independent medical examiner job

[justordinary]

I wanted to ask if anyone has experience working as independent medical examiner.
Recently came across a job that offers $100 for each evaluation (mostly worker's comp and no fault cases) in NYC area..
Pros seem: can work 1-2 days a week (I want to work part time), no "patient responsibility" entailed as I'm not going to be treating any patients (kind of getting tired of doing clinical work), so far no midlevel encroachment.
Con: commute, with nightmare NYC traffic.
I have no background or experience working this type of job and wanted to get anyone's opinion! thanks in advance.

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[PsyDr]

$100 for an IME is ridiculously low. $100/hr is ridiculously low.

 

[psych_0]

Are these going to be all psych cases? Or just any type of workman's comp cases? I would imagine you would be well out of your scope commenting on workman's comp cases related to limb injuries, falls, lung disease, etc. If it is all psych related claims, then maybe could be OK. Sounds low paying unless they are pretty straight forward. If you can't do more than 2-3 per hour, I probably wouldn't do it.

 

[justordinary]

$100 for an IME is ridiculously low. $100/hr is ridiculously low.

What's the typical going rate? does it take up to an hour to do each case?

Are these going to be all psych cases? Or just any type of workman's comp cases? I would imagine you would be well out of your scope commenting on workman's comp cases related to limb injuries, falls, lung disease, etc. If it is all psych related claims, then maybe could be OK. Sounds low paying unless they are pretty straight forward. If you can't do more than 2-3 per hour, I probably wouldn't do it.

I've been told it's 70-80% workman's comp and typical case would be - person claims to have "depression" due to "chronic pain" from "back injury." I would not be commenting on the pain and back injury part, would just comment on the depression part. Sometimes would get no fault cases (person claims to have anxiety after auto accident and so on..). The agency made it sound like once I get used to it, I would be able to do 2-3 cases per hour, but of course I'm not sure if they're exaggerating it and it's more like 1 case per hour..

 

[splik]

These are forensic evals. So they either want lowest common denominator and/or are making a ton of money off guileless physicians. I was offered $375/hr for these evals in 2018 around here by one of the companies (I want to say Examworks I can't remember) which was too low for me.

And to answer your question it will takes hours to do a real evaluation, review records, and write a report. It will take much longer if you don't have experience doing these IMEs. Where I am, you have to do an exam to qualify to do these worker's comp cases and be familiar with the AMA evaluation of permanent impairment guidelines.

 

[justordinary]

These are forensic evals. So they either want lowest common denominator and/or are making a ton of money off guileless physicians. I was offered $375/hr for these evals in 2018 around here by one of the companies (I want to say Examworks I can't remember) which was too low for me.

And to answer your question it will takes hours to do a real evaluation, review records, and write a report. It will take much longer if you don't have experience doing these IMEs. Where I am, you have to do an exam to qualify to do these worker's comp cases and be familiar with the AMA evaluation of permanent impairment guidelines.

hmm it does sound like I'm getting ripped off at $100 per case. I have no background in forensic training. How do people get into these fields? It sounds like it could be lucrative if you have connections in the field, but for me I have 0 connections or network.

 

[Maxeelee]

Is this type of care falls under Medicare or Medicaid?

 

[justordinary]

Is this type of care falls under Medicare or Medicaid?

It sounded like neither...?

The person from this agency definitely did not make it sound like a thorough exam, just said there's a template and it's very focused interview....

 

[TexasPhysician]

That’s a terribly low rate. It’s more detailed than they are letting on unless you are cutting corners.

 

[Maxeelee]

It sounded like neither...?

The person from this agency definitely did not make it sound like a thorough exam, just said there's a template and it's very focused interview....

Yeah got it. I thought, the IME also have to go through the billing process in this field, but it's quite overwhelming to get directly paid in healthcare.
The employer who hires pay them directly.

 

[PsyDr]

It sounded like neither...?

The person from this agency definitely did not make it sound like a thorough exam, just said there's a template and it's very focused interview....

Agencies have repeatedly asked me (a psychologist) to work as a neurologist. That doesn't mean I am competent to do so.

At the bare minimum, you need to know your profession, the 3-4 AMA guides books, your state's laws, your liability, and how to write a forensic report that can hold up under intense scrutiny.

SEAK published a survey for hourly rates in IMEs. $100 is for chumps.

 

[comp1]

I just see this going wrong in so many ways and for so little money. Suddenly you're subpoenaed and have to testify as a fact witness without pay...I mean just...no. Patient seeking chronic disability claims are some of the most challenging patients in a general psych practice and you're going to focus on them? If you want part time without long term patient relationships, call up your local psych hospital.

