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PHYSICIAN PAYMENT: Direct Reimbursement Models

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

By Dr. David Edward Marcinko MBA MEd

BASIC DEFINITIONS

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The Direct Reimbursement Payment Model allows physicians to receive payment directly from patients or employers, bypassing traditional insurance systems. This model emphasizes transparency, autonomy, and personalized care, offering an alternative to fee-for-service and managed care structures.

The Direct Reimbursement Payment Model is a healthcare financing approach in which physicians are paid directly by patients or sponsoring entities—such as employers—rather than through insurance companies or government programs. This model is gaining traction as a response to the administrative burdens, opaque billing practices, and fragmented care often associated with traditional insurance-based systems.

One prominent example of direct reimbursement is Direct Primary Care (DPC). In DPC, patients pay a recurring fee—monthly, quarterly, or annually—that covers a broad range of primary care services. These include routine checkups, preventive screenings, chronic disease management, and basic lab work. By eliminating third-party billing, DPC practices reduce overhead costs and administrative complexity, allowing physicians to spend more time with patients and focus on quality care.

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Employers have also embraced direct reimbursement models to manage healthcare costs and improve employee wellness. In such arrangements, employers reimburse physicians or clinics directly for services rendered to their employees, often through a defined benefit structure. This can be part of a self-funded health plan or a supplemental offering alongside high-deductible insurance policies. The goal is to provide accessible, cost-effective care while avoiding the inefficiencies of traditional insurance networks.

Key advantages of the direct reimbursement model include:

Price transparency: Patients know upfront what services cost, reducing surprise billing and financial stress.
Improved access: Physicians often offer same-day or next-day appointments, extended visits, and direct communication via phone or email.
Lower administrative burden: Without insurance paperwork, practices can operate more efficiently and focus on patient care.
Stronger patient-physician relationships: More time per visit fosters trust, continuity, and better health outcomes.

However, the model is not without limitations. Direct reimbursement may not cover specialist care, hospitalization, or emergency services, requiring patients to maintain supplemental insurance. Additionally, the model may be less accessible to low-income populations who cannot afford recurring fees or out-of-pocket payments. Critics also argue that widespread adoption could fragment care and reduce risk pooling, undermining the broader goals of universal coverage.

Despite these concerns, the direct reimbursement model aligns with broader trends in healthcare reform, including value-based care, consumer empowerment, and decentralized service delivery. It offers a viable path for physicians seeking autonomy and for patients desiring personalized, transparent care. As healthcare continues to evolve, hybrid models that combine direct reimbursement with traditional insurance may emerge, offering flexibility and choice across diverse patient populations.

In conclusion, the Direct Reimbursement Payment Model represents a meaningful shift in how healthcare services are financed and delivered.

By prioritizing simplicity, transparency, and patient-centered care, it challenges the status quo and opens new possibilities for sustainable, high-quality medical practice.

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EDUCATION: Books

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

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Filed under: "Doctors Only", Ask a Doctor, Career Development, Funding Basics, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Insurance Matters, Managed Care, Marketing & Advertising | Tagged: ACOs, david marcinko, direct primary are, direct reimbursement payment, DO, doctors, DPC, DPM, health, healthcare, MD, mental health, physicians, value based csare, VBC | Leave a comment »

REAL-WORLD FINANCE: How Some RNs Can Retire Richer Than Physicians

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

By Dr. David Edward Marcinko MBA MEd

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For generations, the prevailing belief in healthcare has been that physicians [MD, DO and DPM], with their high salaries and prestige, inevitably retire wealthier than nurses. Yet this assumption overlooks the financial realities of different nursing specialties and the long‑term impact of debt, lifestyle, and retirement planning. In fact, some Registered Nurses (RNs)—particularly Certified Registered Nurse Anesthetists (CRNAs), visiting nurses, and those who participate in structured pay programs like the Baylor plan—can retire richer than physicians. The reasons lie in the interplay of education costs, career flexibility, income potential, and disciplined financial planning.

Education Costs and Debt Burden

One of the most decisive factors shaping retirement wealth is the cost of education. Physicians often spend over a decade in training, including undergraduate studies, medical school, and residency. This path not only delays their earning years but also saddles them with substantial student debt. The median medical school debt in the United States exceeds $200,000, and many physicians spend years paying it down.

By contrast, RNs typically complete their training in two to four years, with advanced practice nurses such as CRNAs requiring graduate‑level education. Even so, their debt burden is far lighter, often less than half of what physicians carry. This difference means nurses can begin earning earlier, save for retirement sooner, and avoid the crushing interest payments that erode physicians’ wealth. A CRNA who starts practicing in their late twenties may already be investing in retirement accounts while a physician is still in residency earning a modest stipend.

Income Potential of Specialized Nurses

While physicians generally earn more annually than nurses, the gap is narrower in certain specialties. CRNAs, for example, are among the highest‑paid nursing professionals, with average salaries often exceeding $200,000 per year. This places them in direct competition with some physician specialties, especially primary care doctors, who may earn similar or even lower salaries.

Visiting nurses also benefit from unique financial advantages. Many work on flexible schedules, contract arrangements, or per‑visit compensation models. This allows them to maximize income while minimizing burnout. By avoiding the overhead costs of private practice and the administrative burdens physicians face, visiting nurses can channel more of their earnings directly into savings and investments.

When combined with lower debt and earlier career starts, these income streams can compound into significant retirement wealth.

💰 Highest-Paying Nursing Careers (2025)

Certified Registered Nurse Anesthetist (CRNA) – ~$212,000 annually
Nurse Practitioner (NP) – $120,000–$140,000+ depending on specialty (Family, Acute Care, Psychiatric)
Clinical Nurse Specialist (CNS) – $120,000–$135,000
Nurse Midwife – ~$115,000
Nurse Manager/Administrator – $110,000–$120,000
Informatics Nurse Specialist – ~$115,000
Neonatal ICU Nurse (NICU) – $110,000+
ICU Nurse – $105,000+
Pain Management Nurse – ~$104,000
Oncology Nurse – ~$100,000

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The Baylor Pay Plan Advantage

The Baylor plan, a structured pay program used by some hospitals, allows nurses to work full‑time hours compressed into fewer days—often weekends—while still receiving full‑time pay and benefits. This arrangement provides several financial advantages. First, it enables nurses to earn competitive wages while freeing up weekdays for additional work, education, or entrepreneurial ventures. Second, it reduces commuting and childcare costs, allowing more income to be saved. Third, the plan often includes robust retirement benefits, such as employer‑matched contributions to 401(k) or pension programs.

Nurses who consistently participate in such structured pay plans can accumulate substantial nest eggs, often surpassing physicians who delay retirement savings due to debt repayment or lifestyle inflation. The Baylor plan highlights the importance of systematic investing: by automating contributions and focusing on long‑term growth, nurses can harness the power of compound interest. A nurse who invests steadily for 35 years may accumulate more wealth than a physician who begins saving late and inconsistently, despite earning a higher salary.

Lifestyle and Work‑Life Balance

Another overlooked factor is lifestyle. Physicians often face grueling schedules, high stress, and the temptation to maintain expensive lifestyles commensurate with their social status. Luxury homes, cars, and vacations can erode their financial base. Nurses, while not immune to lifestyle inflation, often maintain more modest spending habits.

Visiting nurses, in particular, enjoy flexibility that allows them to balance work with personal life. This reduces burnout and healthcare costs while enabling consistent employment into later years. By living within their means and prioritizing savings, nurses can accumulate wealth steadily without the financial pitfalls that sometimes accompany physician lifestyles.

Retirement Wealth Beyond Salary

Retirement wealth is not solely determined by annual income. It is shaped by debt management, savings discipline, investment strategies, and lifestyle choices. Nurses who leverage high‑paying specialties like anesthesia, flexible arrangements like visiting nursing, and structured programs like the Baylor plan can outperform physicians in these areas.

Consider two professionals: a physician earning $250,000 annually but burdened by $200,000 in debt and high living expenses, and a CRNA earning $200,000 with minimal debt and disciplined savings. Over decades, the CRNA may accumulate more net wealth, retire earlier, and enjoy greater financial security.

Conclusion

The assumption that physicians always retire richer than nurses is outdated. While physicians command higher salaries, their delayed earnings, heavy debt, and lifestyle pressures often undermine long‑term wealth. Nurses, particularly CRNAs, visiting nurses, and those who participate in structured pay programs like the Baylor plan, can retire wealthier by combining lower debt, earlier savings, competitive incomes, and disciplined financial planning.

Ultimately, retirement wealth is not about prestige but about strategy. Nurses who recognize this truth and act accordingly may find themselves enjoying more financial freedom than the very physicians they once assisted.

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Filed under: "Ask-an-Advisor", finance, Financial Planning, Funding Basics, LifeStyle, Marcinko Associates, Retirement and Benefits | Tagged: Baylor Plan, budgeting, CNS, CRNA, david marcinko, DO, doctors, DPM, finance, Financial Planning, Investing, investments, MD, midwife, NICU, NP, Oncology, personal-finance, physicians, RN, salary reirement | Leave a comment »

PHYSICIAN: Car Repossessions Rise!

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

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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Physicians are increasingly facing car repossessions in 2025 due to rising debt, high vehicle prices, and economic pressures that are reshaping the financial landscape for medical professionals.

Traditionally viewed as financially secure, doctors are now among the growing number of Americans struggling to keep up with auto loan payments. The surge in car repossessions—expected to reach a record 10.5 million assignments by the end of 2025—has not spared the medical community. While physicians often earn higher-than-average incomes, they also carry significant financial burdens, including student loan debt, practice overhead, and personal expenses. These pressures are being amplified by macroeconomic forces such as inflation, high interest rates, and stagnant reimbursement rates.

One of the key contributors to this trend is the soaring cost of vehicles. In 2025, the average price of a new car in the U.S. surpassed $50,000, a dramatic increase from just a decade ago. For physicians who rely on vehicles for commuting between hospitals, clinics, and private practices, owning a reliable car is not a luxury—it’s a necessity. However, the combination of high sticker prices and elevated interest rates—averaging 7.3% for used cars and 11.5% for new cars—has made financing increasingly difficult.

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Even high-income professionals are not immune to the broader auto loan crisis. Subprime auto loan delinquencies reached 6.6% in early 2025, the highest rate in over 30 years.While physicians typically fall into the prime or super-prime credit categories, many are still affected by cash flow disruptions, especially those in private practice or rural areas where patient volumes and insurance reimbursements have declined. Additionally, younger doctors with substantial student debt may find themselves overleveraged, making it harder to keep up with car payments.

The emotional and professional toll of a car repossession can be significant. Beyond the embarrassment and logistical challenges, losing a vehicle can disrupt a physician’s ability to provide care, attend emergencies, or maintain a consistent work schedule. This can lead to further income loss, creating a vicious cycle of financial instability.

To combat this trend, some physicians are turning to financial advisors to restructure their debt, refinance auto loans, or downsize to more affordable vehicles. Others are advocating for systemic reforms, such as student loan forgiveness, higher Medicare reimbursements, and better financial literacy training during medical education.

In conclusion, the rise in car repossessions among doctors is a stark reminder that no profession is immune to economic volatility. As the cost of living continues to climb and financial pressures mount, even those in traditionally stable careers must adapt to protect their assets and livelihoods.

Addressing this issue requires both individual financial planning and broader policy changes to ensure that physicians can continue to serve their communities without the looming threat of personal financial collapse.

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Filed under: "Ask-an-Advisor", Accounting, Ask a Doctor, finance, Financial Planning, Funding Basics, Investing, Marcinko Associates, Taxation, Touring with Marcinko | Tagged: auto costs, auto loans, automobiles, books, car repo man, car repossessions, cash flow, david marcinko, DDS, DO, doctor casr repossessions, doctor debt, DPM, interest rates, MD, medicare, physician debt, physician repossessions, sports, Technology | Leave a comment »

BAD MONEY MOVES of Physicians!

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

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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Money is a powerful tool. It can provide security, open opportunities, and help build a fulfilling life. Yet, when mismanaged, it can quickly become a source of stress and regret. Understanding the worst ways to use money is essential for anyone who wants to avoid financial pitfalls and build lasting stability.

1. Impulse Spending

One of the most damaging habits is spending without thought. Buying items on impulse—whether it’s clothes, gadgets, or luxury goods—often leads to regret and wasted resources. These purchases rarely align with long‑term goals and can drain savings meant for emergencies or investments.

2. High‑Interest Debt

Credit cards and payday loans can trap people in cycles of debt. Paying 20% or more in interest means that even small purchases balloon into massive financial burdens. Using debt irresponsibly is one of the fastest ways to erode wealth.

3. Ignoring Savings and Investments

Failing to save for the future is another critical mistake. Without an emergency fund, unexpected expenses like medical bills or car repairs can derail financial stability. Similarly, neglecting investments means missing out on compound growth that builds wealth over time.

4. Chasing Get‑Rich‑Quick Schemes

From pyramid schemes to speculative “hot tips,” chasing unrealistic returns is a recipe for disaster. These schemes prey on greed and impatience, often leaving participants with nothing but losses. Sustainable wealth comes from patience and discipline, not shortcuts.

5. Overspending on Status

Many people waste money trying to impress others—buying luxury cars, designer clothes, or extravagant experiences they cannot afford. This pursuit of status often leads to debt and financial insecurity, while providing only fleeting satisfaction.

6. Neglecting Insurance

Skipping health, auto, or home insurance to save money may seem smart in the short term, but it can be catastrophic when disaster strikes. Without protection, one accident or emergency can wipe out years of savings.

7. Failing to Budget

Living without a plan is like sailing without a map. Without a budget, it’s easy to overspend, miss bills, or fail to allocate money toward goals. Budgeting is not restrictive—it’s empowering, because it ensures money is used intentionally.

8. Ignoring Education and Skills

Spending money without investing in personal growth is another hidden mistake. Education, training, and skill development often yield lifelong returns. Neglecting these opportunities can limit earning potential and financial independence.

Conclusion

The worst things to do with money often stem from short‑term thinking, lack of discipline, or the desire for instant gratification. Impulse spending, high‑interest debt, chasing schemes, and neglecting savings all undermine financial health. By avoiding these traps and focusing on budgeting, investing wisely, and protecting against risks, money can serve as a foundation for security and freedom rather than a source of stress.

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Filed under: "Ask-an-Advisor", "Doctors Only", economics, Ethics, finance, Financial Planning, Insurance Matters, Investing, Marcinko Associates, Portfolio Management | Tagged: bad money moves, budgeting, CASH, david marcinko, DO, DPM, finance, insurance, interest rates, Investing, investments, MD, money, personal-finance, savings, spending, stocks, wealth manasgement | Leave a comment »

RICARDIAN ECONOMICS: Can it Save Medicine?

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

By Dr. David Edward Marcinko MBA MEd

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Ricardian economics, rooted in the theories of 19th-century economist David Ricardo, emphasizes comparative advantage, free trade, and the neutrality of government debt—most notably through the concept of Ricardian equivalence. While these ideas have shaped macroeconomic thought, their relevance to medicine and healthcare policy is less direct. Still, exploring Ricardian principles offers a provocative lens through which to examine the fiscal sustainability and efficiency of modern healthcare systems.

