Evaluating Adjunctive Job Opportunities

[NeuroCog]

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Hello Forum,

First time poster, long time lurker.

I am a neuropsychologist on the tenure track in an AMC. My FTE split is about 75% research and 25% clinical. I also do expert evals as often as I am able, but I can't control the frequency of these. I probably average one a month. I was approached by an IME finder third-party corp that performs evals solely for Veterans disability evals with psych claims. For one day a week (4 evals), the pay is about $500 as an independent contractor. This is much less than I charge for my own expert evals, but the work is steadier. What does the Group think of taking on this type of work? I know it ultimately comes down to how I value my time and energy, so I'm looking for what you all think, differing perspectives, potential pitfalls, etc.

Thanks in advance!

 

[PsyDr]

That is completely BS pay.

 

[NeuroCog]

That is completely BS pay.

Yeah, it's quite low.

 

[Sanman]

Hello Forum,

First time poster, long time lurker.

I am a neuropsychologist on the tenure track in an AMC. My FTE split is about 75% research and 25% clinical. I also do expert evals as often as I am able, but I can't control the frequency of these. I probably average one a month. I was approached by an IME finder third-party corp that performs evals solely for Veterans disability evals with psych claims. For one day a week (4 evals), the pay is about $500 as an independent contractor. This is much less than I charge for my own expert evals, but the work is steadier. What does the Group think of taking on this type of work? I know it ultimately comes down to how I value my time and energy, so I'm looking for what you all think, differing perspectives, potential pitfalls, etc.

Thanks in advance!

$500 for 4 evals or $500 per eval? $500 per 4 is less than insurance pays for 90791.

 

[NeuroCog]

$500 for 4 evals or $500 per eval? $500 per 4 is less than insurance pays for 90791.

$500 for the 4, so about $62/hour.

 

[Sanman]

$500 for the 4, so about $62/hour.

You would likely make more doing dementia evals for medicare folks.

 

[NeuroCog]

You would likely make more doing dementia evals for medicare folks.

For real. The more I talk about it, the worse it gets.

 

[Therapist4Chnge]

Yeah, that is beyond a trash offer. Experts make hundreds per hour, not per day. Legal work is often 2-3x clinical rates, obviously some variance w experience, region of the country, etc.

 

[Fan_of_Meehl]

One reason they pay so low is because the real 'work' being done isn't actually a full diagnostic eval. It is basically 'rubber stamping' a 'yes' to the PTSD diagnosis.

The modal veteran you're likely to see will be someone who has actual, well-substantiated (in the record), diagnoses of serious substance abuse, criminal history, personality disorder, multiple serious medical complaints (especially neurocognitive), with a non-combat MOS who is claiming PTSD from a questionable Criterion A event (and/or listing out 23 different distinct 'traumatic stressors') and who will respond to all detailed interviewing around PTS symptoms with vague labels and evasive answers (while trying to 'qualify' for having the symptom being asked about). You will see all sorts of non-credible and atypical 'presentations' and histories that bear absolutely no resemblance to the known natural history and pathogenesis of the condition (per the epidemiological literature and your own professional experience) but be expected to render a diagnosis of PTSD in less than 30 mins.

This is an 'easy' and quick evaluation 'task' for someone simply willing to 'check the box' and give the PTSD diagnosis. You will have a very willing and compliant accomplice in the form of your 'interviewee' who will gladly endorse any symptom you put in front of them.

However, to a clinician with a conscience and even a smidgen of training and professional experience...it's kind of a nightmare.

 

[AcronymAllergy]

Agreed with all the other replies--the work itself notwithstanding, just looking at the economics of it, if you're spending more than about 15-30 minutes per eval (total), you're getting pretty significantly underpaid. And if you actually do a legitimate (forensic) evaluation, you're probably making less than clinical rates.

 

[WisNeuro]

Insert hardest no possible here.

 

[NeuroCog]

One reason they pay so low is because the real 'work' being done isn't actually a full diagnostic eval. It is basically 'rubber stamping' a 'yes' to the PTSD diagnosis.

The modal veteran you're likely to see will be someone who has actual, well-substantiated (in the record), diagnoses of serious substance abuse, criminal history, personality disorder, multiple serious medical complaints (especially neurocognitive), with a non-combat MOS who is claiming PTSD from a questionable Criterion A event (and/or listing out 23 different distinct 'traumatic stressors') and who will respond to all detailed interviewing around PTS symptoms with vague labels and evasive answers (while trying to 'qualify' for having the symptom being asked about). You will see all sorts of non-credible and atypical 'presentations' and histories that bear absolutely no resemblance to the known natural history and pathogenesis of the condition (per the epidemiological literature and your own professional experience) but be expected to render a diagnosis of PTSD in less than 30 mins.

This is an 'easy' and quick evaluation 'task' for someone simply willing to 'check the box' and give the PTSD diagnosis. You will have a very willing and compliant accomplice in the form of your 'interviewee' who will gladly endorse any symptom you put in front of them.

However, to a clinician with a conscience and even a smidgen of training and professional experience...it's kind of a nightmare.

Thank you for the detailed response. I will pass on this "opportunity."

 

[NeuroCog]

Yeah, that is beyond a trash offer. Experts make hundreds per hour, not per day. Legal work is often 2-3x clinical rates, obviously some variance w experience, region of the country, etc.

Agreed.

 

[WisNeuro]

Please make sure you let them know that you are passing on the opportunity due to the insulting nature of the reimbursement. They need to hear it as much as they can.