 

[justordinary]

looked at seak.com website and it states "The average length for the entire IME process (record review, examination, and report writing was approximately 6 hours. This means that on average, independent medical examiners earn $355 hour for IME work. Not surprisingly, the specialties with the longest average IMEs were all mental health professionals (psychiatry and psychology)."

Now I'm getting suspicious that this company is cutting corners...

 

[justordinary]

I just see this going wrong in so many ways and for so little money. Suddenly you're subpoenaed and have to testify as a fact witness without pay...I mean just...no. Patient seeking chronic disability claims are some of the most challenging patients in a general psych practice and you're going to focus on them? If you want part time without long term patient relationships, call up your local psych hospital.

yea after doing some research, definitely feel like it's shady...

 

[splik]

I just see this going wrong in so many ways and for so little money. Suddenly you're subpoenaed and have to testify as a fact witness without pay...I mean just...no. Patient seeking chronic disability claims are some of the most challenging patients in a general psych practice and you're going to focus on them? If you want part time without long term patient relationships, call up your local psych hospital.

You would be an expert witness in this situation and you would charge whatever the hell you want.

 

[justordinary]

I was told phone deposition pay $250.. of course I don't know how long that would take.

 

[splik]

I was told phone deposition pay $250.. of course I don't know how long that would take.

Okay this is definitely sketchy. Normally you should be allowed to negotiate your own rates for depositions and testimony. They are probably taking an enormous cut. Either that or they have a government contract where they get paid for doing volume and cutting costs (but they are still taking a huge cut).

 

[justordinary]

Okay this is definitely sketchy. Normally you should be allowed to negotiate your own rates for depositions and testimony. They are probably taking an enormous cut. Either that or they have a government contract where they get paid for doing volume and cutting costs (but they are still taking a huge cut).

dont' want to be involved in anything sketchy.... still young in my career and I want a long profitable career..
out of curiosity - how do people get into this field? It sounds like a nice add-on for doctors who don't want to do purely clinical work, or for surgeons who are near retirement and don't have physical stamina of performing 10hr surgeries..
do you do a forensic fellowhip? do you just need to be lucky and happen to come across someone who is already in this field who will mentor you?

 

[splik]

dont' want to be involved in anything sketchy.... still young in my career and I want a long profitable career..
out of curiosity - how do people get into this field? It sounds like a nice add-on for doctors who don't want to do purely clinical work, or for surgeons who are near retirement and don't have physical stamina of performing 10hr surgeries..
do you do a forensic fellowhip? do you just need to be lucky and happen to come across someone who is already in this field who will mentor you?

I did a forensic fellowship. You can also do courses like through SEAK etc. You could seek paid supervision etc There are many people who provide courses on report writing, doing IMEs, testimony etc

 

[comp1]

The OP will WISH they were being requested as an expert witness, but there's no contract for that mentioned anywhere here. That's exactly where the problem arises. Instead, the OP does an exam they are paid for (apparently $100) and then the disability lawyers are going to be supoenaing them as a fact witness to testify specifically about what they found during that exam, assuming it was in any way supportive of their case. They are not going to be paying the OP at all and it's not going to be optional. This is of course a possibility with any clinical interaction, but the OP is specifically selecting a patient population already all involved with disability litigation, so it's much worse.

 

[Stagg737]

Very different field, but 10+ years ago when I was still a wee pre-med I did an internship with a large orthopedics group that had some doctors who did IMEs. Scheduled appointments were 15 minutes, charge was $900/appointment which insurance paid regardless of if the patient showed or not (no shows meant insurance would no longer pay out WC).

$100/IME seems insane for any medical field, let alone psych where it would take several hours to do this to a standard that would be comfortable in court.

 

[justordinary]

The OP will WISH they were being requested as an expert witness, but there's no contract for that mentioned anywhere here. That's exactly where the problem arises. Instead, the OP does an exam they are paid for (apparently $100) and then the disability lawyers are going to be supoenaing them as a fact witness to testify specifically about what they found during that exam, assuming it was in any way supportive of their case. They are not going to be paying the OP at all and it's not going to be optional. This is of course a possibility with any clinical interaction, but the OP is specifically selecting a patient population already all involved with disability litigation, so it's much worse.

spoke to another doc that works for the company - says he did get paid to go to court, though courts have been closed for no-fault and work-comp cases since covid... was told it's more volume work and cases are pretty straight forward (which might not be straight forward to me as I have no experience, but I guess if you do it over and over then you get better and more efficient).

