Physicians

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

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’re 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.

Physicians serving in medical director or other supervisory roles in medispas, EMS services, nursing homes, and other new health care ventures have become common in recent years. While these positions can offer professional growth and financial reward, they also can present new and unprecedented risks. As a medical director, you are responsible for the overall medical practices within the facility, even if you are not directly performing the procedures. While the staff—typically non-physicians such as estheticians, nurses, and nurse practitioners—administers treatments, the medical director is accountable for ensuring that all procedures are performed according to the highest medical standards. If a patient suffers harm from a procedure such as a Botox injection requiring revision or an adverse reaction to treatment or medication, the medical director can be named in a lawsuit, regardless of whether they administered the procedure or were even on site at the time.

Another scenario is physicians who volunteer for Federally Qualified Healthcare Centers (FQHC) and free clinics. FQHCs are typically nonprofit organizations that provide primary care services to underserved populations, often funded by federal grants. Physicians who practice part-time at an FQHC are often covered for malpractice insurance through the Federal Tort Claims Act (FTCA). If a malpractice claim is filed, the FQHC will typically provide legal defense under the FTCA, meaning the FQHC will arrange and pay for legal representation in case of a lawsuit. If a claim results in a settlement or judgment, the FTCA ensures that the U.S. government will cover the financial responsibility up to the applicable limits. A free clinic is a community-based health care facility that provides medical services at either low or no cost to individuals who are uninsured, underinsured, or otherwise unable to pay for care. Physicians who volunteer at free clinics are not given coverage from the FTCA. Regardless of compensation, physicians are required to get traditional malpractice insurance to cover their work done at these clinics – whether it’s part-time or full-time. So, it’s very important to be aware if the clinic is a FQHC or not. A free clinic isn’t always an FQHC.  

There are many other questions you should ask yourself, your employer, and your malpractice insurance experts at WisMed Assure that are unique to your scenario. It’s important to have a clear understanding of your role and a written description of your responsibilities. These duties will likely fall in the category of either administrative or direct patient care. You must confirm if your or your employer’s insurance policies will cover all of your responsibilities. We urge you to reach out to us! Contact the WisMed Assure team at insurance@wismedassure.org or call 608.442.3810. We are here to serve the health care professionals who serve our communities. We will explore the application of Good Samaritan laws in a future issue of the Antidote.

Please note: Wisconsin Medical Society members have access to our legal assistance hotline for additional discussion about these topics.

Picture of Jensen Peck

Jensen Peck

Business and Professional Insurance Executive

Reach out to me to learn more. You can contact me at jensen.peck@wismedassure.org or 608.442.3731.

Send me an email!
Picture of Jensen Peck

Jensen Peck

Business and Professional Insurance Executive

Reach out to me to learn more. You can contact me at jensen.peck@wismedassure.org or 608.442.3731.

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 decisions. Full disclaimer and contact information.

Dental Benefits with Medicare Advantage

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.

While Medicare Advantage plans can be beneficial, they aren’t the best choice for everyone. These plans often face criticism due to having limited provider networks, higher out-of-pocket costs, and a lack of transparency. These issues can restrict access to care and may provide fewer benefits than expected. It’s important to note that enrolling in a Medicare Advantage plan typically means losing your Medicare supplement plan.

When considering dental plans, we recommend assessing your individual needs and determining the total cost, (including premiums, deductibles, and potential copayments) as well as any waiting periods for certain procedures. Waiting periods for major dental procedures, like crowns or dentures, may apply, and it’s essential to understand these requirements when choosing a plan. For example, treatments like wisdom teeth removal may have waiting periods before coverage kicks in. For individuals with Medicare Supplement plans (Medigap), dental coverage can be added, or separate dental insurance can be purchased. However, it’s important to check whether your preferred dentists are included in a Medicare Advantage plan’s network, because some plans may limit which provider you can visit. As your dental needs increase, it’s vital to carefully consider all available options to ensure both immediate and long-term coverage.

