Extent and determinants of physician participation in expert witness testimony.Objectives: In the recent past, law firms This list of the world's largest law firms by revenue is taken from The Lawyer and The American Lawyer and is ordered by 2006 revenue:[1]
Methods: We conducted a survey of 1,000 Maryland internal medicine physicians. The survey consisted of 24 items designed to collect information on demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. , practice patterns, income variables, and participation in legal review. Results: Twenty-four percent of our respondents reported engaging in expert witness testimony/review to supplement their incomes. Engagement was significantly associated with internal medicine subspecialty subspecialty, n a limited portion of a narrowly defined professional discipline. E.g., surgery is a specialty of medicine and pediatric vascular surgery is a subspecialty. practice, academic practice, a self-perception that personal income was higher than the income of colleagues, and being in practice for 11 to 20 years. Economic factors were not found to be associated with engaging in these activities. Conclusions: Physician participation in legal review and expert witness activities is significant and appears not to be determined by economic factors. Both the positive effects of such participation on the legal system and the potential ethical concerns require further study. Key Words: expert witness testimony, legal review, physician income ********** Whether because of time constraints In law, time constraints are placed on certain actions and filings in the interest of speedy justice, and additionally to prevent the evasion of the ends of justice by waiting until a matter is moot. resulting from being busy practitioners, resentment and distrust toward the legal system, or disinterest dis·in·ter·est n. 1. Freedom from selfish bias or self-interest; impartiality. 2. Lack of interest; indifference. tr.v. To divest of interest. Noun 1. , physicians have been reluctant to testify To provide evidence as a witness, subject to an oath or affirmation, in order to establish a particular fact or set of facts. Court rules require witnesses to testify about the facts they know that are relevant to the determination of the outcome of the case. in medical malpractice Improper, unskilled, or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional. cases. (1) This has occurred despite statements by medical professional associations in favor of such participation. (2,3) In 1990, the American College of Physicians The American College of Physicians (ACP) is a national organization of doctors of internal medicine (internists), physicians who specialize in the prevention, detection and treatment of illnesses in adults. stated that physicians "... have a duty to testify in court as expert witnesses." (2) The deterioration de·te·ri·o·ra·tion n. The process or condition of becoming worse. of the relationship between the medical and legal professions appears to have been catalyzed by the perception of increasing medical malpractice claims ever since the 1970s. (4) Conflicting economic interests in legal actions may have served to bolster the reluctance of medical professionals to participate in the legal process. More recently, physicians have also seen instability in their historically financially secure profession. Limitations on reimbursements, rising educational debt, and escalating malpractice and overhead costs overhead costs see fixed costs. have resulted in many physicians having a decline in their incomes. (5,6) In a response to the change in the medical climate, some physicians have opted to leave their medical practices altogether, whereas others have sought ways to supplement their incomes. (7,8) One such avenue of income supplementation is review of medical malpractice cases. Given that little empirical data on the prevalence of physician participation in expert witness activities currently exists, we designed a study to examine the extent of participation of internal medicine physicians in such activities. We also sought to determine whether economic or demographic factors were associated with engagement in this activity. Materials and Methods Study design and population We conducted a cross-sectional mail survey of 1,000 internal medicine physicians who were randomly sampled from the Maryland American College of Physicians member registry. To be eligible, physicians had to be full members of the American College of Physicians, be 30 years of age or older, and practice either general internal medicine or a subspecialty of internal medicine. Our sampling strategy consisted of systematic alphabetical sampling with a random start. Every third physician on the member registry was asked to participate until we mailed 1,000 surveys. This required two passes through the registry. All surveys were anonymous. We re-contacted nonresponders 3 times by mail and once by fax between February 2000 and January 2001. Sample size was adjusted for surveys that were returned secondary to wrong mailing address or deceased or retired status of the physician. We characterized demographic information on nonresponders by querying the publically available Maryland Board of Physician Quality Assurance web site (http://www.bpqa.state.md.us). The study was approved by the Institutional Review Board of the Johns Hopkins Noun 1. Johns Hopkins - United States financier and philanthropist who left money to found the university and hospital that bear his name in Baltimore (1795-1873) Hopkins 2. Medical Institutions. Questionnaire The survey consisted of 24 multiple-choice questions designed to capture information on participation in legal review. The specific survey question to elicit e·lic·it tr.v. e·lic·it·ed, e·lic·it·ing, e·lic·its 1. a. To bring or draw out (something latent); educe. b. To arrive at (a truth, for example) by logic. 