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Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.
Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.
CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].
As fellow doctors, we understand better than most the more complex financial challenges physicians can face when it comes to their financial planning. Of course, most physicians ultimately make a good income, but it is the saving, asset and risk management tolerance and investing part that many of our colleagues’ struggle with. Far too often physicians receive terrible guidance, have no time to properly manage their own investments and set goals for that day when they no longer wish to practice medicine.
For the average doctor or healthcare professional, the feelings of pride and achievement at finally graduating are typically paired with the heavy burden of hundreds of thousands of dollars in student loan debt.
You dedicated countless hours to learning, studying, and training in your field. You missed birthdays and holidays, time with your families, and sacrificed vacations to provide compassionate and excellent care for your patients. Amidst all of that, there was no time to give your finances even a second thought.
Between undergraduate, medical school, and then internship and residency, most young physicians do not begin saving for retirement until late into their 20s, if not their 30s. You’ve missed an entire decade or more of allowing your money and investments to compound and work for you. When it comes to addressing your financial health and security, there’s no time to waste.
And you may be misled by unscrupulous “advisors”.
For example:
Question: Do you know the difference between a “Fee-Only” and a “Fee-Based financial advisor? Not knowing may cost you tens of thousands of dollars, or more, in excessive advisory fees.
Posted on November 5, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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“The Medicare physician payment schedule released today is an unfortunate continuation of a two-decade march in making Medicare unsustainable for patients and physicians.
For 2024, the new rule indicates there will be another downward adjustment of 3.4 percent, on top of the 2 percent payment reduction in 2023. At the same time, the payment schedule confirms the Medicare Economic Index (MEI) increase at 4.6 percent, the highest this century and on top of last year’s 3.8 percent. MEI is the government measure of inflation in medical practice costs. “
“When adjusted for inflation, Medicare physician payment already has effectively declined 26% from 2001 to 2023 before additional inflation and these cuts are factored in.”
Merck reported $640 million in sales for its Covid-19 drug, Lagevrio, in Q3 earnings, blowing past analyst expectations of $140.8 million. Covid drug sales have dropped for most big pharma companies this year, with Pfizer lowering its total expected 2023 earnings by about $9 billion due mostly to declining Paxlovid sales. Merck attributed the boost to increasing demand for Lagevrio in Japan.
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California’s largest health system agreed to a $200 million settlement on October 12th following an investigation that found the system has failed to provide timely behavioral health appointments for patients and has canceled more than 100,000 appointments.
Kaiser Permanente, which also runs a health plan, will “undertake a systemic overhaul” of its behavioral health services, Mary Watanabe, director of the Department of Managed Health Care (DMHC), the regulatory body that oversees managed care plans in California, said in a statement. The DMHC began investigating Kaiser in May 2022 after the Oakland-based health system saw a 20% increase in behavioral health patient complaints in 2021, the DMHC said in a statement.
President President Biden spoke Tuesday afternoon on what the White House has called a crackdown on “junk fees” in retirement planning. Such fees chip away at account balances over time, leading to lifetime savings that are up to 20% less than if advisors were held to the highest standards, according to a White House statement.
Under current regulations, advisors who provide advice to workers rolling their 401(k) or related plan into an individual retirement account are generally not considered a fiduciary—that is, a professional who must put clients’ interests ahead of their own. This means that an advisor could steer an investor into, say, an annuity that pays the advisor a big commission, even if it’s not the best option for the investor. In some cases, commission costs and other fees are baked into the product, as opposed to paid outright, and investors don’t realize that they are silently eating into returns over time.
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The Federal Reserve left interest rates unchanged Wednesday as it continues to track inflation and the health of the economy. The central bank voted unanimously to leave its primary interest rate in the range of 5.25% to 5.50%. U.S. interest rates are the highest they’ve been in 23 years. That means interest rates on loans such as mortgages have gone up sharply, and so have payments on Treasury bonds and interest-bearing accounts.
Here is where the major benchmarks ended:
The S&P 500 Index was up 44.06 points (1.1%) at 4,237.86; the Dow Jones Industrial Average (DJI) was up 221.71 points (0.7%) at 33,274.58; the NASDAQ Composite was up 210.23 points (1.6%) at 13,061.47.
The 10-year Treasury note yield (TNX) was down about 11 basis points at 4.761%.
CBOE’s Volatility Index (VIX) was down 1.30 at 16.84.
