Interview with Dr. Dan Field
In this week's interview, Dr. Dan Field explains how he went from retirement to ardent CMO.
Dr. Dan Field is the chief medical officer for MDstaffers, recently ranked the 49th fastest-growing company in the United States. There, he oversees all clinical staff operations and quality assurance. He also oversees the Medical Expert staffing component.
Dan is a board-certified emergency medicine physician who practiced for more than 30 years. He serves the California Medical Board as an expert reviewer and consultant.
He is an expert witness for cases involving personal injury, criminal law, standard of care, and malpractice, and is a featured speaker, panelist, media physician, and talk show guest.
Dr. Field received his medical degree from the University of California at San Francisco, followed by an internship at Highland Hospital in Oakland. He then completed his EM residency at University Hospital in Cincinnati.
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How to Go From Retirement to Ardent CMO and Medical Expert
Dan points out that most of us do not truly retire. We may phase out of clinical medicine, which can be intense and emotionally draining. However, by applying transferable skills, we can often move from retirement to ardent CMO or another equally rewarding position.
I advise you to listen as Dan talks about how he pursued interests that satisfied his desire for autonomy, variety, accomplishment, and reward. And he notes that humans are not made to BE happy but, rather, to PURSUE happiness.
Stacking New Skills
Then he provides practical advice about stacking new skills to prepare for your next career. A pertinent example he provides is to work as a state medical board reviewer to gain experience before embarking on a medical expert consulting business.
I think building a skill stack it's like opening up your tool chest and putting tools in it that are going to be useful to you. – Dr. Dan Field
We cover two important topics today: preparing for the transition from retirement from medicine to your next career, and how to prepare to do medical expert consulting. One way to learn necessary skills and find your first clients is to join a company such as MDstaffers.
Summary
I have no financial relationship with the company, but I think exploring MDstaffers at mdstaffers.com is a good place to look for locums jobs and medical expert witness consulting engagements. And from what Dan says during our discussion, he or one of his colleagues can help you to prepare to get started.
NOTE: Look below for a transcript of today's episode that you can download or read.
Links for Today's Episode:
- MDstaffers
- Dr. Dan Field's LinkedIn Profile
- MDstaffers Expert Witness Page
- MDstaffers Locum Tenens Page
- Top Reasons to Become an Expert Witness Now – 163
- How to Develop a Side Gig as an Expert Witness with Dr. Peter Steinberg – 053
Download This Episode:
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Podcast Editing & Production Services are provided by Oscar Hamilton
PNC Podcast Episode 189
How to Go from Retirement to Ardent CMO and Medical Expert - Interview with Dr. Dan Field
John: I'm always looking for chief medical officers who don't work in the hospital setting. So, I'm really glad today's guest is here. And it's kind of a twofer because we're going to talk about his career as a CMO and talk about the company that he works for, which also provides opportunities for expert witness and other types of clinical, but some nonclinical. So, with that, I'd like to welcome Dr. Dan Field to the PNC podcast.
Dr. Dan Field: Good morning. Looking forward to our time together today, John.
John: I'm really looking forward to it because again, I use the term CMO. It's kind of like the term medical director. It just can mean almost anything, but the one thing it does mean is it's a physician. So, tell us a little bit about your clinical background. I've done a separate intro with a lot of the details, but if you want to give us a little bit about your clinical background and then how on earth did you sort of segue into this role as a CMO?
Dr. Dan Field: Okay. Well, I started out as a Kaiser baby and I went to medical school and came back and became a Kaiser doctor and now I'm a Kaiser retiree. So, in that time I did my premed at Irvine and Edinburgh University. I did a little diversity there. Medical school in San Francisco. And I finished up with an emergency residency in Cincinnati before returning home to California.
John: All right. And you did that for a few years, correct?
Dr. Dan Field: Correct. Yes.
John: And a lot of things along with it, right?
Dr. Dan Field: Yeah. Yeah. So, I did 30 years in the emergency department and when I say it like that, I feel like I'm saying I did 30 years in prison. But during that time, I kind of was trying to list some of the things that I did to kind of break out of the standard operating procedure. So, I ran for office, I started a manufacturing company. I engaged in a medical startup. I built a solar-powered home. I became a demo doc for a major CPOE company and I became a deputy sheriff on the SWAT team. So, I tried a variety of things.
John: Oh man, we're going to have to like have another three podcast episodes just to go into each one. But now that's a pretty broad spectrum of things. Now, did you actually completely retire and then kind of search out the CMO role? Or was this something that came up while you were still practicing?