At the heart of Ricardian equivalence is the idea that consumers are forward-looking and internalize government budget constraints. If a government finances healthcare through debt rather than taxes, rational agents will anticipate future tax burdens and adjust their behavior accordingly. In theory, this undermines the effectiveness of deficit-financed healthcare spending as a stimulus. Applied to medicine, this suggests that long-term fiscal responsibility is crucial: expanding healthcare access through borrowing may not yield the intended economic or health benefits if citizens expect future costs to rise.

This insight could inform debates on healthcare reform, especially in countries grappling with ballooning medical expenditures. Ricardian economics warns against short-term fixes that ignore long-term fiscal implications. For example, expanding public insurance programs without sustainable funding mechanisms could lead to intergenerational inequities and economic distortions. Policymakers might instead focus on reforms that align incentives, reduce waste, and promote cost-effective care—principles that resonate with Ricardo’s emphasis on efficiency and comparative advantage.

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However, Ricardian economics offers limited guidance on the unique moral and practical dimensions of medicine. Healthcare is not a typical market good. Patients often lack the information or autonomy to make rational choices, especially in emergencies. Moreover, the sector is rife with externalities: one person’s vaccination benefits the broader community, and untreated illness can strain public resources. These complexities challenge the assumption of rational, forward-looking behavior central to Ricardian equivalence.

Additionally, Ricardo’s theory of comparative advantage—where nations benefit by specializing in goods they produce most efficiently—has implications for global health. It supports international collaboration in pharmaceutical production, medical research, and telemedicine. Yet, over-reliance on global supply chains can expose vulnerabilities, as seen during the COVID-19 pandemic when countries faced shortages of critical medical supplies.

In conclusion, Ricardian economics provides valuable fiscal insights that can inform healthcare policy, particularly regarding debt sustainability and efficient resource allocation. Its emphasis on long-term planning and comparative advantage can guide reforms that make medicine more resilient and cost-effective. However, the theory’s assumptions about rational behavior and market dynamics limit its applicability to the nuanced realities of healthcare. Medicine requires not just economic efficiency but ethical considerations, equity, and compassion—areas where Ricardian economics falls short. Thus, while it can contribute to the conversation, it cannot “save” medicine alone.

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Understanding the Risks of Capitation in Healthcare

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

By A.I.

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The Pitfalls of Capitation in Medicine

Capitation, a payment model in healthcare where providers receive a fixed amount per patient regardless of the services rendered, has been promoted as a way to control costs and incentivize efficiency. However, despite its theoretical appeal, capitation medicine presents significant drawbacks that can compromise patient care, distort provider incentives, and exacerbate systemic inequities.

One of the most concerning aspects of capitation is the potential for under-treatment. Since providers are paid a set fee per patient, regardless of how much care that patient requires, there is a financial incentive to minimize services. This can lead to situations where necessary tests, referrals, or treatments are delayed or denied in order to preserve profit margins. Patients with complex or chronic conditions—who require more frequent and intensive care—may be especially vulnerable under this model. The risk is that medical decisions become driven by cost containment rather than clinical need, undermining the ethical foundation of healthcare.

NURSING CAPITATION: https://medicalexecutivepost.com/2024/07/07/on-nursing-capitation-reimbursement/

Capitation also introduces challenges in maintaining quality standards. Unlike value-based care, which ties reimbursement to outcomes, capitation focuses solely on cost predictability. Without robust oversight and accountability mechanisms, providers may cut corners or avoid high-risk patients altogether. This can result in cherry-picking, where healthier individuals are favored, and sicker patients are subtly discouraged from enrolling. Such practices not only distort the patient pool but also deepen health disparities, particularly among marginalized populations who already face barriers to care.

Furthermore, capitation can strain the provider-patient relationship. Physicians may feel pressured to limit time spent with each patient or avoid costly interventions, leading to a sense of transactional care rather than personalized attention. This erosion of trust can diminish patient satisfaction and reduce adherence to treatment plans. In a system where providers are rewarded for doing less, the intrinsic motivation to go above and beyond for patients may be compromised.

Operationally, capitation demands sophisticated infrastructure to manage risk, track utilization, and ensure compliance. Smaller practices or those serving underserved communities may lack the resources to implement such systems effectively. This can create a two-tiered system where well-funded organizations thrive while others struggle to deliver basic care. Additionally, the administrative burden of managing capitation contracts, monitoring performance metrics, and navigating complex reimbursement rules can divert attention from clinical priorities.

Critics also argue that capitation may stifle innovation. When providers are locked into fixed budgets, there is little room to experiment with new technologies, therapies, or care models that might improve outcomes but carry upfront costs. This conservative approach can hinder progress and limit access to cutting-edge treatments.

CAPITATION HISTORY: https://medicalexecutivepost.com/2025/09/15/capitation-reimbursement-a-historical-economic-review/

In conclusion, while capitation medicine aims to control costs and streamline care, its inherent risks—under-treatment, inequity, and diminished quality—make it a problematic model when not carefully regulated. To truly reform healthcare, payment systems must balance financial sustainability with ethical responsibility, ensuring that every patient receives the care they need, not just the care that fits a budget.

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Filed under: "Doctors Only", Ask a Doctor, business, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Managed Care | Tagged: capitated medicine, capitation, DDS, DO, doctors, financia pitfalls, managedcare, MD, medical payment models, physicians | Leave a comment »

MEDICAL PRACTICE MARKETING: Strategies for Success

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

By Dr. David Edward Marcinko MBA MEd

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In today’s competitive healthcare landscape, effective marketing is essential for the growth and sustainability of a medical practice. Gone are the days when word-of-mouth alone could sustain a clinic. Patients now seek providers who not only offer excellent care but also communicate their value clearly and consistently. Strategic marketing helps medical practices attract new patients, retain existing ones, and build a strong reputation in the community.

🎯 Understanding the Target Audience

The foundation of any successful marketing strategy is a deep understanding of the target audience. Medical practices must identify the demographics, needs, and preferences of their ideal patients. For example, a pediatric clinic will focus on parents, while a dermatology practice may target young adults concerned with skin health. Tailoring messages to resonate with these groups ensures that marketing efforts are relevant and effective.

🌐 Building a Strong Online Presence

In the digital age, a robust online presence is non-negotiable. A professional, user-friendly website serves as the virtual front door of the practice. It should include essential information such as services offered, provider bios, contact details, and online appointment scheduling. Search engine optimization (SEO) ensures the site ranks well on Google, making it easier for potential patients to find the practice.

Social media platforms like Facebook, Instagram, and LinkedIn offer additional avenues to engage with the community. Regular posts about health tips, staff spotlights, and patient testimonials humanize the practice and foster trust. Paid advertising on these platforms can also target specific demographics, increasing visibility and driving traffic to the website.

🗣️ Leveraging Patient Reviews and Testimonials

Online reviews are a powerful form of social proof. Encouraging satisfied patients to leave positive feedback on platforms like Google, Yelp, and Healthgrades can significantly influence prospective patients. Testimonials can also be featured on the practice’s website and social media channels. Responding to reviews—both positive and negative—demonstrates attentiveness and a commitment to patient satisfaction.

📬 Utilizing Email and Content Marketing

Email marketing remains a cost-effective way to stay connected with patients. Monthly newsletters can include health tips, updates on services, and reminders for annual checkups or vaccinations. Content marketing, such as blog posts and educational videos, positions the practice as a trusted authority in healthcare. This not only boosts SEO but also builds credibility and patient loyalty.

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🤝 Community Engagement and Partnerships

Participating in local events, offering free health screenings, or partnering with schools and businesses can enhance visibility and goodwill. These efforts show that the practice is invested in the well-being of the community, which can translate into increased patient referrals and long-term relationships.

📊 Measuring Success

Finally, tracking the performance of marketing campaigns is crucial. Metrics such as website traffic, appointment bookings, social media engagement, and patient acquisition rates provide insights into what’s working and what needs adjustment. Regular analysis ensures that marketing efforts remain aligned with business goals.

Marketing a medical practice requires a thoughtful blend of digital tools, patient engagement, and community outreach. When done right, it not only drives growth but also reinforces the practice’s mission to provide compassionate, high-quality care.

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Filed under: "Ask-an-Advisor", "Doctors Only", Career Development, Marcinko Associates, Marketing & Advertising | Tagged: business, content-marketing, david marcinko, DDS, digital marketing, DO, doctors, DPM, google, marketing, marketing tips, MD, medical practice, medical practice marketing, patients, seo, YELP | Leave a comment »

MEDICAL SCHOOLS: What They Do Not Teach About Money!

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

By Dr. David Edward Marcinko MBA MEd

SPONSOR: http://www.MarcinkoAssociates.com

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WARNING! WARNING! All DOCTORS

What Medical School Didn’t Teach Doctors About Money

Medical school is designed to mold students into competent, compassionate physicians. It teaches anatomy, pathology, pharmacology, and clinical skills with precision and rigor. Yet, despite the depth of medical knowledge imparted, one critical area is often overlooked: financial literacy. For many doctors, the transition from student to professional comes with a steep learning curve—not in medicine, but in money. From managing debt to understanding taxes, investing, and retirement planning, medical school leaves a financial education gap that can have long-term consequences.

The Debt Dilemma

One of the most glaring omissions in medical education is how to manage student loan debt. The average medical student graduates with over $200,000 in debt, yet few are taught how to navigate repayment options, interest accrual, or loan forgiveness programs. Many doctors enter residency with little understanding of income-driven repayment plans or Public Service Loan Forgiveness (PSLF), missing opportunities to reduce their financial burden. Without guidance, some make costly mistakes—such as refinancing federal loans prematurely or choosing repayment plans that don’t align with their career trajectory.

Income ≠ Wealth

Medical students often assume that a high salary will automatically lead to financial security. While physicians do earn more than most professionals, income alone doesn’t guarantee wealth. Medical school rarely addresses the importance of budgeting, saving, and investing. As a result, many doctors fall into the “HENRY” trap—High Earner, Not Rich Yet. They spend lavishly, assuming their income will always cover expenses, only to find themselves living paycheck to paycheck. Without a solid financial foundation, even high earners can struggle to build net worth.

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Taxes and Business Skills

Doctors are also unprepared for the complexities of taxes. Whether employed by a hospital or running a private practice, physicians face unique tax challenges. Medical school doesn’t teach how to track deductible expenses, optimize retirement contributions, or navigate self-employment taxes. For those who open their own clinics, the lack of business education is even more pronounced. Understanding profit margins, payroll, insurance billing, and compliance regulations is essential—but rarely covered in medical training.

Investing and Retirement Planning

Another blind spot is investing. Medical students are rarely taught the basics of compound interest, asset allocation, or retirement accounts. Many don’t know the difference between a Roth IRA and a traditional 401(k), or how to evaluate mutual funds and index funds. This lack of knowledge delays retirement planning and can lead to missed opportunities for long-term growth. Some doctors rely on financial advisors without understanding the fees or conflicts of interest involved, putting their wealth at risk.

Insurance and Risk Management

Medical school also fails to educate students on insurance—life, disability, malpractice, and health. Doctors need robust coverage to protect their income and assets, but many don’t know how to evaluate policies or understand terms like “own occupation” or “elimination period.” Inadequate coverage can leave physicians vulnerable to financial disaster in the event of illness, injury, or litigation.

Emotional and Behavioral Finance

Beyond technical knowledge, medical school overlooks the emotional side of money. Physicians often face pressure to maintain a certain lifestyle, especially after years of sacrifice. The desire to “catch up” can lead to impulsive spending, luxury purchases, and financial stress. Without tools to manage money mindset and behavioral habits, doctors may struggle with guilt, anxiety, or burnout related to finances.

The Case for Financial Education

Fortunately, awareness of this gap is growing. Organizations like Medics’ Money and podcasts such as “Docs Outside the Box” are working to fill the void by offering financial education tailored to physicians.

These resources cover everything from budgeting and debt management to investing and entrepreneurship. Some medical schools are beginning to incorporate financial literacy into their curricula, but progress is slow and inconsistent.

Conclusion

Medical school equips doctors to save lives, but it doesn’t prepare them to secure their own financial future. The lack of financial education leaves many physicians vulnerable to debt, poor investment decisions, and lifestyle inflation. To thrive both professionally and personally, doctors must seek out financial knowledge beyond the classroom. Whether through self-study, mentorship, or professional guidance, understanding money is as essential as understanding medicine. After all, financial health is a cornerstone of overall well-being—and every doctor deserves to master both.

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RE-IMAGINING RETIREMENT: A Path Forward for a Broke 65-Year-Old Doctor

Posted on October 22, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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SPONSOR: http://www.MarcinkoAssociates.com

Turning 65 is often seen as the gateway to retirement—a time to slow down, reflect, and enjoy the fruits of decades of labor. But for some, including doctors who may have faced financial setbacks, poor planning, or unexpected life events, reaching this milestone without financial security can be deeply unsettling. The image of a broke 65-year-old doctor may seem paradoxical, given the profession’s reputation for high earnings. Yet, reality paints a more nuanced picture. Fortunately, even in the face of financial hardship, retirement is not a closed door—it’s a challenge that can be met with creativity, resilience, and strategic planning.

Understanding the Situation

Before exploring solutions, it’s important to understand how a physician might arrive at retirement age without adequate savings. Medical school debt, late career starts, divorce, health issues, poor investment decisions, or supporting family members can all contribute. Some doctors work in lower-paying specialties or underserved areas, sacrificing income for impact. Others may have lived beyond their means, assuming their high salary would always be enough. Regardless of the cause, the key is to shift focus from regret to action.

DOCTORS: https://medicalexecutivepost.com/2025/09/09/doctors-early-investing-needed-for-retirement/

Redefining Retirement

Traditional retirement—ceasing work entirely—is not the only option. For a broke 65-year-old doctor, retirement may mean transitioning to a less demanding role, reducing hours, or shifting to a new field. The goal is to create a sustainable lifestyle that balances income, purpose, and well-being.

Leveraging Medical Expertise

Even if full-time clinical practice is no longer viable, a physician’s knowledge remains valuable. Here are several ways to continue earning while easing into retirement:

Telemedicine: Remote consultations are in high demand, especially in primary care, psychiatry, and chronic disease management. Telemedicine offers flexibility, reduced overhead, and the ability to work from home.
Locum Tenens: Temporary assignments can fill staffing gaps in hospitals and clinics. These roles often pay well and allow for travel or seasonal work.
Medical Writing and Reviewing: Physicians can write for journals, websites, or pharmaceutical companies. Peer reviewing, editing, and content creation are viable options.
Teaching and Mentoring: Medical schools, nursing programs, and residency programs need experienced educators. Adjunct teaching or mentoring can be fulfilling and financially helpful.
Consulting: Doctors can advise healthcare startups, legal teams, or insurance companies. Their insights are valuable in product development, litigation, and policy.

