Have Faith in Your New Life Insurance Medicine Career

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Transcription PNC Podcast Episode 389

Have Faith in Your New Life Insurance Medicine Career

- Interview with Dr. Megan Leivant

John: Over the years, I've had the occasion to meet physicians who work in the life insurance industry, not health insurance not doing UM, but actual life insurance. And I've been sort of very interested in that topic. Those that I have spoken with informally, not necessarily on the podcast have said they really like those jobs. I've been interested in finding someone who's doing life insurance medicine. And so that is today's guest. I'm very happy to have the opportunity to talk to her. Hello, and welcome to the podcast, Dr. Megan Leivant.

Dr. Megan Leivant: Thank you so much for having me.

John: I think this is going to be fun. I wanted to learn more about this for years. And it's not as common a full time or even part time position as let's say, someone working in health insurance. I don't know about disability. Anyway, tell us a little bit about yourself, your mainly your education and clinical background that will get into what you do professionally now.

Dr. Megan Leivant: Sure. Well, thank you so much for having me on the podcast today. I'm really excited to be able to talk about life insurance medicine. It all started for me. I went to DePaul University for my undergrad, and I majored in biology and did a minor in French and then went to IU School of Medicine, Indiana University School of Medicine, and followed that up with my residency in internal medicine at Northwestern in Chicago. And then actually practiced outpatient internal medicine for 10 years.

And I did that in a variety of settings. I started out in a traditional private practice, and then I moved to the VA, and I worked at the VA for about five years. And then I was in more of a hospital based community practice before I made my transition. And then I did have a lot of teaching appointments throughout that period of time as well. And that was something that was really important to me.

John: Very nice. Well, then the obvious question that comes up is when a physician transitions from clinical to nonclinical, what led to that decision?

Dr. Megan Leivant: I would say several years before I transitioned out of clinical practice I realized that I was having an increasingly difficult time coping with the demands of outpatient clinical practice, which I know that many people are feeling that way. And present day. And so I actually started working with a physician career coach, Dr. Heather Fork, through Doctors Crossing, just to see what I could do to help my situation. Because at that point, I wasn't sure if I wanted to leave clinical medicine. I just wanted to try to figure out could I could I do better? Were there changes that I could make to try to make the day to day a little bit more manageable?

And we worked together for a good while. And I ultimately realized that transitioning to a nonclinical career was the path that I needed and wanted to follow. So through coaching, I learned a lot about my interests and my dislikes. We did the Enneagram and talked about marketable skills and personality traits. And it was really just a great growth experience to learn all that stuff and then help leverage those findings to apply them to different nonclinical career options. So part of that process, I attended the SEEK nonclinical careers conference to help jumpstart my research and look into other career options and reached out to former colleagues to kind of explore what they've done in the nonclinical realm.

I made new contacts on LinkedIn. it was a very kind of vulnerable, exposed experience putting myself out there to try to just figure out what was next. And I even tried some telemedicine during that transition. I did a little utilization management just to see what else is out there. But I kept hearing about this life insurance medicine career. And the more I heard about it, the more I thought it would be a really good fit. And so that's ultimately how I got from point A to point B.

John: Well, what you described is really, it could be considered like a model in some ways. These are things we always talk about in the podcast. Okay, getting a coach, using a coach. Heather Fork's been a guest here at least three or four times, and I've been on her podcast several times as well. And so she's kind of an icon from the standpoint of coaching physicians. There's many out there now. But while you've hit on a lot of the points we've talked about Seek here before. Many of the people I've interviewed have actually been alumni from Seek as speakers. So you can add your name to that list now. I guess you've been a mentor there, I believe?

Dr. Megan Leivant: Heather. Yes, I was actually a mentor just this past October, and that was a great experience.

