medical residents

2025 Volume 3

Federal Student Loans: Consider a New Payment Plan

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Closeup image of graduation cap and money on table.

Navigating the world of federal student loans can be complex, especially with constant changes to repayment plans and forgiveness programs. Here is a breakdown of the latest updates and options to help borrowers make informed decisions.

Read more…


Cyber Liability Insurance – An Often Overlooked Essential

By Jensen Peck, Business and Professional Insurance Executive

System hacked. Internet security

Cyber liability insurance is often overlooked but is essential for physician groups of all sizes. Ten years ago, cyber liability insurance wasn’t really discussed as a necessary option. Unfortunately, in 2024 there were 14 data breaches involving more than one million health care records affecting 237,986,282 U.S. residents. That’s approximately 69.97% of the nation’s population. A lot of cyber events were able get through by simply using malicious or phishing emails to staff – taking advantage of human error.

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Ready to Retire? Your Financial Rx for a Smooth Transition – Free Webinar

mature caucasian woman use laptop computer at home

Presented by Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial and Alisa Allen, RHU, REBC, Medicare Benefits Insurance Advisor

After a long and dedicated career, the thought of retirement is both exciting and a little overwhelming. You’ve spent your life providing the best care for your patients, but who is providing the best care for your financial future? Join us for a complimentary, one-hour webinar designed specifically for physicians like you who are either considering retirement or have recently made the transition.

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Employee Benefits More Complicated – Start Planning Now

Roller coaster

By Chris Noffke, REBC, CSFS, GBDS, Vice President of Employee Benefits

When I look at the coming year, 2026 feels like it’s shaping up to be a rollercoaster ride for health insurance and other benefits. Rising medical costs, specialty drugs, and policy changes are making benefits strategies more complex and personalized than ever.

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Add This New Invaluable Rider to Your Term Life Coverage

An elderly man sits on a couch, leaning on a cane and looking lost in thought.

By Tom Strangstalien, Executive Director Individual Insurance Planning

We often view term life insurance coverage as a commodity – the more coverage we can secure at the lowest cost the better. This is a flawed premise. There are numerous options and riders to at least consider when purchasing term life protection. An innovative new rider shatters this basic premise to pieces!

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Understanding the Annual Medicare Open Enrollment

Company employee benefits manual, with cover opening to reveal tabbed contents.

By Alisa Allen, RHU, REBC, Medicare Benefits Insurance Advisor

Each year Medicare allows beneficiaries to make changes to how they receive Medicare coverage during the annual open enrollment period. Let’s review a few of the basics and your options during this annual event.

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Wisconsin Physician License Renewal Now Open

By The Wisconsin Medical Society

Time to renew.

The Wisconsin Department of Safety and Professional Services (DSPS) will open physician license renewal on Friday, September 12, 2025. To keep your license active, you must submit a completed renewal application with payment by 11:59 p.m. on October 31, 2025.

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2025 Volume 2

Does DSPS Know Your Current Address & Email? If Not, You May Be at Risk of Penalty.

By Shawna Bertalot, CIC, ACI, WisMed Assure President

Email electronic communication graphic inbox on computer screen working on the internet. Email marketing and newsletter concept.

Moving is a hassle, including changing your mailing and email addresses, making sure you have notified all family, colleagues, friends, billing payees, and your professional licensing board. It is your responsibility under Wisconsin Law, and you may be penalized if you don’t do so in a timely manner.

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Medicare Resources and Support

By Alisa Allen, RHU, REBC, Medicare Benefits Insurance Advisor

Senior black couple, documents and laptop for planning, budget and taxes with talk for future in home. Old man, woman and reading pc screen for insurance, retirement or finance goals with paperwork

The federal Medicare program is complex and can be confusing when you start reviewing your options at retirement or when you become Medicare-eligible. You may also be assisting your parents, grandparents, or friends with this important decision and searching for information.

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Social Security for Physicians

When should I take social security? Retirement and finance planning question, handwriting on napkin with tea.

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Social Security is a vital part of retirement income for most Americans, including physicians. But navigating Social Security retirement can be confusing. Making an informed decision requires an understanding of benefits, claiming strategies, spousal, and survivor benefits.

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Business Owner’s Insurance for Health Care Clinics

water damage in a clinic

By Jensen Peck, Business and Professional Insurance Executive

Business owner’s insurance policy (BOP) is a cornerstone of risk management for health care clinics. Unlike professional liability (malpractice insurance), which addresses claims against medical services rendered, a BOP addresses business risks such as general liability, commercial property, and business interruption. A BOP covers all these risks by bundling these coverages into one compact insurance policy.

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Adapting Employee Benefits to Support Your Staff

Company employee benefits manual, with cover opening to reveal tabbed contents.