Dr. Dan Field: It took retirement to find it. And it's kind of as serendipity. I was heading towards retirement, and I must have clicked on an advertisement. There are all these online things being thrown at us. And this one probably said something like work in the wine country, $200 an hour. And that probably went into a database and a nice young man, reached out to me and said, “Hey would you like to consider these things?” And he kind of took me by the hand and brought me back into some clinical because that was the contact locums. But then it turned out they had a spot open for a CMO and after our engaging conversation, he said, “Why don't we think about you joining us as a CMO?” And then I said, “Well, I have this idea for a med-legal panel”. And he said, “Well, let's see, we could call that MDexperts”. And we have a hundred thousand doctors in our Rolodex. So, if somebody needed a specialty, wow, we've got it.
So, serendipity led to the situation and I should say, the things that really made it work, is that I personally had a low barrier to entry. I did not say you need to start out with a quarter million or $300,000 a year and no defined value. So, I came into it with the attitude that I was going to create my own value stream in this situation because MDstaffers was a tiny company at the time. And they were rapidly growing and I was right there at the beginning, but there wasn't a way to really pay me out of sales or commissions or so forth. So, I developed a value-added stream sort of approach.
John: Okay. So that means this is kind of like a unicorn or a black swan event, I guess. But I've heard of actually many other physicians who either they're interested in startups, or after retirement looking to be on a panel, to be an advisor. So, in retrospect, MDstaffers looking at it online, it looks like it's into a lot of things. It looks like it's got a lot going on, but you're saying it was pretty much in the early stage when you found them and they found you.
Dr. Dan Field: Yeah. So, they had been growing steadily, but actually, with the advent of the pandemic, our mission is to plug the holes in the healthcare system, the manpower gap. We work mostly with physicians and advanced practitioners and now we do mental health as well. We all know there's a huge gap and it's our mission to fill that. And suddenly with the pandemic, we had a lot of doctors actually being idled, which was a stunning outcome of that to all of us and a need to shift to online health care. So, it was another serendipitous moment.
John: Yeah. When you look at companies like this recruitment and related things, it's always a chicken and egg. You need the bodies and you need the jobs and what do you get first and lots of companies just die because they can't do it. So, there you were, just boom. All of a sudden, we had a lot of people that were ready to look for something. And so, you could just soak that up as you built more and more opportunities. That's fantastic.
So, looking back, what kind of advice could you come up with in terms of someone who thinks “Wow, that sounds pretty interesting. Is there any method to the madness? How can I possibly try to do the same thing?”
Dr. Dan Field: There are so many ways of approaching that. And with our limited time, I'm trying to distill in my mind. I think that you have to know what it is that makes you happy, or at least satisfied. And keep in mind, we are not made to be happy. We're made to pursue happiness. But happiness never occurs. So, it's the pursuit. Now in that pursuit, what makes you feel the best? What tickles your brain and gives you a certain amount of joy and enjoyment? So, I think it's autonomy, variety, accomplishment, and reward. I think those are the four things that tickle my brain the most and give me the most satisfaction. So, something that gives me the autonomy to be able to get up in the morning and go for a run before I settle down, or get up even earlier and do some hard cognitive work and then go for a run and come back and do some more.
So that kind of autonomy, the variety. I'm coming at it from clinical ops, I'm doing med-legal, I'm doing clinical work, variety accomplishment. One of my biggest satisfaction moments came when I built my house because there it was, I did that. I did something. I brought all these parts together and I made something.
And then, of course, reward. Getting some money for what you do. Having people say, “Hey, doctor, you made a real difference on my LinkedIn”. It's especially rewarding. It’s ridiculously rewarding how pleased I am to have somebody just say like, or insightful, or go beyond and say, thank you for stepping out there and making these comments. So, my reward comes from so many different directions now.
John: Yeah. Well, people sometimes call it a purpose or passion and other rewards, but you're right. It's the journey, not so much like you've landed there. But I like you talking about your house because they have a physical representation. That thing is done. We don't always have that in medicine because our patients go away, they get better, they get worse. But if I could build a guitar or build a house.
Dr. Dan Field: Exactly, that's exactly right. Even a well-crafted medical-legal opinion to me where I took an issue. I refined it. I researched it. I made points. I justified those points and I presented them. That is something that's concrete. When I worked in the emergency department and I see the same person for a drug overdose three times, I don't feel like I've made a lot of progress there.
John: Yeah. Really, I can remember those experiences in my office as well. It's frustrating. That's kind of the patient you hate to see. You look at your schedule, you didn't have a schedule to look at, I'd look at a schedule and see the person who was coming back in two hours.
Okay. So, we're going to move to the meadow medical expert in a minute, but I want to ask you because I think this is an interesting transition. Physicians aren't really going to retire. I mean, they might retire from clinical, but our minds are going, we have energy, we have so much knowledge. Do you think that most physicians that practice as long as you did and that kind of environment, whether it's internal medicine, emergency medicine surgery, do you think we should pick up a few new skills at the end of that to anticipate this next? Should we do little pilots or do we have enough of the knowledge and skills that are really going to translate into some other jobs already?
