Interview with Dr. Armin Feldman
In this interview, Dr. Armin Feldman explains how to use a new kind of medical legal consulting as a lucrative side gig.
Dr. Armin Feldman is a graduate of the University of Wisconsin Medical School. He completed his training in psychiatry at the University of Colorado Health Sciences Center.
He practiced psychiatry and psychoanalysis for over 20 years, and he owned a network of out-patient head injury rehabilitation clinics around the country.
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A New Form of Medical Legal Consulting
Armin describes how he developed a unique kind of medical legal consulting during that time. He sold his clinic network about 14 years ago. And he devoted himself to providing those services full time. After a few years of perfecting his approach, he began teaching other physicians how to adopt what he was doing.
Over the past 12 years, he has trained over 1,600 other physicians through his Medical/Legal Consulting Coaching Program.
Active Medical Practice Not Required
Dr. Feldman’s consulting is pre-litigation and pre-trial in nature. He helps attorneys manage the medical aspects of cases, increasing case value and saving attorney time. He enables them to better negotiate and settle cases and get the appropriate medical care for their clients. And he does not participate in medical malpractice cases.
If you want to learn more, you can check out the home page for his coaching services and watch a short video at mdbizcon.com. And if you’d like to sign up for his biweekly email, just send him a note requesting it at armin@golegaldoc.com
Summary
That was an eye-opening interview. And it seems like a fairly compelling way to leverage your medical knowledge. Following Dr. Feldman's methods, you will be able to provide lucrative pre-trial medical legal consulting services on a part-time basis.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
- Medical Legal Consulting Coaching Program
- Sign up for Dr. Feldman's Email Newsletter at armin@golegaldoc.com
- NewScr!pt
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Transcription PNC Podcast Episode 227
How to Do a New Kind of Medical Legal Consulting as a Part-Time Gig
John: I'm excited to bring you today's interview with an expert on a new kind of medical legal consulting. I think you'll find it very appealing. Dr. Armin Feldman, welcome to the PNC podcast.
Dr. Armin Feldman: Hi John. It is a pleasure to be with you.
John: I've really been looking forward to this because I'll just say that I discovered you somehow doing something that I find very intriguing, very appealing. I've always been one to like, although I've never done it myself, medical expert witness sort of work because I think it fits in with physicians as a part-time gig. But I think you've found a way to even improve on that. First, why don't you just tell us a little bit about your background and bring us through your education and so forth and, and then to what you're doing today?
Dr. Armin Feldman: Sure. I grew up in Milwaukee and I went to college at University of Wisconsin. and then I also went there for medical school. After medical school, I did an internship in internal medicine at the University of Colorado. And then stayed at the University of Colorado for my residency in psychiatry.
After I finished my residency in psychiatry, by the way, for the next five years of Friday afternoons and Saturday mornings, I was also a student at the Denver Institute for Psychoanalysis and I am also a graduate of the Denver Institute. For about 20 years, I have practiced psychiatry and psychoanalysis. And an interesting thing happened along the way. When I was still a resident, I met a young personal injury attorney who was doing some work for a friend of mine. We've been friends now for over 30 years. But after I got into practice, he started sending me his injured clients who primarily have head injuries. And that led me into the field of mild traumatic brain injury.
My true specialty in psychiatry turned out to be mild traumatic brain injury. And I wound up owning an outpatient head injury rehabilitation clinic in Denver. I had a treatment program of my own design. I eventually had other psychiatrists, psychologists, neuropsychologists, psychotherapists, biofeedback therapists, and others working at the clinic. And that led me to eventually wind-up owning outpatient head injury rehab clinics all around the country. I was fortunate enough to eventually sell those clinics. And after I sold the clinics, I was thinking about, "Well, what do I want to do next?" I didn't want to retire. I love medicine.
As part of that work, I testified as an expert witness more times than I wanted to remember on behalf of my patients who are either being cut off their medical care or offered some pits of a settlement. And I was quite familiar with our legal system and I thought, "Well, maybe what I could do is just consult attorneys on any kind of medical question that came up in a case and work with them, pretrial pre-litigation".
In other words, in the areas of the law that I started working with attorneys, approximately 9 out of 10 cases settled. And so, that's where I came in. Well, one thing led to another, and I wound up developing what has turned into a whole new subspecialty of forensic medicine that deals with the pretrial pre and aspects of legal cases. And I developed a whole variety of fairly specific services to help the attorneys help their clients to better negotiate and settle cases.
And after doing that for a few years, I realized this probably could be a new field. I started training other physicians how to do this work through a training program and through conferences. And I guess as they say, the rest is history, it's now 14 years later. Through those means I've trained over 1,600 physicians around the country. And so, that brings us up to today.
