Where Have All The Forensic Pathologists Gone?

Television crime dramas may draw big audiences, but they don’t seem to work as a recruiting tool for forensic pathologists.

A draft report by a Justice Department Scientific Working Group for Medicolegal Death Investigation, which is open for comment through Aug. 22, spotlights the nation’s shortage of these highly trained professionals who perform autopsies to determine the cause of death, whether from disease or foul play.

The dwindling numbers have implications for the health care system not necessarily explored on CBS’ CSI: Crime Scene Investigation or on the re-runs of Quincy.

For instance, according to Dr. Randy Hanzlick, the vice chairman of the scientific working group that prepared the report, areas lacking a board-certified pathologist will be ill-equipped to look for unexpected diseases and other risks to public health.

“If you have lay people filling out the death certificate, they may not be as good as they could be,” said Hanzlick, who is the chief medical examiner in Fulton County, Ga.  “[Jurisdictions] may have to hire on a part-time basis, and may not be able to get an autopsy.”

The national autopsy rate is down to a “miserably low” 8.5 percent, with only 4.3 percent of disease-caused deaths undergoing autopsy, the report says.

“This is an extreme example, but if someone is driving down highway and gets killed, without the proper training someone might miss the fact they’ve been shot,” said Hanzlick.  “If we take it for granted, we are not going to find the unexpected case.”

The report identifies a number of causes for the current low rate of autopsy, from limited medical school training programs to low pay.

The shortage of forensic pathologists hampers effective assessment of health care quality and detection of medical errors.  An autopsy can show whether medical procedures were performed properly.

“A general autopsy itself is a very valuable tool in medicine,” said Dr. Stephen Cina, chairman of the College of American Pathologists Forensic Pathology Committee. “Medical autopsy can assess therapy if someone dies of a disease.  What better way to determine skill than with an autopsy?”

Medical autopsies also contribute to medical research and to understanding the progression of diseases. In addition, they can alert families to potential risks, Cina said. “Let’s say someone dies of a car crash, but we notice breast cancer during the autopsy.  We can tell the family that they have now have a history of breast cancer in the family.”