Dr. Dan Field: I think preparation is the way to go. I think building a skill stack it's like opening up your tool chest and putting tools in it that are going to be useful to you. So, I knew that I liked med-legal. For some reason, I was attracted. In fact, when I applied to medical school, I applied, my thought was to do an MD/JD. That was 35 years ago. And it was too startling for most of the medical school admissions committees. And I didn't get accepted when I led with that. But I knew I liked it. And so, I began to add tools along the way. Kaiser doesn't allow you, TPMG, the Permanente medical doesn't allow you to do outside work for a monetary reward if it involves your license. But what they do allow you to do is public benefit.
So, I actually started working as a California medical board reviewer, and here they're asking us to look at medical cases and say was the standard of care met? Was there an education deficit? And I began to develop the evaluation capacity, which actually translated very well to my next stage as an expert witness.
John: Yeah. I think you don't always know where those are going to go, but those extra experiences can be very helpful. Not only because you've learned new skills, but then when someone's looking at you, they say, “Oh, wow, that's something interesting that might be useful for what we need”. So now, from what I understand when you joined MDstaffers and they had never had a CMO. They were small enough that they have a similar position.
Dr. Dan Field: They did have a CMO previous to me. It didn't work out the way they wanted it to and there was a parting of ways.
John: Okay. So, then there you are. And then you were the one I think that introduced this concept of adding the MDexperts to their growing kind of array of topical areas. So, tell us about that. I know you have that interest, but tell us how that transpired and what it is today.
Dr. Dan Field: Let's go back a step to MDstaffers business model. So, they have two clients. They have physicians and advanced practitioners, and that's one group of clients. And on the other side, they have the Adventist selves or the major healthcare organizations who are looking for manpower or person power support.
So, we are recruiting on the one side for those big company clients who need volume and we're prospecting for the workers on the other side, and then we're going to match those. They might say, we need a hundred mental health care workers for our telemedicine product. And we'll say, okay, are you ready for a hundred of them next week? And we've broken the bank there, or the processes for some of our companies because we give them so many high qualities. Well, we now got a hundred thousand plus physicians in our Rolodex and it takes an older person to know what a Rolodex is.
The concept is really simple. Somebody needs a specialty in Hackensack, New Jersey. And they call us up and they say, “Who do you have in Hackensack who is a pediatric pulmonologist?” So, we just go into our tracker database and type in 50 miles from Hackensack and a pediatric pulmonologist. And I get four names and I have the CVs. I have everything ready and we shoot them a CV and they say yes. And then we match the two.
John: What's the experience for the physician? Are they a subcontractor for you and MDstaffers or directly for the attorneys that are looking for them or the insurance company or whatever it might be? How does that work?
Dr. Dan Field: Well, that's a good question. In many of these circumstances, it's a handoff once the connection is made and somehow the value has been extracted before that stage. And then it's up to the physician to work out with the requester. Our model is that we manage the process. We do the invoicing, we guarantee the payment, we pay the liability in this case. And in exchange, we take a less than typical market share. So, it'll be less than 30% for our margin. So that's the model.
John: Do you have a sense of the physicians? Do you get many physicians starting out that haven't done this before and contact you about signing on, or do you generally use more experienced people or both? What feedback do you get from the physicians that are involved?
Dr. Dan Field: A lot of physicians come to us through the recruitment process. So, on MDstaffers side, where we're talking to them and we're engaging in conversations, our recruiters are really good, and we really develop a nice relationship with their doctors. And along the way, we say, “And by the way, are you interested in this line of work over here?” And a high proportion of the people that we talked to say, “Yeah, yeah, I might like to do that, but I haven't had any experience”. Well, we have a little process that we go through to help them begin to build the experience. And in those cases, you can volunteer for your in-house quality assurance committee. You might get paid for that in-house, and you begin to build some variety inside your current practice, which is a very nice longevity tool because again, variety and autonomy and reward.
So, you begin to build some of those inside your current lifestyle. You reach out to your medical board and see if they have a reviewer program. You touch bases with the public defender's office. They're dying for experts, but they can't afford them. And so, we created a government rate basically to help the justice system, and it's much lower than the commercial rates, which we charge at-large criminal product, liability, and so forth. And that is beneficial to society and its benefits to us because it builds experience and volume. So, that's what I tell the new physicians. I say, take them through this route.
John: I had a conversation with one of my colleagues who does a lot of telemedicine. He's licensed in multiple states. And he said that he had discovered that many of the state licensing boards need physicians to review records, review quality, review complaints. So, you're saying that kind of thing could set them up to take the next step and move maybe more directly into an expert witness type of activity.
Dr. Dan Field: Yes. And since a lot of physicians are not looking to leave clinical practice entirely, they're trying to build a side gig inside their current lifestyle, where they can take some of their non-program time and turn it to a monetary reward and then perhaps reduce their clinical. And as we all know, when you reduce clinical, you reduce exposure.