John: Very interesting. And of course, you've touched on some of the factors that maybe make this a little bit more appealing than some other forms of consulting. But why don't I have you really spell those out for us? When we think of medical expert witnesses for legal reasons, of course, we're talking about reviewing charts, then a certain percentage of those will result in a deposition and then even a smaller percentage will potentially end up in court. It can get a little stressful, a lot of time involved. It sounds like you're doing something a little different that doesn't always involve those aspects. So, tell us about that.
Dr. Armin Feldman: Yeah, that's right. First of all, I should say I don't do any expert witness work and I don't work in medical malpractice cases. I am working in other kinds of legal cases. The work is primarily in personal injury cases and workers' compensation cases with regard to injuries. But I'll tell you any physician in any specialty can learn how to do this kind of consulting. What happens is, the attorney will call me with a case. We will discuss the case. They will send the medical records. After I review the medical records, I'll interview the client of the attorney in every case. Typically, it was by phone, but now it might be by Zoom meeting. Less than 3% of the time I may want to interview the client in the attorney's conference room.
Once I do my review of the records and interview the client, then I'm going to do any medical research that I need to do. And then in many cases, I'm writing a report. Many services don't require a report, but the thing to understand is that I answer and other physicians that do this, we answer any kind of medical question that comes up in a case. And so, the issue may be related to a specific medical question, a specific condition, a specific injury.
By the way, there are about 16, 17 different kinds of services that we offer to these attorneys to help them. And what that means is to better settle the case. It means settling the case for better value with less attorney time. Help the attorney get the appropriate medical care for their clients, and also help the attorney just to negotiate all the medical issues in the case.
I'll give you a couple of examples. The service that is most requested is to provide the attorney with comprehensive medical summary reports, by the way, it's just a term I invented. But comprehensive medical summary reports that they will include in settlement demand letters. Through the negotiation process, at some point, the attorney will file or submit to opposing counsel and to the insurance company a settlement demand letter. And in that letter one of the things that the attorney must put in there, these are fairly standardized state by state, but obviously, they have to put in a description of damages. There are all kinds of damages. Damage to a car, loss of work time, loss of enjoyment of life, which by the way isn't medical damage. Medical damages tend to be the biggest group.
We will give our medical opinions based on all the things that I just told you about regarding every injury in the case. And so, we will write a comprehensive report that includes our medical opinions. And one of the things that makes this viable is in our legal system, physicians are expected to, and are sanctioned to give medical opinions to medical questions.
Now, if it's that 1 out of 10 cases that's going to trial, well, then obviously the attorney is going to need medical experts in every area of injury. But for the purpose of negotiating and settling the case, what the attorney needs are medical opinions, reports, and other services, all backed up by evidence from the medical literature that they can use to settle the case. And this is a completely legitimate thing that any physician can do. These reports will cover everything in the case, every injury in the case, along with a number of other fairly specific things that need to be in this kind of report.
Now, another thing that we do is that we can actually physically sit in and observe independent medical exams that other physicians do, which puts us in a position to write IME rebuttal reports. Now we all know that they're very good doctors that do very good IME. We also know that in every community across the country, there are physicians that are specifically asked to do these by the insurance companies because they have a fairly good idea of what the opinions are going to be. I think I was probably the first physician in the country to actually physically sit in and observe IBS and write rebuttals.
Another thing that we do quite often is we'll answer specific medical questions in cases. And when we do that, what we're doing, for the most part, is we're helping what the attorneys call to prove a particular medical theory for the case. Now sometimes we'll do that and we'll tell the attorney, "This isn't going to fly, don't do this". But most of the time what we're doing is we're helping to prove a particular medical theory for the case.
Let me just digress for a sec and I'll tell you one other thing. When I started doing this, let's say there was some issue in the case related to a rotator cuff injury, and the attorney wanted a report and my opinion on that particular thing. I would write up the report in the manner in which I just told you. My report's going to go to opposing counsel. Our work is not behind the scenes. Our reports are seen by opposing counsel. They're almost always seen by insurance adjusters. They're often seen by judges, treating doctors, IME doctors, and others.
And the opposing counsel gets my report. Well, what's the first thing they're going to do? They're going to look me up. They look me up and they call the attorney that hired me and they say, "Well, I looked Dr. Feldman up. Why should I pay any attention to his report? He is not an expert in rotator cuff injuries". And of course, this doesn't happen to me anymore because people know who I am, but that's what happens with everyone.
