CEN outline - Certified Emergency Nurse Updated: 2023

Career Advancement: Stacking credentials with PaCE opens doors to higher-paying positions and more significant responsibilities within the healthcare administration field.

Increased Employability: Employers recognize the value of a multifaceted skill set. By stacking credentials, you position yourself as a well-rounded professional ready to tackle complex challenges.

Flexible Pathways: PaCE offers flexible scheduling and learning options, ensuring that you can balance your professional development with your existing commitments.

Obtaining a CPC, CCA, or CBCS certification implies that an individual has met competencies in the field of medical billing and coding. Certification is invaluable to the student's career goals. Students have an opportunity to make confident, informed decisions about the national certification they prefer.

The Certified Professional Coder (CPC) exam is offered by the American Academy of Professional Coders (AAPC). It is the gold standard entry-level coding certification for physician, or professional fee, coders.

The Certified Coding Associate (CCA) is offered by the American Health Information Management Association (AHIMA). It is an entry-level medical coding certification across all settings--physician practices and inpatient hospital.

The Certified Billing and Coding Specialist (CBCS) is offered by the National Healthcareer Association (NHA) and is currently an entry-level medical billing certification for physician practices. In the summer of 2021, the exam will transition to an entry-level billing and coding certification, with the inclusion of ICD-10-CM, CPT, and HCPCS Level II testing.

At-home tests for sexually transmitted diseases (STD) or sexually transmitted infections (STI) let you know the status of your sexual health without stepping foot in your doctor's office or local clinic. An at-home STD test can also help you minimize the angst of prolonged concerns about your status due to possibly waiting days or weeks for an appointment with a healthcare provider. If you're concerned about exposure to an STD or STI, you're not alone: The US is currently facing record-high numbers of STDs and STIs, with gonorrhea and syphilis especially on the rise, according to the Centers for Disease Control and Prevention. What's even more alarming is the recent study showing there were more than 3,700 babies born with syphilis in 2022, which was over 10 times the number reported in 2012. Furthermore, in 2022, there were 231 stillbirths and 51 infant deaths due to syphilis infection during pregnancy.

Dr Alyssa Dweck, Chief Medical Officer at Bonafide Health, tells us that while the younger generation is disproportionately affected by STD and STI infections, she's noted a rise in sexually transmitted infections in perimenopausal adults and seniors engaging with new partners due to divorce or being widowed. "Many in this demographic don’t necessarily think to use condoms, since contraception may no longer be needed, thus the STI rate increases," she explains. Regardless of age, If you're sexually active it's important to proactively test for common STDs and STIs at least once a year, especially if you have multiple partners.

If you're uncomfortable discussing your sexual health with your doctor or a stranger at a health clinic, fully at-home or hybrid at-home tests that screen for various STDs and STIs are a reliable and fast alternative, "access and affordability are benefits of at-home testing," says Dweck.

What's the difference between an at-home test and a hybrid at-home test?

At-home tests are conducted in the privacy of your home, with all specimens for the test collected by you, and then mailed to an affiliated lab in a prepaid envelope or box included with the test. "I'm an advocate of home tests, and I'm a big advocate of home collection," adds John A. Nelson, director of the AIDS Education & Training Center National Coordinating Resource Center at the Rutgers School of Nursing. Home collection test kits are easy to use, allow for a level of discretion and privacy you can't get in a medical setting, offer the ability to avoid awkward conversations with your doctor or a stranger at a clinic and provide results relatively quickly, he explains.

Conversely, if you need an STD or STI panel and prefer to skip a trip to your doctor or health clinic but are uncomfortable drawing your blood or taking the samples needed for the test on your own, you may prefer the hybrid at-home test approach which, just like an at-home test, allows you to purchase the test online and get your results electronically, but when it comes to collecting the specimens, you'll go directly to the lab to have your samples taken — usually about a 5-10 minute process. Dr Kevin Huffman, Doctor of Osteopathic Medicine, tells us a benefit to taking the hybrid at-home test approach is that "proficient experts conduct in-lab testing, which provides a more extensive and precise evaluation."

If you're unsure which route you want to take (at-home or hybrid), below we outline the best at-home STD tests for various needs and conditions that offer the option to either test yourself or go to the lab to have the samples drawn for you. Above all, the following STD tests do not require a visit to your doctor, insurance or a long waiting period.

What's the difference between an STI and an STD?

It's important to point out that even though the terms STI and STD are often used interchangeably, there is a difference: STIs are infections that have not yet developed into diseases, such as bacterial infections, viruses and parasites. Fun fact (or not): There are more than 30 different bacteria, viruses and parasites that can be transmitted sexually, yet no single test screens for all of them.

Also, different STIs are detected in different ways, regardless of the test you choose: Some diseases or infections are detected through urine, while others are best detected via blood or cavity swabs. Whichever test you choose will guide you on the best collection method — and state upfront what you can expect.

What are the best at-home tests for STDs and STIs in 2023?

There's a surprisingly large range of in-lab and at-home tests available that can be purchased both in-store and online. To find the best STD tests and STI tests available for over-the-counter purchase, our team consulted with multiple doctors and testing experts about what to look for in a good test and rated each based on elements such as if the lab used to process the test is ISO/IEC/CLIA-accredited, test accuracy, ease of use, if medical providers were available for consultation, user experience and cost. Every person has different needs, so we made sure to include a range of tests to cover various diseases, infections, needs and budgets.

Everlywell

Test collection method: Blood, swab (women-only), urine (men-only) | Time until results: 2-5 days | Free shipping: Yes

Everlywell, a trusted name in home testing offering a multitude of tests and prescription services, tops our list of at-home STD tests due to offering male- and female-specific tests that you conduct entirely from the privacy of your home, no trip to the doctor or lab needed. This STD test kit checks for the six top sexually transmitted diseases and infections, such as chlamydia, gonorrhea, hepatitis C (HCV), human immunodeficiency virus (HIV), syphilis and trichomoniasis. The testing process is simple: Take a finger prick and vaginal swab (for women) or finger prick and urine trial (for men). Once the samples are ready, drop your specimens in the mail using the included prepaid shipping box. Within a few days, you'll get results via an app or the website. What especially stands out is that if you test positive for an STD or STI, an Everlywell healthcare provider will reach out to go over what everything means, as well as treatment options and prescribe medication if necessary. If you need your test results ASAP, you can opt for express shipping for an extra charge ($30). 

