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NATIONAL COMMISSION

ON FORENSIC SCIENCE

 Increasing the Number, Retention and Quality of 

 Board Certified Forensic Pathologists

Type of Work Product

Policy Recommendation prepared by the Medicolegal Death Investigation Subcommittee.

Recommendation

The National Commission on Forensic Science requests that the Attorney General of the United States 

approve policy recommending that:

 Medical schools and pathology training programs receiving federal funds should be required 

to assist in the recruitment of forensic pathologists by: (1) in the case of medical schools, 

providing exposure to forensic pathology, i.e. a minimum of two hours of instruction, during 

pathology education and offering elective rotations in forensic pathology; and (2) in the case 

of training programs in anatomical pathology, requiring a one month rotation in a medicolegal 

office where forensic autopsies are performed. 

 All municipal, county, state or federal entities which receive federal grant money for their 

police agencies or crime laboratories require that all forensic autopsies performed under their 

authority be performed by a forensic pathologist.

 Loan forgiveness for forensic pathologists in full time practice for ten years since completion 

of their training in forensic pathology, and Forensic pathologist salaries be made competitive 

with other medical specialties

 There be recognition that Forensic pathologists operate as autonomous, and neutral scientists 

separate from law enforcement, and Forensic pathologists be available for prosecuting (or 

plaintiff) and defense attorneys in both criminal and civil law cases arising from their official 

death investigation duties as well as on independent consultations.

Statement of Issue 

Forensic pathology is a pathology subspecialty that is largely practiced on behalf of the 

public. Forensic pathologists support the public health, public safety and criminal justice systems 

as well as provide critical information to the families of decedents and their treating physicians. 

Because there is a shortage of forensic pathologists in the United States, many communities lack 

the valuable information that these physicians provide. Forensic autopsies are being performed by 

individuals not qualified to perform them or autopsies are not being performed when they should 
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be. The shortage involves not only an inability to recruit forensic pathologists but an inability to 

retain these individuals in practice.

Recommended Implementation Strategy 

The implementation strategy includes measures directed at the following:

 Ensuring through policy that medical schools and pathology training programs provide 

adequate exposure of medical trainees to forensic pathology

 Enforcing professional standards which require that medicolegal autopsies be performed 

by forensic pathologists

 Providing federal funding to increase the pool of potential forensic pathology trainees at 

all points of the pipeline and providing federal incentives to improve the salaries and 

compensation of forensic pathologists

 Providing for, through statute or policy, the independence of forensic pathologists and their 

availability to prosecutors (plaintiff) and defense attorneys in both criminal and civil law 

cases 

Background

Medicolegal death investigation offices cannot perform quality investigations, examinations and 

testing without Forensic Pathologists (FPs). In fact, the National Research Council 2009 report 

on Forensic Science (Strengthening Forensic Science in the United States: A Path Forward), 

specifically recommends that “All medicolegal autopsies should be performed or supervised by a 

board certified forensic pathologist” (1). Unfortunately, there is currently an insufficient number 

of Board Certified Forensic Pathologists (BC-FPs) in the United States to meet national needs with 

some areas having limited or no access to forensic pathologists. (2-3) 

The forensic pathologist should be an independent, autonomous, and neutral physician

independent of political, and law enforcement officials. The work of the Forensic Pathologist 

should be performed in a modern, nationally-accredited medicolegal system independent of 

political and law enforcement control. Independence and good work environment will help attract 

and retain forensic pathologists.

Although, no specific workload numbers exist, in 2013, Weinberg et al published a study 

examining the characteristics of medicolegal death investigation offices accredited by the National 

Association of Medical Examiners (4). In their study, they found that in accredited offices, there 

is an average of 3.7 forensic pathologists per 1 million population conducting an average of 222 

autopsies per pathologist which is within the annual case load limits established by the National 
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Association of Medical Examiners (250 autopsies and autopsy equivalents per year per pathologist 

(5). Utilizing the data obtained by Weinberg et al, it can be extrapolated that between 1100 and 

1200 BC-FPs are required nationally to conduct forensic autopsies. These numbers would include 

fellows in training and take into account FPs such as Chief Medical Examiners and others who 

would perform a reduced autopsy load to accommodate other activities such as administration or

research. Unfortunately, instead of 1100 to 1200 practicing FPs in the U.S, there are estimated to 

be only 500 Board Certified forensic pathologists currently practicing forensic pathology fulltime 

with an average age of 52 (2,6).

