You are 52, healthy, fit and at the peak of your career. Your practice is well established and you enjoy the security of a good income, a group of committed employees and financial security for yourself, your spouse and your children. With most aspects of your life well in control, you can afford the luxury of putting some focus on your own personal health—the one thing that your practice cannot, per se, provide for you. You belong to a fitness club, work with a personal trainer, do your regular aerobic workout each day and generally feel as good as you have felt at any time of your life. Nothing seems lacking and your life is abundant. On an unexpectedly sunny spring day, you decide to take advantage of the warmth and go for a bicycle ride rather than staying indoors and doing your typical stairmaster workout. Water bottle filled, helmet securely fastened, you take off on one of your favorite routes that will not only provide you with an hour of cardio-vascular exercise, but will also swing you past the salt water inlet and through one of the loveliest local parks. Life couldn’t be better. About halfway through your ride, as you are contemplating your next vacation trip, a driver, unbeknownst to you, reaches for something that has fallen onto the passenger side floor of his car. In doing so, his eyes are diverted from the road and in the moments that it takes him to reach the item, he swerves into the oncoming lane of traffic. When he looks up, he sees a car bearing down on him and he instinctively pulls the wheel hard to his right to avoid the collision. The driver loses control of his vehicle, which plows straight ahead toward the curb, passing through the clearly marked bicycle lane and, in the process, runs over you and your bike. The good news is that the final thoughts of your life were positive and you “went out on top.” The bad news is that your life is suddenly over, leaving behind a widow and children, all of whom may be well taken care of by your insurance policies, assuming you made time to secure them. Also left behind are your practice, your employees and your hundreds of patients whose fate is far less clear than your family. What insurance policy will handle this major part of your life? Which insurance policy will maintain your loyal employees’ workplace? Did you take out a policy that will guarantee that the patients who trusted you will have continuity of that care? For many dentists, these are considerations that may never fully reach the level of conscious thought that they deserve. Few of us expect to be a bicycle accident victim at the peak of our lives, yet the story above is a slightly fictionalized version of an actual event that happened to a local dentist in my community. This is not the only possible story, either. I can relate from my personal experience the stories of others: the dentist whose car slid off a curve in the road, plunging him to his premature death, or the stories of actual friends who have endured by-pass surgery, cancer or heart problems that fortunately did not end their lives, but did put them out of their workplace for extended periods of time. These are all situations that have occurred to real people whom I have known. In two of the cases, their worries about the fate of their practices were minimal, for they had secured the cheapest insurance possible—membership in a mutual aid group. This is the best insurance and peace of mind that is obtainable because such a group can maintain a practice in the absence of its owner so that when the afflicted doctor is ready to return, his office is there for him.
Why a Mutual Aid Group?
My definition of a mutual aid group is: several like-minded professionals who are committed to each other to maintain the viability and economic health of an office whose owner is disabled or dies. Although I have never read or heard any hard data on the topic, I would guess that an absence from an office for two or more months might have a significant impact on its viability. Absences of greater duration have the potential for ending the practice’s existence. Without a program for continuity of care for the patients, how long can they reasonably be expected to wait for their needed dental care? Overhead insurance may partially (or even fully) fund the office overhead, but realistically, can employees be expected to sit idly collecting paychecks with nothing to do all day long? My Team members become anxious on days that we are not fully booked—I can hardly imagine how they would fare with an empty appointment book facing them for months! In spite of their loyalty to my practice and me I can’t help thinking there is a limit.
Mutual aid groups can take many forms and each one should be customized to the needs and preferences of the participants. For the purpose of illustration, I will cite in this article the elements of the mutual aid group to which I belong. These are not necessarily intended as “the” guidelines, but rather more tangible examples of how at least one group has done it. We have implemented our assistance program two times in my 22 years of membership and not only did both practices survive and continue forward into the future, the experience was, for the most part, a very stimulating and educational experience for everyone involved. The disabled doctors were tremendously grateful for the support and the adequate time to heal from their infirmities so that their return needed not be premature. For the doctors who went into the practices, it was an opportunity to experience another way of doing things, new materials and techniques and pick up (first hand) new tricks. For the employees (and, ultimately the doctors) of the involved practices, it was the clear realization of their value, since they, in essence, ran the office as usual, but now found that the owner was an interchangeable part. This, by the way, can be a very freeing realization for the doctor, too! Lastly, patients were duly impressed that other doctors held the owner in such high esteem that they would take time out of their practices to come to the aid of a colleague. In short, nobody felt this was anything other than a remarkable and positive experience!
How Does the Program Work?
