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LIAR-LIAR: The Physician Paradox?

Posted on April 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Classic Definition: Suppose someone tells you “I am lying.” If what he/she tells you is true, then he/she is lying, in which case what he/she tells you are false. On the other hand, if what he/she tells you is false, then he/she is not lying, in which case what he/she tells you is true.

Modern Circumstance: In short: if “I am lying” is true then it is false, and if it is false then it is true.

Paradox Example: The paradox arises for any sentence that says or implies of itself that it is false (the simplest example being “This sentence is false”). It is attributed to the ancient Greek seer Epimenides (fl. c. 6th century BCE), an inhabitant of Crete, who famously declared that “All Cretans are liars” (consider what follows if the declaration is true). The paradox is important in part because it creates severe difficulties for logically rigorous theories of truth; it was not adequately addressed (which is not to say solved) until the 20th century.

Paradox Example: Doctors lie because, as caretakers, our role is to improve the lives of their patients. Re-assuring patients during some of the most difficult times of their lives counts as improving their well being! This is an acceptable practice because it does not cause harm.

Paradox Example: Cultural differences may make a lie of omission or the practice of withholding information from the patient, prudent. For instance, some cultures and religions dictate that the husband or head male family members make all medical decisions for women.

Paradox Example: Many physicians don’t report “near misses” to their patients. But, concealing serious medical errors is something we recommend against.

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Filed under: "Doctors Only", Ethics, Health Insurance, iMBA, Inc., Professional Liability | Tagged: crete, DO, DPM, Epimenides, false, friends, liar, MD, paradox, physician paradox, physicians, sex, sports, thoughts, true, untrue | Leave a comment »

The DOCTOR EFFECT

Posted on April 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Dr. David Edward Marcinko; MBA MEd CMP™

Medical Colleagues Beware the Advisors

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SPONSOR: http://www.MarcinkoAssociates.com

Several years ago a group of highly trusted and deeply experienced financial advisors, insurance service professionals and estate planners noted that far too many of their mature retiring physician clients, using traditional stock brokers, management consultants and financial advisors, seemed to be less successful than those who went it alone. These Do-it-Yourselfers [DIYs] had setbacks and made mistakes, for sure. But, the ME Inc doctors seemed to learn from their mistakes and did not incur the high management and service fees demanded from general or retail one-size-fits-all “advisors.”

In fact, an informal inverse related relationship was noted, and dubbed the “Doctor Effect.” In others words, the more consultants an individual doctor retained; the less well they did in all disciplines of the financial planning and medical practice management, continuum.

Of course, the reason for this discrepancy eluded many of them as Wall Street brokerages and wire-houses flooded the media with messages, infomercials, print, radio, TV, texts, tweets, dinners and internet ads to the contrary. Rather than self-learn the basics, the prevailing sentiment seemed to purse the holy grail of finding the “perfect financial advisor.” This realization confirmed the industry culture which seemed to be:

Bread for the advisor – Crumbs for the client!

And so, Marcinko Associates formed a cadre’ of technology focused and highly educated multi-degreed doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries who decided there must be a better way for their healthcare colleagues to receive financial planning advice, products and related advisory services within a culture of fiduciary responsibility.

We trust you agree with this specific niche knowledge, and collegial consulting philosophy, as illustrated thru our firm and these two books.

EDUCATION: Books

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

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Filed under: "Doctors Only", CMP Program, Ethics, Financial Advisor Listings, Financial Planning, Funding Basics, Investing, LifeStyle, Marcinko Associates, Portfolio Management, Touring with Marcinko | Tagged: agents, budgeting, certified medical planner, CFP, CMP, DO, DPM, finance, financial advisors, financial planners, Financial Planning, insurance, Investing, Marcinko, MD, personal-finance, Portfolio Management, RN | Leave a comment »

PHYSICIANS: On Real Estate Investing

Posted on April 14, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

OVER HEARD IN THE FINANCIAL ADVISOR’S LOUNGE

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By Perry D’Alessio, CPA
[D’Alessio Tocci & Pell LLP]

What I see in my accounting practice is that significant accumulation in younger physician portfolio growth is not happening as it once did. This is partially because confidence in the equity markets is still not what it was; but that doctors are also looking for better solutions to support their reduced incomes.

For example, I see older doctors with about 25 percent of their wealth in the market, and even in retirement years, do not rely much on that accumulation to live on. Of this 25 percent, about 80 percent is in their retirement plan, as tax breaks for funding are just too good to ignore.

What I do see is that about 50 percent of senior physician wealth is in rental real estate, both in a private residence that has a rental component, and mixed-use properties. It is this that provides a good portion of income in retirement.

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QUESTION: So, could I add dialog about real estate as a long term solution for retirement?

Yes, as I believe a real estate concentration in the amount of 5 percent is optimal for a diversified portfolio, but in a very passive way through mutual or index funds that are invested in real estate holdings and not directly owning properties.

Today, as an option, we have the ability to take pension plan assets and transfer marketable securities for rental property to be held inside the plan collecting rents instead of dividends.

Real estate holdings never vary very much, tend to go up modestly, and have preferential tax treatment due to depreciation of the property against income.

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EDUCATION: Books

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Filed under: "Ask-an-Advisor", "Doctors Only", Accounting, Experts Invited, Investing, Retirement and Benefits, Taxation | Tagged: Accounting, CPA, diversification, dividends, DO, doctors, DPM, equity markets, finance, Investing, investment, MD, Perry D’Alessio, personal-finance, physicians, physicians real estate, real estate, real-estate, rents, retirement, Taxation | Leave a comment »

CREDIT CARDS: Mistakes All Doctors Must Avoid

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

By Staff Reporters

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Credit Card Mistakes to Avoid

No number has as far-reaching an impact on your money as your credit scores. Here are some credit card obstacles all physicians, nurses and medical professionals should dodge on the road to financial security

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Don’t pay for a credit card repair service.
Don’t miss a payment.
Don’t max out your card.
Don’t take a cash-advance.
Don’t skip using your cards.
Don’t chase interest rates.
Don’t apply for several credit cards all at once.
Don’t co-sign a loan.
Don’t spread our car or mortgage payments.

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Filed under: "Ask-an-Advisor", Financial Planning, Funding Basics, Glossary Terms, Investing, Risk Management | Tagged: cash adane, credit card, credit card doctors, credit cards, credit repair, DO, doctors, interest rates, MD, RN | Leave a comment »

MEDICAL PRACTICE: As a Financial Asset Class?

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

SPONSOR: http://www.MarcinkoAssociates.com

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By Dr. David Edward Marcinko; MBA MEd CMP™

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What Is an Alternative Investment?

An alternative investment is a financial asset that does not fall into one of the conventional investment categories. Conventional categories include stocks, bonds, and cash. Alternative investments can include private equity or venture capital, hedge funds, managed futures, art and antiques, commodities, and derivatives contracts. Real estate is also often classified as an alternative investment.

QUESTION: But what about a medical, podiatric or dental practice?

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An Alternate Asset Class Surrogate?

A medical practice is much like an alternative investment [AI], or alternate asset class in, two respects.

First, it provides the work environment that generates personal income which has been considered generous, to date.

Second, it has inherent appreciation and sales value that can be part of an exit (retirement) or succession planning transfer strategy.

Conclusion

So, unlike the emerging thought that offers Social Security payments as a surrogate for an asset classes; or a federally insured AAA bond – a medical practice might also be considered by some folks as an asset class within a well diversified modern investment portfolio.

EDUCATION: Books

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Filed under: "Ask-an-Advisor", "Doctors Only", CMP Program, Experts Invited, Funding Basics, Glossary Terms, Health Economics, Healthcare Finance, Investing, LifeStyle | Tagged: alternate investments, bonds, CASH, CMP, DDS, dental practice, derivatives, DO, DPM, hedge funds, medical practice, podiatric practice, Private Equity, real estate, retirement planning, social security, stocks | Leave a comment »

PHYSICIAN RETIREES: Home Ownership V. Home Renting

Posted on April 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

THE “FIVE-FIVE” FINANCIAL RULE

By Staff Reporters

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Many of the pros of home ownership will appeal to medical retirees for whom their home is their castle and who appreciate being settled both financially and geographically:

1. Building equity in your home: Each mortgage payment you make brings you closer to owning your house free and clear with no payments. If you can buy a new home or condo outright by selling your current home, you can still build equity in your new home over time.
2. Predictability: If you have a fixed-rate mortgage, your mortgage payments will remain consistent for years and you don’t have to worry about a landlord ever making you move.
3. Tax benefits: You can deduct mortgage interest and property taxes up to certain limits.
4. Customization: You don’t need a landlord’s permission to alter and improve your home.
5. Home appreciation: Homes generally increase in value, so you can increase your net worth by owning a property.

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Renting also has five significant upsides, particularly for physician retirees who want greater freedom to travel and to make bigger moves — potentially across the country or even abroad:

1. Extreme flexibility: You can leave your property after giving notice and go wherever you want much more easily than with an illiquid home you’d have to sell first.
2. Lower upfront costs: You only have to pay first and last month’s rent and a security deposit to move into a rental, not make a large home down payment.
3. No maintenance concerns: If something breaks, your landlord is responsible for the cost of fixing it and the actual repairs. You don’t have to build up an emergency fund for maintenance.
4. Predictable expenses: For the duration of your lease, your monthly housing costs including utilities will remain consistent, even if the cost of energy goes up, for example.
5. Lack of worry: If you’re in a rental apartment, you won’t have to concern yourself with shoveling snow, mowing grass or other matters of upkeep.

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Filed under: "Ask-an-Advisor", Financial Planning, Funding Basics, Glossary Terms, Investing, LifeStyle | Tagged: 5-5 rule, appreciation, DO, DPM, equity, home, home ownership, home rentals, homeownership, homes, Investing, lease, MD, medical, own versus rent, physician, property, real-estate, renting, tax | Leave a comment »

ROTH: Conversion Considerations for Physicians

Posted on April 11, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Why would a doctor consider a Roth IRA conversion?

By Staff Reporters

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A Roth conversion involves transferring funds from a traditional retirement account—such as a 401(k), 403(b), or individual retirement account (IRA) funded with pre-tax dollars—into a Roth IRA.

The biggest benefit lies in the tax treatment of the converted funds. Once the funds are in the Roth IRA, future growth of those assets is tax-free. Withdrawals in retirement are also tax-free, assuming they meet certain criteria. As with any strategy, there are important considerations to keep in mind.

When you convert funds to a Roth IRA, the amount converted is taxable income in that tax year. For example, if you convert $100,000 from a traditional IRA to a Roth IRA, that $100,000 will be added to your taxable income in the conversion year.

Converting large amounts can result in a significant tax bill and may push you into a higher tax bracket. Even so, using retirement funds to pay taxes may make sense for those looking to convert large IRAs to reduce their future required minimum distributions (RMDs).

The timing of your Roth conversion matters too. Generally, it’s a good idea to convert when your income is lower—for example, after you’ve retired and before you begin drawing Social Security. You may also choose to convert over the course of several years to spread out the tax impacts. But if you can get comfortable with these considerations, a Roth conversion can provide you with benefits beyond tax-free growth and withdrawals.

Some of these benefits are:

Tax diversification. Having both traditional and Roth accounts allows you to manage your tax liability in retirement. For example, if your income in a given year is higher than expected, you can withdraw from the Roth IRA without increasing your taxable income.
No RMDs. Traditional IRAs and 401(k)s require you to begin taking RMDs at age 73. Roth IRAs have no RMD requirement during your lifetime. With a Roth account, you have more control over your retirement withdrawals and can leave the funds to grow for your heirs.
Benefits for heirs. Roth IRAs can be passed on to beneficiaries, who can inherit the account income tax-free. This means your heirs can enjoy the tax-free growth and withdrawals if the Roth IRA has been held for five years or more—a significant advantage, especially if your beneficiaries are in a higher tax bracket.

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Filed under: "Ask-an-Advisor", Accounting, Financial Planning, Funding Basics, Glossary Terms, Investing, Retirement and Benefits, Taxation | Tagged: 401(k), diversification, DO, doctor, DPM, Investing, IRA, MD, physician, retirement, retirement planning, RMDs, Roth, roth considerations, Roth Conversion, Roth IRA, social security, tax, tax bracket | Leave a comment »

FINANCIAL MODELING TERMS: All Physicians Should Review and Know

Posted on April 10, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Financial Modeling is one of the most highly valued, but thinly understood, skills in financial analysis. The objective of financial modeling is to combine accounting, finance, and business metrics to create a forecast of a company’s future results.

