The Fun Way Doctors Are Making Thousands of Dollars Without Seeing More Patients

About 15 years ago, a colleague asked Amy Fogelman, a Boston-based internal medicine physician, to review records for a medical malpractice lawsuit that he’d been asked to consult on. The patient in question was a transgender man — an area outside his expertise, but well within Amy’s clinical experience.

Amy enjoyed the case a lot — she got to use her medical knowledge to decipher a new type of puzzle, and it challenged her in a different way than she was used to. “I kept looking at it from the wrong vantage point at first, forgetting that I wasn’t this patient's doctor,” she said. “I didn’t need to pay attention to when their next colonoscopy was due. That’s not what you’re asked to do. You’re asked to review the case and figure out if there was a problem with the care.”

Plus, she got paid well.

Amy reviewed more cases for the same attorney and then started taking on cases from other attorneys too. Medical expert consulting became Amy’s regular side gig and then, eventually, her full-time focus. In 2018, Amy founded the company High Rock Experts, which connects attorneys with physicians (and sometimes other types of medical experts) to serve as expert witnesses in legal cases.

We talked to Amy about what medical expert witness consulting entails, how and how much physicians get paid for the work, and how High Rock helps physicians avoid common errors and become in-demand experts.

Here’s our conversation, edited for length and clarity.

Offcall: At a high level, what does a medical expert witness do, and what sort of legal cases are they usually hired to consult on?

Amy Fogelman: Basically, they’re explaining the medical facts of a case in a way that is accessible to the lay attorney, or the judge, or the jury.

The most common cases that medical professionals are involved in are medical malpractice, and then also personal injury cases — like a car accident, a slip and fall, or a dog bite. Usually what happens is that the person who is harmed is suing the person who caused the injury. The expert explains whether the medical condition was from that trauma, and what the prognosis is for that condition. But a physician could be an expert on any case that has medical facts in it.

Offcall: Your first case came through a colleague. How do physicians usually find this type of consulting work?

AF: A lot of experts get their first cases through word of mouth. You might get an email from an attorney or from a referral service, asking, like, “Hey, are you interested in reviewing this case?” Then, if you do a good job, the attorney's office will want you to do it again. That’s a typical way to get started, but I’ve also seen people who've gotten their starts from being sued themselves. Then they do a good job when they're being deposed, and then either their attorney, who was defending them, or the attorney on the other side might want to hire them. And another way is just by reaching out proactively to attorneys you know in your life.

Offcall: How does a physician’s specialty factor into the cases they’re hired for?

AF: You need to have substantive recent experience in the specialty that is being opined on. A physician in any specialty can be an expert witness. So, for example, one of the most common would be psychiatry, because there's a lot of discussion about whether or not somebody has capacity. In their regular practice of medicine, they interface a lot with the legal system, so they're familiar with it. But it goes beyond that.

In personal injury cases, they might want a neurologist to talk about a concussion or an orthopedist to talk about a specific injury. Primary care doctors like me are also helpful for certain cases, particularly if there were repeat visits to a primary care doctor after a certain event.

If you give me a specialty, I can tell you what types of cases are involved. I'm speaking later this week to a group of dermatologists, and there are obviously med mal cases, but they also have the opportunity to review cases for any kind of burns or rashes, or even workers comp where people are touching tools or chemicals that cause a skin condition.

Offcall: How does High Rock work? What’s the business model?

AF: I connect expert witnesses to attorneys across the country. I've matched 675 experts and counting. There’s the High Rock network, where I refer doctors to different attorneys — and it’s private. Doctors can go onto my website and add themselves to it. There’s no cost to the doctor — it's totally free. There are other expert witness services out there that will take a percentage of the billing, which High Rock doesn't do. We charge the attorneys a fee to make the match.

Then, in 2020, I created the High Rock Academy to educate medical professionals on how to be expert witnesses. And then, and this is brand new within the last couple of weeks, I also launched a directory on my website to spotlight graduates who've completed my program, so that attorneys can find them directly without having to go through me for a match. If you want to be in this public directory, you need to take my course and get a certification. I’m showing that these people know what the heck they're doing.

That gets back to why I created the High Rock Academy to begin with— I would get calls from attorneys about experts who were credentialed clinical physicians but would make mistakes that the attorneys would be pretty upset about. They were some of the same mistakes over and over again, like writing a report without getting permission, or sending a large bill without communicating about it, or writing about whether something was medical malpractice or not, when it was a personal injury case. These are things that we don't learn in medical training, but are very important and foundational for doing the legal work. So I realized that there was a need for a course.

Offcall: Is the course all online?

AF: It’s hybrid. It’s 15 video modules. Most people can complete the course within a couple of weeks. There’s the passive part — watching the videos — but then there's homework that you have to do too. So, it may only take you 10 minutes to watch a video about how to do your CV to make it palatable for attorneys, but then you actually have to go through the work of editing your CV and that's going to take longer.

Then there are also monthly live group calls. We usually have a theme. We're talking about report analysis this month. And if you have any questions any other time during the month, I'm available. So, when I say it's hybrid, I mean that you get the video content, and the live mentorship as well. And you get that for a year after you've signed up.

Offcall: How are rates typically set for medical expert witnesses?