2. information on participation read as follows: "To supplement your income, do you engage in: Legal review/witness as a physician expert?" The questionnaire also obtained demographic information (including age, sex, marital status marital status, n the legal standing of a person in regard to his or her marriage state. , number of dependents, and year of medical school graduation), practice information (years in practice, practice location/setting, and medical specialty/subspecialty), and economic information (annual income, change in income over the last 5 years, educational debt, income satisfaction, compensation structure, and perception of income in relation to other physicians and nonphysician professionals). The choices for compensation structure included salary alone, salary plus percentage of billing revenue, or billing revenue alone. We designed and piloted the survey with 15 physicians in general internal medicine, after which we solicited feedback and modified the survey accordingly. Data analysis First, we compared the characteristics of those physicians who participated in these activities with those of physicians who did not. We used descriptive statistics descriptive statistics see statistics. to assess physician demographics and the percentage of physicians participating in expert witness work. A one-way analysis of variance was used for continuous variables, and the [chi square chi square (kī), n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. ] test was used for categorical That which is unqualified or unconditional. A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding. Categorical is also used to describe programs limited to or designed for certain classes of people. variables. Multivariate analysis multivariate analysis, n a statistical approach used to evaluate multiple variables. multivariate analysis, n a set of techniques used when variation in several variables has to be studied simultaneously. was performed by using a logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. model to assess the presence, strength, and independence of the association between physician characteristics and attitudes and participation in legal review. Variables significantly associated (P [less than or equal to] 0.05) with participation in univariate analyses were included in the logistic regression model. We performed statistical analyses using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. 10.0 (SPSS Inc, Chicago, IL). Results Response rate and participant characteristics Of the 1,000 surveys mailed, 84 were returned undeliverable un·de·liv·er·a·ble adj. Difficult or impossible to deliver: undeliverable mail. un by the post office, 55 were sent to retired physicians, 10 were sent to deceased physicians, 14 were sent to physicians not engaging in any clinical activity, and 2 were sent to individuals who were not internal medicine physicians. Of the 835 remaining eligible participants, 444 (53%) responded. There were no significant differences between the 444 responders and the 391 nonresponders with regard to sex (76% versus 73% male) and specialty (56% versus 52% general internists). However, nonresponders had graduated from medical school approximately 2.3 years earlier than responders (24.7 versus 22.4 years, respectively P = 0.001). The characteristics of our respondents are seen in Table 1. Respondents had a mean age of 48.1 years. The mean number of years since medical school graduation was 22.4 years. More than half of responding physicians described their specialty as solely general internal medicine, with the remaining physicians reporting another specialty or subspecialty (cardiology cardiology Medical specialty dealing with heart diseases and disorders. It began with the 1749 publication by Jean Baptiste de Sénac of contemporary knowledge of the heart. Diagnostic methods improved in the 19th century, and in 1905 the electrocardiograph was invented. , endocrinology endocrinology Medical discipline dealing with regulation of body functions by hormones and other biochemicals and treatment of endocrine system imbalances. In 1841 Friedrich Gustav Henle first recognized “ductless glands,” which secrete products directly into , gastroenterology gastroenterology Medical specialty dealing with digestion and the digestive system. In the 17th century Jan Baptista van Helmont conducted the first scientific studies in the field; William Beaumont published his own observations in 1833. , infectious disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. , nephrology nephrology Branch of medicine dealing with kidney function and diseases. An understanding of kidney physiology is important not only in treating kidney disease but in knowing the effect of drugs, diet, and hypertension on kidney disease, and vice versa. , pulmonology pul·mo·nol·o·gy n. The branch of medicine that deals with diseases of the respiratory system. pulmonology The study of the lungs and respiratory function , rheumatology rheumatology /rheu·ma·tol·o·gy/ (-tol´ah-je) the branch of medicine dealing with rheumatic disorders, their causes, pathology, diagnosis, treatment, etc. rheu·ma·tol·o·gy n. , oncology oncology /on·col·o·gy/ (ong-kol´ah-je) the sum of knowledge regarding tumors; the study of tumors. on·col·o·gy n. , hematology hematology Branch of medicine concerned with the nature, function, and diseases of the blood. It covers the cellular and serum composition of blood, the coagulation process, blood-cell formation, hemoglobin synthesis, and disorders of all these. , or emergency medicine). More than two thirds of participants reported having dependents. When participants were asked about educational debt, more than half had educational debt at some point, but only 13% had current obligation to that debt. More than half of the respondents reported that the income from their primary medical practice remained stagnant stagnant /stag·nant/ (stag´nant) 1. motionless; not flowing or moving. 