From Clinical to Courtroom: What It’s Like to Work as a Law Firm Doctor

Guest post by Dr. Charles Bowers

Most doctors don’t enter into the field of medicine to join a law firm. If you’re like me, then your journey likely began with a simple desire to help others and make a positive difference in society, and the medical field seemed like the best way to do so. However, there comes a certain point in your life and career that your expertise as a medical professional may provide you the opportunity to have a different positive impact on as great a number of people as one did in private practice. In my case, this opportunity was presented as the chance to be the in-house Medical (forensic) physician for a highly respected law firm Ross Feller Casey.

People often ask me what it’s like to go from clinical practice to law, and while there are many nuances, there are a few main points that help to provide an understanding:

• Lawyer stereotypes aside, doctors and attorneys are actually very similar – In my mind, these are the two most honorable professions. Both good doctors and good lawyers are studious, hardworking, and empathetic. They care about their patients and clients, and they help them using their own set of different but valuable skills.

• You’re still helping people, just in a different way – In clinical practice, you directly see the positive impact you have on people’s lives, whether by diagnosing and effectively treating an illness or performing a successful surgery. As in-house medical consultant, you help patients/clients and their families just as much, but it’s less direct. You use your medical expertise to give the attorneys the information and tools they need to effectively represent a client and argue for their rights.

• Many cases go far beyond the initial client/patient – In addition to serving justice for the individual client or clients involved, the results of a case are often far more reaching . For example, a settlement may not only stipulate compensation to the client /patients but also that the defendant changes their procedures in a way that ultimately protects many more patients/clients from being injured. So when you look at it this way, working with a single client can mean you have a positive effect on hundreds or even thousands of future clients/patients who may have been similarly injured if the situation had not been recognized and properly changed.

Testifying as a Medical Expert Witness

There's a great article in the current issue of the Physician Executive Journal titled, "Testifying as a Medical Expert Witness." The article is written by Perry Hookman, MD, FACP, FACG, FACPE.  Dr. Hookman is Associate Professor of Medicine, University of Miami Miller School of Medicine.

Dr. Hookman explains that he enjoys testifying as a medical expert witness. He also writes about his perspectives and experience. Here are a few snippets from the article:

• Only about one-third of an opposing attorney’s questions to you—the physician or expert—will relate to your medical opinion.
• Through diligent and creative discovery, the opposing counsel will develop and analyze flaws or weaknesses in your background, qualifications, education, employment and experience.
• As a start to your testimony you will be served with a subpoena that allows the opposing attorney to obtain a lot of information about you. This includes at a minimum your CV, your background, your publications, and especially a list of your past cases.
• The most frequent attack made on an expert witness is that he or she is a "hired gun" who testifies in whatever way the payee wants.

I know a number of physicians who earn supplemental income by serving as a medical expert witness. After all, our society is full of litigious people and medical malpractice lawsuits seem to come up all the time. There are certain states where these types of legal cases occur more frequently.

American Medical Forensic Specialists

Here's some information about an organization called the AMFS:

American Medical Forensic Specialists (AMFS) is America's premier medical expert witness and medical legal consulting company. We have been a trusted partner with the legal community for more than 20 years providing experts to both plaintiff and defense counsel for personal injury, medical malpractice and other medical-legal matters. Our superior method of retaining the most qualified experts has enabled us to provide board-certified experts in active practice in over 15,000 malpractice and personal injury cases.

Benefits of joining the AMFS network:

* Earn supplemental income without disrupting your practice
* Keep informed of issues affecting your specialty and the medical community
* Accept or decline casework at your discretion and according to your schedule
* Outsource all non-billable administrative tasks and ensure payment for services rendered
* 20 years and 15,000 cases of medical-legal experience and expertise
* Receive complex case facts and briefings from a doctor (AMFS Medical Director)

Learn how you can become an AMFS expert here. (panel of experts limited to actively practicing, board-certified physicians who are willing to testify in support of their unbiased opinion)

Medical Expert Witness Directories

This is not meant to be an exhaustive list, but here are some Expert Witness Directories that list medical, nursing, and other health care professional consultants who are willing to serve as expert witnesses in medicolegal cases.

http://www.jurispro.com/
http://www.seakexperts.com/
http://www.experts.com/
https://www.naclncdirectory.org
http://www.expertwitness.com/
http://www.almexperts.com/ExpertWitness/
http://www.hgexperts.com/
http://expertpages.com/
http://www.roundtablegroup.com/about/

I plan to update this list periodically, so bookmark this page (or this website) and check back frequently.