By Chris Noffke, REBC, CSFS, GBDS, Vice President of Employee Benefits

When I first entered the world of insurance nearly 20 years ago, the employee benefits landscape in Wisconsin was very different from what it is today. Back then, the conversation centered almost exclusively around traditional health plan’s networks. Employers were primarily concerned with keeping costs manageable, while providing a basic level of coverage that checked the necessary boxes.

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Hybrid Policies Shine in Addressing Long-term Care Concerns

By Tom Strangstalien, Executive Director Individual Insurance Planning

image of extended family and long-term care team

It’s not a secret that the rapidly increasing cost of long-term care is driving dramatic increases in long-term care (LTC) insurance premiums. You may also have been victim or witness to a dramatic increase in long-term care insurance premiums on a policy purchased years ago.

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Hidden Tax Benefits of Long-term Care Planning

By Tom Strangstalien, Insurance Advisor

We’re well into the tax season, filing our returns for 2024 and planning for the 2025 tax year, and this is a perfect time to explore the hidden tax advantages offered by diligent long-term care planning.

Some things to consider:

  • Did you know tax-qualified long-term care policies are tax deductible?
  • Do you have funds accumulated in your Health Savings Account that you’re not sure what to do with?
  • Did you know that you can pay premiums for a tax-qualified long-term care insurance policy with your HSA funds?
  • Did you know that any benefits paid out by a qualified long-term care insurance policy are not taxable as income?
  • Are you looking for more tax deductions?

Tax-qualified long-term care insurance premiums can be combined with other medical expenses and be deductible for those who itemize their returns. The sum of medical expenses must exceed 7.5% of one’s adjustable gross income to be deductible. If this is not the case, the premiums alone can be deductible. There are limits on the amount of the premiums that are deductible, based on a taxpayer’s age and adjustable gross income. For this tax year (2024), anyone over the age of 70 can deduct up to $5,880 on their federal tax return. A taxpayer can deduct premiums as medical expenses OR deduct the premiums alone – not both.

To be considered qualified, these policies must adhere to the guidelines established by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This means they must provide coverage for medically necessary care for individuals who are chronically ill and unable to perform at least two activities of daily living such as bathing, dressing, or eating, or who require supervision due to cognitive impairments.

2024 Qualified Long-Term Care Insurance Premium Deduction Limits 

Long-term care insurance premiums can also be deducted on your state tax return. Each state varies with the qualifications and limits that are deductible, so you should consult a financial advisor or tax professional in your state.

If you have accumulated funds in your health savings account, purchasing long-term care protection can be a smart place to use these funds. Not only are you purchasing long-term care insurance with “pre-tax” dollars, any benefits received by the policy will be tax free! It is important to know that if HSA funds are used to pay premiums, these premiums are not eligible to be deductible on your federal or state tax return as mentioned above.

Benefits received by a qualified long-term care policy are not taxable as income. This can also be the case with the increasingly popular “hybrid life insurance policies” that contain long-term care insurance benefits. These hybrid policies can be viewed as a win-win-win and there are many plans available. These policies offer a life insurance amount that is income tax free upon death, an accelerated long-term care benefit where benefits are not taxed as income (subject to the IRS 2025 per diem daily benefit of $420), and a cash value component where cash value amounts of the contract accumulate on a tax deferred basis.

I’m a big fan of the hybrid life insurance policies that offer long-term care benefits. In many cases where I have assisted in long-term care insurance planning, we have utilized an “indexed universal life” policy. Let’s consider the purchase of a $1,000,000 contract. One of three things can happen. If the policy is used for long- term care expenses, most of the policy amount can be used to pay the expenses tax free. When the policyholder passes away, the designated beneficiary will receive the unused portion of the $1,000,000 on an income tax free basis. Lastly, you can choose to access the cash value of the contract if needed in the form of a withdrawal or loan (tax treatment will vary based on many factors). The return on the funds in the cash value account is contingent on the performance of selected stock market indexes. A better alternative to self-funding long-term care? In many cases a resounding yes!

There are numerous tools and options available for long-term care planning. If you want to explore your personal long-term care plan to determine your best course of action, do not hesitate to reach out to the WisMed Assure team at insurance@wismedassure.org, or call 608.442.3810. 

Picture of Tom Strangstalien

Tom Strangstalien

Executive Director Individual Insurance Planning

Reach out to me to learn more. You can contact me at tom.strangstalien@wismedassure.org or 608.442.3730.

Send me an email!
Picture of Tom Strangstalien

Tom Strangstalien

Executive Director Individual Insurance Planning

Reach out to me to learn more. You can contact me at tom.strangstalien@wismedassure.org or 608.442.3730.

Send me an email!

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisionsFull disclaimer and contact information.

2025 Volume 1

Working with WisMed Assure Helps Keep Medical Malpractice Rates Low in Wisconsin

By Shawna Bertalot, CIC, ACI, WisMed Assure President

Clipboard with documents about medical malpractice and gavel.

