Robert Donohoe, TMLT's CEO and President, describes how TMLT positions our policyholders for success with unique rewards, benefits, risk management support, and a commitment to physician wellness. Running time: 21:53

Also available on Apple podcasts.

‍

Transcript
‍

Tony Passalacqua:
Hello, and welcome to this edition of TMLT's podcast, TrendsMD. I'm your host, Tony Passalacqua, and today we are continuing our series, "New-to-Practice Physicians: What you need to know." We have a very special guest today, Robert Donohoe, the President and CEO of TMLT. Today's topic: "The TMLT Difference," specifically discussing what features and benefits make TMLT the first and best choice for professional medical liability coverage in Texas.

Bob Donahoe joined TMLT in January, 2012 as senior vice president and subsequently served as chief operating officer in July of 2014. TMLT's Board of Trustees appointed Bob as the president and CEO role he continues to this day. Welcome Bob and thank you for joining us today.
‍

Robert Donohoe:
Very pleased to be here.
‍

Tony Passalacqua:
So before we jump into discussing your thoughts on what makes the TMLT difference, can you tell us a little bit more about yourself?
‍

Robert Donohoe:
My professional background is all in insurance and reinsurance. I've spent the better part of the last 40 years in the insurance industry. The early part of my career was really much, very much, reinsurance oriented, which is really insurance for insurance companies.

So it's just a secondary level of insurance. But what really drew me to TMLT actually is to be in more of a mission-focused company rather than just trying to, trying to see how big a company you can grow or how much profitability you can have. TMLT is different. We're a mission-driven company, which, yeah, and that's really what gets me outta bed every morning is the opportunity to really fulfill our mission of protecting and serving physicians in Texas and allowing them to take care of their patients each and every day.
‍

Tony Passalacqua:
So, what makes TMLT the go-to carrier for medical liability insurance in Texas?
‍

Robert Donohoe:
I'd say, first of all, it's the mission-driven concept. I mean, it's we, we are here for physicians. We're built around that concept entirely. So I think just the basis of what TMLT stands for is the most important [00:02:00] aspect. But on top of that, and really reflecting on that, that's why we've become the largest carrier for professional liability insurance for physicians in the state of Texas. We now insure over 20,000 physicians in the state of Texas, which is a very dominant position, but it's really because of our service and our mission, in living out that mission to take care of doctors.

We were formed in 1979, in case anybody wants to look back in history, but it's really because there was a medical malpractice crisis that was taking place in the state of Texas where you really weren't able to find med mal insurance coverage for physicians at that time, so we were formed to address that gaping need for physician professional liability coverage.

As I mentioned earlier, we are very physician centric. That's the core. My entire board of directors are Texas physicians. And that's really important because that's sets the tone as to where we're gonna go and what we're going to do and [00:03:00] how dedicated we are to physician's needs.

Our board are leaders in their industry. They're leaders in their geographical area within Texas, and that's really important because that really sets our tone and allows us then again, to focus entirely on our mission. In addition, TMLT, technically, is not an insurance company, which sounds very odd. We're always viewed as an insurance company. We're really not. We are really set up under a very specific statute in Texas Code, and that's important because it allows us to be a little more flexible and, and really approach the business in a different way. Again, making sure that it's really addressing the needs of every Texas physician.

Our loyalties always will lie with our physicians. We're not owned by stockholders. We're not owned by private equity money. We are here specifically set up to address the needs of our physician insureds. So I think that's a huge differentiating factor because we're not listening to anybody else's voice. The voice I want to hear is, what does a physician need? That's the voice that we [00:04:00] respond to. Our board members bring a ton of experience and that same representation of what I'll call their constituents. It's, it's their partners out there in, in the physician space, and so they're really looking at the priorities that these physicians have, how we can address them, how we can lead to a better Texas medical marketplace.

I'm really proud of the role that TMLT has played over the years in tort reform. We started in 1979, but another big pivotal event was 2003 when we had a constitutional amendment passing tort reform for the state of Texas. That's really important, because it has dramatically improved the business environment for physicians because it really limits the non-economic damages available in the case of a claim or a lawsuit brought against a physician.

