Income protection for clinician researchers with Dr. Stephanie Pearson

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I'm your host, Toyosi Onwuemene, and it is an absolute pleasure. It is an absolute pleasure to be with you today. Thank you for tuning in. I am excited today because I have an extra special guest. Today I am joined by Dr. Stephanie Pearson. Stephanie, welcome to the show. Hi, thank you for having me. Stephanie, I'm so excited that you're here because you are not our traditional guest on the show.

1:26 You are here to talk to us about disability insurance. So I want you to introduce yourself to my audience and let us know how did this surgeon now turn to this, to disability insurance as part of what she does. Okay. I will give the very abridged story. So I am an OBGYN by training, trained and worked in the Philadelphia area for my clinical career and unfortunately I was kicked in the shoulder during a difficult patient delivery and she just got me in the right spot. And I ended up with a torn labrum, developed a frozen shoulder, had surgery, went to sleep getting told I'd be back to work in 12 weeks and August there will be 11 years that I am away from clinical medicine, not that I'm keeping count or anything.

2:21 And unfortunately I learned a lot the hard way and I thought that I did everything right in planning for myself and my family. And it was really through sheer ignorance and I don't mean the ignorance that we should know something and we don't. I mean real pure ignorance, the stuff that we don't know because we don't know it. That I felt as though I had not been properly educated or advocated for and really took my journey and what happened to my family and became really passionate about the topic thinking that I couldn't possibly be the only physician in the position I found myself in.

3:08 And after speaking to a bunch of friends and colleagues, it just seemed like this is where my life was supposed to take me. I know it sounds a little bit trite that things happen for a reason and maybe it's just what keeps me focused. I really thought that I would probably die at the OR table in like my 80s and it's just not the deck of cards I got dealt. So here I am, I started an insurance company and we focus mainly on physicians for disability and life insurance. I'm truly trying to change the way that this gets taught to young physicians, the way that it gets handled and really care about the service aspect.

3:56 I went into medicine to have a service led life and this allows me to continue to do that in a little bit of a different space. Stephanie, thank you so much for really distilling the story down. You've done this a lot because I've heard the longer version and to some extent, I do want my audience to just hear a little bit more of that story because it's a really powerful story and you clearly are a remarkable person. You've been through a remarkable number of things and to turn that around into this mission focused career is super awesome. But I do want to take a step back to the part in your story where you didn't know this was coming.

4:41 You struggled through a lot of going through specialists, going through surgeries and at the end of it, you lost your job. I want us to necessarily stay positive, but I do want you to speak to the failure of expectation, all the things that happened in that moment, especially in that journey that was so unexpected and perhaps many physicians feel like, oh, that could never be me, but it could possibly be them. So going way back to the beginning, after the initial injury happened, my first orthopedist quite honestly kind of blew me off.

5:21 He said that professional baseball pitchers pitched with torn labrums, so I should be able to do my job. And he had some other choice words that I'll keep to myself, but I put my head down and I did what I think all type A physicians do, you figure out how to compensate. And I figured out how to compensate until I couldn't. And it was when I really couldn't compensate anymore that I met the orthopedist who ended up doing my surgery. And I woke up from surgery with him sitting at the corner of my bed. And I kind of knew at that point, nothing against orthopedic surgeries, but most of them are so busy that they really don't stick around.

6:05 So I knew the fact that he was there when I woke up was not a great sign. And he did say that it looked like a bomb went off in my shoulder and I probably would not get back to practice the way that I had previously. And to kind of set that up, OB-GYNs wear lots of hats. And my biggest hat was as a surgeon. I was the person that people sent people to and it was my happy place. I mean, I truly, truly loved being in the OR and being able to truly fix and heal people. And I did a lot of OB. I was originally told that I couldn't operate, I couldn't do obstetrics, but I was actually cleared to do office GYN as tolerated.

