By Dr. Gretchen Green, Guest Writer
Non-clinical income can be a key strategy to achieve financial freedom. It can also help you develop skills that serve your personal and professional growth in many ways. Expert witness work enabled me to leverage my skills and knowledge as a physician to reenergize my clinical work and my life outside medicine. Now I dedicate my time teaching other physicians and allied health professionals to find similar success and how to launch and build an expert witness practice.
Become a Knowledge Expert
As an expert witness, you typically review potential medical malpractice cases for plaintiff or defense attorneys and give an opinion as to whether the actions taken were above or below the standard of care. Your opinion is based on your training, experience, and education, but medicine is a dynamic field where knowledge changes over time.
By supporting your expert opinions with literature and resources—including specialty consensus guidelines, professional committee publications, and medical literature—your knowledge base will benefit your patient care and make you a valued go-to resource for your professional colleagues.
Promote Your Professional Skills
As an expert, a lawyer may call you out of the blue and ask if you can review a medical malpractice case. Communicating your skills in a concise manner (i.e., “the elevator pitch”) is important. This isn’t as easy as it seems when society love-hates the “humblebrag.”
First, identify your areas of clinical strength. Next, practice saying your pitch succinctly and with an appropriate measure of confidence. Note that these skills are just as important when talking with patients and family members about how you can help them as they are in the legal arena.
Finally, craft a CV that accurately conveys your professional accomplishments. This is a valuable tool not only in expert witness work but in pursuing other opportunities in and out of medicine.
Expand Your Professional Niche
Expert witness work can help you identify areas in your specialty in which you could develop a niche and enhance your knowledge. For example, after receiving several inquiries about pulmonary nodules and alleged missed lung cancers, I dove deep into the topic of CT lung cancer screening using resources from my professional specialty society that now help me do my routine clinical work even better and offer added value as a specialist in my practice.
Sleep More
Doctors make the most errors in the middle of the night and when fatigued. I used to pick up weekend shifts to make more money but at the cost of personal time to rest, rejuvenate, and spend time with my kids. A side gig with flexible hours lets me supplement my income at the right time of day for me without moonlighting at crazy hours. Bonus: less exhaustion leads to better patient care.
Diversify Your Income, Reduce Burnout
Additional income from side gigs like expert witness work can reduce physician burnout by providing financial security and reducing stress. Being able to stay in your clinical job is typically a good financial move long-term. Income from expert witness work can fund a separate retirement account and provide financial advantages beyond supplemental income.
Finally, expert work is typically highly compensated ($500-$900 per hour depending on physician specialty). It’s hard to find another side gig that makes it possible to earn a six-figure salary on 3-4 hours work per week.
Learn from Others’ Mistakes
Everyone makes mistakes. It’s a lot less painful to learn from others’ mistakes instead of your own. In the 140-plus cases in which I’ve served as an expert witness, I have seen patterns emerge that make medical errors or bad outcomes potentially more likely. I watch vigilantly for these in my clinical practice and do what I can to mitigate that risk and practice the best medicine I reasonably can.
Accept That No One Is Perfect
We physicians set impossibly high expectations for ourselves. Having perspective is key to accepting that your best efforts are just that—the best you can do, not perfection (because there is no such thing!).
Serve as an Impartial Witness
There’s a reason you’re called an expert witness—the job is to objectively review information in a medical malpractice case and use your experience, skills, and training to evaluate if the course of action was reasonable based on what most physicians would do in similar circumstances. (That’s a loose definition of “standard of care.”)
But taken one step further, serving as an expert witness enables you to become a thought leader in medicine with a broad and deep fund of knowledge. This perspective will help you mature as a physician, and it could inspire you to pursue leadership positions, serve on advisory committees, or find other ways to advance the profession of medicine and be more personally fulfilled.
I find it incredibly rewarding to network with other physicians and experts and to know that my work makes a positive difference for the medical profession and for my life personally.
How has expert witness work helped you professionally and personally? Comment below!
