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What is the current hourly rate to review chart and craft an opinion as to meeting the standard of care for anesthesia?
expert witness
- Thread starter Drwine
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Many ways to bill for expert witness
Some of my friends bill per hour per 40 pages of review. So if there are 400 pages to review. That’s 10 hours charged at your agreed rate ($300-600/hr)
Some want a retainer that starts out at 10k. (My pain friends charge this)
Remember to update your medical malpractice policy to state you do expert medical witness as well.
Tried to PM you but your account is restricted.
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Why update med mal?
I’m
Doesn’t affect your malpractice rate overall for most cases. There are a few high risk specialists who may get hit with higher rates but I don’t think anesthesia is one of them.
I always had to disclose if I’m an expert witness in my own malpractice premiums I paid directly.
They want full disclosure on ur activities. This matters more if you are employed by a university entity malpractice
Doesn’t affect your malpractice rate overall for most cases. There are a few high risk specialists who may get hit with higher rates but I don’t think anesthesia is one of them.
I always had to disclose if I’m an expert witness in my own malpractice premiums I paid directly.
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IDK, getting sued for your testimony is extraordinarily unlikely and if you do your medical malpractice carrier isn’t going to cover you for it no matter whether you have told them or not. Errors and Omissions insurance is what you would need to cover that.
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That’s what I carry for my expert witness LLC. Cheap coverage.
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How do you get your foot in to doing this stuff? I’m a board certified early career anesthesiologist
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I used to do a lot of expert witness work. I have stopped it because I think there is significant conflict of interest.
Many companies have popped up and theres a lot of games and shopping around from companies to whoever can do it cheapest.
Examworks pays the least. Best is to find a few attorneys and work with them directly.
In any case, remember, you’re always going to be loyal to whoever is hiring you and paying you. You may deny that but it’s true.
Think of the expert witness during Michael Jackson trial who as an anesthesiologist got on the stand and said that propofol can be ingested and that’s how Michael Jackson died. I mean that’s ridiculous and after that I’m sure no one can take him seriously but he probably sold his words for a lot of money. He was old and almost retired anyways.
Most of these cases are in personal injury world and in regards to out of network billing for pain injections.
Generally (and again there are exceptions) the injection part of it is ok, ie epidurals for HNPs and medial branch blocks for whiplash injury and facet syndrome etc, but of course the billing is high - and that’s because it reflects letter of protection and risk for physicians to provide free service without any promise of Payment. You cannot compare it to insurance or Medicare which are contracted and guaranteed and predictable payments compared to
LOP cases.
I think the ultimate authority is the medical board and malpractice carrier.
They are the true ethical experts as they do not have significant financial interests unlike hired guns that attorneys like and pay for.
Because of incredible advertising by companies like SEAK, a lot of people are getting into this. I do notice it becoming more and more competitive and over time the fee schedule will drop.
AI has made things easy as well and some companies strictly forbid the use of AI.
Many companies have popped up and theres a lot of games and shopping around from companies to whoever can do it cheapest.
Examworks pays the least. Best is to find a few attorneys and work with them directly.
In any case, remember, you’re always going to be loyal to whoever is hiring you and paying you. You may deny that but it’s true.
Think of the expert witness during Michael Jackson trial who as an anesthesiologist got on the stand and said that propofol can be ingested and that’s how Michael Jackson died. I mean that’s ridiculous and after that I’m sure no one can take him seriously but he probably sold his words for a lot of money. He was old and almost retired anyways.
Most of these cases are in personal injury world and in regards to out of network billing for pain injections.
Generally (and again there are exceptions) the injection part of it is ok, ie epidurals for HNPs and medial branch blocks for whiplash injury and facet syndrome etc, but of course the billing is high - and that’s because it reflects letter of protection and risk for physicians to provide free service without any promise of Payment. You cannot compare it to insurance or Medicare which are contracted and guaranteed and predictable payments compared to
LOP cases.