Exploring Non-Clinical Opportunities

Some physicians may wish to pivot entirely. Transferable skills—critical thinking, communication, leadership—open doors in other industries:

Health Coaching or Life Coaching: With certification, doctors can guide clients in wellness, stress management, or career transitions.
Entrepreneurship: Starting a small business, such as a tutoring service, online course, or specialty clinic, can generate income and autonomy.
Real Estate or Investing: With careful planning, investing in rental properties or learning about the stock market can create passive income.

Maximizing Government and Community Resources

At 65, individuals become eligible for Medicare, which can significantly reduce healthcare costs. Additionally, Social Security benefits may be available, depending on work history. While delaying benefits until age 70 increases monthly payments, some may need to claim earlier to meet immediate needs.

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Other resources include:

Supplemental Security Income (SSI): For those with limited income and assets.
SNAP (food assistance) and LIHEAP (energy assistance): These programs help cover basic living expenses.
Community Organizations: Nonprofits and religious groups often provide support with housing, transportation, and social engagement.

Downsizing and Budgeting

Reducing expenses is a powerful way to stretch limited resources. Consider:

Relocating: Moving to a lower-cost area or state with favorable tax policies can reduce housing and living expenses.
Selling Assets: A large home, unused vehicle, or collectibles may be converted into cash.
Shared Housing: Living with family, roommates, or in co-housing communities can cut costs and reduce isolation.
Minimalist Living: Prioritizing needs over wants and embracing simplicity can lead to financial and emotional freedom.

Creating a realistic budget is essential. Track income and expenses, eliminate unnecessary costs, and prioritize essentials. Free budgeting tools and financial counseling services can help.

INVESTING: Rules of Thumb

Emotional and Mental Well-Being

Financial stress can take a toll on mental health. It’s important to cultivate resilience and maintain a sense of purpose. Strategies include:

Staying Active: Physical activity improves mood and health. Walking, yoga, or swimming are low-cost options.
Volunteering: Giving back can provide structure, community, and fulfillment.
Learning New Skills: Online courses, hobbies, or certifications can reignite passion and open new doors.
Building a Support Network: Friends, family, and peer groups offer emotional support and practical advice.

Planning for the Future

Even at 65, it’s not too late to plan. Consider:

Debt Management: Negotiate payment plans, consolidate loans, or seek professional help.
Estate Planning: Create a will, designate healthcare proxies, and organize important documents.
Insurance Review: Ensure adequate coverage for health, life, and long-term care.
Financial Advising: A fee-only advisor can help create a sustainable plan without selling products.

Embracing a New Chapter

Retirement is not a destination—it’s a transition. For a broke 65-year-old doctor, it may not look like the glossy brochures, but it can still be rich in meaning. By leveraging experience, reducing expenses, accessing resources, and nurturing well-being, retirement becomes a journey of reinvention.In many ways, doctors are uniquely equipped for this challenge. They’ve faced long hours, high stakes, and complex problems. That same grit and adaptability can guide them through financial hardship and into a fulfilling retirement.

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Essential Investing Tips for New Physicians

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

HOW TO COMMENCE THE FINE ART OF MONEY

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By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

Investing may seem complicated, but today there are many ways for the newly minted physician [MD, DO, DPM, DMD or DDS] to begin, even with minimal knowledge and only a small amount to invest. Starting as soon as possible will help you get closer to the retirement you deserve.

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Why is investing important?

Investing often feels like a luxury reserved for the already wealthy physician. Many of us find it difficult to think about investing for the future when there are so many things we need that money for right now; medical school loans, auto, home and children; etc. But, at some point, we’re going to want to stop working and enjoy retirement. And simply put, retirement is expensive.

Most calculations advise that you aim for enough savings to give you 70% to 80% of your pre-retirement income for 20 years or more. Depending on your goals for retirement, that means you could need between $500,000 and $1 million in savings by the time you retire. That may not sound attainable, but with the power of compounding growth, it’s not as hard to achieve as you think. The key is starting as soon as possible and making smart choices.

INVESTMENT TYPES: https://medicalexecutivepost.com/2025/08/26/

When should you start investing?

The short answer is “now,” no matter what your age. Due to the way the gains in investments can compound, the earlier you start the better. Money invested in your 20s could very easily grow over 20 times before you retire, without you having to do much.That is powerful. Even if you’re in your 50s or older, you can still make significant progress toward meeting your goals in retirement.

How much should you invest per month?

Most financial experts say you should invest 10% to 15% of your annual income for retirement. That’s the goal, but you don’t have to get there immediately. Whatever you can start investing today is going to help you down the road.

So, if 10% to 15% is too much right now, start small and build toward that goal over time. You can actually start investing with $5 if you want. And you should. Some investment products require a minimum investment, but there are plenty that don’t, and a lot of online brokerage accounts can be started for free.

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

Good beginner investments.

The best investments for you are going to depend on your age, goals, and strategy. The important thing is to get started. You’ll learn as you go. If you have questions, a dedicated DIYer or investment advisor can help give you the guidance and options you need.

ALTERNATIVE INVESTMENTS: https://medicalexecutivepost.com/2022/06/06/risk-aversion-and-investment-alternatives/

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Understanding Doctorate Degrees: A Clear Guide

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

By Staff Reporters

Is the Doctor – In?

SPONSOR: http://www.CertifiedMedicalPlanner.org

INFO-GRAPHIC

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What Is a Doctorate Degree?

Doctorate, or doctoral, is an umbrella term for many degrees — PhD among them — at the height of the academic ladder. Doctorate degrees fall under two categories, and here is where the confusion often lies.

The first category, Research (also referred to as Academic) includes, among others:

Doctor of Philosophy (PhD)
Doctor of Business Administration (DBA)
Doctor of Education (EdD)
Doctor of Theology (ThD)

The second category, Applied (also referred to as Professional) includes, among others:

Doctor of Medicine (MD)
Doctor of Podiatric Medicine (DPM)
Doctor Of Osteopathic Medicine (DO)
Doctor of Dental Surgery (DDS)
Doctor of Optometry (OD)
Doctor of Psychology (PsyD)
Juris Doctor (JD)

As you can see, applied doctorates are generally paired with very specific careers – medical doctors, podiatrists, dentists, optometrists, psychologists, and law professionals.

When it comes to outlining the differences between a PhD and doctorate, the real question should be, “What is the difference between a PhD and an applied doctorate?” The answer, again, can be found in the program outcomes. The online Doctor of Psychology at UAGC, for example, lists outcomes that are heavily focused on the ability to put theory into practice in a professional setting. For example:

Apply best practices in the field regarding professional values, ethics, attitudes, and behaviors
Exhibit culturally diverse standards in working professionally with individuals, groups, and communities who represent various cultural and personal backgrounds
Utilize a comprehensive psychology knowledge base grounded in theoretical models, evidence-based methods, and research in the discipline
Integrate leadership skills appropriate in the field of psychology
Critically evaluate applied psychology research methods, trends, and concepts

Bottom line: As the PhD is more academic, research-focused, and heavy on theory, an applied doctorate degree is intended to master a subject in both theory and practice.

Can a PhD Be Called a Doctor?

The debate over whether a PhD graduate should be called a doctor has existed for decades, and if you’re a member of this exclusive club, you’ll no doubt hear both sides of the argument during your lifetime. After all, if a PhD is a doctor, can a person with a doctoral degree in music – the Doctor of Musical Arts (DMA) – be called a doctor as well?

Those in favor argue that having “Dr.” attached to your name indicates that you are an expert and should be held in higher regard. For some, the debate is at the heart of modern gender disparity. For example, on social media and in some academic circles, there is an argument that female PhD holders should use the “Dr.” title in order to reject the notion that women are less worthy of adding the title to their name once they have earned a doctoral degree.

The American Psychological Association has, for years, challenged the Associated Press (AP) and other news outlets to broaden its use of “Dr.” beyond those that practice medicine – MDs, podiatrists, dentists, etc. – in its reporting. However, the organization was rebuked, as the AP argued that, “It comes down to a basic distinction. Psychologists earn PhDs, and AP style allows the ‘Dr.’ title only for those with medical degrees.”

The AP has, thus far, refused to change their style guide when it comes to the “doctor question.”

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Understanding Medical Office Cancellation Fees

Posted on October 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

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Can a physician medical provider charge an office cancellation fee?

According to the American Medical Association’s Code of Medical Ethics, physicians can charge fees for “missed appointments or appointments not cancelled in advance in keeping with the published policy of the practice”, and they should “clearly notify patients in advance of fees charge” (Opinion 11.3. 2) [28].

And so, if you miss a doctor’s appointment these days, you could get hit with a “no-show” fee of up to $150 — or more for some specialties.

Is it legal for an insurance company to charge a cancellation fee?

These practices are typically legal. They help businesses ensure they can recoup the lost revenue due to no-shows or last-minute cancellations.

Cancellation fees are permitted, but seldom collected absent unusual circumstances, such as a great deal of work having been provided.

QUESTION: As a doctor [MD, DO, DPM or DDS], do you charge an office cancellation fee? If so, how much is it?

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MEDICAL PRACTICE: Part-Time Physician Employment Difficulties

Posted on October 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

SPONSOR: http://www.MarcinkoAssociates.com

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Why It Is Difficult to Practice Medicine Part-Time Today?

In the past, part-time medical practice offered physicians a flexible way to balance professional responsibilities with personal or family commitments. Today, however, the healthcare environment has evolved in ways that make part-time medicine increasingly challenging. From administrative burdens to economic pressures and patient expectations, the obstacles are both systemic and personal.

One of the most significant barriers is the rise in administrative complexity. Physicians are now required to navigate electronic health records (EHRs), comply with insurance documentation, and meet regulatory standards such as HIPAA and MACRA. These tasks consume hours of non-clinical time, which is difficult to compress into a part-time schedule. Even seeing fewer patients doesn’t exempt part-time doctors from the same documentation and compliance requirements as their full-time counterparts.

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Another challenge is financial viability. Many physicians are paid based on productivity metrics, such as Relative Value Units (RVUs), which reward volume over quality. Part-time practitioners often struggle to meet these benchmarks, resulting in lower compensation and reduced benefits. Additionally, malpractice insurance premiums and licensing fees remain fixed regardless of hours worked, further eroding the financial appeal of part-time practice.

Continuity of care is also a concern. Patients increasingly expect immediate access to their providers, especially in primary care and specialties like psychiatry or pediatrics. Part-time physicians may not be available for urgent issues, leading to fragmented care and dissatisfaction. This can strain relationships with patients and colleagues who must cover gaps in availability.

From a professional standpoint, part-time physicians may face limited career advancement. Leadership roles, academic appointments, and research opportunities often favor full-time commitment. There’s also a perception—sometimes unfair—that part-time doctors are less dedicated or less competent, which can affect peer respect and influence within medical institutions.

Technology, while beneficial, adds another layer of complexity. Telemedicine, remote monitoring, and digital communication tools have expanded access but also increased the expectation for constant availability. Part-time physicians may find it difficult to manage asynchronous messages, follow-ups, and virtual visits without extending their work hours beyond what they intended.

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Lastly, burnout and work-life balance—ironically one of the reasons doctors seek part-time roles—can still be elusive. The pressure to maintain clinical excellence, stay updated with medical advancements, and meet patient needs doesn’t diminish with reduced hours. In fact, squeezing these responsibilities into fewer days can intensify stress rather than alleviate it.

In conclusion, while part-time medical practice may seem like a solution to modern work-life challenges, the reality is far more complex. The structure of today’s healthcare system, combined with economic, technological, and cultural pressures, makes it difficult for physicians to thrive in part-time roles. Addressing these challenges will require systemic reform, flexible compensation models, and a cultural shift in how we value and support diverse medical careers.

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SPEAKING: ME-P Editor 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 an RFP for speaking engagements: CONTACT: Ann Miller RN MHA at MarcinkoAdvisors@outlook.com -OR- http://www.MarcinkoAssociates.com

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Filed under: Ask a Doctor, Managed Care, Marcinko Associates, Practice Management, Practice Worth, Professional Liability | Tagged: AI, artificial intelligence, DO, doctor employment, doctors, DPM, eHR, EHRs, EMRs, health, HIPPA, MACRA, Marcinko, MD, medical practice, part time doctor's office, part time doctors, part time medical practice, part time physicians, physician employment, physicians, RVUs, Technology | 1 Comment »

VARIABLE ANNUITIES: Retired Physicians Beware!

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

By A.I. and Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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After a lifetime of hard work practicing medicine and saving, you’re at the retirement finish line. Instead of a paycheck, you’re relying on your nest egg and investment income to cover the bills. Picking the right investments is even more important, as you won’t have much chance to recover as a retired MD, DO, DPM or DDS.

“You made it to the top of the mountain through a systematic approach and are trying to make your way down safely,” says retirement planner John Gillet John Gillet in Hollywood, Fla. “Why throw all caution to the wind and try something different now?”

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Definitions

An annuity is an insurance contract designed to grow your money and then repay it as income. There are different versions. An immediate annuity turns your lump sum into future guaranteed income payments, like your own personal pension. They are simple to understand with no or small fees.

Fixed annuities pay a guaranteed interest rate over a set period to grow your money, like 5% a year for five years. These options could make sense as part of a retirement plan.

A variable annuity, on the other hand, invests your savings in mutual funds. While you can buy riders that guarantee a minimum income, you’ll be paying very much for it. “All in, the annual fees can be 3% or more of your balance,” says Jeff Bailey, an advisor from Nashville. “That’s a huge withdrawal rate from your portfolio versus investing on your own.”

The variable annuity will lock up your money for years. If you cancel early, you owe a surrender charge that could start at 7% or more of your annuity balance before gradually going down as time goes by. “Clients believe they can walk away with their contract value, but that’s often not true,” says Bailey.

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Financial Planning for Physicians: Achieve Your Goals

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

By: http://www.MarcinkoAssociates.com

Your medical practice. Your personal goals. Your financial plan. Our experienced confirmation guide.

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When you know exactly where you are today, have a vision of where you want to be tomorrow, and have trusted counsel at your side, you have already achieved so much success. Marcinko Associates works to keep you at that level of confidence every day. We use a comprehensive economic process to uncover what’s most important to you and then develop a financial strategy that gives you the highest probability of achieving your monetary goals.

We assess, plan, and opine for your success

To accurately see where you are today, chart a strategic path to your goals and help you make the most informed decisions to keep you on financial track, our key services for physicians and high net worth medical clients include:

Investment Portfolio Review
Fee, Charge and Cost Review
Comprehensive Financial Planning
Insurance Reviews
Estate Planning
Investment and Asset Management Second Opinions

We take a deep dive into your financial retirement plans

Physicians and dental employers now have options for how to design and deliver retirement benefits and we can help you make the best choice for your healthcare business. Our services for retirement plans include:

Fee, Charges & Fiduciary Review
Portfolio Analysis
Single Employer Retirement Plan Advisory
Retirement Plans Risk Analysis
Capital Funding and Financing
Business Planning and Practice Valuations
Career Development
and more!

