Exploit Your Medical Knowledge In New Ways

Podcast Editing & Production Services are provided by Oscar Hamilton

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 392

Exploit Your Medical Knowledge In New Ways

- Interview with Dr. Robert Cooper - Part 2

John: Well, let's go back to another one then. I think that's one that you've been doing for the most amount of time and have spent the most cumulative hours on, and that's the disability file reviews. So how did you find that? Did someone point you to it? Were you just searching around the internet? I mean, how did you find that? What should we do if we're interested in it? Because I have looked into this a little bit myself. And I'll just say, as a family physician, they're usually looking for a specialist. I mean, there's a lot for neuro and physiatrists and that, but I know they're out there for primary care at times when they just need the general. So any tips on that? What's it like? How long does it take? We'll kind of do that first, and then we'll move on to the next one.

Dr. Robert Cooper: Sure. The first gig, I think, was through the New England Journal of Medicine. Like I said, I answered that in the New England Journal of Medicine. Small company, I went out and learned how to do it, and they trained you to some degree—not terrific. And I started doing it. I like it because it's almost like taking raw materials, right? Looking through a file like a detective and trying to figure out what's going on. What you're trying to do is determine the level of impairment of a claimant—we call them claimants. There's terminology involved, but you have to know what you're doing when you're going through this. It's a method for actually sorting out the file, figuring out where it is, where the pieces are, how to put it together, and the different components.

I have not found really good training in this, honestly speaking. I took a course in it, but it didn't help me—I had done it before. So I think really providing nuts and bolts is important. I worked for three companies, but there is another way to find it. I'm not gonna mention the specific companies, but I will say that NAIRO—N-A-I-R-O, the National Association of Independent Review Organizations—has companies on there. Now, here's the important thing. Here's the important point for viewers: don't be undersold, okay? A lot of these companies are paying rates that are ridiculous.

What's happened in the disability world, unfortunately, is that they're moving a lot of stuff in-house to do full-time physicians come on board, and they're taking it away from some of that. I found that that's happened over the last five years. I told you before, I worked 10 hours a week for a major insurance company as an independent contractor. So I was doing that in addition to the other vendor companies. It was just a lot of work—10 hours a weekend. But I learned a lot from doing it. Then they stopped that and moved it in-house. So you have to be careful.

There are companies out there who ghostwrite reports. I'll just tell you that what they do basically is—they write the whole report up, and you just sign it. And they pay you very little money to do it. They're trying to save money. That is something you want to avoid. Okay, I won't mention any specific companies except to say that you don't want to do that. You want to really be legitimate about this. This is important. If you're doing this kind of work, it's important to be fair and impartial and to look at the work and come up with a conclusion that's reasonable. And that's what they want, actually—insurance companies want. Unfortunately, they're constrained like everybody else financially, so they're looking to cut corners. Unfortunately, that doesn't work too well when it happens.

So you have to be careful what you're getting yourself into. It's very important to pick and choose who you're working for carefully—not just in terms of what they're paying but also if they're ethical and so forth.

John: So does it seem like that's one of the things that's sort of changed since you've been doing this, right? I mean, heck, you started probably doing this before the pandemic, and then the pandemic hit, and everything's going online. Any other observations about what we should look for or not look for when looking for disability evaluation file reviews?

Dr. Robert Cooper: I mean, a reasonable rate is reasonable. I mean, I don't want to go into exactly what I mean. The ranges generally are, just to give you a range, I mean, $150 to $200 an hour is reasonable or over that. Some companies—I mean, I've not settled for $50 an hour or $25—I mean, it's ridiculous. Some companies that are actually coming into play, I would just walk away from them. Again, walk away. Instead of walking away, they get in trouble with that.

I will make a comment about something you said, John. There are a lot of family physicians doing this—general physicians. It's not actually—it’s just as much general physicians as there are actually specialists doing this because you need to have a holistic point of view of some of these patients. They look for this, and they want somebody to go through everything, all the problems, and come up with a conclusion. So, it's very much driven by primary care, family medicine, and internal medicine. In fact, the whole segment of that, in the company I worked in, was for that. So, you could do that.

You could also use this, by the way, any of these things, as a segue. I mean, mine is the expert network consultant, but a segue to get into full-time work. If it is what you choose to do and say, "Listen, I just don't wanna do clinical medicine anymore. I have to determine this is not for me." I mean, unfortunately, that's what happens sometimes. It's nothing—somebody's choice.

You could use this because many of these companies will ask you, "Have you had any work before? Have you done this before? Have you done disability file review? Have you done medical assessment review before?" Yes, I have. I've done, you know, X, Y, and Z, and this is what I've done. "Okay, great." And they'll interview you. This is why people have a problem getting in at the ground floor if they want to convert to full-time. If that's what they choose to do, it's because they don't have the experience. This is a way to get experience.

