S2 EP7: Planning for the unexpected

Transcript

Ioannidou: [00:00:00] Some big life changes are planned and others seem to come out of nowhere. Hi, I'm Dr. Effie Ioannidou.

Wright: [00:00:07] And I'm Dr. Arnell Wright, and this is Dental Sound Bites. Today we are gonna be talking about parental leave, disability and death, and what you can do to prepare for whatever life brings.

Announcer: [00:00:20] From the American Dental Association, this is Dental Sound Bites. Created four dentists by dentists. Ready. Let's dive right into real talk on dentistry's daily wins and sticky situations.

Ioannidou: [00:00:36] There is a Benjamin Franklin quote that says, “By failing to prepare, you are preparing to fail.” But let me tell you, life can throw some curveballs that you may feel like you cannot prepare for.

Wright: [00:00:48] That's so true. There's some life scenarios that no one's ready for when they happen. We all make it work, but having the right information can really make a big difference.

So today we are so excited to have an expert, ADA's, senior Associate General Counsel, Cathryn Albrecht.

Albrecht: [00:01:05] Thanks for having me. I'm happy to be here.

Ioannidou: [00:01:07] Welcome, welcome.

Wright: [00:01:08] Before we start, we do want to take a moment to congratulate our very own Dr. Effie on some amazing news. Dr. Effie, why don't you share your big news with us?

Ioannidou: [00:01:18] Oh, thanks, ArNell. Yeah, so I was just appointed as the editor-in-chief of the journal. Of periodontology and clinical advances in Periodontology, the two journals of the American Academy of Periodontology, and the same time in a few months, I will be moving to U C S F. You see Cathy, on target with the major life changes.

Right. That, that, I mean, that's right. Three months ago, I wouldn't even suggest that would happen.

Wright: [00:01:43] So excited for you, like you’re hot stuff. I'm, I'm so glad to know you.

Ioannidou: [00:01:48] Thank you. I'm super excited and emails are pouring and people are so nice, so kind. Really, really warm community we have.

Wright: [00:01:57] Well, whenever we see each other in person, I'm gonna make sure that I get a selfie and do my little groupie shot and Oh, definitely get my signatures and all of that.

For sure. You're a big deal. Well, why don't we go ahead and jump in for today. Hi Cathy. Can you tell us a little bit about yourself? Tell us what area you specialize in.

Albrecht: [00:02:13] Happy to. I've been practicing law for 32 years, the last 25 in the area of employment, law, litigation, and counseling. I went to work in private practice for the first 18 years of my practice and I've been at the ADA for 14 years.

I do many things at the ADA, but for these purposes, I support the HR function and rather frequently speak on topics related to employment law, and respond to questions from our states and speak with dental students about employment contracts. I'd love to talk, so I'm glad to be here.

Ioannidou: [00:02:49] Welcome. Welcome.

So let's start talking a little bit about parental leave. ArNell and I are both parents and I'm sure we had both to navigate parental leave with school and dental career. Mm-hmm. I have two daughters. The oldest one was born in 2004. You know, it feels like. It's only 18 years ago, but it really feels as, in terms of shifting culture like a century ago, right?

I remember being pregnant and then I literally worked until the last day. I think I, I worked on Friday and I was in labor for 48 hours Saturday, Sunday, and I finally deliver early morning hours, Monday, and it was natural birth, so it was six weeks of parental leave and I extended this with some vacation, whatever, I maybe up to eight.

And then I went back to work because I could not, not go to work. I was in early stages. Junior faculty, you know, tenure clock is ticking. There was no, if you will, at the time again, only 18 years ago, right? There were not developed policies in academia about, stopping the clock to allow you time to recover.

So it was like a boom, boom, boom type of thing. Now, in a personal level, you may ask me would I like to stay more? Probably not. I would like not to stay morning, and I would like to go back to the adult environment, but I. Certainly didn't have the choice.

Wright: [00:04:14] Mm. Oh my gosh. We have pretty much like opposite situations or, but similar but opposite.