Some good news for Wisconsin Physicians, Certified Registered Nurse Anesthetists (CRNA), and the hospitals and clinics that employ them. At the last meeting of The Board of Governors of the Injured Patients and Families Compensation Fund (IPFCF) in December 2024, the Actuarial Committee made the recommendation to keep rates the same for the IPFCF’s Fiscal Year July 1, 2025 to July 1, 2026. 

Read more…


Last-Minute Money Moves for 2024 Taxes

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Road sign that reads 'Smart Money next exit'

As the April 15 tax deadline approaches, physicians still have opportunities to adjust and improve their 2024 tax returns.

Contribute to a Health Savings Account If you have a high-deductible health plan (HDHP), you may be eligible to contribute to a Health Savings Account (HSA). For 2024, the contribution limits are $4,150 for individuals and $8,300 for families. Contributions can be made until the tax filing deadline.

Read more…


Hidden Tax Benefits of Long-term Care Planning

Documents on table for the premise of calculating the amount needed for retirement and Long Term Health Care.

By Tom Strangstalien, Insurance Advisor

We’re well into the tax season, filing our returns for 2024 and planning for the 2025 tax year, and this is a perfect time to explore the hidden tax advantages offered by diligent long-term care planning.

Read more…


Tenants Improvements and Betterments, Is Your Clinic Properly Insured?

Clinic renovation

By Laura Weber, Senior Large Account Director

If you rent space for your office, clinic, or even just for storage, it’s important to understand per the lease terms which party (lessee versus lessor) is responsible for covering property at the location. The agreement with the building owner should specify:  if a property damage occurs at the rented location, who is responsible for securing insurance to cover walls, flooring, permanent fixtures, including any updates you may have made to the property whether fixed or removable.

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WisMed Assure Implements Employee Navigator to Enhance Benefits Administration

Person presents employee benefits options on a digital interface.

By Martin Hurst, Insurance Service Representative

WisMed Assure is taking a significant step in modernizing benefits administration for our employee benefits clients by implementing Employee Navigator (a leading benefits management platform designed to streamline enrollment, improve efficiency, and enhance overall experience for both employers and employees). This cloud-based platform serves as a central hub for benefits management, integrating with insurance carriers, payroll systems, and HR software to create a seamless and efficient process.

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Good Samaritan Law

By Jensen Peck, Business and Professional Insurance Executive

person helping jogger in distress

Good Samaritan Laws in Wisconsin are vital for protecting physicians who provide emergency care outside of a clinical setting. These laws encourage medical professionals to offer immediate assistance in emergencies without the fear of legal recourse, allowing medical professionals to extend their care beyond hospitals and clinics. However, it is important to be aware of when the law protects you and when it may not apply.

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Don’t Wait for Disability Protection: A True Story

By Tom Strangstalien, Insurance Advisor

When you’re in your twenties and thirties, you can feel invincible. Despite the extraordinary odds of a disability, you might think, “why not wait until later in my career when my income increases?” After all, disability insurance can be expensive and impact your budget. Avoid the mistake of taking your health for granted – as resident and fellow physicians, you witness this every single day. To put it simply, life happens!

Did you know that you can get disability protection with an increasing benefit for as little as $25 to $50 per month? Put disability protection in place as early on in residency or fellowship as you can at as much as your budget allows. Also include a “future increase benefit” that allows you to increase your coverage as your income increases with no medical underwriting to protect your income throughout your entire career. Doing so protects you from the risk of financial ruin.

At WisMed Assure we are experts at designing these plans and work with physicians every single day to place this valuable protection for them. With permission, I’m sharing a story from one of our resident physicians verbatim.

“Hi Tom – this is quite a delay in my response, but I’ve unfortunately had some medical issues pop up in the past few months. I’m still very interested in disability insurance, but these medical things might have changed my situation, and I’ll let you be the judge. I’ll outline the events below. Please feel free to use my story as an example of why residents should do this as soon as possible during residency.

I woke up on a Sunday in mid-April with significant hearing loss in my right ear. I was diagnosed by an ENT provider with sudden-onset sensorineural hearing loss due to a viral infection. I took steroids for two weeks, and my hearing has returned to normal. From a long-term standpoint, there isn’t any increased risk of long-term hearing loss as a result of the condition, and I’m doing well!

As a part of the medical work-up, however, we obtained a brain MRI to ensure that an acoustic neuroma wasn’t causing my symptoms. Thankfully, that wasn’t seen. However, the MRI did find two incidental white matter lesions in my deep right parietal lobe. I don’t have any neurological symptoms and am feeling fine. I just saw a neuroimmunologist at Froedtert in late July, and thankfully, it isn’t likely to be anything clinically significant. These types of spots are typically associated with dementia in elderly patients, but they’re being found in younger patients (as MRI scans are being used more frequently in younger populations) and aren’t associated with any long-term issues. We will get a repeat MRI in one year to make sure it’s stable, and then I won’t require any additional monitoring.

