Practice Development for Medical Expert Witnesses
Beryl Vaughan, Consultant
Nationwide

Email go@forensicexpertpro.com or Call (415) 302-9589

What do you want to know?

Can I be an Expert Witness if I mostly treat patients?

Of course!

In fact, you are considered a more valuable expert witness when it is clear you practice what you claim to know.  Attorneys prefer an expert witness who can testify about what they experience in their day-to-day practice treating clients/patients.  By “client” I mean a person you are treating.

How do I become Board-Certified for Medical-Legal Work Specifically? Is it necessary?

If you are not Board-Certified in your forensic subspecialty, you should consider it if the option is available.

If there is no option, you still have resources to help you in your medical-legal practice. Read below.

If you are a Psychiatrist or Psychologist, there is a defined pathway to Board-Certification in this specialty.

If you are a medical specialist in another field–or any field, continuing education is available that will improve the depth of your skill and service as an expert witness. This translates to a more robust practice.

Read the full article which contains practical ideas and solutions to common concerns for physicians.

What credentials are needed to be an Expert Witness?

Ideally, you are Board-Certified in your medical specialty and hold an active medical license. I have come across practitioners who hold a medical license and are not Board-Certified. In that case, experience and reputation is everything. I would not want to be on the stand being grilled about my qualifications if they are hard to defend. Would you?

If the case requires unique expertise, then you will need to have that expertise and be able to defend any challenges you do not.  For example, a case involves the use of a medical device. If you have never used that device and your practice does not bring you into contact with patients with the device, you may be disqualified from testimony.

The question is not what excludes you but what includes you.

Every doctor knows something about their field and some are particularly knowledgeable about a corner of it.

If a lawsuit involves the area of your expertise, it is essential you communicate it to attorneys–so they know! Whether you write for the Journal of the American Bar Association or your website, it should be possible for an attorney with that case to determine it is something in your wheelhouse.

Nice, but not necessary:

Publishing in your field

Speaking experience about the topics you know best.

Awards, Honors

Faculty Positions about your area of expertise.

 

Do I have to know law? What credentials are required to do medico-legal cases?

The companion to this FAQ is “How do I become Board-Certified for Medical-Legal Work? Is it necessary?” with a practical discussion of training and continuing education of value to enter a medical-legal practice.

The answer is different for all medical specialties vs. Psychiatrists. Only Psychiatrists can achieve Board-Certification in Forensic Psychiatry (as distinguished from general Psychiatry). There is no Board-Certification in Forensic anything in other medical specialties with the exception of Pathology.

Doctors in other specialties without forensic/medical-legal expertise can acquire medical-legal knowledge and experience through Utilization Review and Workers’ Compensation cases.

Forensic work is the interface of medicine and law. Forensic skill benefits from acquiring legal knowledge. Evidentiary and other Rules and laws govern what an Expert Witness can and cannot do/say and a threshold of qualifications that must be met. Disclosure is necessary in many cases.  For example, Rule 26 of the Federal Rules of Civil Procedure require that an Expert Witness produce a list of cases in which they’ve testified going back 4 years.

You will not know this intuitively.

I encourage my clients to conduct research about the law as it applies to them, attend courses, attend Bar Association education programs and pursue mentorship.

The most important legal source is the law itself, like Rule 702. Testimony by Expert Witnesses under the Federal Rules of Civil Procedure, for example, which states the requirements and limitations of the Expert Witness testifying in Federal cases.

Physicians in any specialty are sought for their expertise. Juries must understand medical issues if a medical concern is involved in a litigated matter.

Just for Psychiatrists and Psychologists:

I discuss this question in the FAQ “How do I become a Forensic Psychiatrist or Psychologist.” To summarize: Forensic Psychiatrists do not have to be Board-Certified in the subspecialty of Forensic Psychiatry (ABPN), but it helps tremendously. Ditto for psychologists. About 1% of all psychologists hold the Forensic Psychology Board-Certification, from the ABPP. Think of it as a feather in your cap, not a requirement.