John: I guess I'll go off a little longer on Seek. It's only like 45 minutes from where I live. It's held near Chicago, and I live south of Chicago. I've driven up there and attended a couple of times to meet some of the mentors and the speakers. So that is good. I mean, I think that'll inspire some people to get off the dime because I get asked a lot about what about coaching. And in the old days, Heather and a couple others were like the only ones. I don't know when you started.

Dr. Megan Leivant: Yes, yes, there are a lot of physician coaches out there.

John: It's always something to say, oh to try if that's if you're kind of stuck. All right. You kind of looked at your skills and your interests and what's out there. And then the lifestyle, I think, is always part of that decision. So why don't you start by next telling us what are the duties of a medical director? That's the really the entry point for most if they're going to do life insurance medicine. What does that look like?

Dr. Megan Leivant: Exactly. Yeah. And it is a bit of a of a frame shift, but at the core, I like to think of the primary duties of a life insurance medical director as three pillars. Case consultations are definitely the biggest pillar. And I'll talk about that a little bit more. Teaching is certainly part of that.

And then research. At a very basic level, you're assessing the morbidity and mortality risk of insurance applicants. And so they can be applying for many different types of life insurance products, but really at the core it's mortality and morbidity. And as a physician, really, that responsibility lies in understanding disease processes, their associated risk factors, and how that's going to impact morbidity and mortality. So that's where that frame shift comes in a little bit. as physicians, we are thinking certainly more in the moment, treating what is in front of us.

I think that's probably one of the biggest pivots that has to happen. But there's a number of areas of risk selection. So there's that life mortality risk, there's disability, there's critical illness, and then there's long term care, which is more that morbidity component.

Really a day in the life, the bulk of it is those case consultations. So an underwriter will send over a consultation. And I almost liken that to presentations on rounds. They ideally are sending over, this is a 58 year old male with X, Y, and Z medical conditions. Here's my question. And so, as a medical director, you were there as a consultant to give your opinion. And you provide your opinion back to the underwriter. You're also fielding messages from them and calls and that kind of stuff. But that's, that's, I'd say the bulk of the day to day.

But then you're teaching the underwriters are there to learn from you as well. So that's what I really enjoy about this career is I still get to teach. And it's formal, it's informal you could be giving an external presentation to a room of underwriters, or you're just teaching over over the phone or through one of your consults.

I like that piece of it as well. And then research we're always needing to research these medical conditions that we're encountering. I feel like I've learned so much more in this career, I could probably go back and be a much better clinician. I think from my experiences, but you're doing projects, you're helping update the manual, the manual is what you use to help rate the impairments that the applicants have. That's at the core, I think what the primary duties look like for a medical director.

John: The scary part of that might be if I'm imagining that I'm thinking about taking a job like this, it's well, how I have an understanding of how different illnesses impact one another and why having hypertension might be a risk factor for something involving cardiac problems and so on and so forth. But I'm thinking that people might be like, but I don't know how to quantify that. Where does the quantification come in? Does that come from the underwriter or is that working together or is there a book that has numbers in it? There's some training involved on the job, right?

Dr. Megan Leivant: Oh, yes, absolutely. And I would say it probably takes a good six to 12 months just to really feel comfortable with that. So yes, to your point, when an applicant comes in and presents with, let's say diabetes or heart disease we all have 100% mortality that's a given, right? We all know that. But in the life insurance industry, we use what are called table ratings. And so they go up by 25 increments. 125%, 150%. And that corresponds to a person's mortality. So the higher that number gets the more medical impairments they have.

And every company uses a manual. And that manual includes those conditions like diabetes, heart disease, cancer and there's ratings that are associated with those disease processes. And that can vary. And it does vary per company. But that is where that risk is then assigned to the condition. And then as a medical director, where we come in is, well, what if you've got someone who's had diabetes and heart disease and prostate cancer? Is that a risk that we can consider that the company wants to consider? And from a medical standpoint, can we put all that together to determine if that applicant is suitable for a policy? Jennifer That's a great question.

