Fewer than 60 forensic pathology trainees complete board certification each year in the US, despite a nationwide shortage and growing public health demands, according to a recent review.
Forensic pathology is one component of the broader forensic sciences field, which also includes anthropology, criminalistics, and toxicology. According to a recent review published in The New England Journal of Medicine, forensic pathologists contribute to public health, the justice system, and communication with families. Although frequently associated with criminal investigations, the specialty also addresses deaths caused by infectious disease, natural disasters, and mass fatality events. While the review discusses principles applicable globally, it focuses on the practice of forensic pathology in the US.
In the US, medicolegal death investigation is carried out by medical examiners – physicians board-certified in forensic pathology – and coroners, who may be elected or appointed officials without formal medical training. As of 2022, approximately 750 of the 2,071 coroner and medical examiner offices nationwide were staffed by board-certified forensic pathologists. Each year, an estimated 30 to 60 pathologists complete forensic pathology training, contributing to a workforce shortage. Contributing factors include reduced exposure to autopsy during medical education, the rescission of Medicare requirements related to autopsy services, and relatively low compensation in government-based offices. Although no longer routine in most hospitals, autopsy remains a key method for postmortem diagnosis and diagnostic quality assurance.
Forensic pathologists are responsible for determining the cause and manner of death. This process involves comprehensive investigation and the application of standardized medicolegal terminology. Accurate death certification data are used to monitor trends in both natural and unnatural deaths and inform the distribution of public health resources. In some cases, external examination, medical record review, or toxicologic analysis may be sufficient, depending on local statutes and investigative findings.
The specialty is also involved in responses to public health emergencies. During the COVID-19 pandemic, some jurisdictions – such as New York City – expanded mortuary operations while contributing to disease surveillance. In the opioid epidemic, medical examiners have documented emerging toxicologic trends and supported multidisciplinary efforts, including those of the Drug Intelligence and Intervention Group. Forensic pathologists also engage with families in the aftermath of unexplained deaths and support research through postmortem tissue donation in settings where clinical investigation is not feasible.
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