Forensic Pathologists: The Death Detectives

When the National Academy of Sciences released its 2009 report on death investigation in America, it estimated that fewer than 500 physicians nationwide were practicing forensic pathology full-time -- not nearly enough, the blue ribbon panel suggested, to meet the country's health or criminal justice needs.

With roughly 500,000 deaths per year referred to a coroner or medical examiner for preliminary investigation, the National Association of Medical Examiners says twice that number of forensic pathologists is needed to provide competent service and ensure that pathologists are not performing more than the 250 to 350 autopsies per year its guidelines recommend.

What does a forensic pathologist do?

According to the College of American Pathologists, forensic pathologists are experts in investigating and evaluating cases of sudden, unexpected, suspicious and violent death, as well as other specific classes of death defined by state laws. Most serve the public as a coroner or a medical examiner, or by performing autopsies for those officials. Others are in private practice, and may also work as contract pathologists on a fee-for-service basis.

Why So Few?

Like most medical subspecialties, forensic pathology takes years of training -- typically, four years of medical school, followed by three to four years of training in anatomical or clinical pathology.

Training also entails a one-year fellowship at an approved medicolegal investigation facility, often a medical examiner's or coroner's office, where fellows are expected to perform between 200 and 300 autopsies a year as part of their accreditation. To become board certified -- which is considered the gold standard in death detective credentials -- you must pass a written and practical exam set by the American Board of Pathology and be re-certified every 10 years.

In all, 47 residents enrolled in 39 accredited forensic pathology programs in 2010 -- low compared with many other medical subspecialties and barely on the radar of the roughly 6,000 students who go into internal medicine in the U.S. every year.

Part of the problem, experts say, is there isn't enough material support or direct connections to pathology departments in medical schools and training hospitals, where students could get more exposure to the work of forensic pathology and become more interested in pursuing it as a subspecialty.

There are workplace challenges, too, says Dr. Vincent DiMaio, a retired forensic pathologist and former chief medical examiner in San Antonio, Texas, who has spent 40 years in the profession. "The salaries are not competitive and the facilities are often terrible when you compare them to working in a hospital setting."

Even though the study found that forensic pathologists doing medicolegal death investigations earned between $150,000 and $180,000 per year, it doesn't match even the entry-level salaries of those going into hospital pathology work.

And few would dispute it is unpleasant work: dissecting dead people, working with decomposed bodies, not to mention the psychological stress of dealing with grieving families.

But on that last point, the stress factor, DiMaio points out, "Anybody who's been in forensic pathology going on a couple of years, you don't need psychological counseling. You've gotten out of the business if you can't handle the psychological stress.

"You get used to everything in the end," he says.