Very different field, but 10+ years ago when I was still a wee pre-med I did an internship with a large orthopedics group that had some doctors who did IMEs. Scheduled appointments were 15 minutes, charge was $900/appointment which insurance paid regardless of if they patient showed or not (no shows meant insurance would no longer pay out WC).

$100/IME seems insane for any medical field, let alone psych where it would take several hours to do this to a standard that would be comfortable in court.

yea the rates seem low.. I'd be a 1099 contractor so I understand the middleman take a cut, I understand psych is not the most lucrative field but still low.

 

[watto]

I started doing IMEs in a state that paid $1500 an IME, took the experience, made some connections, now I no longer do WC cases but do expert witness work at a much higher rate (for IME, phone conference, deposition / testimony). I think it is worthwhile to do some for the experience and learning, but not at that paltry rate.

 

[justordinary]

I started doing IMEs in a state that paid $1500 an IME, took the experience, made some connections, now I no longer do WC cases but do expert witness work at a much higher rate (for IME, phone conference, deposition / testimony). I think it is worthwhile to do some for the experience and learning, but not at that paltry rate.

$1500 per IME? Wow thats pretty awesome gig...How long did it take you to see each case? I'm on the fence about this job.. i can do it for a short period of time for the sake of learning and experience as there isnt much to lose, and i have 0 connections to get me "in the door" unless i go through an agency like this... but $100 seem too low, unless i see like 3 per hour...

 

[watto]

Huge variability. 3 hours at a minimum. It seemed like a lot, but there were longer cases. You got paid extra per page for charts over something like 400 pages. I have had charts 8 feet tall.

 

[Bartelby]

At $100 per case I suspect you could hit minimum wage or less for some cases. Factor in record review, a comprehensive exam, and a well written and thoughtful report and you can easily hit 10 hours. You could also do garbage quality work and then enjoy going to court to defend it, but none of the possibilities with this work seem appealing. I would only recommend taking it if you plan to view it as basically free work to gain experience (spending all the time and effort it takes to produce very high quality work even if the pay is almost nothing).

 

[justordinary]

Huge variability. 3 hours at a minimum. It seemed like a lot, but there were longer cases. You got paid extra per page for charts over something like 400 pages. I have had charts 8 feet tall.

Ahh so you had to review previous records!?! Is spending 3+hours typical for workers comp and no-fault cases? This agency told me i dont have to do any chart review, i just fill out their template as i do the interview, and someone types out a report based on the template i filled out, and it's all done in 30min. Im not sure if this is typical...

 

[Merovinge]

$1500 per IME? Wow thats pretty awesome gig...How long did it take you to see each case? I'm on the fence about this job.. i can do it for a short period of time for the sake of learning and experience as there isnt much to lose, and i have 0 connections to get me "in the door" unless i go through an agency like this... but $100 seem too low, unless i see like 3 per hour...

Dude, check out the numbers in this thread. I don't have any idea about these topics at all but the rate of pay you are talking about is insulting. You might make more moonlighting as transcriptionist or as a bartender if this is what you are still considering.

 

[justordinary]

At $100 per case I suspect you could hit minimum wage or less for some cases. Factor in record review, a comprehensive exam, and a well written and thoughtful report and you can easily hit 10 hours. You could also do garbage quality work and then enjoy going to court to defend it, but none of the possibilities with this work seem appealing. I would only recommend taking it if you plan to view it as basically free work to gain experience (spending all the time and effort it takes to produce very high quality work even if the pay is almost nothing).

Definitely did not expect to spend 10hrs per report...... I definitely dont want to work for free...

 

[justordinary]

Dude, check out the numbers in this thread. I don't have any idea about these topics at all but the rate of pay you are talking about is insulting. You might make more moonlighting as transcriptionist or as a bartender if this is what you are still considering.

This might sound sad but i used to be in academia and based on my yearly salary + hours i worked, i used to make $90/hr..... And this is not as a resident, this is as an attending psychiatrist.

 

[justordinary]

I did a forensic fellowship. You can also do courses like through SEAK etc. You could seek paid supervision etc There are many people who provide courses on report writing, doing IMEs, testimony etc

Even if you do courses through SEAK, how do you actually get cases? Even for a peer review, how do you get those jobs?
Im curious because i would like to explore something outside of doing clinical work but feel stuck...

 

[Stagg737]

Ahh so you had to review previous records!?! Is spending 3+hours typical for workers comp and no-fault cases? This agency told me i dont have to do any chart review, i just fill out their template as i do the interview, and someone types out a report based on the template i filled out, and it's all done in 30min. Im not sure if this is typical...

