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We speak with Gretchen E. Green, a radiologist and expert witness, about her journey from full-time clinical practice to building a fulfilling career that balances work, life, and family. She shares insights on transitioning into expert witness work, finding financial security, and designing a life that aligns with personal values. Learn how to leverage your expertise to create a sustainable career while prioritizing what matters most.
Gretchen E. Green is a radiologist.
She discusses the KevinMD article, “Discover the hidden world of state medical board complaints.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Gretchen Green. She’s a radiologist and expert witness. Her KevinMD article is “How a Physician Can Learn to Be an Expert Witness.” Gretchen, welcome to the show.
Gretchen Green: Thanks so much for having me.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Gretchen Green: Sure. So I’m a radiologist in North Carolina, now actually retired from clinical practice. And I got, as is common, an accidental start to expert witness work, getting a call out of the blue.
Kevin Pho: Perfect. And tell us more about that journey into the expert witness world.
Gretchen Green: Initially, my start with medical legal work occurred when I was sued early on in my career. I was named as a defendant, and so I learned from the inside out how medical malpractice lawsuits work. My attorney, who knew we had a very strong defense, encouraged me, when it was all over, to become an expert witness myself, which initially sounded like a crazy idea. But later, when I got contacted out of the blue, like many of us do, I learned my way through that process by trial and error. But then as I built my expert witness practice, I grew to really love that critical thinking and how it improved my practice and my patient care. In 2020, I started teaching other physicians how to launch and build expert witness practices without all the trial and error that costs you time and money that I went through.
Kevin Pho: So before building your own course on being an expert witness, there’s no formal training that you had in doing this. It was purely trial and error. How did you learn how to do this?
Gretchen Green: Right. There was a lot of trial and error, and there also are some courses out there that you can take. A lot of them are great, but few of them, or none, really focus on physicians and knowing in medicine how we have this “see one, do one, teach one” mentality. We learn most from our peers. I adopted this mentorship model that I could really speak to other physicians going through that same process, shorten it, make it very practical, and how to, and then use my lawyer network to leverage those connections to help experts build their own businesses.
Kevin Pho: Now, before talking about your article, just let me ask, what are some of the biggest misconceptions or misperceptions physicians have about expert witnesses?
Gretchen Green: I think one of the biggest barriers, because I think a lot of us do approach medicine as a team approach, is the feeling that you would be testifying against another physician. But the great thing about being an expert witness is that it’s your objective review of the medical care given in a similar clinical circumstance with your skills, training, and expertise. This summer, I read a lot of the Jack Reacher books. For those of you who are familiar, he’s retired military police, and he talks a lot about in these books about policing the police, basically. But that’s not really what an expert witness does. It’s not the physician police. It’s an impartial observer, truly a witness of what happened, and then the ability to use your skills to render an opinion for both sides. The best experts take cases from both plaintiff and defense attorneys and really act as that observer to evaluate the care, especially building your own skills with critical thinking and the literature, consensus guidelines, and white papers that help us ultimately become resources for our patients and for our practices.
Kevin Pho: All right. Let’s talk about your KevinMD article, “How a Physician Can Learn to Be an Expert Witness.” For those of you who get a chance to read it, tell us what it’s about.
Gretchen Green: Okay. So in this article, I covered a number of these barriers and ways that you can get started. I think a lot of us, again, become accidental experts where you wait for a call out of the blue, and that can take a while. But one of the ways that we can build our skills is by networking. Building a community of experts has been something that’s been very important to me to help people build those connections and to put their skills to work. I think a lot of us perceive a lack of time as physicians have faced time pressure; people have felt like there’s just not one more thing that they can add. But what a lot of people don’t know is that expert witnesses can earn $500 to $900 an hour doing this. So in three to four hours a week, you can have a $100,000 side gig, which then can really make a life-changing and career-changing difference in how you invest your time and leverage that.
Kevin Pho: So in terms of the time it takes to be an expert witness, let’s say for a typical case, how much time would a physician take to help prepare for a typical case?