That's enormous because what it does is it really, uh, reduces the cost, reduces the premiums that a physician would have to pay, absent of that tort reform. And TMLT was really [00:05:00] one of the guiding forces that founded that legislation in conjunction with other constituents in the state, whether that be the Texas Medical Association or the organization, TAPA, Texas Alliance for Patient Access, which we were one of the founding members as well, which the sole purpose of that entity is to lobby on behalf of tort reform in the state of Texas. I can't underline it boldly enough as to how important tort reform is. Just from a financial perspective, I could estimate in general, physicians would likely pay three times the premium in the absence of tort reform. So tort reform is that important to the financial success of physicians and allows us to charge much lower rates over time.
‍

Tony Passalacqua:
Bob, can you offer our listeners an example or an anecdote of a recent challenge to tort reform and how TMLT was able to stop it?
‍

Robert Donohoe:
Yeah, absolutely. It, it actually, let me, let me answer it a little bit differently. Because every other year when, when the legislature does meet, there have been bills brought [00:06:00] forth to either eliminate the tort reform or eliminate the cap.

Or index the cap, meaning ratchet it up over time. And we have been vehemently against that. We don't think it's necessary simply because it's a non-economic cap. It does not address economic damages. Those are unlimited based upon what's actually needed. And I think what's really important is we're seeing more and more attacks on tort reform, year after year.

The reason being tort reform was really brought into play because there was a crisis, because lawsuits were going wild, and you're seeing enormous verdicts coming out. Tort reform was meant to really limit those damages to make it still palatable to be a physician. Otherwise, you had these enormous damages, which which were affecting physicians from an economic standpoint. We had to have a way to kind of control that and reign that in. And the unfortunate part is the legislature typically reacts to crises, not to things that are going [00:07:00] well. Now that we've had tort reform in place, every year we've had an indexing bill or something of that nature, trying to attack tort reform and weaken it, which weakens the position for physicians. This year, this most recent legislative session, there was another bill that was brought forth, actually by a Republican freshman representative, which was a, a little concerning from our end just in that, you know, there, there continues to be these attacks on tort reform, which in our eyes our, we we're not looking at it from a financial standpoint. We're looking at it on the impact it's gonna have on the physicians, and that's what worries us is I think it causes financial stress for physicians, which doesn't allow them simply to, to treat their patients, take care of their patients, distribute health care across the state of Texas. So, we're seeing these various gaps and various attacks on tort reform, which we think are troubling and problematic and so we'll continue to fight on our physicians' behalf to assure that tort reform stays in place now and into the future.
‍

Tony Passalacqua:
Right. Yeah. [00:08:00] That always makes me think about just insurance in general, where if you have more and more claims and it costs more, it's gonna end up costing more to ensure those people moving forward, you know, whoever's a policyholder.
‍

Robert Donohoe:
Exactly. Yep. It, it'll that, that follows them forever.
‍

Tony Passalacqua:
So, another way TMLT gives back to its policyholders is financially. Could you tell us a bit about Trust Rewards and our dividends?
‍

Robert Donohoe:
Certainly. Be happy to. We have the two different programs, and when I look at both of these programs, they kind of work together in many ways in our eyes. We've had great financial success over the years and we're proud of that. But we also realize it's because of our physician insured partners that we've insured over the years and, and we, we believe we've done a very good job of managing our expenses and managing the, the funds that they bestowed upon us. But as long as since we've been profitable, we, these are really two different programs that allow us to give back some of that success in a very tangible way to our insureds. The Trust Rewards [00:09:00] program is, is really a loyalty program. So, as physicians have been with us for a long time, what we do is we build up a, a kind of a, a, financial account on their behalf. Think of it in a way as almost like a 401k, although I don't like to use that term because it's not technically that. However, it's a fund that we set up on behalf of each physician so that it really, over time, a portion of their premiums, uh, we hold those and then we put those in that account.

And so in the event of death, disability, or retirement, and we always hope it's retirement, but certainly if, if some other unfortunate event happens, then we simply pay out the balance of that fund. Our board of trustees, every year, will dedicate a certain number of dollars. They'll vote upon it each year and put more dollars into the program.

Then we allocate it to all of our eligible policyholders in the state of Texas. So each year, a physician's balance will grow based upon how long they've been with TMLT and so forth. And, and so we will allocate those dollars and ultimately when they retire, [00:10:00] hopefully, or some other unfortunate event, they will get the entire balance paid out in one check immediately to them.

It's a way of, of allowing us to share some of our financial success with them in a very real way. And when you talk about real dollars, as of this year, we've now dedicated $265 million of potential payouts to this program. So it's not an insignificant amount. It's actually a very significant financial reward at the end of their career, which it's a way of us saying thank you for being such a loyal customer.

The other program we have is our dividend program. That's paid on an annual basis, and again, it's based upon our financial success. As we go through a year, our board will look back and say, yes, we've been profitable. Now we want to turn around and give back some of our profits.