Between 2007-2013, a total of 290 individuals were trained in FP, an annual average of 41 per 

year (7-8). Hanzlick and Haden-Pinneri conducted a study of 190 individuals who did a forensic 

pathology fellowship during the years 2000-2005 (8). Of these, approximately 67% currently 

practice full time forensic pathology; 21% do not practice at all; 7% practice part time; 3% only 

do forensic pathology consulting; and 2.6 % did not complete the fellowship. Additionally, they 

found that only 67% of those who train in Forensic Pathology go on to obtain board certification, 

and only 78% of those practice forensic pathology full-time (8). Thus, of the 41 individuals 

training in FP each year, approximately 27 will become board certified with only 21 of those 

eventually practicing forensic pathology full time. 

Complicating the workforce demographics is the fact that of the 33% of the Forensic Pathology 

trainees that do NOT obtain Board Certification, 44% still practice forensic pathology full-time 

resulting in practitioners who often lack the competence to meet accepted standards of practice

(8).

Considering an annual creation rate of 21 FPs per year, and given the current work force of 500 

FPs, it would take approximately twenty five years to create enough FPs to serve the current US 

population, assuming no population growth during that time. Compounding this issue is the fact 

that the workforce is also annually decreasing due to attrition from retirement, death, and other 

factors, including job dissatisfaction because of the stressful nature of political, legal and media 

encounters, poor working conditions, the nature of the work and/ or low salaries.(2)

In addition to the issues discussed above, the National Research Council’s 2009 report on Forensic 

Science also recommended research in Forensic Pathology be a priority for both the practitioners 

and the offices that employ them (1). To enable time for such research, the number of forensic 

pathologists needs to be increased.

Needs

Exposure to Forensic Pathology

The forensic pathologist supply problem starts earlier than forensic pathology fellowship programs 

and involves the discipline of pathology as well. Approximately 17,500 medical school students 
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graduate each year (9). Of those, approximately 3% of graduates will train in pathology with 7% 

of pathology trainees then training in FP (9-10). The College of American Pathologists believes

that the current numbers of pathologists in training will not match the nation’s need for hospital 

based pathologists (10). Consequently, there is the potential for increased competition for the 

limited number of pathology residents between hospital based subspecialties and forensic 

pathology. 

There needs to be a coordinated effort to recruit more medical students into the fields of pathology 

and forensic pathology. In order to accomplish this, Forensic Pathology should be introduced in 

the Medical School curriculum within the first two years, as this is a prime time to attract future 

FPs. The curriculum should dedicate a minimum of a 2 hour block of time to a lecture on forensic 

pathology. In addition, autopsy case material should be presented by a FP in association with 

trauma and natural disease clinical course material. In the third and fourth year, elective rotations 

in Forensic Pathology should be offered. Since Medical schools receive extensive federal funding, 

a suggestion as to establishment of a block of time to lecture on forensic pathology as well as the

establishment of elective rotations in Forensic Pathology would likely be honored if proposed in a 

strong manner. 

In addition, individuals engaged in an anatomic pathology residency should be required to 

complete a minimum of 4 weeks of training in Forensic Pathology. The ACGME requires that all 

anatomic pathology training programs provide their residents with exposure to forensic pathology. 

This requirement is not always being met. Anatomic pathology residents should be required to 

spend at least four weeks in a medicolegal death investigation office accredited by the National 

Association of Medical Examiners assisting board certified forensic pathologists in the 

performance of medicolegal autopsies. If there are no such opportunities locally, arrangements 

should be made with a medicolegal office to provide such a rotation. Forensic pathologists not on 

the regular pathology department faculty should be compensated for their mentorship.