[Editor's Note: Dr. Gretchen Green is a radiologist with a thriving expert witness business and the creator of Expert Witness Startup School, a comprehensive how-to online course that teaches physicians how to launch and build an expert witness practice. WCI has an affiliate relationship with Expert Witness Startup School. However, this is not a sponsored post. This article was submitted and approved according to our Guest Post Policy.]
Expert witness does not have to be entirely malpractice. I’ve served about 20 or 30 times now exclusively for criminal cases and administrative hearings in military courts.
Being active duty military I can only be an expert witness if it is for the government’s benefit and do so for free. Note that within a court martial or within military administrative boards, both sides are for the government’s benefit (since the government is responsible for arranging for witnesses requested by the defense too). Also “free” just means not paid for my services, any travel is reimbursed and the time away from my day job doesn’t burn leave time since I’m still doing work for the Army.
While doing this sort of expert witness work has not lead me to careful review of guidelines / much impact on my day to day clinical knowledge base, it has still led to me broadening my awareness of forensic medicine. It has also led me to realize some of the axioms we are taught in school about how X or Y is or is not admissible in court so do or don’t do it in your notes/records….not always accurate. Plenty of times I’ve seen EM docs’ notes wind up being used in ways I’m sure they never intended during the course of a criminal trial that didn’t involve the doc at all.
This may of course also be an artifact of working entirely in courts-martial which have different rules than civilian courts (like the “jury” equivalent is a panel of NCOs and officers senior to the accused and is allowed to question witnesses after the government and the defense have finished their lines of questioning). They also tend to be staffed by very junior lawyers. Military trial lawyers tend to be fresh out of law school and carry a very heavy case load/are in court far more often than their civilian peers, until they promote to a supervisor level and then are almost never in court except to watch their underlings.
Great point, KFM! There are a lot of options within expert witness work. Some physicians, especially orthopedics, PM&R, and pain management (to name just a few), also do personal injury cases. There is also product liability, patent case review, and more. You can create a niche and a network to grow your business and highlight your skillset as a physician.
Great point, KFM! There are a lot of options within expert witness work. Some physicians, especially orthopedics, PM&R, and pain management (to name just a few), also do personal injury cases. There is also product liability, patent case review, and more. You can create a niche and a network to grow your business and highlight your skillset as a physician.
Any physician who would participate in this charade of a tort system is no better than the ambulance chasing profiteering lawyers who infect not only medical practice but all aspects of our economy. It costs Americans billions of dollars a year to line the pockets of those who pretend that there is legitimate value to what is simply a form of educated white collar crime. There are those that work within our system to better the world for everyone. There are others who examine our system for its weaknesses and use their intellect to exploit it for personal gain without regard to the costs imposed on others.
You can’t just ignore it. Your colleagues are often being sued inappropriately and part of their defense is a colleague willing to say “No, what they did was just fine even though there was a bad outcome.” Sitting on the sideline and letting them fry because the system has issues isn’t right.
This is a very common concern among physicians considering doing expert work. The key is to review cases objectively. You’re paid for your time and expertise, not your opinion, and lawyers value your unbiased opinion. Often I review cases and find the physician did nothing wrong, and the case is never pursued. Many physicians never know they could have been sued, if not for an expert review that concluded nothing should have been done differently. This work is a service to the medical profession, when done conscientiously and correctly, and I’d rather have a well-qualified expert do their best work regardless of outcome.
True Gretchen, and I’ll note I’ve done some expert witness work as well. However you (not surprisingly, since you sell a course on this work from which you profit) ignore or gloss over the fact that a lot of the “expert docs” out there aren’t as ethical and objective as you, or me. Some (and I’ve seen this multiple times) will essentially tell the plaintiff’s lawyer what they want to hear, so that they’ll be retained. And they’ll say there was indeed malpractice when perhaps it wasn’t so clear. You, me, and many more are ethical and strive to be objective, but you know there are a LOT out there who are not. Thus the conflict with selling a course and promoting this work, knowing some will use that knowledge and income stream to hurt other docs.
So let’s get more ethical ones out there! You can hardly blame someone selling a course because a minority of students of that course may use their newfound knowledge unethically. That’s like saying don’t teach people how to invest because some will use the money to jetset around and destroy the planet. While true, others will use the money to combat malaria.