You will, however, run into serious problems if you create an impression you are Board-Certified and you are not–whatever the specialty.

If you are not Board-Certified in your forensic subspecialty (psychiatrists and psychologists), or are not Board-Certified in a medical specialty in which you are serving as a medical-legal consultant, you should consider it.

It may not be as hard as you think.  From the American Academy of Psychiatry and the Law:

Per the ABPN the primary requirement is  “…successful completion of one year of ACGME-accredited fellowship training in forensic psychiatry……may be completed on a part-time basis as long as it is not less than half time; credit is not given for periods of training lasting less than one year except under special circumstances that must be approved by the ABPN Credentials Committee.”  There are other requirements including exclusions, and the certification examination.  The ABPN site is the best source for this information, not me.  Note: the ForensicExpertPro website contains information for those Board Certified in their primary specialty, (general) Psychiatry or Psychology.  I have limited experience with experts in satellite or adjunct fields. For example, I have worked on cases where forensic opinion and testimony was rendered by a Licensed Social Worker (LCSW) but know nothing other than that it has occurred.

I'm a Psychiatrist (or Psychologist). What are my options?

The answers for a psychiatrist differ from a psychologist. The scope of this article is not intended to address healthcare providers in other specialties.

Psychiatrist

The American Board of Psychiatry and Neurology

A Forensic Psychiatry fellowship is the first step to acquire Board-Certification in Forensic Psychiatry, granted by the American Board of Psychiatry and Neurology.

Fellowship is a one-year program. They are offered at fewer than 50 schools in the US and generally, there are 2 Fellowship spots.

Do not fear rejection.

Obviously, some schools are more competitive than others (and more expensive) but I am continually surprised to see open Fellowship spots far into the “application cycle.” Stipends are not untenable and you may have greater flexibility than, say, residency Match.

Information about Fellowships is available from the American Academy of Psychiatry and the Law site (AAPL). Some schools have open spots for Fall 2022.

Not Board-Certified?

Psychiatrists can and do practice forensic psychiatry (lower case) who are not Board-Certified in Forensic Psychiatry. A psychiatrist can serve as a subject matter expert, for example or have experience in forensic assessment and a reputation in their field that makes Board-Certification less relevant.

The American Board of Medical Specialties

Complementary training and Board-Certification in more than one specialty can make a powerful combination if the case is medically complex. E.g. was behavior related to a psychiatric condition or side effect of meds for another condition? Did addiction impact judgment? 

I recommend you look at The American Board of Medical Specialties report of Board-Certifications and requirements including options for cross-specialization. Read the 2019-2020 ABMS report for more information.

Psychologists

American Psychological Association article on Forensic Psychology.

For a psychologist, dedicated training is available through a wider range of pathways. Disclaimer: This is an overview and not intended to endorse a particular program or approach to building your practice.

A psychologist can pursue postgraduate study; some psychology programs are dedicated to acquiring a PhD or PsyD in both Psychology and Forensic Psychology.

Relatively recently, the ABPP began offering Board-Certification in Forensic Psychology. At last count, fewer than 400 psychologists held this Board-Certification, a significant addition to their credentials and qualifications as an Expert Witness.  Board-Certification in Forensic Psychology from the ABPP, in my opinion, is the gold standard for credentials.

Prior to obtaining a PhD or PsyD, it is possible to pursue a Masters Degree in Forensic Psychology. John Jay College of Criminal Justice, for example, is a top-ranked school for a Master’s Degree in Forensic Psychology. Also highly ranked is the University of Denver’s Master’s Degree in Forensic Psychology. Many forensic psychologists obtain their degree online through lesser known Alliant University, because they can pursue school while holding a day job.

Talk with your colleagues! Learn how they got to their forensic practice. I recommend asking them how their own education stood up to scrutiny on the stand.