I recently worked with a client who had been enrolled in a Medicare Supplement plan for several years. His dental needs had changed, and he needed his wisdom teeth removed in the near future, which is considered major dental surgery not typically covered by basic dental plans. After reviewing a variety of dental coverage options based on his specific needs, we found several plans that provided coverage for surgical extractions, each with different waiting periods and premiums. One plan had a 12-month waiting period before covering such procedures, while another had no waiting period, but came with a higher premium. By carefully weighing his options, we helped him find a plan that balanced cost with timely coverage, ensuring he was prepared for his dental needs.

To learn more about Medicare and dental insurance options, please contact Martin Hurst at martin.hurst@wismedassure.org or call 608.442.3728.

 

Picture of Martin Hurst

Martin Hurst

Insurance Service Representative

Reach out to me to learn more. You can contact me at martin.hurst@wismedassure.org or 608.442.3728.

Send me an email!
Picture of Martin Hurst

Martin Hurst

Insurance Service Representative

Reach out to me to learn more. You can contact me at martin.hurst@wismedassure.org or 608.442.3728.

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 decisions. Full disclaimer and contact information.

PAYE & ICR Plans Reopening for Student Loan Borrowers

By Mark Ziety, CFP®, AIF®, Financial 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.

Focusing on SAVE vs. PAYE only

ICR is typically only used by parent borrowers with Parent Plus loans or consolidated Parent Plus loans. Income Based Repayment (IBR) is also available for borrowers, but the payment amount and treatment of interest are equal to or substandard to PAYE and SAVE plans. Therefore, this article will focus on SAVE vs. PAYE.

Problems with SAVE

As of this writing, borrowers in the SAVE plan have been placed in forbearance with no interest, no payment, and no progress toward loan forgiveness. It’s anticipated this forbearance will last well into 2025.

Making progress toward loan forgiveness

There are two options currently.

  • Switch from SAVE to a different payment plan, like PAYE, with required payments and progress toward loan forgiveness.
  • Anticipate using the PSLF Buyback program later to complete the 120 payments needed for forgiveness (assuming this program can be used to buyback months for the current forbearance.)

Comparing SAVE vs PAYE

  • Payment: Monthly payment under SAVE is typically lower than PAYE. The exception is at high income levels. The PAYE payment rises with higher income, but it is capped at the 10-year standard payment. The SAVE payment rises with higher income uncapped.
  • Interest: For those with relatively low income compared to their debt, the SAVE plan is often better than PAYE. The SAVE plan prevents interest from accruing when the monthly payment does not cover the interest. In contrast, unpaid interest accrues under the PAYE plan until it accumulates to 10% of the loan amount.
  • Length of Repayment: Loan forgiveness for borrowers that don’t qualify for Public Service Loan Forgiveness (PSLF) takes 20 years under PAYE. Under SAVE, forgiveness takes 20 years for undergrad loans, 25 years for graduate loans, or 10 years if the original amount borrowed was $12,000 or less.

Should you switch?

Everyone needs to run their own calculation to see what makes sense for their situation. Many borrowers will benefit by sticking with the SAVE plan if they are working for a government or 501(c)3 non-profit organization, assuming the PSLF Buyback program can be used to gain credit for the current forbearance later. For those with high income and/or their employer doesn’t qualify them for PSLF, switching to PAYE might be worthwhile.

For personalized help eliminating debt, investing smart and securing retirement, please contact Mark Ziety, CFP®, AIF® 608.442.3750.

Mark Ziety, CFP®, AIF®

WisMed Financial, Inc. part of the Wisconsin Medical Society

Picture of Mark Ziety, CFP®, AIF®

Mark Ziety, CFP®, AIF®

Executive Director of WisMed Financial
Certified Financial Planner™ Professional

Reach out to me to learn more. You can contact me at mark.ziety@wismedfinancial.org or 608.442.3750.

