Practice Development for Medical Expert Witnesses
Beryl Vaughan, Consultant
Email firstname.lastname@example.org or Call (415) 302-9589
5 Business Tips for Forensic Physicians
- “Building a practice for the long-term”
- “Practical and Ethical Considerations In Creating a Website”
By Beryl Vaughan
Nuts and Bolts. Ideas for a Successful, Ethical Practice.
Improve your bottom line while building your reputation for integrity and best practices.
The original article focuses on Forensic Psychiatrists and Psychologists, but the concepts are relevant to any physician in medical-legal work.
Steps to develop and manage your practice as a forensic expert.
This overview covers 5 common questions that arise in practice management.
- Get the business: Overview of ethical marketing.
- Working efficiently and effectively for a great professional reputation.
- Billing your client so you’re paid quickly and fully.
- Collect your fees without souring business relationships.
- Get more business from new and returning clients.
Get the business: Marketing
A solid marketing strategy has moving parts. This entire site discusses ideas. The summary below highlights important intentional steps to achieve your practice goals.
Most attorneys seek experts online.
Websites are the holy grail of marketing because attorneys can easily learn about you, if your website invites them to do so.
Most medical-legal experts do not have a website or have an exclusively clinical website. More detail in the article “Website Wins and Fails.”
Free resources like Google MyBusiness provides contact information and name recognition. (Run a Google Search for “Forensicexpertpro.” The big box on the right is my GMB listing.
Listing Services, Expert Witness Directories are another. There are dozens. Only a few are suitable for your practice.
Audio, Video, the Written Word. Some experts are comfortable with a YouTube Powerpoint or interview. Or perhaps your comfort zone is exclusively writing.
CV Online. Your bio, and its lengthier cousin the CV, can be posted online in select settings. A website “About” page provides attorneys with a fast method to identify your credentials.
“Do the work” begins with handling the first call and managing workflow
Getting work begins when you receive a call from an attorney.
That call can quickly transition to the start of your work when the attorney explains to you their case and you communicate, if accurate, your applicable expertise. It isn’t necessarily billable, but it is essential.
- Take the first call yourself
- Answer the phone
- Respond to voice mail messages fast
- Answer emails immediately
- If you’re unavailable, respond quickly with a specific time to do so
Attorneys have told me dozens of times that they retained the expert because they were the first person they called that day who actually answered the phone.
Let’s talk about that first call.
Your work includes understanding the case, sharing your insight (and demonstrating your expertise.)
- Take copious notes, date them (!)
- Get the attorney’s contact information
- Ask how the attorney found you and note it.
- Bear in mind, of course, that these notes will likely be discoverable, but that’s true of almost everything in your file.
Send the attorney an email summarizing all of the above.
Why? Because the attorney might call 3 more experts after your call and you want to be remembered.
Reference the case. Your email should refer back to specifics about the case. It shows you were paying attention.
Reinforce scope and timeline. Remind the attorney of the scope and timeline. This helps with potential sticker shock down the line as that first email documents the scope and cost you first discussed.
Identify next steps. Put the attorney on notice that a retention contract and retainer are required and don’t begin work until you have those in hand.
Calendar case deadlines like expert disclosure, discovery, track hearings and depositions
Follow up with attorneys the afternoon or next day after a relevant hearing or deposition takes place (how did the hearing go on the motion to compel an IME? Did a new attorney substitute in? What experts in your field were named by opposing counsel? Should you look at last week’s deposition transcript? It’s all relevant to you, but even more relevant to the attorney. They will be impressed that you know your way around a lawsuit and are interested in how their case is evolving.
As a practical matter, case management protocol is a time-saving priority and if you don’t have one, it makes everything in this paragraph above easier. You’ll read about this in Do It Like a Lawyer.
Bill the client with transparency, accuracy and without being defensive.
There’s a saying,
“It’s better to ask forgiveness than permission.”
THIS IS A BAD PRACTICE FOR YOU.
That doesn’t mean ask for permission, but it does mean proactively keep your client informed:
Bills that ask for forgiveness are in fact less likely to be paid–no one wants to be surprised by a bigger bill than they expected.
- “In light of the additional material provided and my expanded findings, as well as the questions posed, I am incorporating this in to my expanded and and thorough report.“
- Never wait until the report is done to bill. Instead, invoice on a regular schedule. This takes the sting out of the surprise bill.
- Record your time with detail as you do the work, or shortly thereafter.
- Write off learning curve time.
The goal: no surprises and no arguments about your bill.
Collect the money: the expert witness way
Billing and collections methods that are embedded in your practice routine:
Let’s start with what seems obvious: you can’t get paid what you never billed.
- Keep your time record scrupulously. Today I had to write down my time after many hours of hard work. My head was spinning and I was working so fast I could barely remember what I had done. I stopped and wrote it down. How did I do it? I have a system.
- I sent emails to the client explaining the status of tasks I was doing, that the client was doing or a third party who was going to get back to me.
- I even write emails to myself!
- I invoice promptly and regularly and am not greedy. I write off time if I feel it is appropriate, and I make sure my client is so informed.
- If month after month goes by and I am unpaid, collecting may very well rest on how well my work was understood so it can be acknowledged.