According to Jeff Schmidt, a financial model is simply a spreadsheet, usually built in Microsoft Excel, that forecasts a business’s financial performance into the future. The forecast is typically based on the company’s historical performance and assumptions about the future and requires preparing an income statement, balance sheet, cash flow statement, and supporting schedules (known as a three-statement model, one of many types of approaches to financial statement modeling). From there, more advanced types of models can be built such as discounted cash flow analysis (DCF model), leveraged buyout (LBO), mergers and acquisitions (M&A), and sensitivity analysis

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DEFINED TERMS

Discounted Cash Flow (DCF): A valuation method used to estimate the value of an investment based on its expected future cash flows, adjusted for the time value of money. It’s like deciding whether a treasure chest is worth diving for now, based on the gold coins you’ll be able to cash in later.

Sensitivity Analysis: This involves changing one variable at a time to see how it affects an outcome. Imagine tweaking your coffee-to-water ratio each morning to achieve the perfect brew strength.

Budget – A budget is the amount of money a department, function, or business can spend in a given period of time. Usually, but not always, finance does this annually for the upcoming year.

Rolling Forecast – A rolling forecast maintains a consistent view over a period of time (often 12 months). When one period closes, finance adds one more period to the forecast.

Topside – A topside adjustment is an overlay to a forecast. This is typically completed by the corporate or headquarter team. As individual teams submit a forecast, the consolidated result might not make sense or align with expectations. When this occurs, the high-level teams use a topside adjustment to streamline or adjust the consolidated view.

Monte Carlo Simulation: Picture yourself at the casino, but instead of gambling your savings away, you’re using this technique to predict different outcomes of your business decisions based on random variables. It’s like playing financial roulette with the odds in your favor.

What-If Analysis: Ever daydream about what would happen if you took that leap of faith with your business? This tool allows you to explore various scenarios without risking a dime. It’s like trying on outfits in a virtual dressing room before making a purchase.

Leveraged Buyout (LBO) Model: This is a bit like orchestrating a heist, but legally. It’s about acquiring a company using borrowed money, with plans to pay off the debts with the company’s own cash flows. High stakes, high rewards.

Mergers and Acquisitions (M&A) Model: Picture two puzzle pieces coming together. This model evaluates how combining companies can create a new, more valuable entity. It’s the corporate version of a matchmaker.

Three Statement Model: The holy trinity of financial modeling, linking the income statement, balance sheet, and cash flow statement. It’s like weaving a tapestry where each thread is crucial to the overall picture.

Capital Asset Pricing Model (CAPM): A formula that calculates the expected return on an investment, considering its risk compared to the market. It’s like choosing the best roller coaster in the park, balancing thrill and safety.

Cash Flow Forecasting: This is your financial weather forecast, predicting the cash flow climate of your business. It helps you plan for sunny days and save for the rainy ones.

Cost of Capital: The price of financing your business, whether through debt or equity. It’s like the interest rate on your growth engine, pushing you to maximize every dollar invested.

Debt Schedule: A timeline of your business’s debts, showing when and how much you owe. It’s your roadmap to becoming debt-free, one milestone at a time.

Equity Valuation: Determining the value of a company’s shares. It’s like assessing the worth of a rare gemstone, ensuring investors pay a fair price for a piece of the treasure.

Financial Leverage: Using debt to amplify returns on investment. It’s like using a lever to lift a heavy object, increasing force but also risk.

Forecast Model: A crystal ball for your finances, projecting future performance based on past and present data. It’s your guide through the financial wilderness, helping you navigate with confidence.

Operating Model: A detailed blueprint of how a business generates value, mapping out operational activities and their financial impact. It’s like laying out the inner workings of a clock, ensuring every gear turns smoothly.

Revenue Growth Model: This tracks potential increases in sales over time, charting a course for expansion. It’s like plotting your ascent up a mountain, anticipating the effort required to reach the summit.

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ACO REACH: A New Model

Posted on April 8, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

ACCOUNTABLE CARE ORGANIZATIONS

Realizing Equity, Access, and Community Health

By Staff Reporters

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Model Overview

The ACO REACH Model provides novel tools and resources for health care providers to work together in an ACO to improve the quality of care for people with Traditional Medicare. REACH ACOs are comprised of different types of providers, including primary and specialty care physicians.

The ACO REACH Model makes important changes to the previous Global and Professional Direct Contracting (GPDC) Model which include:

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Promote Provider Leadership and Governance. The ACO REACH Model includes policies to ensure doctors and other health care providers continue to play a primary role in accountable care. At least 75% control of each ACO’s governing body generally must be held by participating providers or their designated representatives, compared to 25% during the first two Performance Years of the GPDC Model. In addition, the ACO REACH Model goes beyond prior ACO initiatives by requiring at least two beneficiary advocates on the governing board (at least one Medicare beneficiary and at least one consumer advocate), both of whom must hold voting rights.
Protect Beneficiaries and the Model with More Participant Vetting, Monitoring and Greater Transparency. CMS will ask for additional information on applicants’ ownership, leadership, and governing board to gain better visibility into ownership interests and affiliations to ensure participants’ interests align with CMS’s vision. We will employ increased up-front screening of applicants, robust monitoring of participants, and greater transparency into the model’s progress during implementation, even before final evaluation results, and will share more information on the participants and their work to improve care. Last, CMS will also explore stronger protections against inappropriate coding and risk score growth.

MORE: https://www.cms.gov/priorities/innovation/innovation-models/aco-reach

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Filed under: "Doctors Only", Accounting, Ethics, Health Economics, Health Insurance, Healthcare Finance, Practice Management, Quality Initiatives | Tagged: Access, Accountable Care Organization, ACO, ACO Reach, CDC, CMS, Community Health, DO, DPM, equity, GDPC, Global and Professional Direct Contracting, health equity, MD, Reach Model, Technology | Leave a comment »

BLOGGING: All Doctors Please Beware!

Posted on April 5, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

WARNING – WARNING

By Dr. DavidEdwardMarcinko; MBA MEd

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According to www.NPR.org, there are more than120,000 health care forums on the Internet with opinions ranging from pharmaceuticals, to sexual dysfunction, to acne. The same goes for commercial doctor blogs that promote lotions, balms and potions, diets and vitamins, minerals, herbs, drinks and elixirs, or various other ingest-ants, digest-ants or pharmaceuticals, etc.

And, to other doctors, the blogging craze is a new novelty where there are no rules, protocols, standards or precise figures on how many “medical-doctor” or related physician-blogs are “out there.” Unfortunately, too many recount gory ER scenes, or pictorially illustrate horrific medical conditions, or serious and traumatic injuries. Of course, others simply are medical practice websites, or those that entice patients into more lucrative plastic surgery or concierge medical practices. Some are from self-serving/credible plaintiff-seeking attorneys wishing to assist patients.

Not all physician blogs are geared toward practice information, marketing or medical sensationalism. In fact, just the opposite seems to be the case in extremely candid blogs, like “Ranting Docs”, “White Coat Rants,” “Grunt Docs”, “Cancer Doc,” “The Happy Hospitalist,” “Mom MD”, “Cross-Over Health”, “Angry Docs” and “M.D.O.D.,” which bills itself as “Random Thoughts from a Few Cantankerous American Physicians.”

According to some of these, they are more like personal journals, or public diaries, where doctors vent about reimbursement rates, difficult cases, medical mistakes, declining medical prestige and control, and/or what a “bummer” it is to have so many patients die; not pay, or who are indigent, noncompliant. We call these the “disgruntled doctor sites.” Some even talk about their own patients, coding issues, or various doctor-patient shenanigans.

But, according to psychiatrist and blogger Dr. Deborah Peel and others, the problem with blogging about patients is the danger that one will be able to identify themselves – the doctor – or that others who know them will be able to identify them.” Her affiliation, Patient Privacy Rights, rightly worries that patients might track back to the individual, and adversely affect their employment, health insurance or other aspects of life.

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And, according to Dr. Jay S. Grife; MA Esq., it is certainly true that if a doctor violates a patient’s privacy there could be legal consequences. Under HIPAA, physicians could face fines or even jail time. In some states, patients can file a civil lawsuit if they believe a doctor has violated their privacy. Still, internet privacy issues are an evolving gray-area that if not wrong, may still be morally and ethically questionable [personal communication].

Our colleague Robert Wachter MD, author of the blog called “Wachter’s World,” says it’s important for doctors to be able to share cases, as long as they change the facts substantially. On the other hand, the author of “Wachter’s World” and a leading expert on patient safety alternately suggests “You might say we as doctors should never be talking about experiences with our patients online or in books or in articles.” But, he says that “patients shouldn’t take all the information on blogs at face value. Taken for what they are — unedited opinions, and in some cases entertainment — blogs can give readers some useful insight into the good, the bad and the ugly of the medical profession”. Link: http://www.the-hospitalist.org/blogs

Well, fair enough! But, doctors unhappy with their current medical career choice, or its modern evolution, should probably consider counseling or even career change guidance, re-education and re-engineering. It is very inappropriate to vent career frustrations in a public venue. It’s far better for the blog to be private and/or by invitation only; if at all [Personal communication].

We believe that a hybrid mash-up of both views can be wholly appropriate, or grossly inappropriate in some cases. Of course the devil is in the details; linguistics and semantics aside. Nevertheless; what is not addressed in electronic physician “mea-culpas” are the professional liability risks and concerns that are evolving in this quasi-professional, quasi-lay, communication forum.

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Example: We have seen medical mistakes, and liability admissions of all sorts, freely and glibly presented. In fact,

“Some physicians find that the act of liability blogging as a professional confession that is useful in moving past their malpractice mistakes. And, it is also a useful way to begin a commitment to a better professional life of caring in the future. It helps eliminate the toxic residue and angst of professional liability and guilt. Moreover, as they are unburdened of past acts of omission or commission, doctors should remember to also forgive those who have wronged them. This helps greatly with the process and brings additional peace.”

However, although some may say that this electronic confession is good for the soul, it may not be good for your professional liability carrier, or you, when plaintiff’s attorneys release a legion of IT focused interns, or automated bots, searching online for your self-admissions and scouring for your self-incriminations. Of course, a direct connection to a specific patient may still not be made and no HIPAA violation is involved. But, a vivid imagination is not need needed to envision this type of blind medical malpractice discovery deposition query even now.

QUESTION: “Doctor Smith, I noted all the medical errors admitted on your blog. What other mistakes did you make in the care and treatment of my client?”

And so, the question of plausible deniability, or culpability, is easily raised. If you must journalize your thoughts for sanity or stress release; do it in print. And, don’t tell anyone about it so the diary won’t be subpoenaed. Then tear it up and throw it away. Remember, with risk management, “It is all about credibility.” Don’t trash yours! These thoughts may be especially important if you covet a medical career as a researcher, editor, educator, medical expert or something other than a working-class or employed physician.

EDUCATION: Books

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Filed under: "Doctors Only", Experts Invited, Marcinko Associates, Marketing & Advertising, mental health, Op-Editorials, Risk Management | Tagged: Angry Docs, anxiety, blogging doctors, blogs, Cancer Doc, DO, doctors, Grunt Docs, Happy Hospitalist, health, healthcare, jay grife, Marcinko, MD, mental health, MOM MD, news, NPR, physicians, Risk Management, Robert Wachter | Leave a comment »

MEDICAL OFFICE: Patient Satisfaction Management

Posted on April 3, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

The “Soft Science” of Patient Relationship Management

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By Dr. David Edward Marcinko; MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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INTRODUCTION

Patient satisfaction occurs when patient perceptions exceed their expectations. They get an intangible “something extra” from their visit, above what they paid for. When patient expectations match their perceptions, mutual obligations are fulfilled, making both practitioner and patient “break-even”.

The clinical result, within a relevant range, is only part of the patient’s perceptions. Numerous sub-conscious impressions comprise the remainder. We’ve all had patients love us despite a less than optimal result. We’ve all had patients angrily leave the practice over some non-clinical matter like a trivial billing dispute. A patient’s perception of any health care service is colored by a vast array of prior experiences that set up current expectations. The patient is pleased to the extent that his current perceptions exceed his/her pre existing expectations. This encompasses far more than the clinical result (within a relevant range), and includes such non-treatment issues as the demeanor of the staff, condition of the physical premises, psychological comfort during the visit, etc.

Remember, all patients talk about you anyway. In the past, a happy patient told four others about what a nice doctor you are. Today, patients post website comments or blogs immediately after their visits. They are more likely to complete treatment and follow instructions, thus obtaining a better medical outcome, and, generating additional fees for the practice. They pay quicker, cause less bad-debt and help create a pleasant environment for us to work in.

An unhappy patient vehemently tells nine others, onground or online, what a nasty greedy rip-off artist you are. Sad, but true! They are not as likely to complete treatment, thus incurring a less than optimal result, and generate fewer fees. They pay slower, if at all, create a stressed environment and detrimentally affect the attitude of other patients in the office.

Try to eliminate problems that might cause negative perceptions (i.e., a filthy restroom) and implement controls that help assure positive perceptions. Patient satisfaction is a soft managerial science. It is a numbers game. Most patients don’t pre-define what would be “acceptable” from this encounter, but have vaguely defined ranges of prior expectations anyway, gleaned from a lifetime of health care related experience. Any variance between these this “acceptable” range of expectations and each trivial encounter invokes some degree positive or negative feeling in the patient.