Autopsy Performance by Forensic Pathologists

A forensic autopsy performed under the authority of a municipal, county, state or federal agency 

should be performed by a licensed physician, who had been certified in forensic pathology by the 

American Board of Pathology (ABP) following training in forensic pathology or has successfully 

completed a training program in forensic pathology that is accredited by the Accreditation Council 

on Graduate Medical Education (ACGME) or its international equivalent and has been officially 

“qualified for examination” in forensic pathology by the ABP for no more than two years since 

completion of training. A forensic autopsy may also be performed by a physician who is a forensic 

pathologist-in-training (resident/fellow) at an institution designated by the ACGME for training in 

forensic pathology and performs autopsies under the direct supervision of either of the two prior 

cited categories of physicians.
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Funding of Training and Improvement of Forensic Pathologist Compensation

There are currently 36 Forensic Pathology training programs accredited by the Accreditation 

Council on Graduate Medical Education (ACGME) (7,11). A recent survey showed that in 2014,

these 36 programs had a total of 78 ACGME-approved positions only 54 (69%) of which were 

funded, and only 42 of the funded positions were filled (7). While it has been proposed to increase 

the funding and the number of positions available for training, since only 78% of funded programs 

were filled, recruitment must increase prior to increasing the number of positions available. Once 

recruitment into the field has increased, it is recommended that all of the ACGME-approved 

positions be funded. This would be possible by providing incentives for training to local 

jurisdictions as well as offering grant funding. In addition, programs should focus on accepting 

candidates who demonstrate a strong propensity to be successful in the field and whom 

demonstrate a desire to practice full-time FP upon completion of training. 

To retain individuals in the field of forensic pathology, we must make Forensic Pathology salaries 

more competitive with hospital/academic pathology and other medical specialties. A survey by 

the College of American Pathologists revealed that the average compensation of full-time 

pathologists is approximately $335,000 annually when base salary, incentive pay, deferred 

compensation, and other income are considered (10). In comparison, a study by Dr. Kemp recently 

showed that the average salary of a Medical Examiner is just under $185,000 (12). The salary is 

only slightly better for Chief and Deputy Chief Medical Examiners who have average annual 

incomes of approximately $220,000 and $190,000 respectively. 

In addition to the low salaries, the average FP just entering the field also has a great deal of debt 

from their undergraduate and graduate medical education. A recent study commissioned by the 

AAMC found that 86% of medical school graduates report having debt, and, in 2012, the median 

debt of graduating physicians was $170,000 (13).

Considering the lower than average salaries and the medical school indebtedness most young FPs 

have, in order to attract and retain individuals into FP the salaries and benefits must be more 

competitive. This can be done through incentives, grant programs or agreements/ relationships 

with associated medical schools. 

Similar to some clinical medical specialties, some areas of the United States lack access to forensic 

pathology services and may be considered to be “unserved” populations. Incentives to place 

forensic pathologists in such areas should be developed, such as loan forgiveness programs similar 

to the clinical disciplines. Having more options for work locations could attract more people into 

forensic pathology.
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The availability of full time jobs in medicolegal centers with reasonable caseload, salary, and 

benefits with opportunities for research, advancement, and professional interaction with peers 

should facilitate recruitment and retention in the field (14,15). 

Independence and Availability 

The forensic pathologist should be an independent, autonomous, and neutral physician

independent of political, prosecutorial, and law enforcement influences. The work of the Forensic 

Pathologist should be performed in a modern, nationally-accredited medicolegal system.

Independence and good work environment will help attract and retain forensic pathologists. The 

ability to be available to prosecution (plaintiff) and defense in both criminal and civil cases should 

also facilitate recruitment and retention in the field. 

NAME has stated that it is imperative that forensic pathologists, and medical examiners remain 

independent officials, and be available for consultation for both prosecuting and defense attorneys 

outside their governmental employment (16). 
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Appendix

Progression of Medical Students to Forensic Pathologists 2013

https://www.aamc.org/download/350998/data/2013gqallschoolssummaryreport.pdf

Medical students - 18,148

Pathology residency - 300 (1.7%)

Forensic pathology fellowship -41

Board Certified - 27

Full-time Forensic Pathology Practice - 21

Death Retirement Change of 

Career

Non Forensic 

pathology 

practice

Part-time or 

consulting 

practice

Not Board 

Ceritified

Other 

subspeciality

Other 

speciality
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References

1 - Committee on Identifying the Needs of the Forensic Science Community (2009), 

Strengthening Forensic Science in the United States: A Path Forward. National Academies 

Press.