But what my attorney's going to say is, "Well, Dr. Feldman acts as a medical consultant for me, by the way, as opposed to a medical expert, but works as a medical consultant for me in all my cases. And if we can't get this issue and negotiate it out in the settlement based on Dr. Feldman's opinions and boards, and I back it up with evidence from the literature so forth, and you forced me to take this case to trial. When I hired my retained orthopedic surgeon, they're going to say exactly what Dr. Feldman said in his report. In fact, they would be both relying on the same literature, so let's get this settled". And that's how it works.
John: Okay. Let me go back a couple of things just to make it crystal clear because these are some of the things I found so fascinating. Number one is you were talking about the IME Independent Medical Exams. And what you're doing when you do them is you're actually observing someone else's IME as a way to kind of keep the whole process valid for your side of the equation for the attorney you're working with. I just want to make that clear. I think you did, but just for the audience to understand. This is like another sort of perspective to the whole process.
Dr. Armin Feldman: Yeah, that's correct. Sometimes it's something as simple as an observation. I did a case. It was a woman that had a head injury. She had
symptoms, there were CNS questions. All the treating doctors were in agreement with this. One IME doctor said, "No, there's nothing wrong with her". So, I went to a different IME and the IME report came back and the report was that Babinski's were negative. Well, one was positive. And I saw it, I observed it. I tested that. I wasn't the only doctor that saw that. Many of the treating doctors saw that.
And so, that was something that came up in that particular IME. But most of the time, it's more of an opinion thing. The person doesn't need revision surgery for the rotator cuff, because there was no dial leakage on her arthrogram. Well, most orthopedic surgeons would say pain and range of motion, degree of functionality. These are the things that would be criteria with regard to whether that revision surgery would be needed or not. And that's what I might talk about in my revision and my rebuttal report.
John: Right. Again, just to point out something you've already said, the fact that you're a psychiatrist really doesn't make any difference. You don't have to be an internist, an orthopedist, or a neurologist. You need really a basic medical background and maybe a little experience and the ability to read the literature and then serve as sort of an interpreter there for your attorney, your attorney's client, that sort of thing.
Dr. Armin Feldman: In fact, John, it's one of the things that's so much fun about this work. Now, some physicians I talk with, they might be interested in doing this. I talk with them and they just want to stay in their lane. They are not interested in this. But if you went to medicine because you found out that you love medicine, and you enjoy learning about all aspects of medicine, then this is just tremendous, it's so much fun.
I'm not in any position to do any orthopedic or neurosurgery, but I put my knowledge base of spine injuries, rotator cuff injuries, complex regional pain syndrome, and other things up against anyone. And I'm such a more well-rounded and better doctor for all of the hundreds of hours of research that I've done over the years.
John: It's interesting. I interviewed someone who is a medical director or a CMO at a life insurance company. And she happened to be a cardiologist. It's like, well, what does a cardiologist know about life insurance? But it was exactly what you're saying. She was asked to interpret. She would do her research. Whether she had to do with pediatrics adult cardiac renal didn't matter. It was all based on the basic background of being a physician that's got a broad sort of training. That's another very interesting perspective. All right. Are there challenges in this thing? It sounds like it's Nirvana, it's fantastic. There's got to be some challenges and probably some pre-work you have to do.
Dr. Armin Feldman: Yeah. Again, I'm not sure this is entirely a challenge, but it's certainly a thing of interest. In my training program, I'm training physicians on two things. I'm training them on the medicine they need to know, but also, I'm training them on how to successfully start-up, but more importantly, how to run a long-term medical legal consulting business. If there's a challenge, it's the issues outside of medicine. How do you get from zero to up and running with your business? How do you market your business? How do you run your operations on a day-to-day basis? How do you do your billing? These kinds of things.
And so, maybe the challenge for physicians is on that side of the equation. Physicians are now just being employees of big corporations or hospital systems. So, what's the biggest trend? Everybody wants their own side gig, right? So many doctors want their own thing. Well, to have your own thing, you have to know something about business and how to run that business. It doesn't run itself. Now for me, of course, this has been part of the fun of it all. But if there's a challenge it's getting used to... And any physician can learn it, but it's getting used to that side.
John: The plus side there it sounds to me is that if someone is unhappy, unfulfilled and is looking for an alternative that if they can just squeeze out some time, they can actually start this on a part-time basis, learn about it, start working on how to get some clients. And then if it really resonates with them, then they can gradually either phase out or quit their other job or get another type of less stressful clinical job let's say.
Dr. Armin Feldman: Yeah, that's right. Now there are physicians that do it full time. There are physicians that do it instead of retiring, but you're right, the largest group are physicians that do this as a part-time side gig.