In addition to technology, communication services and utilities were among the strongest sectors Wednesday. Energy shares were under pressure as crude oil futures extended this week’s slump and ended at a two-month low. The U.S. dollar index (DXY) tumbled from an earlier rally to a one-month high, potentially reflecting expectations that domestic interest rates may be near a peak.
The average cost of a health insurance plan offered through an employer rose 7% this year, to $23,968 for family plans and $8,435 for individuals, according to a new survey from the private health foundation KFF.
The jump—the highest since 2011—was driven by inflation, as well as higher wages for healthcare workers and hospital system mergers, health policy experts say. Here’s what it means for employers and the 150+ million Americans who get insurance through work:
The increase amounted to ~$500 more out of pocket for family plan-holders, and $75 more for solo riders—further squeezing consumer spending power, which is already constrained by wages that haven’t caught up to high inflation.
Employers often bear the brunt of increased health spending because, in the interest of staying competitive, they’re wary of offloading too much of the rising costs onto their workers. That’s likely why deductibles haven’t grown much in the past five years.
KANSAS CITY, Mo.—A federal jury just found the National Association of Realtors and large residential brokerages liable for about $1.8 billion in damages after determining they conspired to keep commissions for home sales artificially high. The verdict could lead to industry wide upheaval by changing decades-old rules that have helped lock in commission rates even as home prices have skyrocketed—which has allowed real-estate agents to collect ever-larger sums. It comes in the first of two antitrust lawsuits arguing that unlawful industry practices have left consumers unable to lower their costs even though internet-era innovations have allowed many buyers to find homes themselves online.
The Sitzer/Burnett class action lawsuit alleged that some of the nation’s largest real estate companies, including NAR, Keller Williams, Anywhere (formerly, Realogy), RE/MAX, Berkshire Hathaway’s HomeServices of America and two of its subsidiaries conspired to inflate commissions.
Over 12% of American families, or over 16 million, are millionaires, per the WSJ.
Median net worth for the 80th-90th income percentile saw net worth gains of 69% from 2019 to 2022.
The upper-middle class is growing and becoming wealthier, particularly among those aged 55-74.
It’s not just the top 1% that’s getting richer — over 16 million American families now have a net worth over $1 million. That’s over 12% of American families, according to a Wall Street Journal analysis of the Federal Reserve’s Survey of Consumer Finances of over 4,600 American households. This compares to just 9.8 million families who were millionaires in 2019, the WSJ found.
The analysis further noted how nearly eight million families have wealth over $2 million, compared to 4.7 million in 2019. This was particularly pronounced among families in the 55-74 age range. On the whole, median net worth — which measures household assets like houses and vehicles, minus debts like mortgages and student loans — rose an inflation-adjusted 37% between 2019 and 2022 up to around $193,000. Meanwhile, the average net worth rose to over $1 million, though this is skewed by extremely wealthy Americans.
Net worth has increased for all income percentiles even amid rising interest rates, though while the top 10% jumped from $1.84 million to $2.65 million, the bottom 20% rose from $10,780 to $16,900.
Finally, here is where the major US stock market benchmarks ended:
Economists expect the Fed to leave interest rates unchanged today, allowing previous rate increases to take greater hold of the economy and granting the central bank time to assess whether another hike will be necessary. Investors and policymakers will closely scour comments made by Fed Chair Jerome Powell for clues about the central bank’s path over the remainder of the year.
The S&P 500 Index was up 26.98 points (0.7%) at 4,193.80, down 2.2% for the month; the Dow Jones Industrial Average was up 123.91 points (0.4%) at 33,052.87, down 1.4% for the month; the NASDAQ Composite was up 61.76 points (0.5%) at 12,851.24, down 2.8% for the month.
The 10-year Treasury note yield was up about 3 basis points at 4.909%.
CBOE’s Volatility Index (VIX) was down 1.61 at 18.14.
Real estate and financial shares were among the strongest performers Tuesday. Semiconductor companies were also higher. Energy shares lagged as crude oil futures extended their slide, dropping to near $81 a barrel to end at a two-month low. The U.S. dollar index (DXY) strengthened to near 11-month highs in the wake of a Bank of Japan (BoJ) policy shift.
At D.E. Marcinko & Associates our clients traditionally includephysicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
D.E.Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
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But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
In the last 20 months, the US Federal Reserve has jacked up interest rates to a 22-year high to tame soaring inflation. And inflation has come down to about half of its June 2022 peak. But the economy is still strong.