I don't know details either, but this sounds like a great way to provide a free service to the agency while also taking on most of the liability...

 

[justordinary]

I don't know details either, but this sounds like a great way to provide a free service to the agency while also taking on most of the liability...

Definitely getting suspiscious. But I cant figure out what liability I would take in doing IME work since ive never done this kind of job... Can anyone inform me??

 

[Stagg737]

Definitely getting suspiscious. But I cant figure out what liability I would take in doing IME work since ive never done this kind of job... Can anyone inform me??

Well, you're evaluating patients that may already be heavily entrenched in insurance or legal proceedings and getting involved will draw you in regardless. However, if you're evaluating someone for disability d/t depression and you evaluate them as not meeting criteria for disability. They find this out and shortly afterward attempt or complete suicide. You've basically just said that someone who attempted or completed suicide did not meet the criteria for disability. When the family comes with the lawyers, do you think the sketchy agency is going to back you up or point to you as the one who evaluated them as not needing disability? Idk what the actual risk of that is, but seems like something to bring up when discussing the contract.

 

[WisNeuro]

Definitely did not expect to spend 10hrs per report...... I definitely dont want to work for free...

Different area somewhat, but the fewest amount of hours I have billed for an IME has been 10, and that was mostly because of minimal records available for review. Usually I get well over 1k in records. So, you have record review, exam time, report, dictation. Adds up. I'm sure some of these fly by night companies cut corners and can shave down the time, but at that rate, I'd be more worried about liability and what kind of coverage they may be omitting (e.g., E&O, etc).

 

[PsyDr]

Definitely getting suspiscious. But I cant figure out what liability I would take in doing IME work since ive never done this kind of job... Can anyone inform me??

Big picture: you don't know the accepted professional standards for this line of practice. Go look up how medical negligence is defined.

 

[justordinary]

Big picture: you don't know the accepted professional standards for this line of practice. Go look up how medical negligence is defined.

Obviously I do know how medical negligence is defined in clinical setting. What I was asking is what kind of liability is entailed with IME jobs. I don't think anyone should be ashamed of seeking further knowledge in a field they are unfamiliar with.

 

[justordinary]

Different area somewhat, but the fewest amount of hours I have billed for an IME has been 10, and that was mostly because of minimal records available for review. Usually I get well over 1k in records. So, you have record review, exam time, report, dictation. Adds up. I'm sure some of these fly by night companies cut corners and can shave down the time, but at that rate, I'd be more worried about liability and what kind of coverage they may be omitting (e.g., E&O, etc).

good point.. thanks for the insight!

 

[WisNeuro]

Obviously I do know how medical negligence is defined in clinical setting. What I was asking is what kind of liability is entailed with IME jobs. I don't think anyone should be ashamed of seeking further knowledge in a field they are unfamiliar with.

I think the comment was more aimed at getting into the field without knowing, just in a blunt way. IMO one of the better ways to get into this area is to find a mentor who is doing this in your locality. Having an understanding of the process, possible pitfalls, local applicable statutes, etc from someone who has been competently doing this in your area for some time can be priceless.

 

[justordinary]

I think the comment was more aimed at getting into the field without knowing, just in a blunt way. IMO one of the better ways to get into this area is to find a mentor who is doing this in your locality. Having an understanding of the process, possible pitfalls, local applicable statutes, etc from someone who has been competently doing this in your area for some time can be priceless.

Can't agree with you more that the best way to get into any field is finding a mentor. Also find it difficult to find a "mentor" as I find older psychiatrists either apathetic or predatory towards training the younger generation, but that is whole another topic in medicine. The owner of this agency was a psychologist btw.. obviously he's a businessman, he's interested in making money with my medical license, why should he care about spending time teaching or training a young psychiatrist?

 

[PsyDr]

Obviously I do know how medical negligence is defined in clinical setting. What I was asking is what kind of liability is entailed with IME jobs. I don't think anyone should be ashamed of seeking further knowledge in a field they are unfamiliar with.

I'm not trying to shame you at all. I'm trying to point you in a VERY good direction. Seriously. Go look up "medical negligence". What it means, what it entails. Then perform a self assessment, applying your personal knowledge to those standards.

 

[Bartelby]

My understanding is that legal liability risk in forensic work is generally low. In clinical work you owe a duty to your patient, who can sue you for substandard work. In forensic work you owe a duty to the retaining party (typically attorney or agency). To be clear, your job is always to tell the truth and not to advocate for one side, but in terms of a legal duty that could give rise to a tort claim it would be to whoever hired you. It is my understanding that they could have standing to sue you. The person evaluated might, though typically under exceptional circumstances (like suing for libel over an assessment of malingering, or the family suing if you fail to act on imminent risk which is generally expected even though the evaluee is not your patient).