While this test is pricy (which is standard for a test that offers a complete STD and STI panel), you can save 15% by signing up for a semi-annual subscription. All packaging involved is plain and discreet, so you don't have to stress about nosy neighbors or roommates. Insurance coverage depends on your plan, but the tests are FSA- and HSA-approved. 

Pros

• Medical provider guidance included
• Screens for six top STD
• Fast results

Cons

• Expensive
• May not be covered by your insurance plan

$169 at Everlywell

STDCheck.com

Test collection method: Blood, urine | Time until results: 1-2 days | Free shipping: N/A

STDCheck's test detects a whopping 10 STDs and STIs: chlamydia, gonorrhea, syphilis, HIV, early HIV, hepatitis A, hepatitis B, hepatitis C, and herpes I and II. The only caveat to this test (but also why it screens for so many STDs and STIs and the results are returned so quickly) is that a trip to an affiliated local lab is necessary to provide your test samples. 

When you purchase the test online, you'll immediately get an access code to schedule an appointment at one of its 4,800 affiliated nationwide labs of your choosing - you may even find you can schedule your appointment with the lab the same day and have your results back within 12 to 48 hours. 

Another major stand-out feature of STDCheck is that you can add the HIV RNA Early Detection test to your order, which is an FDA-approved test that detects early HIV infection within 9 to 11 days after potential HIV exposure. STDCheck.com also offers a range of tests for individual STIs, should you prefer to test for only one or two conditions.

Pros

• Tests for 10 STIs and STDs
• Rapid results within 24-48 hours
• Care advisors available at any time after purchase

Cons

• Must visit an affiliated local lab to provide specimen samples

$139 at STDCheck

CVS

Test collection method: Urine | Time until results: 1-3 days from the date the lab receives the trial | Free shipping: Yes

CVS brand STI test kit tops our list for best budget-friendly at-home test because it covers the top three common STIs for under $100: chlamydia, gonorrhea and trichomoniasis. The test is conducted fully at home and requires a simple urine trial you drop in the mail and ship to the lab (prepaid postage included). A high-complexity CLIA-certified laboratory will process the specimen and then send the report to an independent physician licensed to practice in your state who will review and approve the findings. The final report will be sent to you via a secure online portal in about 1-3 days after lab receipt of your test. Unlike the aforementioned test kits that have a provider available for consultation, you will need to visit your medical provider should you test positive to discuss the best treatment plan.

One reviewer said, "I found this test kit to be extremely user-friendly. The step-by-step instructions were easy to follow, and the entire testing process was efficient." 

Pros

• Checks for the top three STIs
• CAP-accredited and high complexity CLIA-certified laboratory
• reviewed and approved by an independent board-certified physician

Cons

• Urine trial may get messy
• No medical care support included

$90 at CVS

Quest

Test collection method: Blood, urine | Time until results: 3-5 business days | Free shipping: Yes

If the name or logo for Quest is familiar, then it's likely because you have a Quest lab close to you, after all, there are thousands of Quest labs located throughout the US due to many major hospitals and physician offices that use its services. While the major STD and STI panels offered through the Quest website are hybrid tests that require you to buy online and then visit a lab in-person to provide a specimen, there are plenty of at-home tests available that are conducted fully in the privacy of your home.

Quest offers two in-lab STD panel options: A basic STD screening panel ($139) that covers four conditions: Chlamydia, gonorrhea, syphilis, and HIV 1 and 2. There's also the Expanded Screening Panel test ($269) that covers 7 of the most common STDs and STIs: Chlamydia, gonorrhea, hepatitis B, hepatitis C, trichomoniasis, syphilis, HIV-1 and HIV-2. Once you choose a test, you'll make the purchase online, schedule with the lab and then head over to provide your blood and urine samples. The test kit's purchase also includes the option to consult a physician if you happen to test positive, although it will cost you an additional $6. 

In addition to the STD panel tests mentioned above, there are a total of nine STD and STI testing kit options available through the Quest Laboratories website, should you want to zero in on a specific disease or infection or a combination of conditions. At-home and in-lab tests offered by Quest range in condition and price from $45 for the fully at-home HIV 1 and 2 test kit to 19 tests for women's health including a urinary tract infection test (UTI) ($39) and 15 men's health tests, including a test to show health risks based on your genetics.

Pros

• 45+ at-home and hybrid tests available
• Relatively fast results
• FSA and HSA eligible

Cons

• Physician consultation costs extra
• Many test do require a trip to the lab

$139 at Quest

MyLab Box

Test collection method: Blood, urine | Time until results: 2-5 days | Free shipping: Yes

The MyLab Box Love Box is a fully at-home STD test kit specially designed to be inclusive for all couple combinations: male and female, male and male or female and female. In addition to being for couples, the kit costs $378 (with 15% off your first purchase if you join the mailing list ), making it about two-thirds the cost of purchasing two separate complete panel tests at a competitor. Each test screens for the top eight sexually transmitted diseases and infections: chlamydia, gonorrhea, hepatitis C, HIV (I and II), herpes simplex 2, syphilis and trichomoniasis. 

To take the test, you and your partner will first do a finger-prick blood test, then a cavity swab (female) and/or urine trial (male), then drop the samples in the pre-paid box and ship to the lab. A certified CAP and CLIA high-complexity testing lab will then process the specimens. Within 3-5 days after lab receipt, you'll receive your results electronically, and you can rest assured HIPAA web security protocols are enacted to protect your data. If one or both of you test positive, you can consult with a doctor in your state via phone consultation about the next steps and be prescribed treatments if needed. If the tests are negative, you still have the option to consult with a certified STI counselor. The tests are FSA and HSA eligible.