My point was that she didn’t acknowledge this in her response to Fred Willison, as if everyone doing this does the “right thing.” And that she has a conflict to do so, obviously.
I think the conflict is so obvious it doesn’t have to be mentioned.
But what percentage of docs doing med mal work do you really think are incompetent/corrupt? I can’t imagine it’s even 5%. Egregious testimony gets outed so fast these days and people even get sanctioned by their specialty society. This guy literally has the main textbook in EM named after him:
https://www.acepnow.com/article/acep-issues-public-censure/
One of those pretty much ends your career as an expert witness I would think. Imagine what it would look like when the defense counsel puts that thing up on the screen right after your testimony? The case is over.
Here’s another one from EM: https://www.acepnow.com/article/acep-suspends-physician-for-expert-witness-and-ethics-code-violations/
Who’s going to hire someone with one of those out there?
wow, is it Rosen from Barkin&Rosen textbook we all used to study??? Way to sabotage a great academic career
Yup. He was faculty at my program for a couple of months every Winter. Pretty disappointing, right?
This is a great opportunity to talk again about mindset. I can control my own intent and actions, which include helping physicians become educated expert witnesses and have financial freedom to improve their own lives and those of others. I don’t even worry about people using these skills for “evil” rather than “good,” I only focus on how I can be the best expert, doctor, and person I can be. Those are the outcomes I see in students taking my course, as well.
I donate proceeds from the course to nonprofits focusing on STEM and history education, to whom I give my time and financial support. Most importantly, I love when students in my course contact me to let me know the positive change they have achieved in their own lives. Often this is because financial freedom helps them create more time with family, optimize finances, and regain a sense of control over their profession. That is reward enough.
Funny how people think doctors should not be able to make a profit doing anything. I get similar criticism from people who think it’s terrible that I don’t work for free all the time in the ED or with WCI. They’re both very clearly for-profit businesses.
Nothing wrong with wanting to be paid when you create a valuable product or provide a valuable service.
My experience unfortunately is clouded. The one expert witness with whom I practiced regularly was one of the worst clinicians I’ve ever met. He practiced so defensively that you couldn’t count on him to ever get any work done.
Wonder if it was chicken or the egg. Did he do expert witness work because he was conservative or did he become conservative because he did expert witness work.
Being an expert has definitely changed my practice – for the better. Knowing clinical guidelines, literature, and facts from various medical malpractice cases helps me support my clinical decisions better. I think this helps reduce indecision that can come from a lack of knowledge that then looks like defensive medicine.
I’ve had a similar experience. One attending at my residency was very involved in med mal (mostly defense) and workers comp expert witness. He was far and away the worst surgeon I’ve ever operated with. I saw him commit multiple malpractice worthy errors due to simple carelessness. Big name locally, big backslapper, and he is known in the legal system so I don’t think he’ll ever be sued successfully.
Great article. I agree with all of these points.
I have included medico-legal work as part of my practice for over 20 years and I enjoy it. I teach it to residents too.
A couple of other benefits that I have noticed:
1. It is an easy way to develop a business on the side allowing additional retirement contributions (e.g., SEP-IRA) and deductible CME expenses.
2. If you do get sued you will be much more comfortable with the legal process and depositions.
Like it or not, there are places where medicine and law overlap. Why not be better prepared to understand that?
I totally agree. Learning to build a business and develop marketing skills have been unexpected benefits of doing expert witness work. With so many physicians becoming employed rather than owners/partners of their practice, these skills can be helpful to develop in different ways.
How soon after finishing training can one do expert witness cases? I am a few months out of training into my practice and have been approached by a law firm. Would my lack of independent practice experience be used against me if I am hired? How any years into practice do you recommend starting with expert witness work? How about independent medical examinations?
Good question. It’s never too early to start learning about options like expert work! Typically 1-2 years of experience is helpful, but it depends on your background. Maybe you did a lot of research work that gives you unique skills. Maybe you’ve had some additional work experience prior to med school. I would simply discuss your credentials and see how they fit with the expert profile the firm needs. This is a good opportunity to update your CV and identify your clinical skills to discuss with attorneys.