Gretchen Green: It’s highly variable. Some cases may just be a few hours, and some cases may go all the way to deposition or even trial. Usually, only one or two cases will go to trial out of a hundred, and that can be done with scheduling your own time and with kind of guardrails up to guard your time and contracts. But the great thing about expert witness work, especially since 2020, has been that almost all of it is on your own time, done remotely. It’s truly one of the most flexible ways to do this work on your own time. In our COVID-oriented Zoom world, it’s only become easier to do a lot of this remotely and again, in a scalable way, even with a lot of marketing. I was never too busy to take an additional case because it helped me build my flexibility with my time management and to build a business that I was an owner of. Now, with roughly 75 percent of physicians being employed, I think it’s more important than ever that physicians have ownership to learn those negotiation skills and advocacy. It’s a challenge, I think, for people to wrap their heads around those hourly rates, but only because of declining reimbursement and other financial challenges. If we can pay professional athletes millions and millions of dollars every year for entertainment, getting the market rate for your work as an expert and as a physician for providing priceless care for our patients, families, and our society is worth it.
Kevin Pho: So tell us about the spectrum of physicians who go into expert witness work and the type of cases that they can be expert witnesses to. Can they only review and give opinions on their cases in their own specialty, for instance?
Gretchen Green: Yes, and that’s very important—to know where your guardrails and your sandbox are and your clinical specialty. So you’ll be retained in a case for which you’re a good match for the other parties in the case. It’s not even a measure of, are you a good or bad expert witness? If you’re retained in a case, a lawyer is looking for someone with similarities—the practice environment, their training, the background that they’ve had—so that they’re a good match for the people who are involved. I’m often asked, are there specialties that can do it or not do it for others? Basically, if you carry malpractice insurance and you see patients, you have a potential role as an expert because there are potential lawsuits, even generalists, pediatricians, internal medicine, family medicine. They have proportionally a lot more opportunity than what we think of high liability specialties like neurosurgery or OBGYN because there are just more cases and more patients seen by generalists. Every case is different. They can actually involve a lot of different experts. And so that’s another interesting way—it’s that you’re working collaboratively in some way with other experts in the same case, yet representing your own opinion.
Kevin Pho: What do you say to those physicians who may be interested in being an expert witness but are hesitant about testifying against another physician?
Gretchen Green: I think the most important thing is mindset—that it’s advocating for good care. It’s not against another physician. And you can do that even if you believe that someone did something wrong, incorrectly—that it was not done what should have been done. You can still present it in an objective fashion. Truly again, as a witness, someone who is observing rather than acting as the police were expert witnesses are not the physician police, and we’re doing a lot of the same role in communication and education of juries and judges, just as we do with patients, families, and members of society. That communication and education role is really critical for an expert witness. It’s something that I think really strengthens our relationship with the public as authorities and someone who can be relied upon to help them understand better why care was given or if something else should have been done.
Kevin Pho: Are there any risks to being a physician expert witness if they give an opinion that’s off base, or perhaps if there’s retaliation against that opinion? Is there any risk to being a physician expert witness?
Gretchen Green: The biggest risk is having your opinion challenged because you don’t adequately support it, usually with literature or in your expertise or skills. There are two main standards by which your opinion will be evaluated: the Daubert and the Fry standards. It depends on what state you’re retained in, and you don’t have to be licensed in every state to do work there as an expert. Just where you work basically is where your license would be. But it can be challenged in that state if they feel that you haven’t given an opinion that others would likely come to the same conclusion with the same information. So if you’re not out on a limb and you’re supporting again with quality research, or you can indicate why your skills or training say that this is what should be done in that case, then the risk is very low. There is specialized insurance for errors and omissions that experts can buy. It’s usually pretty inexpensive, $1,000 to $2,000 a year for a premium. And as my accountant says, it’s the cost of doing business.
Kevin Pho: Now, sometimes there’s a perception that physician expert witnesses are like mercenaries, and there’s a perception that, I’ve talked to some, that whichever side of the case can always find physicians that can back up their point of view. What’s your perspective on that?
