Episode 328

In today's episode, John helps listeners to decide whether expert witness or medical legal consulting best aligns with your needs.

From decoding the nuances of medical documentation to navigating the uncharted waters of depositions and court testimony, John shares a roadmap for physicians eager to diversify their careers.

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The Role of Physicians in Translation and Interpretation

John sheds light on the pivotal role physicians play in translating and interpreting complex medical concepts. He highlights instances where clinicians, whether employed or in a consulting role, act as bridges between the clinical and administrative realms.

Examples include positions in clinical documentation integrity (CDI), quality improvement, utilization management,  and informatics, where physicians serve as interpreters for those without a clinical background.

Nonclinical Career Paths: Expert Witness Consulting and Medical-Legal Consulting

Delving into nonclinical career options, John explores two distinct avenues—expert witness consulting and medical-legal consulting. He elaborates on the differences between the two, discussing the responsibilities, compensation, and prerequisites for each.

Expert witness consulting, involving legal testimony, is contrasted with medical-legal consulting, a role centered on reviewing, summarizing, and advising on cases without the necessity for courtroom appearances or depositions.

Both freelance consulting businesses offer the benefit of producing hourly revenues that exceed those of typical clinical activities. Yet, they can be done remotely, and with no risk of the kind of lawsuits that practicing physicians must endure. 

Summary

For those considering expert witness consulting, John suggests Dr. Gretchen Green's comprehensive course and SEAK, an organization that offers resources and directories for physicians learning to be expert witnesses. Dr. Armin Feldman's offerings cater to those interested in medical-legal consulting. Both courses cover essential aspects, from legalities to business setup.

NOTE: Look below for a transcript of today's episode. 

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Transcription PNC Podcast Episode 328

Expert Witness or Medical Legal Consulting: Which Should You Pursue?

John: I am doing this on my phone. I think the clarity will be a little bit less than usual. I did a dry run earlier and it was kind of breaking up a little bit, but we'll do our best today. I just want to spend 10 or 15 minutes talking about a particular topic that interest to me, and it's something I've noticed. And then I will talk about the generalities and then work my way into two different nonclinical careers that one might consider to do either as a side gig or full-time, although only one of them can be done as a full-time job.

I'm in Scottsdale, Arizona. I normally am in the Chicago area where I live most of my time, but my wife and I bought a small house out here and it's been getting renovated and we're just kind of out here to check on things. And so, that's part of the issue. But let me get started.

One of the things I've noticed when physicians or other clinicians, anybody's looking for a new position, a new job, particularly in healthcare, even if they decide to do some consulting or even if they're employed, that the jobs that open up for physicians and other clinicians involves either translating or interpreting things.

Because what you do is you start with your one foot in the healthcare medical world and then you obtain some expertise in another area that benefits physicians, benefits healthcare organizations. And then as an employee or as a consultant, you can be the person who can educate and interpret the language and the concepts that maybe are foreign to one side or the other, just like the CEO of a hospital doesn't really understand what a physician goes through for their education, training background and all that. It doesn't really understand how nurses and physicians and therapists interact with patients and kind of bond that we have.

And this is why we get in trouble sometimes because we're trying to fit a square peg in a round hole because the CEO is thinking in terms of the bottom line and finances and making things as productive as possible, and the physicians, nurses, therapists and others are thinking about, "How can I make this patient better? How can I help this patient understand what's going on?"

That comes up a lot and I'll give you some just simple examples. These are jobs I've always talked about in the healthcare field, in hospitals. Let's say clinical documentation improvement. That is a position as a physician advisor or medical director where you are explaining to your colleague physicians the rules and regulations around using the ICD-10 or the DRG system or whatever it may be. It's not really intuitive, it doesn't correlate directly with what we do clinically. In the CDI world, there's different levels. Usually three levels on the inpatient side for heart failure, for pneumonia and so forth. But they're all based on trying to figure out the complexity and then paying a higher amount for the more complex.

But it doesn't directly correlate with what we've learned as physicians and nurses in terms of treating those patients. And so, the physician advisor or medical directors interpreting and translating the concepts from one group to another. That's a great place to be. And there's a lot of jobs and they pay very well when you can find yourself in that important position of making that translation and making that connection and helping others get what they need. And at the same time, capture the true medical information.

Well, the same thing is true in informatics. A medical informaticist is translating to his or her colleagues. Concepts that need to be understood in terms of using an EMR or even beyond that, tracking data. And then it kind of extends into quality improvement where we have to maybe explain the statistical factors that are used in analyzing billing data to measure quality.

And again, it's not an easy to understand topic, but a quality medical director would spend a lot of their time explaining the p-values we use when we're looking at those statistical differences. And the reason why we feel that these comparisons between patients, between groups of patients, groups of physicians and their quality is really truly statistically significant and at the same time is risk adjusted, which is the big issue a lot of times in accepting quality improvement data.