So for one, I have two boys, right. I had my first, my senior year in dental school. So, that was not planned. And so I pretty much, luckily I was, preparing for requirements and things like that, I guess in a very organized fashion. And so it worked out that I was very organized with all of my requirements.

I had 'em in January, so this is like right before we were about to, to walk. Mm. And I had finished all of my clinical requirements, but I had to come back to do some presentations and papers and just really small things. But I carried all throughout senior year and I took boards and it, it was a very hard situation.

Now my second, That's when I had to plan for leaving work. and I stayed out for 12 weeks. But I will say thankfully, like my husband had been working for a long time, he's a nurse in the trauma I C U unit, and that really helped me out. And then COVID hit, so I had situations that kind of like it, it was like not the best timing, but then, yeah, with the things that happened in life, it actually turned out to kind of work okay for me.

But I don't think that that's gonna be everybody's scenario. So I would love to get super into this conversation with you, Cathy, because I'm sure you've seen it all. You've heard it all, you hear. All scenarios from all types of situations, right?

Albrecht: [00:05:39] That's right. And I'm also a mom myself. Yeah. My daughter is 21, going on 22.

Well, the time I'm at my second law firm, people knew I was trying to get pregnant. Eventually I became pregnant right at the time when I was up. For partnership. We had at the time great benefits and we were big enough to be subject to the job protection of the Family and Medical Leave Act. So from my standpoint, I could take a job protected 12 week leave provided I hadn't taken any other leave in the last year, which it turned out to be the case.

So I took 12 weeks off. It was mostly paid. Only because I was able to cobble together a sort of short-term disability, which I was entitled to for six weeks because I'd had a, a natural delivery. Often it's eight weeks. Then if you have to have a cesarean, at least under some policies, I think most policies, and then a mix of vacation, sick pay, and other PTO that I had available to me.

And in fact, I, I, I did become an a partner in the law firm while I was out. On leave, but I was responsible for the maintenance of dozens of active cases at the time. So I had to, you know, spend a lot of time preparing to go on leave.

Ioannidou: [00:06:51] Oh, that's amazing.

Wright: [00:06:52] Cathy, while we're on the topic, like what's one thing that all practicing dentists who are about to become new parents, what can they do to feel prepared at work before taking leave?

Albrecht: [00:07:03] There's a very simple answer to that, that has a couple of moving parts, and I think the simple answer is, plan,  plan, plan, plan. And if you need to map it out and write it down on a piece of paper, you know, I remember in terms of various funding sources for how I'm gonna be able to take off this long, but some tips. and I would say just as a basic starting point, there's a couple of things basically. Number one, know what it is that, you're entitled to in whatever area you practice in. Yeah, so that could be the practice policy. You look, you look in the prac, in the, you know, whatever the policies and procedures are in the practice.

Look those up, dust 'em off. Maybe even put 'em in a notebook while you're trying to remember things. And the other is what are your legal rights? And that again, it, it can be federal, it can be state, and it could be local. There's protections out there and it becomes a policy development issue, which tends to sort of multiply over time.

And, there are a number of states that provide for various reasons and localities even provide for some paid amount of leave for various circumstances or, or provide for different kind of leave or sort of job protected leave when there's not, say, 50 employees within a radius.

Wright: And what about staff?

Any other folks that work in the practice? They have the same rights, and in fact, as a practice owner, it's a little different because if you're a solo practice owner and you're not technically an employee of the company, like saying a partnership or in a solo practitioner, really you're, you're kind of just.

You're more the business owner than the, than the employee. And so there may be a difference between whether you're treated with these various rights as an employee or whether you're treated as a practice owner. Because as a practice owner, you may need to save money and spend money to have, temps come in and do your job for you.

So that's a whole nother different way of looking at it. But again, it comes down to planning and know what is available to you to start that process.

Ioannidou: [00:09:02] I think that this is a very good point that you're making so that know your rights. And I think this is, it's actually, it builds a mindset too.

