Here is the deal with med mal (at least in the NYC area). Also note that my experience is from the Plaintiff side (and I am a practicing attorney admitted to NY 5 yrs ago):
First off, very few "mom n' pop" PI (that's Personal Injury, not Public Interest) do any of their own Med Mal litigation. Most small solo or 2 or 3 partner PI firms simply refer out the med mal work to lawyers (often solos or other small firms) who specialize in this area. Here's a primer on referrals:
When a PI attorney "sends out" a case on referral to another attorney, the referring lawyer takes 1/3 of the ultimate attorney fees in the case. Period. That is the standard referral fee agreement in NYC (and most other states) on PI cases (whether med mal, auto smash, trip n' fall, etc). So if the lawyer it's referred to settles for 90 K, the referring lawyer gets 10 K (or 1/3 of the 1/3). In case you didn't know this, the fee on all PI cases in NY is 1/3 of the settlement/verdict.
But there is a caveat: in med mal (and med mal tort only), there is a "sliding scale" fee that is part of the NY CPLR. Basically on med mal, the fee % is reduced on "whopper" awards - it's quite a complicated formula-but google "ny med mal attorney fees" and you'll be able to see what I mean).
Here's another quirk of med mal: to bring a case, you need an Affadavit of Merit from an MD which affirms under oath that the MD thinks the case had merit based on medical/scientific expertise. This is a total joke. You can find a plaintiff whore MD who will write you an aff of merit for an ingrown toenail or fart that popped out sideways, etc so long as you pay the MD affdavit/file review fee (usually 1500-3500 bucks). The "MD review" quirk was added as window dressing to show stupid laypeople that a "doctor" reviews the case before its filed- this rule is mostly to appease the tort reform dorks). In reality its a joke.
The problem is that none of the clients have any money, so the firm has to front all the fees for the MD aff, the index number, depoisiton transcripts, etc. This can easily run 10-15 K on a standard med mal file, and often far more.
So in short, the way to make money is to make it rain and GET THE CASES! Understand that PI law is mostly a sales job- he who brings IN the case makes the $$$. The "law" itself is very, very boring and the geeks who actually do the paper churning and EBT's (Examination Before Trial, which is NYC's name for a deposition) make peanuts- like 55-65 K tops. It's just boring grunt work and really of no consequence whatsoever as far as getting paid. There are firms (cough cough) who send paralegals to do the depositions and even to court for status conferences and such, and no one really even cares. Remember, this is still shitlaw since personal injury is involved (even though the rainmakers in this gutter out-earn biglaw partners and work 10 hour weeks LOL).
Besides the rainmakers, the only other kids who make $$$ are the ultra-slick trial guys like John Edwards et al. But that insincere bullshit artist act is a God-given gift and cannot be learned anyway, so I wouldn't worry much about it. Try a few trip n' slip trials first and if you win decent $$$ on a broken wrist or other crap injury, you might want to move up to med mal cases and actually learn what you're doing etc. Most of the good NYC med mal guys are old geezers and wouldn't mind letting you tag along and watch a trial or two.
In fact, mostly the old timers are the trial guys since juries tend to believe what old codgers say. Hell, when's the last time you called an old geezer a bullshitter? These grandpas are also good at bossing people around- look at Wilfred Brimley and his diabetes ads: "If you have diabetes, you check your blood sugar and you check it often!" That codger has sold more needles than the Singer Sewing Machine Co.
That's about all there is to know. Here's a personal story: my own grandmother got a Stage IV bedsore in a nursing home and I sent it out to a small med mal firm- they settled for 60 K and I got a hair under 7 K to do nothing more than send them a referral agreement. The best lawyers let the geeks and pack mules churn the paperwork and spend their time getting business. End of story.