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The total perception of the office experience is an aggregate of multiple trivial, often subliminal, observations. Patient satisfaction is an intangible and amorphous process complicated by:

 Inter patient variables: Significant differences between patients in their “expectations”.
 Intra patient variables: A single patient can perceive the same thing or situation differently at different times, depending on uncontrollable variables like mood, or, context of occurrence which may (sometimes and/or partially) be controllable by the practice.
 Luck of the draw” in physical variables: Does Sally or Mary escort the patient to the exam room? Was it the blue or green exam room? Did the last patient to use the rest room, five minutes ago, leave a disgusting mess?
 Heterogeneous staff variables: Even with appropriate training, people are not machines and have their own quirks.

ASSESSMENT

By proactively anticipating the entire visit, from the patient’s perspective, the practitioner can structure and arrange things such that most patients have, mostly positive perceptions, most of the time. This can be done despite all the potential hetero-genicity of the above factors. Patient satisfaction can be improved in any office, and can be done by anyone.

CONCLUSION

Because patient satisfaction is a multi-faceted amorphous subject, there are multiple correct approaches to the subject and no “cook book” recipe on how to proceed. Try and get the big picture. Identify the worst areas and fix them. Identify the best areas and reinforce them. Proceed slowly. It can be done one facet at a time. Adapt things to your own managerial style and personality. Be completely open to suggestion and change.

Finally, be aware that patient relationship and satisfaction implementation strategies frequently overlap.

EDUCATION: Books

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PHYSICIAN PAYMENT INCREASE: Excluded by Continuing Resolution

Posted on April 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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Continuing Resolution Excludes Physician Payment Increase Again

On March 15th, 2025, President Donald Trump signed a continuing resolution (CR) that avoided a government shutdown and funds the federal government for the rest of the fiscal year, i.e., through September 30th, 2025.

Perhaps more notable than what was included in the spending bill was what was once again excluded. While the COVID-era tele-health waivers were temporarily extended, Medicare physician payment rates were not addressed, meaning physicians will continue experiencing a 2.93% pay cut for 2025.

This Health Capital Topics article discusses the healthcare provisions included in and excluded from the CR, and the impacts on healthcare providers. (Read more…)

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HEDGE FUNDS: In Individual Retirement Accounts?

Posted on April 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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QUESTION: What is a Hedge Fund?

A hedge fund is a limited partnership of private investors whose money is pooled and managed by professional fund managers. These managers use a wide range of strategies, including leverage (borrowed money) and the trading of nontraditional assets, to earn above-average investment returns. A hedge fund investment is often considered a risky, alternative investment choice and usually requires a high minimum investment or net worth. Hedge funds typically target wealthy investors.

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SPONSOR: http://www.MARCINKOASSOCIATES.com

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QUESTION: Can I invest my Individual Retirement Account [IRA] in a Hedge Fund?

This is up to the manager, but there is no legal restriction on a hedge fund accepting individual retirement account (IRA) assets. IRA accounts are not well suited for funds that make extensive use of leverage, however. In such cases, the fund is likely to generate significant amounts of unrelated business taxable income (UBTI) – profits of the fund attributable to the use of leverage. The holder of an IRA account must pay taxes on UBTI, even if the UBTI was generated in an IRA account.

But, today’s hedge funds may or may not use leverage. Many hedge funds are not hedged at all, but rather are just specialized versions of regular long stock portfolios. If such funds do not use much leverage, IRA investors will not encounter much difficulty with UBTI and should not hesitate in considering these funds.

In considering whether to accept IRA money, hedge fund managers must consider several factors. If the only type of retirement money accepted by the hedge funds is IRA money, then the manager has no limit on how much retirement money the fund can accept. If, however, there are other types of retirement money invested in the fund, such as pension funds, IRA money will be counted towards a total of 25 percent of fund assets that can be invested in retirement accounts before the fund becomes subject to the Employment Retirement Income Security Act of 1974 (ERISA). Funds subject to ERISA regulations face a heavy administrative burden and more restrictions than most fund managers like.

Finally, IRA distributions from a hedge fund are subject to the standard 20 percent withholding unless the funds are directly rolled over to other qualified plans.

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Providing Physician Centric [Not Advisor Centric] Holistic Financial Planning Advice

Posted on March 30, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BY DR. DAVID EDWARD MARCINKO MBA MEd CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

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Selecting a Healthcare Focused Financial Advisory Team

Most retail financial services products are designed to enhance the well-being of the Financial Advisor and vendor at the expense of clients.

The clients get only the leftovers.

Of course, no one tells them that secret.

They have to figure it out for themselves.

As the old line goes, “Where are the customers’ boats?”

Rowland, M: Planning Periscope [Where Advisors are the Clients]. Financial Advisors Magazine; page 36, April 2014.

EDUCATION: Books

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CELEBRATE: National Physicians Week 2025

Posted on March 29, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

EDITOR-IN-CHIEF

By Dr. David Edward Marcinko; FACFAS MBA MEd

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NATIONAL PHYSICIANS WEEK

National Physicians Week sets out March 25-31 to honor the healers dedicated to the art of medicine. In 2017, National Physicians Week highlighted the shortage of physicians in the United States against a growing landscape of minorities joining the ranks.

#NationalPhysiciansWeek

“In hindsight, I am proud of what we have accomplished in a short period of time, including raising the recognition of our group and spotlighting the years of sacrifice by those in our profession to serve our patients. We are poised to initiate actionable efforts to engage and educate our physician community.”

Cite: Dr. Kimberly Funches Jackson, President

Today in 2025, let’s explore the invaluable contributions of physicians, celebrate their hard work during National Physicians Week, and highlight the essential role that locum doctors play in enhancing healthcare delivery.

A Week to Honor All Physicians

National Physicians Week is a celebration of the remarkable work that doctors do every single day. From diagnosing complex conditions to providing life-saving treatments, physicians dedicate themselves to improving the health and well-being of their patients. It’s a week for healthcare professionals, patients, and communities to come together and show appreciation for the doctors who make a difference in our lives.

Physicians work long hours, face immense pressure, and make critical decisions daily. Their contributions go beyond the walls of the hospital, as many are also involved in research, teaching, and community outreach.

So, this week, it’s important to acknowledge not only their professional expertise but also the compassion and resilience they exhibit in their work.

EDUCATION: Books

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PHYSICIAN NET WORTH: Versus Average Family

Posted on March 28, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd CMP®

SPONSOR: http://www.MarcinkoAssociates.com

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Average Net Worth of an American Family

Both median and average family net worth surged between 2019 and 2022, according to the U.S. Federal Reserve. Average net worth increased by 23% to $1,063,700, the Fed reported in October 2023, the most recent year it published the data. Median net worth, on the other hand, rose 37% over that same period to $192,900.

You might wonder why the average and median net worth figures are so different. That’s because when you take the average of something, you add together every value in a data set and then divide that figure by the number of individual values.

When calculating a median, you simply look at the middle figure within a data set. That said, an average figure can be significantly higher or lower than a median figure if there are extreme outliers – meaning a group of people with significantly more net worth than the rest of the group can bring the average higher.

Average Net Worth by Age

The average net worth of someone younger than 35 years old is $183,500, as of 2022. From there, average net worth steadily rises within each age bracket. Between 35 to 44, the average net worth is $549,600, while between 45 and 54, that number increases to $975,800. Average net worth surges above the $1 million mark between 55 to 64, reaching $1,566,900.

Average net worth again rises for those ages 65 to 74, to $1,794,600, before falling to $1,624,100 for the 75 and older group. The median net worth within every single age bracket, however, is much lower than the average net worth.

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Physicians [MD/DO] Net Worth by Specialty

A 2023 Medscape report shows the top 10 specialties with the most survey respondents saying they are worth more than $5 million.

Plastic Surgery (31% of all survey respondents)
Orthopedics (28%)
Gastroenterology (25%)
Urology (23%)
Cardiology (22%)
Ophthalmology (18%)
Radiology (17%)
Oncology (17%)
Pathology (14%)
Ob/Gyn (14%)

EDUCATION: Books

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MEDICAL OFFICE: Practice Embezzlement Schemes

Posted on March 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DR. DAVID EDWARD MARCINKO; MBA MEd CMP®

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SPONSOR: http://www.MarcinkoAssociates.com

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Without proper internal accounting controls, a medical practice [MD, DO, DPM, DDS, DMD] might never reach peak profitability. Internal controls designed and implemented by the physician-owner help prevent bad things from happening.

Embezzlement protection is the classic example. However, internal controls also help ensure good things happen most of the time; according to colleague Dr. Gary Bode; MSA, CPA.

Some Common Embezzlement “Old School” Schemes

Here are some ‘old-school” embezzlement schemes to avoid; however the list is imaginative and endless.

The physician-owner pocketing cash “off the books”. To the IRS, this is like embezzlement to intentionally defraud it out of tax money.

Employee’s pocketing cash from cash transactions. This is why you see cashiers following protocol that seems to take forever when you’re in the grocery check out line. This is also why you see signs offering a reward if he/she is not offered a receipt. This is partly why security cameras are installed.

Bookkeepers writing checks to themselves. This is easiest to do in flexible software programs like QuickBooks, Peachtree Accounting and related financial software. It is one of the hardest schemes to detect. The bookkeeper self-writes and cashes the check to their own name; and then the name on the check is changed in the software program to a vendor’s name. So a real check exists which looks legitimate on checking statements unless a picture of it is available.

Employees ordering personal items on practice credit cards.

Bookkeepers receiving patient checks and illegally depositing them in an unauthorized, pseudo practice checking account, set up by themselves in a bank different from yours. They then withdraw funds at will. If this scheme uses only a few patients, who are billed outside of the practice’s accounting software it is hard to detect. The doctor must have a good knowledge of existing patients to catch the ones “missing” from practice records. Monitoring the bookkeeper’s lifestyle might raise suspicion, but this scheme is generally low profile and protracted. Checking the accounting software “audit trail” shows the required original invoice deletions or credit memos in a less sophisticated version of this scheme.

Bookkeepers writing payroll checks to non-existent employees. This scheme works well in larger practices and medical clinics with high seasonal turnover of employees, and practices with multiple locations the podiatrist-owner doesn’t visit often.

Bookkeepers writing inflated checks to existing employees, vendors or subcontractors. Physician-owners should beware if romantic relationships between the bookkeeper and other practice related parties.

Bookkeepers writing checks to false vendors. This is another low profile, protracted scheme that exploits the podiatrists-owner’s indifference to accounts payable.

Assessment

Operating efficiency, safeguarding assets, compliance with existing laws and accuracy of financial transactions are common goals of internal managerial and cost accounting in medical practice.

CONCLUSION

Hopefully, the above is a good review to prevent common practice embezzlement schemes. Unfortunately, it is a never-ending endeavor.

References: Marcinko, DE: Dictionary of Health Economics and Finance. Springer Publishing Company, NY 2007.

Related Textbooks: https://tinyurl.com/579rex23

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FINANCIAL ADVISORS & MEDICAL MANAGEMENT CONSULTANTS: Marcinko & Associates, Inc

Posted on March 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

D. E. Marcinko & Associates Core Operating Values

9. We act with honesty, integrity and are always straightforward.
8. We strive to be innovative, creative, iconoclastic, and flexible.
7. We admit and learn from mistakes and don’t repeat them.
6. We work hard always as competitors are trying to catch up.
5. We treat others with dignity and respect.
4. We are the onus of consulting advice for the well being of others.
3. We fight complacency as former success is in the past.
2. The best management styles are timeless, not timely.
1. Our clients are colleagues and always come first.

EDUCATION: Books

SPEAKING: Dr. David Edward Marcinko MBA MEd will be speaking and lecturing, signing and opining, teaching and preaching, storming and performing at many locations throughout the USA this year! His tour of witty and serious pontifications may be scheduled on a planned or ad-hoc basis; for public or private meetings and gatherings; formally, informally, or over lunch or dinner. All medical societies, financial advisory firms or Broker-Dealers are encouraged to submit a RFP for speaking engagements.

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CONTACT: Ann Miller RN MHA at: MarcinkoAdvisors@outlook.com

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PROSPECT THEORY: Physician-Client Empowerment for Financial Decision Making

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

BEHAVIORAL ECONOMICS

By Staff Reporters

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Prospect theory is a psychological and behavioral economics theory developed by Daniel Kahneman and Amos Tversky in 1979. It explains how people make decisions when faced with alternatives involving risk, probability, and uncertainty. According to this theory, decisions are influenced by perceived losses or gains.

Example:

Amanda, a DO client, was just informed by her financial advisor that she needed to re-launch her 403-b retirement plan. Since she was leery about investing, she quietly wondered why she couldn’t DIY. Little does her FA know that she doesn’t intend to follow his advice, anyway! So, what went wrong?