Book an appointment with me!
Picture of Mark Ziety, CFP®, AIF®

Mark Ziety, CFP®, AIF®

Executive Director of WisMed Financial
Certified Financial Planner™ Professional

Reach out to me to learn more. You can contact me at mark.ziety@wismedfinancial.org or 608.442.3750.

Book an appointment with me!

Note: This article is for informational purposes only and should not be considered as financial or tax advice. Please consult with a qualified financial advisor or tax professional before making any financial decisions. Full disclosures.

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

Insurance Advisor

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

Insurance Advisor

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 decisions. Full 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.

Read more…

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.

Read more…

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.

Read more…

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 decisions. Full disclaimer and contact information.

Residual Disability Rider Provides Financial Protection

By Martin Hurst, Insurance Service Representative

Martin Hurst

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. Unlike standard policies that only pay out when the policyholder is completely unable to work, this rider ensures partial benefits if a physician can still perform some duties but earns less due to reduced hours, fewer patients, or other limitations. By covering the income gap during partial disability, it offers crucial financial stability and flexibility throughout a physician’s career, even during recovery periods.

I worked with a physician who injured his wrist while playing tennis. Although he could still see patients for office visits, his ability to perform procedures – which was critical to his practice – was significantly impacted. Thankfully, he had chosen a Residual Disability Rider as part of his disability insurance policy. This rider provided partial benefits, helping to offset the income lost due to his reduced capacity to work. With this coverage, he was able to stay financially stable, cover his expenses, and focus on his recovery.

For physicians, whose income often depends heavily on their ability to perform specific tasks or maintain a certain patient load, the Residual Disability Rider provides a critical safety net. It offers peace of mind, ensuring that a partial loss of ability won’t lead to a total loss of income and helps maintain financial stability during challenging times.

To learn more about your disability insurance options, please contact Martin Hurst at martin.hurst@wismedassure.org or call 608.442.3728.

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.

Worker’s Compensation rates drop

By Brian Fowler, WisMed Assure Account Director

On October 1, 2024, for the ninth consecutive year, Worker’s Compensation (Work Comp) rates in Wisconsin dropped. Overall, there will be a decrease of 10.5% across all employee classifications. Physician rates remain low and competitive. Rates have decreased for physicians within hospital systems and hospital employees other than professional employees.

WisMed Assure also works with dentists and non-physician owned medical professional offices, like chiropractors, therapists, etc.; many of which share this same classification (8832) (see the chart below).  

The following chart shows the current and new rates for the listed class codes (rates are per $100 of payroll):

CodeDescriptionCurrent RatesNew Rates 10/1/2024Change
8832Physician & Clerical0.280.25-11%
8833Hospital Professional Employees0.760.70– 8%
9040Hospital All Other Than Professional3.613.22– 11%

This year there is a very small change to minimum premiums for experience rating. There is an increase of $2,548 in annual remuneration to calculate premiums for sole proprietors and partners and a $3,796 increase in the maximum annual remuneration used for executive officers.

Another difference in how Worker’s Compensation is governed in Wisconsin is there is not a set fee schedule for medical services provided. The Wisconsin Medical Society has long advocated to keep Wisconsin from adopting a Work Comp fee schedule.

Mark Grapentine, Wisconsin Medical Society Chief Policy and Advocacy Officer and a medical liaison to the Worker’s Compensation Advisory Council, told Wisconsin Health News that the current system gets workers back on the job faster and more satisfied with their health care than in other states.

“The news of yet another significant decrease in rates is good news across the board,” he said.

He called the state’s current worker’s compensation system a “national model” that provides injured workers easy access to high quality care. Though he noted that Wisconsin can do better when it comes to its workplace injury rate, and getting that below the national average would be a win-win for everyone.

If you have questions about Worker’s Compensation coverage rates and dividend programs for your practice, please contact Brian Fowler, WisMed Assure Account Director, at brian.fowler@wismedassure.org 608.442.3718.

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.

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

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