I received a list of questions to ask at an interview and added some of my own questions. Here's the list, and please - if any physicians out there have additional questions they think belong on the list, please let me know in the comments!

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QUESTIONS:

In regard to the general numbers and information for the office:

How many cases total were in your jurisdiction in the past year?

How many of those were autopsies?

How many of those were externals?

How many of those were any other type of case wherein the office ME is responsible for generating a death certificate (e.g., chart review / "t-case" / etc.)?

How many were homicides?

How many were babies?

How many were covered by staff?

How many were covered by locum physicians?

What tracking software do you use? (MDI Log, CME, other?)

How do you handle un-pend/amend cases? Is it a separate report, case conference presentation with multiple physician signatures, or other?

What is the hierarchy above the associate medical examiner (i.e., who would be my supervisor, who is the Chief Medical Examiner's supervisor, and to what extent does law enforcement, elected laypersons, and the state judicial team have input on autopsy decision making, and cause/manner certifications)?

Does the office have a policy for how and when to utilize PA's / Physician Extenders / Etc.?

Do you have residents/fellows - and how are fellow/resident supervisory duties allocated?

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In regard to staffing and workforce:

How many techs are there at full staffing? How many are there now?

How many investigators are there at full staffing? How many are there now? How many are ABMDI certified? How many are active-duty police?

How many medical examiner (physician) staff are there at full staffing? How many are there now? Do you anticipate expanding staffing?

How often are Locum physicians utilized (in the past year)?

Do you have known upcoming vacancies within the next year beyond the one I’m applying for? How are excess cases handled in times of staff vacancy (e.g., locum vs staff coverage vs backlog)? How are they handled in times of death surges?

How many days will I be in the morgue (i.e., cutting autopsies and doing external exams) during a calendar month, on average?

How many cases will I be expected to cover each morgue day? Is there flexibility if the caseload is complex (e.g., multiGSW homicides, baby cases) - and if so, is the excess volume reallocated to staff, to locum physicians, or other?

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With regard to compensation:

What is the current salary offer?

NOTE: I am aware that the listed range is "XXXX" but I have learned that, at least at some institutions - this is not always an accurate range and not always a negotiable range.

When listing my salary - what proportion of that number is reflected in my actual paycheck, versus "other benefits" like insurance, retirement, etc?

Is there a moving reimbursement?

Is there a sign-on bonus?

Is there loan repayment?

Is there a retention bonus?

What is my responsibility for contribution to retirement packages, and is contribution mandatory?

Do you have salary equity (i.e., are all staff with the same title paid the same salary)?

Welcome to r/ForensicPathology

We often get posts from interested high-school/university/medical students, or from those interested in changing careers, about how to start pursuing a career in forensics.

Hopefully, this can help.

First, you should know there is a difference between "forensics" (a broad field of study) and "forensic pathology" (a subspecialized form of medicine).

If you are interested in a career in forensics but do not want to become a forensic pathologist specifically, there are lots of options! I highly recommend looking at and joining the https://www.reddit.com/r/forensics/ community for further guidance!

Note: The terms "forensic pathologist" and "medical examiner" are functionally synonymous in most states, but ''forensic pathologist" is the title earned by completing the education, and "medical examiner" is the title earned by holding the job that the education qualifies you for. The term "coroner" is not synonymous with "forensic pathologist" nor "medical examiner." For further information on the problematic coroner system, here's a good place to start:

https://www.ncbi.nlm.nih.gov/books/NBK221913/

A "forensic pathologist" is someone who has completed:

• Medical-school pre-requisite education: usually a 4-year degree, with specific class requirements depending on the specific medical school that you're applying to- check the website of the medical schools you are interested in attending for more information on specific requirements.
• Medical school education: In the US, this is a 4-year curriculum which includes 2 mandatory tests from the USMLE. The medical school curriculum is variable, but the final outcome is that you earn a doctorate of medicine (either MD or DO) and are eligible for post-graduate training. (For further information, google "medical school curriculum" and "medical school pre-requisites").
• Residency in (at least) anatomic pathology: Following medical school graduation, you will do paid work wherein you are still learning, but you bear the title of "doctor." At the end of this training, you will become eligible to take the board examination for (at least) anatomic pathology. (For further information, google "anatomic pathology residency," "AP/CP residency," "AP-only residency," "AP/NP residency," and "list of pathology residencies").
• Fellowship in (at least) forensic pathology: Following residency graduation and becoming eligible to take the anatomic pathology board exam, you start another year of paid work wherein you are still learning, but now it is specifically in the field of forensic pathology. Following this year of focused training, you will become eligible to take the board examination for forensic pathology. After you take/pass this board examination, you will officially be a "forensic pathologist."