John: That's a good part.
Dr. Dan Field: Well, it's a great part. And it has two parts to it itself. This is a little segue, but not only are you reducing your personal exposure, but the very act of studying these things teaches you how to avoid exposure. So, it's a total win-win and perhaps triple win situation.
John: Yeah. I guess if you're gaining expertise on how to be an expert witness and then you know “Oh, my documentation needs to be spruced up a little because obviously, this is what they're asking me to look at”. Or if you happen to go through a deposition, you learn those things pretty quickly.
Dr. Dan Field: Okay. So, let me throw one more thing at you along these lines, because you were asking how we prepare our new doctors for this kind of career. Another thing is just an education on what an actual expert witness is and does. So, we all have kind of our TV imagery. Yep. But what is the reality? And my reality is that I have found that I am an interpreter. That's how I look at my expertise as that of interpretation.
So, I take a medical record and other information that might be confusing and are out of the area of expertise of the judge, the jury, and the attorneys. And I interpret this for them in an ethical, and, what would be a good word? It's somewhat of a blinded fashion. I kind of walk into these cases without a preconceived notion or with the openness that my preconceptions and biases might be changed by the facts of the case. And that happens a lot. I had a great case with the Air Force, where I went in thinking “This guy's a scumbag and I'm here to defend him”. And in the course of the case, it turned out not to be in my opinion. So, you were an interpreter.
John: Now, what I've heard others ask about as well, “How much actual record review am I doing as opposed to actually ended up doing a deposition? And am I likely to ever end up in court in a trial?”
Dr. Dan Field: The answer is no.
John: It's pretty rare.
Dr. Dan Field: Yeah, just like with malpractice cases, mostly favoring the physician. Probably 95%, something like that. That same applies to your chances of actually getting into the court. So, I've probably reviewed a hundred cases by now. Not huge, maybe even 200. And I probably made it into court a total of 15 times, and I love depositions. I love sitting in court. I love that part of it very much. I don't like malpractice. I don't think anybody does, but personal injury and criminal is really nice because I go there as a nonpartisan and I'm here to help and advise.
John: No, I think that's a good picture of how things go. You have to have a certain personality, I suppose. You can't be a hothead that flies off the handle. You have to be able to listen, stop and be calm basically, and give a measured response. But if you can do that, I mean we're well-trained, we should be able to do it in most cases. So, I think it's something that practicing physicians rather than just, say, dumping clinical completely, maybe cut back on the clinical because you need to stay in clinical if you're going to do this anyway, most likely because they want you to know the standard of care. And do this. It's a good side gig. And like you said, it could balance out things.
Dr. Dan Field: Variety and reward and some autonomy. You know what? You really hit upon it, John. I think you were touching on a valuable tool - You need to be a team player. And think, for instance, a physician such as yourself, a family practice person, perhaps with an office or a team, have some nurses, you have an assistant. They're your team and you're working with your team to bring about an end. And when you are an expert witness, you're part of the team. You're not house. You're not the prima donna that everybody's going to come and bow to. You are part of the team and you're working to get to the end to go deliver a product.
John: So, if I was interested, I could get on the phone and call MDstaffers, MDexperts, and just talk to somebody about what it would take to become one of your physicians that do that. And if they have to do some other work first, that's fine. But at least I can learn more about how to get there.
Dr. Dan Field: I'm happy to talk to anybody who wants to discuss this. I've benefited from those who have gone before me. And I will be paying it forward as the phrase goes and helping the people along the way. I’ve got some good ideas for them.
John: All right. I want to remind everyone that the website is mdstaffers.com. That's one word and everything that you've talked about and everything that MDstaffers does is somewhere on that website. And there's probably a contact form to reach out if you'd like to do that. Is there any other thing? Like the mention about MDstaffers, you say you've got a locum’s component as well. So, a lot of people use that as a temporary or permanent change from what they're doing.
Dr. Dan Field: Yes. You should keep in mind, those of us who are near retirement. And if you think, “Well, I might take a couple of years off and travel to Fiji and Bora Bora” and so forth. At least in emergency medicine and probably the same for surgery and some other areas. If you haven't practiced in the clinical setting in the last 18 months, you're out. The process to get back in and to get on staff becomes much more onerous than people would consider.
So, I really advise people to keep their foot and their toe in the bathtub here and keep a little side clinical going. And that can extend your career until as long as you want it to go. I frankly don't know what I would do if I didn't have this to get up to every day. I mean, I could not sit there and read the paper and drink coffee all morning, and then go meet my buddies at the coffee shop for more coffee. I need more than that.
John: No, everyone I've talked to, I haven't really seen a physician. Most of us either practice till we drop, or we do something else. And that's healthy. You need that, I think. All right, well, we're going to run out of time here. So, I guess I would ask you if you have any other advice, maybe for a physician who's maybe not quite ready for retirement, but thinking about those few years down the road. Any specific advice or other comments you would have for us?