Pros

• Inclusive couples testing options (Male + Female; Male + Male; Female + Female)
• Screens for 8 major STIs and STD
• Specimens collected in the privacy of your home

Cons

• No hybrid lab option
• Expensive

$378 at MyLab Box

Nurx

Test collection method: Blood, swab, urine | Time until results: Within days | Free shipping: Yes

Nurx has a range of STI kits that are covered by most insurance carriers, including the Full Control Kit which checks for five STIs: HIV, chlamydia, gonorrhea, syphilis and hepatitis C. There's also a Basics Covered at-home STI Home Test Kit that screens for the four top STIs: HIV, chlamydia, gonorrhea, syphilis. The Healthy V STI Home Test Kit screens for HIV, chlamydia, gonorrhea, syphilis and trichomoniasis. While there is an easy-to-use app, you can still order via the Nurx website, regardless of method, you'll start by answering a few questions about your personal and sexual health to find the best test for your needs; All at-home tests are conducted fully at home then shipped to Nurx affiliated lab. 

Nurx is also a great option for those wanting to move to telehealth for sexual and overall wellness needs, including having the option to get prescriptions for birth control, acne control, emergency contraception and even hair loss products, with all medications delivered straight to your home. There's a $15 sign-up fee, but the fee includes access to a year of unlimited messaging with a provider.

One reviewer raved that the process was "EASY AND CONFIDENTIAL," adding that they "Loved this experience. I hate going to doctors, especially around sexual health. The fact that everything can be done without having an in person or video/phone call is AWESOME!"

Pros

• Covered by insurance
• Offers multiple health and wellness Telehealth solutions
• Prescribing medical support

Cons

• Patients using insurance may receive an additional bill from the lab for copays or any additional costs
• $15 sign-up fee

$45 at Nurx

LetsGetChecked

Test collection method: Blood, urine | Time until results: 2-5 days | Free shipping: Yes

LetsGetChecked is all about making you feel informed from beginning to end. There's a detailed video walk-through on what's in your test kit, how to collect your samples, mistakes to avoid during trial collection, how to ship your samples, and what to expect after the lab receives your samples; there's even a walk-through on how to use the company's super easy-to-use app. 

The test screens for five major STIs: chlamydia, gonorrhea, HIV, syphilis and trichomoniasis. If you test positive, a nurse will reach out with information on what to do next, including helping you set up a virtual consultation (for an additional $39) that will include a consultation with a doctor and a prescription for medication if needed. 

"If you have anxiety about going to the doctor and requesting an STD screening, this is a really good alternative," said a user. "Also, I was able to use my HSA to pay."

Pros

• Helpful video tutorial walks you through the test
• Unlimited messaging with provider after sign-up
• Prescribing providers available

Cons

• Video consultations cost and extra $39

$149 at LetsGetChecked

What to consider when buying an at-home STI/STD test

What you're testing for

If you are being proactive about testing after being with a new partner, it may be best to choose a test kit that screens for a wide range of conditions. If you've had a known exposure to a particular STD or STI, you could choose a test that screens for that particular condition or a combination of conditions.

Testing methods

Methods for at-home testing generally include instructions for self-collection at home via a blood sample, urine or internal swab, which is then shipped to a lab to be tested. If home collection is not something you're comfortable with, then choosing a hybrid test that allows you to visit a lab to have your specimen collected may be the better option.

Budget

As you can see from our list, there is a wide range of pricing options for test kits ranging from $45 for screens for one or two conditions to upwards of $300 for panels for 10+ conditions. In some cases, your insurance may cover the test, if not, HSA and FSA are generally accepted with most all at-home and in-lab tests. Figuring out in advance how much you want to spend can help you choose the right test, whether that be a full panel or a screen for the condition you suspect you may have.

Follow-up care

Some tests include counseling from a healthcare provider, while others do not — and Leslie says that's definitely worth considering. "There are issues of follow-up and high anxiety when a test is positive and no healthcare professional is available," he says. You know yourself better than anyone: If you feel like you would be OK waiting to connect with your doctor or someone at your local health care department if you test positive, there's no need to look for a test with a provider connection. But if you know you'd want to talk to a professional immediately about a positive result, a test kit that includes a health care provider consultation may be the best option.

How we chose the best at-home STI/STD tests

To find the best at-home tests, we spoke to multiple doctors for their input on what to look for in an at-home or in-lab STD and STI kits, as well as different types to consider. From there, we researched more than 25 at-home test kits and rated each on elements including sensitivity, ease of use, whether follow-up care is included and good and bad user reviews.

FAQs

How do at-home STI tests work?

There's variety with these tests and the way they work ultimately depends on the individual test. "Some require an oral or genital swab; others require urine or blood samples, which will then go to a lab," women's health expert Jennifer Wider, MD, co-host of the Open Wider podcast, tells Yahoo Life. It's important to read the manufacturer's information carefully in advance to make sure you're comfortable with the testing procedure.

How do I know whether I have an STI?

The only way to know for sure if you have an STI is to get tested. Some sexually transmitted infections don't have symptoms, so you can be positive without knowing, Wider points out. That puts you at risk for health complications such as fertility issues and also increases the likelihood you'll spread the infection.

Are at-home STI and STD tests reliable?

Every test kit has its own sensitivity — meaning, how likely it is to detect an infection. "Many are quite reliable, especially if collected properly and then brought to a lab as quickly as possible," Wider says. Dr Leslie agrees, adding, "The test kits work when done correctly and reach populations that are at risk and might not seek traditional medical help for suspected STDs."

Where can I get a free STI and STD test?

Local health departments and sexual health clinics such as Planned Parenthood usually offer free or very low-cost sexual health tests. If you prefer to try a local clinic, visit your local health department's website to see what's offered; you may even be able to schedule an appointment for testing on the site.

Our experts

Dr Alyssa Dweck, Chief Medical Officer at Bonafide Health

Dr Kevin Huffman, Doctor of Osteopathic Medicine

Dr Stephen W. Leslie, associate professor, Creighton University School of Medicine

Dr Jennifer Wider, women's health expert and co-host of the Open Wider podcast

John A. Nelson, STI screening researcher and director of the AIDS Education and Training Center at the Rutgers School of Nursing

The reviews quoted above reflect the most latest versions at the time of publication.

