By Jeffrey D. Brunken
President, The MGIS Companies
It takes a certain type of person to become a doctor. In addition to high intellect, doctors must be driven, ambitious, hard-working and confident. They are taught very early on to push through exhaustion and stress. That, combined with the profound ability to save lives, can sometimes cloud a physician’s sense of their own physical limits. The drive to handle difficult, often highly emotional situations for patients can obscure the fact that illness and disability may at some point include them.
A difficult diagnosis
Despite their clear ability to diagnose others, physicians often may not want to acknowledge their own disability. If they do, they can be very reluctant to report it.
A respondent to a 2001 study on general practitioners’ attitudes toward their own illnesses stated it quite well, “We think we’re superhuman and that we don’t get ill, or if we do, we can cope with it.”
Similar studies show that physicians are slow to seek medical attention, often self-prescribe and are reluctant to take time off for illnesses. They often work through maladies they would never expect their patients to, and perceive their own sicknesses and injuries as a weakness.
While admitting physical weakness can be challenging for many physicians, acknowledging a psychological illness is even more difficult.
Due to the extreme stress level from long hours, high expectations, guilt and concerns for the wellbeing of their practices, many physicians suffer quietly with substance abuse, alcoholism and mental disorders such as depression. The statistics on physicians with drug and alcohol problems range from average (about 10 percent), to a little above average (10 to 15 percent). Many researchers believe the number is even higher, and the very fact that we don’t have accurate statistics is indicative of physicians’ natural inclination to deny they have a problem or suffer in silence. Many physicians fear that seeking help could risk their job, license and reputation. But not seeking help early on risks escalation into a long-term disability (LTD) or even worse.
I recall a quote from the October 2000 issue of Southern Medical Journal that summarizes this perspective: “The culture of medicine is one in which perfectionism and ‘workaholic standards’ rule the day. Many practice settings reward long hours and self-neglect. Physicians are encouraged to disregard themselves and deny their own needs.”
The truth about disability
The truth is long-term disability can happen to anyone, anywhere. According to the Council for Disability Awareness, just over one in four of 20-year-olds today will become disabled before they retire, and less then 5 percent of injuries resulting in LTD happen in the workplace. Nearly 90 percent of disabilities arise from illnesses rather than injury, with the most common cause for LTD being diseases of the musculoskeletal system and connective tissues, followed by diseases of the nervous system and sense organs, diseases of the circulatory system and cancer.
By nature, most physicians want to be working, helping their patients, but the point at which there is no denying a disability, physicians are faced with stepping into a lower position or giving up their practice.
That’s what happened to a former colleague of mine, Robert J. Goodrich, MD. He had a thriving Ob/Gyn practice before a permanent hand injury forced him to close his practice and stop practicing medicine. Dr. Goodrich once told me he was young and healthy, working 80 hours a week, and working out another 10-12 hours per week and was convinced nothing would ever happen to him. Fortunately, he had purchased individual disability insurance (IDI) shortly after medical school, as many physicians do, so his finances were covered to some extent. Unfortunately, however, he had cancelled his group policy, leaving a large income gap.
This is a common problem. Physicians have a basic understanding that they need long-term disability insurance, but between running their practice and caring for patients, few have the time to sit down and fully grasp the intricacies of what their policy does and how important it is. Most IDIs only cover a fraction of a physician’s monthly salary. So, in the event he or she becomes disabled, a physician may only be eligible for $5,000 to $10,000 a month.
Group LTD policies are intended to fill that income gap and can be combined with any individual disability plan. Many policies will also allow the injured physician to return to work in whatever capacity they are able while still collecting disability in order to maintain their previous income level.
But not all group LTD plans are created equal. Physicians need to be aware of some basic differences that will determine the coverage that best fits their circumstances. Often they either don’t purchase insurance or purchase a less expensive plan without understanding the details. The average LTD claim for the general population is 31.2 months, but for specialized physicians, that same injury could end their career. With massive student loans as well as lifestyle expenses, the wrong LTD plan, or no plan, could lead to dire consequences for a physician should he or she become disabled.
Choosing a group LTD policy should be as much a part of a physician’s practice as choosing medical liability insurance, and understanding the complexities of the various policies will only make it easier to incorporate one in the overall business plan.
Choosing the right policy
Here are a few basic tips for physicians to ensure you choose an LTD plan that fits your needs:
Work through a broker: Rather than navigating the complex world of LTD, physicians should choose an experienced broker who specializes in physician insurance and can lay out policy options from several different carriers. They work for you, not the insurance companies, and will find a policy fit for you and your practice.
Definition of disability: How your occupation is defined directly relates to your disability eligibility. Some policies define a physician as being disabled if he or she cannot perform as a general doctor, meaning if you are a surgeon who can no longer operate, but you can still function as a general practitioner, you are not disabled. You want to find a plan that defines disability based on specialties and sub-specialties. Also, look for a policy that takes into consideration the material duties you were actually performing, not just what a typical physician in your field is doing. This may cost a bit more, but if you suddenly can’t perform your principle duties, you want a plan that recognizes your distinct skills and capabilities.
What earnings are protected: Most policies will require you to show a minimum loss of income to qualify for LTD. Look for a policy that does not include income stemming from partnership earnings, salary continuation, K-1 and receivables; otherwise, despite your disability, you may not qualify.
Read and understand the policy: Once your broker has assisted you with finding the right policy for your practice, take the time to carefully review it. Ask questions and ensure you understand exactly what will happen in the event you become disabled. Too many doctors wait and find out the hard way that they don’t have suitable coverage for their needs.
Take the next step
No physician wants to admit he or she is disabled, and sometimes may not even recognize the disability. To ensure you, your practice and your family are protected, the best step you can take is to ask yourself what your financial needs will be if you are disabled, do your homework to understand available policies and resources, and be sure you have effective LTD coverage in place.
Jeffrey D. Brunken, CPCU, RPLU, is president and chairman of the board of The MGIS Companies, a leading national provider of physician insurance products. For more information on group long-term disability insurance for physicians, go to mgis.com.