When I started to research what it takes to become an independent medical examiner, I found there are actually two distinct and completely different medical jobs that are called by the same name.
One independent medical examiner is done by doctors, psychologists, and other licensed healthcare professionals who haven’t been involved in a person’s care and will evaluate a patient’s prior treatment and their current condition, usually to clarify medical and job-related issues.
They’re done in all medical disciplines, depending on the purpose of the exam and claimed injuries and give case management information and provide evidence in court cases. Most workers’ compensation statutes include having a medical examination. The specifics can vary from state to state.
The second type of medical examiner investigates sudden, unexpected, or violent deaths. Also called forensic medical examiners, they examine the deceased’s body and are responsible for determining the cause and manner of their death. Once they’ve finished their examination, they will assign one of the five manners of death: homicide, suicide, accidental, natural, or undetermined.
This type of medical examiner is different from coroners in that a medical examiner is a physician, while a coroner doesn’t need to be. A medical examiner uses their medical expertise to evaluate the medical history and examine the body. They are typically appointed officers.
For the sake of clarity, we’ll use the term independent medical examiners to describe those doctors who deal with the living and use the term forensic medical examiners to describe those doctors who deal with the dead.
Independent Medical Examiners
This type of medical examiner performs independent medical exams (IMEs) when there’s a dispute, concern, or question about the treatment or condition of an injured worker. Performing IMEs on behalf of insurance companies and attorneys is a great way to earn additional income and diversify your practice.
Some typical issues that are looked at include:
- Providing a diagnosis
- Identifying the direct cause of an injury
- Assessing whether an illness or injury is work-related
- Identifying current and proposed medical treatment or diagnostic efforts
- Assessing appropriate work and general activity level
- Judging the ability to return to work (fitness for duty)
- Rating for impairment(s)
- Advising on the stability of the medical condition and status regarding maximal medical improvement
- Identifying other nonmedical factors that can have a significant impact on the outcome of the medical condition or treatment
IMEs can help to untangle the sometimes complicated relationship between:
- Pathologies — medical condition or diagnosis
- Impairments — anatomic or functional abnormalities or loss
- Functional limitations — restrictions that can be assessed by objective medical assessments
- Disabilities — inability to perform socially-defined activities or roles
For example, the Americans with Disabilities Act defines a disability as “a physical or mental impairment that substantially limits one or more major life activities of an individual, a record of such an impairment, or being regarded as having an impairment.”
Major life activities include seeing, hearing, speaking, walking, breathing, performing manual tasks, learning, caring for oneself, and working. Therefore, IMEs must be performed objectively using reproducible techniques and agreed-upon standards.
Who Needs an Independent Medical Examiner?
Most often, employers, employees, and their attorneys, insurers, disability management, managed care organizations, Workers’ Compensation Boards, and other bodies that make determinations about impairment and disability are the ones who need an IME.
No matter who the referring source is, the IME needs to be based on unbiased objectivity. There also needs to be an emphasis placed on reproducible techniques of examination.
While physicians perform IMEs in many different specialties, specialized IMEs can be performed by other health professionals, many of whom are licensed to perform these evaluations. These disciplines include chiropractic physicians, psychologists, and others.
Benefits of Becoming an Independent Medical Examiner
Exam fees average $1,500 per exam, often even higher. You can do several exams in a single day, so the earning potential is terrific. As well, testifying at court depositions can earn additional income.
“Excellent independent medical examiners can earn hundreds of thousands of dollars a year. For example, complex IMEs with extensive medical records and subsequent deposition testimony can result in fees of $10,000+.” – SEAK.
IMEs can be done on your schedule, with minimal additional overhead, and without disrupting your current practice. There are no call-outs, nights, or weekends. IMEs are typically conducted during regular business hours.
The legal risk involved in performing IMEs is minimal compared to practicing clinical medicine. There’s very little overhead required, and minimal equipment is needed in general. With low start-up costs, it is relatively easy to get trained and up-to-speed.