If there has been one thing that Medical Properties Trust (NYSE:MPW) has excelled at, it's destroying shareholder value. In less than 2 years, shares of MPW have declined -82.16%, ended their consecutive dividend growth and reduced the dividend by -48.28%. Short interest remains above 20%, and nothing that MPW has implemented has reassured the market that the fears are overblown. I just checked my main dividend account, and I am down -60.84% on invested capital on my investment in MPW. I was bullish for quite some time, and my sentiment switched to neutral as shares were in freefall mode. Coming into the end of the year, I need to decide if MPW will be a candidate for tax loss harvesting or if I will try and buy my way out of what has become a bad situation. Despite management basically cutting the dividend in half, the yield is now exceeding 14%. Obviously, the market has little to no faith in MPW, and a large segment of the investment community is betting against a turnaround.

I try to keep emotions and my ego out of my investment decisions, and I am always willing to throw in the towel and admit defeat if I don't see the light at the end of the tunnel. Right now, my price per share (PPS) is 12.04, and when the dividends I have collected and reinvested are taken into consideration, the PPS is $10.83. If I were to double down, I could lower my PPS to $7.53, and it wouldn't be a difficult task to reduce my cost basis to under $7. I could be 100% incorrect on this move, but I am planning on adding to my position rather than sending MPW to the tax loss harvesting section, and this article will outline the reasons why I have made this decision.

Following up on my previous article about MPW

In my previous article about MPW, which was written on 8/23/23 (can be read here), I discussed how market sentiment was crushed, MPW slashing the dividend in half, the debt profile, and whether there was value to be unlocked in shares. I am following up on this article to discuss earnings, the current state of MPW, and why I am making the decision to add to my position rather than utilize MPW for tax loss harvesting.

If I am buying, how come I am neutral instead of bullish on shares?

I had been bullish on shares of MPW for a long time. While the numbers worked, the investment didn't, and market sentiment triumphed over the numbers. Management was forced to reduce the dividend and is fighting an uphill battle. I don't need to be bullish to add shares. No 2 situations are the same, and my situation is different from everyone who reads this article. I have assessed my PPS, the portfolio weight of MPW in my main dividend account, and what my ultimate exposure is. I have all of the time in the world, and I can choose to sit on my shares for decades or allocate more capital and sit on my shares for decades. There isn't much difference if I sell them now for tax loss harvesting purposes or if they continue to decline and I decide to exit in the future. After going through MPW's financials and the quarterly results, I came to the conclusion that I am willing to try and buy my way out of the red by increasing my position in MPW. The capital I am allocating won't hurt me if it remains dormant or declines in value, as MPW is a relatively small position in my overall portfolio. There is a compelling case for me to back up my current investment with fresh capital, even if I have to sit on it for an extended period of time. Market sentiment is certainly in control, and no matter how compelling of a buy this is for me, I am not bullish because nothing MPW implemented has worked.

Q3 for MPW may not have been as bad as the investment community thought, and there could be light at the end of the tunnel

MPW closed Q3 with $19 billion in assets, which included $12.3 billion in general acute facilities, $2.5 billion in behavioral health facilities, and $1.7 billion in post-acute facilities. There were 441 properties and 55,000 licensed beds across MPW's owned facilities. Since the close of Q3, MPW has sold 4 properties, which has reduced its licensed beds to 43,000 that are leased or mortgaged by 54 hospital operating companies. MPW has run into some hardships with its operating partners, including Steward and Prospect, since the pandemic. MPW recently released a presentation on the Steward investment (can be read here), and despite the revenue cycle management challenges have had on generating cash from operations, MPW believes that Steward will be able to satisfy its rental obligations over the full term of the leases. Prospect resumed payments of approximately $3 million of contractual rent which will be due monthly through February of 2024. In March of 2024, Prospect will begin making full rent payments on its California portfolio at a mid-8% cash rate to MPW.

On a YoY basis for both Q3 and the first 9 months of operations, MPW has declined on every measurable metric that I care about. On a YoY basis in Q3, MPW's funds from operations (FFO) declined by -14.11% to $216.45 million, while its normalized FFO declined -17.18% to $225.52 million. On an adjusted level, MPW's AFFO declined -15.47% to $182.09 million. On a per-share basis, MPW generated $0.36 of FFO, which was a -14.29% YoY decline. For the past 9 months, MPW has generated -$63.68 million less of FFO than in 2022, -$96.45 million less in normalized FFO, and -6.59% less in adjusted FFO. MPW's per share FFO has declined -7.46% YoY in the first 9 months to $1.24 as they have produced $742.3 million in FFO.

MPW has slightly increased its guidance for the 2023 fiscal year as it expects the normalized FFO per share to come in at $1.56 - $1.58 compared to the prior range of $1.53 - $1.57. MPW has agreed to sell 7 facilities back to a tenant in the 1st half of 2024, which represents 1% of MPW's assets but will make MPW whole from its investment in the facilities. MPW is expecting to raise $2 billion in new liquidity over the next 12 months as they consider which projects to divest and new joint venture opportunities. MPW is also looking at limited secured debt financing options, which could provide immediate liquidity based on asset value. By slashing the dividend to be more in line with the new amount of AFFO generated from a smaller portfolio, the near-term APPO payout ratio is roughly 60%, and MPW is in a position to preserve approximately $335 million on an annual basis. Management believes that the new dividend level is positioned to absorb the impacts of additional near-term asset sales, which reduced interest payments will also offset.

For me, there are 2 questions. Is the debt profile manageable, and are the numbers real? As I mentioned in my article from 4/3 (can be read here), I do believe the numbers are real. MPW has used PwC as its auditor since 2008. PwC is a Big Four accounting firm, and they have addressed the issue regarding the statements they have issued on MPW's behalf due to accusations from Viceroy Research. I also don't think that MPW could amass this size of a portfolio, especially hospitals that deal with countless regulations and pay billions in dividends if the numbers were fake. Obviously, anything is possible, but I don't think it is probable that the numbers are fake, so I trust what is being reported. The next aspect is the debt profile. MPW has $340 million in cash on hand and is retaining roughly $83.75 million per quarter or $335 million on an annualized basis from the dividend reduction. This doesn't include the ongoing profitability on a net income or FFO level that MPW will generate going forward. MPW has more than enough liquidity to manage the remaining liabilities for the year, and with management alluding to the fact they will be looking to raise $2 billion in new liquidity over the next 12 months and having the ability to sell assets if needed, I feel the debt profile is manageable.

