Autopsy caseloads rise thanks to shortage of forensic pathologists

Here are two new stories in the Fort Worth Star-Telegram's series on forensic errors in Texas autopsies:

• Autopsy caseloads require stopgap measures
• Pathology shortage poses concern about autopsies

The issue of a pathologist shortage was raised prominently in Chapter 9 of the National Academy of Science's report from last spring critiquing the non-scientific basis of modern forensics. NAS said the shortage occurred because "The selection pool is local and small (because work is inconvenient and pay is relatively low), and medical training is not always a requirement." Indeed, said the report, "death investigations in the United States rely on a patchwork of coroners and medical examiners and that these vary greatly in the budgets, staff, equipment and training available to them and the quality of services they provide."

Said NAS, an estimated 1,300 pathologists have been certified in forensic pathology nationwide since the certification was first offered in 1959. Currently between 400-500 physicians in the United States practice forensic pathology full-time. "Although there are only about 70 positions available each year, recent data indicate that only 70% of the slots are filled."

"Texas doesn’t keep track of how many certified forensic pathologists work in the dozen county medical examiner offices," reports the Startlegram; "some put the number at 50," but "That’s not enough to serve large counties, let alone the 200-plus smaller ones that turn to them for autopsies." Based on autopsy caseload levels recommended in best-practices research, said NAS, there is an estimated national need for around 1,000 forensic pathologists.

The NAS attributes the shortage to high debt loads faced by physicians after college and the relatively low pay of forensic pathologists compared to other medical fields. Sounds to me like some targeted loan repayment assistance for medical examiners might be a way to get more doctors to take these jobs, particularly given how few positions, relatively speaking, come open each year in this subspecialty.