, all of us need to understand the importance of branding. We are CEOs of their own companies, Me Inc.”

To be in business today, our most important job is to be head marketer for the brand called you. As a medical practitioner how do you differentiate yourself from others in your specialty and why should a new patient choose your practice above those of the others in the field? Branding is about finding your big idea and building your identity and game plan around it. The bottom line: if you can’t explain who you are, and the value you bring to your practice in a short sentence or two, you have work to do.

According to Catherine Kaputa, a personal coach she suggests that there are the objective things: your credentials, the schools you went to, your years of experience, and your skill set, which represent what she refers to as hard power. Then there’s soft power: your image and reputation, your visibility in the community, your network of contacts, supporters and mentors. In today’s competitive marketplace, soft power plays a vital role in attracting people to you and your practice.

Standing Out

Peters suggests that everyone has a chance to stand out. Everyone has a chance to learn, improve, and build up their skills. Everyone has a chance to be a brand worthy of remark. Corporations spend millions of dollars creating and maintaining their distinct brand. The Olympic Rings are representative of a brand which the International Olympic Committee guards zealously. Professional services firms such as McKinsey, foster self-branding among their employees. Major corporations have as employees those individuals who are smart, motivated and talented. Self-branding allows the employees to differentiate themselves from their peers.

For one to engage in self-branding is first necessary to ask the question, “What is it that my practice does that makes it different?” You can begin by identifying the qualities or characteristics that make you distinctive from your competitors-or your colleagues. What have you done lately-this week-to make yourself stand out? What would your healthcare colleagues say is your greatest and clearest strength? What would they say is your most noteworthy personal trait? As a medical practitioner does your customer get dependable, reliable service that meets his or her strategic needs?

In addition, ask yourself: “what do I do that adds remarkable, measurable, distinguished distinctive value.” How do you manage your name brand, and content?

Assessment

Content for online brand visibility needs to be well written, fluid, dynamic, and shared. Source: www.digitalc4.com

Conclusion                

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

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Breast Cancer Myths vs. Reality

Turning Data into Information

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

As reported on this ME-P and elsewhere, I was recently in Philadelphia for a number of reasons and had the opportunity to stop by Drexel University to get some information on their nursing program [nursing degree].

There, I learned that it is one of the nation’s top nursing schools.

In fact, Drexel University is ranked one of “America’s BEST Colleges 2011” by U.S.News & World Report. I also learned the following about breast cancer, via: www.breastcancersociety.org

Assessment

Understanding the facts about breast cancer is of vital importance, because it may save your life or the life of someone you love.

Conclusion

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Stock Market Collapse or Earth Quake?

On the Road, Again!

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

A 5.8-magnitude earthquake rattled the East Coast on August 23rd and continued to produce aftershocks for several days. At least 18 aftershocks ranging in magnitude from 4.5 to as little as 2.0 followed the strongest earthquake to strike the East Coast since World War II, according to the US Geological Survey.

Aftershocks are smaller tremors that take place in the weeks and possibly months following a major earthquake like the one centered in Mineral, Virginia. They are usually felt in a smaller area than the original quake. The largest of the aftershocks so far was a 4.5-magnitude quake, according to the USGS. Tens of millions of people from Georgia to Canada were jolted by the initial tremor.

We felt it here in Atlanta too, as well as my home town of Fell’s Point, in Baltimore, Maryland [just north of Washington, DC], where I was visiting Johns Hopkins Hospital, engaging clients and lecturing at the time.

St. Patrick’ Church

Here is a reference file photograph of St. Patrick’s Roman Catholic Church in Baltimore, Maryland, before the quake and just down the street a bit from Johns Hopkins Hospital, toward the waterfront district.

 

Enter the Tremors

Now, here is the church on August 23rd, 2011, after a finial at the top edge of the spire fell, shattering a manhole cover far below.

The Damage Today

Fortunately, no one was injured.

This remaining damage is now the problem on this historic building.

Assessment

However, some ME-P readers and www.MedicalBusinessAdvisors.com clients are wondering if the finial collapse was due solely to the quake, or might the recent world-wide stock market tremors be involved in some way – you decide?