Thanks. I agree. It is probably better to contact you directly to discuss my specific situation. Thanks!
Thanks for the article. Despite the controversy I appreciate being exposed to a potential side gig on a financial blog.
How much is “getting worked over”/grilled by the opposition lawyer a legitimate issue vs a myth, especially for new expert witnesses? Does the field tend to be high stress? Are there any ways working as an expert witness can come back to bite you in a case against you in the future?
Depositions are not as dramatic as you’d think based on TV shows. Yes, I’ve been questioned pretty closely about my opinions, but I prepare expecting to provide strong evidence to support my opinions. Physicians are pretty well trained to keep cool under pressure, and we are accustomed to having tough conversations with patients and families under high stakes situations. This is no different, except that understanding some basic legal lingo and the legal process will also help you navigate expert work.
As for future cases, your testimony and reports can be discoverable in the future, whether in future expert cases or even your own potential case as a defendant in your own medical malpractice case. That’s why it is important to support your opinions, and also to know how medical practice changes over time. Sometimes we modify how we practice based on new evidence, so be prepared to explain why you might do something differently based on new or evolving information. Again, just as we do when taking care of patients.
Every time I think of a court-martial, I just imagine some Kaffee-level attorney getting Jessep to admit he ordered the Code Red. I figured reality would be closer to what you described, but I didn’t think it was quite that bad.
Most of us work with lawyers only under adverse circumstances. However, I have really enjoyed working with attorneys as an expert and have never seen one behave unprofessionally in deposition. Some take a more, ahem, direct approach with questioning, but that’s just a difference in style (and possibly geography). I have uniformly been treated with respect and courtesy, and appreciation for the role I play educating the parties involved in medical malpractice cases.
New York say what? 🙂
Geography is a fun thing. I’ve been impressed with conference dress for instance. I was a resident in Arizona, which may be the least formal place in the country. But I’ve noticed as I’ve gone around the country speaking that the further East you go and the more traditional the specialty, the more formal the dress. Surgery conference in Virginia? Everyone is in a suit and tie or equivalent. Emergency medicine conference in Oregon? There will be more fleece jackets than dress shirts.
I would caution those considering participation in this biggest of all financial scams to avoid being duped. You are being supplied a framework for rationalization. Trying to characterize one’s participation as being one of the “good guys” is just a fig leaf.
While medical malpractice certainly does occur, the tort system in this country, with it’s contingency based personal injury attorney framework, is a ridiculous way of addressing it. The reason it is so ridiculous is because addressing medical malpractice is not really it’s purpose. That is just a distraction and a sideshow to the real purpose, which is extorting money from a gigantic lottery.
Yes, you too can extract money from that giant lottery. However, in so doing, the harm you will cause is incalculable. Financially, morally, humanistically and professionally. Ask any of the many thousands of your fellow physicians whose life has been turned inside out over malpractice suits based on flimsy evidence, medical ignorance, knee jerk legal theories, and the system of “experts “ playing both sides in this corrupt game. Or the millions of patients whose medical care has been compromised by the fear of this system, and what it can do to honest physicians making the very hard decisions we all must make daily on their behalf. Sad.
So your solution is to have no doctors serve as expert witnesses? Good luck. Getting more into the system so the bad ones are easy to spot and not use seems a better method.
Nothing in this thread addresses solutions, which I would wholeheartedly support. The most effective solution is pretty obvious. Partner with other industries hobbled by the corrupt tort game. Using those partnerships, lobby for “loser pays”, as exists in other developed nations. That ends it.
Rather than seeking solutions, this is about getting one’s hands on a piece of the corrupt spoils. Count me out.
It’s a free country. You certainly don’t have to do work that bothers you ethically.
Well, I think that is pretty obvious.
I’m trying to give others some perspective on this issue that may help them form their own opinions on the ethics of the situation. And for those who are fortunate enough to not have experience (yet!) with the system, I encourage you to ask your colleagues for insight. Unfortunately, there is no shortage of physicians with this experience.
