BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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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.
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
Posted on April 23, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Classic Definition: Suppose someone tells you “I am lying.” If what he/she tells you is true, then he/she is lying, in which case what he/she tells you are false. On the other hand, if what he/she tells you is false, then he/she is not lying, in which case what he/she tells you is true.
Modern Circumstance: In short: if “I am lying” is true then it is false, and if it is false then it is true.
Paradox Example: The paradox arises for any sentence that says or implies of itself that it is false (the simplest example being “This sentence is false”). It is attributed to the ancient Greek seer Epimenides (fl. c. 6th century BCE), an inhabitant of Crete, who famously declared that “All Cretans are liars” (consider what follows if the declaration is true). The paradox is important in part because it creates severe difficulties for logically rigorous theories of truth; it was not adequately addressed (which is not to say solved) until the 20th century.
Paradox Example: Doctors lie because, as caretakers, our role isto improve the lives of their patients. Re-assuring patients during some of the most difficult times of their lives counts as improving their well being! This is an acceptable practice because it does not cause harm.
Paradox Example: Cultural differences may make a lie of omission or the practice of withholding information from the patient, prudent. For instance, some cultures and religions dictate that the husband or head male family members make all medical decisions for women.
Paradox Example: Many physicians don’t report “near misses” to their patients. But, concealing serious medical errors is something we recommend against.
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The Medical Executive-Post is a news and information aggregator and social media professional network for medical and financial service professionals.
Feel free to submit education content to the site as well as links, text posts, images, opinions and videos which are then voted up or down by other members. Comments and dialog are especially welcomed.
Daily posts are organized by subject. ME-P administrators moderate the activity. Moderation may also conducted by community-specific moderators who are unpaid volunteers.
Posted on March 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Donald Trump has officially dropped a stablecoin. It’s called USD1, and it’s pegged 1:1 with the US dollar, according to a statement from his family company World Liberty Financial Inc, (WLFI) today. The company says the token is fully backed by short-term US government treasuries, USD deposits, and other cash equivalents. Every token equals one dollar, no exceptions. WLFI says it built the whole thing to give people a stablecoin they don’t have to second guess.
US stocks rose for a third day in a row despite souring consumer confidence — and as investors weighed whether President Trump would temper his plans for upcoming tariffs.
The benchmark S&P 500 (^GSPC) rose more than 0.1%, while the Dow Jones Industrial Average (^DJI) ticked just above the flatline. The tech-heavy NASDAQ Composite (^IXIC) rose nearly 0.5%, bolstered by a more than 3% jump from Tesla (TSLA).
In 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked academe’ by identifying health economics as a separate and distinct field. Yet, the seemingly disparate insurance, tax, risk management and financial planning principles that he also studied are just now becoming transparent to some medical professionals and their financial advisors. Despite the fact that a basic, but hardly promoted premise of this new wave financial planning era, is imprecision.
Nevertheless, to informed cognoscenti like Certified Medical Planners™, the principles served as predecessors to the modern physician-focused financial advisory niche sector. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views.
And now, as a long bull market may be over, and if the current “new-normal” prevails – meaning a 4.5% real annualized rate of return on equities and a 1.5% real rate on bonds – wealth accumulation for all may be reduced.
An Imprecise Science
There is a major variable, dominant in any marketplace that pushes an economy in a forward direction. It is called consumerism. This became apparent while waiting in a doctor’s office one recent afternoon.
Scenario:
The front office receptionist, who appeared to be about 21 years old, was breaking for lunch and her replacement, who appeared not much older, came over to assist. Realizing the propensity for a long wait, one was taken by the size of waiting room and the number of patients coming in and out of the office. [Americans consume healthcare and a lot of it]. There was another notable peculiarity. The sample prescription bags being carried out the door were no match for the bags under everyone’s eyes, including the doctor’s. The office staff was probably working overtime, if not two jobs, and the doctor was working harder and faster in a managed care system.