6:54 And I thought I'd be given that opportunity. I had recently been asked to be the chairperson of our department and I love teaching residents. I thought, okay, I'm still going to practice, I'll be in a little bit differently. And unbeknownst to me, my contract said that I needed to be able to do 100% of my job and I no longer could. And I got unceremoniously terminated the day that my FM ballet was up and nobody called me, like not my office manager, not my senior partners, no one from the hospital. And once I got terminated, it turned out that I couldn't get malpractice insurance because one of my orthopedic notes says that I'm a liability.

7:41 So it really was in a matter of probably days that I went from thinking I still have a job and I can still practice medicine to, oh my God, what am I going to do now? And then to pile on top of that, the group disability benefit that we had at our hospital in fine print didn't cover work-related injuries. So then I got my second blow that I literally got told I would have been better off had I fallen off my bike, which is a tough pill to swallow when you're doing your job, right? I was doing what I was supposed to do. I had a safe baby, I had a safe mom, yet my world kind of came tumbling down.

8:27 So those were the biggest two blows. And then the third blow came when I realized that my private policy just wasn't quite what I thought it was. So going back, I truly thought I did all the right things. I had a policy through the work. I had a policy on my own. And then all of a sudden, it was just not what I thought I had. And so it was a lot. I was not in a good mental head space. But I think like a lot of physicians, I went through the dark spot, came out the other end and figured out what I needed to do to keep going.

9:10 Stephanie, thank you so much for just your courage and sharing your story and the challenges that you've come through. And thank you because you're using it as a platform to help other physicians as well. So I feel like this is a great point at which we should stop and talk about what is disability insurance? And we're going to get into a little bit more of the fine print, but really give us a, I think we have a sense of it, but help us understand and especially kind of actually let me stop there because you have a lot to tell us. No, yeah. So at its basic definition, disability insurance is income protection. So so many of us growing up, we hear about health insurance, we hear about auto insurance, we hear about homeowners insurance or renters insurance.

9:59 People talk about insuring jewelry, right? No one ever told me that I needed to insure my ability to make money, which when you think about it is our biggest asset. And I don't mean that to sound salesy, but it's true, right? We sacrifice so much becoming physicians. We give up our 20s, some of us part of our 30s, our friends are already making money. Not only are we not making a remarkable amount, but we're paying off our loans, right? And so to look at what could happen if the unimaginable happens, it's huge.

10:42 And so many of us aren't taught about it. And if we are taught, it may not be to the fullest extent. And so there's a lot of misinformation. There's a lot of misunderstanding, and I kind of think it's on purpose. I think that insurance companies want us to be a little bit confused. And we don't have to be, you know, it's just, it's a different language. Speaking of language, I think we all have a general sense of what disability insurance is supposed to do for you, for us, but you found out that although you had disability coverage, it wasn't quite the coverage you hoped it would be.

11:31 Speak more about that. So I already mentioned the group benefit had the fine print that it didn't cover work-related injuries. I will tell you back in 2012-13, that was definitely the exception to the rule. It's becoming more and more common, and to be honest, since the highest point of COVID, they're also putting in, now that they're not covering work-related injuries or illnesses, I find that to be a slippery slope. I'm not sure how anyone can prove where they contracted an illness from. And again, it's not everywhere, but the devil's in the details of these employer policies, and they don't really have to tell us what's in it.

12:15 It's usually one line on your open enrollment packet and you check a box. So part of that is just, we don't know what we're supposed to ask for. And so everyone really should be getting a hold of the master copy of their employer's policy to figure out what do you have, what don't you have, where are there holes. So that's the first big piece that I had no idea. Secondly, I thought that I bought the right private policy, and I will tell you that language is actually the biggest issue in that there's no standardization of language in insurance, like there is in medicine and lots of every other fields.

12:56 And I thought that I bought a truly specialty-specific policy that would cover me if I couldn't be an OB-GYN. Well, it turned out that I had two policies. One was the right policy, but didn't have any of the bells and whistles. It was just a clean benefit that I get once a month. It never changes. It doesn't have inflationary protection or anything like that. My second policy is specialty-specific by my occupation, but not necessarily by the definition of total disability.