The answer may be that her advisor didn’t deploy a behavioral economics framework to support her decision-making. One such framework is the “prospect theory” model that boils client decision-making into a “three step heuristic.”

Prospect theory makes the unspoken biases that we all have more explicit. By identifying all the background assumptions and preferences that clients [patients] bring to the office, decision-making can be crafted so that everyone [family, doctor and patient] or [FA, client and spouse] is on the same page. Briefly, the three steps are:

1. Simplify choices by focusing on the key differences between investment [treatment] options such as stock, bonds, cash, and index funds.

2. Understanding that clients [patients] prefer greater certainty when it comes to pursuing financial [health] gains and are willing to accept uncertainty when trying to avoid a loss [illness].

3. Cognitive processes lead clients and patients to overestimate the value of their choices thanks to survivor bias, cognitive dissonance, appeals to authority and hindsight biases.

Assessment

Much like healthcare today, the current mass-customized approaches to the financial services industry falls short of recognizing more personalized advisory approaches like prospect theory and assisted client-centered investment decision-making.

Jaan E. Sidorov MD [Harrisburg, PA]

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STUPID COMMENTS: Financial Advisors Say to Physician Clients

Posted on March 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

BY DR. DAVID EDWARD MARCINKO; MBA MEd CMP®

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SPONSOR: http://www.MarcinkoAssociates.com

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Some Stupid Things Financial Advisors Say to Physician Clients

A few years ago and just for giggles, colleague Lon Jefferies MBA CFP® and I collected a list of dumb-stupid things said by some Financial Advisors to their doctor, dentist, nurse and and other medical professional clients, along with some recommended under-breath rejoinders:

“They don’t have any debt except for a mortgage and student loans.” OK. And I’m vegan except for bacon-wrapped steak.

“Earnings were positive before one-time charges.” This is Wall Street’s equivalent of, “Other than that Mrs. Lincoln; how was the play?”

“Earnings missed estimates.” No. Earnings don’t miss estimates; estimates miss earnings. No one ever says “the weather missed estimates.” They blame the weatherman for getting it wrong. Finance is the only industry where people blame their poor forecasting skills on reality.

“Earnings met expectations, but analysts were looking for a beat.” If you’re expecting earnings to beat expectations, you don’t know what the word “expectations” means.

“It’s a Ponzi scheme.” The number of things called Ponzi schemes that are actually Ponzi schemes rounds to zero. It’s become a synonym for “thing I disagree with.”

“The [thing not going perfectly] crisis.” Boy who cried wolf, meet analyst who called crisis.

“He predicted the market crash in 2008.” He also predicted a crash in 2006, 2004, 2003, 2001, 1998, 1997, 1995, 1992, 1989, 1984, 1971…

“More buyers than sellers.” This is the equivalent of saying someone has more mothers than fathers. There’s one buyer and one seller for every trade. Every single one.

“Stocks suffer their biggest drop since September.” You know September was only six weeks ago, right?

“We’re cautiously optimistic.” You’re also an oxymoron.

[Guy on TV]: “It’s time to [buy/sell] stocks.” Who is this advice for? A 20-year-old with 60 years of investing in front of him, or a 82-year-old widow who needs money for a nursing home? Doesn’t that make a difference?

“We’re neutral on this stock.” Stop it. You don’t deserve a paycheck for that.

“There’s minimal downside on this stock.” Some lessons have to be learned the hard way.

“We’re trying to maximize returns and minimize risks.” Unlike everyone else, who are just dying to set their money ablaze!

“Shares fell after the company lowered guidance.” Guys, they just proved their guidance can be wrong. Why are you taking this new one seriously?

“Our bullish case is conservative.” Then it’s not a bullish case. It’s a conservative case. Those words mean opposite things.

“We look where others don’t.” This is said by so many investors that it has to be untrue most of the time.

“Is [X] the next black swan?” Nassim Taleb’s blood pressure rises every time someone says this. You can’t predict black swans. That’s what makes them dangerous.

“We’re waiting for more certainty.” Good call. Like in 1929, 1999 and 2007, when everyone knew exactly what the future looked like. Can’t wait!

“The Dow is down 50 points as investors react to news of [X].” Stop it – you’re just making stuff up. “Stocks are down and no one knows why” is the only honest headline in this category.

“Investment guru [insert name] says stocks are [insert forecast].” Go to Morningstar.com. Look up that guru’s track record against their benchmark. More often than not, their career performance lags an index fund. Stop calling them gurus.

“We’re constructive on the market.” I have no idea what that means. I don’t think you do, either.

“[Noun] [verb] bubble.” (That’s a sarcastic observation from investor Eddy Elfenbein.)

“Investors are fleeing the market.” Every stock is owned by someone all the time.

“We expect more volatility.” There has never been a time when this was not the case. Let me guess, you also expect more winters?

“This is a strong buy.” What do I do with this? Click the mouse harder when placing the order in my brokerage account?

“He was tired of throwing his money away renting, so he bought a house.” He knows a mortgage is renting money from a bank, right?

“This is a cyclical bull market in a secular bear.” Vapid nonsense.

“Will Obamacare ruin the economy?” No. And get a grip.

So, don’t let these aphorisms blind you to the critical thinking skills you learned in college, honed in medical school and apply every day in life.

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EDUCATION: Books

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A NEW NORM: Revising Financial Planning Principles for Physicians?

Posted on March 1, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DR. DAVID EDWARD MARCINKO; MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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In 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked academe’ by identifying health economics as a separate and distinct field. Yet, the seemingly disparate insurance, tax, risk management and financial planning principles that he also studied are just now becoming transparent to some medical professionals and their financial advisors. Despite the fact that a basic, but hardly promoted premise of this new wave financial planning era, is imprecision.

More: https://medicalexecutivepost.com/2024/11/09/arrow-information-paradox/

Nevertheless, to informed cognoscenti like Certified Medical Planners™, the principles served as predecessors to the modern physician-focused financial advisory niche sector. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views.

More: http://www.CertifiedMedicalPlanner.org

And now, as a long bull market may be over, and if the current “new-normal” prevails – meaning a 4.5% real annualized rate of return on equities and a 1.5% real rate on bonds – wealth accumulation for all may be reduced.

An Imprecise Science

There is a major variable, dominant in any marketplace that pushes an economy in a forward direction. It is called consumerism. This became apparent while waiting in a doctor’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, who 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 system.

Assessment

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.

Conclusion

Finally, as women medical professionals entered the workforce in unprecedented numbers, the stock markets reached an all time high in 2025, even as money was spent at a feverish pace as the Federal Reserve pumped out money in inflammatory fashion.

EDUCATION: Books

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DOCTORATE: Physical Therapy

Posted on February 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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A Doctor of Physical Therapy (DPT) helps people improve their mobility and physical functioning, manage pain, and prevent disability. After earning an undergraduate degree, a person can enroll in a DPT program, which is typically three years. The curriculum includes courses in biology, anatomy, physiology, kinesiology (movement), neurology, cardiopulmonary (heart and lung) rehabilitation, behavioral sciences, and pharmacology.

Clinical rotations are a major component of DPT education. They may perform clinical rotations in various settings including a PT clinic, hospital, nursing care facility, rehabilitation clinic, and school. At the end of their coursework and clinical rotation, a student earns a DPT degree but still must pass a state licensure exam to practice as a physical therapist.2

On average, a DPT in the U.S. makes $105,710 per year, according to 2024 statistics.

While a DPT may use the title “Dr,” they are different from an MD/DO/DPM/DDS. A DPT cannot write prescriptions or perform surgery. A DPT is also different from a PhD (Doctor of Philosophy). DPT is treatment-focused, whereas the PhD is research-focused.

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NEWEST THOUGHTS: Physician Personal Emergency Fund Size is Getting Complicated

Posted on February 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.MarcinkoAssociates.com

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By Dr. David Edward Marcinko MBA MEd

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It has been said that most ordinary people should have at least three to six months of living expenses (not including taxes) in a cash-equivalent reserve fund that is easily accessible (i.e., liquid). The amount needed for a one-month reserve is equal to the amount of expenses for the month, rather than the amount of monthly income. This is because during no-income months there is no income tax.

However, the situation might not be the same for physicians in today’s harsh economic climate.

The New Realities

Now, some physician-focused financial advisors, financial planners and Certified Medical Planners™ suggest even more reserve fund savings; up to two years. That’s because many factors come into play when determining how much a particular doctor’s family should have.

For example:

Does the family have one income or two? If the doctor is in a dual-income family with stable incomes and they live on a single income, the need for a liquid reserve is less.
How stable is the doctor’s income source? If a sole provider with an unstable income who spends all of the income each month, the need for a liquid cash reserve is high.
Does the doctor own the practice, work in a clinic, medical group, hospital or healthcare system? In other words – employee (less control) or employer (more control).
What is the doctor’s medical specialty and how has managed care penetrated his locale, or affected her focus? What about a DO, DDS/DMD or DPM, etc.
How does the family use its income each month; does it have a saver, spender, or investor mentality?
Does the family anticipate the possibility of large expenses occurring in the future (medical practice start-up costs or practice purchase; children, medical school student debts; auto or home loans; and/or liability suits, etc)?
Pan physician lifestyle?

The Past

In the ancient past, a doctor may have opted for a nine-twelve month reserve if the need for security was high – and a six-to-nine month reserve if the need for security was low. But today, even more may be needed. How about 15-18 months, or more? Perhaps even 24 months!

So, the following questions may be helpful in determining the amount of reserve needed by the physician:

1. How long would it take you to find another job in your medical specialty if you suddenly found yourself unemployed – same for your spouse?

2. Would you have to relocate – same for your spouse?

3. How much do you spend each month on fixed or discretionary expenses and would you be willing to lower your monthly expenses if you were unemployed?

Assessment

Once the amount of reserve is determined, the doctor should use the appropriate investment vehicles for the funds.

At minimum, the reserve should be invested in a money market fund. For larger reserves, an ultra-short-term bond fund might be appropriate for amounts over three-six months. While even larger reserves might be kept in a short term bond fund depending on interest rates and trends.

So, what do the initials M.D. really mean? … More Dough!

How much reserve do you have and where is it stashed?

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EDUCATION: Books

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HEALTH ECONOMICS: Who Should Study and Learn this Dismal Science?

Posted on February 21, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DR. DAVID EDWARD MARCINKO MBA MEd CPHQ CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Who should study health economics?

Understanding how economic behavior factors into health and health care decisions can benefit anyone interested in this field. However, the following groups of individuals may benefit most from the study of health economics:

Medical providers: Doctors, nurses, and assistants can evaluate new treatments, technologies, and services to determine ways to deliver value-based care. Medical providers benefit from understanding the economics behind these developments [MD/DO, DPM, DDS/DMD, RN, PA, etc].

Administrators: Health care administrators process insurance co-payments and manage financial metrics for health care providers. Learning the intricacies of health care economics can provide the necessary context as they liaise with insurance providers and use new technologies to process payments.

Policymakers or public health officials: Those who are in charge of policy decisions at the local, state, federal, or international levels benefit from understanding the economic relationship between stakeholders and the general public.

Business leaders: Because many Americans receive private insurance, health care becomes a major expense for employers. Business leaders must understand the health economics outlook to appease their employees, shareholders, and even their customers.

EDUCATION: Books

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OPTOMETRY Doctor [OD]

Posted on February 19, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Optometry Doctor [OD]: An optometrist has an Optometry Doctor (OD) degree and can assess overall eye health and the quality of a person’s vision through a comprehensive examination. They diagnose and treat many eye disorders that do not require surgery or further specialized care. An optometrist can also identify symptoms of other health conditions that may affect the eyes, such as diabetes. Some also specialize in a field like pediatric care.

Optometrists [OD] and ophthalmologists [MD/DO] are both eye doctors, but they have different types of training and areas of expertise. If you need an eye exam—and think you may need glasses or contact lenses—an optometrist is a good first choice. To become an optometrist, a person needs to complete four years of additional education after a bachelor’s degree. Sometimes they complete a residency as well.

Now, ODs are licensed doctors and can prescribe medication. However, optometrists have a defined scope of practice that that revolves largely around the eyes. Optometrists can not prescribe all the same medications that your family doctor or ophthalmologist can.

So, if your eye issue requires surgery, or for specific conditions related to your eyes or overall health, you’ll want to visit an ophthalmologist [MD/DO].

On average, an optometrist in the U.S. makes about $131,860 per year, according to 2023 statistics.

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LMU: Doctor of Medical Science [DMS] Degree?

Posted on February 18, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

LEGIT or NOT?

By Staff Reporters

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A new pathway will result in a degree called the “Doctor of Medical Science” (DMS); this training is designed for someone—not a physician—to practice clinical medicine with all of the privileges afforded to a medical doctor in the discipline of primary care.

