THE ORIGIN OF ERX SOAP
During his service on the Florida Medical Association Board of Governors, Michael Giongo observed a recurring challenge.
Many physicians faced increasingly interconnected financial, business, estate, tax, and risk-management decisions. While each area was important, they were often addressed independently despite their potential impact on one another.
This observation reinforced a simple principle:
Complex decisions are often best evaluated within a coordinated planning framework.
ERX was built around sequencing, documentation, and coordination across interconnected planning decisions.
An Influence on the Framework
An important influence on the ERX planning process came from Marie Giongo, Co-Founder of ERX Wealth and a licensed physical therapist.
Drawing on her clinical background, she noted similarities between the firm's planning process and the SOAP methodology physicians use throughout their careers:
Subjective. Objective. Assessment. Plan.
That observation influenced the development of the ERX SOAP framework—a structured process used to document observations, evaluate alternatives, and organize planning decisions.
Today, ERX SOAP remains one component of the broader ERX Operating Standard and Decision Architecture framework.
THE PHYSICIAN FRAGMENTATION TAX™
Most consequential financial decisions do not occur in isolation.
Practice, tax, estate, liquidity, and risk decisions often influence one another in ways that may not be immediately apparent.
The Physician Fragmentation Tax™ is a term used by ERX Wealth Partners to describe the cumulative friction that can arise when practice, household, tax, estate, liquidity, and risk decisions are evaluated independently despite their potential interaction.
In our view, fragmentation may increase what we refer to as Sequence of Decisions Risk™—where otherwise reasonable decisions can create unintended downstream effects across liquidity, taxation, enterprise value, risk exposure, and continuity planning.
Over time, these interactions may influence economic efficiency, flexibility, enterprise value, and long-term wealth preservation outcomes.
The ERX Z-Axis™ is the framework through which ERX applies its Decision Architecture approach to interconnected household and enterprise planning considerations.
The GOVERNANCE LAYER
Where sequencing, exposure, and continuity converge.
As complexity increases, coordination becomes increasingly important across interconnected financial decisions.
ERX serves as the coordination layer across the physician enterprise — aligning decision architecture across capital, liquidity, tax posture, estate structure, enterprise strategy, and risk oversight.
We do not replace the client's CPA, attorney, investment manager, or other specialist advisors.
We help coordinate alignment across them.
The objective is not simply portfolio management.
It is continuity of decision-making across the client's broader economic system.
I. PRACTICE & ENTERPRISE STRATEGY
Capital Allocation
Aligning enterprise liquidity with long-term strategic objectives.
Partner Transition
Coordinating ownership, succession, and transition decisions.
Recapitalization Alignment
Aligning valuation, liquidity, and transition considerations.
Real Estate Strategy
Integrating enterprise and family real estate decisions.
II. STRUCTURAL ARCHITECTURE
Entity Framework
Coordinating structures for liability management and tax efficiency.
Compensation Alignment
Aligning enterprise cash flow with household objectives.
Risk Oversight
Coordinating risk management across enterprise and family systems.
III. LEGACY & CONTINUITY
Tax Posture Coordination
Coordinating tax considerations across major financial decisions.
Estate & Continuity Planning
Aligning legal intent with long-term capital objectives.
Governance Documentation
Establishing a decision record for future generations.
ERX maintains the Operating Standard while coordinating alongside a client's existing CPA, attorney, and specialist advisors.
THE ERX METHOD
THE FIRST 30 DAYS
A structured process for documenting, sequencing, and coordinating complex financial decisions.
Weeks 1–2 | Blueprint + SOAP™
We establish the decision record, define decision ownership, Our team maps your g financial, legal, tax, and risk architecture alongside your existing advisors to isolate etax posture opportunities, structural entity leakages, and asset protection gaps.
Week 3 | System Mapping
We identify interdependencies across financial domains, evaluating sequencing considerations, exposure points, and structural inefficiencies. This mapping directly designs your corporate asset protection boundaries and multi-generational trust structure
Week 4 | Governance Framework
We finalize your operational roadmap, establishing a structured review cadence with your advisory bench. This ongoing governance layer synchronizes your multi-entity distribution schedules, monitors tax mitigation strategies, and mitigates, where possible, Sequence of Decision Risk.
Blueprint → SOAP™ → Map → Governance
One economic system.
One coordination structure.
One operating standard.
WHO WE SERVE
One operating standard across the physician lifecycle.
Whether establishing a foundation or governing a multi-location enterprise, the ERX Operating Standard is designed to coordinate decisions across capital, tax, estate, enterprise, and risk decisions throughout each stage of growth.
Residents & Fellows | The Structural Foundation
Establishing the blueprint before complexity compounds.
We focus on cash flow architecture, debt sequencing, protection structures, and foundational financial discipline.
Attending Physicians | The Growth Phase
Aligning liquidity strategy, investment management, and evolving tax posture with increasing professional complexity.
Practice Owners | The Integrated System
Coordinating the practice and household as one interconnected economic system.
This stage requires sequencing across entity structure, compensation design, transition planning, tax posture, and long-term continuity.
Medical Groups & Enterprises | The Governance Layer
A formalized structure for physician enterprises operating at scale.
ERX provides coordinated oversight across partner transitions, capital deployment, benefit architecture, vendor accountability, enterprise risk, and continuity planning.
Begin With a Strategic Architecture Review
A private strategic review focused on fragmentation, governance, and decision coordination across the physician enterprise.