So, QUITE a change in my health status. I’m feeling fine, and I’m not taking any medications at the moment. I also didn’t miss any time with these conditions. Otherwise, my answers to your initial list of questions haven’t changed. It wouldn’t take a genius to guess this would increase my monthly cost for disability insurance. Do you have any other insights or recommendations? Could you get some quotes again?”

Life truly does happen, and we don’t know what our future holds. I encourage all of you to obtain individual disability protection as soon as possible. Do not wait until it’s too late. My team and I are here to help and will passionately search for you and design a plan that is suitable for you. We exist for your benefit and it’s what we do.

For help with your insurance planning, contact Tom Strangstalien at 608.442.3730 or the WisMed Assure team at insurance@wismedassure.org, or call 608.442.3810.

Picture of Tom Strangstalien

Tom Strangstalien

Executive Director Individual Insurance Planning

Reach out to me to learn more. You can contact me at tom.strangstalien@wismedassure.org or 608.442.3730.

Send me an email!
Picture of Tom Strangstalien

Tom Strangstalien

Executive Director Individual Insurance Planning

Reach out to me to learn more. You can contact me at tom.strangstalien@wismedassure.org or 608.442.3730.

Send me an email!

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisionsFull disclaimer and contact information.

2024 Volume 4

Don’t Wait for Disability Protection: A True Story

By Tom Strangstalien, Insurance Advisor

MRI Brain Scan of head

When you’re in your twenties and thirties, you can feel invincible. Despite the extraordinary odds of a disability, you might think, “why not wait until later in my career when my income increases?” After all, disability insurance can be expensive and impact your budget. Avoid the mistake of taking your health for granted – as resident and fellow physicians, you witness this every single day. To put it simply, life happens!

Read more…


PAYE & ICR Plans Reopening for Student Loan Borrowers

Pay As You Earn Repayment PAYE Plan paperwork

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

The Pay As You Earn (PAYE) and Income Contingent Repayment (ICR) plans will reopen in mid-December under an Interim Final Rule. For borrowers forced into forbearance under the Saving on a Valuable Education (SAVE) repayment plan, should you switch plans? Let’s find out.

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Common Moonlighting Scenarios – What’s Covered by Your Malpractice Insurance?

Free Medical Clinic sign

By Jensen Peck, Business and Professional Insurance Executive

As the insurance agency for the Wisconsin Medical Society, we receive calls often from members and client physicians who are considering supplemental employment (side gigs) outside of their regular scope of practice. They are often told to “not to worry about” the liability because it’s either covered by the employer or “minimal exposure.” Fortunately, most physicians recognize this may not be true and it’s best to receive input from an insurance agency that specializes in health care liability. Let’s review a few of the more common scenarios and important questions that need to be answered to confirm potential malpractice exposures are covered.

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Dental Benefits with Medicare Advantage

Dentist or dental hygienist in operation with patient.

By Martin Hurst, Insurance Service Representative

Medicare provides essential health care coverage for individuals over 65, but it does not cover routine dental services such as cleanings, exams, fillings, or dentures. For those in need of dental care, there are a couple options to enhance your Medicare coverage. You can consider Medicare Advantage plans that include dental benefits or opt for a standalone dental insurance plan.

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Lifetime Term Life Insurance. Does It Exist?

By Tom Strangstalien, Insurance Advisor

Last month was life insurance awareness month, but we should be aware of the value of life insurance and the opportunities it offers all year round. A relatively new concept in life insurance is guaranteed no-lapse universal life. So, what exactly is this new form of life insurance, and does it potentially serve a purpose in your life?

Term insurance is the least expensive and most common form of life insurance. You choose a term period of one year (annual renewable term), ten years, twenty years, thirty years, or in rare instances even 40 years. If you pay your premiums on time, the coverage is guaranteed to be in place if needed. At the end of the term period, you are now older and while you can potentially renew the coverage for another term, because you are older, the cost will be substantially higher. Alternatively, you could pay the current premium for our attained age each year until it reaches the point where it simply isn’t affordable anymore. Lastly, depending on the product that you purchased, you may not have the option to renew the coverage, and the policy simply lapses, so the coverage goes away.