2. inactive; not developing or progressing. or decreased over the previous 5 years. More than half were dissatisfied with their income. Participation in expert witness activities Twenty-four percent of our respondents reported engaging in legal review and/or expert witness testimony in an effort to supplement their incomes. In univariate analysis, male sex, subspecialty practice, full-time academic practice, urban practice location, number of years in practice, a perception that other physicians in the same field were making less, and annual income were positively and statistically significantly associated with participation (Table 2). Age, number of years since graduation, educational debt, and satisfaction with income were not statistically significantly associated with participation. After adjustment in multivariate analysis, the odds of men participating in legal review activities were two-fold greater than the odds for women, but this difference did not achieve statistical significance. Subspecialty internal medicine practice and academic practice remained strongly and independently associated with physician participation. Physicians with these characteristics had about a threefold greater odds of engaging in legal review than their counterparts (general internists and nonacademicians, respectively). Physicians who were in practice for 11 to 20 years were more likely to participate than physicians with fewer years in practice. Physicians who perceived that their income was higher than their colleagues' were also more likely to participate. The odds of physicians who incurred educational debt after medical school engaging in expert witness activities was greater than their counterparts with no educational debt, although this difference was not statistically significant. Discussion The recent rise in medical malpractice lawsuits and awards has been suggested as the impetus for the formation of an expert witness industry, made up of a handful of economically motivated physicians. (1,9,10) This study suggests that this may not be the case. About one quarter of the internal medicine physicians we surveyed engaged in legal case review and/or expert witness testimony, indicating that involvement in the legal system by physicians may be more widespread, and not dominated by a few "hired guns Hired Guns is a computer role-playing game produced by DMA Design (distributed by Psygnosis) for the Amiga in 1993. The game is set in the year 2712, in which the player controls four mercenaries selected from a pool of twelve. ." Serving as an expert witness can provide significant noneconomic benefits. It can serve to enhance a physician's reputation, add variety to routine clinical practice, and allow for greater understanding of the litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute. When a person begins a civil lawsuit, the person enters into a process called litigation. process. Numerous studies have demonstrated deficiencies in physicians' knowledge of the legal system. (11,12) This probably stems from the limited exposure that most medical students and residents have to medico-legal issues while in training. Involvement as an expert witness can provide practitioners with a means of overcoming that deficiency in an increasingly litigious litigious adj. referring to a person who constantly brings or prolongs legal actions, particularly when the legal maneuvers are unnecessary or unfounded. Such persons often enjoy legal battles, controversy, the courtroom, the spotlight, use the courts to punish society. However, linkage linkage In mechanical engineering, a system of solid, usually metallic, links (bars) connected to two or more other links by pin joints (hinges), sliding joints, or ball-and-socket joints to form a closed chain or a series of closed chains. of expert testimony Testimony about a scientific, technical, or professional issue given by a person qualified to testify because of familiarity with the subject or special training in the field. with financial gain does introduce the potential for conflicts of interest. (13) In their guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for physician expert witnesses physician expert witness A principal actor in the drama of malpractice litigation, defined by guidelines from the Council of Medical Specialty Societies. See Expert, Hired gun. , the American College of Physicians states that "compensation of the physician expert witness should be reasonable and commensurate com·men·su·rate adj. 1. Of the same size, extent, or duration as another. 2. Corresponding in size or degree; proportionate: a salary commensurate with my performance. 