In theory you could cut corners (like not reviewing records in full) and thus make an error in your assessment. This would not simply be a difference in opinion from other experts but an outright error. If the attorneys on your side built their case relying on your substandard opinion, in theory they could sue for damages. In reality this is unlikely for a variety of reasons and I have never heard of it happening.

I have heard of experts who are viewed as high volume hired guns getting reported to the medical board. I have no first-hand knowledge of how that might play out, but I would view this as more likely than a lawsuit.

The most likely negative, though, would be getting grilled and humiliated on the stand if cutting corners led to an opinion you could not defend. This would be highly unpleasant, and the transcript (and possibly video if taken) could be spread around and used against you when you try to take on forensic cases in the future.

 

[justordinary]

My understanding is that legal liability risk in forensic work is generally low. In clinical work you owe a duty to your patient, who can sue you for substandard work. In forensic work you owe a duty to the retaining party (typically attorney or agency). To be clear, your job is always to tell the truth and not to advocate for one side, but in terms of a legal duty that could give rise to a tort claim it would be to whoever hired you. It is my understanding that they could have standing to sue you. The person evaluated might, though typically under exceptional circumstances (like suing for libel over an assessment of malingering, or the family suing if you fail to act on imminent risk which is generally expected even though the evaluee is not your patient).

In theory you could cut corners (like not reviewing records in full) and thus make an error in your assessment. This would not simply be a difference in opinion from other experts but an outright error. If the attorneys on your side built their case relying on your substandard opinion, in theory they could sue for damages. In reality this is unlikely for a variety of reasons and I have never heard of it happening.

I have heard of experts who are viewed as high volume hired guns getting reported to the medical board. I have no first-hand knowledge of how that might play out, but I would view this as more likely than a lawsuit.

The most likely negative, though, would be getting grilled and humiliated on the stand if cutting corners led to an opinion you could not defend. This would be highly unpleasant, and the transcript (and possibly video if taken) could be spread around and used against you when you try to take on forensic cases in the future.

Thank you for your insight! Now I have a better picture of what "cutting corners" means in this field... And why it would take several hours to do a case if you are doing it properly. I guess this field can be very lucrative if you are in a field like orthopedic surgeon, i would assume you don't need to spend hours reviewing documents and interviewing patient, as it would be a pretty straight forward encounter... Definitely could see how you have to invest more time if you are a psychiatrist. The field does sound interesting and i would want to get proper training.. though ive heard its near impossible to break into forensic field even if you do a fellowship, unless you have connections, as docs who do this work want to keep it for themselves... Thanks again!

 

[splik]

Thank you for your insight! Now I have a better picture of what "cutting corners" means in this field... And why it would take several hours to do a case if you are doing it properly. I guess this field can be very lucrative if you are in a field like orthopedic surgeon, i would assume you don't need to spend hours reviewing documents and interviewing patient, as it would be a pretty straight forward encounter... Definitely could see how you have to invest more time if you are a psychiatrist. The field does sound interesting and i would want to get proper training.. though ive heard its near impossible to break into forensic field even if you do a fellowship, unless you have connections, as docs who do this work want to keep it for themselves... Thanks again!

The orthos don't do high volume either, they charge $1000/hr for this kind of thing

 

[watto]

And you really need to do a thorough chart review prior to seeing the claimant - you have to assess for inconsistencies in the record and be prepared to query the examinee in a nuanced way about these, if they are present.

 

[calvnandhobbs68]

Dude why would you even consider this? I can see two stable Lexapro refills for 100 bucks an hour. That’s like resident moonlighting rates haha.

 

[Merovinge]

Dude why would you even consider this? I can see two stable Lexapro refills for 100 bucks an hour. That’s like resident moonlighting rates haha.

Ergh, I got paid $140 hour for IP weekend coverage as a resident many years ago...

 

[Therapist4Chnge]

$1500 per IME? Wow thats pretty awesome gig...How long did it take you to see each case? I'm on the fence about this job.. i can do it for a short period of time for the sake of learning and experience as there isnt much to lose, and i have 0 connections to get me "in the door" unless i go through an agency like this... but $100 seem too low, unless i see like 3 per hour...

That is a really poor rationale for a predatory rate. If it were $250-$350/hr, you could decide if it was worth it for your situation, but $100/hr is a joke for clinical, let alone getting dragged into a legal case. Accepting predatory rates will encourage those types of companies to perpetuate those rates. They surely take a big chunk and stick their providers with any problems that pop up.