Dr. Dan Field: Yeah, yeah. Realize that failure equals experience. Don't be afraid to go out and try something. You're going to learn. You're going to learn as you go. So, when I went out and worked in the business world, I learned some business concepts and I learned how important it was to be a team player. Don't quit your day job. Find a way of diversifying your day job internally and pick up skills so that you have something to offer when you get out.
I think you should try to find out what tickles your brain and then make that the direction that you're going to move. So, you're going to build your skillset around those things that bring you that happiness or satisfaction. And there are ways to do that by taking baby steps. So, I'm an incrementalist. I like job security and a paycheck, so that's my advice.
John: All right, Dan. Well, this has been very interesting. We've learned a lot about the two major topics that I think we're going to be able to learn from and apply. So, I really want to thank you for spending the time. Again, that's mdstaffers.com. I'm sure they can track you down there, or you can go on LinkedIn and probably get a hold of you and contact you that way.
Dr. Dan Field: Absolutely.
John: All right. Well, with that, I guess I'll just have to say goodbye.
Dr. Dan Field: Okay. Thank you.
John: You're welcome. Bye-bye.
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PNC Podcast Episode 189
How to Go from Retirement to Ardent CMO and Medical Expert - Interview with Dr. Dan Field
John: I'm always looking for chief medical officers who don't work in the hospital setting. So, I'm really glad today's guest is here. And it's kind of a twofer because we're going to talk about his career as a CMO and talk about the company that he works for, which also provides opportunities for expert witness and other types of clinical, but some nonclinical. So, with that, I'd like to welcome Dr. Dan Field to the PNC podcast.
Dr. Dan Field: Good morning. Looking forward to our time together today, John.
John: I'm really looking forward to it because again, I use the term CMO. It's kind of like the term medical director. It just can mean almost anything, but the one thing it does mean is it's a physician. So, tell us a little bit about your clinical background. I've done a separate intro with a lot of the details, but if you want to give us a little bit about your clinical background and then how on earth did you sort of segue into this role as a CMO?
Dr. Dan Field: Okay. Well, I started out as a Kaiser baby and I went to medical school and came back and became a Kaiser doctor and now I'm a Kaiser retiree. So, in that time I did my premed at Irvine and Edinburgh University. I did a little diversity there. Medical school in San Francisco. And I finished up with an emergency residency in Cincinnati before returning home to California.
John: All right. And you did that for a few years, correct?
Dr. Dan Field: Correct. Yes.
John: And a lot of things along with it, right?
Dr. Dan Field: Yeah. Yeah. So, I did 30 years in the emergency department and when I say it like that, I feel like I'm saying I did 30 years in prison. But during that time, I kind of was trying to list some of the things that I did to kind of break out of the standard operating procedure. So, I ran for office, I started a manufacturing company. I engaged in a medical startup. I built a solar-powered home. I became a demo doc for a major CPOE company and I became a deputy sheriff on the SWAT team. So, I tried a variety of things.
John: Oh man, we're going to have to like have another three podcast episodes just to go into each one. But now that's a pretty broad spectrum of things. Now, did you actually completely retire and then kind of search out the CMO role? Or was this something that came up while you were still practicing?
Dr. Dan Field: It took retirement to find it. And it's kind of as serendipity. I was heading towards retirement, and I must have clicked on an advertisement. There are all these online things being thrown at us. And this one probably said something like work in the wine country, $200 an hour. And that probably went into a database and a nice young man, reached out to me and said, “Hey would you like to consider these things?” And he kind of took me by the hand and brought me back into some clinical because that was the contact locums. But then it turned out they had a spot open for a CMO and after our engaging conversation, he said, “Why don't we think about you joining us as a CMO?” And then I said, “Well, I have this idea for a med-legal panel”. And he said, “Well, let's see, we could call that MDexperts”. And we have a hundred thousand doctors in our Rolodex. So, if somebody needed a specialty, wow, we've got it.
So, serendipity led to the situation and I should say, the things that really made it work, is that I personally had a low barrier to entry. I did not say you need to start out with a quarter million or $300,000 a year and no defined value. So, I came into it with the attitude that I was going to create my own value stream in this situation because MDstaffers was a tiny company at the time. And they were rapidly growing and I was right there at the beginning, but there wasn't a way to really pay me out of sales or commissions or so forth. So, I developed a value-added stream sort of approach.
John: Okay. So that means this is kind of like a unicorn or a black swan event, I guess. But I've heard of actually many other physicians who either they're interested in startups, or after retirement looking to be on a panel, to be an advisor. So, in retrospect, MDstaffers looking at it online, it looks like it's into a lot of things. It looks like it's got a lot going on, but you're saying it was pretty much in the early stage when you found them and they found you.