Most malpractice suits last years, and they take their toll.
This system is responsible for much psychological trauma, family strife, even physician suicides. While perhaps sometimes it is deserved, more often it is just good docs trying to do the right thing under difficult circustances.
I’ll tell you this much : I promise you that if you give me a patient in my field with a bad outcome, and give me all the medical records leading up to that outcome, I will have no problem retrospectively identifying “errors”.
Just think carefully about what you are enabling. There are much better ways to make money as a physician, IMHO.
Thanks for sharing your opinion, but I’m not going to have any trouble looking at myself in the mirror for this. Sorry. The fact that you’re the only one of 30,000 readers (most of whom are docs) who seems to have a real issue here with this should say something.
Wow.
Well perhaps so.
I have not conducted any polls, but I definitely have heard from my fellow physicians about this debacle for several decades.
I certainly hope I am not the only physician out of the 30K readers here who questions the ethics of participating in the tort extortion of their fellow docs. That would be depressing.
No emails and you can read the comments. What you see is what I got.
I’m all for tort reform. But tort reform through trying to get all the doctors to stop being expert witnesses is just tilting at windmills.
I agree with Fred. So now there are two of us out of 30,000.
You think getting every doctor to refuse to serve as an expert witness is somehow going to change the system? Really? They’ll just get nurses to testify as to what the standard of care is.
Better to spend your time making sure your professional specialty organization censures those who provide egregious testimony IMHO. Look, I’d love to see us move away from litigation toward a no-fault system, but that’s not the same thing as telling doctors who serve as expert witnesses they’re scabs.
When I was sued, I was grateful for the expert who reviewed my case and supported my decisions. I never met or interacted with them. I didn’t become an expert with an agenda to defend physicians, instead I recognized it is an important role that physicians perform in these situations. I also learned from my case and continue to learn from others.
Whether or not you participate in the medical malpractice system is optional. But experts will continue to be needed. Whether or not an expert is considered part of the problem or a solution, is entirely up to one’s decision to show up as either.
We have to recognize that none of us is perfect. Occasionally a physician does something that could have been done differently with potentially a better outcome. The day I stop continually examining my own practice for opportunities to improve myself and learn is the day I’ll retire. And then I’ll continue to search for ways to perform at the highest possible level in other areas of my life.
I wouldn’t say it’s optional. I got to “participate in it” twice as an intern. Being an expert witness is optional, but most docs will participate in it whether they like it or not at some point in their career.
True, most of us will be sued so I absolutely agree that it’s mandatory when considered from that perspective.
As a different commenter mentioned, being an expert can be a great learning experience in the event you get sued as a defendant.
I would like to direct people’s attention to my comment that, in retrospect, I am certain that I could find something in the medical record that could be considered an “error” in ANY case of a bad outcome in my field. I suspect this is true of any field.
Egregious testimony is not needed. Medical issues are often complex and there are many gray areas. When a bad outcome happens and a lawsuit ($$) is desired, the medical records are examined by the plaintiff’s attorney. What I have seen in my experience, is that the lawyers with their “expert” come up with a legal theory of liability. It isn’t about finding the truth , it is about constructing an argument to win in court. This is the process you are involving yourself in as an “expert” witness.
For those that have never been through the process, they may assume that doing good medicine and treating patients well is the best defense. But the reality is, when the medical records are put under the microscope with a goal to find an angle to find you liable, well, you will be in an impossible position. And you will be twisting in the wind for several years with the threat hanging over your head. Moreover, most malpractice insurance has a limit of around $1M per case. Judgments over $1M then threaten your personal assets.
I could certainly make money playing this game, but I never would. It is a game, and a lot of hands are in the till, but it is a cruel game and many thousands of physicians suffer from it.
Whether you hate the tort system like most of us or not and whether you think being an expert witness is ethical or not, the data on above policy limits judgments not reduced on appeal is very clear.