We take a broad and balanced look at your financial life life

We coordinate our recommendations with your other advisors, including attorneys, accountants, insurance professionals and others, to ensure each decision is consistent with your goals and overall strategy. For example, through our partnerships we offer physician colleagues deeper expanded advisory services, like:

Estate, Gift, and Trust Planning
Tax Planning and Compliance
Medical or Dental Practice Worth
Business Succession Planning
Practice Exit Planning
Transaction Advisory Services
and more!

EDUCATION: Books

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

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Fiduciary Financial Colleagues Advising Medical Colleagues … in Turbulent Times!

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Understanding Hobson’s Choice in Healthcare

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

By Dr. David Edward Marcinko MBA MEd CMP™

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Hobson’s Choice in Medicine

SPONSOR: http://www.CertifiedMedicalPlanner.org

Hobson’s choice is a free choice in which only one thing is actually offered. The term is often used to describe an illusion that choices are available. The best known example is “I’ll give you a choice: Take it or leave it”, wherein “leaving it” is strongly undesirable.

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

A CASE MODEL

Half of Physicians Plan to Change Career Paths

The Physicians Foundation recently conducted a survey on physician practice patterns and perspectives. Here are some key findings from the report:

• 31% of physicians identify as independent practice owners or partners.
• Almost half (47%) of physicians plan to change career paths.
• 78% of physicians sometimes, often or always experience feelings of burnout.
• Nearly a quarter of physician time is spent on non-clinical paperwork.

This result is not a good Hobson’s Choice in Medicine.

Cite: The Physicians Foundation, September 2018

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Understanding Different Medical Degrees: MD, DO, and DPM

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

Doctor of Medicine

Doctor of Osteopathic Medicine

Doctor of Podiatric Medicine

By Staff Reporters and APMA

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APMA INFOGRAPHIC: https://www.apma.org/apmamain/document-server/?cfp=/apmamain/assets/file/public/about/physician-education-comparison-fact-sheet.pdf

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Financial Self-Discovery for Medical Professionals

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

By Dr. David Edward Marcinko; MBA MEd CMP™

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

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SPONSOR: http://www.CertifiedMedicalPlanner.org

A Financial Self Discovery Questionnaire for Medical Professionals

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

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

Childhood

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

Cultural heritage

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

Family

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

Your parents

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

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

Childhood: Revisited

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

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

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

Credit

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

Adulthood

Have your attitudes shifted during your adult life? Describe.

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

Adult attitudes

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

Conclusion

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

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

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

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Why Many Doctors Struggle Financially: 5 Key Reasons

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

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Despite their high salaries, not all doctors are wealthy, and some live paycheck to paycheck. Here are 5 reasons why many doctors today are broke, according to https://medschoolinsiders.com

1 | Believing They Are Universally Smart

The first reason so many doctors are broke is that many doctors believe they are universally smart. While most doctors have deep specialized knowledge, there’s a big difference between being smart in your profession and being smart with money. A physician’s schooling is quite thorough when it comes to the human body, but med school doesn’t include a prerequisite class on how to handle finances.

MORE: https://medicalexecutivepost.com/2022/11/18/what-is-the-dunning-kruger-effect/

Graduating medical school is a major feat and certainly demonstrates superior work ethic and cognitive abilities. But many new doctors believe these accomplishments transcend all aspects of life. If you’re smart enough to earn an MD, you’re certainly smart enough to handle your finances, but only once you properly and intentionally educate yourself.

The truth is doctors, especially traditional graduates, haven’t had an opportunity to manage large sums of money until they become fully trained attending physicians and start pulling in low to mid six figures in income. Prior to that, there was very little of it to manage.

Far too many aspiring doctors, and students in general, don’t take the time to learn financial basics, in part because it’s uncomfortable and seems like something they can figure out “later”, whenever that may be. Their poor spending habits and lack of investment knowledge carry over into their careers, causing many to make irresponsible decisions.

MORE: https://medicalexecutivepost.com/2025/07/17/doctors-and-lawyers-often-arent-millionaires/

2 | Overspending Too Soon

The second factor is overspending too soon, and this comes up at two points in training.

First, it’s natural to want to start spending more as soon as you get into residency and start making a little more money. After all, you’ve been a broke student for 8 or more years, and now you’re finally making a reasonable and reliable wage. But that’s where young doctors get into trouble. Residency pays, but not nearly as much as you will be making once you become an attending physician. The average resident makes about $60K a year, and if you begin spending all of that money right away, thinking you’ll handle your loans once you become an attending, you delay paying off your medical school debt, which means the compounding effect through your student loan interest rate works against you.

Now that $250,000 in student loans has ballooned to over $350,000 by the time you finish residency. The compounding effect, which can be one of your greatest allies in your financial life, becomes an equally powerful enemy when working against you through debt. But of course, pinching pennies is easier said than done, especially when you’re in residency and are surrounded by peers in different professions. They’ve been earning good money much longer than you have, and they can afford more luxurious lifestyles.

They may not be worried about indulging in fine dining or how much a hotel costs when traveling. Students in college and medical school are often confident they will resist the temptations, but the desire to keep up with your friends and family can be difficult to ignore, which causes many to overspend before they technically have the money to do so.

The same is true of attending physicians. As soon as those six-figure salaries come rolling in, many physicians go overboard with spending, trying to make up for lost time and to treat yourself.

Now, we are not suggesting you shouldn’t reward yourself for completing residency, but that reward shouldn’t be a Lamborghini. It’s best to continue living like a resident in your first few years after becoming an attending to pay off loans, put a down payment on a home, and get your financial foundation built before loosening the purse strings.

3 | Decreasing Salaries

Third, doctors continue to make less money than they did before. And this includes nearly all 44 medical specialties. For example, while physician compensation technically rose from $343k to $391k between 2017 and 2022, this rise does not keep up with inflation. The real average compensation in 2022 was less than $325k—a $20k decrease in purchasing power in only six years.

For doctors who are already spending to the limits of their salaries with huge mortgages, car payments, business costs, and other luxuries, a decreased salary can have a huge impact. You might be able to cut back by going on fewer vacations or eating out less frequently, but many accrued costs are locked in, such as a mortgage payment, car loan, or leased rental space for your practice.

4 | Increasing Costs of Private Practice

In the past, running a private practice was much simpler, but recent stricter guidelines and regulations have made it difficult for solo practices to keep up. While regulations like the Health Insurance Privacy and Portability Act, or HIPAA, and mandatory Electronic Medical Records, or EMRs, are necessary to protect patients, they make costs higher for physicians who run their own private practice. These physicians need to spend their own money to set up and maintain EMRs as well as invest in security to ensure patient data is protected.

With the steep rise of inflation we’ve seen over the past couple of years, everything is more expensive, which means costs, such as business space, equipment, and even office supplies, have gone up for private practice physicians while salaries have not. 2013 to 2020 saw an annual inflation rate of anywhere from 0.7% to 2.3%. This skyrocketed to an annual inflation rate of 7.0% in 2021 and another 6.5% in 2022. In fact, the cost of running a private practice has increased by almost 40% between 2001 and 2021.

These increased costs are exacerbated by another problem plaguing private practices; decreased reimbursement. While costs increased by almost 40%, Medicare reimbursement only increased by 11%. When doctors see patients who are insured, the insurance companies pay the physicians for their time. For Medicare, the new proposed rules for 2023 would cut reimbursement by around 5%. When adjusting for inflation, Medicare reimbursement decreased by 20% in the last 20 years.

These costs add up, making it extremely difficult for physicians to thrive financially while running a private practice.

5 | Tuition Debt

Lastly, we can’t talk about a doctor’s finances without mentioning the exorbitant debt so many graduating physicians are left with. It won’t shock you to hear that med school is expensive. Extremely expensive. The average cost of tuition for a single year is nearly $60k, with significant variance from school to school, and that’s before accounting for living expenses.

In-state applicants pay less than out-of-state applicants, and students at private schools typically pay more than students at public medical schools. The astronomical costs mean the vast majority of students can’t pay for medical school out of their own pockets. And unless your family is part of the 1%, even with your parents footing the bill, it’s difficult to cover tuition, let alone rent, groceries, transportation, tech, social activities, exam fees, and application costs.

The average total student debt after college and med school is over $250k. But keep in mind that’s the average, which includes 27% of students who graduate with no debt at all. This means the vast majority of students leave medical school owing much more than $250k.

For some perspective, in 1978, the average debt for graduating MDs was $13,500, which, when adjusted for inflation, is a little over $60,000. There are multiple ways to eventually repay these loans, but time and discipline are essential to ensure this money is paid off as quickly as possible.

MORE: https://medicalexecutivepost.com/2024/12/03/12-investing-mistakes-of-physicians/

THE FINANCIAL FIX

According to financial advisor Dr. David Edward Marcinko MEd MBA CMP™; consider the following:

Place a portion of your salary (15-20% or more) into a savings account, and another portion (10-20% or more) into wise investments [stocks, bonds, mutual funds, and/or ETFs].

Pay off your bills each month, and then use leftover spending money to purchase fun things like vacations and fancy dinners, within your means. Shop sales, buy used clothes, and use credit card points for travel.

Hire an excellent tax professional and meet with an investment advisor once or twice a year about your investment status and strategy. http://www.MarcinkoAssociates.com

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CAPITATION REIMBURSEMENT: A Historical Economic Review

Posted on September 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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DEFINITION

Capitation is a type of healthcare payment system in which a physician or hospital is paid a fixed amount of money per patient for a prescribed period by an insurer or physician association. The cost is based on the expected healthcare utilization costs for a group of patients for that year.

With capitation, the physician—otherwise known as the primary care physician— is paid a set amount for each enrolled patient whether a patient seeks care or not. The PCP is usually contracted with an HMO whose role it is to recruit patients.

ACOs: https://medicalexecutivepost.com/2024/12/01/record-breaking-savings-for-acos-in-2023/

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CAPITATION REIMBURSEMENT HISTORY

According to Richard Eskow, CEO of Health Knowledge Systems of Los Angeles, capitated medical reimbursement has been used in one form or another, in every attempt at healthcare reform since the Norman Conquest. Some even say an earlier variant existed in ancient China [personal communication].

Initially, when Henry I assumed the throne of the newly combined kingdoms of England and Normandy, he initiated a sweeping set of healthcare reforms. Historical documents, though muddled, indicate that soon thereafter at least one “physician,” John of Essex, received a flat payment honorarium of one penny per day for his efforts. Historian Edward J. Kealey opined that sum was roughly equal to that paid to a foot-soldier or a blind person. Clearer historical evidence suggests that American doctors in the mid-19th century were receiving capitation-like payments. No less an authoritative figure than Mark Twain, in fact, is on record as saying that during his boyhood in Hannibal, MO his parents paid the local doctor $25/year for taking care of the entire family regardless of their state of health.

Later, Sidney Garfield MD [1905-1984] is noted as one of the great under-appreciated geniuses of 20th century American medicine stood in the shadow cast by his more celebrated partner, Henry J. Kaiser. Garfield was not the first physician to embrace the notion of prepayment capitation, nor was he the first to understand that physicians working together in multi-specialty groups could, through collaboration and continuity of care, outperform their solo practice colleagues in almost every measure of quality and efficiency. The Mayo brothers, of course, had prior claim to that distinction. What Garfield did, was marry prepayment to group practice, providing aligned financial incentives across every physician and specialty in his medical group, as well as a culture of group accountability for the care of every member of the affiliated health plan. He called it “the new economics of medicine,” and at its heart was a fundamentally new paradigm of care that emphasized – prevention before treatment – and health before sickness. Under his model: the fewer the sick – the greater the remuneration. And: the less serious the illness, the better off the patient and the doctors.

VBC: https://medicalexecutivepost.com/2018/12/07/the-state-of-value-based-care-vbc/

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Such ideas were heresy to the reigning fee-for-service, solo practice, ideologues of the mainstream medical establishment of the 1940s and ‘50s, of course. Throughout the period, Garfield and his group physicians were routinely castigated by leaders of the AMA and county medical associations as socialistic and unethical. The local medical associations in Garfield’s expanding service areas – the San Francisco Bay Area, Los Angeles, and Portland, Oregon – blocked group practice physicians from association membership, effectively shutting them out of local hospitals, denying them patient referrals or specialty society accreditation. Twice in the 1940s, formal medical association charges were brought against Garfield personally, at one time temporarily succeeding in suspending his license to practice medicine.

Of course, capitation payments made a comeback in the first cost-cutting managed care era of the 1980-90s because fee-for-service medicine created perverse incentives for physicians by paying more for treating illnesses and injuries than it does for preventing them — or even for diagnosing them early and reducing the need for intensive treatment later. Nevertheless, the modern managed care industry’s experience with capitation wasn’t initially a good one. The 1980-90s saw a number of HMOs attempt to put independent physicians, especially primary care doctors, into a capitation reimbursement model. The result was often negative for patients, who found that their doctors were far less willing to see them — and saw them for briefer visits — when they were receiving no additional income for their effort. Attempts were also made to aggregate various types of health providers — including hospitals and physicians in multiple specialties — into “capitation groups” that were collectively responsible for delivering care to a defined patient group. These included healthcare facilities and medical providers of all types: physicians, osteopaths, podiatrists, dentists, optometrists, pharmacies, physical therapists, hospitals and skilled nursing homes, etc.

However, the healthcare industry isn’t collective by nature, and these efforts tended to be too complicated to succeed. One lesson that these experiments taught is that provider behavior is difficult to change unless the relationship between that behavior and its consequences is fairly direct and easy to understand.

MORE: https://medicalexecutivepost.com/wp-content/uploads/2008/11/capitation-actuarial-medical-econometrics.pdf

Today, the concept of prepayment and medical capitation is to uncouple compensation from the actual number of patients seen, or treatments and interventions performed. This is akin to a fixed price restaurant menu, as opposed to an àla carte eatery.

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Filed under: Ask a Doctor, Career Development, CMP Program, curated experts,, economics, Ethics, Experts Invited, finance, Glossary Terms, Health Economics, Health Law & Policy, Healthcare Finance, Marcinko Associates | Tagged: AMA, capitation, capitation economics, CMP, david marcinko, DDS, DMD, DO, doctor compensation, DPM, exchange-server, Health Economics, Health Insurance, HMO, Managed Care, MD, PCP, physician compensation, powershell, primary care provider, Richard Eskow, RN, Sidney Garfield, system-center | Leave a comment »

FORENSIC PODIATRY: Previously Unknown But Now in the Forefront

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

By Dr. David Edward Marcinko MBA MEd

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BREAKING NEWS

Law enforcement officials in Utah released a video of the suspected shooter in the assassination of Turning Point USA co-founder and CEO Charlie Kirk, saying that the person wore Converse tennis shoes and left a hand print and a shoe print at the scene.