After going through the financials and looking at the potential value, I am willing to try and buy my way back into profitability

MPW is currently valued at $2.54 billion, while its total equity on the balance sheet is $8.29 billion. MPW has $19 billion in total assets and $10.72 billion in total liabilities. Even if MPW's gross property plants and equipment got rerated by -25% they would be valued at $9.78 billion instead of $13.04 billion. MPW's total assets would still be valued at $15.74 billion, which would still place the total equity at $5.02 billion, which is almost double the current market cap. MPW's tangible book value is $13.84, which is 226.42% more than the current share price. Earlier in the article, I had said that if I doubled down, I could get my PPS to $7.53. Hypothetically, if the tangible book value ends up changing for any reason in the future due to a rerating or any other reason, it could decline by -40% and still be $8.30, which would be $0.77 higher than my PPS if I doubled down. This makes me optimistic that I could get back to it even quicker if I add to my position, as the total equity and tangible book value are so much higher than the current valuation of MPW.

This also doesn't take into consideration the future dividends if they remain at $0.15 per share. Hypothetically, if MPW's share price didn't move and the quarterly dividend remained at $0.15 per quarter, it would take me 10.98 years to break even. By doubling down, I could cut this time down to 5.49 years to break even under that scenario, and that doesn't include the power of increasing my forward income by reinvesting the dividends. I have 5.49 years to wait this out, and if I were to allocate more capital, I could decrease how much time I would need to wait to break even under the scenario of the price not moving and the dividend remaining at this level.

Conclusion

MPW has been a bad situation for many investors, including myself. This is why I don't buy on margin, and I don't overextend in any position. I am well diversified, and the -60% loss in MPW doesn't make me lose sleep at night. While I see value in shares of MPW, I am remaining neutral because sentiment is awful, and MPW isn't necessarily trading based on the financials. If MPW's financials and balance sheet were different, I would probably sell and send this off to tax harvesting land, but I think shares could rebound in 2024 or 2025. I have the time to wait this out, and I am willing to deploy more capital to reduce my PPS and increase the amount of income MPW is generating. With MPW generating over 14% from the dividend, I could theoretically double down on my position and wait 5.49 years to break even as long as the dividend stays the same and the price doesn't move. For me, this is worth the risk, and I will be buying more before 2023 is over. Please do your own research and use MPW as an example of why it's important to diversify and not overextend into a position. Even if the company looks drastically undervalued based on the financials, the ultimate decision maker is Mr. Market.

CSA-Printstock/Getty Images

As much as we’re bombarded with images of clear, glowy, and pretty much perfect skin online, it’s totally normal to have bumps on your face. Many of them are annoying, sure, like a chin zit that refuses to budge. For the most part, though, these irregularities are harmless. With that said, there are some exceptions—and it’s important to recognize which sneaky outliers deserve closer attention.

As long as your bump isn’t changing color or size, it probably doesn’t need any immediate medical intervention, Naana Boakye, MD, board-certified dermatologist and founder of Bergen Dermatology in Englewood Cliffs, New Jersey, tells SELF. But unless you’re a dermatologist who analyzes all sorts of growths, blemishes, and lesions for a living, it can be a real chin-scratcher (heh) to distinguish a benign pimple from something more suspicious.

Seeing a derm or even your primary care doctor, if you have one, is the best way to get an accurate assessment of the bump(s) in question. But because not everyone has access to these pros (nor does every little whitehead warrant a pricey and time-consuming visit), we asked experts to outline some of the most common causes of facial bumps—hopefully, their advice can help you figure out whether or not it's worth bringing your specific spots up to a doctor.

1. Comedones

Comedones are a fancy way of describing clogged pores, and there are two common types: closed comedones (whiteheads) and open comedones (blackheads), Joel Schlessinger, MD, a board-certified dermatologist and cosmetic surgeon based in Omaha, tells SELF.

Blackheads get their color when dead skin and excess oil inside the pore are exposed to air (or oxidized), resulting in a brown or blackish spot, Dr. Schlessinger explains. Whiteheads, on the other hand, are closed comedones—meaning that air can’t come in contact with all that buildup. That’s why a whitehead maintains a flesh-colored or, yep, whitish appearance.¹

How to treat them: Whiteheads can be oh-so-tempting to pop. But before you supply in to the urge, know this: “Picking at them only delays the healing process and can lead to scarring,” Dr. Boakye warns. Instead, she suggests attacking them with over-the-counter acne products (think cleansers, spot treatments, or pimple patches) with salicylic acid or benzoyl peroxide—both ingredients are known to calm inflammation and prevent future breakouts.

As for blackheads, you can follow the above advice and also consider adding alpha hydroxy acids (AHAs) like mandelic, glycolic, and lactic acid to your routine. They can dissolve the dead skin cells and excess oil that are congesting your pores, Dr. Boakye says. Oh, and you should also avoid using pore strips to remove these dark spots: “The adhesive used to stick them to the skin can strip [the area] of natural oils, and they’re usually only successful in removing the tops of blackheads, keeping pores clogged and your problem intact,” Dr. Schlessinger says.