2. – Scientific Working Group on Medicolegal Death Investigation. Increasing the Supply of 

Forensic Pathologists in the United State: A Report and Recommendations. December, 2012. 

Available at: http://www.swgmdi.org/images/si4.fpsupplyreportpublisheddecember2012.pdf

Accessed March 4, 2015. 

3. Scientific Working Group on Medicolegal Death Investigation. Workplace Locations of 

Forensic Pathologists in the United States who Perform Medicolegal Autopsies for medical 

Examiner/Coroner Systems: 2012. December, 2013. Available at: 

http://www.swgmdi.org/images/SI7.PRC13.WorkplaceLocations.Final.%20Published.%2012.12.13.pdf

Accessed March 4, 2015.

4 - Weinberg M, Weedn VW, Weinberg S, Fowler D (2013) Characteristics of Medical 

Examiner/ Coroner Offices Accredited by the National Association of Medical Examiners. 

Journal of Forensic Sciences. 58(5): 1193-9.

5 – NAME Inspection and Accreditation Checklist (2014) National Association of Medical 

Examiners. Available at:

https://netforum.avectra.com/temp/ClientImages/NAME/de7871b6-1a1f-403c-9c23-d6d623e7a4a8.pdf

Accessed march 4, 2015.

6 - Hanzlick R. Work location and effort of forensic pathology fellows who completed training 

in 2012. Acad Forensic Pathol. 2012: 2(3); 290-293.

7 – Hanzlick R (2014) Incoming Forensic Pathology Fellow and Fellowship Program 2014-2015. 

Prepared for Forensic Pathology Subcommittee of National Association of Medical Examiners. 

8 - Hanzlick R. Haden-Pinneri K. Forensic Pathology Fellowship Training Positions and 

Subsequent Forensic Pathology Work Effort of Past Forensic Pathology Fellows. Acad Forensic 

Pathol. 2011. 1(3):322-327

9 - Barzansky B, Etzel SI (2011) Medical Schools in the United States, 2010-2011. JAMA. 

306(9); 1007-1014. 

10 - College of American Pathologists 2011 Practice Characteristics Survey. College of 

American Pathologists. 
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11 – Accreditation Council on Graduate Medical Education. Accredited Programs in Forensic 

Pathology. Available at: 

http://www.acgme.org/ads/Public/Reports/ReportRun?ReportId=1&CurrentYear=2014&Specialt

yId=59&IncludePreAccreditation=false 

Accessed March 4, 2015.

12 – Kemp WL (2014) Forensic Pathologist Salaries in the United States: The Results of Internet 

Data Collection. Academic Forensic Pathology. 4(4): 505-513.

13 - Youngclaus J. and Fresne JA (2013) Physician Education Debt and the Cost to Attend 

Medical School 2012 Update. Association of American Medical Colleges.

14. Scientific Working Group on Medicolegal Death Investigation. Status of and Perceived Need 

for Regional Medicolegal Death Investigation Centers. July 2013. Available at: 

http://www.swgmdi.org/images/si5.prc7.regionalcenterreport.published.7.19.13.pdf

Accessed March 4, 2015. 

15. Scientific Working Group on Medicolegal Death Investigation. Regional Medicolegal 

Autopsy and Death Investigation Centers: Construction, Staffing, and Costs. September 2013. 

Available at: http://www.swgmdi.org/images/si6.facilityconstruction.published.9-17-13.pdf

Accessed March 4, 2015. 

16. National Association of medical Examiners Forensic Autopsy Performance Standards. 

Available at:

https://netforum.avectra.com/temp/ClientImages/NAME/de7871b6-1a1f-403c-9c23-d6d623e7a4a8.pdf

Accessed March 4, 2015.