Dr. Dan Field: Yeah. So, they had been growing steadily, but actually, with the advent of the pandemic, our mission is to plug the holes in the healthcare system, the manpower gap. We work mostly with physicians and advanced practitioners and now we do mental health as well. We all know there's a huge gap and it's our mission to fill that. And suddenly with the pandemic, we had a lot of doctors actually being idled, which was a stunning outcome of that to all of us and a need to shift to online health care. So, it was another serendipitous moment.
John: Yeah. When you look at companies like this recruitment and related things, it's always a chicken and egg. You need the bodies and you need the jobs and what do you get first and lots of companies just die because they can't do it. So, there you were, just boom. All of a sudden, we had a lot of people that were ready to look for something. And so, you could just soak that up as you built more and more opportunities. That's fantastic.
So, looking back, what kind of advice could you come up with in terms of someone who thinks “Wow, that sounds pretty interesting. Is there any method to the madness? How can I possibly try to do the same thing?”
Dr. Dan Field: There are so many ways of approaching that. And with our limited time, I'm trying to distill in my mind. I think that you have to know what it is that makes you happy, or at least satisfied. And keep in mind, we are not made to be happy. We're made to pursue happiness. But happiness never occurs. So, it's the pursuit. Now in that pursuit, what makes you feel the best? What tickles your brain and gives you a certain amount of joy and enjoyment? So, I think it's autonomy, variety, accomplishment, and reward. I think those are the four things that tickle my brain the most and give me the most satisfaction. So, something that gives me the autonomy to be able to get up in the morning and go for a run before I settle down, or get up even earlier and do some hard cognitive work and then go for a run and come back and do some more.
So that kind of autonomy, the variety. I'm coming at it from clinical ops, I'm doing med-legal, I'm doing clinical work, variety accomplishment. One of my biggest satisfaction moments came when I built my house because there it was, I did that. I did something. I brought all these parts together and I made something.
And then, of course, reward. Getting some money for what you do. Having people say, “Hey, doctor, you made a real difference on my LinkedIn”. It's especially rewarding. It’s ridiculously rewarding how pleased I am to have somebody just say like, or insightful, or go beyond and say, thank you for stepping out there and making these comments. So, my reward comes from so many different directions now.
John: Yeah. Well, people sometimes call it a purpose or passion and other rewards, but you're right. It's the journey, not so much like you've landed there. But I like you talking about your house because they have a physical representation. That thing is done. We don't always have that in medicine because our patients go away, they get better, they get worse. But if I could build a guitar or build a house.
Dr. Dan Field: Exactly, that's exactly right. Even a well-crafted medical-legal opinion to me where I took an issue. I refined it. I researched it. I made points. I justified those points and I presented them. That is something that's concrete. When I worked in the emergency department and I see the same person for a drug overdose three times, I don't feel like I've made a lot of progress there.
John: Yeah. Really, I can remember those experiences in my office as well. It's frustrating. That's kind of the patient you hate to see. You look at your schedule, you didn't have a schedule to look at, I'd look at a schedule and see the person who was coming back in two hours.
Okay. So, we're going to move to the meadow medical expert in a minute, but I want to ask you because I think this is an interesting transition. Physicians aren't really going to retire. I mean, they might retire from clinical, but our minds are going, we have energy, we have so much knowledge. Do you think that most physicians that practice as long as you did and that kind of environment, whether it's internal medicine, emergency medicine surgery, do you think we should pick up a few new skills at the end of that to anticipate this next? Should we do little pilots or do we have enough of the knowledge and skills that are really going to translate into some other jobs already?
Dr. Dan Field: I think preparation is the way to go. I think building a skill stack it's like opening up your tool chest and putting tools in it that are going to be useful to you. So, I knew that I liked med-legal. For some reason, I was attracted. In fact, when I applied to medical school, I applied, my thought was to do an MD/JD. That was 35 years ago. And it was too startling for most of the medical school admissions committees. And I didn't get accepted when I led with that. But I knew I liked it. And so, I began to add tools along the way. Kaiser doesn't allow you, TPMG, the Permanente medical doesn't allow you to do outside work for a monetary reward if it involves your license. But what they do allow you to do is public benefit.
So, I actually started working as a California medical board reviewer, and here they're asking us to look at medical cases and say was the standard of care met? Was there an education deficit? And I began to develop the evaluation capacity, which actually translated very well to my next stage as an expert witness.
John: Yeah. I think you don't always know where those are going to go, but those extra experiences can be very helpful. Not only because you've learned new skills, but then when someone's looking at you, they say, “Oh, wow, that's something interesting that might be useful for what we need”. So now, from what I understand when you joined MDstaffers and they had never had a CMO. They were small enough that they have a similar position.
Dr. Dan Field: They did have a CMO previous to me. It didn't work out the way they wanted it to and there was a parting of ways.