Again, going back 18 years ago, I don't want to hide it, but I, I really felt at the time that, you know, oh my God, I have to. I have to make sure that I don't disturb the division. I have to take the minimum time, make sure under the radar a little bit to say that I'm pregnant.

Make sure that I got the clinic. So there was a lot of guilt. It, it was a difficult, difficult mindset. I think now, I mean, You know, I see you ArNelle, you did it in dental school, you did it after. I mean, I salute you. This is, this is the way to do it. I mean, this is the way that, I think that that's why I mentioned at the beginning that there is definitely a cultural shift.

I feel that for sure. Now, you know, you make a decision. It's a family decision and. That's how you roll and that's your right.

Albrecht: [00:09:57] It's interesting that you mention that Effie, because I completely agree. I felt that pressure leaving. I, I'm up for partner and it's like, Hey, see you guys in like three months.

I'll be, you know, and I'm responsible for a number of different things. the one thing though, to keep in mind with respect to the Family and Medical Leave Act for one thing, and maybe some of the state laws, they can't make you work. If you have a right to work, you don't need to be on email. In fact, at the ADA our staff members who are on F M L A, we turn off their email.

Now, we may call every now and then, but it is technically a violation of the policy to be asking someone to work while they’re on leave ‘cause that ain't really leave.

Ioannidou: [00:10:44] Mm, that's absolutely right.

Wright: [00:10:45] Right. Hope y'all heard that. Hope you heard it.

Albrecht: [00:10:49] So, a couple of other things, if I may, on this sort of checklist.

Yes. Please. On your plan. Let the practice owner know that you are pregnant. You know, at least, at the very least, them, because they're gonna be the person you are going to need to be planning with. you can't really make someone, you know, tell you they're pregnant, but it's gonna, you know, at some point.

They're gonna know. And, um, and it helps to have them involved in the process of planning in a way that works both for the, organization and for the, uh, the mom going out on leave or the, or the person, the dad, the adoptive parent. Talk to the practice owner. If you're entitled to the leave, let them know.

If you had a coworker who been through the process before you were talk to, them's good at the same place. They know the ropes. And, you know, create your own leave plan. You know who's gonna cover for you, and this you'll do in, in organi, you know, collaboration with whoever you need, what's gonna be paid, what will not be paid by some mechanism, how accessible are you gonna be?

I mean, in your mind. Know the way this is gonna happen, ‘cause guess what? You can't plan when that happens. Mm-hmm. I mean, I eventually did and when it became apparently popular for people to induce because my mom had been there and she'd quit her wage job for two weeks to come with my due date being in the middle, I'm like, I, how am I gonna?

I'm not sure I'm gonna have this baby before you leave. So planning is important. And finally, anticipates surprises such as early labor. So have someone at your organization or someone who has the ability to communicate it. If you start going into labor, At the practice, something happens early.

There's a, there's a, situation, a medical situation, where you need to go and get care now. Let someone know who's your OBGYN? Where are you going to deliver? What hospital are you gonna deliver at home? How are you gonna deliver? And let someone in the office know in case there's an emergency.

Ioannidou: [00:12:51] That's so funny you say, because my, my second one came five weeks earlier and, I deliver in the middle of the night. The next day I was supposed to be in the clinic. I didn't show up. Obviously. I didn't, I, I mean, clearly from the hospital room, I wouldn't. Call them to, I had already forgotten about the clinic, but funny stories that, cause I deliver in the same, you know, at the, at u Conn that we are in a, a dental school within the hospital, right.

So I deliver in the same hospital that day of delivery. People somehow found out I was receiving visitors colleagues and, and students and, and I looked horrific. It was so bad.

Wright: [00:13:29] Nobody cares about that. Nobody, they just wanna see the baby.

Ioannidou: [00:13:32] Nobody cares. Exactly. Nobody, nobody cares about that.

Wright: [00:13:36] Yeah. Oh my gosh. I can think of a scenario. I know I don't wanna belabor the point here, but I can think of a scenario when I was in transition between, one job and another, but then I was pregnant with my second and, I actually told the BO, you just jogged my memory, Cathy, when you said tell the practice owner.

