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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

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

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

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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My [Jaguar] Mechanic vs. Doctor Story

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Everyone wants to be a doctor – or get paid like one!

dem21[By Dr. David Edward Marcinko MBA CMP™]

Most regular ME-P readers and subscribers know that I am a Jaguar automobile fan. Except perhaps for a Bentley or Rolls Royce, I think that Jags are the finest mass produced luxury vehicles on the planet.

Backstory

My regular car guy, Jimmie the mechanic, was removing a cylinder head from a late model Jaguar sedan when he spotted a world-famous heart surgeon in his garage; we have many such dignitaries on this side of town.

In fact, it is called “pill-hill” around here, for the many hospitals, medical clinics and physician offices. The heart surgeon was waiting for the service manager to come and take a look at his car.

The Query

Jimmie shouted across the garage, ‘Hey Doc can I ask you a question?’

The famous surgeon, a bit surprised, walked over to him.  Jimmie straightened up, wiped his hands on a rag and asked, ‘So Doc, look at this engine. I also can open hearts, take valves out, fix’em, put in new parts and when I finish this Jaguar will work just like a new one.’

Salary Comparisons

“So how come I work for a pittance and you get the really big money, when you and I are doing basically the same work?”

The MD’s Answer

The surgeon paused, smiled and leaned over and whispered into Jimmie’s ear: ‘Try doing it with the engine running.’

***

Jag sedan

ME-P Jag

***

Assessment

Of course this story is a classic; oft repeated ad nauseam.

Conclusion

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

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Beware these “Old-School” Medical Practice Embezzlement Schemes!

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2 Doctors and 2 CPAs Discuss Office Internal Controls

  • Perry D’Alessio CPA
  • Dr. Gary L. Bode MSA CPA LLC
  • Dr. David Edward Marcinko MBA CMP

Internal controls are simply those systems, processes, procedures, and mechanisms controlled by management that make it possible for a medical practice, clinic or any health entity to successfully achieve its goals and objectives.

Internal controls designed and implemented by the practice physician-owner, help prevent bad things from happening. Embezzlement protection is the classic example.

However, internal controls also help ensure good things happen, at least most of the time. A procedural manual that teaches employees how to deal effectively with common patient complaints is one example.  Operating efficiency, safeguarding assets, quality patient care, compliance with existing laws, and accuracy of financial transactions are common goals of internal controls.

***

9805af30277425_561bf03a87d59

***

Common Office Schemes

  • 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 or your accountant writing checks to themselves. This is easiest to do in flexible software programs like QuickBooks, Peachtree Accounting and financial software [www.Peachtree.com]. 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.
  • Accountants or bookkeepers paying bills of others and posting the disbursements as if they were for a practice obligation. Checks payable to the Internal Revenue Service for example can bill used to pay tax obligations of another and are described in the bookkeeping as practice taxes due.
  • Employees ordering personal items on practice credit cards.
  • Bookkeepers receiving insurance company checks or patient checks, demonstrating the receipt of such in the EMR software and not posting in the practice bookkeeping software. Instead checks are illegally depositing them in an unauthorized, pseudo practice checking account, set up by them-selves 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, this is hard to detect. Executive-management 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, but protracted. Checking the accounting software “audit trail”, this 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 physician-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 physician-owner’s indifference to accounts payable.

More:

  1. Understanding the Healthcare Fraud and Abuse Control Program

Assessment

Beware these “od-school” schemes that are making a comeback, today.

Conclusion

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

***

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

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

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

***

What If You Could Start From Scratch – Doctor?

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How would you restart your career in medicine?

[By Dr. David Edward Marcinko MBA CMP™]

[By Hope Rachel Hetico RN MHA CMP™]

dave-and-hope9We’ve known this physician-client-friend for 10 years, and while he didn’t tell us what he wanted to discuss, we knew it was important.

After exchanging pleasantries, he shocked both of us: He said he’s totally unfulfilled in his current job and wants to do something new.

We were floored because he is an outstanding doctor – at the top of his game. From the outside looking in, he appears to be “living the dream”.

After that bombshell, we asked him the question we couldn’t get out of our mind: “Are you afraid?”

“Yes,” he said; “Afraid and relieved.”

His relief stemmed from the fact that he is going to shed the tremendous demands of being a doctor at the highest levels. He was afraid because he didn’t know what was next.

We thought afterward, “What a courageous and totally refreshing move.”

ME-P Doctors, Advisors and Consultants

A Fantasy Reboot

That dialogue triggered a larger internal conversation within; and with others.

  • What would you do if you could start from scratch?
  • How would you proceed if you could just wipe the slate clean and restart your career in medicine?

For those quietly pondering a similar path, three great opportunities seem crystal clear.

First, we would create our own practice playbook. Discard the ready-made choices served up by your old practice. For the independent physician today, there’s almost infinite variety. The pleasure in creating your own approach is that there are so many options. Your patients will appreciate the greater choice and flexibility, too.

Second, we would whole-heartedly embrace technology; but not necessarily EHRs at this time. Rather, build your own HIT framework to complement your medical practice. Innovate across your entire operations – everything from medical records, to online appointment access, secure FAX machines, to patient portals and laboratory results reporting to your own mobile phone app. Freeing yourself from your current archaic technology will be life altering by itself.