The major question with term insurance is, “What if I need the coverage after the end of the term period?” As outlined above, it can create a situation that is not ideal. Life happens and there are numerous scenarios where you might want life insurance coverage for a lifetime and not just a specified number of years. A no-lapse universal life insurance policy can address these concerns. With universal life insurance, you pay more into the policy than you would with term insurance. It has a cash value component where excess funds are deposited in the earlier years of the contract. Those funds then assist in paying premiums in later years when you are older and premiums are more expensive. You can “cash out” your account at anytime if the coverage is no longer needed. If funded properly, the premiums will not change, however it must be carefully reviewed each year if anticipated interest rates (or the performance of the cash account) do not perform to the expected standards. If it’s not earning sufficient interest, premiums and/or the amount of coverage may need to be adjusted, or the policy can be in jeopardy of lapsing in the future since it’s not properly funded. It simply can run out of money.

With guaranteed no-lapse universal life, you pay more at your attained age [EW1] than you would with term insurance. However, like traditional universal life, it does have a cash value account. Yet, as long as you pay the no-lapse premium, the coverage is guaranteed to be there for life! Unlike traditional universal life, the contract is never in jeopardy. The cash account may or may not perform as anticipated, however this has no bearing on the life insurance coverage. It will always be there! It’s essentially a pseudo lifetime term insurance program!

What will your future hold? How will your health be? Will you want to create a legacy, a charitable endeavor, or a scholarship fund? Will you want to create wealth for your future generations? As you consider term life insurance, what term limit will you choose? Or maybe you should explore coverage for your lifetime in the form of guaranteed no-lapse universal life.

The WisMed Assure team would be happy to provide you with quotes from several companies. Our allegiance is always to you, and as always thank you for all that you do!

For help with your insurance planning, contact Tom Strangstalien at 608.442.3730 or the WisMed Assure team at insurance@wismedassure.org, complete this quick online form or call 608.442.3810.


Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisionsFull disclaimer and contact information.

2024 Volume 3

Worker’s Compensation Rates Drop

By Brian Fowler, WisMed Assure Account Director

Workers compensation program word concepts banner. Protection employer legal right. Infographics with linear icons on dark green background.

Starting October 1, 2024, for the ninth consecutive year, Worker’s Compensation rates in Wisconsin will drop. Work Comp rates in Wisconsin are set by the state and are the same for every insurance carrier.

Read more…


Residual Disability Rider Provides Financial Protection

red umbrellas over a bag of cash

By Martin Hurst, Insurance Service Representative

The Residual Disability Rider is an essential addition to a physician’s disability insurance policy. It provides financial protection in the event of a disability that limits your ability to work at full capacity.

Read more…


Investing in Private Equity: A Pre-IPO Opportunity

Businessperson working on laptop with PRIVATE EQUITY inscription

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Private equity offers a unique opportunity to invest in promising companies before they go public. Unlike publicly traded stocks, which are bought and sold on stock exchanges, private equity investments are made in privately held companies.

Read more…


Open Enrollment

Open Enrollment concept. White lightbox on a gray office desk

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Now is a good time to start thinking about your open enrollment. Many companies fail to properly do an open enrollment, or maybe it’s your first time. We had our HR OnDemand professional create this checklist to help you make sure you don’t miss anything. 

Read more…


Lifetime Term Life Insurance. Does It Exist?

Question mark and life planning images

By Tom Strangstalien, Insurance Advisor

Last month was life insurance awareness month, but we should be aware of the value of life insurance and the opportunities it offers all year round. A relatively new concept in life insurance is guaranteed no-lapse universal life.

Read More…


New Rules Regarding Overtime Pay

Overtime law book and calculator in an office.

By Fine Point Consulting HR Professional

The Department of Labor announced a final overtime rule, Defining and Delimiting the Exemptions for Executive, Administrative, Professional, Outside Sales, and Computer Employees, on April 23, 2024. The rule revised the regulations issued under the Fair Labor Standards Act (FLSA) that implement the exemptions from minimum wage and overtime pay requirements.

Read More…


Artificial Intelligence (AI)-Generated Healthcare Content; Understanding the Limitations

By Kaelin O’Reilly, ProAssurance communications specialist

Artificial intelligence (AI), including chatbot tools like the popular ChatGPT, has made possible many useful applications in the healthcare sphere. ChatGPT’s ability to generate human-like responses to natural language inputs has made it an attractive tool for professional and student writers.1 The application can help develop quality and informative content in the form of articles, reports, blogs, tweets, and emails.2 This content may be produced in less time than traditional writing, and the burden of arduous research tasks can be reduced. In the fields of medicine and science, healthcare providers, researchers, and academics can access valuable medical education; supplement record documentation; and produce journal articles, clinical studies, and research papers with assistance from the tool.1

ChatGPT’s natural language processing model builds on older technologies of speech recognition, predictive text capability, and deep learning.3 It can function as a search engine, providing direct responses to user queries by applying specific criteria to locate appropriate resources. ChatGPT can aid in topic generation and provide translation for some medical and technical jargon. Because its algorithm is “trained” on a robust dataset of conversational text, the tool can address and generate practical written responses for a broad range of prompts, capturing many of the nuances and variations unique to human speech. It can also present language that is clear, easy to follow, often eloquent, and in the appropriate, specified structure.1