Conclusion

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Understanding Client Engagement Letters for Financial Advisors

Review the Basics to Protect Yourself from Liability

By Dr. David Edward Marcinko MBA CMP™

http://www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

According to the Professional Liability Agents Network (PLAN), a nonprofit association of insurance agencies specializing in risk management and loss prevention, there are two things that FAs should remember about engagement letters: have them and revise them. In fact, according to iMBA Inc’s Dr. Gary L. Bode CPA MSA – an accountant, financial advisor and board certified doctor – not all financial advisors and financial planners use engagement letters. “And, I think they are making a big mistake.”

www.MedicalBusinessAdvisors.com

Moreover, merely having a standard engagement letter is not enough: The changing scope of client service requires advisors and planners to review and update their engagement letters annually. Engagement letters should be updated to reflect changes in the engagement’s scope or timing. Many attorneys also recommend using a separate engagement letter each year to avoid problems of continuous representation and to establish the date of the statute of limitations before the engagement begins (thereby limiting the time period in which a client can file a claim).

The 10 Essential Elements

Even short, simple engagement letters are binding contracts. When creating or updating your engagement letters, make sure several essential provisions are included. Although additional clauses may be necessary, these basic provisions are the framework of your engagement letter.

1. Scope of Services and Limitations

Many doctors and lay professionals think of financial planning as a comprehensive analysis. If your engagement is limited, you must state that clearly in your engagement letter. Courts have held that it is reasonable for a client to expect a comprehensive analysis unless you state otherwise.

2. Client Responsibilities

The client’s role in an engagement is to provide the advisor or planner with certain data and to verify its accuracy. An engagement letter should contain a provision identifying the assistance you expect from your client in providing information and verifying its accuracy. The engagement letter should also specify any timetables applicable to this information.

3. Fees and Billing Procedures

Fee collection suits by advisors and planners against clients can result in professional liability counter-suits. You can prepare for this problem by specifying fees and billing procedures. An important part of this provision is your right to suspend work in progress until unpaid balances are brought current.

4. SEC Provisions for Investment Advisors

Planners who serve in investment advisory roles are required by the SEC to add several clauses to their engagement letters. First, if you collect any part of your fee in advance, you must explain in your engagement letter how a refund of the advance fee will be calculated if the client decides to stop the relationship before you have finished your work.

Second, you must state that you will not assign your responsibilities as a planner to a third party without the written consent of the client.

Finally, you can avoid regulatory responsibilities resulting from your possessing discretionary authority to act on behalf of your client by including in your engagement letter a disclaimer that says you will not exercise your discretionary authority without the client’s express written consent.

5. IRS Requirements

The IRS requires financial advisors and financial planners to have written consent to use a client’s tax return for purposes other than preparing a tax return. Thus, to protect yourself from liability, it’s important to add a “consent to use tax return information” clause in engagement letters.

6. Sharing of Information

Many financial advisors and planners recommend including in engagement letters a clause that allows the planner to receive information from and share information with their client’s other advisors. But, if you’re going to exchange information about a client, you’d better have the client’s affirmation; much like the HIPAA Statutes [business associates agreement].

7. Dispute Resolution

Include an arbitration clause in every engagement letter – arbitration is much faster and cheaper than taking a case through the court system. This theory is supported by PLAN, which recommends including in every engagement letter details about the type of dispute resolution to be used in the case of a disagreement.

8. Limitation of Liability

PLAN recommends that client service professionals require clients to either indemnify them from certain types of claims or establish a dollar limit on their liability. Although this provision has been used successfully in other professions, the SEC position on such clauses seems unclear. So, before adding a limitation of liability or indemnification clause, then, check with your state and federal regulatory agencies about standard procedure.

9. Good Will

Many firms conclude an engagement letter with a “good will” provision that thanks the client for his or her business and offers to discuss the letter and its provisions if the client has questions. While this provision may appear gratuitous, PLAN believes this can be critically important to a defense if a client claims to not know what he or she was signing.

10. Signature

As mentioned above, your engagement letter becomes your contract for professional service. As such, it is important to have it signed by your client http://www.plan.org

Assessment

Much like medical and surgical consent forms, or even treatment plans, client engagement letters for financial services professionals now seem the norm.

Note: Julie Schaeffer, a Chicago-based freelance writer, assisted in the original version of this essay.

Conclusion

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How Investors View Financial Advisors?

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A Public Opinion Survey

Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.org

Boston-based Dalbar company is a surveyor of financial information for the mutual fund industry. About a decade ago Dalbar released a nine-part survey on personal financial advice to measure the level of demand for advice that existed back then and to ascertain consumer preferences, expectations, beliefs, and sources for personal financial advice.

Now, please allow me to suggest that all FA colleagues use the results to evaluate your current practices and planed initiatives to determine how current thinking must change to meet today’s and tomorrow’s needs. And so, we now share some of the results of this survey.

Customer Expectations of Personal Financial Advisors

• Investors and prospective investors expect their personal financial advisors to educate them about investments and to minimize the taxes they pay.

• Unrealistic expectations present a major problem to personal financial advisors. The expectations for advisors to produce the highest returns, prevent investing mistakes, and avoid losses set the stage for disappointment in the future, thus undermining the public trust of advisors.

• Advertising, training, compensation, and industry practice is out of step with customer expectations. This survey indicates that emphasis in all these areas should be directed to vastly simplify education, increase use of tax saving strategies, and help investors to define financial goals.

Demand for Personal Financial Advisors

• Of the consumers surveyed, 89% report the need for a personal financial advisor for assets of $100,000 or more. This contradicts the notion that a growing number of people prefer to do-it-themselves. This finding presents the advisor with an opportunity: The demand for advice is higher than the market would suggest.

• The demand for advice, as measured by the Advice Demand Index (ADI) is highest among those who prefer to pay for advice through commissions. The ADI is highest for commission-payers at 93%, followed by those who prefer to pay a percentage of their assets (92.5%). Flat-fee payers have the lowest demand for advice, at just 88.7%.

Importance of Personal Financial Advice Functions

• Consumers unanimously agree that the ability of their advisor to provide clear explanations of investment alternatives, to be available when needed, and to keep them informed of their investment status are the most important financial advice functions.

• Consumers revealed that the delivery of a comprehensive written financial plan is the least important function that their advisor performs.

Assessment

This report was not physician specific so one wonders how applicable it is to medical providers; especially the “no-desire” for a financial plan part?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Are the results still valid today; or after the 2008-09 “flash crash”? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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On Standard & Poor’s Depository Receipts

Don’t be Afraid of ‘SPIDERS’

By Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.com

[Publisher-in-Chief]

What they are – How they work?

No, I’m not talking about creepy, crawly insects. I’m referring to Standard & Poor’s Depository Receipts (SPDRs, or spiders), a derivative product, which combines many of the advantages of index funds with the superior trading flexibility of common stocks.

Creation

SPDRs were created in January 1993 by the American Stock Exchange. SPDRs are units in a trust holding the S&P 500 securities in proportion to their index weighting and which are adjusted as necessary to track changes made to the index by S&P. They pay quarterly cash dividend distributions based on the accumulated dividends paid by the stocks held in the SPDR trust minus an annual fee of about .19% of principal to cover trust expenses. They trade at approximately one-tenth the value of the index.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Do you use SPDRs; why or why not? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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On Stock Market [Mis]Timing Strategies

Do They Come Up Short?

Dr. David Edward Marcinko MBA CMP™

www.CertifiedMedicalPlanner.com

[Publisher-in-Chief]

Stock market investment rules are notorious for showing profit when tested on the same sample period from which they were developed, and then failing when applied to a new period. According to Professor Roger C. Vergin, it’s dangerous to use the same data to both discover and test the rules.

Of Marty Zweig

Using the “Zweig Strategies” developed by Martin Zweig and published back in 1986 in Winning on Wall Street (WOWS), Professor Vergin shoots some rather sizable holes in Zweig’s indicators by testing them against the 10-year period since WOWS was published. Zweig’s models are applied to various periods from 19 to 33 years, ending in 1985, and they claim to outperform a buy-and-hold strategy with annual rates of return as much as eight times as large, according to some measures. When the author ran these strategies for the 10-year period ending Dec. 5, 1995, not only did they not outperform a buy-and-hold strategy, but they trailed the market averages by a significant amount—9% vs. 14.4% for buy-and-hold.

The “Z” Indicators

Zweig’s indicators include a prime rate indicator, a Federal Reserve indicator, an installment debt indicator, a 4% indicator (market momentum), a monetary model, and a “super” model, which Zweig referred to as “the only investment model you will ever need.” 

Vergin corrects for inconsistencies in the evaluation criteria from one strategy to the next in WOWS and runs the numbers for the original test period first. Zweig’s strategies still outperform buy-and-hold. But, when run against an independent time period, as the author has done, the wheels fall off. Vergin runs the Zweig Strategies against the S&P 500, the Value Line Index, and an index developed by Zweig called ZUPI (all NYSE stocks).

Assessment

Over the 10-year period, none of the six Zweig Strategies outperformed a simple buy-and-hold strategy when compared against any of the three indexes mentioned above. They produced an average return of 9% compared to 14.4% for buy-and-hold.

In fact, Dr. Burton Malkiel’s [personal communication] conclusion in his book A Random Walk Down Wall Street, was that: “market timing is likely, not only to not add value, but to be counterproductive” seems to have borne out again.”

Note: “Market-Timing Strategies: Can You Get Rich?” by Roger C. Vergin. The Journal of Investing, Winter 1996, pp. 79–85, Institutional Investor, Inc. [212] 224-3185)

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. By trying enough patterns against past events, one can always find simple rules that “would have” worked well in the past. But, do they hold up against differing periods of time; like say 2008-09? … At least not yet! What do you think?

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

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The Effects of Healthcare Reform Legislation on Physician Compensation

Is a Future Look Predicated on the Past?

By Dr. Brian J. Knabe; CFP® CMP™

By Dr. David Edward Marcinko; MBA CMP™

By Prof. Hope Rachel Hetico; RN, MHA CPHQ CMP™

www.BusinessofMedicalPractice.com

With the passage of healthcare reform legislation, officially known as the Patient Protection and Affordable Care Act of 2010, many questions remain regarding its effect upon physicians’ livelihood.

Undoubtedly this bill moves the healthcare system several steps closer to a socialized model, but the effects on physicians’ salaries and compensation models are far from clear.

Other Countries

One way to see the effect that this shift may have on compensation is to look to other countries, many of which already have a more socialized system in place.

According to the CRS Report for Congress, US Health Care Spending:  Comparison with Other OECD Countries http://assets.opencrs.com/rpts/RL34175_20070917.pdf) US specialists rank near the top in compensation compared to these other countries, trailing the Netherlands and Australia.  The average specialist in the US made $230,000 in this survey.  The comparable salary in Canada is $161,000, $150,000 in the UK, and $253,000 in the Netherlands.  Generalists in the US are at the top in terms of compensation with an average of $161,000.  This compares to $107,000 in Canada, $118,000 in the UK, and $117,000 in the Netherlands.

Inflation Adjustments

Another indicator of physician salary trends is the change in compensation adjusted for inflation.  According to the American Medical Association, the inflation-adjusted income for the average patient care physician declined from $180,930 to $168,122 from 1995 to 2003, a 7% decrease. And, the inflation adjusted decrease is more substantial given the low interest rate environment thru 2010, and going forward.

Physician Net Income Chart

  Average net income
  1995 2003 Decrease
All patient care physicians $180,930 $168,122 7%
Primary care physicians $135,036 $121,262 10%
Medical specialists $178,840 $175,011 2%
Surgical specialists $245,162 $224,998 8%

Source: http://www.ama-assn.org/amednews/site/free/prsc0724.htm

Given these trends, as well as the fact that an increasing percentage of healthcare payments are coming from dwindling government sources, it is likely that physician salaries will decline as “healthcare reform” legislation is implemented.  In fact, it is likely that this trend will accelerate.  A 15% to 25% inflation-adjusted decline in salaries over the next decade is a reasonable prediction.

Assessment

It is also important to note that the level of student debt in the US continues to rise, while college and medical education are usually subsidized in other countries.  Many foreign physicians graduate with no student loan debt.  The ratio of debt level to salary in the US continues to become more onerous for new physicians.

Conclusion

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ME-P Corporate Seminar Information

By Ann Miller RN, MHA

[ME-P Executive-Director]

Our Editor-in-Chief, Dr. David Edward Marcinko MBA, CMP™, enjoys public speaking and gives as many talks each year as possible, at a variety of medical society, pharmaceutical and financial services conferences around the country and world [Cannada, Belgium, Germany and Finland].

These have included lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal quarterly and annual meetings for small bio-tech firms as well as big pharma.

Topics of Interest

The presentations of Dr. Marcinko are engaging, iconoclastic, and humorous. His most popular presentations include a diverse variety of topics and typically include those in all iMBA Inc’s textbooks, handbooks, white-papers and our 2-volume quarterly print journal; as well as most topics covered on this Medical Executive-Post blog.