Many physicians continue to do IMEs even after they stop seeing patients clinically. The intellectual challenge of doing something different than general practice can be interesting for many physicians.
5 Things You Need to Become an Independent Medical Examiner
1. Excellent reputation
This seems self-evident. When you do excellent work, you’ll generate word-of-mouth referrals and get repeat business. Top quality IME physicians often experience exponential growth in their practices once the word gets out about their availability.
2. Available schedule
A percentage of cases will lead to depositions and court testimony. Physicians routinely charge at least $500/hour or more for their time associated with expert testimony, so this aspect of IMEs is a great way to earn.
IME physicians also routinely charge for no-shows, meaning they often get paid even if the examinee doesn’t show up.
3. Qualifications
The qualifications needed to become an independent medical examiner are basically to be a board-certified doctor in good standing. Specialists that perform the vast majority of IMEs are clinicians such as physiatrists, psychiatrists, psychologists, neurologists, neurosurgeons, orthopedists, specialists in pain medicine, chiropractors, and occupational medicine physicians.
However, there is work available for just about any specialty that deals with the medical issues in the particular matter at hand.
4. Ability to write a well-crafted report
IMEs are most commonly ordered in Workers’ Compensation and tort cases. Tort cases most often involve motor vehicle collisions or general liability cases such as slips and falls.
The medical examiner is commonly asked to address and write a clear, easy-to-understand report about the diagnosis, the cause of the injury or illness in question, and the appropriateness (or inappropriateness) of past medical treatment.
As well, there will need to be information given on whether any further evaluation and treatment will be necessary. Any past time loss and current work capacity/restrictions, maximum medical improvement, impairment rating, and prognosis will also need to be addressed.
5. Minimal equipment
The overhead and equipment required are typically minimal but will be specialty specific. Office space can be rented on an as-needed basis, and contractors can be used for transcription.
IME companies will sometimes provide office space and transcription services for you, and any medical equipment required is generally quite basic.
Depending on what issues you’re dealing with, you may need basic equipment like:
- Finger goniometer
- Two inclinometers
- Grip and pinch strength measuring devices (a Jamar dynamometer)
- Tongue blades
- Stethoscope and blood pressure cuff
- Goniometers
- Pen light
- Tape measure
- Reflex hammer
- Purdue pegboard
- Tuning fork
- Cotton balls
- Two-point discrimination measuring device
- Applicable edition of AMA’s “Guides to the Evaluation of Permanent Impairment”
Forensic Medical Examiners
A forensic medical examiner’s duties vary by location but typically include:
- Collecting evidence from crime scenes
- Examining physical evidence through physical and chemical analysis
- Performing autopsies
- Determining the cause of death
- Examining the condition of the body
- Studying tissue, organs, cells, and bodily fluids
- Issuing death certificates and preparing reports
- Working closely with law enforcement
- Testifying in court
Within the United States, there is a mixture of coroner and forensic medical examiner systems and, in some states, dual systems. In addition, the requirements to hold office vary widely between jurisdictions.
Many health systems currently hire doctors as part-time forensic medical examiners and encourage them to take extra training to increase their medical expertise in death investigation.
The National Association of Medical Examiners and the American Academy of Forensic Sciences are two organizations that offer specialized training. Currently, 23 states have examiner systems, and 18 have mixed systems that combine the job of medical examiner and coroner.
Qualifications for Becoming a Forensic Medical Examiner
Qualifications for US forensic medical examiners vary from jurisdiction to jurisdiction. In Wisconsin, for example, some counties don’t require individuals to have any special educational or medical training to hold this office.
In most jurisdictions, a forensic medical examiner is required to have a medical degree, although, in many, the degree doesn’t need to be in pathology. Other jurisdictions have stricter requirements, including additional pathology, law, and forensic pathology education.
They aren’t usually required to be a specialist in death investigation or pathology and can practice any branch of medicine.
