Medical care practitioners, especially physicians, must learn their skills on their patients. The first several years of this training are done in formal education programs where the hospital or other institution pays the student as an employee to take care of patients as part of their training. The patients are supposed to be notified that they are being examined and treated by students, and most programs do inform them. The care is supervised and signed off by staff physicians who are expert in the area. The federal government pays most of the costs of this training. The patients, or the government on their behalf, pay the costs for the care, but this is generally limited to the work performed by the attending physicians, not the student. If the resident does not know how to do a procedure, the patient is not charged extra for time needed to train the resident. After formal clinical training, physicians and other medical care practitioners, like all professionals, must continue learning on the job. The cost of this training is amortized over all the patients treated. No individual patient is charged extra because the physician spends an hour reading a journal article about his or her disease, or bought a new reference text. There may even be a duty to inform the patient if the practitioner is trying a new technique in which he or she is not skilled.

Attorneys, however, charge each client for the time the attorney spends learning about the law governing the client’s problem. Attorneys working in an area of law new to them not only have no duty to warn the client; they may be paid extra for the additional time needed to research this unfamiliar area. Attorneys working in an unfamiliar area spend time researching irrelevant issues, miss important issues, and have difficulty in translating legal research into useful legal advice. Once it is accepted that clients should pay for educating senior attorneys, then it is a logical extension to expect clients to pay for educating junior attorneys. Thus, the client’s financial advantage of hiring an attorney expert in a particular problem often evaporates. The client may get the advantage of the senior attorney’s judgment but have to pay junior attorneys to duplicate this knowledge. In the worst case, the client pays the junior attorneys to learn judgment and there is no expert senior attorney supervising the work.

A more fundamental problem is that law has only limited formal specialty certification boards and no formal specialty training analogous to medical residency training. Attorneys are deemed specialists because they have worked in the area for some time, or because they happen to work for a law firm that has the reputation of having expertise in a given area of law. There is no credentialing process by legal institutions in the way physicians have to be credentialed to ensure their competence. This makes it difficult for a client to ensure that an attorney is really expert in an area such as health law.