13:38 So let me take a step back. What you want a private policy to say is that you're considered totally disabled if you cannot do your job, regardless if you're gainfully employed in another occupation. Now most group benefits, instead of the word regardless, it's the word not. So you're considered totally disabled if you can't do your job and you're not gainfully employed. So that definition isn't great for most of us who are not hardwired to be stay-at-home parents. I have the utmost respect for them. I am not supposed to be one.

14:20 And what my policy added was a clause that said until you make your pre-disability earnings. Now this one's a little hard to digest sometimes when we talk about disability insurance being income replacement protection. The issue is with that phrase, you lose your earning potential. So 11 years later, I still have to send in my banking statements and my company profit and loss statements for them to decide if they're going to pay me or not. And where it becomes a kicker is the company can do well, but I may not take a distribution.

15:05 I still get dinged because I have equity in the company. So I can kind of get double screwed for lack of better phrasing because now I'm not taking money from the company because we do a lot of reinvesting in our people and our technology and all of that stuff. And now I'm not getting my benefit. And I thought I was going to be covered if I couldn't do the job that I did. And I think the way to make it make the most sense is think about yourself as a resident. You're nowhere near your earning ceiling.

15:45 I bought that policy my first years in attending. I wasn't near my earning potential. And let's be clear, if I could make doing this what I made my last years in attending, would I need my insurance? Probably not. But it's a giant mental thing that it's not what I thought I bought. And if I had made that decision through informed consent, which I know really doesn't totally exist outside of medicine, but I try to make it, then that's on me. But it wasn't. It's not what I thought I got.

16:26 And I would never sell a policy like that to somebody earlier in their career because things happen. I've had residents go out. I've had fellows go out. I've had very early attendings go out. And if they're not taking into account your future earning potential, you could be in a really bad spot. Yeah. So the situation seems... Oh, actually, I was going to say it seems bleak, and it does. But there's a ray of hope because that's why you're here, to help physicians think really about how they should be thinking about disability insurance and what coverage they should make sure they have. So I want you to speak first about own occupation disability.

17:09 And I want you to speak especially to my audience. I mean, we're clinician researchers. We're like, well, if I can't see patients in the clinic, I'm just going to go do research. Can you speak to why people like me need to be thinking about disability insurance and that we're appropriately covered? Absolutely. So the first part, the comment of this is bleak, but look, like I said, I'm doing this now to try to change the industry. I know that that's a little bit hyperbolic, but I don't want to be... Or I should say, I don't want anyone else to go through what I went through. So I do see this as being bigger than me and my family or my family and me.

17:53 As far as clinician researchers, I think that there is... And I don't mean to offend anybody, but I think there's a little bit of a misunderstanding or misconception that only proceduralists need to have disability insurance, right? If you don't use your hands, you don't need this. Well, first of all, that's not true. One, a lot of physician researchers use their hands and are very much proceduralists. I worked in a genetics lab for a long time, and if I couldn't use my hands, I would have been in a lot of trouble, right? But we're not talking about just using your hands.

18:34 You guys really need to think about your brains probably more than anybody else. And there are a lot of things that knock that out that we just don't want to think about. There's a tyranny of perfection that lives in medicine, right? We're tougher than stronger than we're resilient than... Something bad's going to happen to us. That's just not true. And there are a lot of things... Look, think about outside of even basic traumatic brain injuries, right? So you have car accidents, ski accidents, bike accidents, during storms, tree branches, fall. I mean, they're not called widow makers for nothing.

19:17 And think about all the things that cause fatigue, right? There are things where it's not you're going to wake up one day, be able to do your job, and wake up the next day and completely not be able to do your job. Think about things like MS, other autoimmune diseases, right? ALS, working through chemotherapy, things where a treating physician is going to say to you, look, you can actually do your job. So now I'm focusing more on that fatigue piece. You can do your job, but you can't do it sustainably. Well, you're going to lose money, right? And your policy should have something in it called a residual or partial disability benefit, which is going to kick in if you have to go part time.