John: Okay. So, then there you are. And then you were the one I think that introduced this concept of adding the MDexperts to their growing kind of array of topical areas. So, tell us about that. I know you have that interest, but tell us how that transpired and what it is today.
Dr. Dan Field: Let's go back a step to MDstaffers business model. So, they have two clients. They have physicians and advanced practitioners, and that's one group of clients. And on the other side, they have the Adventist selves or the major healthcare organizations who are looking for manpower or person power support.
So, we are recruiting on the one side for those big company clients who need volume and we're prospecting for the workers on the other side, and then we're going to match those. They might say, we need a hundred mental health care workers for our telemedicine product. And we'll say, okay, are you ready for a hundred of them next week? And we've broken the bank there, or the processes for some of our companies because we give them so many high qualities. Well, we now got a hundred thousand plus physicians in our Rolodex and it takes an older person to know what a Rolodex is.
The concept is really simple. Somebody needs a specialty in Hackensack, New Jersey. And they call us up and they say, “Who do you have in Hackensack who is a pediatric pulmonologist?” So, we just go into our tracker database and type in 50 miles from Hackensack and a pediatric pulmonologist. And I get four names and I have the CVs. I have everything ready and we shoot them a CV and they say yes. And then we match the two.
John: What's the experience for the physician? Are they a subcontractor for you and MDstaffers or directly for the attorneys that are looking for them or the insurance company or whatever it might be? How does that work?
Dr. Dan Field: Well, that's a good question. In many of these circumstances, it's a handoff once the connection is made and somehow the value has been extracted before that stage. And then it's up to the physician to work out with the requester. Our model is that we manage the process. We do the invoicing, we guarantee the payment, we pay the liability in this case. And in exchange, we take a less than typical market share. So, it'll be less than 30% for our margin. So that's the model.
John: Do you have a sense of the physicians? Do you get many physicians starting out that haven't done this before and contact you about signing on, or do you generally use more experienced people or both? What feedback do you get from the physicians that are involved?
Dr. Dan Field: A lot of physicians come to us through the recruitment process. So, on MDstaffers side, where we're talking to them and we're engaging in conversations, our recruiters are really good, and we really develop a nice relationship with their doctors. And along the way, we say, “And by the way, are you interested in this line of work over here?” And a high proportion of the people that we talked to say, “Yeah, yeah, I might like to do that, but I haven't had any experience”. Well, we have a little process that we go through to help them begin to build the experience. And in those cases, you can volunteer for your in-house quality assurance committee. You might get paid for that in-house, and you begin to build some variety inside your current practice, which is a very nice longevity tool because again, variety and autonomy and reward.
So, you begin to build some of those inside your current lifestyle. You reach out to your medical board and see if they have a reviewer program. You touch bases with the public defender's office. They're dying for experts, but they can't afford them. And so, we created a government rate basically to help the justice system, and it's much lower than the commercial rates, which we charge at-large criminal product, liability, and so forth. And that is beneficial to society and its benefits to us because it builds experience and volume. So, that's what I tell the new physicians. I say, take them through this route.
John: I had a conversation with one of my colleagues who does a lot of telemedicine. He's licensed in multiple states. And he said that he had discovered that many of the state licensing boards need physicians to review records, review quality, review complaints. So, you're saying that kind of thing could set them up to take the next step and move maybe more directly into an expert witness type of activity.
Dr. Dan Field: Yes. And since a lot of physicians are not looking to leave clinical practice entirely, they're trying to build a side gig inside their current lifestyle, where they can take some of their non-program time and turn it to a monetary reward and then perhaps reduce their clinical. And as we all know, when you reduce clinical, you reduce exposure.
John: That's a good part.
Dr. Dan Field: Well, it's a great part. And it has two parts to it itself. This is a little segue, but not only are you reducing your personal exposure, but the very act of studying these things teaches you how to avoid exposure. So, it's a total win-win and perhaps triple win situation.
John: Yeah. I guess if you're gaining expertise on how to be an expert witness and then you know “Oh, my documentation needs to be spruced up a little because obviously, this is what they're asking me to look at”. Or if you happen to go through a deposition, you learn those things pretty quickly.
Dr. Dan Field: Okay. So, let me throw one more thing at you along these lines, because you were asking how we prepare our new doctors for this kind of career. Another thing is just an education on what an actual expert witness is and does. So, we all have kind of our TV imagery. Yep. But what is the reality? And my reality is that I have found that I am an interpreter. That's how I look at my expertise as that of interpretation.
So, I take a medical record and other information that might be confusing and are out of the area of expertise of the judge, the jury, and the attorneys. And I interpret this for them in an ethical, and, what would be a good word? It's somewhat of a blinded fashion. I kind of walk into these cases without a preconceived notion or with the openness that my preconceptions and biases might be changed by the facts of the case. And that happens a lot. I had a great case with the Air Force, where I went in thinking “This guy's a scumbag and I'm here to defend him”. And in the course of the case, it turned out not to be in my opinion. So, you were an interpreter.