Lincoln Memorial University (LMU) recently announced the start of this new program. In a recent press release they stated, “Lincoln Memorial University is pleased to announce a new type of medical training with its launch of the brand new Doctor of Medical Science (DMS) degree. The only one of its kind, this program bridges the gaps between physician and physician assistant (PA) training for the development of a new type of doctoral trained provider to aid Appalacia and other health care shortage areas.”

The DMS will be for Physician Assistants who have at least three years experience in clinical practice. The curriculum will be a two year program and will consist of 50 credits. The first year will have online didactics delivered by clinical and PhD specialists on staff at LMU-DeBusk College of Osteopathic Medicine and other teaching hospitals. The second year will be more online didactics specific to a clinical specialty.

LMU has already received approval for this program from the Southern Association of Colleges and Schools Commission on Colleges.

Cite: https://www.huffpost.com/entry/the-doctor-of-medical-science_b_593ef537e4b094fa859f1af3

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PharmD: Doctor of Pharmacy

Posted on February 12, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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PharmD – Doctor of Pharmacy

A Doctor of Pharmacy [ParrmD] is the professional degree required to become a pharmacist in the US. Practicing pharmacists complete an average of six years in school—including their pre-pharmacy education—before passing required exams and completing post-graduate training.

Here’s where things often get confusing. The word “pharmacist” is sometimes used in casual conversation to refer to healthcare professionals who aren’t technically licensed to be pharmacists.

For example, pharmacy technicians assist licensed pharmacists. They work behind the counter among the medications right alongside the pharmacist. However, they don’t need a Doctor of Pharmacy to do their job. A pharmaceutical sales representative typically needs four years of a bachelor’s degree with a foundation in chemistry and biology, though this is not always a requirement. Neither of these professionals is technically a pharmacist, although laypeople may mistakenly describe them that way.

And pursuing a PharmD doesn’t always mean you’ll work in a community pharmacy. In fact, just slightly fewer than half of all PharmD recipients end up in this role. Another 15 percent practice in other healthcare settings—hospitals, nursing homes, and managed care centers, for example. Other pharmacy students pursue research roles, government regulation positions, or work in highly specialized areas like oncology or geriatric pharmacy.

A PharmD or RPH [registered pharmacist] fills the electronic or written prescriptions of a MD/DO/DPM/DDS/DMD. They generally can not prescribe drugs or write prescriptions, however.

As of February 01, 2025, the average annual pay of Doctor of Pharmacy in the United States was $196,904. While Salary.com suggests that a Doctor of Pharmacy salary in the US can go up to $236,908 or down to $149,197, most earn between $171,932 and $217,844.

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FLEXNER REPORT: Medical Education

Posted on February 4, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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According to Wikipedia, the Flexner Report was a book-length landmark report of medical education in the United States and Canada, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation. Flexner not only described the state of medical education in North America, but he also gave detailed descriptions of the medical schools that were operating at the time. He provided both criticisms and recommendations for improvements of medical education in the United States.

Many aspects of the present-day American medical profession stem from the Flexner Report and its aftermath. While it had many positive impacts on American medical education, the Flexner report has been criticized for introducing policies that encouraged systemic racism and sexism.

The Report, also called Carnegie Foundation Bulletin Number Four, called on American medical schools to enact higher admission and graduation standards, and to adhere strictly to the protocols of mainstream science principles in their teaching and research. The report talked about the need for revamping and centralizing medical institutions. Many American medical schools fell short of the standard advocated in the Flexner Report and, subsequent to its publication, nearly half of such schools merged or were closed outright.

Colleges for the education of the various forms of alternative medicine, such as electro-therapy were closed. Homeopathy, traditional osteopathy, eclectic medicine, and physiomedicalism (botanical therapies that had not been tested scientifically) were derided.

The Report also concluded that there were too many medical schools in the United States, and that too many doctors were being trained. A repercussion of the Flexner Report, resulting from the closure or consolidation of university training, was the closure of all but two black medical schools and the reversion of American universities to male-only admittance programs to accommodate a smaller admission pool.

In Chapter 11, Flexner stressed that the success of medical education reform and the professionalization of medicine relied heavily on the effective legal and ethical functioning of state medical boards. However, he noted that these boards were failing in their mission, stalling progress and allowing substandard medical practices to continue, thereby jeopardizing public health. This problem persists as a significant issue in the current practice of medicine in the United States.

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COUNTDOWN: To End of Year BOI Reporting?

Posted on December 5, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Beneficial Ownership Information

By Staff Reporters

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Small business owners face severe penalties if they don’t report to the federal government by year’s end. And, thousands of businesses may not realize they are subject to a new reporting process mandated under the Corporate Transparency Act, which went into effect in January 2024. Even lawyers, doctors, financial advisors and accountants are affected; along with “mom and pop”business owners.

For most eligible businesses, the filing deadline is Jan. 1, 2025, according to the U.S. Chamber of Commerce. “Those who fail to file by this deadline — or fail to update this information if needed — could face up to two years imprisonment and fines up to $10,000, in addition to civil penalties of up to $591 per day,” the U.S. Chamber of Commerce website reads.

Businesses that meet the reporting criteria must submit a Beneficial Ownership Information Report to the U.S. Department of Treasury’s Financial Crimes Enforcement Network (FinCEN), according to the U.S. Chamber of Commerce.

The law was created “to combat illicit activity including tax fraud, money laundering and financing for terrorism by capturing more ownership information for specific U.S. businesses operating in or accessing the country’s market,” the chamber website explained.

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A federal court has ruled that the beneficial ownership information (BOI) reporting requirements established by the Corporate Transparency Act (CTA) are unconstitutional¹ ² ³. The decision is currently under appeal¹.

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Understanding Traditional “Full-Service” Stock Brokers

Posted on September 4, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

Fundamentals of Physician Investing

By Daniel B. Moisand CFP®, and ME-P staff

It used to be that the only way to get investments and investment information was through paying commissions to a traditional broker. Then in the 70’s (specifically, May, 1975) the brokerage industry went through significant deregulation allowing for the discounting of commissions. Charles Schwab and Company, among others, was able to eliminate the advice component and offer trades at dramatically reduced rates. The full service brokerage business responded by emphasizing the scope of their services namely research and advice in order to compete. The demand for both has continued to grow, even though research information is now readily available through many sources. These brokerage firms continue to thrive despite their poor performance in analyzing tech stocks and the Enron and Global Grossing debacles. More recent debacles in 2008-09, the flash crash a decade ago and more recent developments are legion, as well.

Fundamental Flaws

The fundamental flaw with these firms is the array of conflicts of interest between the firm and its customers. While the incentive to trade has been well chronicled as a conflict, these firms have not let consumer’s demand for a better-aligned compensation arrangement go unnoticed. Fee-based account relationships have proliferated accordingly. In theory, this type of arrangement, usually a percentage of assets, gives an incentive for performance and service rather than trade activity. This certainly has merit. However, conflicts remain that should be considered.

Pay to Play

The practice of paying brokers, higher levels of compensation for in-house products was commonplace. Today, explicitly higher payouts still exist but are less common. Instead, many firms use the sale of proprietary mutual funds and other products as part of management’s compensation. Other forms of non-monetary compensation such as a better office can be used as incentive for the brokers. The greater profitability of these in-house offerings will keep this conflict around for some time.

Subtle Conflicts of Interest

Less obvious is the conflict between the investment banking arm, the research department, and the retail brokerage operations of a firm. Even firms with no proprietary funds to sell may grapple with this issue. Here, research is pressured to say favorable things about a particular company’s stock by the investment bankers in hopes of obtaining more of that company’s business. When a firm brings a company public odds are great that a “strong buy” rating will come with the IPO. Of course, the lesson remains – consider the source.

Assessment

Traditional brokers have a somewhat higher standard of accountability than the on-line firms as to their accountability. If you buy the stock of a company that goes bankrupt through an on-line broker you have little recourse. After all, that was your choice. If a full-service broker recommended the stock to you, that broker will have to defend the recommendation.

Conclusion

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

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

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PODCAST: How to Select a Physician?

Posted on May 27, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Eric Bricker MD

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Is a Podiatrist …. A Physician?

Posted on March 20, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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MD versus DO: https://medicalexecutivepost.com/2023/06/17/the-md-versus-do-degree/

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Almost every medical profession has its fair share of grossness and unbelievable moments. But, when it comes to podiatrists, you could argue that they have it extra bad for the simple reason that they specialize in feet. Most people would probably agree feet can be one of the human body’s most disgusting parts. People often neglect or ignore their feet, which can suffer badly from some common diseases and become a hotbed for unsanitary practices.

But, is a podiatrist really a physician?

You bet! Now, while the American Podiatric Medical Association [APMA] defines Doctor of Podiatric Medicine, or podiatrist, as “a physician and surgeon of the foot and ankle,” the The Social Security Administration’s Program Operations Manual System (POMS) legally defines a podiatrist as the following:

A podiatrist is a “physician” with respect to those functions which the podiatrist is legally authorized to perform in the State in which the individual performs them. Furthermore, the POMS states: A podiatrist is considered a “physician” for any of the following purposes: 1. for making the required physician certification and re-certifications of the medical necessity for Part A and Part B provider services. 2. for the purpose of establishing and periodically reviewing a home health plan of treatment; and for purposes of constituting a member of a Utilization Review (UR) committee but only if: a. the performance of these functions is consistent with the policy of the institution or agency with respect to which the podiatrist performs them; b. the podiatrist is legally authorized by the State to perform such functions; and c. at least two of the physicians on the Utilization Review committee are doctors of medicine or osteopathy.

In the United States, podiatrists are educated and licensed as Doctors of Podiatric Medicine (DPM). After a 4-year bachelor’s degree, the preparatory education of most podiatric physicians — similar to the paths of traditional physicians (MD or DO) — includes four years of undergraduate work, followed by four years in an accredited podiatric medical school, followed by a three or four year hospital-based residency program.

Optional one to two-year fellowships in foot and ankle reconstruction, surgical limb salvage, sports medicine, plastic surgery, pediatric foot and ankle surgery, and wound care is also available. Podiatric medical residencies and/ or fellowships are accredited by the Council on Podiatric Medical Education (CPME). The overall scope of podiatric practice varies from state to state with a common focus on foot and ankle surgery. Podiatrists work in hospitals, private practices and clinics, university medical centers and/or specialized practices.

Generally podiatrists can:

Perform physical examinations and study medical histories
Order and interpret X-rays and also other imaging studies like MRIs, and CAT scans.
Giving podiatric advice, second opinions and diagnosis
Administer drugs, narcotics, anesthetics and also sedation
Perform surgery related to the foot, ankle and legs
Perform plastic, macro and micro-surgeries and reconstructive bone surgeries
Prescribe medications such as narcotic pain killers, sleep aides and antibiotics
Perform certain physical and occupational therapies
Be on hospital staffs and take Emergency Room hospital call
Be on health insurance plans for covered physicians and medical providers
Prescribe, order, and fit prosthetics, casts, insoles, and orthotic devices
Attest to physical disability, write a doctor’s medical, treatment or absentee note, etc

In fact, the American Board of Podiatric Medicine [ABPM] offers a comprehensive qualification and certification process in podiatric medicine and orthopedics. Sub-specialties of podiatry include:

General podiatry
Podiatric reconstructive surgery
Podiatric medicine
Podiatric orthopedics
Podiatric sports medicine
Podiatric high-risk wound care
Podiatric rheumatology
Podiatric oncology
Podiatric vascular medicine
Podiatric dermatology
Podiatric radiology
Podiatric gerontology
Podiatric diabetology (limb salvage)
Podiatric pediatrics
Forensic podiatry,
etc.

MD/DO: https://medicalexecutivepost.com/2023/06/17/the-md-versus-do-degree/

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The MD versus DO Degree

Posted on June 17, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

Battle of the Allopathic Vs. Osteopathic Physicians

By Dr. David Edward Marcinko MBA

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What’s the difference between an MD and a DO?

An MD is a Doctor of Medicine, while a DO is a Doctor of Osteopathic Medicine. The bottom line? They do the same job, have similar schooling, can prescribe medication and can practice all over the U.S.

“In general, DOs practice a more holistic, whole-person type of care,” explains Dr. Vyas. “MDs take a more allopathic, or illness-based, approach.”

Allopathic and osteopathic medicine differ in several ways:

Allopathic medicine uses medication, surgery and other interventions to treat illnesses.
Osteopathic medicine emphasizes the relationship between the mind, body and spirit. It focuses on treating the person as a whole and improving wellness through education and prevention. DOs also receive extra training in osteopathic manipulative medicine (OMM), a hands-on method for diagnosing and treating patients.

But these philosophical differences don’t necessarily define the way DOs and MDs practice medicine. For example, DOs use all types of modern medical treatments, and MDs provide whole-person and preventive care.

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What’s in a Medical Degree?

Allopathic and Osteopathic medical schools have similar curriculum structures. Students spend 12–24 months of their program in the classroom and then continue training in clinical settings, according to the American Medical Association (AMA).