Some products to try:

Peace Out Skin Care Acne Dots

$19.00, Amazon

Neutrogena On-The-Spot Acne Spot Treatment

$7.00, Target

Clearstem Clearity Exfoliating Facial Serum

$65.00, Amazon

Dermalogica Daily Glycolic Cleanser

$37.00, Sephora

2. Acne

To get technical, there are different types of acne, Dr. Boakye explains. First, you’ve got your comedones (whiteheads and blackheads), which we just covered. Then there are papules, inflamed yet relatively small (about 1 mm) bumps that are sensitive to the touch.² The slightly bigger version of a papule is called a pustule—what you probably think of as a standard pimple with a white or yellow pus-filled tip.¹ And finally, acne can also come in the form of nodules (or cysts), the most stubborn of all the types, according to Dr. Boakye: “These are hardened lesions. They’re basically a large papule that is deeper in the skin.”¹

How to treat it: Whatever you do, avoid squeezing—you know, for the whole scarring reason we mentioned earlier. Instead, try using a gentle cleanser with benzoyl peroxide (an antibacterial ingredient that kills C. acnes, one of the bacteria that can cause breakouts) and choose oil-free, non-comedogenic products, Jerome Garden, MD, a board-certified dermatologist and director of the Physicians Laser and Dermatology Institute in Chicago, tells SELF. This will help to minimize sebum (oil), which, in excess, can clog pores, Dr. Garden says.³ Another option to consider: Niacinamide, which is known to reduce inflammation and Improve acne.

Hormonal imbalances can also trigger zits, so if your skin care routine isn’t doing the trick, it’s a good idea to see a dermatologist or your primary care doctor to get to the bottom of your blemishes.⁴

La-Roche Posay Effaclar Duo Acne Treatment With Benzoyl Peroxide

$36.00, Dermstore

PanOxyl Acne Foaming Wash Benzoyl Peroxide 10%

$10.00, Amazon

3. Milia

If you’ve ever noticed a cluster of tiny white bumps around your eyelids that aren’t quite poppable whiteheads—and definitely aren’t blackheads—you might be dealing with harmless cysts called milia (a.k.a. “milk spots”).⁵

“Milia are hard, flesh-toned bumps that form when keratin [a protein found in the outer layer of the skin] and dead skin get trapped underneath the surface,” Dr. Boakye explains.^{6 5} They can resemble acne to the naked eye, but unlike regular ol’ pimples, milia are painless and lack the inflammation, itchiness, or redness commonly associated with acne, she adds.⁷

These little bumps tend to show up around the eyelids, cheeks, or forehead, according to Dr. Schlessinger, and they’re usually caused by oil-based, pore-clogging products, excessive sun exposure, topical steroids, or simply genetics, per the American Academy of Opthalmology.⁵

How to treat them: Again, milia are basically trapped keratin and dead- skin buildup, so they’re not doing any real harm—aside from being a superficial nuisance for some folks. The good news is they usually clear up on their own, Dr. Boakye says, but retinoids and chemical exfoliants (like glycolic acid) can help speed up the process by shedding the dead skin and keratin that got stuck.^{5 7 8}

A dermatologist can also manually remove milia with a minor incision. Basically, they’ll use a sterile needle or scalpel to create a tiny opening and extract the buildup. But please, don’t buy a drugstore extractor tool and attempt this procedure in your bathroom—you’ll run the risk of damaging your skin barrier and causing scarring, Dr. Boakye warns.

L'Oréal Revitalift Derm Intensives 10% Pure Glycolic Acid Serum

$33.00, Ulta

Shani Darden Skin Care Retinol Reform Treatment Serum

$88.00, Sephora

4. Fungal acne

Despite its super misleading name, fungal acne (or pityrosporum folliculitis) isn’t really acne at all. “What’s actually happening is an overgrowth of pityrosporum yeast that lives in our hair follicles,” Ife J. Rodney, MD, board-certified dermatologist and director of Eternal Dermatology Aesthetics in Fulton, Maryland, told SELF in 2021. As a result, you may experience groups of small bumps on your chest, back, or face (on the forehead, typically) that resemble skin-colored pimples—but again, they’re not!⁹

One telltale sign that your skin bumps are fungal acne is if they appear in clusters, rather than isolated zits here and there, Dr. Boakye says. Other giveaways include uniformity (“fungal acne tends to be monomorphic,” she says, meaning the bumps will all be the same size) and whether or not the spots respond to conventional antibacterial treatments like benzoyl peroxide. (In the case of fungal acne, they won’t.)⁹

How to treat it: A dermatologist can prescribe oral antifungal medications, such as fluconazole, or topical options like ketoconazole cream. These treatments are designed to specifically address the excess yeast behind the bumps, Dr. Boakye explains.⁹ You can also try using an over-the-counter dandruff shampoo containing selenium sulfide or zinc pyrithione as a cleanser—studies suggest that these anti-fungal ingredients can also stop the growth of pityrosporum yeast.¹⁰

Because the yeast thrives in warm, moist, and humid environments, the American Academy of Dermatology (AAD) also recommends changing out of sweaty clothes promptly after working out and opting for loose, breathable fabrics (like cotton) when it’s hot outside.

5. Keratosis pilaris

If you notice goosebump-like spots on your arms, legs, or face—and you’re not freezing or freaked out—that could be keratosis pilaris, a condition commonly referred to as “chicken skin.” It’s usually found on the thighs and upper arms, but it can also appear on your cheeks.¹¹ “Keratosis pilaris is caused by small plugs of dead skin cells that block the hair follicle,” Dr. Schlessinger says, which explains why the affected areas can feel rough, dry, and almost sandpaper-like if you have this condition.¹¹

The exact cause of keratosis pilaris isn’t fully understood, but research has found that it’s usually genetic—meaning that if your parents have it, you may be more likely to develop it.¹¹

How to treat it: Keratosis pilaris can occur at any age, but it’s more common in kids and tends to Improve in adulthood, the Mayo Clinic says. Research-backed treatments like retinoids, glycolic acid, and salicylic acid can also help shed the dead skin that’s clogging the hair follicles.^{12 11} Because this condition can come with unpleasant peeling and itchiness, the Mayo Clinic also recommends using moisturizers or ointments with lanolin, petroleum jelly, or glycerin to seal in hydration and smooth out any rough patches.

6. Moles

Moles are perfectly normal and, most of the time, harmless. They often appear as brown, skin-colored, or red bumps on the face (as well as other parts of the body), and nearly everyone has at least one, according to the AAD.