The Fed’s rate-hiking jamboree was expected to slow hiring, spending, and broader economic growth as unfortunate side effects of popping the inflation balloon. However, a series of recent reports shows that the US economy is still roaring in the ’20s:
Jobs: Employers smashed expectations by adding 336,000 jobs in September, and the unemployment rate remains at a low level of 3.8%.
Spending: Retail sales also blew past estimates in September, a sign that American consumers remain the undisputed shopping world champs. This probably helped: Americans’ household wealth surged 37% from 2019 to 2022, according to Fed data released on Wednesday. That’s more than double the second-highest increase on record.
Economy: After the strong retail sales numbers came out this week, Morgan Stanley raised its Q3 economic growth outlook to 4.9% from 4.5%. Context: One year ago this week, Bloomberg economists predicted a 100% chance of a recession…within a year.
The markets are down again and stocks continued their September slump with tech companies getting hit especially hard as investors fretted about another possible Fed rate hike because of data showing prices for manufacturing and services trending upward. It was a mixed bag for the meme stock faithful, with AMC hitting an all-time low after releasing a plan to sell new shares and GameStop rising after-hours thanks to better-than-expected sales last quarter.
This all may demonstrate that private companies looking to fund growth in this high-interest rate environment are facing a tough time raising capital amidst falling valuations, according to a new Deloitte survey.
The problem is particularly acute for smaller companies. Many of the companies challenged by capital raising saw themselves putting out the “For Sale” sign within the next six months, which could lead to an M&A boom later this year.
“The No. 1 largest factor that people saw as a challenge or a barrier was a decrease in valuations of their business,” Wolfe Tone, vice chair and US and Global Deloitte Private leader, told CFO Brew. “Clearly, increasing interest rates and pricing was closely behind that. Liquidity challenges not far behind that.”
Private companies have been looking to raise capital to fund a range of growth initiatives; meeting talent needs and expanding tech capabilities are at the top of the list, Tone said. Not far behind was “increasing productivity and improving cost structures.”
Posted on October 9, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
The Institute of Medical Business Advisors is a leading national scope provider of healthcare economics, finance, investing, managerial accounting, policy, management and business administration education and medical practice management textbooks, reports, hand-books, dictionaries, journals, white-papers, fair-market valuations [FMV] and legal advisory opinions using multi-platform and traditional seminars and channels of knowledge distribution. iMBA helps the nation’s financial, healthcare and education professionals make decisive improvements in their direction and performance by empowering them through unbiased information, consultants and proprietary tools, books, templates and B-school styled case models.A virtuous “win-win” situation for all concerned.
The firm serves universities, medical, business, graduate and nursing schools; physicians, dentists, attorneys and legal societies – accountants, financial service providers, stock brokers, RIAs, wealth and hedge fund managers – emerging entities, hospitals, clinics, outpatient centers, CXOs and their BODs – the press, media and related academic entities.
Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.
Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.
CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].
As a new physician investor, it’s important to know the distinctions between like measurements because the market allows firms to advertise their numbers in ways not otherwise regulated. Often companies will publicize their numbers using either GAAP or non-GAAP measures. GAAP, or generally accepted accounting principles, outlines rules and conventions for reporting financial information. It is a means to standardize financial statements and ensure consistency in reporting.
When a company publicizes its earnings and includes non-GAAP figures, it means it wants to provide investors with an arguably more accurate depiction of the company’s health (for instance, by removing one-time items to smooth out earnings). However, the further a company deviates from GAAP standards, the more room is allocated for some creative accounting and manipulation.
When looking at a company that is publishing non-GAAP numbers, new physician investors should be wary of these pro forma statements, because they may differ greatly from what GAAP deems acceptable.
GAAP is set forth in 10 primary principles, as follows:
Principle of consistency: This principle ensures that consistent standards are followed in financial reporting from period to period.
Principle of permanent methods: Closely related to the previous principle is that of consistent procedures and practices being applied in accounting and financial reporting to allow comparison.
Principle of non-compensation: This principle states that all aspects of an organization’s performance, whether positive or negative, are to be reported. In other words, it should not compensate (offset) a debt with an asset.
Principle of prudence: All reporting of financial data is to be factual, reasonable, and not speculative.
Principle of regularity: This principle means that all accountants are to consistently abide by the GAAP.
Principle of sincerity: Accountants should perform and report with basic honesty and accuracy.
Principle of good faith: Similar to the previous principle, this principle asserts that anyone involved in financial reporting is expected to be acting honestly and in good faith.
Principle of materiality: All financial reporting should clearly disclose the organization’s genuine financial position.
