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  • David E. Marcinko [Editor-in-Chief]

    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

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

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

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

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

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

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

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.



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Understanding the Modern Challenges of Student Doctors

An Evolving Educational Model

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By Cyndi Laurenti


Medical education could be driving potential doctors away and damaging those who do go on to practice with long hours, high debt, inconsistent training, and lack of emotional support. Research indicates the current structure of residency programs produces resident physicians who are stressed, sleep-deprived, and prone to medical errors.

Medical Residents

Medical school graduates who’ve begun their on-the-job training are called residents varying in length from three to seven years, depending on the specializations doctors pursue. Most programs utilize experienced physicians called preceptors to teach the new doctors how to practice their particular branches of medicine. Another common practice is to pair second- or third-year residents with one or more first-year residents, so the senior students take on some of the teaching and supervision roles.


Residents admit patients to the hospital, obtain medical histories, perform examinations, and administer treatments or do procedures under the guidance of the senior resident or preceptor.

The hours in a residency program are long. Despite recommendations from the Institutes of Medicine intended to decrease long shifts and work hours, 80-hour weeks are common in residency programs and 30-hour shifts with five-hour sleep periods are the norm. Moreover, those 80-hour work weeks represent the average over a four-week period, so a resident might actually work considerably longer in a single week.

Work Shifts

Rotating shifts, in which residents work at different times of the day or night, are also common. Sleep deprivation is the norm: a 2004 survey of over 3,000 residents reported 66 percent slept less than six hours a night, and 20 percent slept less than five. Of even more concern, those who slept less than five hours a night reported they had used alcohol, resorted to stimulants to stay awake, had serious accidents or injuries, had conflicts with other professional staff, or made serious medical errors.

Financial Stress

Many residents also face financial or family stressors as well. Debt is common in medical school: the New England Journal of Medicine reports one fourth of graduating residents have debt exceeding $200,000. Some residents use their limited free time to moonlight for additional income as the average medical resident salary is about $45,000 per year.


Medical residents are often in their late twenties or early thirties, a time when many people look to starting families. The lack of income may drive them to work extra hours in an already crowded schedule, which prevents them from spending time with children or a spouse, if indeed they manage to have either. Research from as far back as 1986 indicated over 40 percent of medical residents experience problems with their spouses during residency. Respondents often feel the working conditions of residency contribute to family problems, which in turn affect their hospital work as a result. On a positive note, researchers have found stress can be moderated by family relationships and social contact, and recommended social support systems be fostered in residency programs.


Emotional stress related to patient care is another aspect of the issues with residency. Over 70 percent of residents in one study reported hospital activities such as cardiopulmonary resuscitation were extremely stressful and the lack of a debriefing session afterward increased the impact of that stress, particularly when the resident felt the resuscitation was inappropriate.

Recipe for Disaster?

The combination of stress and sleep deprivation is a recipe for disaster. A study at HarvardUniversityfound residents who worked extended shifts or long hours were involved in 300 percent more fatal errors than when they did not work excessive hours. These same physicians reported they were likely to fall asleep during surgery, patient examinations, hospital rounds or lectures, and that their medical errors induced guilt, anger, humiliation, and decreased compassion for the patients they treated.

To add to these stresses, as recently as October 2011 almost half of graduate physicians in one survey reported they had been harassed, intimidated or discriminated against while residents. These behaviors took the form of verbal abuse and being assigned extra work as punishment. The sources of inappropriate behavior were primarily specialty physicians, but specialty residents, hospital nurses, and patients also participated in the harassment.

The Changing Paradigm

Some residency programs have made changes to improve the quality of life for residents. These include strategies such as decreasing patient load, senior residents supervising a single resident instead of two or more, and decreasing hand-offs, the transfer of patients from one group of residents to another. Other recommendations include debriefing sessions for stressful situations such as cardiopulmonary resuscitation, ethics committees to which residents can take complicated problems, and increased emotional support.


Other possible strategies include a decreased shift length, or simply adherence to the Institutes of Medicine’s guidelines for residency training programs. Social networks for residents’ spouses and families would provide a forum to air concerns and obtain emotional support from those in similar circumstances.

Additional efforts to relieve medical student debt would also make a considerable positive impact. A program currently exists in theUnited Statesfor physicians to obtain loan forgiveness: the National Health Service Corps pays off medical student debt if the physician practices full-time at a NHSC-approved site, usually a federally-qualified health center, rural or Indian Health service clinics, or prison. If a physician serves full-time for six or more years, the entire debt may be repaid by the NHSC.


Most residency programs in other parts of the world are similar to those in theUnited States, although there may be different laws that affect work hours or salaries. There is clear evidence that overstressed and sleep-deprived residents are more likely to make serious or even fatal medical errors and lose their sense of compassion for patients. The current residency system is expensive, emotionally stressful, and puts the lives of patients at risk. America (and likely other nations as well) would benefit from making even more changes in residency programs to provide adequate time for sleep, family or social interaction, and emotional support for fledgling doctors.

About the Author

While she figures out her next career move, Cyndi Laurenti works as an online writer and editor. Her primary interests are education, technology, and how to combine them. She enjoys the trees and beaches of thePacific Northwest, and looking things up on other people’s iPhones.


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Rags to Riches thru [Medical] Education?

Or … Riches to Rags for Docs and the ACA?

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American society prides itself on being a meritocracy, particularly with the fruition of the ‘American Dream’ being achieved by individuals from all types of backgrounds; like doctors, Financial Advisors [FAs] and all medical professionals.


Success today typically involves some form of higher education, to expand intellectual capacity and to hone a skill-set.

However, the highest quality education is not the most easily accessible. And so, this infographic takes a look at how the elite tend to fare well, and how the disadvantaged aren’t provided the same opportunities.

Source: www.onlineschools.org


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