John: Dr. Justin Marchegiani. But just like anything that you're doing, when you're going from clinical to non-clinical, there's obviously something you're doing in that new job that, well, it uses those skills and that background. It's different because it's a different industry. And I think that's what stops some people. And the thing is, all of these things have been figured out. whether you're going to health insurance or life insurance or pharma, these are not mysteries to the people that are on the other side. And usually they are well-prepared to train you. Now, there isn't really any certification that a physician would typically pursue or do other education before maybe applying for their first job as a medical director in the insurance industry.

Dr. Megan Leivant: That's correct. there are definitely a number of things a person can do to build their knowledge base. But there are a number of directors, myself included, where I walked into this industry very green. I'd had no experience in life insurance medicine, and I was trained on the job. And I've done a lot of those additional classes and certifications now as a director within the industry.

John: I want to hear more about what your career has done since you've been there. But why don't we go first into the obvious question? Maybe they've talked to people that have started doing this, they really love their job, their lifestyle is good. How would I start to look for those jobs and or prepare for the job?

Dr. Megan Leivant: Yeah, that's a great question. So I think there's a number of ways to start looking into this career. And I think there's not just one pathway, probably one of the most useful tools would be to consider joining AIM.

And through that organization, this is kind of like our governing body, if you will, of within insurance medicine. So it's a group of insurance medicine directors, but there are also underwriters and that are members as well. And when you become a member of AIM, you actually can get paired up with a mentor. And the mentor is usually a director who is already in the industry. And I have really found that that's been a great way for individuals who are interested in getting into the industry. they now have a point of contact.

And that really can be a great nurturing relationship to help jumpstart that interest within insurance medicine. But then I think it's a lot of the other things that individuals do to look for new jobs, right? Look for job postings on LinkedIn, get your LinkedIn profile spruced up, try to reach out to if you happen to know anybody that's in the life insurance industry, certainly that's always really, really helpful.

Let others know that you are looking for a new career or that you're interested in this. Connect with an industry recruiter. they are definitely out there. Depending on where you live most of our positions are remote. There are some that are hybrid, but research life insurance companies that are in your hometown that could always potentially provide an opportunity, whether it's a bigger name or a smaller name. And attending a meeting.

That's an absolutely wonderful way to get to network and meet other industry directors, industry professionals. And there's a number of those. So, AIM has its own meeting every fall. And then there are several others that also could provide really good opportunities to try to help kind of jumpstart that career.

John: That sounds logical. Yeah. And I, one thing that I ask about, because we, for some of the big industries, there are these things like LinkedIn groups and Facebook groups. Do are there any such entities that you're aware of for life insurance medicine?

Dr. Megan Leivant: AIM does have a presence on LinkedIn, and I would say that would be a great place to start. I am not aware of any specific life insurance medicine, Facebook groups or anything, but, but AIM again has so many great resources. And so, that's where we end up directing a lot of our individuals that are interested.

John: Okay. So, I'll be sure to put a link to AIM in the show notes.

Dr. Megan Leivant: Yes.

John: So, now let's talk more about you. A couple of things. Maybe you can tell us a little bit about what you like about it and, and, and then what you've done because you're, I think you're no longer an entry-level medical director. We'll just kind of talk about both of those issues.

Dr. Megan Leivant: Sure. I'd say what, what keeps me coming back every day is that this is a really mentally stimulating job. I've really enjoyed, and I continue to enjoy the, the challenge that comes from reviewing these cases that come through every day. This is why I went into internal medicine. I love to solve problems. So, it really gives me the chance to still continue to do that on a day-to-day basis.

There's a ton of variety. I'm seeing diseases that to this day, I still had never seen before. So, I'm still getting to use my medical, medical degree. I'm growing my knowledge base, and, and that was really important to me as I was considering the, the pivot. But it's also a small industry, so there's a lot of great networking opportunities. I've really been able to kind of expand a different part of my marketable skills, if you will.