It is EXCEEDINGLY rare for a doctor lose personal assets in a malpractice lawsuit. I calculate my personal risk out as less than 1 in 20,000 per year of part-time EM practice. And when doctors do lose personal assets, it is generally a relatively small (punitive) amount for egregious behavior, not being cleaned out and having to declare bankruptcy. But even if one had to declare bankruptcy, they generally get to keep a significant chunk of their assets depending on the state, including some or all of their home equity, pretty much all of their retirement accounts, some personal goods, and perhaps some cash value from a life insurance policy or annuity.
More info here: https://www.whitecoatinvestor.com/asset-protection/
As an aside, I love these kinds of questions because they are great preparation for deposition and trial.
For those of you interested in being an expert, you’ll learn how to handle these with clarity and even a little humor. So, thank you all for the comments and keep them coming! 🙂
I have worked as an expert witness for about 15 years. I work for both plaintiff and defense. I review cases and give opinions honestly without regard to any outside influences. The attorneys I have worked with for the most part have been fair and upstanding. Only a few bad ones. I absolutely agree with the comments of WCI.
That’s great that you have had a good experience and it’s important to work with both defense and plaintiff attorneys. It gives you perspective to work with both sides.
Great Post…I will add a few takeaways that I have learned from providing medical expert legal opinions.
1. The first case I took was specifically to learn how the system works in case I were to ever get sued. I learned a ton and was very happy to have taken the case. I’m sure it has helped me avoid mistakes that would make me more liable in a medicolegal case against me if I were to ever have one. (Knock on wood, none yet)
2. It is actually quite time consuming. I learned that I don’t have time to do much of this work at this point in my career. Expect to invest a significant amount of time that can actually take you away from your practice. If the case goes to trial or you have to be deposed, you may have been better off just staying in clinic.
3. Be sure to charge appropriately for your work. Even though my fees are very high, it is technically a financially losing proposition for me if I have to provide an opinion at a trial. Record review, opinion letters and depositions can typically be done remotely in your “free time” but you are at the whim of the courts and lawyers if the case goes to trial.
4. Be glad you are not the one being sued. It is very easy to remain level headed when an opposing lawyer attacks your character, skill, or knowledge if you are not the one on trial. It is good practice in case you ever become the defendant in a case and get deposed or called to the stand.
Thanks!
These are great points. I’m interested in what you think are “very high” fees. With most physician experts charging $500-$900/hr and a daily rate for trial of $5000-10,000, expert witness work usually works financially in your favor over working extra shifts/moonlighting. This is because the work is hard and does take time away from other potential pursuits. With appropriate fees, physicians should be able to do this work and more than balance it with time away from regular work and family. Thanks for your comments!
My hourly rate is on par…Looks like I need to hike up my trial rate. But I’m actually trying to do less/none of it now until my kids are older.
I am an endocrinologist. Not many malpractice issues. Any use for me in this expert witness side gig world? Is it worth taking the course if there’s isn’t much business for my specialty
Good point. I guess if there isn’t any work at all, no point in trying to do it. There must be some though, so a few experts must be needed.
Hi, Tessey. Yes, there are plenty of cases where endocrinologists may serve as experts. Even when a particular physician such as an endocrinologist is not being sued directly, you may still be needed to give opinions on subject matter in the case. Experts serve primarily an educational role in cases, so almost all physicians can have opportunities to be involved in cases.
I’m an ER/ICU doc and have been asked to comment on the quality of care for patients presenting with both DKA and hyperosmolar syndrome. So yes, there are endocrine emergencies that lead to malpractice claims.
I am willing to testify at te request of a plaintiff only when there are very serious errors in the care of a patient.
As far as supporting the defense of a case, most doctors do a reasonably good job of providing care, and they are entitled to a good expert to defend them even if some of the decisions made used reasonable medical judgment that turned out, in retrospect, to be wrong.
If you do this work, you are morally obligated to apply the highest level of integrity to your opinions. I strive for that level of excellence in each case that I am asked to review.
Tort reform is desperately needed, but for now we need to do the best we can with quality experts to work towards reasonable justice.
Over the course of a long career, I treated over 100,000 ER/ICU patients. I was sued twice and won both times with the help of a highly credentialed, ethical physician expert.
Well said. I completely agree.