Gretchen Green: That’s why I think it’s so important to have even more physicians doing this. I would love it if this were perceived like jury duty, that it was the norm, that we did it as a service to the medical legal environment. I think some physicians believe that if they boycott, if they just say they’re not going to be an expert witness in any cases, that somehow that will have a downstream reduction in lawsuits. But it doesn’t, because that’s a parallel universe that we don’t have control over. What we can control is our involvement and how many of us are available to provide as much of a diverse specialty contribution in service with these cases. And people will say, what happens if you are retained in a case and you don’t agree with the side? But again, it’s everything—keeping it independent, keeping it as an observer role helps protect you from being biased. That’s where you have the most power as an expert: to be an unbiased observer who gives that kind of opinion.
Kevin Pho: So clearly you have a business that surrounds the expert witness work that you’re doing. Give us some examples of other physicians who may still be clinically practicing and do expert witness work on the side. What do their careers look like?
Gretchen Green: Yes, it’s been amazing. In the five years that I started teaching students in Expert Witness Startup School, it has been truly an evolution to see how others have built their businesses, and everyone does it differently. For some of them, it means as simple as they make some money on the side and stop taking additional calls. Some of them have revamped their clinical schedules so that they go part-time. Others have really done a lot of marketing on their own, but that’s optional. There are lots of ways to tap into this network to get your name out there. But the most amazing thing has just been how much physicians have transformed their practice, how they have become more energized to continue operating at what they feel is an even higher level. That’s based on that additional education, honing their skills, working on communication and education that is so central to the role of an expert. It’s given a lot of people, including me, a lot of joy and a lot of fulfillment in a way that’s again, surprising based on the perception a lot of people have for me personally. It’s been amazing to help other physicians do this. This is a job that, for me, didn’t exist five years ago. To see just the evolution of all of this coming full circle has been very rewarding for me as well.
Kevin Pho: So if a physician decides to take expert witness work and takes a course like the one that you offer and makes himself available for expert witness work, how easy or difficult is it to find those cases?
Gretchen Green: So much. It can be very easy if you have an outreach that gets your name in front of a lot of attorneys very fast. I offer that because I’ve built my lawyer database now over years of blood, sweat, and tears—doing things manually, moving up from manual mailings to my own emails to now emailing a list of what will next week be 15,000 lawyers nationwide. But building your reputation is really where the value is. When you become known nationally and lawyers share your name, you get repeat cases. That’s ultimately the kind of value that you have in marketing your business.
Kevin Pho: Are there specific specialties that are more amenable to becoming physician expert witnesses?
Gretchen Green: I think proportionately, there are some specialties that tend to name some more than others. Again, the denominator is very large for things like pediatrics or internal medicine, family medicine. So they’re going to get a lot of cases just because they have a higher denominator of patients overall. But every subspecialty gets requests, and sometimes I get very, very focused requests from attorneys. I had someone request somebody with experience in the inner ear, or retinal surgery. So it gets as general as it can be, you see a spectrum all the way to very specialized work as well. So that’s always fun—to approach my colleagues and find somebody who’s a good match to make that connection.
Kevin Pho: We’re talking to Gretchen Green. She’s a radiologist and expert witness. Today’s KevinMD article is “How a Physician Can Learn to Be an Expert Witness.” Gretchen will end with some take-home messages that you want to leave with the KevinMD audience.
Gretchen Green: Yeah, thank you. I think the most important thing is to question your assumptions about expert witness work and see the opportunity that it is possible through focused training, just as we approach everything in medicine, instead of accidental exposure, to hone your skills as an expert, improve your care for patients, and improve your own relationship professionally. I will next offer Expert Witness Startup School as I do about twice a year. It will open for enrollment in January of 2025 for the next enrollment. And I can’t wait to see what the next cohort of students will accomplish.
Kevin Pho: Gretchen, thank you so much for sharing your perspective and insight. And thanks again for coming on the show.
Gretchen Green: Thanks so much for having me.