I told him and he was totally okay with still bringing me aboard, but I just felt terrible, and, and maybe we'll cover this at some point in the episode, but I felt terrible starting a new job knowing that, you know, in like. Six months, I was gonna be out for three. and so I ended up not taking the position.

I stayed at my old job, Yes. I didn't take the position. No, I didn't. This is with my second, and I stayed at my old job for a little bit longer because I was like, oh, I rationalized. I said, well, I've been here for longer. I can do the FMLA. I'll have all of this, but. Again, you just don't know what you don't know.

Mm-hmm. This might be good to talk about.

Albrecht: [00:14:32] I would say this, in that situation, if that practice had 15 or more employees and they told you they weren't gonna hire you because you were pregnant, you would've had a law. They would've had a lawsuit on their hands.

Wright: [00:14:43] Oh no, he didn't say that.

Albrecht: [00:14:45] Cause that's illegal.

Ioannidou: [00:14:45] But to your point, People need to be alert of this,  I mean, yeah, yeah, yeah, yeah. A lot of people, a lot of women, a lot of families are unaware of the illegality of this statement.

Wright: [00:14:58] Yeah. No, he still said he would he, he would bring me on and it's funny because one of my girlfriends, he was like, oh my gosh, you're putting me to shame because I didn't say anything when I was pregnant and you were forthcoming about it.

And I was like, well, I kind of just feel like. They need to know that I'm gonna be out in a little bit, you know, so I, I don't know. I didn't know how to navigate that, but now thinking back, I probably would've done things differently.

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Wright: [00:15:54] What if something serious happens to you or a loved one? Let's talk about what you need to know about your disability rights. But first, Gina Goodreau from Protective helps us understand the difference between short-term and long-term disability.

Goodreau: [00:16:07] Hi, I'm Gina Goodreau. I'm with Protective. I'm a lawyer. I also work and have worked exclusively on the ADA members insurance plans, and today I'm going to talk to you about the difference between short-term and long-term disability insurance. So starting off with short-term disability, a good way to understand if you have a short-term disability insurance or if you think that you may need it versus long-term disability is identifying the waiting period and how long benefits pay.

And so with short-term, you would have a very short disability waiting period, usually five to seven days. So it, it acts a lot like extended sick leave. Where usually employees who have this coverage will use PTO, like pay time off to continue their salary during the waiting period, which is usually, like I said, five to seven days.

And this type of benefit is payable for usually 90 days to maybe six months. So it has a short waiting period, and it has a short benefit payment duration where long-term disability. Would have the opposite. You would have a much longer waiting period and it would pay benefits for a longer period. So the most common waiting period usually is 90 days.

But you can also find policies that would have 180 day wait benefits are almost always paid to retirement age, So 65 or 67, they will oftentimes have a cost of living adjustment to keep up with inflation while you are receiving benefits. You can also find policies that may pay even lifetime benefits.

Okay. And so how it works, just from a practical standpoint, if you have. A temporary disability, like an emergency appendectomy. You have surgery that is going to be picked up and paid under a short-term disability policy very quickly after a five or seven day waiting period, and it will pay through the length of that disability because it should be a six to eight week maximum recovery.

So that will easily fall under a 90 day to a 180 day payment period. Under a long-term disability policy. However, it wouldn't even be paid because you would never see it last longer than 90 days. It wouldn't even last two 90 days. So even though it's not specifically excluded under a long-term disability policy, It just would not meet that waiting period to where benefits would be payable.

Short-term disability insurance is almost always provided in the employment setting, and it's either a salary continuance where the employer just continues salary during an approved disability, or it's under an insurance policy long-term disability. That too can be provided by an employer, but especially for medical professions, dentists or even lawyers like myself, usually that would be more of an individual policy, something that the professional would purchase on their own.

Ioannidou: [00:19:06] That's really important. So Cathy, what are the first things that dentists need to know about your disability rights?