Again, these are all interpretations and translations between these groups of people and get them to buy in and understand then learn how to do it better. UM it's the same thing. We don't think in terms of utilization management or benefits management when we're trying to take care of our patients, but if we do understand it better, then we can actually be more effective.

But one area where this comes up, which we don't normally think of as specifically this issue, but it is, and that's in any kind of consulting. And the type of consulting I am going to talk about today is legal. Medical legal types of consulting. And when I think about that as a nonclinical job, I think of maybe two sides of the same coin. Probably the most common areas where attorneys and physicians interact. And that is on one hand being an expert witness consultant or starting on expert witness consulting business, and what many of us now call medical-legal consulting.

Those are two really different ways of interfacing with the legal system as a healthcare provider. There are some opportunities in both of those for let's say a nurse or a physical therapist, something like that. Probably more opportunities for physicians. That's what I'm going to be speaking about for the next five minutes or so.

Let's compare those two types of consulting. Expert witnesses. Most of us understand what that means. Basically, we will provide services to an attorney and usually picking one side or the other in this case because it's usually because of a lawsuit that has been filed. And in this case it's often a medical liability lawsuit. And so, as an expert witness, you can be on the side of the patient who's accusing the physician of doing something wrong or missing something or failing to document something or failing to communicate. There's a whole lot of reasons why you can get sued.

And other expert witness consultants are going to be on the acute side, the physician side, explaining why the physician really did follow the standard of care. And that sometimes things just don't go well because it's the nature of medicine. We all die, we all get sick, we all have injuries that hopefully we treat properly and within the scope of practice and within the standard of care.

Now, an expert witness, number one, it's a very highly compensated physician. Let's say that you're going to be an expert witness for a family physician. Let's say you're a family physician. Now many expert witnesses, of course, are board certified, fellowship trained even in specific subspecialties, but there are a lot of internists, ER docs, family physicians who do expert witness consulting because you just have to talk to the standard of care, which most of us know very well because we work in it every day.

But it's very good pay. So, we'll start with that. Let's say I'm on a three star scale. I would say its three stars. Really as a family physician or an internist, if you take all the hours you work doing your medical records and everything into account, you'd be lucky to make $100 to $150 an hour. Because usually, let's say you're making $200,000 to $300,000 a year. If you're working 60 or 70 hours a week, that doesn't come up to that much. As an expert witness, you are going to be charging 2, 3, 4 times that amount on an hourly basis, and you get paid for every minute you spend doing that work unlike in clinical practice, which is why the numbers don't look so good.

That's one good thing about being an expert witness. However, most expert witnesses have to be in practice, active practice because they start to lose their credibility if they start to do that full-time. You can definitely cut back on your hours in clinical. And what I often talk about is spending, let's say you could easily drop 20 hours of clinical practice to do 10 hours of expert witness care or expert witness consulting and make equal to or more than you would've clinically. So, it is very well paid, and the more experience you get and the more time you've done it, then the better the pay gets and you can charge higher levels.

As an expert witness, you're doing three things. Basically you are reviewing charts and writing reports about your opinion. And then you might be attending a deposition and you might end up testifying in court. Now, most attorneys don't like to... Well, it's not that they don't like to go to court, but they prefer to have a settlement if they can. I think the patients prefer that. Oftentimes the physician prefers that or whoever else is being sued.

When you're involved as an expert witness, you're doing mostly chart review and report, and then you're doing a smaller percentage of depositions and then some go quite a while before they ever have to testify in court. But eventually it will probably happen if you do it long term. You obviously need to be licensed because you need to be in practice and you probably need to be board certified to do that.

Now, there's a different type of expert consulting called medical-legal consulting, specifically as a terms coined by Dr. Armin Feldman, who to some extent has actually created this specialty. And what's nice about medical-legal consulting is it still pays very well, probably double what you would make an hourly basis as a physician.

But it does not require testimony in court. It does not require even doing a deposition. And you're not acting as an expert witness. What you're doing is you're reviewing records here, organizing records, summarizing records, and then providing feedback to the attorney about whether the case should be pursued or not.

And these cases, which usually fall into this category are personal injury cases, workers' comp, automobile accidents, which is a type of personal injury. And so, you're putting what can sometimes be a very complex situation and in which an insurance company has refused payment or the insurance company of a business has refused payment. You've heard of these cases, you've probably been involved in these cases where one of your patients gets injured and it's sometimes hard to know for sure how much is organic, how much is secondary gain, are there ways to sort that out?

And so, Dr. Feldman came up with this pre-litigation medical-legal consulting where you as a physician will help to sort through that. And the thing about this is you don't necessarily have to be in active practice to do this. You just need to have a medical degree. It helps to be board certified in something. You don't necessarily have to maintain your maintenance of certification because when you're doing these reviews, you've narrowed your focus now down to injuries. And really you just need to know the basic physiology and the basic approach to evaluation and treatment. You can learn as you go and you can become an expert in this area with just a little bit of time and effort. And you're not worried about having this go to court. If one of these does go to court and you need a medical expert, then that will be an expert witness consult that will take care of them.