John: Okay. Now, how does someone get paid doing this? Do you just sort of have a retainer? Do you use an hourly rate? Do you do a case rate? All the above? I think people will have that question.
Dr. Armin Feldman: The way I train the physicians that are doing this is I charge by the hour for everything that I do. One hourly fee. I keep the billing log form along. Attorneys understand hourly billing. Now, of course, in the areas of the law, which I work primarily, it's done by contingency. But I charge by the hour for everything that I do. Just to quick aside. Now I'm not working on contingency. When I send my bill, I expect to be paid in the next 30 days. And in the real world, 90% of the time I'm paid within 30 to 60 days of sending my bill.
But the way that I've advised physicians over the years is to do an informal survey of their colleagues, determine what you think is the average fee per hour for doing medical expert work in your community. Now, obviously, there's a range, right? Not hard to figure the average. So once you get that average, then you want to come in somewhat below what the medical experts are charging doing this acting as a medical consultant, pretrial, pre-litigation.
John: Okay. That's pretty straightforward. And they can get some either from you, if they take your coaching course or elsewhere, they can figure that out. Tell us about your course exactly. What is it? What is it like now? Is it face to face? Is it live? Is it online? Is it recorded? What does it look like?
Dr. Armin Feldman: It's one year and the physician gets all of the business concepts, all the business tools they need, the medical tools, the training, the manual, the how-to on every aspect of the business. They get everything that I use in my business. They get a website, so forth. And it's both on the business side and on the medical side. But the big thing is they get a year of coaching with me. And I've been doing this full-time for 14 years. And so, it's not an absolute necessity. Occasionally somebody joins the coaching program, I don't hear from them much and they're successful. But far and away, far, far and away, the physicians that stay in close touch with me are the most successful. Whatever they need during the launch plan period, I help all of the physicians with some of their marketing. That's how they learn it in the beginning. I'll actually help them to get their first cases in the door. I read tons of drafts of reports before they go out to their attorneys, and really anything I can do from my end that's going to help them to be successful.
John: That sounds like it's fairly comprehensive for those that take advantage of it. Can you give me an example? I'm curious if everyone that learns this from you, do they do exactly what you do or do you see examples where someone might say, "Well, I want to focus on this aspect or that aspect?" Or maybe they just end up doing something slightly different, just because we're all different. Any examples like that?
Dr. Armin Feldman: There's kind of a tried and true way to do this. And not that I haven't learned from coaching members over the years and made adjustments to things, both on the business side and the medical side. But the fact is if you vary too far from the standard approach, it tends not to be as successful.
John: Well, when you've been doing something for 15 years it tends to be a pretty well-oiled machine at that point, I assume.
Dr. Armin Feldman: Yeah. Yeah. And not that I'm not open to hearing what physicians that are training or have trained are doing. But most of them come back around to doing it the way they were trained.
John: Got it. All right. Well, before we go any further, we're getting near the end here, but I want to make sure I mention your website. Actually, it's sort of a page that has this course on it. It's called mdbizcon.com. And I found a video there. It pretty much explains everything. It's again, pretty interesting. That's one of the things that got me interested in getting you on here in the podcast today. So, let's not forget about that. And then I'm also going to put a copy of your email address in the show notes for anyone that would like to get on your email list. Is that doable?
Dr. Armin Feldman: Yeah, that would be great. I do have a newsletter once a month for physicians that are interested in this topic. And then two weeks after the newsletter comes out, I send out a shorter plain text email with tips, advice on various topics as they come up in my day-to-day work. And then I'll talk about it.
John: If you were to be addressing some of my listeners here who are sometimes a little bit burned out or they're just frustrated with medicine in general, what advice might you have for them in terms of thinking about their careers?
Dr. Armin Feldman: I think as physicians, we all want to help people. That's a good portion of the reason we got into it. So, I would say, first and foremost, find something that you can use your medical knowledge to still help people. And this isn't anything profound, I'm sure you've heard it before. But if you're doing something that you really enjoy and find fun, it doesn't seem much like work. If you're going to do something on the side or look for something to cure that burnout, make sure it's something that you really enjoy, that you find fun doing every day. And if you can combine that with helping people, and by the way, making money, what's better than that?
John: Oh, that's absolutely right. Great advice. Yeah, I think if people don't know about these things, then they feel sort of frustrated or resigned that they can't break away from the corporate practice of medicine or something like that. But just in having conversations with people like you, we've seen just dozens and dozens of different opportunities and options for people if they just sort of open their eyes and look around. I appreciate those comments. Anything else you need us to know about this new kind of medical legal consulting?