Whether you were born with them or you’re noticing some new arrivals, these spots form when the skin’s pigment cells (called melanocytes) clump together in one localized area, rather than being spread out evenly, according to the National Cancer Institute. “Moles can be flat or raised and, if benign, are typically round,” Dr. Schlessinger says. If they’re not cancerous (more on that below), it’s not medically necessary to treat or remove them.

How to treat them: Experts aren’t totally sure what, exactly, causes moles to show up, but excessive exposure to sunlight can increase your chances of developing them, research shows.¹³ That’s why slathering on sunscreen daily is the move here—aside from the obvious skin protection benefits, a religious SPF 30 (or higher) routine may prevent moles and keep existing ones from getting darker, Dr. Boakye says.

If you’re dead set on getting rid of a mole, you’ll need to see a dermatologist. This is especially important if you’re even slightly concerned that your spot might be melanoma (the most deadly form of skin cancer). We’ve already spelled out the signs of a cancerous mole, but to summarize, look out for:

• Asymmetry: If you mentally draw a line down the middle, both halves don’t match.

• Border: The mole’s border is irregular or poorly defined.

• Color: You notice variations, instead of one consistent color throughout.

• Diameter: Melanomas are usually larger than 6 millimeters (about the size of a pencil eraser), though they can be smaller.

• Evolving: The spot looks different from others on your body, or you’ve noticed changes in its size, shape, or color

7. Dermatosis papulosa nigra (DPN)

If you notice a bunch of tiny mole- or freckle-like bumps on your face, you may have what’s known as dermatosis papulosa nigra (DPN). These completely harmless black or brown spots are common in darker complexions and tend to run in families.¹⁴

Unlike moles, which are deeper in the skin, “DPNs are a very superficial buildup of epidermal cells,” Dr. Garden says. “They can be very small and don’t grow much larger than a few millimeters; however, one person can have dozens on the face.”¹⁴

How to treat it: The good news is they’re purely cosmetic, much like freckles.¹⁵ There’s not much you can do to prevent DPNs from forming or becoming more noticeable—other than practicing sun protection.¹⁵ However, a dermatologist can remove DPNs via laser treatments or electrocautery (a.k.a. burning them off).^{14 15} (An important caveat: Lasers can cause hyperpigmentation in people with dark skin tones, so you’ll want to speak to your doctor about the best treatment for you.)¹⁶

Supergoop! PLAY Everyday Lotion SPF 50

$34.00, Sephora

Black Girl Sunscreen Broad Spectrum SPF 30

$16.00, Target

8. Skin tags

We’re talking about those fleshy little projections that are attached to your skin via a stalk. These bumps tend to show up in places where your skin folds, like your neck, underarms, groin area, or around your eyelids, Dr. Schlessinger says.¹⁷ That’s because, despite not having one definitive cause, skin tags are commonly linked to skin-on-skin friction or tight clothing—along with certain health conditions like high blood pressure, type 2 diabetes, and high cholesterol.

They can vary in shape, ranging from finger-like to more circular in appearance. In terms of size, they can span anywhere from one tiny millimeter to five, more noticeable, millimeters, studies show.¹⁷

How to treat them: Unfortunately, there’s not much you can do to prevent skin tags, Tracy Evans, MD, board-certified dermatologist and medical director of Pacific Skin and Cosmetic Dermatology in San Francisco, recently told SELF.

That said, you’re also not stuck with them. They’re harmless, but if you simply don’t like the way yours look or feel, a doctor can “remove them by cutting them off or cauterizing them with heat,” Dr. Schlessinger says.¹⁷

And even if they don’t bug you, you should still get them checked out by a dermatologist if you can.¹⁷ “It’s very common for me to have patients who think they have what looks like a ‘skin tag,’ but in reality is a skin cancer,” Dr. Schlessinger says.

9. An allergic reaction

Sometimes bumps on your face (or other parts of your body) can be indicative of an allergic reaction to something you ate, wore, or applied on your cheeks and forehead.

Hives (also called urticaria) are a type of rash that appears as raised, itchy, and sometimes red welts. They pop up suddenly, upon exposure to an allergen, then disappear a few hours later, per Dr. Schlessinger.¹⁸ Another common allergic reaction is allergic contact dermatitis, which is your immune system’s response to an allergen. In this case, you may experience more severe symptoms, such as burning, intense itching, and excessive dryness hours, even days, after exposure, as SELF previously reported.

How to treat it: This is probably a no-brainer, but you should stop using (or eating) whatever’s causing your facial freak-out. To determine what triggered it, you can see an allergist for a prick or patch test. It can also help to think about any latest product changes you made, such as a new detergent, face wash, or perfume, Dr. Boakye says.

If your allergic reaction is mild and relatively painless, a cool bath and perhaps an over-the-counter oral antihistamine or hydrocortisone cream should do the trick to relieve itching or inflammation, Dr. Schlessinger says. If your symptoms are more intense or you’re also noticing swelling, having trouble breathing, or feeling lightheaded, call your primary care doctor or an emergency room, ASAP. (These could be signs of anaphylaxis, a life-threatening allergic reaction.)

10. Bumps due to eczema

Dryness and flaking aren’t the only annoying characteristics of atopic dermatitis, the most common form of eczema. Bumps, too, can (ahem) arise with this condition, and they’re pretty easy to differentiate from the pus-filled or angry zits you know and loathe. If eczema is the culprit, they’ll usually appear as “oozing or crusted bumps, scaly patches, or plaques,” Jeremy A. Brauer, MD, board-certified dermatologist and clinical assistant professor at NYU Langone Medical Center, tells SELF.¹⁹

How to treat them: There’s no way to “cure” eczema, sadly, but you can manage the symptoms and prevent flare-ups. For example, Dr. Brauer recommends taking shorter, lukewarm showers, since hot water can deplete the skin of its natural oils and dry it out. A thick, cream-based moisturizer—ideally with ceramides, shea butter, and/or glycerin—can also alleviate any cracking or flaking, according to the National Eczema Organization.