Principle of continuity: This principle states that all asset valuations in financial reporting are based on the assumption that the business or other entity will continue to operate going forward.
Principle of periodicity: This principle refers to entities abiding by commonly accepted financial reporting periods, such as quarterly or annually.
Posted on October 3, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
Hospitals are Dropping Medicare Advantage [Part C] Plans – Left and Right
By Dr. David Edward Marcinko MBA
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Hospitals SayBye-Bye?
Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether. Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
“It’s become a game of delay, deny and not pay,” Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker’s. “Providers are going to have to get out of full-risk capitation because it just doesn’t work — we’re the bottom of the food chain, and the food chain is not being fed.” Van Gorder said the health system is facing a loss of $75 million this year on the MA contracts, which will end December 31st for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers.
Source: Becker’s Hospital Review [9/27/23]
COMMENTS APPRECIATED
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Cigna to Pay $172M Over Alleged Medicare Advantage Fraud
The Cigna Group will pay $172.3 million to resolve allegations that it violated the False Claims Act by submitting incorrect Medicare Advantage patient data to CMS to receive higher payments from the agency. The U.S. Attorney’s Office for the Eastern District of Pennsylvania alleged Sept. 30 that Cigna also falsely certified that the submitted data was accurate, failed to withdraw the “untruthful” data, and did not repay CMS.
Cigna will use $135.3 million from the settlement to resolve the allegations from the Justice Department. The remaining $37 million will resolve allegations related to unsupported diagnoses for Medicare Advantage enrollees that received in-home services from Cigna. As part of the settlement, Cigna has entered into a five-year accountability and auditing agreement with HHS’ Office of Inspector General, which will require company executives and board members to certify Cigna’s compliance moving forward. The payer must also conduct annual risk assessments and submit to independent risk adjustment audits.
Source: Jakob Emerson, Becker’s Payer Issues [10/2/23]
Earnings before interest, taxes, depreciation, and amortization
A company’s earnings before interest, taxes, depreciation, and amortization is an accounting measure calculated using a company’s earnings, before interest expenses, taxes, depreciation, and amortization are subtracted, as a proxy for a company’s current operating profitability. Though often shown on an income statement, it is not considered part of the Generally Accepted Accounting Principles by the SEC.
A medical practice name should be easy to say, hear, spell, and remember-unlike prescription drugs. It should be appealing and resonate with your target patient base. Here are some common naming methods for small to medical medical practices use.
We, and most experts, recommend against naming a new medical practice with your own name because it limits future growth and you may lose the benefits that a more descriptive name would bring. Your business name will likely be incorporated using your practice’s name, although larger (multi-specialty group) practices may use a more general name for the entire enterprise; and then having multiple “dba’s” (”Doing Business As”) for the individual practices under the umbrella.
It is important to discuss these options with an attorney if you believe this arrangement has advantage; others find it confusing. Usually, your medical specialty can be used as a base-name, and then some descriptor to differentiate it from local competing practices. Selecting a name like “The Medical Allegiance Partners” does not indicate that medicine is your service. On the other hand, naming your practice “Dental Associates of Your Town” won’t be helpful to patients looking for you in the yellow pages, or internet search engines, and finding your practice listed just before “Your Town Dental Partners”. It is therefore good to be cognizant of your competitors’ names when choosing your own.
And, you should select a name that will hopefully grow with you into a larger enterprise.
For example: You are a solo doctor, but are pretty sure you’ll take on one or more partners in the future? Then besides not naming your practice after yourself, you may choose to add “Group” or “Partners” to your name initially even if you’re the only doctor.
Moreover, is there any possibility you’ll open a second office in another town? Naming your medical practice something like the ”Apple Street Internal Medicine Group” may not make sense when your second office is opened on Main Street in a nearby city, in a few years.
Several years ago a group of highly trusted and deeply experienced financial services professionals and estate planners noted that far too many of their mature 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 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, 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 was a confirmation of the industry culture which seemed to be: Bread for the advisor – Crumbs for the client!
And so, at D.E. Marcinko & Associates, our informed cadre’ of technology focused and highly educated doctors, nurses, financial advisors, attorneys, accountants, psychologists and educational visionaries decided there must be a better way for healthcare colleagues to receive financial planning advice, products and related management services within a culture of fiduciary responsibility.
We trust you agree with this ME Inc, and Certified Medical Planner™ consulting philosophy, as illustrated on our website.