20:08 Now going back, and I might have done this a little out of order, I apologize, but you mentioned talk about the own occupation piece, and you'll maybe realize that I said specialty specific in the beginning, and that's because companies use different phrases to mean the same thing. And so what we hear kind of around the water pool is own occupation, own occupation, own occupation. But then you find out that other companies call it something else, or even worse, companies can call it own occupation, but define it differently. And that goes back to the group versus private. Most group policies will say that they're own occupation, and the assumption there is you're covered for what it is you do day in and day out.

20:54 But when you go into the fine print of the policy, it may be what's called held to the national economy or the local labor market. It's not specific to what one employee does at one employer site. That allows them to cast a really wide net that says this is what you would, could, should be able to do based on your training, education, and skill set. So that's not really an ideal definition, but oh, it says it's own occupation. So it's almost a lie of omission, right? Whereas in the private sector, it can be called true own occupation, own occupation, regular occupation, that there's about five to seven different terms that are used, right?

21:38 What you want to know is, in fact, are you covered for what it is you do day in and day out, not what your neighbor does? And will you be considered totally disabled if you can't do that, regardless if you're gainfully employed in another occupation? So I kind of went a little bit out of order there, but I think I got the point across if I didn't, you know, I'm certainly happy to delve into it a little bit more. But I truly think from a researcher standpoint, I think you have to think of yourselves as hands on. I do think you guys are proceduralists.

22:20 I think that, you know, you have to protect your brains, you have to protect your stamina, right? Cancer doesn't discriminate. ALS doesn't discriminate, right? And that's just the tip of the iceberg. I mean, I can get, I have hundreds and hundreds of stories. I don't want to turn this into a fear mongering episode, but you guys have a specific skill set and that skill set needs to be protected. Thank you. Yeah. When you're talking about using our hands, I'm thinking I'm typing all the time. I need to be able to type. Even when you do voice to text, you still have to go back and do some editing.

23:03 And clearly the brain, you don't even have to sell that at all. So okay, so we have a stab. Yeah, yeah. I left that out, but think about how much you read, how much you have to analyze. Blindness happens, right? Accidents happen. And so there are many things for you to be worried about. Sure. So, so now you've sold us on the necessity, right? We all agree. We should get disability policy, but what should we be looking for now that it sounds like every disability policy is not the one we want?

23:46 So the short answer to that is there are five carriers that truly give the language that we need as physicians. So that's that. But beyond that, you want to make sure that the language is tight. You want to make sure that you can access additional coverage without having to go through medical underwriting again. So medical underwriting is part of most policies when you're trying to get it for the first time. And it's really invasive. I mean, you may have to pee in a cup. You may have to give up some blood.

24:26 You absolutely have to answer a million medical questions a million times. They have access to your medical records, your pharmaceutical records, your motor vehicle records. You want to give that info once and never have to give it again. And all of these carriers have money sitting somewhere that you can access as your income ascends, as you change jobs and have different benefits, where all we have to do is show them proof of income. So I think that's probably the second most important part. And then you get into these smaller pieces. I had mentioned the partial or residual benefit. There are actually more partial slash residual claims filed and paid every year rather than total.

25:12 So I think that was super important. There's inflationary protection that you can add. So it's known as the COLA or the cost of living adjustment. Now the interesting thing with that is that doesn't kick in until you're on claim. So you're sick or injured, they're paying you. When you hit your anniversary, that benefit will go up. And so as I mentioned, I'm approaching my 11th year out. I've gone up 10 times. So what I'm getting this year every month is not the same as what I got in 2013 every month.

25:54 And that can amount to thousands and thousands of dollars over time. There is something called a catastrophic benefit, which is exactly what it sounds like. So in the event something awful happens and you're left unable to perform two or more of your activities of daily living without assistance, or you're severely cognitively impaired, you could get an additional benefit. So it's additive. Think of X plus Y. X is your monthly benefit, Y is the catastrophic benefit that we have seen utilized in some of our older clients. I know it can happen younger, but thankfully it hasn't happened with us yet.

26:36 But I do think that's important as we get older and bad things happen. The biggest difference amongst the carriers right now has to do with how they treat mental health and substance abuse. And it is a very individualized topic. Some companies give you options. Some of them it's built into the policy. And so there's a lot of movement there. And one of the first questions I tend to ask people is how important is that coverage for you? You know, we know that there are some people that have really good support systems. They don't have any family history. They would seek care if they needed it.