Many other sites do a better job of answering this question than me and there are dozens of dedicated Forensic Psychology programs, so I will leave it to them.

View this answer in full

How much do Medical Expert Witnesses Earn? Do the same rules apply to non-Medical Experts?

This is the question I hear the most often. I write on the topic in depth using as an example Psychiatrists and Psychologists–but data is consistent with other medical specialties.  Setting the Right Fee in Medical-Legal Work.

A physician in any medical specialty will find information of use there.

In short, your fees reflect:

  • How easy it is to find you
  • How easy it is to reach you*
  • Your demonstrated knowledge
  • The quality of your reports (get feedback and improve)
  • Times you’ve testified
  • How many attorneys know you
  • The number of inquiries you receive from attorneys

*Surprisingly, attorneys report they often retain the first Expert who takes their call.

Documented Rates Don’t Exist

No legitimate survey has been carried out for forensic medical professionals, including psychiatrists and psychologists–it is too specialized. I go into the hard(er) data below.

However, information exists through legal documentation of fees, first hand reports and a little  deduction and extrapolation.

My experience is $250/hour to $1200/hour (how’s that for a range!), the bottom being a PhD, Psychologist, Nurse Practitioner, or someone fresh out of school and without testimony experience.

The more education you have, such as a  Fellowship and Board-Certification in more than one subspecialty, the more you can charge.

  • For experts with 1-3 years of experience who have testified 5-15 times, the mean is nearer $400
  • Mid-career doctors with sound credentials usually charge $500-800
  • A doctor at the top of their field might expect to charge as much as $1,000-1,300/hour
  • All testimony is charged at a higher rate than the base rate (add 40% or so to the figures above)

This is from my own personal experience.

INCOME-RATE RELATIONSHIP

Fee Income = billable rate x number of hours available for a forensic practice

Profit = Fee income, less expenses.

Projected Income: You are in control: your hours in demand x your fee (increasing over time) less expenses.

Income is limited to how often you are retained. Thus, income is driven by demand.

Demand is generated through action.

Data Geeks: summary of hard data

There exist 2 private surveys conducted by expert witness directories. The samples are small, the statistics misleading and application to your field is next to null. Most importantly, annual income reported is not usually identified as being full time or part-time. Not helpful.

Bureau of Labor Statistics is often cited in the press, but actually is not helpful because forensic work isn’t a separate category of data collection.

I believe forensic physicians in any field do not make as much income from their forensic practice as they could, by which I mean more billable hours. Yours change over time and ultimately reflect your experience: i.e., the number of billable hours you have spent learning your trade.

That is the point of my services–to get my clients more billable hours.

Whatever you decide to charge, don’t intentionally try to undersell your competition.

Your services are not available on Groupon.

Further, your rate reflects your experience. If you cut your rate because you want more work, it will be easier for attorneys to assume the rate is an accurate reflection of your experience even if it is not.

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What's the difference between a "forensic" professional and being an "Expert Witness? Do they always go together?

A forensic scientist studies material to form educated conclusions. 

An “Expert Witness” is a legal role. The person serving in this role renders opinions to help a jury or judge to understand the results of the investigation–an investigation the expert witness likely has conducted.

In short: If liability is proven, teaching the trier of fact will assist them in their decisions about the damages experienced by the injured party, and an appropriate award.  Some experts are “fact” witnesses and not “damages” experts. In that case they explain information resting on their professional acumen in a general way.

An Expert Witness is officially disclosed to the Court and all parties, subject to laws about their qualifications and limits to testimony.  

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What does "forensic" mean?

Etymology: Forum, as in presented in a public forum (Latin)

“Relating to or dealing with the application of scientific knowledge to legal problems…”  (Merriam Webster)

“Belonging to Courts of Justice.”

(Black’s Law Dictionary per “The Law Dictionary Featuring Black’s Law Dictionary Free Online Legal Dictionary, 2nd Ed.”)

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What is Forensic Psychiatry? How about Forensic Psychology?