I think the ultimate authority is the medical board and malpractice carrier.
They are the true ethical experts as they do not have significant financial interests unlike hired guns that attorneys like and pay for.
Because of incredible advertising by companies like SEAK, a lot of people are getting into this. I do notice it becoming more and more competitive and over time the fee schedule will drop.
AI has made things easy as well and some companies strictly forbid the use of AI.
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That’s not accurate or reflective of market rate unless a stat report is needed for a review of 1200 pages and you are going to give up your weekend to do it.
40 pages of medical records should not and does not take an hour to review since 85% of all records are fluff.
The most important thing is how much you value your work and expertise. Market rate is really how much the attorney is asking for in a lawsuit. A 3 plus million dollar case vs a 300k case is a world of difference where the attorney stands to receive a ton of money.
It’s the same difference why some attorney charges $300/hr vs $800/h in the same market for the same work.
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I changed that.
Again
Those numbers you have posted are not reflective of reality.
The review companies such as ISG and Exam works have set fee schedules and own majority of the business.
Secondly before you engage with attorneys, they will ask you for your fee schedule and if it is too outlandish, you will rarely receive work.
Why would anyone pay twice the amount for two physicians that are both board certified. After 5 years of practice and no malpractice no one cares
In quality between two physicians as long as they are in good standing and have a busy schedule and in active practice. In order to do expert witness work you must be in active practice.
Once in a while you can charge a premium but that’s if it’s an urgent report.
Secondly, over 99% of the cases settle in personal
Injury pre trial. Going to court is a waste of time for every one so that means that original payout is not what anyone will get.
Typical payout is 28-32 cents on the dollar and keeping in mind auto policy limits. That reduces the payout significantly. And then if they have to pay the expert witness a significant amount, it’s not worth it. So expert witness fees certainly matter. Thats why they shop around.
So if you want high volume and consistent work, you need to keep your fees competitive.
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Or be amazingly effective. Historically, some VERY big names in Anesthesia have given absolutely outrageous testimony on behalf of plaintiffs. Recognizable Chairs of major departments and textbook authors. AKA Liar for Hire.
Yup
Expert witness work is not what you think it is. There’s vested interests. The companies that send you work are also commission based.
You’re selling your soul to be an expert and there’s definite conflict from whoever is paying you.
It didn’t sit too well with me so I no longer do it. But everyone is different…
I do peer reviews here and there, but that’s it. Even then my threshold is pretty lenient. I look at standard of care as a bench mark and not best practices. I do mention best practices, but the measuring stick is standard of care and reasonableness of charges, etc etc.
I think that true authority to determine standard of care breaches are medical boards, ethical committees, local medical staff and malpractice carrier. These have committees and multiple experts and they’re not paid per hour.,
Everything is negotiable. They will shop around as well.
It’s your time.
You are wrong on the high volume and consistent work. It’s like realtors. Do you want to sell high volume lower price homes or work on bigger homes and sell less homes.
Correct on the settlements. Most attorneys want to settle. It’s easier for them. Ortho doc I’m with this morning. Just settled for 100k for BS pre existing back pain case he did.
Look. Attornies can use whoever they want. You can take the price or not.
It’s the same as u shopping for an attorney in a civil case.
Ask yourself. I see on the physicans dad forms everyone ask for a shark attorney no matter what the cost. So people are willing to pay for a top attorney. Why don’t they use any attorney out in practice for 5 years? They are all board certified.
You are just under valuing your own fees. Which is fine. If you are comfortable with what they are paying you. That’s all that matter.
Next time you need an attorney. One who charges twice as much as the other attorney. Go with the cheaper attorney for ur civil or even criminal case.
These are just some unbiased comments on expert witness fees. So people realize I don’t make up crap. Everyone I always post is from either personal life experience or friends who tell me what they charge.
Those posts do not indicate how much volume they’re getting.