 

[NeuroCog]

Please make sure you let them know that you are passing on the opportunity due to the insulting nature of the reimbursement. They need to hear it as much as they can.

Oh I'll certainly tell them why I am passing.

Any tips on how to stabilize the flow of IME i receive? I've been doing them for a couple years and they seem to come in waves.

 

[WisNeuro]

Oh I'll certainly tell them why I am passing.

Any tips on how to stabilize the flow of IME i receive? I've been doing them for a couple years and they seem to come in waves.

Depends on saturation of your area, your reputation with clients from previous reports, how quickly you can accept as well as turnaround a report, how well you do in depos, etc. Kind of tough to say. How many IME companies are you paneled with?

 

[NeuroCog]

Depends on saturation of your area, your reputation with clients from previous reports, how quickly you can accept as well as turnaround a report, how well you do in depos, etc. Kind of tough to say. How many IME companies are you paneled with?

The vast majority of cases I get come directly from law firms, though I have received a couple from two IME companies. Of course the repeat business with law firms is great.

 

[WisNeuro]

The vast majority of cases I get come directly from law firms, though I have received a couple from two IME companies. Of course the repeat business with law firms is great.

You can build an IME case load with purely direct law firm stuff, but some law firms will only use IME companies, for the most part. If you want to increase referrals, you could credential with one or two.

 

[AcronymAllergy]

You can build an IME case load with purely direct law firm stuff, but some law firms will only use IME companies, for the most part. If you want to increase referrals, you could credential with one or two.

Agreed. That's probably the most straightforward way to get more cases. Maybe just check with some colleagues for recs as to which IME companies to get involved with in your area.

 

[Therapist4Chnge]

Building up consistent IME referrals is more of a years thing than a year or less. If you can get in with 1-2 IME companies that pay your full fee, that can build up some consistency. Direct law firm referrals seem to be more sporadic, at least for me. In the beginning, I would get a lot of plaintiff referrals, but they were often bad cases that I passed on too. Most experts have a clear lean with who they work with more, though I continue to make an effort to be 50/50 with plaintiff/defense bc I view it is better for my reputation. mTBI defense cases are my preference bc the research favors them, though the devil is in the details, so I try and vet every cases pretty thoroughly before I take it. This approach has led to more mediators using me because both sides agree to use me. Pre-litigation and review but no report cases are two of my fav types of referrals, as often I can get paid to review records and do a phone conference, but probably half the time never even have to write anything...I just offer my opinions, answer questions, and then send the invoice. I don't mind writing because it can add up in hours, but not having to produce work product has its advantages too.

 

[WisNeuro]

Building up consistent IME referrals is more of a years thing than a year or less. If you can get in with 1-2 IME companies that pay your full fee, that can build up some consistency. Direct law firm referrals seem to be more sporadic, at least for me. In the beginning, I would get a lot of plaintiff referrals, but they were often bad cases that I passed on too. Most experts have a clear lean with who they work with more, though I continue to make an effort to be 50/50 with plaintiff/defense bc I view it is better for my reputation. mTBI defense cases are my preference bc the research favors them, though the devil is in the details, so I try and vet every cases pretty thoroughly before I take it. This approach has led to more mediators using me because both sides agree to use me. Pre-litigation and review but no report cases are two of my fav types of referrals, as often I can get paid to review records and do a phone conference, but probably half the time never even have to write anything...I just offer my opinions, answer questions, and then send the invoice. I don't mind writing because it can add up in hours, but not having to produce work product has its advantages too.

This can be tough. I have never seen a plaintiff lawyer around here hire a board certified neuropsych to do an eval.

 

[Therapist4Chnge]

This can be tough. I have never seen a plaintiff lawyer around here hire a board certified neuropsych to do an eval.

Agreed.

I basically only take catastrophic injury plaintiff cases bc they are mostly about the severity and level of impairment, and there are positive imaging findings and related supportive data. Too many pitfalls taking the vast majority of mTBI plaintiff cases. Most of the plaintiff mTBI cases have junk experts who can claim some interesting things….none that I’d want to have to comment on. All of the known ambulance chasers hate me, but I’ve carved out a niche with some ethical PI attorneys.

 

[WisNeuro]

Agreed.

I basically only take catastrophic injury plaintiff cases bc they are mostly about the severity and level of impairment, and there are positive imaging findings and related supportive data. Too many pitfalls taking the vast majority of mTBI plaintiff cases. Most of the plaintiff mTBI cases have junk experts who can claim some interesting things….none that I’d want to have to comment on. All of the known ambulance chasers hate me, but I’ve carved out a niche with some ethical PI attorneys.

What magical fantasy land is this?

 

[Therapist4Chnge]

What magical fantasy land is this?

LOL....I know. I've found a few smaller/niche firms that do related work in the area, but aren't the stereotypical PI ambulance chasers. They aren't huge referral sources, but I feel a lot more comfortable working with them because they seem to care about their clients and not just looking for a quick settlement. Churn & Burn PI firms are so predatory, but there still can be some decent PI attorneys in firms that do related work. They all found me via word of mouth, as I likely wouldn't have found them otherwise, not that I really look for firms.

ps. Early on in my legal consulting I did some talks at a few different PI events to get to know the local market, and I definitely ran into a lot of skepticism from PI attorneys. Most complained about neuropsych experts being wishy-washy/non-commital, and others flat out said they avoided them because they didn't "trust" testing.