I miss seeing patients, but I'm still able to create relationships. It's just done in a different way now. And so I'd say that those are probably the big things that kind of keep me coming back every day. It's critical thinking, it's teaching, it's teamwork and collaboration. So, I'm getting to still use a lot of those skills that I used when I was a practicing physician. Yeah, as far as my kind of course throughout my career so far, I've been in the industry over six years, and I started out at what's called a direct life insurance company.

So, a direct life insurance company would be the company where you apply for your life insurance policy. So, they directly, they do that underwriting, and I worked there as a medical director for just under two years, and I got that experience. And then I've, since then, have been working for reinsurance companies.

There are a lot more direct life insurance companies than there are reinsurance companies. So, reinsurance companies help to insure the direct insurance companies. That's probably a very high-level way to kind of describe it, but, but so our clients are the direct insurance companies.

We still, as a medical director, are doing very much the same thing on a day-to-day basis, whether you're at a reinsurance company or a direct insurance company. But in a reinsurance company, we're probably seeing cases that might be a little bit more medically complex. There are certainly some differences there. But at the core, like I said, this is ultimately, it's still the case consults, but there's more teaching, there's more research, and that's kind of helps keep it really interesting and a lot of variety.

John: I wonder I was a CMO for a hospital for a while, and our hospital insured itself from liability. We're talking a little different than life insurance. But they had a consortium, they were so, quote, self-insured. But they did have a reinsurance company, I think, on top of that. Like, there's things that happen that they can't really predict or plan for. So, it's kind of the same idea.

Dr. Megan Leivant: Exactly. if I had a whiteboard, I could draw a diagram the direct companies would be in the middle, and then the reinsurance would kind of be a bubble around it. So, here's an extra layer of protection. We might take on the full risk that a direct company doesn't want to take, or maybe we share that risk because it's a really high net worth case. There's just so many different permutations. But that is a great way to describe it.

John: All right. Now, let me ask you this. Do most of medical directors for a reinsurance company come from a direct insurance company, or are they just out there trying to grab anybody that comes along?

Dr. Megan Leivant: No, that is a really, really great question. I would say, on the majority, physicians that are within reinsurance companies usually are coming to those companies with some direct experience. Now, I'm going to say that's not an absolute, because I do know of some directors that started out in reinsurance. And you're going to get that on-the-job training, no matter where you are. But I would say, on the majority, that's probably the path that you normally see is a direct to a reinsurer.

John: Now, in other industries that are similar, in my mind, to this, they have this whole hierarchy of medical directors and senior medical directors and executive medical directors, and then they get into the VP level. And again, kind of mirrors even the hospital setting. medical director is still involved in the clinical stuff a lot.

The VP or the chief medical officer is really an executive position. So how does that work? The physicians, because I did know one VP of a life insurance company. I haven't talked to him in many years, but I didn't know exactly what he did as a VP, which was different from what he maybe had done prior in previous roles.

Dr. Megan Leivant: Yeah, that's a great question. I think it really, at least what I've seen, is that it really varies per company. I know a number of medical directors, whether they're in a direct company or a reinsurance company in that core role, they have a VP title associated with what they're doing. And I can't speak to the full industry as far as how many are VPs, but I think generally you're going to see that title or you will have that title as a medical director coming into a role, but it's very company specific.

The step up after that, though, is that, yes, depending on how big the company is, then some of them do have a chief medical director, and that's where you start to see some of that delineation as far as the administrative duties etc. Usually the chiefs are probably doing less casework and they're more involved with maybe research or product development or kind of higher level higher level concepts.

John: Yeah, that makes sense. And we see that in a lot of other industries where they just they just have a cascade of titles just to recognize the skill, the experience, and so forth. And then in some cases, it really means you're part of the senior executive team, which does a lot of the strategic planning and creating new service lines and things like that. So each industry, I think, has its own specific ways of doing things.