John: One of the things in my little research I've done on this topic is looking at Social Security disability file reviews. And that one seems to be a unique animal. Have you ever done those for Social Security? I think they have different companies specifically that only do SSDI-type reviews.

Dr. Robert Cooper: I have a friend that does that for endocrinology. But the problem is they don’t pay well. Private insurances, the vendors, the ones that deal with private insurance, pay much more. So it's not uncommon to get about a third or a half. She actually looks at me and says, "Oh my God, you're getting that kind of thing for doing it for the vendors? That's ridiculous, I'm getting nothing." And so I don’t, and I get those rates back, and they come back to me. And then, you know, people come to me and they'll approach me all the time. Today I had three of them approach me. "Would you like to do some work for us?" And I just look at it and say, "It's not worth it for me to do what I make." It’s not gonna do it. And I think once you get to the point where you're comfortable doing this, you’re gonna realize that and say, "You know, I’ve just not." It’s better to walk away.

John: Well, that’s good to know. I’ll just stop even trying because it’s been difficult to get any information on the SSDI ones, but they don’t pay well. What’s the point? Are there other types of chart reviews? This one, I get this question all the time. I know, for example, that state medical societies, you know, they have quality reviews. Those are pretty few and far between. But any other types of, you know, more or less paperwork, file review, based on your clinical knowledge that you've done or that you know of?

Dr. Robert Cooper: The medical necessity ones are good ones actually too, because they could be quick sometimes. Unfortunately, they don’t pay as much as the disability ones. But some of the private vendors will pay fairly well for a medical necessity review. The big thing about— I didn’t talk about this—but the peer-to-peer phone calls, those can be challenging. So you have to have a thick neck about you, particularly when you're doing a peer-to-peer for a medical necessity review. But I worked full-time for the insurance company. Every day was filled with these peer-to-peers. And eventually, after about two or three months, I said, "Uh-uh, no more." I went back to clinical medicine because I just didn’t want to. I was just... But doing it on a part-time basis, you know, and calling up, you can conduct these, and it's an act of doing this. You have to have a knack for doing this and calling up, but it’s a challenge sometimes. Because physicians are generally, you know, not going to be amenable. You know, they’re frustrated and upset. You’re calling them up and telling them that you're going to deny something or you don’t have the adequate information, and they're gonna come back at you. But there’s a way to handle yourself in both these things. And that includes disability file reviews too, because there’s peer-to-peer for that as well when you're calling up the attorney position. So you get that a lot too. So you have to be willing to do that. Some people are, some people aren’t. And just handle that. I mean, everything has its pros and cons. Every one of these things, okay? So you have to kind of take the good with the bad when you're doing it.

John: Well, yeah, I guess, you know, each person has to sort of assess what they’re good at, what they’re interested in. You know, I’m a meticulous person. Maybe that helps in certain situations. Maybe it doesn’t help in others. I was going to also ask your opinion, switching gears here, on some follow-up on—you've been, in the past, an expert witness, which, you know, as you mentioned earlier, in the field of endocrinology. But what advice would you have for physicians who maybe are still working, you know, part-time, thinking about entering that field?

Dr. Robert Cooper: It’s a good field. It’s very lucrative. I mean, it’s not uncommon for somebody to charge upwards of up to a thousand dollars an hour in some cases for some specialties. I mean, it sounds great, but it has its problems too. I mean, you have to have a thick neck. I mean, just sitting in the seat I'm in right now—I told you last week, I had a deposition. I was deposed actually on a case. I have another case that’s going on that I’m getting subpoenaed in. I might have to travel to a different state—it’s a criminal case that spun out of a civil case. I mean, I’ve never had that happen before in the years I’ve been doing it, but I mean, these things happen, and they can be disruptive to practice. They can be disruptive to doing it. You have to have a contract in place. I mean, all these things are important. They're not something that you just kind of throw yourself into. And you have to be able to carry yourself well to be able to do that.

I mean, writing an expert report is very important. I mean, SEEK has some courses on this, how to do it. There's a great book on that too, but I think also being coached—like, how do I write a report? How do I put one together that's going to make sense, that's going to flow? Because the better your report is, the less chance you're going to be deposed or put to court because it's going to settle most of these cases. So you have to learn that. It's the kind of thing that you learn as you go along.

So again, you need to enact this—kind of figuring out what is the best way to put a good report together, different stages, learning a little bit about law and how it works, and the evolution of a case. How do you get deposed? When you get deposed, how do you handle yourself during a deposition? How do you handle yourself during a trial? These are all things to consider because if you screw up a couple of times, you're not going to get asked again to do any cases.