Assessment
Why? So they all could afford to buy and voraciously consume for their children and themselves. Americans indeed work longer hours than any other industrialized nation.
Conclusion
Finally, as women medical professionals entered the workforce in unprecedented numbers, the stock markets reached an all time high in 2025, even as money was spent at a feverish pace as the Federal Reserve pumped out money in inflammatory fashion.
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
Posted on February 26, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
In great news for investors, a new study found that major healthcare companies have paid out $2.6 trillion to shareholders over the past 20 years in the form of dividends and share buybacks, and those payments are increasing. Bad news for patients: Some of that money could’ve been spent on, well, healthcare. The study, published Februrary 10th in JAMA, found that publicly traded S&P 500 healthcare companies paid shareholders a total of $170.2 billion in 2022, up 315% from payouts of just $54 billion in 2001.
The S&P 500 fell 0.5%. The NASDAQ 100 slid 1.2%. A gauge of the “Magnificent Seven” mega-caps sank 2.2%. Nvidia Corp.’s shares slid 2.8% on the eve of the company’s results, while Tesla slumped 8.4% to fall below $1 trillion in market value. The DJIA was up.
Posted on February 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™
FULL ARTICLE WITH TAKE AWAY POINTS
By Vitaliy Katsenelson CFA
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Key Take Away Points
The Consumer Electronics Show revealed that robotaxis are expanding beyond just Waymo, with multiple players entering the market – this fragmentation could actually benefit Uber’s switchboard system and transform sectors like school transportation.
Chinese EV manufacturers have leapfrogged traditional auto manufacturing much like Africa skipped landlines for mobile phones – their fresh designs and cost advantages could seriously challenge Western incumbents if tariffs weren’t a factor.
Autonomous and remote-controlled equipment is set to revolutionize traditional industries like construction, mining, and farming – transforming physically demanding jobs into office work and potentially reshaping immigration policy needs.
The path to cracking the US market has fundamentally changed – companies no longer need traditional retail gatekeepers like Best Buy or Costco, just a product and Amazon advertising budget, as demonstrated by companies like Renpho.
Brand value remains crucial in an era of rapid technology commoditization – your observations of the 15 Oura ring competitors and the GoPro story demonstrate that without strong brand differentiation, even good products can’t command premium pricing in today’s market.
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Full Article
I wrote this from Las Vegas, where my son Jonah and I were at CES (the Consumer Electronics Show).
In investing and life, it’s very easy to get tunnel vision – doing what works and staying in your comfort zone. I wanted to attend CES to shake myself out of this pattern.
It’s hard to describe how massive this event is. It sprawls through five enormous pavilions at the Las Vegas Convention Center and takes up two floors of the Venetian Hotel. It is attended by over one hundred thousand people.
Here are my initial, off-the-cuff, somewhat random thoughts from CES.
Robotaxis There were several robotaxi companies here, in addition to Alphabet’s Waymo. Multiple robotaxis are going to hit the market over the next few years; it won’t be just Waymo. Most will start geofenced (they’ll work in specific areas), just like Waymo did.
This is good news for Uber: The more fragmented the robotaxi market, the more players are in this market, the more valuable is Uber’s switchboard system (which will bring higher utilization to robotaxi operators).
This will also hugely transform public transportation. Think about school buses – that market is primed for disruption since most buses follow the same route every day in a relatively small area.
Chinese EVs Chinese electric cars are awesome. This reminds me of what happened in Africa. Most of Africa skipped phone landlines completely and went straight to wireless phones. Similarly, Chinese automakers weren’t great at making regular gas-powered cars (everyone else had dominated that space), so they just leapfrogged straight to electric cars. And leapfrog they did – they’ll make even Tesla work hard.
I can’t speak for their reliability, but their designs are fresh; and without labor unions mandating how many workers need to screw in a single lightbulb, they’re much cheaper than Western alternatives.
If they hit the US market without tariffs, they would decimate the incumbents – similar to what Japanese carmakers did in the early 80s to the Big Three.
