Do I really need to work for a medicolegal agency?

Amongst the lively discussion and my recent IME Discovery workshop was the question of whether to work for an agency or go it alone.

Similar to when we start out in private practice, the sense of having a safety net when it comes to establishing a referral base, as well as administration support is a huge advantage.

But what are we trading for this safety net?

I started in medicolegal practice with eReports, a company who was found to be trading while insolvent, and many of us lost a lot of money while this was happening and we were unaware. Now that is a very rare occurrence, thank goodness, and most agencies do operate with a much greater standard, ensuring their experts are paid according to the work they do.

The greatest mistake to make when being recruited by an agency is that you lack the skills to work as a medicolegal expert without them. And often what they offer is not necessarily something you actually need.

Agencies cannot operate without a panel of experts, and so therefore you are crucial to their business. When just starting out, it is an easy trap to fall into that you cannot find work without them, and this may be largely the case at the very outset.

The offer of consulting rooms, administration support and the provision of templates and training do sound attractive. But they come at a cost. At least 30% of the report fee will be deducted before you are paid for these services. Sometimes, if using their suites, that fee is higher. 

And the flip side of that is that agencies will generally tend to increase the fees they charge their clients to recoup that cost. That means, establishing your own referral base as soon as you can means you will have a competitive financial edge, as you won’t be asking for the same fees agencies do to provide reports.

Speaking to my clients, I have discovered that they do prefer to engage experts directly because of this. They also prefer to engage the expert they feel comfortable with, the one that they have identified writes clear, professional and independent reports, over somebody an agency chooses to allocate the work to. Gender matters on occasion, and female IME’s are highly sought after for historical sexual abuse matters for examile, and having your own client base that prefers that matters wahy more to you than an agency. 

 Often agencies promote the provision of templates to assist with report writing. However, there is not one right way to write a report. Reports, correspondence, and invoices bear the agency’s name and logo and you are effectively functioning under their umbrella. For psychiatrists seeking to establish a recognised name in medico-legal practice, this can impede brand development.

Also, some experts work across different agencies, and as such, their presence can be difficult to identify, especially if lawyers are impressed with your work, but would rather contact you directly over paying higher fees. Developing and refining your templates is a constant work in progress, and a valuable professional exercise after obtaining feedback from the referrers and reading your colleagues reports when you are provided with them as part of a bundle of evidence. 

One of the biggest drawbacks of working for an agency is their QA team. It is purported to be of value for you, and often agencies see this as a marketing advantage to attract more business. 

However, what QA teams actually do is read your reports looking for typographical errors or inconsistencies with dates and critical information. Some agencies try and recommend you change wording, which should never be entertained. At the end of the day, if you are called to court it is your words and your ability to defend them that matter. 

Learning how to phrase opinions, or answer questions posed is a skill that develops over time, one that can be mastered with good clinical supervision, attendance at professional development workshops and again, learning from your colleagues when you see their reports as part of evidence. 

For accuracy, having an editor or copywriter to check for spelling mistakes or inconsistencies is a much more valuable alternative. However, be very careful if using AI and never use open AI platforms to check your work, as you cannot ensure privacy and confidentiality. 

Then there is payment. Initially, the fees you receive for a report seem very advantageous. You might have to wait for a monthly remittance however, rather than payment upon completion which hampers your cash flow, that you have no control over. Also, there can be limited transparency when keeping track of cancellation fees or report writing fees on the agencies invoicing, again something you have no control over. 

Perhaps try an exercise of costing out using Telehealth options, avoiding an office, or check out the fabulous range of coworking spaces now available. I work from one and love the community it offers, as well as the access to professional suites when I need to examine a person face to face. These fees are much less than 40% of a report I would generate, and I can control my overheads directly.

Administration teams may appear advantageous initially but remember that ultimately, confidential and accurate record keeping is your responsibility. You own your records and you are responsible for who sees referrals and ultimately your report. Releasing your reports without your oversight can also carry risks you don’t want to be exposed to. 

I also prefer that I can set my own fees rather than accept what is offered. I can add in fees such as when asked to review documents over a certain number of pages, or charge a rush fee to turn around a report in a short period of time, pleasing a client who has been notified of an urgent court date. I can also charge cancellation fees and set fee increases in line with the increasing costs of running a business, knowing that despite doing this, I generally still charge less than an agency would. 

Some agencies market their practice of releasing reports before the client has paid for them. It has always been my practice and what I have been taught is that I never release a report before it has been paid for, as it can be very hard to recoup that fee once the report has been sent. My good clients pay on time and this is never an issue. Be careful if an agency promotes this, and ensure that you are paid regardless of whether or not the report has been paid for. 

Ultimately I have learnt that lawyers and barristers speak, and your abilities to generate professional independent reports that truly assist the legal process means more than anything. So setting out with the correct education, accreditation, training and supervision is the best place to start. Believe that your opinion does matter, and the way you convey that speaks more to the expert that you are, rather than how an agency has trained you. Enjoy building your reputation, your work and your professionalism in what is a rewarding area of psychiatry. 

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Dr Helen Schultz is a Psychiatrist IME with years of experience educating and training psychiatrists, now running face-to-face practical workshops for those looking to transition into medicolegal psychiatry practice — and accepting referrals for medicolegal reports across Australia in personal injury matters, including third party, medical negligence and historical abuse claims. Register for the next Sydney workshop at www.drhelenschultz.com.au/workshopor book via hello@drheelnschultz.com.au.