Many variations exist, but it is my opinion that to be effective, a minimum of 9-10 doctors should be involved. This number enables the group to provide maximum support without crippling the practices of the doctors providing coverage. A clear contract must be written that sets the guidelines for the agreement. Included in this contract must be all of the following elements:
• Duration of coverage
• Definitions of disability
• Mechanics of coverage
• Any special stipulations
Duration of Coverage
It is vitally important to establish the exact period of time for which the mutual aid group is legally and morally responsible for covering the practice of the disabled or deceased member. It cannot be overstated that sympathy, compassion or desire to help will compel a group to continue helping beyond a point that is advisable. On the other hand, inconvenience, economics and personal feelings might influence the group in the opposite direction. By setting the guidelines early, it frees the group of any need to make decisions or, more importantly, exceptions, to the coverage of a practice. It is already established, in writing, so that everyone goes into the process knowing just how long the agreement will be in place.
In my group, we have agreed to a maximum of six months of coverage, no matter the situation. It is the collective opinion of our group that this is an appropriate period of time for the practice to be sold, in the events of death or permanent disability, or maintained to allow the temporarily disabled doctor to return. It is less important for this guideline to be established from this article or our group’s decision than it is for the new group to discuss thoroughly the goals and needs of the mutual aid program they are creating.
Definitions of disability
Perhaps no area of this agreement has more potential for creating misunderstandings or problems than the definitions of disability. There are a variety of ways to define disability, but the easiest way is to look at existing definitions from insurance policies. These may vary, so conversation within your group will be important. The elements we have included in our agreement are as follows:
1. The doctor must be unable to perform the usual tasks or procedures in his/her professional practice
2. The doctor is under supervision and the orders of a physician
3. The doctor isn’t (or is, as the case may be) expected to return to full-time practice
In addition to these definitions, we have further defined the degree of disability (in the case of temporary) as follows:
1. If the doctor is unable to perform his/her regular duties for more than 4 hours per day, the mutual aid group will provide full coverage
2. If the doctor is able to perform his/her regular duties for at least 4 hours per day, but not for a full week, coverage will be provided only for the days on which he/she cannot be present
3. If the doctor is able to perform his/her duties for at least 4 hours per day for an entire week, the group is not required to provide coverage
In this way, there are no “gray zones” for coverage and the group has clearly defined limits and obligations on covering for a disabled colleague.
Mechanics of coverage
It is my opinion that the mechanics of coverage must be meticulously spelled out to insure proper aide to the disabled doctor. It is not uncommon for a group to find that inconvenience becomes a factor in stepping forward to work for the person in need of assistance. In our agreement, we have a pre-established rotation that was determined by random draw so that everyone signing the agreement understands exactly when his/her turn will come up. That is, once the disabled doctor’s office has contacted the program administrator, it becomes a simple process of assigning days based on the agreed-upon rotation so that nobody can claim that it “wasn’t convenient” on a certain day. The order of this rotation does not change, but each year it is changed by an increment of doctors that will insure equal opportunity both at being first in line as well as last.
The starting point of coverage is another item that must be carefully defined. In our agreement, we felt that starting coverage three weeks after the first day the member doctor misses is appropriate. The group also requires a minimum of two weeks’ notice. In the instance that the doctor has been expecting to be back “any time,” but misses two weeks before notifying the group, the group would not be required to provide support until the start of the fourth week (since it would be two weeks after the notification). This is an important point to clarify, since the range in time may be deemed shorter for some groups. Our feeling is that because each member would be canceling patients at his/her own practice, it would be impractical to start less than two weeks after notification. That gives the offices adequate time to reschedule clients. Again, this is merely the guideline we have established, but need not necessarily be embraced by any other group.
Last of all, the specific time expectations for the supporting doctors to be in the disabled doctor’s office need to be established. When geography creates a challenge for travel, the request may arise for shorter hours at either the outset or the completion of the day to enable the traveling doctor to commute back and forth. In our group, we have established a clear boundary around that potential situation by defining the support as being for the normal working hours of the practice receiving aid.
Any special stipulations
Any group considering a mutual aid agreement should include any special stipulations, such as mutual aid for the circumstances of disability related to alcohol or drug use or high-risk hobbies. In the former, for example, we limit the coverage to a shorter period of time than six months and only agree to provide aid if the individual is in a treatment program. In the latter, it must be decided if coverage will be provided if the disability is related (for example) to skydiving, mountain climbing or other hobbies inherently dangerous. You may want to include stipulations about pregnancy (whether it is covered or not) and any other situations that could arise out of unusual circumstances.
Because our group has activated our agreement twice, we have learned much about the potential pitfalls and have continued to create an agreement that will foresee as many of these as possible. No document will be perfect, but the more thought that has been put into the agreement, the higher likelihood for success. While I don’t put much time or thought into considering my own premature death or disability, I do enjoy enormous peace of mind knowing that under those circumstances, my family, my practice, my clients and my Team members will be supported in the best way I can imagine—through the efforts of my trusted colleagues. I would never suggest that anyone reading this article stop riding a bike, but I definitely recommend that at least some thought be given to eventualities that could radically impact all the people who are important to you. A mutual aid program is not only practical; it is inexpensive and is the most profound peace-of-mind insurance you can buy!
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