The suspect in Charlie Kirk’s assassination has been identified as Tyler Robinson, a 22-year-old Utah resident. Law enforcement sources told the Daily Mail that Robinson was taken into custody as the alleged assassin who killed Kirk at a rally at Utah Valley University on Wednesday.

PODIATRY EDUCATION: https://medicalexecutivepost.com/2025/09/11/education-md-do-and-dpm/

Forensic Podiatry on TV

Before today, forensic podiatry has even made it into the public zeitgeist with the hit TV show “Bones” which premiered on September 13, 2005, and concluded on March 28, 2017, airing for 246 episodes over 12 seasons. The show was based on forensic anthropology and forensic archaeology, with each episode focusing on the mystery behind human body remains brought in for examination and identification.

PODIATRY TYPES: https://medicalexecutivepost.com/2025/07/28/podiatrist-types-specialization-and-salary/

In one show, eight pairs of dismembered feet washed ashore after a flood on the U.S.-Canada border, but things didn’t add up when only seven pairs of feet were identified as research corpses from a nearby university body farm.

When the fictional Canadian forensic podiatrist Dr. Douglas Filmore took the remains back to Canada, he had to form a jurisdictional alliance with the United States to match the pairs of feet and identify the victims. A rare and expensive pair of sneakers led the team to the victim’s murderer.

In 2016, an actual forensic podiatry club was started at the Barry University School of Podiatric Medicine. And, a formal class covering aspects of forensic podiatry is held at the New York College of Podiatric Medicine. Students exit the class with an in depth knowledge of forensic podiatry and other legal knowledge applicable to current cases.

More expertly, real-life colleague Michael Steven Nirenberg DPM actually testified in the murder trial of defendants Kailie Brackett and Donnell Dana with the state calling three witnesses to testify, including the podiatrist who claimed Brackett’s footprints match the ones found in blood at the apartment of the victim, Kimberly Neptune. The forensic podiatrist focused on the footprints discovered at Neptune’s apartment, using prints and images of the defendant’s feet taken by law enforcement. After study, he claimed the prints at the scene bore a resemblance to Kailie Brackett’s in the width of the foot. The defense questioned the field of forensic podiatry and pressed Dr. Nirenberg on whether the measurements would be altered depending on how thick the sock covering the foot was woven.

Dr. Nirenberg was also interviewed on National Public Radio’s Morning Edition on April 14th 2023 about the gait of the bombing suspect associated with the capital riot on Wednesday January 6^th, 2021. Dr. Nirenberg is president of the American Society of Forensic Podiatry and co-editor of the textbook: “Forensic Gait Analysis: Principles and Practice”. The bombing suspect had placed bombs at the DNC and RNC headquarters in Washington, DC on the night before. NPR asked Dr. Nirenberg to comment on the features of the person’s gait.

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Is a Podiatrist …. A Physician?

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Additionally, Nirenberg was interviewed by Nancy Grace on her TV show Crime Stories. Grace interviewed Nirenberg about his forensic podiatry work in helping to solve the murder of a mother of 3 who was killed in a church. The case remains unsolved. The episode, “Fitness-Mom Missy Bevers Bludgeoned Dead in Creekside Church” aired June 6th, 2024 and is available online at Merit+ TV.

And, Netflix’s 2023 docu-series, “Till Murder Do Us Part”, recounts the killings of Derek and Nancy Haysom by including a series of interviews with a cast of real people. The four-part docu-series revolves around the unpacking of how a wealthy couple was murdered in Virginia in 1985. It also focuses on how the suspects, Elizabeth Haysom, and her boyfriend, Jens Soehring, betrayed each other during the trial. Dr. Sarah Reel DPM was the forensic podiatrist who was involved with Jens’ and Elizabeth’s footprint examination. Dr. Reel pointed out that, statistically, there was no difference “between a bare footprint and a socked footprint.” The doctor suggested that Jens’ reference footprint matched closely with the crime scene footprint.

Cite: Aeron Mer Eclarinal, The Direct [11/9/23]

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Filed under: Ask a Doctor, Career Development, Ethics, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance, Practice Management, Professional Liability | Tagged: "BONES", Barry University Forensics, charlie Kirk, daily mail, david marcinko, DDS, DNC, DO, DPM, foot prints, forensic podiatry, Haysom, MD, Michael Steven Nirenberg DPM, Nancy Grace, physicians, podiatric physician, podiatrist, podiatry, S&P 500, Sarah Reel DPM, turning point USA, tyler robinson | Leave a comment »

QUATERNARY: Medical Care Defined

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

Primary – Secondary – Tertiary Care

By A.I. and Staff Reporters

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In medicine, there are four levels of care: primary, secondary, tertiary, and quaternary. The levels of care refer to the complexity of the medical cases that doctors and healthcare providers treat and the skills and specialties of the providers.

Primary care involves consulting with a primary care provider. Secondary care refers to seeing a specialist such as a dermatologist, neurologist or oncologist. Tertiary care is specialized care in a hospital setting such as brain surgery, renal dialysis or heart surgery.

Quaternary care is thus an advanced level of specialized care.

PRIMARY CARE: https://medicalexecutivepost.com/2024/09/27/cms-a-new-primary-care-medicine-model/

QUATERNARY CARE

Classic: Sometimes used as an extension of tertiary medical and surgical care in reference to advanced levels of medicine which are highly specialized and not widely accessed by most patients.

Modern: A higher level of specialized care within a hospital. Experimental medicine and some types of uncommon diagnostic or surgical procedures are also considered quaternary care.

According to the Wonca International Dictionary for General/Family Practice -Quaternary Prevention [QP] – is defined as: ‘Action taken to identify patient at risk of over medicalization, to protect him/her from new medical invasion, and to suggest to him interventions, which are ethically acceptable’.

Examples: Types of quaternary care include: experimental medicine, procedures and uncommon and specialized surgeries. This includes sub-specialty services such as advanced trauma care and organ [heart, lung, liver, kidney, etc] transplantation.

MEDICAL CARE: https://medicalexecutivepost.com/2024/07/29/survey-primary-care-doctors-deliver-most-medical-care/

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PHYSICIAN BANKRUPTCY: Six Total Types to Know!

Posted on September 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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According to Medical Economics, there were 10 clinic and physician practices filing bankruptcy in 2024, making it the highest level of the last six years, according to a new analysis of cases with liabilities of at least $10 million.

Meanwhile, the Steward Health Care System bankruptcy, which was based in Massachusetts but making headlines across the nation, has become “the largest hospital sector bankruptcy by far in the last 30 years,” according to a new analysis by Gibbins Advisors, based in Nashville, Tennessee.

Health care bankruptcy filings totaled 57 last year, down from 79 in 2023, said “Healthcare Restructuring: Trends and Outlook.” The report analyzed Chapter 11 health care bankruptcy cases with liabilities of at least $10 million, since 2019.

Last year’s total was down 28% from 2023’s peak, but greater than the 2019 to 2022 average of 42 filings a year, the report said.

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

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Bankruptcy, often considered a last financial resort, is a legal process that can help alleviate outstanding debts for individuals and businesses. Reasons to file for bankruptcy can include divorce, job loss, exorbitant medical bills or credit card debt.

There are several types of bankruptcy — six, as a matter of fact. The two most common types of bankruptcy for individuals are Chapter 7 and Chapter 13.

But there are four other types as well: Chapter 9, Chapter 11, Chapter 12 and Chapter 15. And, the type of bankruptcy filed depends on the situation.

Regardless of which type, the process is typically the same: You’ll usually retain an attorney and make your case before a judge, who will then erase some debts or set up a repayment plan.

Also note that an eligibility requirement — for all bankruptcy chapters — is that you must undergo credit counseling within the 180 days before filing.

DOCTORS: https://medicalexecutivepost.com/2025/07/17/doctors-and-lawyers-often-arent-millionaires/

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Hospital Acquisitions of Physician Practices Increase Prices

Posted on September 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Health Capital Consultants, LLC

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A recent study of hospital physician acquisition and employment found that such acquisitions decrease competition and raise prices. A National Bureau of Economic Research (NBER) working paper, released in July 2025, “empirically analyze[d] the effects of mergers between complementary firms on competition and pricing,” and found hospital prices increased by an average of 3.3%, while physician prices increased by an average of 15.1%.

This Health Capital Topics article reviews the study’s findings and implications for the healthcare industry. (Read more…)

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PSYCHOLOGICAL BIAS: The Ikea Effect in Finance?

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

By Dr. David Edward Marcinko; MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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IKEA EFFECT BIAS

Ikea Effect Bias describes the tendency of people to place a higher value on products they have partially created or assembled themselves. This phenomenon is named after the Swedish furniture retailer Ikea, known for selling furniture in flat-pack kits that customers must assemble at home.

he IKEA effect was identified and named by Michael Norton of Harvard Business School, Daniel Mochon of Yale University and colleague Dan Ariely PhD of Duke University, who published the results of three studies in 2011. They described the IKEA effect as “labor alone can be sufficient to induce greater liking for the fruits of one’s labor: even constructing a standardized bureau, an arduous, solitary task, can lead people to overvalue their (often poorly constructed) creations.”

Example: A prospect is more likely to pursue his/her own financial plan than that one from an informed financial planner, CPA or professional advisor.

2011 study found that subjects were willing to pay 63% more for furniture they had assembled themselves than for equivalent pre-assembled items.

IN FINANCE AND INVESTING

The IKEA effect can contribute to reducing panic selling. Investors typically reduce their stock market exposure after a financial crash which often results in “buy high, sell low” strategy that is detrimental to long-run wealth accumulation.

Ashtiani et al.’s study proposes a nudge utilizing the IKEA effect to counteract this phenomenon: “actively involving investors in the selection process of the risky investments, while restricting their selections in a way that preserves a large degree of diversification.”

DIVERSIFICATION: https://medicalexecutivepost.com/2025/06/17/correlation-diversification-in-finance-and-investments/

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PHYSICIANS: Alimony V. Palimony

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

By A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What is Alimony

According to Hello Divorce, alimony, often referred to as spousal support, is a court-ordered payment from one spouse to the other following a divorce or legal separation. Its existence is tied to the legal status of marriage. The underlying principle is that both spouses contributed to the marital standard of living, and the dissolution of the marriage should not cause an inequitable economic outcome for the lower-earning spouse. This support is not intended as a punishment but as a means of mitigating the financial impact of divorce.

The purpose of alimony can vary. In some cases, it is rehabilitative, providing temporary support while one spouse obtains education or job training to become self-sufficient. For longer marriages, it might serve to help maintain the standard of living established during the partnership. Alimony is a legal tool derived from family law statutes to address the financial interdependence created by marriage.

DIVORCE: https://medicalexecutivepost.com/2025/08/14/physician-divorce-within-the-medical-profession/

Note: The federal tax treatment for alimony changed with the Tax Cuts and Jobs Act of 2017. For any divorce or separation agreement executed after December 31st, 2018, alimony payments are no longer tax-deductible for the person paying them. The recipient of the support does not report the payments as taxable income. This change is permanent and does not expire with other provisions of the act.

What is Palimony

According to Wikipedia, Palimony refers to financial support that may be awarded after an unmarried couple separates. Unlike alimony, palimony is not rooted in family law but is a concept derived from contract law. An award depends on the existence of an agreement between the partners. This agreement can be a formal written contract or an oral or implied agreement for support in exchange for services, such as managing the household.

The legal basis for palimony was established by the 1976 California Supreme Court case, Marvin v. Marvin. In that case, the court ruled that unmarried cohabitants could make enforceable contracts for support, as long as the agreement was not based on sexual services. Because it is a contract claim, a palimony case is pursued in civil court, not family court. Palimony is not available in all states and is only recognized in a minority of jurisdictions.

MEDIATION: https://medicalexecutivepost.com/2023/08/12/a-step-wise-approach-to-the-divorce-mediation-process-for-doctors/

Note: The tax implications of palimony are less defined than alimony because the IRS does not have a specific rule for it. How palimony is treated depends on the nature of the underlying claim. If the payments are a settlement for services rendered, they may be considered taxable income to the recipient. If the payments are characterized as a gift, they are not considered taxable income for the recipient.

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PHYSICIAN BURNOUT: Causes and Conclusions

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

By Dr. David Edward Marcinko; MBA MEd

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Healthcare comes with its share of mental challenges, especially considering that clinicians often care for patients when they’re in difficult and sometimes tragic situations. New research shows that even the path to getting into the workforce can be a challenge, with some physicians burning out before they make it to graduation.

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American medicine is undergoing vast changes, placing the status of physicians in the medical industrial complex at great risk. Most physicians feel overwhelmed by increasing bureaucratic mandates from insurers, hospitals, and government. At the same time, physicians are the front line employees of healthcare and assume the majority of the risk for patient care. This has left many in the profession with increasing disillusionment.

Samantha Meltzer-Brody a psychiatrist and director of, Taking Care of Our Own, University of North Carolina, Chapel Hill, NC states it best:

“Daily, I am contacted by good doctors who are struggling with symptoms of burnout syndrome and who have become overwhelmed by the challenges of attempting to practice medicine in today’s health care environment. As a psychiatrist who runs a program to address and treat these distressed doctors, I am troubled by the ever-growing number of calls I receive.”

What causes physician burnout?

The “Big 4” factors known to contribute to stress and burnout include:

Time pressure, especially in patient visits or documentation
Lack of control over work environment
Chaotic, fast-paced workplaces
Culture of the organization, specifically a culture that does not emphasize communication, cohesion, trust, and alignment of values between clinicians and their leaders

In addition to burnout rates, these factors can be assessed to help direct interventions toward those drivers that are most likely to be contributing to burnout at your organization.

OK BURNOUT: https://medicalexecutivepost.com/2022/08/30/u-s-hospitals-feeling-the-pain-of-physician-burnout/

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The burned-out physician is exhausted — mentally and physically — and often no longer able to find empathy or connection with patients. The question of how to escape from what has become a highly unpleasant situation becomes a frequent one. Given the high demands of the profession and serious consequences of mistakes, the burned-out doctor is a potentially impaired one. And the impaired physician is not able to maintain the unflappable, perpetually cool under fire, always objective, professional and yet compassionate demeanor that is expected by society. Worst of all, the impaired physician is at great risk for developing depression, suicidal ideation, or a serious addiction.

The doctors who contact me report feeling beaten down by an increasingly hostile work environment. They say that they don’t have time to take care of patients the way they envisioned when they decided to apply to medical school. Many describe feeling betrayed by a system that they say seems focused on achieving the bottom line with little regard for the impact on both doctors and patients.

Most of these doctors report spending a significant amount of their time dealing with the electronic medical record and documentation. The ratio of time spent on doctor-patient

interactions compared to physician-computer ones appears so horribly skewed that it has reached the point of complete dysmorphia. These good physicians call me when they feel like they can’t continue any longer in the profession. They want to quit medicine. They report a loss of joy and meaning in their work. They describe the toll that the profession has had on their mental health, physical health, and personal lives. And most wrenchingly, they don’t see an end.