Albrecht: [00:19:13] You know, in many ways it's very similar to what you would do in any situation. First of all, What, are there any practice policies that apply to this situation? In other words, does the practice have short-term disability?

The policy may either have, you have to pay for it with PTO, or it's paid otherwise under some policy. So check the policy. And then the question is in terms of what short, or long-term insurance policies apply. Now, if you're someone who buys the policy for themselves, then you wanna look at that contract that says what you're entitled to and when, if, in the case of long-term disability, but again, In this situation, it's probably not long-term disability.

So what do the policies provide and, and in including that, do they pay your full pay rate or is it at some reduced rate? Because that can sometimes happen. So you gotta look at the policy. And then the other thing you really wanna know before you go on is what documentation. Both of those things would require before you're able to pursue that avenue.

In other words, do I need a certification from a medical provider saying that I suffer from a particular condition? You know, how does that need to be related and how does that need to be stated? And that will. Typically also be a function of the policy of the practice or the policy requirements themselves.

Wright: [00:20:37] Cathy, I have a question for you about the pay rate portion. So for doctors who are employee dentists like myself, sometimes they may not have like a set salary. So what if, if they're paid, is it just depending on the language of the contract and and that's how you determine what the pay rate would be?

Albrecht: [00:20:56] That's a really good question, and it will depend on what the policy requires. But there are a number of statutes and laws that will define that. Sometimes they do, sometimes they don't. Various employment laws. Figure that out differently. It's not uncommon and the policy will tell you. But as a general matter, what happens in those situations is there will be some mechanism or you can employ a reasonable standard.

Often it will be what is your average take home pay over some period of time, and then it will be calibrated that way. You know, worker's comp has the same kind of issue, hourly wage earners have the same kind of issues, so it will kind of depend on how exactly it is they're paid and what the typically state law will say on how you calculate that or what the policy says.

Wright: [00:21:44] Okay. I just kind of wanted to make that clear for our listeners, especially, you know, considering graduation as recently happened, you know, we have a lot of new graduates that are deciding, where they're gonna go and practice modality they'll work in. So that was really good. Just to kind of clarify for our listeners.

Albrecht: [00:22:00] Now the only other thing I'll add with respect to the issue of a disability that's specifically correlated with the pregnancy situation, typically that's more like a short-term disability situation. It's typically not a disability under the Americans With Disabilities Act, but the Pregnancy Discrimination Act, which is a federal law says that as in the case with the Americans with Disabilities Act, as in that case, you need to make accommodations for known disabilities. And what the Pregnancy Discrimination Act that that Federal Act says is that you need to treat these sort of short-term disabilities as potential disabilities related to pregnancy.

So sometimes that can mean if you have preeclampsia, if you have. post FMLA or post leave law issues that may be considered a disability, which would in entitle you to a reasonable accommodation under the Pregnancy Discrimination Act.

Ioannidou: [00:22:56] I wonder if the postpartum depression is considered.

Albrecht: [00:22:59] Yes. The Americans with Disabilities Act covers both physical and mental conditions and that that would most certainly as does aggravated morning sickness and those kinds of things. Yes, they are covered.

Wright: There you go.

Ioannidou: [00:23:11] And another important, sudden thing that can happen in life is death. Right? So you can lose someone very close to you. Yeah. Um, And, and sometimes, you know, the unexpected can happen and this person may be your business partner or your associate. So it's a really very complicated scenario. It has many layers of grief. It's the loss of person, but also the loss that might affect your business. So, What can we do if this happens?

If something like the, you know, one of the, it's a really bad case scenario, of a business partner or an associate passes away.

Albrecht: [00:23:46] Yeah. Clearly not something that most people anticipate. However, you almost really need to anticipate that if you have an agreement with an associate or with a business partner, because in either case, let's say the associate dies before receiving a final paycheck, that paycheck will go to the estate of that individual or either, either according to the statute or according to a will or a surviving family.

So a business partner is a little more tricky than the partnership agreement should between the parties generally will and absolutely should say what happens in that situation because the same situation applies. Let's say you have a partnership where you're 50-50 partners. What happens when your partnership and you share the profits and you share the expenses alike, what happens to that other person's partnership share?