In the last, I believe for the last seven or eight years straight, we've provided a 10% dividend. So what we'll do is credit it to their next year's premium as a reduction. So it's a true cost savings and, again, [00:11:00] it's a way of saying we've been profitable. We're not here to see how large a, how largely profitable we can be.

We instead look at that profitability and say, it's really because of really good work by our physicians. Taking good care of their patients and haven't had a lot of claim activity, it allows us to give some of that money back to them each year. And so we're very proud of these two programs together.

One goes directly back to the physicians in an account, and the other one is an annual reduction really of their future costs.
‍

Tony Passalacqua:
Bob, just looking at a report, in 2024 we projected that we had returned more than $389 million in dividends back to policyholders. And, then together with our Trust Rewards, we have shared $644 million with our policyholders.

Does that sound right to you?
‍

Robert Donohoe:
Yeah, I think that is about right, that we're, we're really proud of the fact that's, that we've been able to give so much back to our policyholders. And as a matter of fact, just as a side note, during COVID, we actually declared a second dividend, [00:12:00] which we paid in April of that year, right in the middle of that year.

And if you recall, that was right in really the most troubling time of COVID, and also troubling time for physicians because many of their practices were closed and they were in some really financial hardship. So our board stepped forth and said, let's declare an extra 10% dividend. So that year, actually we paid 20%.

That's included in that $644 million. But that's just to reflect on how we view our policyholders and how we view our financial success in a way to share that and make their life a little bit easier.
‍

Tony Passalacqua:
In the time of trial. Aren't there also premium discounts for new-to-physician practices?
‍

Robert Donohoe:
Yes. As a, as a matter of fact, there are physicians that are entering practice, either coming right out of residency programs, graduate training, military service, academics, what have you. If they're coming new into, into practice, we offer those physicians a 40% discount for the first year, and then that just rolls down a little bit down to [00:13:00] 20% for the second year. And again, it's just recognizing that you're starting in your career. Want to make it a little easier path to get started and get on your feet seeing patients as you go forward.
‍

Tony Passalacqua:
I think the newest benefit we offer our physicians is the Physician Wellness Program.
‍

Robert Donohoe:
I'm glad you brought that up, Tony. Just that's one that we're particularly proud of. For several years, we're trying to figure out, were there ways that we could help the physicians in Texas dealing with mental health crises.

We realized this actually goes a little bit outside of our traditional professional liability role as a, as an insurance carrier, but that's what part of what differentiates us as well. Because really for us it's, what can we do to help physicians? Most cases it's going to be with their professional liability insurance, but here was an opportunity to address it.

What we saw as a real intense need in the physician area right now, and we all know that mental health is a challenge throughout our country. But with physicians, it's actually much more intense [00:14:00] because of the intense role they play, what they see each day, and all of the challenges, the burnout challenges, the interpersonal relationships, it's seeing difficult patients. It's all of these things that really mount up. And physicians unfortunately bottle a lot of this up because they don't feel that it's appropriate for them to seek mental health care, which may seem odd. But most physicians will nod their heads and say, you know, that's right. There's a stigma around it, particularly for physicians. So what we did was we really went out searching for, is there a way that we can help in some manner. And we found a very good partner in Travis County Medical Society, one of our, our organized medicine partners who already had a program called the Safe Harbor Program.

And so we felt that it was a very well constructed program with the proper vetting of PhD-level counselors. And really the infrastructure was there. It was just on a smaller basis. We stepped forth and really partnered with them to offer this [00:15:00] across the state of Texas for all TMLT physicians. And really what that looks like is, any physician and their significant other are allowed to get four counseling sessions paid for by TMLT.

And the key is that all these visits are confidential - and that's essential. For instance, TMLT doesn't get any report telling us that somebody sought counseling or entered the program. All we know was we will pay for any visits and we only know that there were a number of visits that TMLT pays for, and that's it.

As long as they're TMLT policyholder, we're not asking any questions. We don't want to even know. What we want is, we want them to voluntarily and comfortably get confidential counseling. And that's the key for us. These sessions are available either in person if you're in Austin, because most of the PhD level counselors are located here in Austin.