- A legal aside: invoices are usually included in discovery and often brought up at trial. In some cases, the Expert’s fees can be reimbursed to the retaining party from the losing part (if they are different.) Everyone benefits by a detailed record of your time.
“Collections” practices are tightly tied to billing practices.
In house collection methods, if done right, canbe a reputation-enhancing moment. How you nudge an attorney to pay an outstanding invoice will impact your future relationship with that attorney and colleague he or she speaks to about your services in the future (e.g. referrals).
I’ve put every approach to the test. One works better than the others: Be nice. Be a good cop. Bees to honey. If you approach a client like a collections agency would, you can kiss Goodwill goodbye. Sounds obvious, but it isn’t.
Outsourced Billing and Collections
Is your billing being handled by someone who can talk with an attorney? Does your billing method reflect the important ethical concerns of the profession?
Bookkeepers and Collections Agencies are used by some doctors. Attorneys are at the receiving end.
It’s always dicey to put your billing and collections in someone else’s hands. However, if you’re busy, delegating is still smart. Also, the learning curve for these tasks is steep and may not be worth your time.
Before you hire someone whose work reflects on you, they will benefit from training about medical-legal practice administration. I do this sort of training because it is so crucial and can be subtle.
A Bookkeeper Impacts Your Reputation
Bookkeeping services, software and inadequately trained staff can detract from your practice’s fine reputation. Ignorance is the most common problem. An invoice that doesn’t reference the case citation. Testimony fees are not separated from other work. When an attorney calls about a bill, they know what to say–or not say. E.g. clinical practitioners may accept a negotiated discount of their fees; an Expert Witness should not.
Invoices should ALWAYS pass through your hands before sending out. It’s your reputation on the line. A mistake has consequences.
Intermediary “Mark Up” Referrers
If you were retained via a referral service that charges an add-on to your rate, you will be handling the billing to them and they will be restructuring it for the attorney. Your bill to them is precisely the same as any invoice to an attorney.
There are a number of such businesses and some produce solid cases and have a loyal attorney following–making it a good move to “sign up.” However, such services don’t want the attorney to know about their markup. I’ve had good and bad experiences with companies that operate on this model. I’ve blacklisted a few. Minimize your exposure to loss.
- Don’t let anyone else have the contractual relationship with the attorney. Even if a referral service does the billing, you can still insist on your retention contract that excludes reference to your rates. The contract establishes the terms of your retention and defines who is retaining who, and in what capacity.
- Commit the referral service to your entire fee schedule. It is very common for these services to focus on your hourly rate and testimony rate. Cancellation fees and how you bill for travel time are the most common to go by the wayside.
- Be a watchdog. Audit their charges and practices. In one case I worked on, the intermediary service began to harass and threaten the attorney only a month after they submitted an invoice.
- There’s already enough ugly backsplash on the expert because of the plumped up bill. Heavy-handed collections can further besmirch your fine reputation for fairness.
- Most referral services want you to stay at arm’s length from the attorneys with respect to billing. Be proactive. If you don’t like how things are being handled, make an apology to your client and a gentle reminder that you are not behind the invoices they receive.
Cooperative billing and collections with your client are part of the overall customer service experience. Avoid pitfalls by anticipating and responding to your clients’ requests for the format of invoices and remittance procedures.
Different cases mean different procedures: 2 Examples
Litigation and Criminal Cases. Cite the case on your invoice. The citation is “Joe Blow v. Blow Industries, [State and County] Superior Court Case No. C01050 (along those lines.) On your invoice include your Tax ID Number if you have one–it makes the attorney’s life easier. Invoices are another opportunity for effective communication associated with repeat cases from the same firm.
Fitness for Duty. In a Fitness for Duty evaluation, for example, you might have to invoice a large company with internal procedures, Purchase Order and Contract numbers, layout and even payment rules. Some pay right away, in 30 days, 45 days or even 90 days. On your invoice, always reference your own file name as well as theirs, to keep cases separate.
Outcome. A word about outcome: if the attorney that retained you loses the case (regardless of whether your opinion had anything to do with it) the attorney may be paying your fees out of his or her own pocket. This is true when the attorney is working on contingency or has a client without funds. Guess how willing that attorney will be to pay your final invoice? Stay out of this scenario. Your retention contract and retainer procedures can protect you. Increasing the retainer before trial is another option.
Get more work.
See 1-4 above. When these work, you boost your reputation on the many fronts described. Methods and strategies are effective, but not intuitive.
Reach out to attorneys who have retained you in the past. Reach out to opposing counsel on cases in which you have worked in the past! Stay in touch. Follow up. Don’t let them forget your name.
Stay fresh with your marketing strategy. The internet is changing all the time. Website design, resources, browsers are all shifting, adding and deleting services.
Get help with what you don’t know. That’s what your attorney clients do when they retain you as an expert witness.
Who is your expert?
**Marita K. Marshall, Former Senior Partner at Folger Levin, Professor at Stanford School of Law, San Francisco Superior Court pro tem Judge, and a former boss, taught me early that written communication should be self-explanatory, on its face. It should be possible to pick up any note, email, memo, correspondence and know what is being said and in context no matter how many years have passed.
 The statement presumes an existing website is built on a solid technical foundation.