5 new rules for how doctors interact with health care IT

Third, cull the difficult people from your life. These are the naysayers who weigh you down – superiors, colleagues or patients. Negativity is corrosive, and it always lingers. It also distracts you from giving others your best. While you’re at it, cull the skills you mastered to survive in your career so you can focus on those that really matter.

Non-Traditional Doctors

Case Model

So, we wanted to share one of the all-time greatest reboots we know because it shows what is possible if you believe in yourself.

A decade ago, one of our osteopathic physician clients delivered some bad news. She was quitting her job as a medical associate, to transition into her own direct pay practice.

At the time, this was unheard of: No one walked away from a potential medical practice partnership to become a solo physician. But, Sue had a different vision. She wasn’t fulfilled and she knew it. With the support of her husband, she decided there was a better way. So she started from scratch.

How did it work out?

Unbelievably well – but NOT overnight!

With our meager assistance, Sue’s been cash flow positive for the last 7 years, and now earns more money than before, with less stress; and she is the captain of her ship. A few colleagues who have worked with her have even gone on to achieve comparable success. She’s become a role model to others too, and she remains one our heroes.

The Decision

Starting from scratch may or may not translate into more money, but it often means this: More happiness in your life. Sue’s decision, just like our friend who bared his soul to us over coffee, were both made for the right reasons.

We wish our friend well on his journey, confident knowing that a happy ending is just over the horizon for him, too.

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Assessment

Send us your own success/failure story, so we might learn from you. Would you even stay in medicine or transition/begin another career; anew?

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Financial Planning MDs 2015

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

Is Physician “Consumerism” Akin to Lay Consumerism?

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Revising Economic Principles for the “New-Normal”

[By Dr. David Edward Marcinko MBA CMP™]

[By Hope Rachel Hetico RN MHA CMP™]

David and HopeIn 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.

http://www.CertifiedMedicalPlanner.org

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.

The “New-Normal”

And now, as a three decade long bull market in bonds and equities is 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, and appeared not much older, came over to assist.

Realizing the propensity for a long wait, one was taken by the size of waiting room and the number of patients coming in and out of the office. [Americans consume healthcare and a lot of it]. There was another notable peculiarity. The sample prescription bags being carried out the door were no match for the bags under everyone’s eyes, including the doctor’s. The office staff was probably working overtime, if not two jobs, and the doctor was working harder and faster in a managed care system.

Why?

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

This continues to occur just as the stock markets reached an all time high recently, even as money is spent at a feverish pace as the Federal Reserve [FOMC] pumps out even more money in inflammatory fashion.

Medical Niche Space Spending

In the medical space, a noted study by the Kaiser Permanente Foundation in California, reported that doctor’s there chose to work four hours longer each week rather than take a ten percent pay cut.

Consumerism is what keeps economies alive and well. What a perfect way to describe medical and health care professionals, sans most basic economic fundamentals of modern financial planning.

Assessment

“Physicians have a significantly low propensity to accumulate substantial wealth.”

Thomas Stanley

[Author “The Millionaire Next Door”]

New Financial Planning Book for Doctors

How come doctors fail to get rich? Re-read the above! And, obtain, read and execute the strategies in this new book

Financial Planning MDs 2015

BOOK:

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

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Conclusion

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

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Thoughts on an Emerging Hybrid [Two-Tiered] Medical Payment Model

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The Changing Reimbursement Paradigm Shift

[By Dr. David Edward Marcinko MBA CMP™]

[By Prof. Hope Rachel Hetico RN MHA CPHQ CMP™]

David and HopeCurrent medical payment and reimbursement structures involve the submission and payment of medical CPT® coded claims.

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

Moreover, this pay-for-quantity model is slowly being relegated to the past in light of current P4P, ACO, and values based reimbursement models that favor modern payment-for-quality initiatives.

Tug-of-War System

Obviously, contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip.

Instituting quality metrics should be included in this equation, and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.

A Two Tied System

This hybrid reimbursement system might use a two-tiered payment structure something like this:

  1. For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission; partially decreasing office ARs, and favoring the time-value of money [TVM] equation.
  2. The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, is then paid quarterly. It would be based on scores like patient satisfaction, quality metrics, and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record [EHR].

Green Dollars

Assessment

Such a hybrid payment system would remove unnecessary steps, like re-submitting claims and would lower the operational and administrative costs of healthcare claims processing.

These changes would decrease operational office costs and drive quality stewardship of the diminishing healthcare dollar.

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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New Medical Practice Entrepreneurial Business Rules for Young Physicians [circa 2018]

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Go “Out-of-Box” – OR – Go Employee

By Dr. David Edward Marcinko MBA CMP™ www.CertifiedMedicalPlanner.org

There are more than 950,000 physicians in the United States. Yet, the brutal supply and demand, and demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. More so, going forward with the PP-ACA OR, perhaps not so much after the Trump election.