3. with the time and effort given to the preparation for depositions and court appearances." (2) This seems appropriate, given the time that such activities can take away from primary patient care activities. Yet, the definition of "reasonable" is subject to debate as physicians may charge from $150 per hour to $3,000 per day for their expertise. (1) In addition, some may argue that remuneration REMUNERATION. Reward; recompense; salary. Dig. 17, 1, 7. , even for professional services (job) professional services - A department of a supplier providing consultancy and programming manpower for the supplier's products. , may impair im·pair tr.v. im·paired, im·pair·ing, im·pairs To cause to diminish, as in strength, value, or quality: an injury that impaired my hearing; a severe storm impairing communications. objectivity. (14) To counteract this potential, some states have created panels to hear medical malpractice claims, whereas the American Medical Association American Medical Association (AMA), professional physicians' organization (founded 1847). Its goals are to protect the interests of American physicians, advance public health, and support the growth of medical science. has recommended peer review of expert witnesses and disciplinary action against physicians providing fraudulent testimony. (15) Contrary to our initial hypothesis, engagement in legal review activities was not associated with declining income or with dissatisfaction with income, suggesting that the stimulus for participation in such activities may be noneconomic. Physicians who have been in practice for 11 to 20 years were more likely to participate than younger physicians. This may be due to limited opportunity for younger physicians, since many states require at least 5 years of work in the same specialty of the accused. (16) The fact that specialists engaged in these activities more frequently than generalists is consistent with a definition of "expert" that includes level of training and education. In addition, specialists are typically at higher risk for litigation than generalists. Our study also shows that academic internal medicine physicians were more likely to take part in expert witness activities. Again, the "expert" status attached to academia probably results in this finding. Academics may also have more flexibility in their work schedules. Several limitations to this study deserve mention. First, our sample was random but limited to internal medicine physicians in the state of Maryland. Physicians in other specialties and other states and specialties may have different patterns of involvement in the legal process. Second, nonresponse bias is a concern in any study such as this that uses systematic survey methods with potentially sensitive subject matter. Although it was reassuring re·as·sure tr.v. re·as·sured, re·as·sur·ing, re·as·sures 1. To restore confidence to. 2. To assure again. 3. To reinsure. that responders and nonresponders were similar with regard to sex and specialty, they may differ on other unknown characteristics. Third, our response rate of 53% was not optimal, although it is comparable to the mean response rates of mailed physician surveys of similar size. (17,18) Finally, we do not have data on the level of payment for or the nature of the legal activities (eg, reviews cases for plaintiffs, defendants, or both) in which the physicians engaged. Conclusion In summary, the substantial involvement of physicians in legal review activities demonstrated in this study and the factors associated with this involvement are important. The benefits that such relationships may have on the legal process must be weighed against the potential for conflicts of interest. The impact of the relationship between physicians and the legal profession deserves consideration and warrants further study to improve the medical malpractice system.
He has all the virtues I dislike and none of the vices I admire.
--Sir Winston Churchill
Table 1. Characteristics of Responding Physicians (n = 444) (a)
Age, mean [+ or -] SD 48.1 (9.30)
Years since medical school 22.4 (9.81)
graduation, mean [+ or -]
SD
Sex, n (%) Female 107 (24)
Male 337 (76)
Marital status, n (%) Single 51 (12)
Married or live with 392 (88)
domestic partner
Spousal/domestic partner No 154 (35)
income, n (%)
Yes 237 (53)
NA 51 (11)
Dependents, n (%) None 124 (28)
At least one 320 (72)
Years in practice, n (%) [less than or equal to]5 50 (11)
6-10 98 (22)
11-15 80 (18)
16-20 68 (15)
>20 147 (33)
Specialty, n (%) Other specialty 194 (44)
Internal medicine 250 (56)
Practice location, n (%) Urban 194 (44)
Suburban 205 (46)
Rural 43 (9)
Practice setting, n (%) Private/group--single 160 (36)
specialty
Private/group--multiple 54 (12)
specialty
Staff model HMO 12 (3)
Full-time academic faculty 94 (21)
Military 1 (0)
Solo practice 77 (17)
Other internal medicine 45 (10)
specialty
Practice compensation, n Salary only 176 (40)
(%)
Salary and billing revenue 96 (22)
Billing revenue only 166 (37)
Full time/part time, n (%) Part time 54 (12)
Full time 390 (88)
Past 5-year income change, Decreased/no change 255 (57)
n (%)
Increased 169 (38)
NA 20 (5)
Income satisfaction, n (%) Satisfied 199 (45)
Dissatisfied 237 (53)
Educational debt after No 124 (28)
medical school, n (%)
Yes 316 (71)
Obligation to medical No 388 (87)
school debt, n (%)
Yes 56 (13)
Where physicians saw Somewhere else/retired 197 (44)
themselves in 5 years, n
(%)
In present practice 247 (56)
Would physicians chose No 107 (25)
medicine again, n (%)
Yes 325 (75)
Perceived income of Higher 210 (47)
physicians in same field,
n (%)
Same 173 (39)
Lower 56 (13)
Perceived income of Increasing at higher rate 386 (87)
nonmedical professionals,
n (%)
Increasing at the same rate 33 (7)
Increasing at a lesser rate 14 (3)
Annual income, n (%) [less than or equal to]$100 117 (26)
k
$101-$200 k 228 (51)
>$200 k 88 (20)
(a) HMO, health maintenance organization; NA, not available.