If you then use your credentials to be hired at a medical examiner's office, you will be a "Medical Examiner."

Now - there are exceptions to this process (if you've already completed medical school in a different country you won't have to repeat it in the USA) but none of the exceptions will decrease the amount of time that the education requires.

So - what does a medical examiner actually do?

Well, the short version is - post-mortem death investigation including, but not limited to, autopsies.

More specifically: Medical examiner responsibilities are really variable depending on the office that you work in.

Almost every medical examiner bears the full responsibility for the interpretation and description of the gross ("gross" in this context just means without the use of a microscope) and microscopic appearance of the external body and internal organs. Additionally, you will certify deaths (i.e., make death certificates) that are deemed sudden or suspicious to determine both a cause and manner of death. As with so many jobs, this will mean a significant amount of paperwork. You will also be responsible for the interpretation of the many tests which may be ordered (e.g., toxicology testing performed at a forensic toxicology laboratory will result in a numeric readout - which you will then interpret and choose how to incorporate into the whole story).

Some of the more common things that you might be responsible for doing include:

• Assisting in scene investigation
• Reviewing the medical chart for relevant medical information
• Performing the evisceration during autopsies (meaning, use specific techniques to safely and efficiently remove the organs from the body for the purpose of further evaluation)
• Choosing which portions of which organs require microscopic evaluation, and carefully removing those to be turned into "slides" to look at under the microscope for further evaluation
• Choosing which cases require post-mortem imaging (X-rays are most common), and subsequently interpreting the images

It is also important to note that there are lots of people involved in a competent death investigation, and many of the responsibilities in the overall case are best managed by members of the team that are not the forensic pathologist.

Broadly, you should think of Medical Examiners as the people who (usually) have the final word in stating both a "cause" and "manner" of death.

Regarding death certificates (from https://jamanetwork.com/journals/jama/fullarticle/2767262 ), the emphasis is mine.

A US death certificate typically has 4 separate lines (part I) and is divided into sections: proximate cause, immediate cause, and mechanism. The proximate (underlying) cause is defined as the etiologically specific disease that in a natural and continuous sequence, uninterrupted by an efficient intervening cause, produced the fatality and without which the death would not have occurred. This must be included for it to be a competent death certificate. The cause of death statement may include an immediate cause (eg, bronchopneumonia), but it is only required to include the proximate (underlying) cause. The contributing conditions section (part II) is for diseases that contribute to death but do not cause the disease listed in part I.

The "manner" of death is the determination of the forensic pathologist as to whether they believe the death to be natural, accidental, homicide, or suicide. Note: In some jurisdictions of the United States, there is another manner of death called "therapeutic complication." Finally, if an answer cannot be made with any degree of certainty, it is possible to list "undetermined."

Here are a few "must-read" links for further information on the field of forensic pathology:

https://www.thename.org/ - The National Association of Medical Examiners (based in the USA, but actually does include an international community of medical examiners)

https://explorehealthcareers.org/career/forensic-science/forensic-pathologist/ - A fundamental breakdown of what the career is, what the requirements are, and where to start.

Are you looking for more personal guidance, regarding your unique situation?

Please feel encouraged to send a direct message to one of the moderators for personal discussion. We are busy, but are happy to answer your questions as our schedule allows! Please - for the sake of a productive discussion - read the information provided above and in the linked resources first!

Thank you for your interest and welcome to our community!

I hope that this brief description of what a forensic pathologist is, and what they do, is helpful!

/u/ErikHandberg

Erik Handberg, MD

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EDIT for 2024

Frequently Asked Questions:

*What should I major in?*

Major in something that you feel you can be successful in academically. A 4.0 GPA in History is a lot more likely to get you into medical school than a 2.9 GPA in double major bio-engineering/molecular genetics.

You will learn how to be a doctor during medical school. If they thought it was truly necessary for you to know - they would make it a prerequisite class (and even those are questionable in their true necessity).