Machines on Autopilot Autonomous and remote-controlled equipment is going to change construction, mining, and farming completely. Imagine excavators digging dirt on a project in the middle of nowhere, operated remotely from air-conditioned urban offices – maybe even by experienced operators brought out of retirement.
Jobs that were physically demanding and that pulled workers away from their families are going to become regular nine-to-five office jobs. This means workers can have normal family lives and work longer – way past when they’d normally have to retire due to the physical demands of the job.
Or picture a colony of Caterpillar trucks working autonomously 24/7 at a mine site. The efficiency and safety gains would be huge. You’ll still need workers, but different workers, and fewer of them.
Think about agriculture. All those jobs that “Americans don’t want to do” will be done by tractors or other farm equipment going through strawberry fields, using AI to spray pesticides only where needed and collecting apples and oranges.
Here’s an economic observation with slight policy overtones: The nature of the job market will change. This is one of those turning points in history where our immigration policy should be forward-thinking, adjusted for the world where AI will be playing a larger role in it (that is inevitable), not just focused on the past and today’s needs.
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Cracking the US Market China has a significant competitive advantage in manufacturing; it has a very robust ecosystem and well-oiled supply chain – nothing new here. Its labor is no longer the cheapest, but Chinese manufacturing is getting more automated.
We talked to one of the chief designers of Renpho, a Hong Kong company that makes digital scales (among other gadgets) and is the number one seller of those scales on Amazon. They outsource all manufacturing to China, and the factory that manufactures their scales is completely automated.
What’s also interesting is that in the past, to break into the US market, you had to have relationships with Best Buy and Costco. They were the gatekeepers and also the quality-control testers. Today, all you need is a product. You have direct access to the US consumer through Amazon – you just have to be willing to spend on Amazon advertising to promote your product.
Brand or Bust It’s incredible how fast technology gets commoditized. There are literally fifteen (!) companies selling Oura-like rings (sleep-tracking biometric devices worn as a ring; I’ve been wearing one for five years).
In technology, you need to keep moving all the time or you’ll be eaten by the competition (true in life in general), but you also need a strong brand. I couldn’t tell the difference between my Oura ring and the fifteen replicas, most of them sold at a fraction of Oura’s price. But I trust Oura, and that’s the power of the brand.
I remember researching GoPro stock after it got bombed out (down 80%). During our research, I found that GoPro was selling their cameras for $300-400, while Chinese-made, no-name replicas were sold on Amazon for $40. These replicas didn’t have GoPro’s brand, but they had tens of thousands of five-star (hard to fake) reviews on Amazon. GoPro may have been exceptional (loved by pros), and these no-name cameras were just okay, but they were 10 times cheaper.
I put GoPro stock into the “too hard” pile and moved on – thank God I did; after declining 80%, the stock fell another 80%.
This brings me back to the value of a brand. GoPro wasn’t worth 10x more to consumers than Chinese no-name alternatives. Can Oura command 10x pricing over its no-name competitors? I don’t know. That’s the beauty of investing – I don’t have to have an actionable opinion on everything. With time I have become very comfortable saying “I don’t know.” Investing is one of the few professions where you don’t have to have an answer for everything. “I don’t know” should be the default answer, unless you do know. Which isn’t that often.
Global Tech Showdown Korean companies are really dominating screen technology. LG and several other Korean companies showed off transparent, glass-like LCD screens at CES. Imagine sitting in your self-driving car, and your windows are both regular see-through glass and LCD screens at the same time. Our lives are slowly becoming what we used to see in sci-fi movies, and these screens are definitely a leap in that direction.
CES is a truly global show, with technology on display that spans every aspect of our future. There were a lot of companies from Asia (especially China). In certain pavilions focused on consumer or business hardware, China completely dominated the exhibits. There were quite a few large American companies and many American startups, mostly focused on software (though all their hardware was manufactured in Asia). America still dominates in software.
