Neurologists in private practice have been dealt a few blows in recent years — think decreasing reimbursement and increasing regulatory challenges. Then came COVID-19. More than ever, keeping the doors open, let alone turning a profit, means running a lean operation and finding additional revenue streams.
One of the best avenues when it comes to low overhead and excellent income potential is medical legal consulting, says Todd Barnes, a neurology practice administrator in Oklahoma. Barnes has been working with neurologists and neurosurgeons doing this kind of work for more than 20 years.
“I look at this as a supplemental, low-overhead type of income for your practice, because it doesn’t require your front desk and doesn’t require other staff,” he says. “It’s just your time working around the rest of your day. I think it’s very complementary to a practice and a very complementary source of income as well.”
We met Barnes at the 2019 annual meeting of the American Academy of Neurology. More recently we had the chance to ask him some additional questions about medical legal consulting for neurologists.
Below are excerpts from that conversation, lightly edited for clarity and flow.
NI: What does medical legal work entail for a neurologist?
Barnes: The neurologist would be contacted by an attorney who wants some kind of expert opinion or for them to look over a case that they were either thinking about taking or had taken on, and they really don’t know what to make of some of it.
Then you say, well, how much time do you want? It usually starts out at 30 minutes or they may want an hour. A lot of times that can be done at the end of the day, once you’ve finished the clinic. They’ll come to your office, out of convenience, and you’ll meet with them for some amount of time. Most attorneys, at least here, are very amiable to basically working around the physician’s schedule.
After that, most of what our work entails is writing a narrative report. They bring in all the medical records and we go through them and kind of summarize them. Or, if somebody’s gotten into a motor vehicle accident and they claim they have long-term deficits, you may do an independent medical evaluation on them and render your opinion. You may do a deposition in your office or the attorney’s, and we have had some [physicians] that have gone to court.
NI: How does payment work for this kind of service?
Barnes: You need to come up with a fee schedule of the various things like depositions and court appearances, narrative reports, chart reviews, and independent medical [evaluations]. You’re going to have to figure out what your time is worth; what the interruption and all that is worth to you. And that can be very different depending where you are; in New Jersey, I think their fees are double what mine are. Typically, you want to get most of this paid for up front.
NI: What should neurologists know before taking a case?
Barnes: The first thing we do when we get asked to be involved in a case is send it to our risk management people and say, are we involved in this somehow? At the very least, you’d probably want to know the parties involved, just to make sure you’re not testifying against your good friend across town, if you’re not willing to do that.
NI: How would a neurologist get this kind of work?
Barnes: I would recommend figuring out who’s handling personal injury cases in your town, who’s handling auto crashes. If you can, meet with somebody. If not, then write a very nice cover letter stating who you are and that you’re open to doing these kinds of cases. And give them your fee schedule. Mail it out to 15 or 20 law firms in town, just to let them know you’re there. Say, “I’m a neurologist, and I can deal with these kinds of issues.” That’s really the way to start.
I don’t know any of my people that have marketed. It’s kind of a sideline. Not even really going out [and marketing themselves], I’ve had doctors make $8,000 or $10,000 extra in a year just on one case.
Special thanks to Todd Barnes, MBA, Clinical Business Administrator, Departments of Neurology/Neurosurgery at the University of Oklahoma Health Sciences Center in Oklahoma City, Oklahoma.