Register for ACPE's popular Health Law course!

In ACPE's Essentials of Health Law course you'll learn to think like a lawyer. Help keep your organization out of the courtroom. This course will give you a basic understanding of laws pertaining to health care organizations. You'll discuss the hot legal issues of today—privacy, managed care contracting, patient rights, peer review protection-and how they apply to your organization. Highlights include:

* Avoiding antitrust violations.
* Deciphering Stark Legislation.
* Integrating HIPAA rules in your organization.
* Frequently asked questions about managed care organizations.
* Tips for dealing with disruptive practitioners.
* Practitioner health issues.
* Key elements for physician employment contracts

The next session begins Friday, Oct. 22. Click here to register or learn more.

(This course is required to become a Certified Physician Executive.)

File Review Consulting Assignments

Here's information about the SEAK National Directory of Medical File Review Consultants:

The deadline to place your listing in the SEAK, Inc. National Directory of Medical File Review Consultants, is Thursday, September 30th, 2010.

File reviews can be done from home, are low stress, do not require any patient contact or travel, almost never results in having to testify and generally pays $100-$200/hour or more.

File review consulting work is varied and includes: utilization reviews, peer reviews, chart reviews, second opinions, underwriting reports, disability opinions and pre-authorizations.

To place your listing, please sign up online at http://filereviewconsultants.com/signup

A one-year listing is only $395 and we offer a full 100% money back guarantee with your listing. If you are not satisfied with the number and quality of file review assignments that you receive or for any other reason, you have until August 1, 2011 to request and receive a full refund of your standard listing fee.

Master of Jurisprudence in Health Law

If you're already a doctor, maybe you don't need another doctorate degree. How about a master's degree in health law?

Loyola University Chicago School of Law offers an MJ online. There are other schools such as Widener Law that also offer the Master of Jurisprudence in Health Law degree. Now, you won't become an attorney if you get an MJ (you need a JD to practice law), but maybe you'll learn some useful things about health law.

Here's some more information about the Loyola University Chicago School of Law Master of Jurisprudence in Health Law Online Degree Program:

* Be part of the health care reform debate
* Gain sophisticated legal knowledge about health care
* Discover new career opportunities
* Interact with health care experts
* Convenient, online format

Master of Jurisprudence in Health Law

Professor Barbara Youngberg, former general counsel for the University Hospital Consortium, is a national expert on patient safety, risk management, and quality.

During a recent presentation to health care professionals, Professor Youngberg highlighted some important developments in current healthcare reform and patient safety, and shared her thoughts on what these developments could mean for the future of the healthcare industry.

How to Start, Build and Run a Successful Expert Witness Practice

SEAK specializes in showing practicing physicians how to become highly successful expert witnesses. They have an upcoming conference titled:

How to Start, Build and Run a Successful Expert Witness Practice

February 3-4, 2011
Naples, FL
The Naples Beach Hotel and Golf Club

Excellent and ethical medical-legal consultants can easily double their clinical income by devoting one day a week to medical-legal matters. Time spent by physicians on such matters is commonly billed out at $400-$1000 per hour. How to Start, Build and Run a Successful Expert Witness Practice is an intensive, content rich workshop that is designed to show physicians how to start, build, and run a successful expert witness practice. This course is appropriate for physicians with all levels of medical-legal experience including prospective and novice expert medical witnesses. Physician attendees will learn from an experienced faculty in a step-by-step fashion how to start, build, and run a successful and ethical expert witness practice.

Learn more here.

Review charts as a physician expert witness (legal medicine)

Many physicians have found that they can review medical charts and earn supplemental income as a physician expert witness. Some people think that they may need to testify in court, but this does not happen very frequently. We all know that many cases get settled outside of court. If you'd like to be a medical consultant for attorneys, then you should pursue a career in the field of legal medicine. 

One way to get started in the field of legal medicine is to add your name to an Expert Witness Directory. For example, SEAK has an Expert Witness Directory and they offer a 100% Money Back Guarantee. Here's what they say:

If at any time within 8-months after the publication of the first Directory in which you appear you are not completely satisfied, you may request and receive a full refund of your standard listing fee.