So it's all about putting your hands into one thing. You know, I always step back and say, "You know what, I want to do a good job. I really do, as an expert witness." But if, for some reason, something out of my control happens—and it does sometimes—that I get looked upon or frowned upon negatively for whatever reason, I have something else to fall back on. I can do other work. I don't have to throw myself into one particular thing. That's how I always look at it. I still want to do a good job.

John: Let me ask you this, because this comes up, I think, in others I’ve spoken with who are looking to get more and more into expert witness consulting. I guess, marketing themselves—how do they find clients or attorneys? Do they just come to you when you've done this just because of your local notoriety? Or do you have a process for trying to get visibility for some of these attorneys who are looking for help?

Dr. Robert Cooper: First off, you have to be careful with that. If you start listing yourself all over the place, that's going to come up during deposition. It came up last week. "How many directories are you in, Dr. Cooper? How many times do you do this? What are you doing?" Because they're looking for people that are hired guns and trying to nail them on that. So actually, I don’t list myself in anything except SEEK. SEEK is the only directory I list. I’ll make a little plug because they’re a good company.

I just had somebody call me right before I got on the phone with you, saying, "You know, the spam call—it wasn't a spam call—it was somebody trying to get me into a directory." I just quickly got them out of there. "How much money is it going to cost me? What is it going to do?" I really don't have a need to list myself in 16 different directories. I've never really found it to be helpful.

I think the best thing is word of mouth. When you do a good job, the next thing that happens is the next attorney tells somebody else about it. Then they call you and say, "You know, you worked with my friend on a case, and I want to work with you too as well. I've heard that you are pretty good. You're responsive, you get back to me, and you're available."

I think calling people—like if an expert, if an attorney calls you—you need to get on the phone with that attorney the same day, within an hour or two. Get on the phone and respond to that attorney, saying, "What's the deal?" And also, you're interviewing them too. You don’t want to get involved with any type of attorney who’s not doing anything ethical. Everything has got to be ethical. It’s got to be impartial. You don’t want to come across as somebody who’s biased during a case.

These are all things you learn as you do it. There’s a way to conduct yourself. It’s very, very important. You don’t just jump into these things—you have to know what to do to provide a good product.

John: I think that particular one—the expert witness—it’s a good combination because you're acting as a physician, as an expert, as a professional, but at the same time, it’s a business if you decide to continue doing it on a regular basis. So you have to know about those resources, like the SEEK list of available consultants.

And again, there are places where you can learn—SEEK included—that, you know, maybe give you a little advice on how to prepare for these things. And if you're doing your first deposition, that kind of thing. So that's always been interesting to me.

Dr. Robert Cooper: Yeah, oh, sure. It's a very interesting thing. I mean, I've done probably over 100 cases in expert witness work over the last 10 years. And I would say that I've had everything from somebody having a terrorist attack and blowing up the pituitary gland in our country and having me testify in that to, you know, hypoglycemic episodes in jail and things like that. I've had cases like that. I mean, it's so fascinating. It really is. You find yourself like a detective. Many times, I've come back to an attorney and said, "You know what, you don't have a case here." They don't want to hear that, but you don't have a case. You have to be honest, very honest with your attorneys that are coming to you. Very ethical and very honest. This is very important, any of the work you do.

John: Well, they might not like to hear that, but better that than they waste tens of thousands of dollars and find out at the end that they don't have a worthwhile case at that point.

Dr. Robert Cooper: That's right.

John: All right, well, have there been any of these other side gigs, consulting types of things, and reviews that we haven't learned yet from you, any others, examples, or have we kind of covered the majority today?

Dr. Robert Cooper: Well, there is another thing I do—I love actually too. I teach actually, I teach at a, there's a company called MCE—I'll just be specific I guess about that. Cause I teach that once a year or twice a year, they have me fly out somewhere and teach primary care and I love it actually. I really enjoy it. We have about 150 people there sometimes and it's on it, usually it's on endocrinology review for primary care. And I've enjoyed that. I've had two stints in Disney world already.

John: Oh yeah?

Dr. Robert Cooper: Where I've gone out there and done that. And I love having people respond back and ask questions.

John: So that's just like a continuing education for physicians?

Dr. Robert Cooper: Yeah, that's right. That's right.

John: Okay.

Dr. Robert Cooper: Another part of this that we didn't talk about actually, too. Maybe we should at some point. Maybe we've done now. Locums. Locums are a way to freedom, actually, too. And I think I've done that. I've done a lot of locums work in the past. I don't now. I'm permanent. But it's some of the best freedom you can get. And if you're like in this position right now where you're kind of considering, like, I think I would just say to your viewers, if you're in a position where you say, "Oh my God, I can't go back to work," and you have that feeling in your stomach on Sunday night, like I've had a couple of times, think back for a second and say to yourself, "Hey, why do I feel that way?" That's the first thing—introspection. Why do I feel that way? Is it something that I could change in the environment I'm in first that could actually make things better? Or, if it's not, is it a different environment clinically that I could be in? Or do I need to figure out a way to integrate this other stuff maybe into place that I could do it so I could cut back on that? Because I don't think it's all or nothing.