AF: For physicians, hourly rates generally start at about $500 an hour and then go up to $900 an hour or more. That’s just for document review. Most physicians ask for a four- to five-hour retainer, an upfront payment. So you would get paid, like, $2,500 just to get the initial documents to review. But you also get paid for everything that you do, which is so different from what we’re used to in clinical work, where you get paid for the visit and then you’re on your own for everything that you do outside of that. But with this, it’s your time that you're billing for. Your time includes reading records, writing emails, writing reports, talking to the attorney.

And depositions and trials tend to be reimbursed at even higher rates — usually $100 to $200 more per hour.

A couple of things that people sometimes don't know is that, in general, you should be clinically active if you're going to be doing expert witness work, particularly in medical malpractice cases.

The other thing is that you need to at least be willing to testify at deposition or trial. Sometimes I'll reach out to people and say, “Hey, would you review this?”

And they'll say, “Well I will, but I don't want to ever testify.” That's not helpful because if an attorney were to pay for your review, and then you said, “Yes, there's a case here.” Then they would need to hire somebody else to do the review a second time, if they were going to take it to trial. So, you get paid such high rates because of the possibility that you would be deposed or go to trial. But only about 5% of cases go to trial. It’s a very small number. You can do most of this work while your baby's sleeping, or you’re in your PJs, or on the side of the soccer field. It’s very flexible.

If a case were to go to deposition or trial, the time between when you first start the case and the end of the case is long. We're talking years. You have plenty of time to prepare.

Offcall: So, with expert consulting, physicians get to bill for their time the way lawyers typically do.

AF: Well, yes, but that’s not how lawyers get paid for plaintiff cases. This is a misconception, and it’s part of why there's sometimes a disconnect between the expert and the attorney. Attorneys on plaintiff cases usually bill on contingency, so only if there’s a settlement or they win at trial, and then they get a percentage. If it goes all the way to trial and they lose, they make no money. There will be times when an attorney who's brand new might say to the expert, “Look, I'm only being paid on contingency, so I want you to be paid on contingency.” Well, it’s completely unethical for an expert to have their opinion be contingent upon whether the plaintiff wins or loses. Because then there's a financial reason for what the expert would say. That's not what we do.

Offcall: What can physicians do to make sure they get compensated fully for their work?

AF: There are a bunch of things. One of them is to have a contract. I give a customizable template as part of my course. But there are also attorneys who will do this for you. So have the attorney who hires you sign a contract, and ask for that up-front retainer before you review anything. If it looks like you're getting this huge tome of records, that there’s no way you can review in five hours, stop and get permission before you review those records. You don’t want to send them a bill for $15,000 afterwards, because they might not pay you.

Anytime you have leverage, ask for payment — ask to be paid before you release your report, before you’re deposed, and before you testify at trial.

Offcall: Why is being clinically active so important for medical malpractice cases?

AF: A lot of states have tort reform that requires a certain amount of clinical activity, and it's a way to prevent having professional experts who only do expert work and are willing to say whatever as long as the check clears. The thing about High Rock is that I'm a big believer in having integrity.

And the facts are the facts. It doesn't matter what side hires you. You're not there to win the case. You are literally there to give your opinion, and your opinion doesn't change.

Offcall: Have you ever personally felt pressured by an attorney to arrive at a certain conclusion?

AF: Yes, it happens all the time, because the attorney is there to advocate for their client. This is part of why I think it's really nice to have a mentor like me, to help with this stuff, because you can get a sense of the difference between what's normal with an attorney — putting some pressure on you to make sure you’ve thought about your opinion. But if the attorney's like, no, you have to say this, that’s not normal.

Offcall: So, in High Rock Academy, you help physicians navigate those types of situations?

AF: Yeah, it’s hard, I think physicians can really appreciate this. When you start taking care of patients, you don't know how to read them and you don’t know the red flags. For example, for a drug seeking-patient — once you've been doing it for a while, you can sniff that out pretty quickly. It’s the same thing with those types of attorneys. Sometimes they're looking for a rush opinion. That’s usually a red flag because it means somebody else dropped out beforehand. So you want to sniff out why it's a rush.

The other thing is that they may push you for your opinion before you've had a chance to review the records. You can give some initial upfront thoughts, but the records are what you're reviewing, and a lot of times what the attorney thinks are in them is not what you actually find, because there are medical nuances that they don't understand. And that's why they're paying you to review them. I love to help brand new experts figure out these things.

Offcall: Did you plan to grow High Rock into what it is today, or has it just evolved organically?

AF: It has totally evolved. I was a doctor. I didn't have any idea that I would be creating a business and using skills that I hadn't used since middle school, like creative skills for social media posts, or marketing myself, which is something I felt very uncomfortable with. These are brand new things I never thought I would do, but I’ve just noticed what the market has needed and I've continued to expand based on what I see.

Offcall: What’s the hardest decision you've had to make as the founder and CEO of a company?

AF: Well, I'm starting to get some inquiries about being bought out. I want to be thoughtful about how that could be helpful, but I also want to keep my vision focused on ethical, credible, expert work. If I let go of that control, I won't necessarily be able to have control over my legacy.

Offcall: In your opinion, why is medical expert witness consulting a great side gig for a physician?

AF: It’s very lucrative. I think it's fun. I think it gives you a sense of professional satisfaction beyond clinical care. It lets you use your voice in a way, and you're really helping make the system better for everybody.

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Check out High Rock Experts here, and connect further with Amy on LinkedIn here.