It doesn't automatically go to you, it goes to the state of the person that has passed. So what typically happens in that situation is that the practice will, as an expense to the practice by what's called a key man policy or key person policy, I think you can Google now, but what it means is that if one person of a partnership or a very important person in a company dies, it will pay the organization whatever it costs to buy out the other person through their estates.

So in other words, The proceeds for that insurance policy will pay for you to buy out if you, if you, if that's what you wanna do, buy out the other person's portion of the practice without having to come up with money, very quickly. The other thing I will say about the situation and the death of a practice partner is that dental practices don't manufacture widgets, their bread and butter,  and they don't have rolling stock or cars and train cars, they have a patient base, they have a cash flow from that. You know, you may have a loan on a seric machine still, but there's not a lot in assets other than the goodwill of the practice.

So the primary asset of a dental practice is typically the patient base and the cash flow that comes from it.

Now, When someone dies, the last thing you wanna have happen is that, you know, nothing happens for a while and that just dwindles and goes away. The sort of spoiling or deterioration of that asset can happen very quickly, and it could happen very quickly even before the estate figures out what they wanna do.

So in the partnership agreement, there may also be provisions for, you know, in the event of sudden death of somebody, the other partner has the right to run the business on their own for some period of time and for some circumstances. But that's to preserve the value of the asset, which is the full worth of the organization.

Ioannidou: [00:26:48] Oh yeah. That's really important because otherwise, yeah, as you said, if the practice remains closed for a certain period of time, this can be really detrimental for the practice.

Albrecht: [00:26:58] Right. And if there's nothing in the agreement, the best thing to do is immediately negotiate with the family because they will appreciate the fact that you need to maintain the asset if you're gonna be buying it from them they want it to continue to maintain its values. So there may be issues under state law that will restrict who can prac, who can, in other words, can the spouse run the practice afterwards? Some states will provide that for a certain period of time. They can in this situation, but again, that may be something you don't wanna stumble on either,if you agree to do this, make sure you're allowed to.

Wright: Right, right.

Ioannidou: [00:27:34] I remember George Costanza on Seinfeld that was like travel to a funeral with his girlfriend and he really wanted to get from the airlines the low rate or because of a sudden, you know, death event. So in the funeral he was asking for a copy of the death certificate, which is, you know, I mean, it's really hilarious. I'm not a good actress, but it's really a hilarious moment.

Albrecht: [00:27:58] I, I'll go so far as to say that's generally not done.

Ioannidou: Yes.

Wright: [00:28:02] Well, thank goodness, right?  So, well, I have a question actually. So what is it, what's one thing that you wish, Cathy, all dentists did to prepare for big life events, like what we've been talking about so far?

Albrecht: [00:28:15] I hate to sound like a broken record, but you really need to plan. And you know, if you're like me and I keep notes on little Post-its laying around the place, write it down, put it in a place because you never know. You never know when something's gonna come up, and the more you're prepared, the more that does not become an additional anxiety to the already very stressful situation.

Announcer: [00:28:43] On the next Dental Sound Bites…

Ioannidou: [00:28:45] Where do you go for answers when you have a tough clinical question? We're getting an inside look at cutting edge testing, new recommendations and inventions from the ADA Science Research Institute that will change the way you practice.

Wright: [00:28:59] Plus we'll hear the answers to the questions dentists ask the ADA's science team most frequently and talk about how you, yes, you can join in on the work they're doing from the comfort of your own home.

Wright:  Well, this was a really, really good conversation, Cathy. You helped us out a lot and I'm pretty sure our listeners are gonna be very, very well-informed and they're going to try and plan early enough for just major life events.

Albrecht: [00:29:27] Well, thanks for having me, you guys. It was really fun and I'm glad you got something out of it.

Ioannidou: [00:29:31] Oh my God, we love that. It was so informative. Great conversations. Thank you so much Cathy.

Albrecht: [00:29:36] My pleasure.

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