Forensic medical examiners specialize in forensic knowledge and rely on this during their work. In addition to studying cadavers, they are also trained in toxicology, DNA technology, and forensic serology (blood analysis).
Pulling from each area of knowledge, a forensic medical examiner is an expert in determining a cause of death. This information can help law enforcement crack a case and is crucial to their ability to track criminals in the event of a homicide or other related events.
5 Things You Need to Become a Forensic Medical Examiner
Becoming a forensic medical examiner in the US involves undergraduate study, followed by medical school and the completion of a residency and fellowship. Below are details on the five things you need to become a forensic pathologist.
1. Earn a bachelor’s degree
To pursue a forensic medical examiner career, you need to complete an undergraduate degree. Many schools offer specific pre-medical bachelor’s degree programs that help you meet the qualifications for medical school. Degrees in fields like biology, chemistry, biochemistry, physics, and English are common. In a pre-med bachelor’s degree program, you might take courses in cell biology, molecular biology, biochemistry, and microbiology.
2. Complete medical school
While there isn’t a specific “forensic medical examiner” degree, those interested in this job will need to complete medical school, just like all other types of medical doctors. Medical school gives you an intensive exploration of the human body and teaches students about the cardiovascular, respiratory, nervous, musculoskeletal, and gastrointestinal systems.
Through four years of study, you’ll learn how to identify diseases and cure or manage ailments. The first two years are academically oriented and focus on basic science. The final two years are typically spent doing hands-on learning, such as in clinics.
3. Complete an anatomic pathology residency
Your forensic medical examiner schooling should also include a residency program in anatomic pathology. This immerses you in the process of diagnosing diseases through an autopsy.
Programs are built around rotations in the major sub-specialties of anatomic pathologies, such as surgical pathology, cytopathology, and forensic pathology. Opportunities are available to minor in sub-specialties as well, including gynecologic pathology, dermatopathology, and neuropathology.
Programs last four years and are divided into a two-year anatomic pathology segment and a two-year clinical pathology segment. Others are three-year programs dedicated solely to anatomic pathology.
4. Complete a forensic medical examiner fellowship
In a forensic medical examiner fellowship, you develop your expertise in investigating instances of violent or unexpected death. Training emphasizes evidence collection and the identification of poisoning, disease, trauma, or ballistic wounds during autopsies. Many programs have you working for your local medical examiner or coroner’s office. Fellowship programs typically last one year.
5. Apply to work in a medical examiner’s or coroner’s office
You will probably have to get work experience as a forensic medical examiner before working as a forensic medical examiner. While the US Bureau of Labor Statistics (BLS) doesn’t have specific statistics for forensic medical examiners, they are included in the occupation group for physicians and surgeons. Before practicing, they must also become certified through the American Board of Pathology.
According to the BLS, this group can expect job growth of 3% during the 2020-2030 decade, which is slower than the average for all US occupations. Payscale.com reports that at the end of May of 2022, the median salary for forensic medical examiners is $103,249/year.
Note: While the greater part of the work of a forensic medical examiner is centered around the dead, a clinical forensic medical examiner may also be called on to examine living patients, usually in cases where sexual assault or abuse is suspected.
Once all the evidence is analyzed, the forensic medical examiner prepares a written report and may also be called on to testify to their findings in court.
With all the attention currently given to true crime TV shows and podcasts, it seems that the job of a forensic medical examiner has never attracted so much interest. Ideal for those who love the detective aspect of medicine, this job provides such an important service to families looking for justice or simply answers to how their loved one died.
On the other hand, the work of an independent medical examiner also provides a valuable service to those who need a fair and impartial assessment of their medical condition to get the care and support they badly need.
Let me know if either of these types of medical examiner jobs interests you! I’d love to hear what you are doing to become an entrepreneurial MD and what challenges you may face.
That’s my area of interest and passion. I’m here to share what I’ve learned and to inspire you to take charge of your career and practice medicine on your terms.