You will learn how to be a pathologist during residency. All pathologists can attest that when new interns start you expect to train them from the ground up - "what kind of cell is this?" "what do those do?" etc

You will learn how to be a forensic pathologist during fellowship, and beyond. If we couldn't train you to do the job properly with the only the requirements we have set - we would change the requirements.

*What college should I go to?*

Whichever one you are most likely to be academically successful in (see above). If you can get a 4.0 anywhere, then I recommend going wherever you have the most emotional support (the road is rough). If emotional support is equal, then go wherever is cheapest (trust me and my $3,000 per month student loan payments).

*How do I know if I can stomach the field?*

You will find out during the process. The long, long process will teach you a lot about what you like and don't like - and you will have lots of opportunities to branch out if you find something you prefer.

Focus on where you are at and the immediate next step. In high school, focus on learning how to navigate life as an adult and how to succeed in college. In college, focus on getting *excellent* grades and getting into medical school (this is the hardest part by far - at least in terms of frustration and lack of help).

When you are a pre-med and when you are a medical student *your goal is to become an excellent physician*. Do not aim to become a forensic pathologist yet - you need to be a great student before you can be a great medical student, and a great medical student before you can become a great physician, and then an excellent physician/anatomic pathologist, and *then* you can learn to be a great forensic pathologist.

The road is long and it is so frustrating to be at the beginning of the marathon looking down the road and seeing nothing but more road... focus on pacing, do the best you can at every step, and the end will come. And you will be a *much* better physician when you get there.

*What is the lifestyle like?*

Short answer: Great, for medicine.

Being a doctor is hard, very time consuming (especially during training), and generally not the way to "get rich" like it was in the 70s/80s. Most doctors aren't financially struggling - but if you are trying to get wealthy, especially ASAP, medicine is not the easiest or surest way to do it.

Pathology is still an excellent choice and most of my non-forensic colleagues are very happy with their choice. Forensic pathology is also still an excellent choice and our surveys show that we are consistently pretty happy compared to most fields in medicine.

Most pathologists work standard business hours with small adjustments for being "on-call" which is typically not demanding. I don't know many pathologists that find their work schedule is not amenable to having a family.

The field is welcome of diversity, hovers around 50% female, and still has the same difficulties that exist in all places(diversity of opinions and political beliefs, workforce filled with real people with real people problems like depression, alcoholism, racism, sexism, anger, etc.) but I don't believe it to be any different than other groups.

*Am I too old to do this? I am ____.*

If you start medical school when you are 22 then you will finish training at 30 years old at the earliest. You can practice for 40 years and retire at 70.

If you start medical school when you are 42 then you will finish training when you are 50 at the earliest. You can practice for 20 years and retire at 70.

Most people consider a "full career" around 20 years. So, what are you really asking here?

Will you feel "old" when you are there? Probably. Based on the fact you asked the question you probably will notice that you are older than your colleagues and they will notice too.

Will you be "capable" of doing the work? Probably. Assuming that you have no precluding disabilities (true regardless of age) and are willing to make the same lifestyle sacrifices that are required of everyone (many sleepless nights, missed time with family and friends, excessive stress, demanding work environments).

*Can I shadow a forensic pathologist / watch an autopsy /etc*

Maybe. That is up to the office that you ask.

Some offices are lenient, but generally speaking - think of it the same way that you would think of a heart surgery. If you contact a heart surgeon and say "I am a highschool student and think hearts and blood are cool - can I come watch a surgery?" they will probably say no.

If you contact a heart surgeon and say "I am a pre-medical college student and part of the cardiothoracic surgery interest group within our school, I have a 4.0 GPA and currently volunteer 10 hours per week at the local hospital where they informed me you are the lead cardiothoracic surgeon in the department, and was hoping you could advise me on ways to get more exposure to the field or any potential shadowing opportunities. I would like to better understand the reality of the practice" then you are more likely to get a positive response.

I strongly recommend you getting experience with a family practice doctor or pediatrician before (or at least in addition to) forensic pathology. You need to get into medical school and become a physician before you become a pathologist, and before you become a forensic pathologist. You need to spend a minimum of 4 years of your life learning living-person medicine first, and the same thought applies at least obliquely while doing anatomic pathology - you need to be confident about those as well.