What can we do? There are no easy answers to the complex issues that threaten our profession. “The Taking Care of Our Own Program…has had an over 200% rate of growth in the first year, reflecting the enormous need…”

PHYSICIAN COACHING: https://medicalexecutivepost.com/coach/

Assessment

Burned out physicians will eventually be labeled as disruptive, impaired, an outlier or arrogant. There’s a reason it’s difficult and extremely expensive for physicians to find disability insurance; psychiatric claims. Burnout leads to depression, anxiety, PTSD, suicide, divorce, drug abuse, surly behaviors and interactions, etc. It’s nothing new; it’s been occurring for a long time. Go without routine sleep, eat erratically, work long hours, operate under constantly stressful situations and have no time for your family or self and most individuals will de-compensate physically and psychologically within weeks.

Conclusion

Physicians operate within these parameters year after year.

How are they to remain healthy, functional humans? They can’t. Even a superhero couldn’t, yet physicians are expected to endure and thrive under such conditions.

If a physician makes a single mistake, or snaps just one day, their entire career is on the line.

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PHYSICIANS: Why Salary is Down?

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

MEDICAL PROVIDER PAYMENTS LOWERED

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Statistic: $2.8+ billion dollars

That’s how much Blue Cross and Blue Shield plans agreed to pay to settle litigation over claims they conspired to lower payments to providers. (Healthcare Dive)

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MANAGED CARE ORGANIZATION: Fraudulent Faux (“Mirror”) Schemes

Posted on August 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko; MBA MEd

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Physician Beware Fraudulent Faux (“Mirror”) MCO Schemes

A silent, non-directed, ghost, blind, faux, or “mirror” PPO, HMO, or other provider model is not really a formalized managed care organization [MCO] at all. Rather, it was simply an intermediary attempt, and Ponzi-like scheme, to negotiate practitioner fees downward, by promising a higher volume of patients in exchange for the discount.

Of course, the intermediary [discount-broker] then resells the packaged contract product to any willing insurance company, HMO, PPO or other payer, thereby pocketing the difference as a nice profit. Sometime, these virtual organizations are just indemnity companies in disguise.

CLEVELAND CLINIC: https://medicalexecutivepost.com/2025/05/17/cleveland-clinic-controversial-new-health-insurance-co-payment-policy/

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NOTE: The term indemnity insurance refers to an insurance policy that compensates an insured party for certain unexpected damages or losses up to a certain limit—usually the amount of the loss itself. Insurance companies provide coverage in exchange for premiums paid by the insured parties.

These policies are commonly designed to protect professionals and business owners when they are found to be at fault for a specific event such as misjudgment or malpractice. They generally take the form of a letter o indemnity.

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As part of a silent PPO scheme, insurers try to pass off the discount as legitimate on Explanation of Benefit [EOB] forms. Physicians should not fall for this ploy, since pricing pressure will be forced even lower in the next round of “real” PPO negotiations!

Medical providers should also be on guard for silent HMOs, MCOs and any other silent insurance variation, since these virtual organizations do not exist, except as exploitable arbitrage situations for the middleman.

PRE-PAID PLANS: https://medicalexecutivepost.com/2025/04/17/health-insurance-pre-paid-plans/

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INVESTMENT TYPES: Young Physicians and Medical Practitioners

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

By Dr. David Edward Marcinko MBA MEd

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Types of investments

Once a physician [MD, DO, DPM or DDS] has a brokerage account, the young doctior will need to decide what to invest in. There are lots of options, and each comes with different benefits and drawbacks. Here are some of the most common options for new physician investors.

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

Individual stocks.

Stocks are the first thing most people think about when they are considering investing, but they are not the only option. The prices of stocks change daily, sometimes by large amounts, as the market adjusts to news and various cycles. For that reason, it’s important to do your research. If you’re just beginning with a retirement account, you could also consider the longer-term products listed below.

Index funds and mutual funds.

Index funds attempt to replicate the performance of an un-managed market index. The performance of mutual funds [open and closed] varies. You can often get involved for a lower initial investment, and they can provide good diversification,which makes your portfolio better equipped to handle market fluctuations [active and passive].

For that reason, many financial experts say they should form the core of your retirement portfolio. While they have many similar characteristics, there are important differences. Read more about some of the differences in index funds and mutual funds.

Why Some Career Doctors Still DO NOT Get Rich?

Annuities.

These technically aren’t investment products; they are a contract between you and an insurance company. However, they work to accomplish a similar goal. There are immediate annuities that convert some of your existing savings into lifetime payments, but if we’re talking about saving for retirement, a deferred income annuity is the closest comparison. You make premium payments into the deferred annuity on a regular or irregular basis depending on the contract terms, and when you reach retirement age, you annuitize those savings and receive payments for the rest of your life. They can make a valuable addition to a retirement savings strategy.

Other investments.

There are many other types of investments and financial vehicles: bonds [local, state or US], money market funds, certificates of deposit through a brokerage account or investment apps. Even the cash value of life insurance can play a part. They are all designed to address different needs and have benefits and drawbacks and may be important to your overall strategy.

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ALTERNATE INVESTMENTS: 401[k] Accounts

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Crypto-Currency.

Crypto.com is a cryptocurrency company based in Singapore that offers various financial services, including an app, exchange, and noncustodial DeFi wallet, NFT marketplace, and direct payment service in cryptocurrency. As of 2024, the company reportedly had more than 100 million customers and more than 4,000 employees.

CRYPTO CURRENCY: https://medicalexecutivepost.com/2025/03/27/cryptocurrency-real-money-or-not/

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PHYSICIANS BEWARE: The APR Car Lease “Money Factor”

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

By A.I. and Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What is it?

The so-called money factor (abbreviated as MF on invoices) is a number in a decimal form that dealers use to calculate the APR of a car lease. It’s a major part of your monthly payment and dealers are known to jack up the money factor to pad their profits.

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

How it works

Most doctors don’t ask to see it because they’re not aware of it or don’t know how to calculate it. Ask to see the money factor, then multiply it by 2,400.

For example, if the money factor is .00150, you multiply it by 2,400 to get 3.6%. If that’s higher than the prevailing rate, you have room to talk them down.

How to reduce it

So how do you get a good interest rate when you lease a vehicle? The same way you do when borrowing for any other reason, whether it’s buying a home or applying for a personal loan: by having good credit. This may reduce your interest rate because you’ll represent a lower risk to a lender.

A high residual value on the car could also help you get a better interest rate. A higher residual value means you’d have lower monthly payments because there would be less depreciation on the vehicle. Since interest is applied to your monthly payment, a lower monthly payment would equate to reduced interest charges.

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

Financial implications

The money factor is one of the many numbers you may want to learn about when leasing a car. It’s one of the transactional costs that come with leasing, and allows dealers and finance companies to make a profit on every lease they execute. As a consumer, it’s a smart idea to learn the financial implications of this number and how it’ll affect your overall costs over the course of a multi-year lease.

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If the interest rate is too high, you may need to shop around for a better rate, negotiate with the dealer or lender to lower the money factor, or consider leasing another vehicle that’s more in line with your budget. Either way, make sure you explore all your financial options before taking a car off the lot.

SALARY NEGOTIATIONS: https://medicalexecutivepost.com/2016/08/21/salary-negotiations-skills-for-doctors-hospitalists/

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Filed under: "Ask-an-Advisor", Accounting, Ask a Doctor, business, CMP Program, economics, Ethics, finance, Risk Management | Tagged: APR, auto depreciation, auto invoice, budgeting, car borrowing costs, car dealerships, car lease, car lot, CASH, CMP, DO, doctors, DPM, finance, finance companies, interest rates, IRS, lease vehicle, MD, MF, money, money factor, personal-finance, physicians, real-estate, residual value, vehicle depreciation | Leave a comment »

V.I.P. PATIENT PARADOX: A Joe Biden Medical Scenario?

Posted on August 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr. David Edward Marcinko MBA MEd

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Dr. David Edward Marcinko with non-VIP patients

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The House Committee on Oversight and Government Reform expanded its investigation of the cover-up of former President Joe Biden’s health, prostate cancer, and mental decline.

On June 4th, Chairman James Comer subpoenaed five former senior White House aides to appear for transcribed interviews in addition to Biden’s physician, Kevin O’Connor, M.D. In May, Biden revealed he was diagnosed with advanced prostate cancer. The announcement left the public dumbfounded.

At 82, having spent more than five decades as a president, vice president and senator, Biden had access to world-class medical care. Donald Trump Jr. was one of many political observers who speculated the diagnosis might have been covered up to win the 2020 election. And, Biden’s doctors may have followed standard medical guidelines, and the recommendations about screenings for people of different ages can be controversial, writes health care economist Devon Herrick at the Goodman Institute Health Care Blog.

“Experts often say that men are more apt to die with prostate cancer than from prostate cancer,” wrote Herrick. “There is even some disagreement about whether doctors should treat most occurrences of prostate cancer in older men. That partly explains why Biden had not been screened in a decade.”

Screenings can be costly, time-consuming and uncomfortable, and false positive results can lead to invasive procedures that do not markedly extend life or health. Biden made his first public remarks about his cancer after a Memorial Day event. Biden said he was “feeling good” and expected to “be able to beat this.”

QUESTION: So, was this a case of VIP Patient Paradox?

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DEFINITION: “VIP medical patient paradox syndrome” is a term coined in 1964 by the psychiatrist Walter Weintraub to describe an intriguing paradox: Throughout history, the rich and famous, with all their resources and fancy doctors, have often received worse medical treatment, and suffered from worse health outcomes, than the average person.

VIP DEFINED: https://mdwhistleblower.blogspot.com/2024/08/the-vip-syndrome-threatens-doctors.html

Example: When physicians afford “special privileges” to their powerful patients, from “Mad King” George III to Michael Jackson, they seem to get sicker and even die.

While Weintraub, a psychoanalyst, attributed the problem in part to doctors unconsciously resenting their influential patients, it seems doctors simply get starstruck around famous people and high-ranking figures. Despite their medical expertise, these physicians find themselves opting out of basic tests for “privacy” or prescribing dangerous medications for “comfort.”

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Filed under: Ask a Doctor, Drugs and Pharma, Ethics, Marcinko Associates, mental health | Tagged: Biden, devon herrick, doctors, DPM, Dunning, fancy doctors, goodman institute, health, history, James Comer, kevin O'Conner, Marcinko, MD, medicine, mental health, physicians, politics, prostate, prostate cancer, travel, vip, vip syndrome, Walter Weintraub | Leave a comment »

PHYSICIANS: Side Gigs and Hustles?

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

By Dr. David Edward Marcinko MBA MEd

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In today’s dynamic economic landscape, the concept of a “side hustle” has evolved from a mere trend to an essential component of personal financial strategy for many individuals; even doctors.

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

What Is a Side Hustle?

A side hustle is a way to earn extra income outside of your primary job or main source of employment. It typically involves part-time work, freelancing, small businesses, or gig-based activities that can be pursued flexibly in your free time. Unlike traditional employment, side hustles often offer more autonomy, creative freedom, and the potential to monetize skills, hobbies, or passions.

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Doctor Gigs?

So, if you’re a doctor, dentist or podiatrist considering a side hustle, focus on something sustainable and long-term. Ask yourself: What am I already good at? What do people already ask me to help with? The best side hustles don’t require reinventing the wheel — just monetizing the one you’ve already been pushing uphill.

EXAMPLES: https://www.physiciansidegigs.com/side-gigs

But, avoid gigs that require a huge upfront investment or promise overnight success. Instead, look for something that offers flexibility, ideally something that works with your schedule, not against your sanity.

MONEY ADDICTION: https://medicalexecutivepost.com/2025/08/07/moiney-addicted-physicians-the-investing-and-trading-personality-of-doctors/

Track your earnings and how much time you’re putting in. Side income should support your goals, whether that’s paying off debt, saving for a trip or just breathing easier when office rent comes due.

But, if it’s draining your energy from your medical practice with little to show for it, it might be time to rethink the hustle.

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OB-GYN V. Obstetrician V. Gynecologist V. Mid-Wife V. Doula

Posted on August 15, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

DEFINITIONS

A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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OB-GYN

An obstetrician-gynecologist, or OB-GYN, has expertise in female reproductive health, pregnancy, and childbirth. Some OB-GYNs offer a wide range of general health services similar to a primary care doctor. Others focus on the medical care of the female reproductive system. OB-GYNs also provide routine medical services and preventive screenings. This type of doctor has studied obstetrics and gynecology. The term “OB-GYN” can refer to the doctor, an obstetrician-gynecologist, or to the sciences that the doctor specializes in, which are obstetrics and gynecology.

Obstetrician

Obstetrics is the branch of medicine related to medical and surgical care before, during, and after a woman gives birth. Obstetrics focuses on caring for and maintaining a woman’s overall health during maternity. This includes:

pregnancy
labor
childbirth
the postpartum period

OB-GYNs can conduct office visits, perform surgery, and assist with labor and delivery. Some OB-GYNs provide services through a solo or private practice. Others do so as part of a larger medical group or hospital.

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Gynecologist

Gynecology is the branch of medicine that focuses on women’s bodies and their reproductive health. It includes the diagnosis, treatment, and care of women’s reproductive system. This includes the:

vagina
uterus
ovaries
fallopian tubes

This branch of medicine also includes screening for and treating issues associated with women’s breasts. Gynecology is the overarching field of women’s health from puberty through adulthood. It represents most of the reproductive care received during a lifetime. If pregnant, one goes to an obstetrician.

Mid-Wife

Midwives are registered nurses who specialize in midwifery. As such, they’re trained healthcare providers who can oversee low-risk pregnancies, labor, and birth. They can provide other obstetric and gynecological services too. They can do exams and help with basic gynecological concerns like sexually transmitted infections, urinary tract infections, or yeast infections. They help support during labor and in the postpartum period with breastfeeding and birth control.

Doula

Doulas aren’t clinical professionals and can’t give medical advice. They can’t prescribe medicines, and they can’t deliver a baby. But they can offer physical and emotional support during labor—and sometimes during and after pregnancy. Doulas can help with breathing techniques, positional changes, and relaxation strategies during labor. Studies show doulas are associated with fewer C-sections and more vaginal births.

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PHYSICIAN DIVORCE: Within the Medical Profession

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

By Dr. David Edward Marcinko MBA MEd

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SPONSOR: http://www.MarcinkoAssociates.com

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DIVORCE WITHIN THE MEDICAL PROFESSION

A Johns Hopkins University study, by Michael J. Klag MD in 1997, found that physicians in some specialties — chiefly psychiatry and surgery — are at higher risk for divorce than their medical brethren in other fields. But, the results did not support the common view that job-related anxiety and depression are linked to marital breakup. Alerting medical students to the risks of divorce in some specialties may influence their career choices and strengthen their marriages whatever field they choose. The study, supported by the National Institutes of Health [NIH], was published in the March 13th issue of The New England Journal of Medicine. Results also strongly suggested that the high divorce risk in some specialties may result from the inherent demands of the job as well as the emotional experiences of physicians who enter those fields.

