According to the National Association of Medical Examiners (NAME), the United States has about 750 full-time, board-certified forensic pathologists. But, experts say that number needs to be at least 1,500—if not more—to deal with the rising caseloads across every state. For example, in November 2022, NAME had 55 forensic pathologist job openings posted on its website. Unfortunately, only about 40 people become board-certified forensic pathologists each year.
Forensic Editor-in-Chief Michelle Taylor recently spoke to Gregory McDonald, DO, from the Philadelphia College of Osteopathic Medicine (PCOM) about the escalating shortage crisis. In this Q&A, McDonald—who is chairman of the Department of Forensic Medicine and Pathology as well as dean of the School of Health Sciences at PCOM—shares his thoughts and expertise on ways to increase the forensic pathologist workforce, ensuring families get the answers they need and justice is served whenever possible.
Q: The forensic pathologist shortage has been happening for the better part of a decade now. How did we get from ‘there is a shortage’ to ‘there is an absolutely critical shortage?’
A: This issue has multiple factors. First, the COVID-19 pandemic had a big impact on the profession as pathologists were getting sick and quarantining. While the shortage of forensic pathologists had existed before the pandemic, the impacts of this became more prominent and critical in the last few years. Second, we are seeing more and more older pathologists retiring, which may have been influenced by the pandemic. Another major driver of the pathologist shortage is the opioid epidemic. Between fentanyl deaths and violent crimes with drug trades, forensic pathologists are overloaded with cases. The combination of these issues has pushed the profession to its capacity.
Q: Beyond the drug crisis and the COVID-19 pandemic, what are other factors that contribute to today's shortage?
A: Beyond the pandemic and drug crisis, we are seeing fewer medical students consider forensic pathology as a career choice. This is also the case for general pathology. Students are choosing to pursue career paths in the healthcare space that are more competitive financially and require less training time. Not to mention, many students do prefer to work with living patients. TV shows like CSI make the job look exciting—and I’d argue this profession is incredibly interesting—but it does take a certain type of student to want to pursue this path. Another issue is there’s often not adequate funding for forensic pathology programs. Because there are less students enrolled in forensic pathology programs compared with others, there is not much funding. Because there isn’t proper funding, there are often not enough students.
Q: What is the first priority to help alleviate the shortage?
A: The first thing we can do to alleviate the shortage is to talk to those already enrolled in these programs—current pathology residents. Before you can do forensics, students must do at least two years of anatomic forensic pathology residencies. So, we can start to target those individuals who are in the beginning stages of their residency training and encourage them to go into forensic pathology. We also need to show students how interesting this career is and the impact it has on families. While this is a short-term solution, we might see an uptick in individuals applying for forensic pathology fellowships in a year or two. We also need to leverage the residents we currently have. When I was a forensic pathology resident, I was hired by the Philadelphia County Medical Examiner’s Office. While I was overseen by a senior forensic pathologist, I would do some of the work on my own. I worked on non-homicide and less complicated cases to alleviate some of the strain that was put on those forensic pathologists. It depends on jurisdiction whether this would be a viable solution or not, but it’s a way to get educated hands to help with forensic pathology work.
Q: What about second and third priorities?
A: Programs need to increase the number of spots available for forensic pathology fellowships. We also need more board-certified forensic pathologists to oversee fellowship training programs. We need to get out of this cycle where we don’t have enough forensic pathologists to train fellows, but we also don’t have enough individuals to fill those fellowship roles. Additionally, increases in compensation should be considered if we want to be competitive with other careers in the healthcare space. More funding would also allow for new facilities or updates to older facilities that make the profession more attractive. These changes need to be made nationwide.
Q: How do you make the forensic pathology field more attractive for those who may be on the fence about joining the profession?
A: As an educator at the Philadelphia College of Osteopathic Medicine, I incorporate forensic pathology into my general pathology lectures. I address the misconceptions about the forensic pathology industry and what challenges forensic pathologists undertake. I show medical students that forensics isn’t all just crime scenes and homicides. I talk about how forensic pathologists interpret wounds on living people, testify in court and provide the public health sector with accurate documentation of communicable diseases, drug-related deaths and suicides. There is much more to this career than what is assumed.
In clinical medicine, individuals have different rewards. If you’re an internal medicine specialist, you’re treating someone’s symptoms and improving their quality of life. If you’re an oncologist, you may be curing someone of cancer. If you’re an emergency physician, you may save a person’s life if they’re going into cardiac arrest or having an allergic reaction. To many, forensic pathologists don’t have this type of reward, but that’s incorrect. We have rewards, they are just different but still valuable and impactful. We provide family members with closure when a loved one dies, and we provide a valuable duty to the judicial system by testifying to ensure people who are guilty of violent crimes are held accountable. We need to get this across to medical students and show them the impact our profession has on so many.
Q: What is one specific way the Philadelphia College of Osteopathic Medicine is working to combat the forensic pathologist shortage?
A: The Philadelphia College of Osteopathic Medicine is unique because forensic medicine is incorporated into our curriculum. Not many schools offer this, and not many medical schools have a board-certified forensic pathologist as a full-time faculty member. I’m able to share my experiences in classrooms and incorporate many of my cases into general pathology lectures, clubs and continuing education courses. Current students can sit in on these lectures and get exposed to the forensic pathology program, but also practicing physicians can join and understand the importance of forensic pathology. We also offer a robust master's program in forensic medicine. This program is available to train those who support forensic pathologists—such as forensic investigators and autopsy technicians—and can help take the pressure off current forensic pathologists.
Q: What steps can be taken right now to help take pressure off current forensic pathologists who are dealing with excessive workloads?
A: Forensic pathologists would benefit from getting general pathology residents to handle some of the non-homicide cases that don’t go to trial. Not only do they gain valuable experience, which helps them in their careers, but it alleviates forensic pathologists’ workloads. We can also ask some of those who have retired to come back, even if on a part-time basis. Since there is a lot of training involved in forensic pathology, we must implement these changes now so the community can reap the benefits in years to come.
Q: In terms of bills and laws, what could towns/cities/states be doing to help address the shortage?
A: The main thing that can be done to address the shortage would be to educate the public on the importance of forensic pathology. We need to convey the importance of our role, and also how important it is to have forensic facilities that are state-of-the-art alongside well-trained—and well-compensated—forensic pathologists. Bills for tuition reimbursement or loan forgiveness would also help to attract more individuals to the field. But firstly, and most importantly, we need the general public to support us and we can do this by educating them.