A few, mainly Chinese, companies were showcasing their humanoid robots. One robot was slowly but accurately moving and stacking boxes in a defined area. Others were roaming more freely and were good at avoiding objects. At this point, these robots have the IQ of a smart dog, an average cat (now cat lovers will love me), or Siri. I bet in a few years this will have changed.
I was only mildly surprised by how few European companies were at the show. It’s a very broad generalization, but Europe seems to be running on fumes of past glory. Western Europe has become a pro at regulation and mastered the redistribution of wealth (activities that don’t help innovation or economic growth), and not much else. Yes, there are exceptions, but that’s the point – they are exceptions. If Europe doesn’t change course, eventually it will run out of fumes.
The beauty of learning is that you don’t always know everything you’ve learned at the moment of learning. Often, you’re just depositing data points that will crystallize into insights at a much later date. I don’t know if CES will become an every-year tradition or something I do sporadically, but it’s definitely fertile ground for learning.
STRIPS (Separate Trading of Registered Interest and Principal of Securities) is an acronym that describes both a government bond issuance program and the securities issued by the program. STRIPS are a form of zero-coupon security (defined below) created under the U.S. Treasury’s STRIPS program.
Originally, zero-coupon securities were created by broker-dealers who bought Treasury bonds and deposited these securities with a custodian bank. The broker-dealers then sold receipts representing ownership interests in the coupons or principal portions of the bonds.
Some examples of zero-coupon securities sold through custodial receipt programs are CATS (Certificates of Accrual on Treasury Securities), TIGRs (Treasury Investment Growth Receipts) and generic TRs (Treasury Receipts). The U.S. Treasury subsequently introduced a program called Separate Trading of Registered Interest and Principal of Securities (STRIPS), through which it exchanges eligible securities for their component parts and then allows the component parts to trade in book-entry form.
STRIPS are direct obligations of the U.S. government and have the same credit risks as other U.S. Treasury securities. STRIPS are generally considered the most liquid (easily bought and sold) zero-coupon securities.
Posted on October 12, 2024 by Dr. David Edward Marcinko MBA MEd CMP™
MEDICAL EXECUTIVE-POST–TODAY’SNEWSLETTERBRIEFING
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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants
“Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily“
A Partner of the Institute of Medical Business Advisors , Inc.
Fastenal climbed 9.76% after the construction and hardware equipment manufacturer posted stronger-than-expected revenue last quarter.
Symbotic popped 8.80% on news of a deal with the Walmart division of Mexico and Central America for its AI-powered robots to help with warehouse automation.
Affirm soared 12.07% after Wells Fargo analysts upgraded the buy now, pay later company thanks to its partnership with Apple Pay.
Ferrari raced 3.54% higher thanks to an upgrade from JPMorgan analysts, citing the carmaker’s EV division and hopes of a Chinese market recovery.
Stocks down
Stellantis continued to tumble today, falling another 2.22% after the carmaker announced its CEO will step down in early 2026.
A.O. Smith probably doesn’t ring a bell, but there’s a good chance they made the water heater in your basement. Unfortunately, they’re not selling too many these days, and shares sank 6.25% after the company cut its full-year outlook.
The SPX rose 34.98 points (0.61%) to 5,815.03 to end the week up 1.11%; the $DJI added 409.74 points (0.97%) to 42,863.86 to end the week up 1.21%; and the $COMP gained 60.88 points (0.33%) to 18,342.94 to end the week up 1.13%.
The 10-year Treasury note yield (TNX) fell two basis points to 4.07% but rose nine basis points this week.
The CBOE Volatility Index® (VIX) slipped to 20.41, still up slightly for the week.
Fidelity Investments has notified 77,099 people that their personal information was stolen in an August data breach. he mega asset manager has not disclosed what data the digital crooks nabbed, but assured customers that the security snafu “did not involve any access to your Fidelity account(s).” But hey, no worries, the firm claimed no evidence of data misuse.