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RELATED: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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MARCH: National Save Your Vision Month 2023

Posted on March 25, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Eye doctors can track changes in your vision, as well as detect abnormalities in the retinas and lenses of the eyeball. If your eyes are reddened and itchy and the issue is not resolved with over-the-counter eye drops, make sure you see a doctor to eliminate the possibility of an eye infection.

VISION RULE: Here’s your reminder to practice the 20-20-20 rule: Every 20 minutes, take a 20-second break from your screen and look at something 20 feet away.

MORE: https://www.iabhp.com/national-wellness-observance-calendar/save-your-vision-month/

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PHYSICIANS: “Aging Out”

Posted on March 22, 2023 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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According to HealthcareBrew, thousands of doctors are expected to reach retirement age in the next three years, and their replacements won’t be physicians. Instead, physician assistants (PAs) and nurse practitioners (NPs) will increasingly provide primary care services, according to a report from consulting firm Mercer.

By 2026, 21% of family medicine, pediatric, and obstetrics and gynecology physicians—or about 32,000 doctors—will be 65 or older, and Mercer anticipates about 23,000 physicians will leave the profession permanently. At the same time, demand for primary care physicians is expected to grow 4%, the report found.

PAs and NPs—also called advanced practice providers (APPs) or physician extenders—are highly trained medical professionals. To become a PA, you have to have both a bachelor’s and a master’s, some clinical work experience, pass the Physician Assistant National Certifying Exam, and then apply to get licensed in your state (you know, easy peasy). It takes seven to nine years to go through that process, compared to 11+ years to become an MD.

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

To become an NP, you must have both a bachelor’s and a master’s in nursing, become a registered nurse, and pass a national NP board certification exam. It takes between six to eight years to become an NP.

Compared to physicians, PAs and NPs are “considerably younger professions with less than half the retirement risk,” the Mercer report stated. Roughly 40,000 PAs and NPs join the workforce annually.

“We’re certainly going to see increasing demand for APPs,” David Mitchell, a partner in Mercer’s career consulting business and a specialist in the healthcare industry, told Healthcare Brew.

While most state licensing boards require a physician to oversee APPs, both PAs and NPs have the authority to do many services primary care physicians do, like seeing and diagnosing patients, ordering lab tests, and writing prescriptions, said Mitchell.

READ HERE: https://www.healthcare-brew.com/stories/2023/03/16/non-mds-will-provide-primary-care?cid=30859907.17846&mid=349b552221c994e2540a304649746d7c&utm_campaign=hcb&utm_medium=newsletter&utm_source=morning_brew

MORE: https://www.aamc.org/data-reports/data/2022-physician-specialty-data-report-executive-summary

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PODCAST: Medical Billing Charge Abuse by Radiologists

Posted on November 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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NUMBER of Physicians in the USA

Posted on April 19, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and US Census Bureau

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Physicians in The U.S.A. in 2019

• Emergency medicine physicians: 13,741
• Radiologists: 19,421
• Other Physicians: 698,316
• Surgeons: 48,495
• Physician assistants: 107,710
• Podiatrists: 7,568
• Audiologists: 14,517

Source: U.S. Census Bureau, March 2022

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PODCAST: Physician Specialties

Posted on December 1, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

40 DOCTOR SPECIALTIES

BY ERIC BRICKER MD

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Happy National Osteopathic Medicine Week 2020

Posted on April 25, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

My Fond Memories

By Dr. David E. Marcinko MBA

National Osteopathic Medicine Week takes place April 19-25, 2020. It is a special time where the osteopathic medicine profession comes together to help educate the world about what osteopathic medicine is.

At first glance, the difference between DOs and MDs is difficult to distinguish. They’re both fully licensed physicians, trained in diagnosing and treating illnesses and disorders and providing preventive care.

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But, the foundation of osteopathic medicine is that people are more than just the sum of their body parts.

Learn more about National Osteopathic Medicine Week and how you can share your DO pride.

Assessment: I trained at several DO hospitals in my early career for which I am very grateful.

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BUSINESS TEXTS FOR PHYSICIAN-EXECUTIVES AND MEDICAL CXO:

1 – https://lnkd.in/eEf-xEH

2 – https://lnkd.in/e2ZmewQ

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The DDS / Doctor [Salesman] will See [Up-Sell] you Now

Posted on May 25, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Blurring the Line between Medical Professionalism … and Mercantilism

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Concerns and complaints about pushy dentists are apparently becoming more numerous among consumers, as elective cosmetic treatments and marginally effective tests and modalities are increasingly available from the same providers that patients formerly turned to for unbiased dental advice and oral healthcare. All for a price!

http://www.msnbc.msn.com/id/37198272/ns/health-oral_health

So, enter the cosmetic [rank-and-file] dentists and the elective renaissance of the profession – at least economically. An entire industry has even sprung up teaching dentists how to sell various products, and up-sell related services and procedures.

[picapp align=”none” wrap=”false” link=”term=dentists&iid=166771″ src=”0163/1731b859-b744-4a0e-b055-a9e985ad8673.jpg?adImageId=12959860&imageId=166771″ width=”372″ height=”459″ /]

Root-Cause [pun intended]

Why is this happening? Economics of course! Dental profession success in eradicating cavities, caries and other common mouth disorders – which used to comprise 80% of dental procedures and income – is now a two-edge sword working against their financial self interests … damn!

In fact, I recall about three decades ago when the situation first became acute, as more than a few of our nation’s dental schools closed for lack of interest in matriculation. Right here in Atlanta, the prestigious Emory University School of Dentistry closed its doors while I myself was a patient there; and employed as a surgical resident at a nearby acute care hospital. Contemporaneous cocktail party talk and medical gossip centered on the “death of dentistry” as I exhaled a sigh of relief at my career choice.

Going forward, years later, far too many managed care contracts reimbursed so poorly that they became a loss-leader [access portal to a patient population] for dental practitioners. In other worlds, lose money or break-even on the covered services contract, but profit handsomely by offering [pushing] non-covered services to cohort contract members … and their sphere of influence.

One Word from Mrs. Robinson – Plastics

Plastic surgeons, of course, are still the doctors most commonly associated with non-covered and purely cosmetic and elective treatments such as Botox injections, facelifts and tummy tucks. But, similar elective procedures — which generally aren’t covered by insurance — are being offered by a wide variety of medical specialists.

For example, many dermatologists, who treat patients for skin cancer and other diseases, also promote treatments to smooth wrinkles, lighten age spots and remove hair. Otolarnygologists, who care for patients with conditions of the ear, nose and throat, commonly perform nose jobs, brow lifts and eyelid surgery. And, podiatrists, who are often experts at foot reconstructive, diabetic and ankle surgery, sell shoes, shoe-inserts, laser beam treatments for fungus toenails and various cosmetic and prosthetic devices for deformed toenails and crooked digits.

Medicare Limits – Privates Don’t

At least Medicare requires an ABN [advanced beneficiary notice] for non-covered medical services, and limits non-participating doctors to 115% of the Medicare fee schedule for all providers. Increasingly, some private health plans are doing and proposing, same.

Practice Management Guru

Now, I have no issue with efficient medical practice management operations, for any specialty. In this era of managed care and health 2.0, governmental intervention is onerous, competition is fierce and patient empowerment is reversing the aging command-control medical establishment. Nor, do I have a problem with offering the entire range of therapeutic and/or elective options to any patient. This is a “good – better – best” elective marketing concept.

In fact, the third edition of our best-selling book, the Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] will soon be released this autumn www.BusinessofMedicalPractice.com. In it, we seek to educate doctors about modern business, management and economics practices; as well as the emerging participatory health 2.0 philosophy and information technology skills. Our goal is enhancing the survival potential of the independent practicing medical professional.

But, the ever expanding menu of treatment options – promoted by a trusted medical professional – should include procedural risks and complications, period of recovery and alternatives, including benign neglect [watchful waiting], marginal benefit and marginal utility, as well as price transparency.

Call this new-wave litany, a type of “informed patient business consent”.

[picapp align=”none” wrap=”false” link=”term=doctor+money&iid=182012″ src=”0178/66353b45-9776-48b9-9bdd-2993a48f32bf.jpg?adImageId=12959922&imageId=182012″ width=”372″ height=”459″ /]

Aphorisms of the Past

Over the years, we have heard phrases like the following from all sorts of independent specialists. I know I have, and so have you. Many are the butt of “insider” jokes:

MD: I’m sure that appendix is hot – I have a car payment to make

DPM: Even the normal foot can be surgically improved

DO: Now, I can bill like a real MD

DDS: We can straighten out – the straightest teeth

DC: I’ll crack your back in only forty sessions … and I finance

But, these are aphorisms of the last-generation. Today we are responsible adults. Let’s grow up and become medical professionals and “DOCTORS” again … not healthcare merchants, sales sharks or equipment shills that offer strategic competitive advantages; but not real patient benefits.

Assessment

The old practice management business adage of yesteryear – to work longer hours, see more patients quicker, up-sell marginally effective procedures, or do more treatments in order to realize more income – will not necessarily hold true in the modern era.

http://www.washingtonpost.com/wp-dyn/content/article/2010/05/17/AR2010051703034.html

According to colleague, financial advisor and ME-P thought leader Brian J. Knabe MD – a primary care physician and current www.CertifiedMedicalPlanner.com matriculant – and textbook chapter 27 co-author on physician compensation and salary:

In the environment of Healthcare 2.0, those doctors who embrace efficiency, innovation and appropriate business models will be better positioned to optimize their incomes.

http://businessofmedicalpractice.com/chapter-27-salary-compensation-2/

Conclusion

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Filed under: "Doctors Only", CMP Program, Ethics, Op-Editorials, Quality Initiatives | Tagged: ABN, DDS, DMD, DO, DPM, MD, medicare, osteopaths, Otolarnygologists, podiatrists, Practice Management, www.BusinessofMedicalPractice.com, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbussinessadvisors.com | 2 Comments »

Understanding the Medical Career Choice!

Posted on May 2, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Regrets and Recriminations – or Joy and Bliss?

By Eugene Schmuckler PhD, MBA

http://www.CertifiedMedicalPlanner.org

By Dr. David E. Marcinko MBA

www.MedicalBusinessAdvisors.com

Jimmy’s mother called out to him at seven in the morning, “Jimmy, get up. It’s time for school.” There was no answer. She called again, this time more loudly, “Jimmy, get up! It’s time for school!” Once more there was no more answer. Exasperated, she went to his room and shook him saying, “Jimmy, it’s time to get ready for school.”

He answered, “Mother, I’m not going to school. There are fifteen hundred kids at that school and every one of them hates me. I’m not going to school.”

“Get to school!” she replied sharply.

“But, Mother, all the teachers hate me, too. I saw three of them talking the other day and one of them was pointing his finger at me. I know they all hate me so I’m not going to school,” Jimmy answered.

“Get to school!” his mother demanded again.

“But mother, I don’t understand it. Why would you want to put me through all of that torture and suffering?” he protested.

“Jimmy, for two good reasons,” she fired back. “First, you’re forty-two years old. Secondly, you’re the principal.”

Similar Physician Sentiments

Many of us have had conversations with medical colleagues at which time sentiments of those expressed by Jimmy have been voiced. The career choice that was made many years ago is now, for some reason, no longer as exciting, interesting and enjoyable, as it was when we first began in the field. The career that was undertaken with great anticipation is now something to dread.

The reason for this is occurrence is not that difficult to understand. Two of the most important decisions individuals are asked to make are ones for which the least amount of training is offered: choice of spouse and choice of career. How many college students receive a degree in the field they identified when they first enrolled at the college or university? In fact, how many entering freshmen list their choice of major as undecided? It is only during the sophomore year when a major must be declared is the choice actually made. So, career choices made at the age of 19 might be due to having taken a course that was interesting or easy, appeared to have many entry level jobs, did not require additional educational or professional training requirements, or was a form of the “family business.” Now as an adult, the individual is functioning in a career field that was selected for him or her by an eighteen-year-old.

Judging Career Success

How do we judge career success? A career represents more than just the job or sequence of jobs we hold in a lifetime. The typical standard for a successful career is by judging how high the individual goes in the organization, how much money is earned, or one’s standing attained in the medical profession.

Yet, career success actually needs to be judged on several dimensions. Career adaptability refers to the willingness and capacity to change occupations and/or the work setting to maintain a standard of career progress. Many of you did not anticipate the managed care, Health 2.0, or political changes in your chosen medical profession, or specialty, when you began your training.

A second factor is career attitudes. These are your own attitudes about the work itself, our place of work, your level of achievement, and the relationship between work and other parts of your life.

Medical Career Identity

Career identity is that part of your life related to occupational and organizational activities. This is the unique way in which we believe that we fit into the world. Our career is only one part of our being. We play many roles in life each of which combine to make up or totality. At any point in time one role may be more important than another [life saving physicians versus retail sales clerk]. The importance of the roles will generally change over time. Thus at some point you may choose to identify more with your career, and at other times, with your family.