John: Now, what I've heard others ask about as well, “How much actual record review am I doing as opposed to actually ended up doing a deposition? And am I likely to ever end up in court in a trial?”
Dr. Dan Field: The answer is no.
John: It's pretty rare.
Dr. Dan Field: Yeah, just like with malpractice cases, mostly favoring the physician. Probably 95%, something like that. That same applies to your chances of actually getting into the court. So, I've probably reviewed a hundred cases by now. Not huge, maybe even 200. And I probably made it into court a total of 15 times, and I love depositions. I love sitting in court. I love that part of it very much. I don't like malpractice. I don't think anybody does, but personal injury and criminal is really nice because I go there as a nonpartisan and I'm here to help and advise.
John: No, I think that's a good picture of how things go. You have to have a certain personality, I suppose. You can't be a hothead that flies off the handle. You have to be able to listen, stop and be calm basically, and give a measured response. But if you can do that, I mean we're well-trained, we should be able to do it in most cases. So, I think it's something that practicing physicians rather than just, say, dumping clinical completely, maybe cut back on the clinical because you need to stay in clinical if you're going to do this anyway, most likely because they want you to know the standard of care. And do this. It's a good side gig. And like you said, it could balance out things.
Dr. Dan Field: Variety and reward and some autonomy. You know what? You really hit upon it, John. I think you were touching on a valuable tool - You need to be a team player. And think, for instance, a physician such as yourself, a family practice person, perhaps with an office or a team, have some nurses, you have an assistant. They're your team and you're working with your team to bring about an end. And when you are an expert witness, you're part of the team. You're not house. You're not the prima donna that everybody's going to come and bow to. You are part of the team and you're working to get to the end to go deliver a product.
John: So, if I was interested, I could get on the phone and call MDstaffers, MDexperts, and just talk to somebody about what it would take to become one of your physicians that do that. And if they have to do some other work first, that's fine. But at least I can learn more about how to get there.
Dr. Dan Field: I'm happy to talk to anybody who wants to discuss this. I've benefited from those who have gone before me. And I will be paying it forward as the phrase goes and helping the people along the way. I’ve got some good ideas for them.
John: All right. I want to remind everyone that the website is mdstaffers.com. That's one word and everything that you've talked about and everything that MDstaffers does is somewhere on that website. And there's probably a contact form to reach out if you'd like to do that. Is there any other thing? Like the mention about MDstaffers, you say you've got a locum’s component as well. So, a lot of people use that as a temporary or permanent change from what they're doing.
Dr. Dan Field: Yes. You should keep in mind, those of us who are near retirement. And if you think, “Well, I might take a couple of years off and travel to Fiji and Bora Bora” and so forth. At least in emergency medicine and probably the same for surgery and some other areas. If you haven't practiced in the clinical setting in the last 18 months, you're out. The process to get back in and to get on staff becomes much more onerous than people would consider.
So, I really advise people to keep their foot and their toe in the bathtub here and keep a little side clinical going. And that can extend your career until as long as you want it to go. I frankly don't know what I would do if I didn't have this to get up to every day. I mean, I could not sit there and read the paper and drink coffee all morning, and then go meet my buddies at the coffee shop for more coffee. I need more than that.
John: No, everyone I've talked to, I haven't really seen a physician. Most of us either practice till we drop, or we do something else. And that's healthy. You need that, I think. All right, well, we're going to run out of time here. So, I guess I would ask you if you have any other advice, maybe for a physician who's maybe not quite ready for retirement, but thinking about those few years down the road. Any specific advice or other comments you would have for us?
Dr. Dan Field: Yeah, yeah. Realize that failure equals experience. Don't be afraid to go out and try something. You're going to learn. You're going to learn as you go. So, when I went out and worked in the business world, I learned some business concepts and I learned how important it was to be a team player. Don't quit your day job. Find a way of diversifying your day job internally and pick up skills so that you have something to offer when you get out.
I think you should try to find out what tickles your brain and then make that the direction that you're going to move. So, you're going to build your skillset around those things that bring you that happiness or satisfaction. And there are ways to do that by taking baby steps. So, I'm an incrementalist. I like job security and a paycheck, so that's my advice.
John: All right, Dan. Well, this has been very interesting. We've learned a lot about the two major topics that I think we're going to be able to learn from and apply. So, I really want to thank you for spending the time. Again, that's mdstaffers.com. I'm sure they can track you down there, or you can go on LinkedIn and probably get a hold of you and contact you that way.
Dr. Dan Field: Absolutely.
John: All right. Well, with that, I guess I'll just have to say goodbye.
Dr. Dan Field: Okay. Thank you.
John: You're welcome. Bye-bye.
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