Let's take a look at what it means to be a physician expert witness. Here's what the American Academy of Family Physicians (AAFP) has to say about being a physician expert witness:

1. The physician expert witness must have a current, unrestricted license to practice The physician expert witness should be fully trained in the medical specialty or area of practice about which he or she is testifying.
2. The physician expert witness must have current clinical experience in the medical specialty or area of practice about which he or she is testifying and during the two-year period immediately preceding the occurrence which led to the lawsuit, such person must have been actively engaged in clinical practice in the medical specialty or area of medicine about which he or she is testifying.
3. At least one physician expert witness for the plaintiff and one physician expert for the defendant should be in the same clinical specialty as the defendant physician. (1989) (2009 COD)

Interested in legal medicine? You may want to learn about the American College of Legal Medicine (ACLM)

The Mission of the American College of Legal Medicine is to “promote the continued professional advancement of its members, as well as non-member physicians, and other interested professionals, through education, research, publications, and interdisciplinary and collaborative exchanges of information. The educational meetings are designed to improve the professional performance of the participants and focus primarily on research, methodologies, techniques, and issues and advances in the field of legal medicine. The education activities encourage interdisciplinary exchanges of ideas and information and thereby facilitate enhanced service to society in the healing arts and legal professions.”

Misconceptions about non-clinical careers on Sermo

If you're a U.S. physician, you've probably heard of Sermo, an online physician community. Recently, there have been many discussion about health care reform and practice management. I'm a bit surprised because there are not too many recent discussions about non-clinical career options for physicians. There are some misconceptions regarding the various resources that are currently available for physicians who wish to pursue non-clinical careers.

• For instance, one physician seems to think that SEAK, a national conference, is only for physicians interested in legal medicine. Not true.
  
• Another physician voiced that SEAK was not helpful. Others chimed in to say that SEAK is beneficial for some and not for others.
  
• Some seem to think that an MBA or JD is the way to go (I'm not saying this is a misconception, but some seem to think that an MBA is required). An MBA can add value, but it's not necessary.
  

You'll also find some good advice on Sermo:

• Join the ACPE (American College of Physician Executives).
• Expand your social network and look for opportunities through the people you know.
• Use the Internet to look for job opportunities.
• Visit this site: http://www.nonclinicaljobs.com/

If you're a U.S. physician, have you joined Sermo yet?

Physician jobs as an independent medical examiner

This is a question that comes up quite often: "how do I become an independent medical examiner?"

There's some confusion in the community about what the phrase "independent medical examiner" or IME. What does an IME examine or review? Patients? Charts? Malpractice cases? Personal injury? Workers' compensation? Disability claims? Insurance records? This is one area where many nurses are leveraging their clinical skills to review charts and work as chart reviewers.

According to the American Board of Independent Medical Examiners (ABIME):

Independent medical examinations (IMEs) are evaluations performed by an evaluator not involved in the care of the examinee, for clarifying clinical and case issues. IMEs are an important component of workers' compensation systems, and are also used to clarify other disability or liability associated cases. Impairment evaluations are often used to provide a more objective understanding of the impact of an injury or illness.

The ABIME offers certification so that you can become a Certified Independent Medical Examiner (CIME) or a Certified Independent Chiropractic Examiner (CICE). Once you gain that certification, then you can put your name on various directories and lists to advertise your services. Some clinicians work as full-time IMEs. Others may work part-time. If you're willing to review some charts in your spare time, it's one way to generate some supplemental income.

Professional Matchmaking

No, not the romantic type of matchmaking so please don't start getting any strange ideas. I met a medical school graduate who had some questions about life as an MD/JD. You don't have to be an MD/JD to understand legal medicine - there are some expert witness physicians who know the legal system inside and out. Since I don't have a law degree, I didn't feel qualified to answer the questions I was being asked. So, I directed this person to an MD/JD who I knew and did some matchmaking as a professional courtesy. The world of legal medicine is very broad and unless you've worked as a physician attorney, I don't think you'll have the right type of perspective to give advice and direction. LinkedIn is a great social network where you can meet and help other people.

American College of Legal Medicine (ACLM)

Have you considered a career in legal medicine? The American College of Legal Medicine has an upcoming meeting later this month. You missed the 7-day Caribbean cruise that focused on medical-legal issues (among other things). That just happened in mid-January.

However, you can attend the annual meeting that's happening in Las Vegas. Go through the "medical malpractice mock trial" and see what that's like. Maybe you'll be inspired to attend law school and make legal medicine your future career. In any case, you may want to learn more if any of this is peaking your interest.

Check it out here:
http://www.aclm.org/