We have the ability to provide extensive analysis of value components in healthcare practices and provide appraisals based on business, economic, and market conditions. This involves detailed examination of financials and clinical data in the context of numerous factors including medical specialty, physician supply and demand, payer mix, regulatory environment, regional dynamics, and risk premium.
At Marcinko & Associates our clients traditionally includephysicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
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But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
Did you know that at MARCINKO & Associates, all medical colleagues throughout the United States may contact us when they are considering the sale, purchase, strategic operating improvement, merger, acquisition and/or other financial business or related personal financial planning transaction?
Our difference is “hard” knowledge and insider financial guidance that helps medical colleagues, nurses, private practitioners, clinics, ambulatory surgery, radiology and outpatient wound care centers realize their ultimate economic goals. This typically includes managerial and cost accounting, financial ratio analysis, fair market valuation business appraisals, business plan creation and personal financial planning.
Our “expert witness” business litigation support service and divorce mediation, arbitration, asset division, settlement and second opinion offerings are always available, as well.
And, our “soft” skill professional career guidance and mentoring center includes executive coaching, consulting and mentoring advisory programs for stressed, conflicted or burned-out physicians and medical practitioners.
Most importantly, our professional fees are reasonable and always transparent.
MARCINKO & Associates also serves universities, medical, business, graduate and nursing schools; physicians, dentists, podiatrists, optometrists and legal societies. This includes accountants, financial service providers, wealth and hedge fund managers, emerging entities, hospitals, CEOs and their BODs, the press, media and related organizations.
We have the ability to provide extensive analysis of value components in healthcare practices and provide appraisals based on business, economic, and market conditions. This involves detailed examination of financials and clinical data in the context of numerous factors including medical specialty, physician supply and demand, payer mix, regulatory environment, regional dynamics, and risk premium.
At D.E. Marcinko & Associates our clients traditionally includephysicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
D.E.Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
***
But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
From 2020 to 2021, when VC money was cheap and tech IPOs were hot, the tech companies that went public via IPO were mostly growth-focused unicorns that had yet to see any profits. But Instacart, which has turned a profit for the last five quarters, is something different.
Chip design company Arm, which debuted last week in the year’s biggest IPO, was the first venture-capital-backed startup to go public in the US since December 2021. It may have broken the ice, but Instacart is the next big test.
However, being profitable and being valuable aren’t the same thing. In 2020, investors valued Instacart at $39 billion, its highest valuation and roughly $29 billion more than what it’s expected to be worth to investors today.
Late-stage investors in Instacart, such as Fidelity and T. Rowe Price, stand to lose 40% or more.
Sequoia Capital—Instacart’s largest external shareholder—was also one of its earliest. Its initial $8 million investment in 2013 is worth $1 billion today, but its later investment of $50 million in 2021 has shrunk to $12 million.
At D.E. Marcinko & Associates our clients traditionally includephysicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
D.E.Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
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But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
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Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
Did you know that at MARCINKO & Associates, all medical colleagues throughout the United States may contact us when they are considering the sale, purchase, strategic operating improvement, merger, acquisition and/or other financial business or related personal financial planning transaction?
Our difference is “hard” knowledge and insider financial guidance that helps medical colleagues, nurses, private practitioners, clinics, ambulatory surgery, radiology and outpatient wound care centers realize their ultimate economic goals. This typically includes managerial and cost accounting, financial ratio analysis, fair market valuation business appraisals, business plan creation and personal financial planning.
Our “expert witness” business litigation support service and divorce mediation, arbitration, asset division, settlement and second opinion offerings are always available, as well.
And, our “soft” skill professional career guidance and mentoring center includes executive coaching, consulting and mentoring advisory programs for stressed, conflicted or burned-out physicians and medical practitioners.
Most importantly, our professional fees are reasonable and always transparent.
MARCINKO & Associates also serves universities, medical, business, graduate and nursing schools; physicians, dentists, podiatrists, optometrists and legal societies. This includes accountants, financial service providers, wealth and hedge fund managers, emerging entities, hospitals, CEOs and their BODs, the press, media and related organizations.
At Marcinko & Associates our clients traditionally includephysicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
***
But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.
Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.
CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].
At Marcinko & Associates our clients traditionally includephysicians [MD, MBBS and DO], dentists [DDS and DMD], podiatrists [DPM], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.
The above are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, etc].
Marcinko & Associates understands the complexity of financial and non-financial deal terms because we are also doctors. Our “hard” knowledge of your business comes from being actual healthcare facility owners, operators and medical practitioners [with additional professional licenses and expertise] enabling us to effectively analyze your business, take corrective measures and present your healthcare entity in the best possible and accurate light.