Samples and Examples 

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Assessment 

To find out more information about our corporate seminars and workshops, please contact us for details: MarcinkoAdvisors@msn.com.

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When Investing or Stock Trading Is No Longer Fun

Understanding Obsessive-Compulsive Behavior

By: Dr. David Edward Marcinko; FACFAS, MBA, CMP™

By: Dr. Eugene Schmuckler; MBA, CTS

By: Dr. Kenneth H. Shubin-Stein, CFA

By: Richard B. Wagner; JD, CFP®fp-book1

An obsession is a persistent, recurring preoccupation with an idea or thought. A compulsion is an impulse that is experienced as irresistible. Obsessive-compulsive individuals feel compelled to think thoughts that they say they do not want to think or to carry out actions that they say are against their will. These individuals usually realize that their behavior is irrational, but it is beyond their control. In general, these individuals are preoccupied with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

Specifically, behaviors such as the following may be seen:

  • Preoccupation with details.
  • Perfectionism that interferes with task completion.
  • Excessive devotion to work and office productivity.
  • Scrupulous and inflexible about morality (not accounted for by cultural or religious identification).
  • Inability to discard worn-out or worthless objects without sentimental value.
  • Reluctance to delegate tasks or to work with others.
  • Adopts a miserly spending style toward both self and others.
  • Demonstrates a rigid, inflexible and stubborn nature.

Most people resort to some minor obsessive-compulsive patterns under severe pressure or when trying to achieve goals that they consider critically important. In fact, many individuals refer to this as superstitious behavior. The study habits required for medical students entail a good deal of compulsive behavior.

Related Addictions

As the above examples suggest, there are a variety of addictions possible. Recent news accounts have pointed out that even high-level governmental officials can experience sex addiction. The advent of the Internet has led to what is referred to as Internet addiction where an individual is transfixed to the computer working for hours on end without a specific project in mind. The simple act of “surfing” offers the person afflicted with the addiction some degree of satisfaction.

The Gambler

Still another form of addictive behavior is that of the compulsive gambler. This is the behavior of an individual who is unable to resist the impulse to gamble. Many reasons have been posited for this type of behavior including the death instinct; a need to lose; a wish to repeat a big win; identification with adults the “gambler” knew as an adolescent; and a desire for action and excitement. There are other explanations offered for this form of compulsive behavior. The act of betting allows the individual to express an immature bravery, courage, manliness, and persistence against unfavorable odds. By actually using money and challenging reality, he puts himself into “action” and intense emotion. By means of gambling, the addicted individual is able to pretend that he is favored by “lady luck,” specially chosen, successful, able to beat the system and escape from feelings of discontent.

Just Plain Greed

Greed is another reason. In fact, a 1987 poll conducted by the Chicago Tribune revealed that people who earned less than $30,000 a year, said that $50,000 would fulfill their dreams, whereas those with yearly incomes of over $100,000 said they would need $250,000 to be satisfied. More recent studies confirm that goals keep getting pushed upward as soon as a lower level is reached. Now, consider Bernie Madoff, and the recent sub-prime mortgage debt fiasco in this light?

Compulsive Doctors

Edward Looney, executive director of the Trenton, New Jersey based Council on Compulsive Gambling (CCG) reports that the number of individuals calling with trading-associated problems is doubling annually. In the mid 1980s, when the council was formed, the number of people calling the council’s hotline (1 – 800 Gambler) with stock-market gambling problems was approximately 1.5 percent of all calls received. In 1998 that number grew to 3 percent and it is projected to rise to 7-8 percent by 2005. Dr. Robert Custer, an expert on compulsive gambling reported, that stock market gamblers represent over 20 percent of the gamblers that he has diagnosed. It is evident that on-line trading presents a tremendous risk to the speculator. The CCG describes some of the consequences:

  • Dr. Fred B. is a 43-year-old Caucasian male physician with a salary above $100,000 and in debt for more than $100,000. He is married with two children. He was a day trader.
  • Michael Q. is a 28-year-old Caucasian male registered nurse. He is married and the father of one (7 month old) child. He earns $65,000 and lost $40,000 savings in day trading and is in debt for $25,000. He has suicidal ideation.

Assessment

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Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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