Some percentages do not sum to 100% due to missing data: 1% for
spousal/domestic partner income, 1% for dependents, 1% for practice
location, 1% for practice setting, 1% for educational debt after medical
school, 1% for perceived income of physicians in the same field, 2% for
compensation structure, 2% for income satisfaction, 3% for annual
income, 3% for perceived income of nonmedical professionals, 7% for
change in income over last 5 years.
Table 2. Association between physician characteristics and participation
in legal review activities (a)
Participating Unadjusted odds
Characteristic n (%) ratio (95% CI)
All physicians 107 (24)
Sex
Female 10 (9) 1.00 (reference)
Male 97 (29) 3.95 (2.00-7.80)
Dependents
None 29 (23) 1.00 (reference)
One or more 78 (25) 1.06 (0.66-1.73)
Specialty
General internal medicine 35 (14) 1.00 (reference)
Internal medicine subspecialty 72 (37) 2.12 (1.43-3.23)
Practice setting
Nonacademic 66 (19) 1.00 (reference)
Full-time academic 41 (44) 3.31 (2.03-5.37)
Practice location
Rural 7 (16) 1.00 (reference)
Suburban 38 (19) 1.20 (0.79-1.82)
Urban 62 (32) 2.43 (1.02-5.88)
Number of years in practice
[less than or equal to]10 28 (19) 1.00 (reference)
11-20 42 (29) 1.73 (1.00, 2.99)
>20 37 (25) 0.83 (0.49, 1.40)
Educational debt after medical school
None 38 (21) 1.00 (reference)
Any amount 69 (27) 1.37 (0.87-2.14)
Perceived income of physicians in the
same field
Higher 46 (22) 1.00 (reference)
Same 40 (23) 1.07 (0.66-1.73)
Lower 21 (38) 2.13 (1.13-4.00)
Practice plan over next 5 years
Leave practice/retire 48 (24) 1.00 (reference)
Stay in current practice 59 (24) 0.98 (0.64-1.52)
Income satisfaction
Satisfied 46 (23) 1.00 (reference)
Dissatisfied 58 (29) 1.07 (0.69-1.67)
Annual income
[less than or equal to]$100 k 19 (16) 1.00 (reference)
$101-$200 k 57 (25) 1.71 (0.96-3.05)
>$200 k 29 (33) 2.33 (1.21-4.45)
Adjusted odds ratio (b)
Characteristic (95% CI)
All physicians
Sex
Female 1.00 (reference)
Male 2.13 (0.97-4.64)
Dependents
None 1.00 (reference)
One or more NA
Specialty
General internal medicine 1.00 (reference)
Internal medicine subspecialty 3.0 (1.72-5.26)
Practice setting
Nonacademic 1.00 (reference)
Full-time academic 2.95 (1.45-5.98)
Practice location
Rural 1.00 (reference)
Suburban 1.00 (0.67-1.48)
Urban 1.25 (0.45-3.44)
Number of years in practice
[less than or equal to]10 1.00 (reference)
11-20 2.22 (1.08-4.59)
>20 2.54 (0.86-7.47)
Educational debt after medical school
None 1.00 (reference)
Any amount 1.61 (0.91-2.84)
Perceived income of physicians in the
same field
Higher 1.00 (reference)
Same 1.24 (0.71-2.20)
Lower 2.94 (1.45-5.98)
Practice plan over next 5 years
Leave practice/retire 1.00 (reference)
Stay in current practice 0.75 (0.44-1.26)
Income satisfaction
Satisfied 1.00 (reference)
Dissatisfied 1.27 (0.76-2.13)
Annual income
[less than or equal to]$100 k 1.00 (reference)
$101-$200 k 1.25 (0.63-2.50)
>$200 k 1.51 (0.65-3.52)
(a) CI, confidence interval; NA, not available (variables were not
examined in the multivariate model).
(b) Adjusted for age, annual income, years in practice, income
satisfaction, educational debt after medical school, where physicians
see themselves in 5 years, practice setting, sex, physician specialty,
practice location, and perceived income of physicians in the same field.