Furthermore, many large health care corporations, hospitals, and clinical and medical practices have not been market responsive to this change. Some physicians with top-down business models did not recognize the changing health care ecosystem or participatory medicine climate. Change is not inherent in the DNA of traditionalists. These entities and practitioners represented a rigid or “used-to-be” mentality, not a flexible or “want-to-be” mindset.

Yet today’s physicians and emerging Health 2.0 initiatives must possess a market nimbleness that cannot be recreated in a command-controlled or collectivist environment. Going forward, it is not difficult to imagine the following rules for the new virtual medical culture, and young physicians of the modern era.

A. Rule 1

Forget about large office suites, surgery centers, fancy equipment, larger hospitals, and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manners, or competitive advantage can outfox a slew of insurance companies, Certified Public Accountants, or the Associate Management Accountant, while still serving patients and making money. It is now a unit-of-one economy where “ME Inc.,” is the standard. Physicians must maneuver for advantages that boost their standing and credibility among patients, peers, and payers.

Examples include patient satisfaction surveys, outcomes research analysis, evidence-based-medicine, direct reimbursement compensation, physician economic credentialing, and true patient-centric medicine. Physicians should realize the power of networking, vertical integration, and the establishment of virtual offices that come together to treat a patient and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not a magnificent office suite or onsite presence.

B. Rule 2

Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus, and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking.” Do traditionalists or collective health care reform advocates react rationally or irrationally?

For example, some health care competition and career thought-leaders, such as Shirley Svorny, PhD, a professor of economics and chair of the Department of Economics at California State University, Northridge, wonder if a medical degree is a barrier—rather than enabler—of affordable health care. An expert on the regulation of health care professionals, including medical professional licensing, she has participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that licensure not only fails to protect consumers from incompetent physicians, but, by raising barriers to entry, makes health care more expensive and less accessible.

Institutional oversight and a sophisticated network of private accrediting and certification organizations, all motivated by the need to protect reputations and avoid legal liability, offer whatever consumer protections exist today.

C. Rule 3

Differentiate yourself among your health care peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors must create and innovate, not blindly follow entrenched medical societies into oblivion.

For example, the establishment of virtual medical schools and hospitals, where students, nurses, and doctors learn and practice their art on cyber entities that look and feel like real patients, can be generated electronically through the wonders of virtual reality units.

D. Rule 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of quick change with fast, but informed decision making. Do what you love, disregard what you do not, and let the fates have their way with you.

Assessment

I receive a couple of phone calls each month from young doctors on this topic. I ask them to decide if they are of the philosophical ilk to adhere to the above rules; or become another conformist and go along … to get along? In other words, get fly!

Or, become an employed, or government doctor.  Just remember … the entity that gives you a job, can also take it away.

Sample fly: http://crossoverhealth.com/

Conclusion

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

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
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Are Physicians Really Going Broke?

Am I Prescient, Lucky or Just an Observant Trend Reporter?

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

A few years ago I was involved in a Physician’s Money Digest report that showed the average physician reader (ie, 47 years old and $184,000 in annual income) would need about $5.5 million to retire. This was in 2007-08, right before the infamous financial “meltdown”.

Lifestyle Preservation

Now, that’s if they planned to have the same lifestyle after retirement as in the years just prior to retirement. In other words, to live on 80% of pre-retirement income, my doctor colleagues would need about $4.4 million. Although that isn’t exactly loose change, the average PMD reader at the time, had a head start, with a net worth of $1.1 million. By maxing out on retirement plans, we reckoned the average reader could be in shouting distance of the goal by age 65.

Although the figures were daunting, they were a wakeup call to the fact these doctors, now age 52-53, still needed to save more aggressively to be able to finance the retirement they were working toward. But since then, their home worth and practice value, savings, investment and retirement accounts are probably down in 2012; as is their net worth. Down –  and I mean way down!

Link: http://www.physiciansmoneydigest.com/issues/2005/92/3951

Fast Forward to 2012

Today, some pundits posit that doctors in America are harboring an embarrassing secret: Many of them are going broke. This quiet trend and seeming reality, which is spreading nationwide, is claiming a wide range of casualties including family physicians, cardiologists and oncologists. Sadly, it is a trend that I have professionally observed and personally seen.

Link: http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. And, no doubt, these are all true reasons – in part. But, some experts counter that doctors’ lack of business acumen is also to blame.

So, that’s why we started our physician focused financial planning firm www.MedicalBusinessAdvisors.com  –  and – our online educational program for their managerial consultants and financial advisors www.CertifiedMedicalPlanner.com These firms were conceived and launched more than a decade ago; to much derision and haughtiness at the time. Not some much today, however! Why?

Assessment

A decade ago, Forbes magazine ran an article about doctors making six figure salaries and still wanting a medical union to bargain collectively.  This was a bit difficult for the average man or woman in the street to imagine about such learned professionals, formerly considered affluent and a cut above the rest. So, where is medical union clout today? Where is MD salary clout? And, where is physician net worth now – and in the future?  Doctor – what’s in your wallet?

Conclusion           

And so, your thoughts and comments on this ME-P are appreciated. Are doctors really going broke? Are they OWS…ers? Was I prescient, lucky or just an observant reporter of this trend, early on? Please review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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