While AI tools like ChatGPT present significant advantages for writers, these applications are not without shortcomings. AI-generated content raises the following concerns4:

  • Authorship and Accountability
  • Inaccuracies and Errors
  • Biases and Prejudices
  • Lack of Regulations, and Privacy and Security
  • Dependence and Job Displacement

Moreover, developing and fine tuning the ChatGPT algorithm necessitates the collection and analysis of huge volumes of text data across the internet. Notably, these data collections have been relatively sporadic, with the last two collections covering information only up to September 2021, then up to April 2023 with its newer model. This may result in the information generated by ChatGPT being erroneous or out of date, or perpetuating an incomplete or distorted picture of the subject matter.1,5 Misinformation may be overlooked or unknown, and inadvertently passed on in published work.2 As AI implementations become even more commonplace, both readers and writers should be mindful to question the validity and reliability of content and familiarize themselves with the functional limitations of chatbots like ChatGPT.1

The Limitations and Concerns of ChatGPT-Generated Content

Authorship and Accountability

AI-generated content invites questions about authorship and accountability and, specifically, whether tools like ChatGPT should be applied in research and writing, including healthcare works. Credit for published material has traditionally been given to the individual contributors for their work in applying intelligence to idea generation, research and analysis, design, and execution. It is suggested that definitions of authorship may need to be revisited and specified, considering use of ChatGPT and other AI tools in the healthcare ecosystem is only growing. However, most journals will not allow designation of ChatGPT as an author, suggesting that although the tool does mimic human thought progression and language, create a logical and well-developed piece of writing in an appropriate format, it may not have the capability to produce information that is 100% reliable. As AI is non-human, it cannot be held responsible for its content in the same way as individuals with intention and legal obligations.1,4

Supporting the argument of accountability is an acknowledgment of the continued need for human intervention with use of these tools, despite their impressive capabilities. Specifically, processes like editing and applying reason and specialized expertise lie beyond the product’s scope of training but are nevertheless essential in writing It may be acceptable, however, and even beneficial for writers to include references to such AI tools along with the other resources they have used in the development of their work. Doing so might establish greater transparency while allowing the author to claim appropriate responsibility for the validity of their content. Further, such citations may bring awareness to the merits of AI resources like ChatGPT as supplemental assistants to the research and writing processes.1,4

While AI algorithms evolve with new and expanding data collections, opportunities for misuse and plagiarism emerge. In one study, plagiarism detection software and detection tools used to identify AI-generated content (“AI output detector”) were applied to 50 research abstracts that were generated solely by ChatGPT. The ChatGPT had created these abstracts following its review of excerpts from journals like JAMA and The New England Journal of Medicine. The plagiarism detection software found no plagiarism by ChatGPT, while the AI-output detector recognized only 66% of the abstracts as being AI-created. It is encouraging that ChatGPT was not found to have plagiarized the journal articles. However, as ChatGPT seemed to be able to pass through the AI-output detector checks with relative ease, it may be deduced that an individual reader would be unable to make the differentiation.1

Inaccuracies and Errors

Accuracy and reliability of text generated by AI models depend on the quality of data used in training the models. ChatGPT, like any AI model, may have errors or biases built into its core algorithm and, as a result, its output based on these inaccuracies will sometimes be incorrect.1 Language models are inherently intricate, complex, and potentially difficult to understand. A user may lack the foresight or knowledge necessary for gauging the correctness of an AI-generated answer or spotting specific errors, especially if the user is not aware how the tool arrived at these conclusions.4 There may be ambiguities in the user’s prompt or question (i.e., vague wording, meandering, or unfocused speech), resulting in an answer that is in turn, also ambiguous.1 In addition, using preset calculations to parse through data and elect the “best” answer in mere fractions of a second—even when there is no clear or easy answer available—can result in incomplete, skewed information. These types of outputs, known as AI “hallucinations,” are presented as factual but are really more of an improvised best guess generated by the chatbot, and have a high potential for inaccuracy.6

ChatGPT has a limited ability to apply deductive reasoning in its approach to answers, or to deconstruct and prioritize answers to layered questions. It can have trouble inferring underlying meanings or handling complex, “niche” topics. This weakness becomes even more challenging in detailed areas of science and medicine, which require subject matter expertise and an acute awareness and ability to analyze the constant changes and developments characteristic of these fields. Though ChatGPT is skilled in performing some language translation and adjustment to make medical conditions and treatment terminology more digestible for the average person, the tool may have a hard time interpreting or “understanding” certain medical phrases or jargon specific to a lesser-known subject or subspecialty.7