Presented in part at the Society of General Internal Medicine Society of General Internal Medicine (SGIM) is an American professional society composed of physicians engaged in internal medicine research and teaching. Originally named The Society for Research and Education in Primary Care Internal Medicine (SREPCIM), at its inaugural meeting annual meeting, May 2003, Atlanta, GA. Accepted June 21, 2004. References 1. Levy DA. Physicians are being persuaded to participate as medical witnesses. Ann Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med 1996;125:I-40. 2. American College of Physicians. Guidelines for the physician expert witness. Ann Intern Med 1990;113:789. 3. Professional Liability Committee of the American College of Surgeons This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article. . Statement on the physician expert witness. Bull Am Coll Surg 2000;85:24-25. 4. Gibson JM, Schwartz RL. Physicians and lawyers: science, art, and conflict. Am J Law Med 1980;6:173-182. 5. Moser JW. Socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. Characteristics of Medical Practice 1997/98. Chicago, Center for Health Policy Research, American Medical Association, 2000, pp 5-14. 6. Goldberg JH. Primary care earning plummet. Med Econ 2000;77:141-157. 7. Greenberg M. Developing alternative revenue sources. Med Group Manage J 2000;47:26-29. 8. Pham HH, Devers KJ, May JH, et al. Financial pressures spur physician entrepreneurialism. Health Aff 2004;23:70-81. 9. Weintraub MI. Expert witness testimony. Neurol Clin 1999;17:363-369. 10. McAbee GN. Improper expert witness testimony. J Leg Med 1998;19:257-272. 11. McCrary SV, Swanson JW, Perkins HS, et al. Treatment decisions for terminally ill Terminally Ill When a person is not expected to live more than 12 months. Notes: Any gifts given out by the afflicted person at this time may be considered as a dispersion of the estate rather than a gift. patients: physicians' legal defensiveness and knowledge of medical law. Law Med Health Care 1992;20:364-376. 12. Darvall L, McMahon M, Piterman L. Medico-legal knowledge of general practitioners general practitioner n. Abbr. GP A physician whose practice consists of providing ongoing care covering a variety of medical problems in patients of all ages, often including referral to appropriate specialists. : disjunctions, errors and uncertainties. J Law Med 2001;9:167-184. 13. Thompson DF. Understanding financial conflicts of interest. N Engl J Med 1993;329:573-576. 14. May WF. Money and the medical profession. Kennedy Inst Ethics J 1997;7:1-13. 15. American Medical Association. Expert witness testimony (H-265.992). Available at: http://www.ama-assn.org/apps/pf_new/pf_online?f_n=resultLink&doc=policyfiles/HnE/H-265.992.HTM&s_t=expert+witness+testimony&catg=AMA/HnE&&nth=1&&st_p=0&nth=3&. Accessed April 23, 2004. 16. Weintraub MI. Expert witness testimony. A time for self-regulation? Neurology neurology (n  rŏl`əjē, ny–), study of the morphology, physiology, and pathology of the human nervous system. 1995;45:855-858.
17. Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997;50:1129-1136. 18. Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res 2001;35:1347-1355. RELATED ARTICLE: Key Points * A number of physicians engage in legal review and expert witness testimony to supplement their incomes. * The motivation for such participation does not appear to be based on decreases in income or income satisfaction. * The benefits that may arise from widespread involvement of physicians in the review process must be weighed against the potential for conflicts of interest that can accompany remuneration for services. Bimal H. Ashar, MD, Redonda G. Miller, MD, and Neil R. Powe, MD, MPH, MBA MBA abbr. Master of Business Administration Noun 1. MBA - a master's degree in business Master in Business, Master in Business Administration From the Division of General Internal Medicine, The Johns Hopkins University School of Medicine The Johns Hopkins University School of Medicine, located in Baltimore, Maryland, USA, is a highly regarded medical school and biomedical research institute in the United States. , Baltimore, Maryland "Baltimore" redirects here. For the surrounding county, see Baltimore County, Maryland. For other uses, see Baltimore (disambiguation). Baltimore is an independent city located in the state of Maryland in the United States. ; the Departments of Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause and Health Policy and Management, The Johns Hopkins University Johns Hopkins University, mainly at Baltimore, Md. Johns Hopkins in 1867 had a group of his associates incorporated as the trustees of a university and a hospital, endowing each with $3.5 million. Daniel C. Bloomberg School of Public Health, Baltimore, Maryland; and Welch Welch , William Henry 1850-1934. American pathologist and bacteriologist who discovered the bacteria that causes gas gangrene. Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland. The study was approved by the Institutional Review Board of the Johns Hopkins Medical Institutions. Reprint reprint An individually bound copy of an article in a journal or science communication requests to Dr. Bimal H. Ashar, Johns Hopkins Greenspring Station Greenspring Station is an office complex located in Lutherville, Maryland, though it has a postal zone and post office of its own known as Brooklandville (zip code 21022). , 10753 Falls Road The following roads are called Falls Road:
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