But also you can do an online virtual counseling session, which has been really popular, and allows us then much more effectively [00:16:00] to give coverage and, and offer this service to any physician within the state of Texas regardless of where they reside. And just to underline this, visits are absolutely confidential. There is no diagnosis that's made. There's no insurance that gets billed and there's nothing that's reported to credentialing entities nor the Texas Medical Board. And that's really important. That's why we call it the Safe Harbor. It is entirely confidential.
‍

Tony Passalacqua:
So, I'm guessing there may be physicians wanting to take advantage of this program, but worried that participation could affect their insurance rates, insurability, or any claim that may occur. Can you address any of that?
‍

Robert Donohoe:
Absolutely. I think that's a very logical question, but I can confirm none of these things would be affected at all by participation in the Physician Wellness Program. Since a participant's information is is never, ever shared with TMLT, accessing the program won't affect the physician's rates, insurability, claim history, any of those things, because [00:17:00] we're not even aware that they're taking the counseling.

We're just pleased that people are utilizing the program.
‍

Tony Passalacqua:
Another thing I wanted to touch on is TMLT's risk management support. Can you share with us some of the risk management resources available to our policyholders?
‍

Robert Donohoe:
Oh, definitely. We're very, very proud of our risk management approach to business.

We think it ultimately helps physicians operate much more effectively and avoid a lot of risk over time. Let me touch on a couple of the high points. All the TMLT policyholders can contact our Risk Management Department during work hours or email for free confidential help. We're there to provide answers to any of their questions, provide resources and referrals, and, most importantly, give them some peace of mind. Our phone consults are available. You can email questions at any time. Another free risk management service that we provide are practice reviews. At a practice review, one of our Risk Management Representatives will identify and determine any risk exposures in your practice. So [00:18:00] things like documentation methods, office policy and procedures, medical record reviews, things of that nature. Once we do the practice review and it's complete, the representative then meets with you or your staff to discuss any of the findings and offer customized recommendations. I should also note that policyholders who complete and meet review recommendations may earn a 5% premium discount. And our practice reviews can be requested online or by calling TMLT's offices as well.

One other thing to note is that we do offer a 6% premium discount to any physician who completes two, two-hour continuing medical education courses in any given policy period. Then lastly, TMLT offers a variety of CME courses that help physicians meet licensing requirements and enhance patient care. And keep in mind, these are both offered online and in person as seminars to accommodate everyone's schedules.
‍

Tony Passalacqua:
Bob, I'd like to touch [00:19:00] on TMLT's relationship with different organizations such as the Texas Medical Association and organized medicine. How do we have relationships with those different groups?
‍

Robert Donohoe:
Yeah, absolutely, they're very important relationships, and I would say they're really important especially for a new-to-practice physician who's probably has a ton of questions as to how you, you've learned how to be a physician, now you've gotta learn how to be a physician, taking care of patients, and in this marketplace, and setting up a practice or joining a practice. So I think it's really important to find where those resources are.

We have had a long and storied relationship with the Texas Medical Association - TMA - in particular but also county medical societies and all of organized medicine. They've been partners of ours since our origin back in 1979, and I think, you know, we partner with them collaboratively on a lot of things.

We are the professional liability carrier of choice for the TMA physicians, but also TMA offers a ton of consultive services, [00:20:00] CME, access to different products in other areas, and advocacy, which is really important for physician causes. So, we see organized medicine as a partner of ours that are helping to take care of physicians and especially, like I said, especially new-to-practice physicians who likely have a a lot of questions and need resources in order to guide their career as they go forward.
‍

Tony Passalacqua:
We have a podcast episode from 2022 where we discuss the TMA and our continued efforts to defend tort reform. We also cover how the TMA works with county medical societies. You can find that podcast on our website.

Bob, is there anything else that you would like to say to new-to-practice physicians who may be listening? Either those who are already policyholders or those considering TMLT.
‍

Robert Donohoe:
I appreciate the, the opportunity. TMLT is an organization that's based entirely on commitment and experience. Our board, our leadership, and our staff are all dedicated to keeping the needs of our physician policyholders at the forefront of absolutely everything that we do.[00:21:00]

I know each of us at TMLT draws upon our own hopes for Texas health care to guide our day-to-day operations and the support that we offer to our policyholders. I welcome the opportunity to continue our working relationship with physicians or to find new innovations that serve our physician community so that you in turn may provide excellent care for your patients.

Just know TMLT is in your corner always.
‍

Tony Passalacqua:
Thank you, Bob, and thank you for your time today.
‍

Robert Donohoe:
Thank you, Tony.
‍

Tony Passalacqua:
As always, thank you to our listeners. Please feel free to contact us with any questions at 1-800-580-8658 or check out our resources by visiting us at www.tmlt.org.

‍

Additional episodes in this series:

• Episode 1: How to buy insurance
  ‍
• Episode 2: The claims process
  ‍
• Episode 3: Social media: Dos and don'ts