Olehenriksen Skin Barrier Strengthening Moisturizer with Peptides and Niacinamide

$51.00, Sephora

Farmacy Honey Halo Ultra-Hydrating Ceramide Moisturizer

$48.00, Sephora

11. Bumps due to rosacea

Also a chronic issue, rosacea typically appears as persistent blushing on the face.²⁰ But in rosacea type 2 (a subtype of the condition), red, painful, and inflamed papules or pustules are also part of the problem.²¹ They’re different from acne in that they aren’t the result of clogged pores, Dr. Boakye explains. (Limited research suggests that rosacea bumps might actually be an inflammatory reaction, which, in some people, may be triggered by an overgrowth of Demodex mites that naturally live in hair follicles and sebaceous glands.)²²

Much like eczema, the exact cause of rosacea isn’t known, but a bunch of factors can lead to frustrating flare-ups, Dr. Boakye says. For example, spicy foods, caffeine, and sunlight are some of the most commonly reported triggers to avoid if you’re dealing with this condition.²³

How to treat them: Unfortunately, there aren’t any permanent cures for rosacea yet, either.²³ But once you’re officially diagnosed, topical azelaic acid and oral antibiotics like doxycycline can target those bumps specifically.^{24 25} “People with rosacea tend to have more sensitive skin, so swapping out harsh soaps for gentle cleansers and light moisturizers is also helpful,” according to Dr. Garden.

12. Ingrown hairs

Most of us have experienced an ingrown hair or two at some point in our lives. But what exactly causes that swollen little bubble after tweezing, shaving, or bikini waxing?

When hair regrows, it emerges up and above the skin. But if it starts to curl back instead (because the follicle is clogged by dead skin cells or dirt), it can get trapped and form a small, raised, and (in some skin tones) red, bump, per the Mayo Clinic.

Luckily, ingrown hairs are often pretty easy to ID, appearing as a tiny loop stuck in the skin at both ends; other times, however, you might not even see the strand and instead notice the resulting inflammation in the form of a cyst-like lesion.

How to treat them: Poking and prodding your skin in an attempt to yank out the stray hair is not the answer. In fact, tweezing, as well as waxing or shaving an ingrown can potentially lead to infection. Instead, apply a warm compress and gently rub the spot in circular motions; this will help to soften the top layer of your skin, which should make it easier for the hair to break free, as SELF previously reported.

Another, more long-term solution to consider is laser hair removal, which, Dr. Garden says, damages the follicle and reduces the likelihood of getting ingrowns.²⁶ However, there are risks involved—including the potential for hyperpigmentation, burns, or even scarring—so it’s always important to seek out a dermatologist’s advice before deciding on the treatment.²⁷

The next time you start freaking out about your textured forehead, say, or that raging honker on your cheek, take comfort in the fact that many facial bumps are manageable and not the end of the world. If you’re worried (or annoyed), though, it definitely doesn’t hurt to check in with a dermatologist or your primary care doctor. After all, your skin health—and especially your precious little face—is definitely worth the extra caution.

Sources:

1. InformedHealth.org, Acne: Overview

2. StatPearls, Acne Vulgaris

3. Clinical, Cosmetic and Investigational Dermatology, The Association Between Stress and Acne Among Female Medical Students in Jeddah, Saudi Arabia

4. Journal of Cosmetic Dermatology, A Review of the Role of Sebum in the Mechanism of Acne Pathogenesis

5. StatPearls, Milia

6. Oncology Letters, Milia May Originate from the Outermost Layers of the Hair Bulge of the Outer Root Sheath: A Case Report

7. Journal of the American Academy of Dermatology, Milia: A Review and Classification

8. Clinical, Cosmetic and Investigational Dermatology, Glycolic Acid Peel Therapy – A Current Review

9. The Journal of Clinical and Aesthetic Dermatology, Malassezia (Pityrosporum) Folliculitis

10. Journal of the American Academy of Dermatology, The In Vitro Antifungal Activity of Ketoconazole, Zinc Pyrithione, and Selenium Sulfide Against Pityrosporum and Their Efficacy as a Shampoo in the Treatment of Experimental Pityrosporosis in Guinea Pigs

11. Cureus, A Narrative Review on the Role of Acids, Steroids, and Kinase Inhibitors in the Treatment of Keratosis Pilaris

12. StatPearls, Keratosis Pilaris

13. BMC Family Practice, Patient Understanding of Moles and Skin Cancer, And Factors Influencing Presentation in Primary Care: A Qualitative Study

14. StatPearls, Dermatosis Papulosa Nigra

15. The Journal of Clinical and Aesthetic Dermatology, Dermatosis Papulosa Nigra: A Quality of Life Survey

16. StatPearls, Laser Complications

17. StatPearls, Skin Tags

18. Northern Clinics of Istanbul, Diagnosis and Treatment of Urticaria in Primary Care

19. StatPearls, Eczema

20. Dermatology and Therapy, Rosacea Treatment: Review and Update

21. Dermatology Reports, Rosacea: A Clinical Review

22. Indian Journal of Ophthalmology, Demodex and Rosacea: Is There a Relationship?

23. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Rosacea: Diagnosis, Treatment, and Steps to Take

24. Expert Opinion on Pharmacotherapy, Azelaic Acid 15% Gel in the Treatment of Rosacea

25. Clinical, Cosmetic and Investigational Dermatology, Safety and Efficacy of Doxycycline in the Treatment of Rosacea

26. The Journal of Clinical and Aesthetic Dermatology, Folliculitis Induced by Laser Hair Removal: Proposed Mechanism and Treatment

27. StatPearls, Laser Hair Removal

Related:

Originally Appeared on SELF

Introduction to Medical Assisting
Telecommunications, Written Communications, Computers, and the Medical Office Environment
Patient Scheduling and Managing Medical Records
Medical Insurance and Coding
The Revenue Cycle
CPR Certification
Pharmacology
Fundamentals
Pathophysiology
Infection Control and Medical Asepsis
Chief Complaint, Patient History, and Vital Signs
Assisting with Examinations
The Physician’s Office Laboratory
Cardiology and Diagnostic Imaging Procedures
Surgical Asepsis and Minor
Office Surgeries
Medication Administration Procedures
Emergencies, First Aid, and Mental Health in the Medical Office
Rehabilitation and Nutrition
Workplace Readiness