Dr. Megan Leivant: Definitely.

John: All right. Well, have I forgotten any important questions to ask you? I'm going to let you go in a minute. I definitely shed a lot of light. So any last comments or other things maybe that we've missed in this last 20 minutes or so?

Dr. Megan Leivant: Sure. Well, I think one thing you asked earlier was about prerequisites in a way of getting into the industry. And while there isn't anything that you need to specifically do to get into the industry, there are definitely once you are in, like, we actually, insurance medicine is a boarded specialty.

After you've been in the industry for several years, and there are definitely other courses you have to take and criteria you have to meet, but you can be boarded in insurance medicine. I'm actually working towards that myself. So I did want to kind of add that. And we do what's called a basic morbidity and mortality course that is part of that board preparation. So there are definitely all these opportunities to get that teaching that is needed as just part of the core function of our roles as medical directors.

John: Yeah, I would bet 99.9% of physicians coming out of the training would have no idea that there's such a thing as board certification in life insurance medicine.

Dr. Megan Leivant: Oh, sure. And it's both a written exam and an oral exam. So it's a process that can take up to a year really to kind of go through both of those.

John: And I saw that there's some certifications. Again, I'm assuming that those kind of things are sought after you're in the industry, but I noticed that there are certain things maybe you can explain a little bit about that.

Dr. Megan Leivant: Absolutely. There's a lot of, like I said, a lot of different initials, you can get after your name, a lot of certifications. And these are the courses that the underwriters take. There's LOMA courses, which is Life Office Management Association. And then there's ALU, which is the Association of Life Underwriting. And there are a myriad of different courses within each of those groups.

And those you take those and they're great courses. They really help teach you about the life insurance industry, especially the LOMA courses. Those are definitely more geared towards life insurance, just basic knowledge financial underwriting, risk management all of that. So yes, you can take a number of those courses and then ultimately get different designations depending on what combination of those courses you've taken.

John: Very good. Appreciate that. Yeah, I don't know. I'm a little too old to apply for a life insurance medicine job, but it sounds like the course might just be interesting.

Dr. Megan Leivant: Maybe not. And it depends on the company not everybody needs to be boarded. I think that's very company specific. There are definitely companies that might lay that down as an expectation. But I know there are directors out there that might do this part time and that's not an ask for them. So it's not I think there's definitely a spectrum.

John: Okay. Well, that's really good to know. Maybe they could create a career where they're doing half clinical and half something like this whether it's in this industry or even UM, whatever, that sometimes can be very positive from a lifestyle standpoint.

Dr. Megan Leivant: Sure. And I know of directors that are still doing that very thing. I do know of some that are still practicing clinical medicine, and then they do their life insurance job as well.

John: Excellent. Well, you did mention earlier, this whole thing about networking, tracking down your colleagues and former co-residents and so forth. But one of the things that I'm sure that our listeners might want to do is reach out to you. Hopefully that would be okay to do on LinkedIn. At least you can control that somewhat.

Dr. Megan Leivant: Yes, I'm happy to certainly connect with anybody that would like to do that through LinkedIn.

John: Okay. I'll put your LinkedIn, a link to your LinkedIn profile in the show notes as well, although if they just input your name, they're going to find you. So, all right, Megan, I think we've learned a lot today. I know I have, and I've appreciated this. I really encourage people who are listening to consider this because again, it's a small number, but the people I've talked to, some of them, they just love their jobs, you know? And so there's just something about applying your medical knowledge in this way that just so lines up so well with a lot of our intellectual stimulation, what we love and challenges. And so, I really appreciate you for describing all this and sharing this with us today.

Dr. Megan Leivant: Thank you so much for having me. Yes. Medical directors in this industry are very happy.

John: Nice. All right, Megan, you take care.

Dr. Megan Leivant: Thanks, John. Appreciate it. Bye.

John: Bye-bye.

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