27:16 They might benefit from a lower benefit that usually comes with a discount. If you're somebody who's had a strong family history, who is concerned about that taking you out, then you have to expect that you're going to pay a little bit more to have that full coverage. And you might want to look at specific companies that do offer that. I can tell you back in 2005 when I got my policy, it was actually the only question that I thought to ask of. My mom was a very poorly controlled bipolar sufferer who had a late break. I was petrified that I was going to be in my 40s and have a psych break and have to leave.

27:58 And at the time there were only two companies in the state of Pennsylvania that would cover OBGYNs for mental health for the length of the policy. So I only looked at those two companies. Wish I knew other questions to ask at the time, but that was the one. Thank you. That's a really, really good summary of the things that we should be thinking about. I think definitely physicians need more help and we're going to talk about how they can access help through you. But I think what I'm hearing you say is don't just accept whatever policy you're giving, ask questions, and make sure it's actually tailored to what you might need.

28:38 That's important. Okay. All right. And group policy is if they're paid for by your employer, you have to have it. So it's something that you have to have. You might as well know what's in there, right? You can plan accordingly. And I don't know, I'd like to think that if my husband and I knew what we had and what we didn't have, that we would have planned differently. Yeah, no, that's good. Getting informed is important. So we're kind of getting close to the end of the show. I'm wondering what is an important aspect of disability insurance that we haven't talked about just yet? Wow, we haven't talked about.

29:21 I don't know. We've hit the major pieces of the puzzle, which are called riders. And I explained why I think it's so important for researchers. There's more to talk about the differences between group policies and private policies, but that would probably be a talk for another day. There are a few really... I could say the big differences have to do with taxation, ownership, and language. So your employer's paying for a policy, any of the benefit that you would get would actually be considered taxable. And anything that you're paying for would be tax free because you're paying those tax dollars and the government hasn't quite figured out yet how to tax up some both sides.

30:10 So big difference between money that's getting taxed and money that's not getting taxed. Ownership, as I mentioned, if you have an employer paid policy, you have to accept it, but you have no control in creating it, keeping it. They're usually employment dependent, so if you change jobs, oftentimes it's not going to go with you. Whereas a private policy, it's yours. You should help create it. You get to control it. You get to keep it. It's going to go with you wherever you go. And again, most importantly, as I mentioned before, has to do with the language and does it mean what it really says? How are they defining words or phrases?

30:54 What are the limitations? And I think that's probably the one thing that we didn't really get into. Sure, sure. You know, it sounds like more help is needed. So for those who are saying, huh, I need to figure out if I'm adequately covered or for those who don't have disability insurance yet, who are thinking about it, how can they find you? Well, our website has a lot of frequently asked questions and information. So PearsonRabbits.com. Obviously I am on all socials. I am my name, Stephanie Pearson. Some of them, it's Stephanie Pearson MD, some it's PearsonRabbits. But if you Google Stephanie Pearson, you'll find me out a lot.

31:37 You can call the office 610-658-3251. I'm so accessible now. Thank you, Stephanie. And for those who are listening, I will put that in the show notes so that you have access to her information as well. Stephanie, this is such an important conversation. I want to thank you for coming on and sharing your story and helping physicians. I so appreciate that you're very mission-minded and I think physicians are a group that absolutely need help. And I'm so glad that you're in this space helping us out. Thank you, Stephanie. Oh, thank you so much for having me. I'm honored and humbled. And please don't forget you guys need this protection.

32:20 Thank you, Stephanie. Thank you. All right. All right, everyone. Thank you so much for tuning in. I hope you have seen how important this is and definitely reach out to Stephanie, get the help you need, make sure you have the disability coverage that you need because we need to continue to be able to protect our income really for as long as we're working. So thank you all for tuning in and I look forward to seeing you again next time on the Clinician Researcher Podcast. Thanks for listening to this episode of the Clinician Researcher Podcast where academic clinicians learn the skills to build their own research program whether or not they have a mentor.

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