I see people at SEEK when I taught this year. They come up to me at lunch and say to me, they sit down—we have like a group of, like, I have 50 people sitting next to me—and they say, "How do you kind of get away from this?" One physician came to me and said to me, "When I was pregnant, I was sitting on my bed. They were giving me an epidural, and the administrators were coming over to me, saying, 'Look at the computer at the CMR, at the letter on medical records, and go back to the records.'" And I said, "I can't believe that." She said to me, "How do you function in that environment? This is what I'm going through," she said. "I have to find some relief," she said, "because I don't have a break ever." I find that so difficult to deal with. I mean, you have to be able to practice. Medicine is a great field to be in. It's a great thing to be a physician, regardless of what specialty you're in. But I think you have to do it on your own terms. You can't have that plugging and deal dread and stuff. So that's the important point, actually, too.

John: Yeah, absolutely. And... You shouldn't put up with being burnt out and frustrated and unfulfilled for too long. You can do it for a little while, but you don't need to put up with that. Because really, as you said earlier, physicians, they have a lot of information, a lot of knowledge, skills, and it's all very valuable if you can leverage it to your advantage.

Dr. Robert Cooper: I think the thing about locums, I was going to say before, just to get back to that for a second, we used to think of locums as being outsiders. But the truth of the matter is that locums are actually becoming sort of the norm, almost.

John: Right.

Dr. Robert Cooper: That's not a great... I mean, it's getting competitive, actually, to get a locum position or something like that. Because there's a shortage of positions, people are looking. But there are some great companies out there that do locums kinds of activity, a call, and they can really provide you with some great experiences to do it, too. I mean, it may not be for everybody, but it's a way to sort of break away.

John: Yeah, I think if you're feeling desperate, you might as well consider everything and narrow it down, maybe, to what fits best. But locums and part-time work and consulting and telemedicine, you know, is another option.

Dr. Robert Cooper: Yeah, right.

John: So, let's see. So, you told me that you like to help other physicians learn this stuff. You're teaching at SEEK and other places. So, let's see if someone would want to get a hold of you, learn more about what you've been doing, and get some help. I think you are on LinkedIn, is that correct?

Dr. Robert Cooper: That's right. I have a website. You have it there. RJCmedicalconsulting.com.

John: Okay. RJCmedicalconsulting.com. Okay, go ahead.

Dr. Robert Cooper: Correct, correct. I'm looking at some point maybe in... I actually developed a course already for leveraging medical. I haven't done it yet. I'm looking to see if there's any traction, if people want to take it. And when I get a critical volume of people together, I might do that, actually, too—online or in person at some point. And I, you know, all these topics, I think, as I mentioned before, preparation and learning how to do it is very important. So, you know, you could direct them there to that website, and certainly, they can.

John: Yep, I will put those links in the show notes, along with a transcript of our whole conversation. And yeah, maybe they should reach out and at least maybe follow you or connect with you on LinkedIn and then look at the website for more information.

Dr. Robert Cooper: The other thing I haven't done, but if anybody is interested, if they want me to come out and give a lecture at one of the meetings, either a keynote or something else on this particular topic, I'm happy to come out there too. So I'll just ask you that.

John: Yeah, absolutely. In fact, I'll mention this. I haven't talked about this in the podcast much, but when you talk about these opportunities and sort of the non-clinical side of things, most of the time, it still qualifies as CME. So, some of these organizations can actually give you CME credit for it because it's something that supplements your practice. And, as I think you have said in the past, you know, like when you're doing expert witness work, you actually become a better physician. To prepare for that, you have to. So, that's all good stuff for CME.

Dr. Robert Cooper: Absolutely right, absolutely right. And even expert network consulting stuff—you learn things. And things that you wouldn’t know are coming—ARE coming and are the wave of the future. And it really keeps you up to date on what’s happening. It makes it diversified. So it gives a different meaning to going in every day and seeing patients.

John: Exactly.

Dr. Robert Cooper: When you're doing it.

John: Exactly. All right, well, I think we're pretty much at our time now. So I want to say thank you very much for joining me today, Robert. This has been great. And I think the listeners will really appreciate all the wisdom you've shared with us today.

Dr. Robert Cooper: Thank you for having me on. I hope that reaches people and hopefully, we can help them.

John: I'm sure it will. All right. Bye now.

Dr. Robert Cooper: Thanks, John.

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

Disclaimers:

Many of the links that I refer you to, and that you’ll find in the show notes, are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. And I only promote products and services that I believe are of high quality and will be useful to you, that I have personally used or am very familiar with.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. It should not be construed as medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career.