Good morning. Direct primary care is the radical idea of getting paid by your patient instead of three middlemen. Today we're going to talk about another radical idea: getting paid your actual rate for your actual expertise, in expert witness work.
In today's newsletter:
FTC has a new healthcare task force
Medical Expert Witness as a side gig
Practical Win: Change your Linkedin headline for more expert witness work
Locums Corner: Consider going direct
What I’m Reading
New AMA reports released this week show 28.7% of physicians have been sued at least once in their career in 2024, down from 31.2% in 2022. Surgical specialties remain highest-risk (nearly half of surgeons have been sued), with OB/GYN and general surgery topping the list. Endocrinology and psychiatry are lowest at under 10%.
The catch: malpractice premiums for general surgery, OB/GYN, and internal medicine have been climbing steadily since 2019, with almost 40% of premiums going up in 2025. The AMA notes upward trends not seen since the early 2000s. If you're a 1099 and carrying your own policy, expect possible renewal sticker shock.
FTC forms healthcare task force.
FTC Chairman Andrew Ferguson directed the agency to form a task force focused solely on healthcare, per a March 20 memo reported by Healthcare Brew on April 28. The group pulls from the Bureaus of Competition, Consumer Protection, and Economics, and plans to expand to include HHS and DOJ. Stated goal: making healthcare more affordable.
The recent Express Scripts settlement (forcing the PBM to drop preferences for more expensive drugs on standard formularies) is the model for the kind of action they're targeting. For independent physicians, this could mean more scrutiny on PBM practices, hospital consolidation, and anticompetitive contracting.
The highest hourly side hustle
Most physicians have heard that expert witness work pays well. Almost none of us were taught how it actually works. How cases find you, what to charge, how the money flows.
Here's a quick breakdown:
The mechanics. Two sides: plaintiff (representing patients alleging harm) and defense (representing physicians or hospitals being sued). A case typically moves through four phases, each billable:
Record review (around 5 hours)
Written report or affidavit (5-10 hours)
Deposition (rates jump significantly here)
Trial testimony (highest rate, often billed as half-day or full-day blocks). Fewer than 5% of cases go to trial, so most expert work is record review and reports
How cases find you. Direct attorney outreach via your CV, LinkedIn, or a Google search for "[specialty] expert witness [city]." Referral services like AMFS, Expert Institute, MES Solutions, and SEAK. Word of mouth once you've done good work. Your own simple website. Physician Side Gigs (PSG) also runs a free expert witness matching database for verified physician members.
What to charge. Most physicians dramatically underprice on the first few cases. PSG's expert witness database shows the average physician requested rate is around $475/hour, with most rates falling between $300-600/hour. White Coat Investor (WCI) cites $500-900/hour as the standard market rate for physician experts, with established experts in high-stakes specialties pushing past $1,000/hour. Expert Institute data from over 100,000 cases shows national averages of $356 for review, $448 for deposition, and $478 for trial, but that pool includes non-physician experts.
The structure most experts use:
Record review / report: base rate
Deposition: typically 1.25-1.5x base, half-day minimum
Trial testimony: 1.5-2x base, half-day or full-day blocks
Retainer upfront: 3-6 hours of work, often nonrefundable
Often you will bill in quarter-hour increments and document everything. The retainer is yours even if you decline the case after initial review. Charge “portal-to-portal” for travel time at your hourly rate.
The economics: A first year expert might do 3-5 cases. A seasoned expert with a built reputation might do around 30-50 cases a year. WCI notes it's possible to earn a six-figure income on roughly 3-4 hours of expert work per week once you're established. Income is 1099 and flows cleanly through an LLC, same as locums income. Standard deductions apply.
Remember that this is not passive. Record reviews are demanding. Depositions are stressful. The work compounds in skill but not in leverage. You're still trading hours for dollars, just at a much better hourly than clinical work.
If you’re interested, the most important asset you can build is reputation. The expert witness world is small within each specialty. Take cases where your honest opinion supports the side asking for it. Don't take cases where you'd have to bend. That's what separates a long career from a short one.
🚀 The Practical Win: Update your CV
Pull up your CV (and resume) and add a "Medical-Legal Consulting" section. Even if it's empty for now. Attorneys look for this section when vetting experts. The act of creating the heading also forces you to think about how you'd position yourself: subspecialty focus, board certifications worth highlighting, publications relevant to medical-legal work. Take five minutes to get it filled out.
The Locums Corner
Hospitalist demand has softened slightly per CHG's data, but rates haven't followed because hospitals are still struggling with W2 retention. Two practical takeaways:
Watch the IMLC pipeline. The Interstate Medical Licensure Compact remains the cleanest way to expand your footprint. Application through your state of principal license, then issuance through each compact state. It’s still much faster than full state applications by months.
Direct contracts beat agency rates by 20-30% on average. Agency markups typically run 20-50% per PSG's data, with most in the 30%+ range. With the locums market at $9.6B and hospitals fighting margin pressure, more facilities are open to direct hospitalist contracts than they were two years ago. The ones that say no usually have an exclusive with a contract management group (SCP, TeamHealth, Sound). The ones that say yes are typically independent or regional systems. The tough part? Finding a contact at a hospital who will get back to you.
That’s it for this week. Have a great weekend and thanks for reading!
What would you like covered in future issues? Reply to this email and let me know!