Career Performance

A final factor is career performance, a function of both the level of objective career success and the level of psychological success. How much you earn and your reputation factor into, and reflect, objective career success. To be recognized as a “leader” in a medical field and asked to submit chapters for inclusion in text-books, medical journals or new-wave blogs such as this may be a more important indicator of career success than money.

Psychological success is the second measure of career performance. It is achieved when your self-esteem, the value you place on yourself, increases. As you can see, there is a direct relationship between psychological success and objective success. It may increase as you advance in pay and status at work or decrease with job disappointment and failure. Self-esteem may also increase as one begins to sense personal worth in other ways such as family involvement or developing confidence and competence in a particular field, such as consistently shooting par on the golf course. At that point, objective career success may be secondary in your life. This is why many people choose to become active in their church or in politics. Even though one may have slowed down on the job, or in their professional career they can be extremely content with their life.

Case Model Scenario

Consider the following situation.

You are traveling on business. Although you are on a direct flight, you have a one-hour layover before the second leg of the flight and your final destination. Leaving the plane, after having placed the “occupied” card on your seat you walk down the concourse. On the way, you encounter a friend that you knew in high school. The two of you sit to have a cup of coffee and then you realize that your departure time is rapidly approaching. In fact, you will be cutting it quite close. Running down the concourse you return to the gate only to find that the door has been closed, the jetway is being retracted and the plane is being backed away from the gate. You stare out the window watching the plane go to the end of the runway and then begin its takeoff. Something goes horrible wrong and the plane crashes on takeoff, bursting into flames. It is apparent that there will be no survivors.

Assessment

To the world you are on that plane (remember the occupied card). Traveling on business your generous insurance policy will be activated. In anticipation of being in a location where they may not have ATM machines you have a good deal of cash, sufficient for at least a month.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

McNally, D. Even Eagles Need A Push, New York, NY: Delacorte Press, 1991.

Invite Dr. Marcinko

***

Filed under: "Doctors Only", Career Development, CMP Program, Ethics, iMBA, Inc., Op-Editorials | Tagged: CMP, CMP www.CertifiedMedicalPlanner.com, DDS, DO, Eugene Schmuckler, HMOs, job performance, job self esteem, MD, medical career, medical career identity, medical jobs, medical students, P4P, pre-med students, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.medicalbusinessadvisors.com | 3 Comments »

Your Chance to be Heard on the ME-P

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

What Gripes You?

By Ann Miller; RN, MHA

[Executive Director]

The Medical Executive-Post is among the web’s most influential and well-read health economics and financial blogs, with more than 100,000 subscribers. But, we refrain from Twitter triteness on our more than 50 topic channels with deep experienced gravitas.

Reach our Audience and be Heard

You can have the opportunity to reach this target audience by submitting a guest opinion piece or post on anything related to health care economics, medical practice management and physician focused financial planning. Articles of about 500 words in length, free of grammatical and spelling errors are preferred. Accepted pieces will not only be published on the blog, but may be syndicated on affiliated networks, as well as an e-newsletter distributed to thousands.

Professional Organization Members

Members of professional organizations, such as the American Medical and Dental Association, and the Financial Planning Association, already contribute as individual readers and subscribers. Other writers refuse to join these organizations for various reasons. They too are welcomed. There is also an opportunity to become a regular contributor to the blog if several, quality, guest posts have been accepted and published.

Assessment

Articles for consideration can be e-mailed directly to me.

MarcinkoAdvisors@msn.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. 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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My Favorite Health 2.0 Experience from McDonalds

Posted on August 20, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Meet the Schwieterman’s

By Dr. David Edward Marcinko; MBA, CMP™

Back in 2005, we published the second edition of our popular textbook: the Business of Medical Practice. And, we are now working on the third edition. At the time however, I was fortunate to have a colleague from the Microsoft Corporation pen our Foreword, now reprinted below for your review.

Link: http://www.springerpub.com/prod.aspx?prod_id=23759

What a Family Tradition!

My favorite story came from Dr. Thomas Schwieterman, a fourth-generation physician working in the same medical office his great grandfather established in 1896 in the town of Mariastein, Ohio. From those same historic environs, Schwieterman has used Microsoft Access to create his own physician assistant application.

The Schwieterman Family Physicians practice kept him so busy that he was wondering how he could keep up with his patient caseload. Schwieterman wanted a faster way to handle prescriptions, provide medical information, and record data for his patient records. He walked into a McDonald’s restaurant one day and had an idea.

The Epiphany

“I ordered a cheeseburger and fries and watched the person at the counter touch the screen of the cash register a few times, and realized the order was getting transferred back to the food preparation area, and that by the time I paid, my order was ready,” he said. “I thought to myself: ‘That’s what I need!’” He searched for commercially available solutions, but when he couldn’t find an exact match for his needs, and when he found prices steep for a small private practice, he decided to create his own – using Access. He also called upon a friend with a Master’s Degree in electrical engineering to help on the coding. His creation boosted his income by 20 percent – “Which was important because we pay more than $60,000 a year for malpractice insurance even though our clinic has never been sued since it was founded 107 years ago.”

Assessment

What my friends at Microsoft especially like about this story is that when Dr. Schwieterman’s colleagues tried his program, liked it, and suggested he try to sell it, he put together a PowerPoint presentation – and landed a partnership agreement with a major healthcare supply and services corporation to market his ChartScribe solution.

Conclusion

So, the pressures facing physicians are great, but so are their resources. Information technology is one resource, this book is another, but the greatest of all is the innate curiosity and drive to discover and create that seems to be so much a part of those who are drawn to this noble profession.

Ahmad Hashem; MD, PhD

Global Healthcare Productivity Manager

Microsoft’s Healthcare Industry Solutions Group

Microsoft Corporation

Redmond, Washington

Conclusion

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Filed under: Book Reviews, iMBA, Inc., Information Technology, Media Mentions and PR, Practice Management, Recommended Books | Tagged: Access, Ahmad Hashem, Business Medical Practice, ChartScribe, david marcinko, DO, eHs, EMRs, Mariastein, MD, medical records, microsoft, Ohio, PhD, PowerPoint, Schwieterman, Thomas Schwieterman | Leave a comment »

Sponsorship Opportunities

Posted on July 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Advertise on the Medical Executive-Post

Reach out and impress more than 100,000 physician and nurse-executives, financial advisors, CEOs and medical management consultants in the health 2.0 space. Our premium institutional e-journal: www.HealthcareFinancials.com and complimentary companion newsletter blog: www.HealthcareFinancials.wordpress.com has limited sponsorship and advertising opportunities available; So, act now!?

Advertise with us!

Reserve your space today.

For more information please contact: Edward

MarcinkoAdvisors@msn.com

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Discount Brokerages versus On-Line Brokerages

Posted on June 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Physicians Must Appreciate the Differences

By Daniel B. Moisand; CFP® and the ME-P Staff

Here are a few questions for all physician-investors to consider in 2009:

1. True or False?

The key to investment success is to pay as little for a trade as possible.

2. True or False?

The higher the number of trades in an investment account, the better the investment results.

3. True or False?

The majority of revenue of a discount or on-line brokerage comes from trades.

A: The answers should be crystal clear! False, False and True. It is almost entirely that simple.

Cost Control

Much like a medical practice, keeping costs down is an important objective of personal finance but, it is certainly not the key to success. There are many studies that show that active trading garners inferior results compared to a longer term buy and hold type of strategy. One of the most publicized recently was conducted by a UC-Davis team led by Dr. Terrance Odean. The study examined the actual tracing activity of thousands of self-directed accounts at a major discount brokerage over a six-year period. The results were clear. Regardless of trading level, most of the accounts underperformed the market and showed that the higher the number of trades, the worse the result.

Of Bulls and Bears

While the U.S. markets were on a dramatic upswing a decade ago, the general interest level in them increased as well. More households owned financial assets than ever before. Demographics drive much of this surge. The older edge of the baby boom generation is finding that as the children leave home, they have more income than ever before and saving for retirement becomes a higher priority. The proliferation of defined contribution [401-k, 403-b] retirement plans has also forced more people to take responsibility for their long-term security. When, the US stock market was on a tear; one would have be wise to remember an old Wall Street saying – “Don’t confuse brains with a bull market.” Unfortunately today, far too many self-directed investors did not heed the warnings. The media is full of stories about investors whose portfolios were decimated by the recent bear market. While this loss of wealth is somewhat tragic, in almost all cases the losses were made possible by poor planning and/or poor execution that a mediocre advisor would have avoided.

The Business of Advice

One also cannot conclude that everyone is acting as his or her own investment advisor. The advice business continues to thrive. Sales of load mutual funds have continued to grow, as has commission revenue at full-service firms. No-load funds have continued to grow as well and gain market share from the load funds. However, it would be inaccurate to tie that growth to do-it-yourselfers. Much of the growth of no-load funds can be attributed to the advice of various types of advisors who are recommending the funds. In addition, several traditionally no-load fund families have begun to offer funds through brokers for a load.

The Discounters

For physicians and all clients, the primary attraction to a discounter is cost. Everyone loves a bargain. Once it is determined that it is a good idea to buy say 100 shares of IBM, the trade needs to get executed. When the trade settles one owns 100 shares of IBM, regardless of what was paid for the trade. There is no harm in saving a few bucks. However, the decision to buy the IBM shares and when to sell those shares will have a far greater impact on the investment results than the cost of the trade as long as the level of trading is kept at a prudent level. The fact is that most good advisors use discount firms for custodial and transaction services. The leading providers to advisors are Schwab, Fidelity, and Waterhouse.

Ego Driven

In addition to cost savings, discounters appeal to one’s ego for business. Everyone wants to feel like a smart investor; especially doctors. Often, marketing materials will cite the IBM example and portray the cost difference as an example of how the investor is either stupid or being ripped off. There is also a strong appeal to one’s sense of control. An investor is made to feel like they are the masters of their own destiny. All of this is a worthy goal. One should feel confident, in control, and smart about financial issues. Hiring a professional should not result in losing any of these feelings, rather solidify them. Getting one’s affairs in order is smart. The advisor works for the client so a client should maintain control by only delegating tasks to the extent one is comfortable. Knowing that the particular circumstances are being addressed effectively should yield enhanced confidence.

Sales Pressure Release

The final reason people turn to discount and on-line brokerages is to avoid sales pressure. Unlike the stereotypical stockbroker, no one calls to push a particular stock. Instead, sales pressure is created within the mind of the investor. By maintaining a steady flow of information about stocks and the markets to the account holders, brokerages keep these issues in the forefront of the investor’s minds. This increases the probability that the investor will act on the information and execute a trade. Add some impressive graphics and interfaces and the brokerage can keep an investor glued to the screen. The Internet has made this flow easier and cheaper for the brokerages, lowering costs and increasing the focus on trade volume to achieve profitability.

Assessment

The pressurized information flow however, does little to protect investors during a bear market. Ironically, this focus on trading is one of the very conflicts investors are trying to avoid by fleeing a traditional full service broker.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What are your feelings on discount and internet brokers? Tell us what you think. 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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Filed under: "Doctors Only", Book Reviews, CMP Program, Financial Planning, Portfolio Management, Recommended Books, Risk Management | Tagged: certified financial planner, certified medical planner, CFP, CMP, common stock, daniel moisand, david marcinko, DDS, discount broker, DO, DPM, Dr. Terrance Odean, Fidelity, financial advisors, Financial Planning, internet broker, Investing, load funds, MD, Mutual Funds, no-load funds, online broker, Schwab, stock broker, stock shares, Waterhouse, www.certifiedmedicalplanner.com | 2 Comments »

Healthcare Organizations – The eJournal on CD

Posted on June 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Journal of Financial Management Strategies **

Beginning in August 2009, we are pleased to inform you of two new milestones reached by Healthcare Organizations [e-Journal of Financial Management Strategies].

First, we have achieved journal status with our periodical publication. From a nomenclature perspective, we will no longer be known as a guide, but more rightly as the comprehensive journal we envisioned at inception.

Second, we have ceased our print-only existence and migrated to a CD-ROM format, via Adobe Reader, with quarterly email updates. This transition illustrates our collaborative philosophy in the modern health 2.0 participatory era. Of course, all chapter files are still printable at your own discretion.

“Bridging the Intersection of Medical Mission and Profit Margin”

All hospitals, healthcare systems and organizations use a variety of teaching, educational and didactic techniques to bring value to patients, payers, providers, governments and third-party intermediaries. This Intellectual Capital is the sum total of all knowledge and expertise used to serve society and stakeholders. Leaders, CXOs and employees provide almost all of this Intellectual Capital.

We believe that Healthcare Organizations [e-Journal of Financial Management Strategies] adds to this Intellectual Capital by guiding you, empowering your organization, and creating value for your patients, employees, investors and clients by bridging the intersection of medical mission and profit margin.

* Unlimited non-transferabl license; not for redistribution or resale.