Biases and Prejudices

Data used in the development of AI algorithms may be limited to over- or under-represent certain groups, genders, ages, races, and cultures.8 A close examination will reveal that this overgeneralized and unbalanced data base fails to properly include certain populations. Therefore, the results from AI chatbots may be unreliable as applied to those groups. The potential biases and discriminatory attitudes that may be apparent in data collected across the web, and that inform the outputs generated by tools like AI chatbots, reflect not only society’s culture but also the potential culture of technological innovators of the AI-assisted product. A lack of diversity among these teams, as well as collective misconceptions or prejudices can become “embedded” in product development, meaning that product may exclude sizable groups of the population. As well, an unintentional flaw in the product design or in the algorithm’s data input can also yield such biases. These biases perpetuate when AI presents flawed conclusions to users, who may rely upon and pass along that skewed information. Large, varied groups and underrepresented communities should be included in research studies, to effectively create more diverse training sets for new algorithms. Doing so will allow ChatGPT and similar tools to provide a more valuable application that generates more accurate, reliable, and inclusive results.9

Lack of Regulations; Privacy and Security

Training of algorithms for ChatGPT and other chatbot implements incorporates access to extensive datasets, which may potentially include health information, particularly if the AI tool is utilized across healthcare facilities through sharing of patient information. Of course, a concern with utilizing health information is the privacy and security of the details within that gathered data, which may be vulnerable to hackers and data breaches. When the underlying data for an AI algorithm contains health information of an actual person, utilizing only properly de-identified data that does not contain protected health information of any individual will avoid violations of HIPAA and breaches of privacy. With no universal guidelines in place to govern the use, efficacy, implementation, and auditing of newer AI tools like ChatGPT in the healthcare sector, legal and ethical debates circulate around the handling and quality of data, patient consent, and confidentiality. A lack of clarity about data models and algorithms plus inadequate training on the user functions of AI equipment invite warranted skepticism and present a need for greater transparency and education across healthcare organizations. It is suggested that collaboration among AI innovators, security experts, and policymakers, as well as healthcare clinicians and providers, is necessary for the development and implementation of rules, regulations, and guidelines to address these novel issues of transparency and security and provide a smoother integration of AI into clinical practices. Specifications in these guidelines could include restrictions on data usage and the sharing of information and impose quality control measures for de-identification, encryption, and anonymization. These specifications would help ensure privacy and security, while maintaining quality of patient care and compliance with existing national healthcare regulations.8,9

Dependence and Job Displacement

There does exist a concern for dependence and overreliance on AI-assisted tools, especially if their algorithm models are flawed, contain biases, or are simply outdated. Leaning too heavily on these tools can result in missed errors, and a complacency around fact checking and quality assurance for documentation and other important practical applications in healthcare. Regarding the production of healthcare and scientific-related written content, it holds that creativity, personal experience, and an individual voice contribute to quality and originality. The potential for overreliance on AI causes deep concern that these attributes may be lost using a tool like ChatGPT. Content generated through a chatbot should be reviewed and edited for factual merit, quality, grammar, consistency, and timeliness. While AI technology advances in functionality and versatility, researchers and writers may fear job loss or a reduction of employment opportunities. However, the elements common to valuable written pieces illustrate integral contributions that can only come from individual authors: demonstrated depth of knowledge, critical and applied thinking, anecdotes and specific deductive reasoning, and a personal connection to the audience. These are human attributes that cannot be fully replicated or recreated by any technology. ChatGPT and other chatbot tools currently work best alongside humans, serving as resources and tools, making the processes of writing and research smoother and more manageable.4,8

References

1. Tirth Dave, Sai Anirudh Athaluri, Satyam Singh, “ChatGPT in Medicine: An Overview of Its Applications, Advantages, Limitations, Future Prospects, and Ethical Considerations,” Frontiers in Artificial Intelligence 6 (May 4, 2023), https://www.frontiersin.org/articles/10.3389/frai.2023.1169595/full.

2. Jodie Cook, “6 Giveaway Signs of ChatGPT-Generated Content,” Forbes, Dec. 6, 2023, https://www.forbes.com/sites/jodiecook/2023/12/06/6-giveaway-signs-of-chatgpt-generated-content/?sh=10b8c9181e7d.

3. “The Benefits of AI in Healthcare,” IBM Education, July 11, 2023, https://www.ibm.com/blog/the-benefits-of-ai-in-healthcare/.

4. Alexander S Doyal et al., “ChatGPT and Artificial Intelligence in Medical Writing: Concerns and Ethical Considerations,” Cureus Journal of Medical Science 15(8) (August 10, 2023), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492634/#:~:text=Some%20suggested%20uses%20of%20ChatGPT,in%20the%20writing%20of%20medical.