Dr. Armin Feldman: If you enjoy medicine as a whole, and you got a kick out of being in med school and learning all the things that we know, and you want to put that medical knowledge to work in a nonclinical field that really helps people and is lucrative, this is something that you should look at.
John: Yeah, that's what I thought when I first heard about this. It's intellectually stimulating. It builds on your medical and actual understanding of the healthcare system itself. And you don't have to be in any particular specialty and you don't have to keep practicing to do this ultimately if you decide to do it full-time from what you've said.
Dr. Armin Feldman: Right.
John: All right. Well, thank you very much. This has been very fascinating, Armin. I really appreciate you for coming on today. And I hope a few of my listeners take you up on the email letter and maybe even enroll in your coaching course. With that, I'll have to say bye-bye.
Dr. Armin Feldman: Okay. Thank you, John. It's been my pleasure.
John: It's been great. Thanks. Bye-bye.
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Transcription PNC Podcast Episode 227
How to Do a New Kind of Medical Legal Consulting as a Part-Time Gig
John: I'm excited to bring you today's interview with an expert on a new kind of medical legal consulting. I think you'll find it very appealing. Dr. Armin Feldman, welcome to the PNC podcast.
Dr. Armin Feldman: Hi John. It is a pleasure to be with you.
John: I've really been looking forward to this because I'll just say that I discovered you somehow doing something that I find very intriguing, very appealing. I've always been one to like, although I've never done it myself, medical expert witness sort of work because I think it fits in with physicians as a part-time gig. But I think you've found a way to even improve on that. First, why don't you just tell us a little bit about your background and bring us through your education and so forth and, and then to what you're doing today?
Dr. Armin Feldman: Sure. I grew up in Milwaukee and I went to college at University of Wisconsin. and then I also went there for medical school. After medical school, I did an internship in internal medicine at the University of Colorado. And then stayed at the University of Colorado for my residency in psychiatry.
After I finished my residency in psychiatry, by the way, for the next five years of Friday afternoons and Saturday mornings, I was also a student at the Denver Institute for Psychoanalysis and I am also a graduate of the Denver Institute. For about 20 years, I have practiced psychiatry and psychoanalysis. And an interesting thing happened along the way. When I was still a resident, I met a young personal injury attorney who was doing some work for a friend of mine. We've been friends now for over 30 years. But after I got into practice, he started sending me his injured clients who primarily have head injuries. And that led me into the field of mild traumatic brain injury.
My true specialty in psychiatry turned out to be mild traumatic brain injury. And I wound up owning an outpatient head injury rehabilitation clinic in Denver. I had a treatment program of my own design. I eventually had other psychiatrists, psychologists, neuropsychologists, psychotherapists, biofeedback therapists, and others working at the clinic. And that led me to eventually wind-up owning outpatient head injury rehab clinics all around the country. I was fortunate enough to eventually sell those clinics. And after I sold the clinics, I was thinking about, "Well, what do I want to do next?" I didn't want to retire. I love medicine.
As part of that work, I testified as an expert witness more times than I wanted to remember on behalf of my patients who are either being cut off their medical care or offered some pits of a settlement. And I was quite familiar with our legal system and I thought, "Well, maybe what I could do is just consult attorneys on any kind of medical question that came up in a case and work with them, pretrial pre-litigation".
In other words, in the areas of the law that I started working with attorneys, approximately 9 out of 10 cases settled. And so, that's where I came in. Well, one thing led to another, and I wound up developing what has turned into a whole new subspecialty of forensic medicine that deals with the pretrial pre and aspects of legal cases. And I developed a whole variety of fairly specific services to help the attorneys help their clients to better negotiate and settle cases.
And after doing that for a few years, I realized this probably could be a new field. I started training other physicians how to do this work through a training program and through conferences. And I guess as they say, the rest is history, it's now 14 years later. Through those means I've trained over 1,600 physicians around the country. And so, that brings us up to today.
John: Very interesting. And of course, you've touched on some of the factors that maybe make this a little bit more appealing than some other forms of consulting. But why don't I have you really spell those out for us? When we think of medical expert witnesses for legal reasons, of course, we're talking about reviewing charts, then a certain percentage of those will result in a deposition and then even a smaller percentage will potentially end up in court. It can get a little stressful, a lot of time involved. It sounds like you're doing something a little different that doesn't always involve those aspects. So, tell us about that.
Dr. Armin Feldman: Yeah, that's right. First of all, I should say I don't do any expert witness work and I don't work in medical malpractice cases. I am working in other kinds of legal cases. The work is primarily in personal injury cases and workers' compensation cases with regard to injuries. But I'll tell you any physician in any specialty can learn how to do this kind of consulting. What happens is, the attorney will call me with a case. We will discuss the case. They will send the medical records. After I review the medical records, I'll interview the client of the attorney in every case. Typically, it was by phone, but now it might be by Zoom meeting. Less than 3% of the time I may want to interview the client in the attorney's conference room.
Once I do my review of the records and interview the client, then I'm going to do any medical research that I need to do. And then in many cases, I'm writing a report. Many services don't require a report, but the thing to understand is that I answer and other physicians that do this, we answer any kind of medical question that comes up in a case. And so, the issue may be related to a specific medical question, a specific condition, a specific injury.
By the way, there are about 16, 17 different kinds of services that we offer to these attorneys to help them. And what that means is to better settle the case. It means settling the case for better value with less attorney time. Help the attorney get the appropriate medical care for their clients, and also help the attorney just to negotiate all the medical issues in the case.
I'll give you a couple of examples. The service that is most requested is to provide the attorney with comprehensive medical summary reports, by the way, it's just a term I invented. But comprehensive medical summary reports that they will include in settlement demand letters. Through the negotiation process, at some point, the attorney will file or submit to opposing counsel and to the insurance company a settlement demand letter. And in that letter one of the things that the attorney must put in there, these are fairly standardized state by state, but obviously, they have to put in a description of damages. There are all kinds of damages. Damage to a car, loss of work time, loss of enjoyment of life, which by the way isn't medical damage. Medical damages tend to be the biggest group.
We will give our medical opinions based on all the things that I just told you about regarding every injury in the case. And so, we will write a comprehensive report that includes our medical opinions. And one of the things that makes this viable is in our legal system, physicians are expected to, and are sanctioned to give medical opinions to medical questions.
Now, if it's that 1 out of 10 cases that's going to trial, well, then obviously the attorney is going to need medical experts in every area of injury. But for the purpose of negotiating and settling the case, what the attorney needs are medical opinions, reports, and other services, all backed up by evidence from the medical literature that they can use to settle the case. And this is a completely legitimate thing that any physician can do. These reports will cover everything in the case, every injury in the case, along with a number of other fairly specific things that need to be in this kind of report.
Now, another thing that we do is that we can actually physically sit in and observe independent medical exams that other physicians do, which puts us in a position to write IME rebuttal reports. Now we all know that they're very good doctors that do very good IME. We also know that in every community across the country, there are physicians that are specifically asked to do these by the insurance companies because they have a fairly good idea of what the opinions are going to be. I think I was probably the first physician in the country to actually physically sit in and observe IBS and write rebuttals.
Another thing that we do quite often is we'll answer specific medical questions in cases. And when we do that, what we're doing, for the most part, is we're helping what the attorneys call to prove a particular medical theory for the case. Now sometimes we'll do that and we'll tell the attorney, "This isn't going to fly, don't do this". But most of the time what we're doing is we're helping to prove a particular medical theory for the case.
Let me just digress for a sec and I'll tell you one other thing. When I started doing this, let's say there was some issue in the case related to a rotator cuff injury, and the attorney wanted a report and my opinion on that particular thing. I would write up the report in the manner in which I just told you. My report's going to go to opposing counsel. Our work is not behind the scenes. Our reports are seen by opposing counsel. They're almost always seen by insurance adjusters. They're often seen by judges, treating doctors, IME doctors, and others.
And the opposing counsel gets my report. Well, what's the first thing they're going to do? They're going to look me up. They look me up and they call the attorney that hired me and they say, "Well, I looked Dr. Feldman up. Why should I pay any attention to his report? He is not an expert in rotator cuff injuries". And of course, this doesn't happen to me anymore because people know who I am, but that's what happens with everyone.
But what my attorney's going to say is, "Well, Dr. Feldman acts as a medical consultant for me, by the way, as opposed to a medical expert, but works as a medical consultant for me in all my cases. And if we can't get this issue and negotiate it out in the settlement based on Dr. Feldman's opinions and boards, and I back it up with evidence from the literature so forth, and you forced me to take this case to trial. When I hired my retained orthopedic surgeon, they're going to say exactly what Dr. Feldman said in his report. In fact, they would be both relying on the same literature, so let's get this settled". And that's how it works.
John: Okay. Let me go back a couple of things just to make it crystal clear because these are some of the things I found so fascinating. Number one is you were talking about the IME Independent Medical Exams. And what you're doing when you do them is you're actually observing someone else's IME as a way to kind of keep the whole process valid for your side of the equation for the attorney you're working with. I just want to make that clear. I think you did, but just for the audience to understand. This is like another sort of perspective to the whole process.
Dr. Armin Feldman: Yeah, that's correct. Sometimes it's something as simple as an observation. I did a case. It was a woman that had a head injury. She had
symptoms, there were CNS questions. All the treating doctors were in agreement with this. One IME doctor said, "No, there's nothing wrong with her". So, I went to a different IME and the IME report came back and the report was that Babinski's were negative. Well, one was positive. And I saw it, I observed it. I tested that. I wasn't the only doctor that saw that. Many of the treating doctors saw that.
And so, that was something that came up in that particular IME. But most of the time, it's more of an opinion thing. The person doesn't need revision surgery for the rotator cuff, because there was no dial leakage on her arthrogram. Well, most orthopedic surgeons would say pain and range of motion, degree of functionality. These are the things that would be criteria with regard to whether that revision surgery would be needed or not. And that's what I might talk about in my revision and my rebuttal report.
John: Right. Again, just to point out something you've already said, the fact that you're a psychiatrist really doesn't make any difference. You don't have to be an internist, an orthopedist, or a neurologist. You need really a basic medical background and maybe a little experience and the ability to read the literature and then serve as sort of an interpreter there for your attorney, your attorney's client, that sort of thing.
Dr. Armin Feldman: In fact, John, it's one of the things that's so much fun about this work. Now, some physicians I talk with, they might be interested in doing this. I talk with them and they just want to stay in their lane. They are not interested in this. But if you went to medicine because you found out that you love medicine, and you enjoy learning about all aspects of medicine, then this is just tremendous, it's so much fun.
I'm not in any position to do any orthopedic or neurosurgery, but I put my knowledge base of spine injuries, rotator cuff injuries, complex regional pain syndrome, and other things up against anyone. And I'm such a more well-rounded and better doctor for all of the hundreds of hours of research that I've done over the years.
John: It's interesting. I interviewed someone who is a medical director or a CMO at a life insurance company. And she happened to be a cardiologist. It's like, well, what does a cardiologist know about life insurance? But it was exactly what you're saying. She was asked to interpret. She would do her research. Whether she had to do with pediatrics adult cardiac renal didn't matter. It was all based on the basic background of being a physician that's got a broad sort of training. That's another very interesting perspective. All right. Are there challenges in this thing? It sounds like it's Nirvana, it's fantastic. There's got to be some challenges and probably some pre-work you have to do.
Dr. Armin Feldman: Yeah. Again, I'm not sure this is entirely a challenge, but it's certainly a thing of interest. In my training program, I'm training physicians on two things. I'm training them on the medicine they need to know, but also, I'm training them on how to successfully start-up, but more importantly, how to run a long-term medical legal consulting business. If there's a challenge, it's the issues outside of medicine. How do you get from zero to up and running with your business? How do you market your business? How do you run your operations on a day-to-day basis? How do you do your billing? These kinds of things.
And so, maybe the challenge for physicians is on that side of the equation. Physicians are now just being employees of big corporations or hospital systems. So, what's the biggest trend? Everybody wants their own side gig, right? So many doctors want their own thing. Well, to have your own thing, you have to know something about business and how to run that business. It doesn't run itself. Now for me, of course, this has been part of the fun of it all. But if there's a challenge it's getting used to... And any physician can learn it, but it's getting used to that side.
John: The plus side there it sounds to me is that if someone is unhappy, unfulfilled and is looking for an alternative that if they can just squeeze out some time, they can actually start this on a part-time basis, learn about it, start working on how to get some clients. And then if it really resonates with them, then they can gradually either phase out or quit their other job or get another type of less stressful clinical job let's say.
Dr. Armin Feldman: Yeah, that's right. Now there are physicians that do it full time. There are physicians that do it instead of retiring, but you're right, the largest group are physicians that do this as a part-time side gig.
John: Okay. Now, how does someone get paid doing this? Do you just sort of have a retainer? Do you use an hourly rate? Do you do a case rate? All the above? I think people will have that question.
Dr. Armin Feldman: The way I train the physicians that are doing this is I charge by the hour for everything that I do. One hourly fee. I keep the billing log form along. Attorneys understand hourly billing. Now, of course, in the areas of the law, which I work primarily, it's done by contingency. But I charge by the hour for everything that I do. Just to quick aside. Now I'm not working on contingency. When I send my bill, I expect to be paid in the next 30 days. And in the real world, 90% of the time I'm paid within 30 to 60 days of sending my bill.
But the way that I've advised physicians over the years is to do an informal survey of their colleagues, determine what you think is the average fee per hour for doing medical expert work in your community. Now, obviously, there's a range, right? Not hard to figure the average. So once you get that average, then you want to come in somewhat below what the medical experts are charging doing this acting as a medical consultant, pretrial, pre-litigation.
John: Okay. That's pretty straightforward. And they can get some either from you, if they take your coaching course or elsewhere, they can figure that out. Tell us about your course exactly. What is it? What is it like now? Is it face to face? Is it live? Is it online? Is it recorded? What does it look like?
Dr. Armin Feldman: It's one year and the physician gets all of the business concepts, all the business tools they need, the medical tools, the training, the manual, the how-to on every aspect of the business. They get everything that I use in my business. They get a website, so forth. And it's both on the business side and on the medical side. But the big thing is they get a year of coaching with me. And I've been doing this full-time for 14 years. And so, it's not an absolute necessity. Occasionally somebody joins the coaching program, I don't hear from them much and they're successful. But far and away, far, far and away, the physicians that stay in close touch with me are the most successful. Whatever they need during the launch plan period, I help all of the physicians with some of their marketing. That's how they learn it in the beginning. I'll actually help them to get their first cases in the door. I read tons of drafts of reports before they go out to their attorneys, and really anything I can do from my end that's going to help them to be successful.
John: That sounds like it's fairly comprehensive for those that take advantage of it. Can you give me an example? I'm curious if everyone that learns this from you, do they do exactly what you do or do you see examples where someone might say, "Well, I want to focus on this aspect or that aspect?" Or maybe they just end up doing something slightly different, just because we're all different. Any examples like that?
Dr. Armin Feldman: There's kind of a tried and true way to do this. And not that I haven't learned from coaching members over the years and made adjustments to things, both on the business side and the medical side. But the fact is if you vary too far from the standard approach, it tends not to be as successful.
John: Well, when you've been doing something for 15 years it tends to be a pretty well-oiled machine at that point, I assume.
Dr. Armin Feldman: Yeah. Yeah. And not that I'm not open to hearing what physicians that are training or have trained are doing. But most of them come back around to doing it the way they were trained.
John: Got it. All right. Well, before we go any further, we're getting near the end here, but I want to make sure I mention your website. Actually, it's sort of a page that has this course on it. It's called mdbizcon.com. And I found a video there. It pretty much explains everything. It's again, pretty interesting. That's one of the things that got me interested in getting you on here in the podcast today. So, let's not forget about that. And then I'm also going to put a copy of your email address in the show notes for anyone that would like to get on your email list. Is that doable?
Dr. Armin Feldman: Yeah, that would be great. I do have a newsletter once a month for physicians that are interested in this topic. And then two weeks after the newsletter comes out, I send out a shorter plain text email with tips, advice on various topics as they come up in my day-to-day work. And then I'll talk about it.
John: If you were to be addressing some of my listeners here who are sometimes a little bit burned out or they're just frustrated with medicine in general, what advice might you have for them in terms of thinking about their careers?
Dr. Armin Feldman: I think as physicians, we all want to help people. That's a good portion of the reason we got into it. So, I would say, first and foremost, find something that you can use your medical knowledge to still help people. And this isn't anything profound, I'm sure you've heard it before. But if you're doing something that you really enjoy and find fun, it doesn't seem much like work. If you're going to do something on the side or look for something to cure that burnout, make sure it's something that you really enjoy, that you find fun doing every day. And if you can combine that with helping people, and by the way, making money, what's better than that?
John: Oh, that's absolutely right. Great advice. Yeah, I think if people don't know about these things, then they feel sort of frustrated or resigned that they can't break away from the corporate practice of medicine or something like that. But just in having conversations with people like you, we've seen just dozens and dozens of different opportunities and options for people if they just sort of open their eyes and look around. I appreciate those comments. Anything else you need us to know about this new kind of medical legal consulting?
Dr. Armin Feldman: If you enjoy medicine as a whole, and you got a kick out of being in med school and learning all the things that we know, and you want to put that medical knowledge to work in a nonclinical field that really helps people and is lucrative, this is something that you should look at.
John: Yeah, that's what I thought when I first heard about this. It's intellectually stimulating. It builds on your medical and actual understanding of the healthcare system itself. And you don't have to be in any particular specialty and you don't have to keep practicing to do this ultimately if you decide to do it full-time from what you've said.
Dr. Armin Feldman: Right.
John: All right. Well, thank you very much. This has been very fascinating, Armin. I really appreciate you for coming on today. And I hope a few of my listeners take you up on the email letter and maybe even enroll in your coaching course. With that, I'll have to say bye-bye.
Dr. Armin Feldman: Okay. Thank you, John. It's been my pleasure.
John: It's been great. Thanks. Bye-bye.
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