** Embossable binder available at slight surcharge

Letter: Publisher’s Letter

Conclusion

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Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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And, credible sponsors and like-minded advertisers are always welcomed.

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Filed under: Alerts Sign-Up, Breaking News, Career Development, iMBA, Inc., Marketing & Advertising, Practice Management | Tagged: ASCs, CD-ROM, clinics, david marcinko, DC, DDS, DMD, DO, DPM, economc journal, financial journal, health 2.0, Healthcare Organizations, hope hetico, hospitlas, MD, medical clinics, medical offices, medical practices, OD, www.healthcarefinancials.com, www.medicalbusinessadvisors.com | Leave a comment »

Understanding the Health Maintenance Organization Delivery Model

Posted on April 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Defining Terms and Concepts

By Staff Writers

www.HealthcareFinancials.com

An HMO is a legal corporation that offers health insurance and medical care. It is a health care delivery system that provides comprehensive services for subscribing members in a particular geographic area. Most HMO care is provided through a managed network made up of MD/DOs, hospitals, and other allopathic/osteopathic professionals selected by the HMO. HMO enrollees are required to obtain care from this network of providers in order for their care to be covered, except in cases of emergency. All the care the members may need is paid for by the single monthly fee, plus nominal co-payments. HMOs typically offer a range of health care services at a fixed price (capitation).

Different Types

The types of HMOs are:

1. STAFF MODEL: Organization owns its clinics and employs its doctors.

2. GROUP MODEL: Contract with medical groups for services.

3. INDEPENDENT PHYSICIAN ASSOCIATION (IPA) MODEL: IPA contract that in turn contracts with individual physicians.

4. DIRECT CONTRACT or NETWORK MODEL: Contracts directly with individual physicians.

5. MIXED MODEL: Members get options ranging from staff to IPA models.

6. OPEN-PANEL MODEL: A managed care plan or HMO where members can see any provider for an extra premium cost.

Assessment

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated?

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Filed under: "Ask-an-Advisor", Book Reviews, Career Development, Glossary Terms, Health Insurance, iMBA, Inc., Managed Care | Tagged: david marcinko, Dctionary of Health Insurance and Managed Care, DDS, DO, DPM, Group Model HMO, health maintenance organization, HMO, hope hetico, IPA, Managed Care, MD, medical network, mixed model HMO, open panel HMO, staf model HMO, www.healthdictionaryseries.com | 1 Comment »

More about Healthcare Organizations [Financial Management Strategies]

Posted on April 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Our Print-Journal Preface

By Hope Rachel Hetico; RN, MHA, CMP™

As Managing Editor of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our Preface.

A Two-Volume Guide

As so, our hope is that Healthcare Organizations: [Financial Management Strategies] will shape the hospital management landscape by following three important principles.

What it is – How it works

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace. Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Second, our writing style allows us to condense a great deal of information into each quarterly issue. We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists. The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite. Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.

www.HealthcareFinancials.com

Assessment

Rest assured, Healthcare Organizations: [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to your subscription. Most importantly, we hope to increase your return on investment [ROI] in some small increment.

Visit and Order Now

Specialty Technical Publishers

8 – 14th Street

Blaine, WA 98230

1-800-251-0381

orders@stpub.com

http://www.stpub.com/pubs/ho.htm

TOC: http://www.stpub.com/pdfs/toc_ho.pdf

Conclusion

And so, your thoughts and comments on this Medical Executive-Post, complimentary e-companion are appreciated. If you would like to contribute material or suggest topics for a future update, please contact me. Subscribers, have we attained our goals and objectives, as a work-in-progress in this preface statement?

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: "Advisors Only", "Doctors Only", Accounting, Book Reviews, Career Development, Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Information Technology, Managed Care, Media Mentions and PR, Practice Management, Practice Worth, Professional Liability, Quality Initiatives, Recommended Books, Research & Development, Risk Management, Sponsors, Taxation | Tagged: ARs, ASC, asset management, capitation, CEO, CFO, claims management, clinics, competitive healthcare strategies, COO, cost management, CPT codes, CXO, david marcinko, DDS, dentists, DO, doctors, DPM, EHRs, EMRs, EMTALA, endowments, EOQ, ePHRs, health fraud, health information technology, Healthcare Organizations, HIPPA, hope hetico, hospitals, IBNRs, ICD-10, ICD-9, inventory management, MD, Medicaid, medical compliance, medical practices, medicare, MedPAC, nurse executives, nurses, OSHA, osteopath, Patriot Act, physician-executives, physicians, podiatrist, Sarbox, social medicine, workplace violence | Leave a comment »

About: Healthcare Organizations [Financial Management Strategies]

Posted on April 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Our Print Mission Statement

[By Dr. David Edward Marcinko; MBA, CMP™]

Publisher-in-Chief

As Editor-in-Chief of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our mission statement; or the journal’s raison d’etra.

A Two-Volume Guide

As so, Healthcare Organizations: [Financial Management Strategies], with its quarterly updates, will promote and integrate academic and applied research, and serve as a multi-disciplined communications forum for the dissemination of financial, managerial, business and related economic information to decision makers in hospitals, outpatient centers, clinics, medical practices and all mature and emerging healthcare organizations.

Target Market and Ideal Reader

Healthcare Organizations [Financial Management Strategies] and its quarterly updates should be in the hands of all:

* CFOs, CEOs, COOs, CTOs, VPs and CIOs from every type of hospital and healthcare organization including: public, federal, state, Veteran’s Administration and Indian Health Services hospitals; district, rural, long-term care and community hospitals; specialty, children’s and rehabilitation hospitals; diagnostic imaging centers and laboratories; private, religious-sponsored, and psychiatric institutions.

* Physician Hospital Organizations, Management Services Organizations (MSOs), Independent Practice Associations (IPAs), Group Practices Without Walls (GPWWs), Integrated Delivery Systems (IDSs) and their administrators, comptrollers, cost accountants, budget directors, cash managers, auditors, healthcare attorneys and consultants, and actuaries, and all endowment fund directors, executives, consultants and strategic financial managers.

* Ambulatory care centers, hospices, and outpatient clinics; skilled nursing facilities, integrated networks and group practices; academic medical centers, nurses and physician executives; business school and health administration students, and all economic decision-makers and directors of allopathic, dental, podiatric and osteopathic healthcare organizations.

Assessment

After publication, my suggestion is to read, study and act upon the guide in this way:

1. First, browse through the entire text.

2. Next, slowly read those chapters and sections that are of specific interest to your professional efforts.

3. Then, extrapolate portions that can be implemented in specific strategies helpful to your healthcare setting.

4. Finally, use its’ ME-P updates as a reference manual to return to time and time again; and enjoy!

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Accounting, Book Reviews, Career Development, Drugs and Pharma, Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Information Technology, Managed Care, Practice Management, Practice Worth, Professional Liability, Recommended Books, Research & Development, Risk Management, Sponsors | Tagged: administrators, ASCs, CEO, CFO, children’s hospitals, clinics, community hospitals, COO, CXO, david marcinko, diagnostic imaging centers, DO, doctors, DPM, healthcare administration, Healthcare Organizations, hospital management, hospitals, Indian Health Services, laboratories, long term care, MD, medical journals, medical practice management, medical practices, nurse executives, nurses, oasteopaths, OD, office managers, outpatient centers, physicians, physisician executives, podiatrists, practice managers, psychiatric institutions, rehabilitation hospitals, RNs, rural hospitals, specialty hospitals, Veterans Administration | 1 Comment »

Impact of Size on Mutual Fund Performance

Posted on April 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Vital Information for Doctors to Consider

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

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]

The actual size of a mutual or index fund, in terms of amount of assets, and the growth rate of a fund are the two aspects of size to consider. The impact of size on mutual fund performance varies—it can be negative, neutral, or positive. Size affects different types of funds differently; it also affects the manager’s ability to achieve objectives. Monitor size changes and make investment decisions accordingly.

Economies of Scale

A relatively large amount of assets available to a portfolio manager presents various economies. The costs at most funds (e.g., expense ratios) are reduced as a percentage of net asset value as the fund grows. Expense ratios can have a major impact on performance. In addition to being an effect of size, low fees can cause size changes. Funds do at times waive some fees to attract assets.

Asset Base

A larger asset base provides more liquidity to a fund. With more assets, the manager can buy more shares and more stocks. Transaction costs are reduced if higher trading volumes are achieved. A larger asset base also can reduce relative tax costs. Realized but undistributed capital gain can be spread over more shares at the time of year-end distribution. A larger asset base and manager success attracts higher-caliber managers to the management team.

Fund Growth

Growth of fund assets impairs certain funds more than others. Generally, bond funds are less affected by asset growth and size than equity funds. Growth may have a positive impact on bond funds because buying bonds of similar characteristics further diversifies credit, event, and other risks. Equity funds that invest in larger capitalization stocks can be less affected than funds buying less liquid small-cap stocks. (This is so because funds usually limit their investments in a single company, i.e., many funds will not buy more than 5% of a specific company. Five percent of a small company uses up less cash than 5% of a large company. Therefore, a small-cap fund is more likely to exhaust its choice of available companies sooner than a large-cap fund. A large-cap fund could increase its investment to a 5% level, whereas a small-cap fund may already be fully invested in the companies the manager likes to own.)

Growth Rate

The rate of growth can affect performance. Rapid growth may mean that a large portion of the portfolio remains un-invested. A rapidly growing growth-type equity fund with a high percentage of cash earns lower returns in a rising market than a fully invested fund. With rapid growth, the fund may not provide pure exposure to the desired asset class. At a certain point, however, fund asset growth impairs the manager’s ability to achieve objectives. For this reason, funds often close to new investors or to new investment once they have reached a certain size. Growth affects managers in many ways. Many fund managers or teams of managers direct a number of funds and possibly even private accounts. As the fund grows, managers are spread thin and may have difficulty in reacting quickly or efficiently to changing market conditions. Managers may need to hire assistant portfolio managers or delegate work to analysts or other employees. As a result, the manager manages people, administration, or internal quality control systems rather than studying companies or investment strategies. Also, a manager may become complacent in periods of rapid asset growth. Such growth can mean their own compensation is substantially greater, which may in turn change the manager’s motivation. Rapid growth often changes a fund because there are not enough opportunities to invest in the targeted securities. For example, a fund can change from aggressive to conservative, small cap to large cap. Managers may have to slow trading or increase liquidity in the portfolio to prevent this occurrence.

Meaningful Positions Difficult

Rapid growth or a large asset base can prevent managers from taking meaningful positions in market sectors they believe will outperform others. Smaller funds are more flexible and may take advantage of opportunities or liquidate unwanted positions faster than larger funds. A large fund that owns a significant position will negatively affect a security’s market price if it unloads shares all at one time. Rapid growth also impairs research of funds, affecting an investor’s choice of funds. A fund with outstanding performance over the past 5 years and a $150 million asset base may be much different when its base grows to $1 billion; at that point, it may no longer be the “right choice” for an investor.

Asset Declinations

Just as rapid asset growth affects performance, a rapid decline of fund assets also may impact performance. Significant quantities of redemptions over short periods force managers to liquidate security positions, often at the wrong time (i.e., they would rather be buying in a declining market than selling to accommodate redemptions). To prevent this scenario, some funds have redemption charges to discourage investors from such short-term decisions. Such environments can negatively impact bond funds as easily as equity funds. Large redemptions compound the effect of declining fund net asset values.

What a Doctor-Investor Can Do?

What can physician-investors do to avoid negative effects on investment? Avoid overloading a portfolio with hot, rapidly growing funds, if possible. Generally, size should be a neutral factor for most bond funds. Small and/or aggressive equity funds can be affected by growth, however. Emphasize funds that promise to close to new investors after assets reach a certain size. Once a fund becomes large, monitor it closely for problems caused by the growth. If there is a better, smaller fund, it may be wise to change. Also, closed-end funds are always a possibility. These funds have a major advantage in that their asset base is a factor of growth in security values, not new investment (unless the fund makes a secondary stock offering). Closed-end managers work with a finite portfolio, which reduces the problem of sudden asset growth.

Assessment

To the extent that a lack of SEC and FINRA over-sight, and the recent financial, insurance and banking meltdown has affected the above; such investing is left up to the doctor’s discretion and personal situation. When it comes to the financial services product sales industry; always remember “caveat emptor” or “buyer-beware.”

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

Conclusion

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Filed under: Experts Invited, Financial Planning, iMBA, Inc., Insurance Matters, Investing, Media Mentions and PR, Op-Editorials, Portfolio Management, Recommended Books, Risk Management, Taxation | Tagged: CFP, CMP, CPA, david marcinko, DDS, DO, DPM, financial advisors, Financial Planning, fund assets, fund costs, fund expenses, fund growth, fund managers, fund size, hope hetico, index fund, index fund size, Investing, MD, mutual fund expenses, mutual fund performance, mutual fund size, OD, physician investors | 2 Comments »

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