There’s a point in some careers when protection that once felt solid starts to feel thin. Nothing has gone wrong yet. No diagnosis. No accident. Just a quiet realization that the numbers no longer line up the way you assumed they would. That tension came up repeatedly in my recent conversation on The Income Protection Podcast, where I sat down with Tom Petersen, a senior partner at Petersen International Underwriters. We weren’t setting out to talk about physicians specifically. We were talking about athletes, entertainers, founders, and people whose income behaves in unconventional ways. But the further we went, the clearer it became that many physicians encounter the same moment — often without realizing it. Petersen works in the specialty disability market through Lloyd’s of London, an area designed for situations that don’t fit neatly inside traditional policy limits. As he described it, this world exists where income is high, contracts are complex, and standard assumptions quietly break down. Listening to him explain how those gaps form made me think about how often doctors assume that having a policy means having enough protection. He pointed to a threshold that surprises people. Not extreme wealth. Not celebrity income. A level where success accelerates, obligations harden, and the percentage of income actually protected begins to shrink. Above that point, coverage may still exist, but it stops scaling with real life. What changes how this lands is hearing him talk about speed. Petersen shared how an accident abruptly ended his own ability to work and how quickly income evaporated once production stopped. Within months, the business he had built was gone. It wasn’t a physician story, but it carried the same lesson: when income disappears, life doesn’t pause to give you time to adjust. Where protection quietly stops scaling Most physician disability insurance conversations focus on technical choices — own-occupation language, benefit periods, elimination periods, riders. Those decisions matter. But Petersen kept returning to proportion. As income rises, lifestyles and commitments tend to rise with it. Housing, practice expenses, staff, long-term planning — none of these flatten simply because income is interrupted. Yet many high earners discover too late that the share of income they’ve actually protected is smaller than they assumed. That’s where the conversation shifts from income replacement to asset protection. Petersen pushed back on the idea that insurance exists only to cover monthly bills. In his view, it also exists to prevent forced liquidation — selling assets, unwinding structures, or making irreversible decisions under pressure. This is where the discussion intersects directly with disability insurance for physicians. Many doctors have strong base coverage from traditional carriers. Fewer have stepped back to ask whether that coverage still reflects the complexity of their financial lives as income, responsibilities, and exposure evolve. Why specialty underwriting looks at risk differently Petersen’s firm typically layers coverage on top of existing policies rather than replacing them. The goal isn’t to redo what works, but to extend protection where standard participation limits end. What stood out was how differently risk is evaluated. Specialty policies are often written for shorter terms and revisited, rather than locked in for decades. That flexibility creates room for solutions when income structure, medical history, or occupational nuance makes traditional underwriting difficult. He was candid about exclusions as well — not as deal-breakers, but as tools. Excluding specific conditions can still leave meaningful protection for everything else that could derail a career. Listening to him explain this in real time reframes exclusions from rejection to engineering. The specialty market’s time horizon also matters. Petersen described underwriting that focuses on what’s likely to happen in the next year or two, not the next twenty. For physicians accustomed to long-duration planning, this perspective can feel unfamiliar — but it explains why some people can secure coverage now and reposition later. What you don’t fully get from a written summary is how calmly he describes these dynamics. There’s no alarmism. Just a steady explanation of how success can outpace assumptions. The most revealing moments in the episode come not from definitions, but from the way he walks through examples and pauses before answering questions that don’t have neat edges. The reason to listen to this episode of The Income Protection Podcast isn’t to memorize policy features. It’s to hear how someone who works at the edge of the market explains the moment when income protection stops feeling adequate — and why that realization usually arrives later than it should.