BENEFICIARY DESIGNATIONS: Top 10 Tips for Medical Professionals

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Divorce Prone Medical Specialties*

For example, the Hopkins team assessed the specialty choices, marriage histories, psychological characteristics, and other career and personal factors of 1,118 physicians who graduated from The Johns Hopkins University School of Medicine from 1948 through 1964. Over 30 years of follow-up, the divorce rate was 51 percent for psychiatrists, 33 percent for surgeons, 24 percent for internists, 22 percent for pediatricians and pathologists, and 31 percent for other specialties. The overall divorce rate was 29 percent after three decades of follow-up and 32 percent after nearly four decades of follow-up.

Physicians who married before medical school graduation had a higher divorce rate than those who waited until after graduation (33 percent versus 23 percent). The year of first marriage was linked with divorce rates: 11 percent for marriages before 1953, 17 percent for those from 1953 to 1957, 24 percent for those from 1958 to 1962 and 21 percent for those after 1962. Those who had a parent die before medical school graduation had a lower divorce rate.

Female physicians had a higher divorce rate (37 percent) than their male colleagues (28 percent). Physicians who were members of an academic honor society in medical school had a lower divorce rate, although there was no difference in divorce rates according to class rank. Religious affiliation, being an only child, having a parent who was a physician and having a divorced parent were not associated with divorce rates. Physicians who reported themselves to be less emotionally close to their parents and who expressed more anger under stress also had a significantly higher divorce rate, but anxiety and depression levels were not associated with divorce rates.

MEDIATION: https://medicalexecutivepost.com/2024/09/15/financially-egalitarian-dating-marriages-and-divorce-mediation-for-doctors/

*Cite: Co-authors of the study, which was part of the Johns Hopkins Precursors Study, an ongoing, prospective study of physicians from the Hopkins medical school graduating classes of 1948 through 1964, were lead author Bruce L. Rollman, M.D., Lucy A. Mead, Sc.M., and Nae-Yuh Wang, M.S.

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The Painful Truth

In their article “The Painful Truth: Physicians Are Not Invincible” [1] Miller and McGowen state that divorce rates among physicians have been reported to be 10% to 20% higher than those in the general population. They explain that for many years in pre-med college, medical school, and residency, physicians focus on getting through the next hurdle. They may postpone the pleasures of life that others enjoy. Compulsive traits that allow them to postpone enjoyment may have the unwanted consequence of leading to more distant relationships., thus placing strain on intimate relationships.

A 2002 study looking at dual physician marriages found they have a relatively low divorce rate of 11%. “They’re a happily married cohort,” says Dr Wayne Sotile of the Sotile Cetner for Resilience (www.sotile.com). “They’re more compassionate about the passion for the career — they understand the calling because they share it.”

A study published in The New England Journal of Medicine in 1997 with Bruce L. Rollman as the lead researcher [2] found that physicians in some specialties — chiefly psychiatry and surgery — are at higher risk for divorce than their medical brethren in other fields. Alerting medical students to the risks of divorce in some specialties may influence their career choices and strengthen their marriages whatever field they choose.

The study suggested that the high divorce risk in some specialties may result from the inherent demands of the job as well as the emotional experiences of physicians who enter those fields. The divorce rate was 51 percent for psychiatrists, 33 percent for surgeons, 24 percent for internists, 22 percent for pediatricians and pathologists, and 31 percent for other specialties.

The overall divorce rate was 29 percent after three decades of follow-up and 32 percent after nearly four decades of follow-up. Physicians who married before medical school graduation had a higher divorce rate than those who waited until after graduation (33 percent versus 23 percent). Female physicians had a higher divorce rate (37 percent) than their male colleagues (28 percent).

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References:

Miller, M. N., McGowen, R., 2000, “The painful truth: Physicians are not invincible,” Southern Medical Journal, 93: 966-973.
Rollman BL, Mead LA, Wan NY, Klag MJ. Medical specialty and the incidence of divorce. N Engl J Med. 1997;336:800–3

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Ophthalmologist V. Optometrist V. Optician V. Ocularist

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

A.I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Difference-between-Optometrist-and-Ophthalmologist

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An ophthalmologist is a physician [MD, DO] who undergoes sub-specialty training in medical and surgical eye care. Following a medical degree, a doctor specializing in ophthalmology must pursue additional postgraduate residency training specific to that field. In the United States, following graduation from medical school, one must complete a four-year residency in ophthalmology to become an ophthalmologist. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology.

Ophthalmologists prescribe medications to treat ailments, such as eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists provide both primary and specialty eye care—medical and surgical. Most ophthalmologists participate in academic research on eye diseases at some point in their training and many include research as part of their career. Ophthalmology has always been at the forefront of medical research with a long history of advancement and innovation in eye care.

Optometrist

Optometrists focus on regular vision care and primary health care for the eye. After college, they spend 4 years in a professional program and get a doctor of optometry degree. But they don’t go to medical school. Some optometrists get additional clinical training or complete a specialty fellowship after optometry school. They:

Perform eye exams and vision tests
Prescribe and fit eyeglasses and contact lenses
Monitor eye conditions related to diseases like diabetes
Manage and treat conditions like dry eye and glaucoma
Provide low-vision aids and vision therapy

There are specialties among optometrists. They include:

Pediatric optometry. These providers work with babies, toddlers, and children, using special techniques to test their vision.

Neuro-optometry. If you have vision problems that result from a brain injury, this is the type of optometrist you might visit.

Low-vision optometry. If you have low vision—that means you can’t see well enough to perform your daily activities and your sight can’t be corrected by glasses or contact lenses, medicine, or surgery—low-vision optometrists offer devices and strategies that can improve your quality of life.

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Optician

An optician is an eye care specialist who helps you choose the right eyeglasses, contact lenses or other vision correction devices. They can’t diagnose or treat conditions that affect your eyes or vision. They’ll work with you to get the right corrective lenses after your optometrist or ophthalmologist gives you a prescription.

Ocularist

An ocularist is an eye care specialist who provides care for people needing prosthetic eyes due to injury, infection or congenital disease (present at birth). Losing or damaging an eye can be a traumatic experience, and the need for a prosthetic can be overwhelming. Ocularists offer long-term care. They collaborate with your healthcare team to create or restore a more natural facial appearance with the goal of enhancing your health-related quality of life.

A former term for this medical branch is oculism.

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Why [Too Many] Physician Colleagues Don’t Get Rich?

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

Filed under: "Ask-an-Advisor", Ask a Doctor, Career Development, Experts Invited, finance, Financial Planning, Health Economics, Health Insurance, Health Law & Policy, Touring with Marcinko | Tagged: ACA, CFP, CMP, CMS, DDS, doctors, DPM, dumb doctors, dumb physicians, Dunning, financial advisors, HHS, Marcinko, MD, Paul Larson, physicians, poor physicians, PP-ACA, rich physicians, Thomas Stanley | Comments Off on Why [Too Many] Physician Colleagues Don’t Get Rich?

EMOTIONAL INTELLIGENCE & ORGANIZATIONAL BEHAVIOR: Economic Risk Management Classification for Medical Professionals

Posted on July 28, 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

ORGANIZATIONAL BEHAVIOR AND CLASSIFICATION OF RISKS

DEFINITION EMOTIONAL INTELLIGENCE: Emotional intelligence [EI] refers to the ability to identify and manage one’s own emotions, as well as the emotions of others. Emotional intelligence is generally said to include a few skills: namely emotional awareness, or the ability to identify and name one’s own emotions; the ability to harness those emotions and apply them to tasks like thinking and problem solving; and the ability to manage emotions, which includes both regulating one’s own emotions when necessary and helping others to do the same.

DEFINITIONAL ORGANIZATIONAL BEHAVIOR: Organizational behavior (OB) is the study of how individuals, groups, and organizations interact and influence one another. Though it is largely used within the field of business management as means to understand–and more effectively manage–groups of people. The reason businesses look to OB is because it can help organizations increase employee performance, while also creating a positive working environment.

CITE: Eugene Schmuckler; PhD MBA MEd CTS®

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And so, as we review the concept of Emotional Intelligence and Organizational Behavior, it is possible to set up five EI/OB risk classes, based on the economic consequences of the occurrence of specific individual risks:

1. Prevented risks: Risks whose cost of occurrence is higher than their cost of management and whose occurrence may invoke additional legal sanctions. This class would include intentional torts and injuries caused by gross negligence.

2. Normally prevented risks: Risks whose cost of occurrence is greater than the cost of their management but whose occurrence will be considered only as negligent. This class includes most negligent injuries
and most types of product liability actions.

3. Managed risks: Risks whose cost of occurrence is only slightly greater than their cost of management. The plaintiff usually has the burden of showing that the defendant owed the plaintiff a special duty to recover for one of these risks.

4. Un-Prevented risks: Risks whose cost of occurrence is less than their cost of management. The classic example of this class is the cost of railroad crossing barriers compared to the cost of people being hit by
trains.

5. Un-Preventable risks: Risks whose occurrence is unmanageable. The assignment of a risk to one of these classes is a major problem in medical and healthcare quality control, because the class of a risk determines how much effort must be expended to prevent the risk. The misclassification of a prevented or normally prevented risk as a managed or un-prevented risk can result in large financial losses.

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For example: A medical clinic that does not update obsolete equipment, such as inaccurate oxygen monitors, would be liable for any injuries attributable to the obsolete equipment. The classifications of risk must be reviewed periodically to determine if the cost of the risk-taking behavior has changed, thereby altering the classification.

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For example: A small hospital in a rural area would not be expected to have the sophisticated equipment as a major hospital in a city. If an accident victim is brought into the rural facility, the hospital’s duty may be to transfer the patient to a better-equipped facility. The patient will face the risk of dying because of the delay in treatment, but the risk of insufficient treatments outweighs the risk of transfer. If the same victim were brought into a hospital in a major metropolitan center, the duty would be to treat the patient without a transfer. The risk of transfer has not changed, but the risk of insufficient treatment has disappeared.

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Filed under: "Ask-an-Advisor", "Doctors Only", Ethics, Experts Invited, mental health, Op-Editorials, Risk Management, Sponsors, Touring with Marcinko | Tagged: books, DO, doctor EQ, DPM, economics, Emotional Intelligence, EQ, intelligence quota, IQ, Marcinko, MD, OB, op-editorial, organizational behavior, physicians IQ, Risk Management, schmuckler, Technology | Leave a comment »

PHYSICIANS: Do You Use A Financial Planner?

Posted on July 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

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TO: All Physicians and Dentists

QUESTION?

Do you use a financial advisor?

What has been your experience with him or her?

THANK YOU

EDUCATION: Books

Filed under: Ask a Doctor, Career Development, economics, finance, Financial Planning, iMBA, Inc., Investing, Marcinko Associates | Tagged: DC, DDS, DMD, DO, doctors, DPM, finance, financial advice, financial advisors, financial planners, Marcinko, MD, physicians | Leave a comment »

PHYSICIANS: Do You Use A Financial Advisor?

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

By Staff Reporters

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TO: All Physicians and Dentists

QUESTION?

Do you use a financial advisor?

What has been your experience with him or her?

THANK YOU

Filed under: "Advisors Only", "Ask-an-Advisor", Career Development, Investing, Portfolio Management | Tagged: DDS, dentists, DMD, DO, financial advisor, financial planner, MD, physicians, podiatrists | Leave a comment »

DOCTORS AND LAWYERS: Often Aren’t Millionaires

Posted on July 17, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

Filed under: "Ask-an-Advisor", "Doctors Only", Ask a Doctor, Experts Invited, Financial Planning, Funding Basics, Investing, Marcinko Associates, Portfolio Management | Tagged: attorneys, books, DDS, dentist, DMD, DO, doctors, DPM, lawyers, Marcinko, MD, medicare, Millionaires, news, photos, physicians, podiatrist, poor attorneys, poor doctors, portfolio managers, rich attorneys, rich dentists, rich doctors, Technology | Comments Off on DOCTORS AND LAWYERS: Often Aren’t Millionaires

Psychiatrist V. Psychologist V. Psychotherapist

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

DEFINITIONS
By A. I. and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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The terms “psychologist” and “psychiatrist” are often used interchangeably to describe anyone who provides therapy services, but the two professions and the services they provide differ in terms of content and scope. A major difference between the two types of experts is that psychiatrists can prescribe medication [Rx].

As physicians [MD/DO] psychiatrists are trained to recognize the ways biological processes affect mental functioning.
Psychologists are oriented to how thoughts, feelings, and social factors influence mental functioning.

PSYCHIATRIST

Psychiatrists are medical or osteopathic doctors who are able to prescribe psychotropic medications, which they do in conjunction with providing psychotherapy though medical and pharmacological interventions are often their focus.

PSYCHOLOGIST

Though many psychologists hold doctorate degrees, they are not medical doctors, and most cannot prescribe medications. Rather, they solely provide psycho-therapy, which may involve cognitive and behavioral interventions, psycho-dynamic or psycho-analytic approaches.

NOTE PROTECTED TITLE: The title of “psychologist” can only be used by an individual who has completed the required education, training, and state license requirements. Informal titles, such as “counselor” or “therapist,” are often used as well. Other mental health care professionals, such as licensed social workers, can claim those titles, but not the title of “psychologist.”

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BRAND MANAGEMENT: 7 Approaches For Doctors and Financial Advisors

Posted on July 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By A.I.

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Any extensive analysis of numerous papers published on brand management leads to the seven approaches mentioned below. This included 300+ articles from Journal of Marketing, Journal of Marketing Research, Journal of Consumer Research, Harvard Business Review and European Journal of Marketing.

So, it can be safe to claim that no matter which framework or model one follows it must have originated via one of the seven approaches listed below.

The Seven Branding Approaches are:

The economic approach: the brand as part of the traditional marketing mix.
The identity approach: the brand as linked to corporate identity.
The consumer-based approach: the brand as linked to consumer associations.
The personality approach: the brand as a human-like character.
The relational approach: the brand as a viable relationship partner.
The community approach: the brand as the pivotal point of social interaction.
The cultural approach: the brand as part of the broader cultural fabric.

There are multiple theories and model to be followed in the area of brand management with their own school of thought and have been proven to work.

These include the Aaker’s brand identity model, Kapferer’s brand prism or Keller’s customer-based brand equity pyramid. All of them will enhance the brand equity of the product or service but may have evolved from different school of thoughts. Though everyone talks about the different models, rarely we find text on the school of thought rather then the actual model in practice.

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And, you will find the Brand Asset Valuator Model in many books but you might never come to know the author’s perspective.

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Filed under: Ethics, iMBA, Inc., LifeStyle, Management, mental health, Research & Development | Tagged: Aaker, attributes, brand, brand asset valuator model, communications, DDS, DMD, doctors, DPM, financial advisors, identity, Kapferer, Keller, marketing, MD, mental health, positioning, PR, public relations, sales, strategies, values | Leave a comment »

DOCTOR BRANDING STRATEGIES: Exploring 9 [NINE] Different Types

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

By A.I.