Secondly expert witness is an umbrella term. There is a difference between controverting affidavits, peer reviews and appropriateness of billing, depositions and testimony. I charged 6000/ half day and 12000 for full day plus time to prep for deposition. Thats not majority of expert witness work. That’s standard rate.
99% of the work is review and reports.
All are paid differently. There is a difference in comp also if you’re wanting it done q/a format or narrative.
I used to work directly with a senior attorney in Texas for a large insurance company. I did about 500 cases in 2023 - my fees were never that high for that work, and they couldn’t be for record reviews because the margins aren’t there.
If you’re trying to settle a case for 30k, you’re not going to pay the expert witness 7k.
Secondly expert witness is an umbrella term. There is a difference between controverting affidavits, peer reviews and appropriateness of billing, depositions and testimony. I charged 6000/ half day and 12000 for full day plus time to prep for deposition. Thats not majority of expert witness work. That’s standard rate.
99% of the work is review and reports.
All are paid differently. There is a difference in comp also if you’re wanting it done q/a format or narrative.
I used to work directly with a senior attorney in Texas for a large insurance company. I did about 500 cases in 2023 - my fees were never that high for that work, and they couldn’t be for record reviews because the margins aren’t there.
If you’re trying to settle a case for 30k, you’re not going to pay the expert witness 7k.
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Name and shame
I understand what you are saying. Many prelim stuff they actually run it through nurses to be honest with insurance reviews so even cheaper than your “standard costs”
When case is going to trial. That’s when the real fees hit. You even mention yourself how much you charge for half a day and full time. That falls in line with “standard rate 6-12k a day” and you don’t do it often.
You basically confirmed what I already stated and what the Reddit docs state.
I don’t know what the argument is about.
An attorney wanted a $1500 retainer for a property division. “Standard rate” comes out to around $350/hr
He said if we go to trial it will cost me 30k. This is over a 1.2 million dollar piece of property.
It’s no difference.
The fees add up as the stakes get higher. A settlement for the property was 200k on my end.
He said if we go to trial it will cost me 30k. This is over a 1.2 million dollar piece of property.
It’s no difference.
The fees add up as the stakes get higher. A settlement for the property was 200k on my end.
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Honestly that lawyer fee schedule sounds like a relative bargain. I had to hire an attorney to defend myself after whistleblowing against a toxic hospital. Retainer was $8,000 and billing rate was $500/hr for the partner and $350 for the associate (often involving both at the same time). It was well worth it though - the hospital backed off quickly once they knew I lawyered up.
The argument is just that expert witness is an umbrella term.
The costs of 6-12k is for depositions
It’s really not for records review and controverting affidavits etc
So e personal injury charts are literally 5-7 visits. New patient eval, injection # 1, follow up, injection # 2, follow up
Release
To review the billing for that - it’s probably an hour to two long worth of work plus notary if it’s controverting affidavit
The charge for that would not exceed 1000-1200
If personally charge 600-800 for that work because:
1. I have templates and it’s repetitive
2. Everything was already streamlined for me and In reality it would not take me more than 45 minutes
correct. I’m not trying to start an argument.
I agree with you.
People need to be more specific in what they are looking for in terms of work and charging.
It’s easy money some of my friends do it while working at their full time w2 job (yes that looks bad lol). That’s what you call maximizing your time.
Especially early afternoon when lunches given and cases start to slow down.
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That’s a big range. 1200 for 2 hrs of work would be worth my time. 400 for 2 hrs of work not so much.
Yeah but it’s generally not under your control what kind of cases you’ll get
Sometimes easy cases are easy 1200
Sometimes challenging cases are 600
Because a lot of attorneys pay by page number or “inch of medical records”
There’s no real set formula
In PI world, some of the documentation is purposely vague, evasive and just overall crazy. That’s why they’re sending you the records to review.
Again I speak to my experience - everyone is different. My work was never part of the legal records or could be used in deposition. It was for their adjusters.