“Forensic Psychiatry is a subspecialty of psychiatry in which scientific and clinical expertise is applied in legal contexts involving civil, criminal, correctional, regulatory or legislative matters, and in specialized clinical consultations in areas such as risk assessment or employment. These guidelines apply to psychiatrists practicing in a forensic role.”

American Academy of Psychiatry and the Law, Ethics Guidelines for the Practice of Forensic Psychiatry, Adopted May 2005

The American Board of Professional Psychology provides a similar definition:

“Forensic Psychology is the application of the science and profession of psychology to questions and issues relating to law and the legal system.  The word “forensic” comes from the Latin word “forensis,” meaning “of the forum,” where the law courts of ancient Rome were held.  Today forensic refers to the application of scientific principles and practices to the adversary process where scientists with specialized knowledge play a role.”

Forensic Psychology as defined by the American Board of Professional Psychology

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Is forensic work profitable?

This is the elephant in the room.  When you want to be known for your sage knowledge, you might not want your motivation to seem to be money.  The fact is, forensic work and Expert Witness work are conducted as a business.  Fees are charged.  Payment is expected. Costs are incurred.  Taxes are paid.  You have competitors who will take work from you if you aren’t actively promoting yourself. As a general rule, forensic work is considered a higher and best use of skill and experience than the ongoing business of providing services.  In other words, an Expert Witness on the topic of safe plumbing practices would be expected to know more than a garden variety plumber. For that reason, Experts are usually paid more than they receive in carrying out the duties of their profession.  Testimony is usually charged at a higher hourly rate than other work because it is more difficult and the stakes are higher. In some professions, Forensic work pays considerably better than an ongoing job.  To know the value of your skill in a legal environment requires research.  The usual sources of data, like the Bureau of Labor Statistics don’t tend to break out income for forensic work from the profession at large.  Some online services that provide information to attorneys about specific Experts have conducted surveys that may be helpful. When I am helping someone determine their fee, I consider the rarity of their knowledge and competitive value among others in their field. A commercial electrician is more valuable in commercial construction cases than a residential electrician. The commercial electrician can charge more, in my opinion, as a result.  A casual informational interview with a few attorneys in your area wouldn’t be amiss if you are just now considering taking on Expert work. Click here for a printable version of this answer

How much do you charge to do my marketing?

Whether you’re hiring a marketing consultant, or an attorney retaining a forensic Expert Witness, we all want to know if we can afford what we need, and what will be the return on our investment.

In fact, this is one of the first questions you, the Expert, will have to answer when an attorney calls you.

The question is actually “how much is this going to cost me?” I ask you to consider how you would handle this question from an attorney and apply it to the question you are asking me.

Like a records review or IME, a marketing budget is hard to pin down because there is no rubber stamp to expertise services–yours or mine.

The answer relies on what “this” is.

Scope of a marketing plan has moving parts.

And the parts between are work are pretty similar.

The moving parts of your practice are

  • Have the quantity of records to review been doubled?
  • Did the IME drag on due to an examinee’s Personality Disorder?
  • Did the attorney ask for a longer, or shorter report after you did the the first report?

For me the unpredictable answers are:

  • Are we talking about a website design? Big, small, tailored to my recommendations?
  • Which of the parts will I handle and which will you?
  • If I recommend a course of action outside the website.
  • Do you want me to do it or you? Do you have the time? Can you do it correctly for max effect?

Turnkey services are fine.  Or are you more of a DIY person with hidden talents?

Experts sell their time and experience, as do we all.

I do my best to describe a reasonable range of cost based on experience. Promises are never a good idea, for you or me.

Remember though, no one ever complained about costs coming in lower than expected, but when scope balloons, we need to communicate for transparency and planning.

My job is to help you make proven and wise decisions for the practice you have now and the one you want.

The bottom line is: I charge less than you do or, if I don’t, then we should discuss your rate.  Let’s talk. Click here for a printable version of this answer

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