5. Aaron Mok, “ChatGPT Is Getting an Upgrade That Will Make It More Up to Date,” Business Insider, Nov. 6, 2023, https://www.businessinsider.com/open-ai-chatgpt-training-up-to-date-gpt4-turbo-2023-11#:~:text=ChatGPT%20users%20will%20soon%20have,at%20its%20first%20developer%20day.

6. Sindhu Sundar and Aaron Mok, “How Do AI Chatbots Like ChatGPT Work? Here’s a Quick Explainer,” Business Insider, Oct. 14, 2023, https://www.businessinsider.com/how-ai-chatbots-like-chatgpt-work-explainer-2023-7.

7. Bernard Marr, “The Top Limitations of ChatGPT,” Forbes, Mar 3, 2023, https://www.forbes.com/sites/bernardmarr/2023/03/03/the-top-10-limitations-of-chatgpt/?sh=5b49a2158f35.

8. Josh Nguyen and Christopher A. Pepping, “The Application of ChatGPT in Healthcare Progress Notes: A Commentary From a Clinical and Research Perspective,” Clinical and Translational Medicine 13(7) (July 2, 2023), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315641/.

9. Bangul Khan et al., “Drawbacks of Artificial Intelligence and Their Potential Solutions in the Healthcare Sector,” Biomedical Materials & Devices 1-8 (Feb. 8, 2023), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9908503/.

Originally posted in ProVisions, reposted with permission

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisionsFull disclaimer and contact information.

Med Mal 101 Refresher for All Physicians

By Shawna Bertalot, CIC, ACI, WisMed Assure President

The WisMed Assure team spends a lot of time the first half of the year doing Medical Student and Resident education on topics especially important to those who are completing their education and heading off to their first jobs. Part of that education is Medical Professional Liability (Med Mal) 101. While most physicians are now employed by large groups, hospitals or health systems that purchase their Med Mal insurance for them, there are a few key elements and responsibilities that every physician should know.

Med Mal insurance requirements vary by state. Wisconsin has strong tort reform laws* and requires all physicians and CRNAs who are licensed and practice in the state to carry insurance limits of $1M per medical incident and $3M aggregate per policy year. This insurance must be with an insurance carrier approved by the Wisconsin Office of Commissioner of Insurance to qualify for the unlimited excess coverage of the Injured Patients and Families Compensation Fund (IPFCF). Illinois by comparison has no requirement for physicians to carry insurance, no excess liability fund and no tort reform, thus insurance premiums and severity of claim awards are much higher than in Wisconsin.

It is important for you to know and track the type of Med Mal policy you have throughout your career. The two types are Claims-Made and Occurrence; the primary difference being whether the policy covers claims that are MADE during the policy year or claims where the alleged wrongful event OCCURRED during the policy year.

Graphic explaining Claims-Made and Occurrence Med Mal

The most important difference is that if you have a Claims-Made policy and you leave your employer or cancel the policy, all coverage ends unless an “Extended Reported Period,” commonly called “Tail” coverage, is purchased. If you are employed, you need to know if your policy is Claims-Made and who is responsible for purchasing a Tail per your contract. If your employer requires you to pay for the tail upon leaving, then it would be beneficial to check with your employer’s risk manager, insurance agent, or company to determine the cost. The IPFCF requires that a tail is purchased.

Understanding your responsibilities under the IPFCF is an important responsibility that rests with each individual physician. In January 2023, the IPFCF implemented a new policy and administration system that allows participants to review their status and pay online. Your employer may handle the primary insurance and payment of IFPCF fees; however, it is the responsibility of every resident and physician to know their status and maintain compliance with the IPFCF. Click here for more information.

We recommend all physicians keep their own file on their Med Mal coverage. This file should include a Certificate of Insurance for each year of coverage. This certificate will show your policy number, insurance carrier information, and limits of coverage. Generally, Medical Staffing and Credentialing offices can provide you with copies of your insurance information. You should also keep a file on any claims including dates and final resolution. This will allow for a much smoother credentialing and on-boarding experience.

Wisconsin is a great state to practice medicine, especially for physicians. As discussed above, the IPFCF and the state law that established it, Wis. Statute Chapter 655, create certain responsibilities to carry Med Mal insurance and pay annual IPFCF fees. That said, Statute 655 and the tort reform that the Wisconsin Medical Society advocates for and works hard every year to protect make Wisconsin one of the best judicial environments with the lowest Med Mal premium rates. Only eight states have some sort of excess patient compensation fund for Med Mal, and Wisconsin is the only state to provide unlimited coverage beyond the required $1M primary Med Mal insurance.

Please contact your WisMed Assure agent or shawna.bertalot@wismedasure.org with any questions.

*Thirty-three states have imposed caps on damages sustained in Med Mal lawsuits. The caps range from $250,000 per incident to as much as $2.25 million. In Wisconsin, non-economic damages are capped at $750,000.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.