So there’s a lot in this field but it’s competitive as well.
State medical boards are frequently looking for expert reviewer and medical consultant work. Fees aren't great as you can imagine but at least you aren't selling your soul to the devil. You are examining a complaint and usually determining that a particular board complaint has no merit/is frivolous and thus helping out a worried/stressed out colleague. It's not we-pay-you-to-say-what-we-want-you-to-say garbage.
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I’m relatively cheap, well under what most physicians would charge. I could probably charge more since I’m kind of a niche expert but I hope being reasonable gets me some return or referral business. But I charge for every minute I’m doing anything related to the case. If I get a 1200 page chart that’s not indexed and I have to hunt for important records that can be pricey. I got an incomplete chart once that lacked the Code Blue record. They sent the whole chart and that was about $1000 of time spent looking for it. BTW - EMR charts are mind-numbingly repetitive.
My retention agreement has a clause that my opinion may not agree with what the attorney is hoping for. Too bad. They can drop me if they don’t want me. I require an up-front retainer before I give any opinions so I’m getting paid regardless.
My retention agreement has a clause that my opinion may not agree with what the attorney is hoping for. Too bad. They can drop me if they don’t want me. I require an up-front retainer before I give any opinions so I’m getting paid regardless.
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This is for defense of a malpractice case. I have only done 2 previously both at the request of former trainees which is how I was asked to do this one.
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My colleague is looking for an expert witness on his case where the attorney has multiple anesthesiologists declined to help, likely due to the nature of the case.
In this scenario, will he able to find one to help? Or I should just tell him to give up.
Not sure it matters, but it was a supervision case that the issue occurred when he was not present in the OR.
In this scenario, will he able to find one to help? Or I should just tell him to give up.
Not sure it matters, but it was a supervision case that the issue occurred when he was not present in the OR.
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Just speculation, but I suspect that they declined to help because in the opinion of the reviewers, whatever happened was below the standard of care.
Assuming that this is a bad decision by a CRNA that he was supervising and present in the OR suite. Not doing pain blocks next door or something equally indefensible.
Even if the anesthesiologist was not at fault, there is a good chance that he will be held partially responsible.
Ask the attorney if they know any shady experts who are willing to aggressively interpret the standard of care. There are plenty on the plaintiff side. Must be a few on the defense side.
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Thank goodness I sit my own cases with federal tort reform. #untouchable
The most recent asa closed claim case (in the news letter) had came this month mentioned shoulder case with cardiac arrest. (No intravascular cause)
Anesthesia did everything right , patient recovered do the most part with some cognitive dysfunction
So even when you do the right things. You stil get sued and case was settled.
I’m sure they consulted mutiple anesthesia docs in that case
Anesthesia did everything right , patient recovered do the most part with some cognitive dysfunction
So even when you do the right things. You stil get sued and case was settled.
I’m sure they consulted mutiple anesthesia docs in that case
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I am sure that there were multiple people willing to defend the care provided. Unlike the query that @GASMAN mentioned.
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He is very stress out and depressed sometimes. Anyone know who can help, feel free to PM. He told me how much they are paying for the expert services, so I can pass along.
Will this be a career ending for him? Like he becomes uninsurable, malpractice wise. So no one can hire him.
Will this be a career ending for him? Like he becomes uninsurable, malpractice wise. So no one can hire him.
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Just not enough info. Was this:
1. A bad decision by a CRNA/Resident that he was supervising?
2. A bad anesthetic plan by him?
3. bad personal behavior leading to a bad outcome?
No way 1. Will be a career ender. 2. Is Not good, but as long as this is the only blemish on his record, should almost certainly be survivable. 3. Maybe.
is it something that his employer would cause them to not renew him Is the more pressing question that I would worry about.
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Agreed not enough info. But statistically speaking it’ll probably settle. And it won’t be career ending.
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Let me get more info from him.