But as a physician, you can analyze, and again, some nurses do this as well looking at it from the nursing standpoint, but physicians are in a particularly good position to say that within a reasonable degree of medical certainty, either A, this is caused by the accident or isn't. B, what are some of the unrecognized illnesses?

And your main goal is to try to maximize the support and the payments to the patient. And if you look at it from that perspective, you're not trying to gain the system or take advantage of the insurance company or the employer. Usually workers' comp covers this obviously, but you're just trying to make sure that all those things that resulted from the accident, from whatever happened, are fairly compensated. And we've all seen patients who have what seemed to be a minor accident and then a year or two later they're still having problems.

They might have developed some long-term complication, what we used to call reflex sympathetic dystrophy, which is severely debilitating. And there have been many times where patients were not compensated and didn't receive the care they needed for something that was a delayed result of an injury like that. So, it's really an interesting area.

Again, it involves interpreting and advising and translating information and then putting things into a report. Both of these that I've talked about today are good ways to reduce your burnout, do something that you enjoy, apply all the medical knowledge that you have garnered over the years to a particular field. And in the case of expert witness, over time you can cut back your clinical time to 10 or 20 or less hours a week, do some expert witness consulting and make a better income than you would have burning both ends of the candle doing clinical work.

And in the medical-legal consulting, again, you could do that part-time, you could do it full-time and you can definitely make a lot of income without the stress of working in a high pressure corporate style environment.

Now I want to talk to you a little bit about some resources that we have available to us. And some of these I have promoted in the past. I'm not an affiliate for either of these experts I'm going to mention, but let me just tell you what I know here. If you're interested in becoming an expert witness, there are courses you can take to build the business standpoint how to do that legally and how to set up things as well as understanding how attorneys think, how they speak and being able to talk their language.

I've had Dr. Gretchen Green on my podcast two or three times, and she produces a very, very good expert witness course. I think it's completed over four or five weeks. It's rather intense. It has a lot of homework, it has a lot of supporting materials. Really she's been doing this now for three or four years and I've spoken with some of her graduates and they are definitely pleased with it. So, you can find that at theexpertresource.com/enroll if you want to learn specifically about that course. Because I think she has some other courses.

Now, there's also another resource for becoming an expert witness, which is SEAK. It's the same organization that puts on an annual nonclinical career meeting on a weekend in October. I think they're up to the 14th or 15th iteration of that. But one of the things they're also well known for is teaching physicians how to learn to be an expert witness. They have resources where you can get your name put in these directories that they then share with attorneys.

There's a lot out there about becoming an expert witness. And rather than struggle through it, you'd probably be best to take advantage of one of these resources. I think the SEAK resources mainly are on a CD or online, although I think they also have a live version of that. That's just something to think about as you can kind of morph your practice into half expert witness, half regular clinical practice.

Now on the other side, medical-legal consulting, Dr. Armin Feldman has his course. He does it in different ways. I actually took his course over a period of four or five weeks. There was a series of videos although he also sometimes does a live version of that. He also has a one year coaching program where he'll walk you through the entire process. I think it's a combination of videos and a lot of coaching from him to where you can have your practice set up.

This could be something for people that are in active practice, something where you're maybe semi-retired and there are definitely retired physicians who do this as well. As long as you stay current in this particular field, you can write wonderful reports, really help your attorneys to decide whether to move forward, whether to settle and you help get your attorney client's patients all the help they need for some long chronic result of an injury that occurred either through an auto accident or work related.

Dr. Feldman's website is mdbizcon.com. If you go there, there is a little intro where you'll learn more about it and they'll give you an opportunity to learn in a really quick fashion. Again, I took the course. I have, I don't know how many files that I've downloaded and went through multiple times. He walks you through, he shows you how to create letters to generate business. So you've got setting up the business, marketing, and so forth.

A lot of things Gretchen Green talks about in her course. It's pretty similar no matter what sort of side gig you're doing, you got usually involved in setting up an LLC and setting up your accounting and then doing marketing, creating all the fields, maybe setting up a website. And these are the kind of things that they both talk about in their respective courses.

The other thing that Armin has, which is really interesting, is he created a podcast which is designed for the attorneys themselves so that they understand how to work with a medical legal consultant and help them understand the lingo that we're using. And that podcast is called Physicians Helping Attorneys Helping People, although if you look up Physicians Helping Attorneys, you'll get to it. I think it's got at least 30 or 40 episodes now. It was just started about a year or so ago. I've listened to just about every episode. It's extremely interesting and very helpful and for no cost whatsoever you can really get an idea of what a medical-legal consultant does in this role.

I'm just looking at my notes here to see if I forgot anything. Nope, I think that's it. Remember that in a lot of your nonclinical jobs, you're going to end up being in the middle as a consultant who does interpretations and helps other people understand the other side of the equation of whatever it is you're talking about. And specifically the medical-legal has a lot of opportunities. And you might consider expert witness consulting or medical legal pre-litigation consulting.

All right, with that, I will close for today and I hope to see you next week.

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