Disability can be a devastating outcome to a doctor's career. Here's how handle it.

Disability can be a devastating outcome to a doctor’s career and self-image. Think about it: You busted your butt to learn how to do a Whipple procedure, end up getting into a skiing accident that ends your career right there. No worries, because you purchased the appropriate coverage of own-occupation disability insurance, right?

Having disability insurance certainly provides a protective cushion, especially you are the sole breadwinner. This is a no-brainer, and something that I think all new graduates ought to consider. One of the reasons why many of my co-residents (myself included) shied away from disability insurance during our training was that it did take up a moderate chunk of our income. At that point in our careers, every single dollar made a difference. Some of my colleagues were single without any dependents, so it was easier for them to convince themselves not to get insured. If they were not able to practice medicine, they could rot in the gutter somewhere without putting any family members in a dire financial situation.

The problem with disability insurance, too, is that it does grow with your income as you decide to increase coverage. If you don’t end up using it, the money is gone into the insurer’s pockets—but that is how insurance is supposed to work.

Enough about that.

What seems to fall into the grey zone is that if you become ailed with something that a medical or psychiatric diagnosis is unable to quantify. Let’s say you fall while rock climbing and fail to break any bones or tear any ligaments. None of the MRI’s or clinical exams reveal any damage, so you don’t get to invoke any of your insurance claims. However, when you’re feeding that guide wire when placing that port or stent, something isn’t right. You can still do your job, but it seems that you’re having a much more difficult time accomplishing what you otherwise were able to do with ease.

Sometimes these hinderances are even more subtle. Maybe you tweaked your finger while playing basketball, started getting mild headaches whose only treatments include enough medications to put down a 300-lb wrestler, or simply just lose your stamina to power through an eight-hour cardiothoracic surgery. It could be all in your head, but the problems could also be real. Maybe it’s just a combination of age, genetics, and bad luck, sort of like those vague symptoms your patients with IBS have but you don’t really have any real suggestions to resolve them.

This is the realm that disability insurance isn’t going to cover. You’re not really disabled by any strict definition, and you’d better be sure that your insurer won’t be cutting you any checks when you’re still able to power through more surgeries than ever but just feel like crap doing it.

This is a problematic situation to be in, and I frankly am not sure what percentage of doctors remain in the workforce who are working in what they themselves consider to be suboptimal. I surmise that this number might be higher than we realize. Perhaps this percentage increases as doctors move past their prime and closer to normal retirement age.

How to cope with purgatory

What do you do if you aren’t 100% but function roughly at the cusp of where you think that you need to be to continue practicing medicine? At what point do you hang up your hat and cut your losses?

The easiest answer is to get yourself into a situation where you can walk away at any time without putting your family in a financial predicament in case you fall into purgatory. While there’s no need to live in fear every day agonizing over how to get to some magical net worth number, you can work towards achieving a sustainable lifestyle based on your I/O’s.

You’d want to find that sustainable situation while you are still able to function at 100% of your earning power. Focus on building your earning power while not completely squandering your hard-earned finances. This might simply mean moving a percentage of your paycheck to savings before you accidentally burn through it in one go.

Heed the wake-up call

If you do find yourself working as your suboptimal self but are unable to leave your work situation financially, consider it to be a wake-up call. No matter what stage in your career you are in, remember that you can always crunch down your expenses just like what you is in residency.

Axe those car payments on your M5, sell the car, and get a used beater. Remember that driving that M5 doesn’t confer you any bragging rights. Nearly every single person in the hospital doctor’s parking lot can also afford that car. You aren’t as special as you think.

Your family will thank you for being diligent about your situation. Get them involved, and have them realize that it’s a group effort to make the financial ship run. No one can depend upon nice doctor incomes forever. I have seen doctors in their mid-fifties turn their financial situation around.