***
But, if you’re looking at this website, chances are you are fed up, burned out, seeking practice management techniques or a better work-life balance. Or, you are looking for a new non-clinical career, thinking of finance, investing, retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical or professional career? This is known as “soft” psychology, coaching, personal consulting or fraternal advice.
***
Regardless, of your “soft” personal or “hard” corporate needs, our transparent Fees for Service [FFS] model is moderated for all colleagues based on the acuity and urgency of their engagements. Reduced rates and/or limited charity work may also be possible.
Venture capital funding in the digital health space cooled a bit in 2022 following a red-hot 2021. Overall, digital health companies raised $15.3 billion last year, down from the $29.1 billion raised in 2021—but still above the $14.1 billion raised in 2020, according to Rock Health a seed fund that supports digital health startups.
Nevertheless, analysts predict VC investors and bankers will still put a good amount of money into digital health in 2024 and 2025, especially in alternative care, drug development, health information technology technology, EMRs and software that reduces physician workload.
Of course. an essential first part of attracting VC interest and money is the crafting and presentation of your formal business plan [“elevator pitch”]; as well as the needed technical and managerial experience. This is crucial for success and exactly where we can assist.
Venture capital funding in the digital health space cooled a bit in 2022 following a red-hot 2021. Overall, digital health companies raised $15.3 billion last year, down from the $29.1 billion raised in 2021—but still above the $14.1 billion raised in 2020, according to Rock Health a seed fund that supports digital health startups.
Nevertheless, analysts predict VC investors and bankers will still put a good amount of money into digital health in 2024 and 2025, especially in alternative care, drug development, health information technology technology, EMRs and software that reduces physician workload.
Of course. an essential first part of attracting VC interest and money is the crafting and presentation of your formal business plan [“elevator pitch”]; as well as the needed technical and managerial experience. This is crucial for success and exactly where we can assist.
DEFINITION: One way to accelerate and support learning is with continuous up-skilling. A key component is micro-certification and credentialing, which is best thought of as learning that happens in smaller “chunks” — such as boot-camp training, an online course from a university or other provider, or even an apprenticeship.
When competency in a specific knowledge area or skill is demonstrated, a micro-certification is issued, which can be listed on a resume or displayed as a “badge” or a mastery credit on an online profile.
Over time, individuals can amass portfolios of competencies that characterize their capabilities in a way that is much more relevant to their professional lives than relying solely on academic credentials.
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So – Do you ever wish you could acquire specific information or subject matter expertise for your career activities without having to complete a college or university Master’s Degree in Business or finish our entire online Certified Medical Planner™ professional certification and designation program?
Topics include: economics, finance, investing, marketing, advertising, sales, start-ups, business plan creation, financial planning and entrepreneurship, etc.
Well, Micro-Certifications and Credentials from the Institute of Medical Business Advisors, Inc., might be an alternative knowledge pursuit.
Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.
Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.
CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].
Posted on August 9, 2023 by Dr. David Edward Marcinko MBA MEd CMP™
RICHARD CAYNE
By Staff Reporters
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SEC money market fund reforms: On July 12, 2023 the SEC released new rules intended to decrease the risk of runs on money market funds (MMFs). MMFs must charge liquidity fees if their daily net redemptions exceed 5% of their net assets, or if their boards deem it necessary, and must maintain a liquidity buffer of at least 25% of their total daily assets and at least 50% of their weekly assets. MMFs are also no longer allowed to use “gates” to temporarily suspend redemption!
In more than 118,000 real transactions at the university bookstore, buyers tended to slap their plastic on the counter for school supplies but pay with cash for “harder-to-justify” items like a stuffed plush mascot. And when asked how they’d pay for a hypothetical Reiki session, participants leaned toward credit card when the treatment was described as doctor-recommended but toward cash when they were told it was just an impulse purchase.
Experts estimate that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves the profession because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt [Mayo Clinic researcher and Stanford Medicine’s first Chief Physician Wellness Officer] said Stanford, Harvard Business School, Mayo Clinic and the American Medical Association (AMA) are further cost estimating the issue. Nevertheless, Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.
Fortunately, we can help. From formal coaching to second career opinions, mentoring and advising, we can help with our remediation executive career programs. Regardless of what is happening in your life, it is wonderful to have a non-partial, confidential and informed career coach and sounding board on your side.
CITE: JAMA Internal Medicine [Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians].