Why Become an Expert Witness and How to Begin

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Transcription PNC Podcast Episode 410

Why Become an Expert Witness and How to Begin

- Interview with Dr. J. Jordan Romano

John: When physicians think about moonlighting or starting a side gig, we often forget about the most logical option, expert witness consulting. For most expert witnesses, replacing clinical time with expert witness activities is a no-brainer for a variety of reasons, which I think we're going to learn about today. I invited Dr. Jordan Romano, a well-known medical expert witness, to share his expertise with us. Hello, Jordan, and welcome to the PNC podcast.

Dr. J. Jordan Romano: Thanks for having me.

John: I think this is going to be fun. I always look back at my career, and I'm way towards the end of mine. And I wish I had done something like this when I was younger, because I think it would have been fun. And the few times I was deposed, I kind of liked it, even though I was being sued. It was kind of fun in a way. Just tell us a little bit about yourself, a little bit about your training, and then how you got into expert witness consulting, and then we'll go from there.

Dr. J. Jordan Romano: Sure. I grew up in the suburbs of Philadelphia, didn't travel too far for undergrad. I went to Franklin and Marshall College, which is in Lancaster County, Pennsylvania, where Amish buggies and that sort of thing in that area. It was a unique place. A small liberal arts school, if you will. I took a year off before going to medical school at the Philadelphia College of Osteopathic Medicine. I taught high school biology. It was a tough job, and showed me that I definitely want to go to medical school. After finishing medical school, I matched at Dartmouth-Hitchcock Medical Center in internal medicine. So I did an internal medicine residency at Dartmouth. That's three years, as everyone listening knows.

I spent two years on staff of Dartmouth Medical School after finishing up my residency, and I worked nights. I want to say it was the best first job I've ever had. Probably the only first job I've ever had, but after training. But it was just fun. I felt like I owned the house. The hospitalist group, we're talking 20 years ago now. So even hospital medicine certainly has matured in two decades. Back then, it was just me. I like to say I owned the house. It was myself and residents and maybe a couple other blurry-eyed attendings that were working nights, and it was just a great way to cut your teeth after residency.

And then for the past 15 years, I've been at Harvard and Massachusetts General Hospital down here in Boston. Just recently, I transitioned to Tufts Medical Center for another chapter in my career, my clinical career. I still practice hospital medicine. There were some times in the past couple decades where I've done outpatient medicine as well. And so, it's been a lot of fun.

There are a lot of other cool little jobs I've done in there. I've been a physician for the Boston Bruins, the ice hockey team, for a few years. I've done some hospice work. I've done a lot of teaching in the medical schools. I've done some medical device development. And I think that's what's kind of fun about what we're going to be talking about here today is what I think is fascinating is medicine can take you in a lot of different places. And so my career has been very interesting, and I'm looking forward to sharing more.

John: Yeah, it's pretty impressive, too, to be a Mass General at Harvard Medical School, now at Tufts and that. I'm sure that you've seen a lot and experienced a lot, and people can use your expertise. What was it that led you to think about becoming an expert witness or to carve the time out, which I'm assuming it does take a significant amount of your time when you're involved in these cases? What led to that?

Dr. J. Jordan Romano: That's what I would say. Looking back, it's easy to see where I am now and say, oh, well, you knew. I had no clue if you talked to me a decade ago that I would be on a podcast talking about the work that I'm doing here. The first case was serendipity. It was a colleague of mine who was kind of tired at the end of the day. And I just said, hey, what's going on? And he said, I'm kind of stressed. I'm really busy. I'm on service, and I've got this case I have to deal with tomorrow.

Surgeons tend to talk about cases. And so that wording was kind of weird. And I was like, what do you mean, what case? Where's the patient? Can I help? I was on service as well. And they said, no, no, no. It's something with an attorney. And he said, wait a minute. How long have you been out of residency? And I can't remember. It had been a few years at that time. And he was like, I think you can do this. And I'm like, you're acting weird. What are you talking about? And he's like, let's go out to lunch, and I'll talk to you about tomorrow.

Over pizza, he kind of gave me the dime tour of the medical legal space, connected me to my first case. I had a very sheepish call with an attorney. And from there, I was off to the races. It was a slow start. Again, my first year, I did one case. My second year, probably two cases. And over that, over the last decade plus, I've embraced it and found that I actually enjoy the work.

But also, to a lot of folks out there, this is not something I knew. I didn't know much about it when I started. I didn't know I would enjoy it. And like most things, how can you be good at it if you haven't done much of it? There are certain skill sets and traits that individuals may have or can develop that will put them at an advantage in this space. But when I started out over a decade ago, I really didn't know I'd be in the situation that I'm in today.

John: It's funny you should say that because I've spoken with a lot of physicians and they're doing either something part-time or even full-time that doesn't even involve medicine. And I would say about 95% of them never had an inkling they would be doing that as they went into their practice. They didn't think about, well, someday I'm going to work for UM or someday I'm going to be a consultant or whatever, you name it. And so, I'm impressed by those that actually plan to do it. But like you and I are the same, it's like, no, these things just come up. There's opportunities and take advantage of them. And it turns out there's a lot of fun things to do that are sort of adjacent to medicine. So it makes a lot of sense.

Dr. J. Jordan Romano: I couldn't agree with that more. I think that when I was figuring out where I wanted to go to residency, it was sort of like medicine or surgery. At the 11th hour, I pivoted from surgery to medicine, but it was sort of like, are you going to be research or a clinician? I had my head down in the clinical grind during residency and I didn't really start realizing what was out there until I kind of came into being an attending. And slowly but surely, and certainly once I came down to Mass General, I realized, oh, wow, there is a lot of different things that you could be involved with.

I think it's important to be involved with as well. You have a skillset and caring for patients certainly is first and foremost, but there are things that are, as I like the word you used, adjacent and running in parallel that your participation is quite helpful in.

John: Yeah, and I suspect that that was one of the things that attracted you. I've talked to other physicians who said it's kind of like, I get to really use my knowledge of medicine and leverage that to help other people, in some cases, an attorney or their client. When you were having that conversation with that surgeon or that whoever, whatever he was doing, what were the things that he said, he or she, that interested you? What was like, made it attractive sounding to you?

Dr. J. Jordan Romano: I think it was mainly curiosity. I just was like when you, at that point perhaps, I suspect I had been attending for a number of years and I you're always, in my mind, I'm looking for learning something new or experiencing something new. And it sounded like, oh, I could be helpful. I could help a friend out. A colleague and a friend out. And there's something new and it wasn't terribly scary and it's using, I just have to review some records and talk about medicine. Okay, that sounds simple enough. Obviously, it's a lot more nuanced than that, as I've learned over the years.

But maybe my naivete was quite helpful that helped me to wade into it, because when you look online and you start maybe hearing some of the folklore of the space, I wasn't even at that level. That's how naive I was. It was like, I want to help a colleague out. And he was like, yeah, can you speak to this attorney and he'll talk to you about the records and you'll just review some records.

I didn't really get into the whole, I wasn't even at step one of understanding like, oh, there's nefarious attorneys and you need to watch out for X, Y, and Z and you shouldn't be doing, I was leaps and bounds away from that. And looking back on it, it was great because maybe I would have steered away from it had I been biased by some of the opinions of what I think are people who are maybe not as well-informed in the space.

John: If you think back to those first two or three or four cases that you were involved with, what was it about those cases and your participation that made you want to continue to do that?

Dr. J. Jordan Romano: Well, it's variety. You don't when you're talking to someone, everything can be different. I'm an internist and hospitalist. We cover a lot of ground in terms of, could it be a nephrology case or is it, is it dealing with an infectious disease situation or a thrombosis situation or a misdiagnosis or something along those lines. You know, I like the plaintiff in defense. Not everything I did was plaintiff straight away.

I did a mix of, and have continued to do a mixture of plaintiff and defense work. And so the different perspectives, I think is quite interesting. Learning from the attorneys, I think was a piece that, to this day, I really enjoy, which is we hang out with one subset of advanced degree professionals when you're, when you're a clinician, but here we have this other track, the very highly educated individuals who have a different.

It's like learning a new language. You know medicine, but you don't know legalese. And it's just, it was, I think that's what was sort of exciting. It was using my expertise, but there was, it was like visiting a new country. It was just exciting.

John: Now I've heard other people mention that have been involved, that they kind of like the challenge of it. It's one thing to take care of patients, but then to be questioned about it and to be quizzed on potentially in court, although that probably happens very rarely. Is that one of the things that you find enjoyable?

Dr. J. Jordan Romano: I didn't know I was going to enjoy it. The one thing that to new folks and for those who are listening that are involved in this and want to do more, maybe their, and their involvement hasn't matured to the point where they're being deposed quite frequently. It takes time. There's a long tail to these cases. Now, vast majority, as you suggested, a vast majority of them settle in 90 plus percent of cases will settle. And depending on who you are, maybe you'll be asked to write a report. Maybe you'll be deposed, which is where you'll be asked questions under oath for several hours at a time.

And maybe you'll go to trial. But trial, we're talking one to five percent of all cases, maybe. And deposition, maybe 10 to 20 percent, somewhere in there, call it 15 percent. So I didn't really know that. I hadn't even been exposed to being deposed until like a couple of years in. I deposed a couple of times, because if you if you experience a deposition once maybe you won't go back again. But if you've done it a few times, you understand the variation sometimes.

And so, the back and forth, it takes a particular type of individual to thrive and to enjoy that, maybe not enjoy, but some people tolerate that sort of environment. It can be rather unpleasant at times, but with the right amount of practice and doing it a couple times and learning, by our nature, physicians learn through an apprentice model having an open mind and be willing to learn something, a new skill, it can be quite enjoyable.

John: Now, I know my listeners, they typically have similar questions about different topics related to doing nonclinical things. But probably two questions. One is going to be, how do I get into this? Is there maybe a way to be more proactive and decide I want to do this and things I can do? And two, what kind of payment do you think I'll be receiving? Is it worth it to cut off my clinical for a few hours on a day to do some chart reviews or take the time to do a deposition?

Dr. J. Jordan Romano: Yeah, that's fantastic questions. Certainly, you got to start from the place of, are you qualified? We hang out with doctors all day long. And so you can easily be like, oh, I'm not the smartest person in the group or I'm not. And oh, I didn't go to Harvard. I will tell you, I certainly have been excluded, not excluded from the case, but the attorney decided not to retain me because they wanted somebody from a small town rather than from an Ivy League institution.

First of all, don't disqualify yourself before you get started. What I would say is there are networks online. Spend some time reaching out to individuals to learn more. LinkedIn is not a bad place to find individuals. And I think the more you start asking your kind of immediate network, you'll probably find individuals who are doing this work and then just speak with them.

Getting your first case usually comes, can come in several ways. One of them is through your immediate network. And so after my first case, I just told other friends of mine that this was the work I was doing. And I found out other individuals who were doing it and spoke to them.

The other way you can do it is through marketing. There are a number of ways online, directories, if you will, which are like online billboards where you put your name and your experience and what you're doing and your specialty, and attorneys can reach you that way. And those range anywhere from free to where you pay money for them. And this goes without judgment. These are just sort of the vehicles of getting known because that's the issue is when you start out, nobody knows you and nobody knows you're available to do this.

The other way to do it is there are agencies. I run an agency that helps individuals, helps other clinicians and physicians get their name out there to the attorneys. And those relationships look arrive in many different forms, but some of them have education attached to them and mentoring attached to them if you so choose to engage in those sorts of communities. But I think that I would encourage every physician, if they're thinking about it, to engage in the broader community, whether it's LinkedIn or just reach out to individuals like myself to dig a little deeper and get a case and see how it goes.

I don't think by any means at any stretch that physicians should feel obligated to do this work or certainly be mandated to do this work. But what my goal is when I started this a decade ago, this is a space where people didn't talk about it. People didn't like to talk about being a medical expert witness. There was a lot of and still, I think, to a certain extent, a lot of folklore out there as to what it's like to operate and what does it mean and that I'm not always on the plaintiff's side. A lot of the cases I'm retained by an insurance company or defense counsel in defense of physicians.

So you call balls, balls, strikes, strikes. They need help. What people, what the clinicians need to realize is the legal system is moving forward with or without you and they need your help. The system needs good ethical clinicians who can share their knowledge. This is reviewing the records and explaining the medicine. And so, if you're even the slightest bit curious, engage online, get your first, get your first case and then take it from there.

You don't need to solve everything in in the next few months. Just dip your toes in, see if see how it feels, speak to some individuals who are more experienced, continue to learn, be curious. And after you take one case, take a second case. It took me many, several cases before I even had to write a report, several more before one matured to the point where I was deposed.

It's hard to make a judgment until you've done, until you've done a bunch of it. Now, if you know straight away, this is not something you're going to want to do, or you start speaking with an attorney and you're like, you know what? I'm not cut out for this, or I, I don't want to move forward. Fantastic. You know, early on. I think that's a good way of, of doing it. But there are individuals who I think maybe don't know where to start. And I would say that's why I'm here. Because I wish I had someone like myself to speak to when I was starting early on. And really it was kind of clandestine and kind of behind the curtain. And it took me years to really find out who the network is and to find out who, who are the physicians and clinicians in this space.

Honestly, the biggest way that I found out is by speaking to attorneys and they're like, oh yeah, do you know Dr. So-and-so in your emergency room? He also does expert witnessing. And I was like, oh, is that right? I just saw him the other day. And you know, this is not something that we, we share with one another. I think that being curious is, is certainly the best way of, of getting started.

This is a long answer to a short question. But the next thing that you were talking about was this, the schedule and how do you plan things? The working backwards, thankfully trials don't happen that frequently and they can be disruptive. You can do them since the pandemic. A lot has been done by Zoom and over the computer. So very little of the work is actually done face-to-face. It's over the phone or communications over the phone or over Zoom.

When you're reviewing the records to start, again, that's something you can do in your pajamas on the weekend if you really wanted to. The deposition, even for a busy proceduralist or surgeon or clinician, that's really based on your schedule. Now they may say, hey, do you have time within July? And then you say, yeah, I'm free the 22nd in the afternoon. So you get to choose.

Now you kind of need to set aside an afternoon. If your current practice is in a way where you're like, that's vacation time and I'm not willing to do that. But keep in mind, roughly 15% of cases will, will eventually require you to set aside time to be deposed. And that's typically while it doesn't take the whole afternoon, it's best to bookend it by allowing enough time to speak to the, your retaining attorney beforehand to do the deposition and maybe debrief afterwards. So that's an afternoon.

The trial is the tricky part. Thankfully, it doesn't happen that frequently. Look, this past year, I canceled a trip, a family vacation, because there was going to be a trial. And then at the 11th hour, the trial didn't go forward because the case settled at the 11th hour. That was a tough one at home to describe. And, but thankfully, again, in 10 years, I can count on one hand how many times that's happened. So, it's a very rare event to go to trial. But yes, you need a, you need a, you need flexibility in your schedule to, to do the depositions and to the, to the trials.

But remember, it's a long tail. The trials may not happen for 18 to 36 months down the line. So, it's really not where is your practice today, but if you think you're going to drop your FTE or you've been dropping your FTE, where is your FTE going to be 24 months from now? Because that's when you're going to be potentially, as you're taking on more cases, going to be deposed more and go to trial more. The reviewing the cases is easy. You can do that at any time. And there's usually flexibility in get you get it done in the next couple of weeks. You can do it at night or on the weekend or something along those lines. So, hopefully those are some long answers, but hopefully some, some useful information for your audience.

John: No, that's very useful. And in fact, I want to get even like a specific example. I can imagine something where someone is, they're getting older. They're just sometimes not liking the grind of the clinical. Doesn't mean they don't like medicine and they're not current. So what, what is the range in terms of a mixture of hours that you've seen either yourself or with others? Can someone go to me really doing like a 10, 15 hours a week of this? If you take all the components together, cut their clinical down and you didn't directly address the financial part, but what I've heard is you're going to get a paid enough that it's really worth your while to do that. If that's the way you want to go. And so, I'm just kind of wondering what you've seen out there in terms of that mix of expert witness while still practicing, which I think you have to do in most cases.

Dr. J. Jordan Romano: Yeah. What I would say is I would say most clinicians, irrespective of the topic we're discussing here today. I think most hospital systems are struggling post pandemic because physicians across the board are cutting back their FTE. They're filling it with things that you talk about here on your podcast and medical expert witnessing happens to be one of them. You could say what came first, the chicken or the egg, are they cutting back the hours because of the expert witnessing or have they cut back their hours and now they have free time and they want to fill it with something else. I suspect it's a mixture.

What I would say is the average expert witness? It really depends on your specialty. The range call it somewhere between $500 to $800 an hour. A pediatrician might be in the lower range of that. Maybe even 400 a neurosurgeon, depending on their experience level is probably the $800 to $1,200 an hour. And then it gets nuanced very quickly in terms of their jurisdictions that put limits on how much individuals can charge.

But generally speaking, I think it's fair to say if this was a bell curve distribution, it's probably somewhere between %500 to $800 an hour. How much time people spend is really up to them. Now, depending on the jurisdiction. And when I say jurisdiction for the audience, it's really what state you're in. But depending on the state, you need to be in clinical practice, a certain percentage to be regarded as a medical expert witness. And it gets even more nuanced than that.

But generally speaking, you need to be in active clinical practice at the time the alleged event took place. I just had a conversation the other day, somebody's like I finally I don't have my license anymore. And I finally stepped away. And I'm like, is there any way you can work and this was a prominent surgeon. And I said, is there any way that you could work 20% or a one day a week in a clinic or something along those lines. And he was like, I have absolutely no interest.

It doesn't mean there's still ways that they can engage and that gets a little bit more nuanced, but for the vast majority of folks, you need to be practicing, you need to be practicing 25 to 30% at least to be, to be qualified. Having an active license is helpful. In terms of the money, I've seen it, I've seen it run, run the gamut, but it is not the thing you have to be ready for. This work can come in fits and starts. You could not get called for a couple months and then get called and get the same firm could ask you to review two cases.

You have to be ready for that sort of cadence, which is like, you think nothing's working. And then all of a sudden I joke and I say, it's like Noah's Ark, things come in at two at a time. And I think that being patient also, most of the people who are doing this usually are starting if you're a little younger, you could be doing this for two decades. You certainly having a, having patients in, in the process, I think is important.

Now, if you're later in your career, the other advice I would say is you need as much help as you can get, because if you're planning on hanging up your license and your clinical practice, call it in the next five years. The issue in this space is these are high pressure situations. They're very important situations.

And the attorneys want to retain somebody that they know they like, and they trust. So a lot of people say like, oh, well, will I get more cases if I'll just charge less at a certain point to the attorneys? While the money certainly matters, they really are more interested in your experience. And they know that they can trust you when you're handling this important situation. And so if you're, if don't discount yourself, if you're kind of sunsetting your career I, your expertise and this particular individual I was speaking with recently had like three decades of surgical experience. He's the type of individual that the medical legal space needs to hear from.

He is a very, very experienced operator. But when you're in that situation and you think you probably have five years or less in this work, you need to really seek help to get known because attorneys aren't going to retain you unless they know you and they kind of need to like you and they definitely need to trust you. And that takes time.

But the biggest part is getting known. If they don't know you're doing this, when you're younger, you have time, the network effects, you can let those kind of marinate over time. But when you're older, I think engaging with some of these other companies and agencies that are out there or doing advertising, if your institution allows it, I don't think it's wrong. I actually think it's important because how else are attorneys going to find you?

John: Well, you were telling me before we got on the call here that you do some mentoring and I don't know if it's coaching, what it is, but explain what you do that can help maybe get some people moving in their career a little quickly in this area.

Dr. J. Jordan Romano: Yeah, it's sort of a Catch-22 because individuals who have done a little work, like the work, they've been told they're good at the work, but don't know how to get more cases. I was thinking back a number of years ago and I'm like, I want to help people in this space. I'm an educator by my nature. And so the question is, what can I do to help? I just thought, what would help everybody? And I just thought rather than just doing one-on-one mentoring, why don't I also offer an agency?

I offer an agency that helps anyone, established experts, or individuals who are new to the space, get known and get their names out there to the attorneys across the country. And in addition to that, there are question and answer sessions. I'm available for mentoring. I frequently field, while we were on, you probably saw me on my phone, I was answering a couple questions. Somebody has their first deposition coming up, which is a frequent situation. And I have some recorded materials that I push out to those individuals to help support them through that process.

I think that the more that we can do this as a community to really raise the bar of the individuals that are out there and just welcome people into the space and have conversations like this, I think the more people will be willing to participate. And like I said before, the process is going on with us or without us. And I think having more clinicians here is better. That being said, to your point, how do you get better at something without doing more cases? And so that's why I really have been focused on this agency to help get these newer clinicians up to speed as quickly as possible.

John: All right. So do you have a website or how do we find out about your services for this part?

Dr. J. Jordan Romano: Yeah, you can find me at medicalexpertwitness.com. Directly there you can schedule a time to speak with me, whether you're an existing medical expert witness or you're thinking about getting started. I'd love to have a conversation with you. I help individuals who have been doing this for 20 years and people who have just started thinking about it after watching this podcast. So, definitely look me up, medicalexpertwitness.com and I look forward to speaking with you.

John: I'll put that in the show notes for sure. I think it's great because why should we struggle? You know, we have a few questions we're going to have to go out there on the internet or something and try and get to answer those questions or track down someone that's in our hospital, half of which we don't even know they're doing expert witness because they haven't really told anybody.

I think it's fantastic that you're putting resources together for physicians who might be interested in this. And yeah, you're right, the closer they are to retirement, the quicker they need to get in and get some business going before they decide to pull the trigger and walk away from all of it, I guess. As I do think some physicians don't understand why this is potentially such a potentially fulfilling and useful way to apply their skills.

Dr. J. Jordan Romano: Yeah, speaking to the clinicians directly, you're an expert in what you've done. Again, maybe there are exceptions in the sense that if you're just out of residency, maybe get a couple of years of being an attending under your belt. There are individuals who, and exceptions depending on your history where earlier in your career, I don't want to discourage you. Certainly I've seen individuals be successful who are out for one year or so, but you're going to be commenting on the standard practice of what attendings do essentially. And if you haven't been attending that long, it can be a little tricky to confidently have that conversation.

But this is an exciting space. You have a skillset and the US legal system requires individuals and leans on individuals like ourselves to comment on the medicine. Alot of people feel like we're being an advocate for the case or the individual, and that's not it. You need to be an advocate for the standard of care, which is what any reasonable clinician should be doing in same or similar circumstances.

The attorneys can't comment. They can read the records all they want, but they haven't been there. And you are the expert and commenting in these situations is essential. And there are attorneys right now looking for people in your specialty. I can guarantee it. I think there is also an opportunity to, if you will, fix what you see wrong in this space. I think that staying on the sidelines doesn't fix anything. And the way I see it is by my nature, I don't want to necessarily be on podcasts, but what I find that's important is speaking to individuals. And I appreciate the opportunity to speak to your tribe, if you will, speaking to individuals to say, hey, look, it's worth taking a look at medical expert witnessing.

There are more people coming into the space and there are individuals like myself who are here to help you. It is something that I think that it's that important that I'm on podcasts, even though it's not something that I do naturally, but I want to raise the caliber of the average expert witness. I want to open the tent and invite in as many clinicians as possible. And so any of that sort of nefarious stuff that you might've heard happen in the space, it gets drowned out by all of the ethical actors that we bring in and that we help coach.

John: I tell physicians all the time when they're thinking of doing something different because maybe just the clinical medicine isn't still for them. In this situation included, you're going to be helping someone. You're going to either be helping an injured patient. Hopefully they're injured. If they're not, then you need to be telling your attorney, we shouldn't even bring take this case or you're helping defend it and you're helping one of your colleagues. So I don't know how that cannot be in and of itself some pretty good reasons to share your expertise.

Dr. J. Jordan Romano: Yeah, those are fantastic reasons. And I think, again, I think the flexibility is not only you're helping the legal system on the whole, you're using your expertise and your education and you're buying back some of your time, if you will. I think that that's something that can be quite rewarding for the individuals participating in it. There are a lot of folks who are, and hospitals and clinics are kind of reorganizing how they're engaging. And I think physicians are part of that conversation about you know what? I want to step away and enjoy some more time with my family. And this is another way that you can remain active using your degree and your expertise while not seeing patients.

John: All right, Jordan. I think that has been very, very helpful, interesting, and we covered a lot of ground there. I really appreciate you taking the time to join us today. It's been really good. Again, the site is medicalexpertwitness.com. Anyone who's even thinking about getting into this, you might at least check out Jordan's website and his services. And with that, I'll say goodbye and thanks for being here today, Jordan.

Dr. J. Jordan Romano: Thanks for having me.

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