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Medical doctors, dentists, and podiatrists have to undergo extensive training before they can practice medicine independently. Once they receive training, there are opportunities to increase pay and prestige in the medical field through a series of promotions. As a doctor, how much training, experience and skills you have can determine your ability to move upward in these levels. But, personal branding strategies may even be more vital in today’s social media age?

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Physician, medical and healthcare branding is more than just the creation of logos, taglines, or specific brand messaging. It’s about creating a meaningful connection between your mission, vision and values and the people served – from patients and their families to local and global communities.

While there are many different types of branding strategies in marketing science, they all share key elements that serve as the foundation for the strategy. These 9 elements for all physicians and medical professionals include the following:

Brand purpose: The reason the physician is in practice and what he/she is trying to achieve.
Brand vision: The ideas and goals behind the dentist which serve as inspiration for practice growth.
Brand values: The osteopaths beliefs and what they stand for.
Target audience: The demographic(s) and patient targets that the podiatrist is aiming to reach.
Market analysis: An analysis of the marketplace that identifies gaps where the chiropractor has an opportunity to position him/her self based on a unique value proposition.
Awareness goals: The initiatives the doctor will take in order to reach a target market patient demographic.
Brand personality: The human-like attributes of the physician that will help build relationships with patients, consumers and other physicians and practitioners.
Brand voice: The language and tone the doctor uses to communicate with patients, physicians and consumers.
Brand tagline: A memorable slogan that sums up the physician and their medical offering in a few choice words.

And so, physician branding is the development of a easily recognizable identity for a medical practice, clinic or healthcare organization that helps to shape perception by current and prospective patients and the wider world.

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Filed under: "Ask-an-Advisor", "Doctors Only", Career Development, Glossary Terms, LifeStyle, Managed Care, Marketing & Advertising, Practice Management | Tagged: advertising, branding, brands, business, DDS, digital marketing, DO, doctors, DPM, marketing, MD, physicians, PR, promotions, public relatiions, sales, seo, slogans, tagline | Leave a comment »

BRANDS & BRAND MANAGEMENT: Defined and Explored for Doctors and Advisors

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

By A.I.

SPONSOR: http://www.CertifiedMedicalPlanner.org

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What Is a Marketing Brand

A brand is a name, term, design, symbol or any other feature that distinguishes one seller’s goods or service from those of other sellers. Brands are used in business, marketing and advertising for recognition and, importantly, to create and store value as brand equity for the object identified, to the benefit of the brand’s clients, patients, customers, its owners and shareholders. Brand names are sometimes distinguished from generic or store brands.

BRANDING: https://medicalexecutivepost.com/2023/02/02/podcast-personal-branding-for-doctors/

What is Brand Management?

Brand management, also known as Marketing, is responsible for the overall management of a brand. This includes everything from product or service development and marketing to advertising and public relations. All of these aspects work together to create a particular image or reputation for a brand. The goal of brand management is to create a robust and positive reputation for a brand that will result in increased sales and market share.This process helps companies create a unique identity for their products or services in the marketplace. A successful brand management strategy can build client, patient and customer loyalty .

BRANDS: https://medicalexecutivepost.com/2021/06/03/physician-branding-post-pandemic/

Branding is essential for financial advisors, doctors and businesses because it involves creating a unique identity for a company’s products, offerings and services. It can also help build customer, client and patient loyalty and emotionally connect with the practitioner. Branding can be complex, but it is essential to understand the basics before starting a brand strategy.

Thus, doctors, podiatrists, dentists, CPAs, insurance agents, financial advisors and their practices need to understand the different aspects of branding and brand management to create a strong brand identity.

SELF BRANDING: https://medicalexecutivepost.com/wp-content/uploads/2011/03/leadership-self-branding-marcinko.pdf

EDUCATION: Books

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NEW AMA PRESIDENT: Robert Mukkamala MD

Posted on June 27, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

NEWS UPDATE!

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On June 10th, Bobby Mukkamala was inaugurated as the 180th president of the American Medical Association (AMA).

An otolaryngologist from Flint, Michigan, Mukkamal chairs the organization’s substance use and pain care task force, won the AMA Foundation’s Excellence in Medicine Leadership Award last June, and served on the AMA board of trustees in 2017 and 2021.

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Filed under: "Doctors Only", Ask a Doctor, Breaking News, Career Development, Health Economics, Health Insurance, Health Law & Policy | Tagged: AMA, american medical association, doctor, ears, ENT, eyes, GI, gut, MD, nose, otolaryngologis, physician, Robert Mukkamala, throat | Leave a comment »

PERSONAL COACHING: For Physician Colleagues

Posted on June 7, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Dr David Edward Marcinko MBA MEd

http://www.MarcinkoAssociates.com

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COACHING: Careers

If you’re looking at this tab, chances are you are fed up, burned out, seeking a better work-life balance, looking for a new non-clinical career, thinking of retirement, or all of the above. Perhaps you are just looking to regain the joy and meaning in your medical career. No worries! You may have come to the right place.

We work only with doctors, dentists, podiatrists, nurses, technicians and healthcare providers who struggle with personal and professional disillusionment, burnout, financial distress and an unbalanced life – all of which can happen at any stage of a medical career.

Through our coaching sessions, medical and healthcare professionals and colleagues can achieve a more meaningful, purposeful, and financially flourishing life.

Invite Dr. Marcinko

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HOW MAY WE SERVE YOU?

CONTACT: Ann Miller RN MHA CPHQ to schedule an appointment: MarcinkoAdvisors@outlook.com

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Filed under: "Doctors Only", Career Development, Events-Planner, Experts Invited, LifeStyle, Marcinko Associates | Tagged: DDS, DO, DPM, financial coaching, Marcinko, MD, medical coaching, personal coaching, physician coching | Leave a comment »

FINANCIAL LIFE PLANNING? For Physicians and Medical Professionals

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

SPONSOR: http://www.MarcinkoAssociates.com

By Dr. David Edward Marcinko; MBA MEd CMP™

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Life planning and behavioral finance as proposed for physicians and integrated by the Institute of Medical Business Advisors Inc., is unique in that it emanates from a holistic union of personal financial planning, human physiology and medical practice management, solely for the healthcare space. Unlike pure life planning, pure financial planning, or pure management theory, it is both a quantitative and qualitative “hard and soft” science, with an ambitious economic, psychological and managerial niche value proposition never before proposed and codified, while still representing an evolving philosophy. Its’ first-mover practitioners are called Certified Medical Planners™.

Life planning, in general, has many detractors and defenders. Formally, it has been defined by Mitch Anthony, Gene R. Lawrence, AAMS, CFP^© and Roy T. Diliberto, ChFC, CFP^©of the Financial Life Institute, in the following trinitarian way.

Financial Life Planning is an approach to financial planning that places the history, transitions, goals, and principles of the client at the center of the planning process. For the financial advisor or planner, the life of the client becomes the axis around which financial planning develops and evolves.

Financial Life Planning is about coming to the right answers by asking the right questions. This involves broadening the conversation beyond investment selection and asset management to exploring life issues as they relate to money.

Financial Life Planning is a process that helps advisors move their practice from financial transaction thinking, to life transition thinking. The first step is aimed to help clients “see” the connection between their financial lives and the challenges and opportunities inherent in each life transition.

But, for informed physicians, life planning’s quasi-professional and informal approach to the largely isolate disciplines of financial planning and medical practice management is inadequate. Today’s practice environment is incredibly complex, as compressed economic stress from HMOs managed care, financial insecurity from insurance companies, ACOs and VBC, Washington DC and Wall Street; liability fears from attorneys, criminal scrutiny from government agencies, and IT mischief from malicious electronic medical record [eMR] hackers. And economic bench marking from hospital employers; lost confidence from patients; and the Patient Protection and Affordable Care Act [PP-ACA] more than a decade ago. All promote “burnout” and converge to inspire a robust new financial planning approach for physicians and most all medical professionals.

The iMBA Inc., approach to financial planning, as championed by the Certified Medical Planner™ professional certification designation program, integrates the traditional concepts of financial life planning, with the increasing complex business concepts of medical practice management. The former topics are presented in this textbook, the later in our recent companion text: The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors].

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For example, views of medical practice, personal lifestyle, investing and retirement, both what they are and how they may look in the future, are rapidly changing as the retail mentality of medicine is replaced with a wholesale and governmental philosophy. Or, how views on maximizing current practice income might be more profitably sacrificed for the potential of greater wealth upon eventual practice sale and disposition.

Or, how the ultimate fear represented by Yale University economist Robert J. Shiller, in The New Financial Order: Risk in the 21st Century, warns that the risk for choosing the wrong profession or specialty, might render physicians obsolete by technological changes, managed care systems or fiscally unsound demographics. OR, if a medical degree is even needed for future physicians?

Say, what medical license?

Dr. Shirley Svorny, chair of the economics department at California State University, Northridge, holds a PhD in economics from UCLA. She is an expert on the regulation of health care professionals who participated in health policy summits organized by Cato and the Texas Public Policy Foundation. She argues that medical licensure not only fails to protect patients 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.

Yet, the opportunity to revise the future at any age through personal re-engineering, exists for all of us, and allows a joint exploration of the meaning and purpose in life. To allow this deeper and more realistic approach, the informed transformation advisor and the doctor client, must build relationships based on trust, greater self-knowledge and true medical business management and personal financial planning acumen.

[A] The iMBA Philosophy

As you read this ME-P website, we hope you will embrace the opportunity to receive the focused and best thinking of some very smart people. Hopefully, along the way you will self-saturate with concrete information that proves valuable in your own medical practice and personal money journey. Maybe, you will even learn something that is so valuable and so powerful, that future reflection will reveal it to be of critical importance to your life. The contributing authors certainly hope so.

At the Institute of Medical Business Advisors, and thru the Certified Medical Planner™ program, we suggest that such an epiphany can be realized only if you have extraordinary clarity regarding your personal, economic and [financial advisory or medical] practice goals, your money, and your relationship with it. Money is, after only, no more or less than what we make of it.

Ultimately, your relationship with it, and to others, is the most important component of how well it will serve you.

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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: CONTACT: MarcinkoAdvisors@outlook.com

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Filed under: "Ask-an-Advisor", "Doctors Only", CMP Program, Experts Invited, Financial Planning, Glossary Terms, Health Economics, Healthcare Finance, iMBA, iMBA, Inc., Insurance Matters, Investing, Managed Care, Marcinko Associates, Op-Editorials, Portfolio Management, Practice Management, Practice Worth, Professional Liability, Recommended Books, Touring with Marcinko | Tagged: ACA, ACOs, behavioral finance, certified medical planner, CFP, CMP, DO, doctors practice management, DPM, finance, Financial Planning, HMO, iMBA, Investing, life planning, Marcinko, MBA, MD, medical business advisors, personal-finance, PPACA, PPO, retirement planning, VBC | 1 Comment »

MEDICINE: Flat Fee Per Patient Treatment Case

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

By Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Flat Fee-Per-Case

Classic: Flat fee paid for a patient’s treatment based on their diagnosis and/or presenting problem. For this fee the provider covers all of the services required for a specific period of time.

PHYSICIAN SALARY: https://medicalexecutivepost.com/2023/04/14/physician-salary-pay-gap/

Modern: Often characterizes “second generation” managed care systems. After a Managed Care Organization squeezes out costs by discounting fees, they often come to this method. If provider is still standing after discount blitz, this approach can be good for provider and clients, since it permits a lot of flexibility for provider in meeting client needs.

PHYSICIAN NET WORTH: https://medicalexecutivepost.com/2024/09/21/physician-net-worth-personalized-projections/

Example: A Flat fee system paid for a medical treatment based on a patient’s diagnosis for a specific period of time.

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Filed under: "Doctors Only", Drugs and Pharma, Ethics, Glossary Terms, Health Economics, Health Insurance, Managed Care, Marcinko Associates, mental health | Tagged: case fee, CMP, diagnosis, DO, DPM, Drugs, flat fee, HMO, Marcinko, MCO, MD, mental health, patient, treatment | Leave a comment »

FROM: Zocdoc to Zo

Posted on May 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters and AI

SPONSOR http://www.CertifiedMedicalPlanner.org

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When New York-based Zocdoc was founded back in 2007, the idea was to help patients get off the phone, founder and CEO Oliver Kharraz told Healthcare Brew. The company created a website that helps patients find clinicians who fit their needs in their area and are under their insurance, and books appointments online.

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

But on May 1st, Zocdoc launched a new product to get people back on the phone: an artificial intelligence (AI) voice agent called Zo. Zo helps people book doctor appointments 24/7—but instead of speaking with a person, patients speak with an AI voice that is trained to meet their needs.

DPM Podiatrist: https://medicalexecutivepost.com/2024/03/20/is-a-podiatrist-a-physician/

“Until recently, we didn’t do the phone because the experience on the phone was just so miserable,” Kharraz said. “Now you can actually have a consistent experience, where the AI can pick up after the first ring an unlimited number of times concurrently [and] have a natural conversation with you.”

Tele-Health: https://medicalexecutivepost.com/2022/04/04/types-of-patient-care-healthcare-providers-deliver-via-tele-health/

Click here for more on the rise of voice agents in healthcare.

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Filed under: "Doctors Only", Ask a Doctor, Career Development, CMP Program, Experts Invited, Information Technology | Tagged: AI, allopath, Artificial Intelligence Medicine, CMP, DO, DPM, health care, Healthcare Brew, Kharraz, MD, medicine, osteopath, podiatrist, tele health, tele medicine, voice agents, Zo, ZocDoc | Leave a comment »

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Education Costs and Debt Burden

Income Potential of Specialized Nurses

💰 Highest-Paying Nursing Careers (2025)

The Baylor Pay Plan Advantage

Lifestyle and Work‑Life Balance

Retirement Wealth Beyond Salary

Conclusion

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1. Impulse Spending

2. High‑Interest Debt

3. Ignoring Savings and Investments

4. Chasing Get‑Rich‑Quick Schemes

5. Overspending on Status

6. Neglecting Insurance

7. Failing to Budget

8. Ignoring Education and Skills

Conclusion

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🎯 Understanding the Target Audience

🌐 Building a Strong Online Presence

🗣️ Leveraging Patient Reviews and Testimonials

📬 Utilizing Email and Content Marketing

***

📊 Measuring Success

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The Debt Dilemma

Income ≠ Wealth

Taxes and Business Skills

Investing and Retirement Planning

Insurance and Risk Management

Emotional and Behavioral Finance

The Case for Financial Education

Conclusion

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Understanding the Situation

Redefining Retirement

Leveraging Medical Expertise

Exploring Non-Clinical Opportunities

Maximizing Government and Community Resources

Downsizing and Budgeting

Emotional and Mental Well-Being

Planning for the Future

Embracing a New Chapter

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Why is investing important?

When should you start investing?

How much should you invest per month?

Good beginner investments.

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What Is a Doctorate Degree?

Can a PhD Be Called a Doctor?

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Can a physician medical provider charge an office cancellation fee?

Is it legal for an insurance company to charge a cancellation fee?

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