how much money to do forensic path?

[mlw03]

For a few years I've wondered if more path residents would consider careers in forensic pathology if the pay were better. I can't really prove or refute this, but anecdotally from discussions, the poor pay in the US seems to be part of the woeful recruiting into forensic path. Recognizing the lack of scientific validity here, I'm just curious what this cross-sampling will say to the poll question. Please feel free to add additional comments as well of course.

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[bps]

It's all about the money. I know many people who would do it if they would make the same as surgical pathologists. I understand them-you are having the same training as your friends in hospitals and getting paid 50%...

 

[TX515]

For me it is not all about the money, rather, it is about job location and personal satisfaction. Digging in someone's head removing shotgun pellets doesn't give me the satisfaction. I don't think I could do it starting at 300k, maybe a year or two at the most.

 

[bps]

Sure, it's not for everybody... But we wouldn't have a shortage of FP if salary is $300K

 

[BrainPathology]

Way too much politics in Forensics for me.. there is nearly too much in private practice as it is. Also way too much dealing with police and detectives which, in my short experience on that service as a resident, have 0 interest in the truth and 100% interest in you proving whatever story they've come to you with before you've so much as seen the body so they don't have to actually do any work finding out who actually committed crimes. Give me 1 million a year for that and I'd still turn it down.

 

[mlw03]

Sure, it's not for everybody... But we wouldn't have a shortage of FP if salary is $300K

Well, that is what the salary is in much of Canada, and there's still a shortage (though probably not as bad as in the US).

Way too much politics in Forensics for me.. there is nearly too much in private practice as it is. Also way too much dealing with police and detectives which, in my short experience on that service as a resident, have 0 interest in the truth and 100% interest in you proving whatever story they've come to you with before you've so much as seen the body so they don't have to actually do any work finding out who actually committed crimes. Give me 1 million a year for that and I'd still turn it down.

I'd have to disagree with that in my experience in a few places. Police I have dealt with genuinely listen to what we have to say and I've never felt pressured to call a case a certain way. And FPs never answer the who part of the crime anyway. There is politics because coroners are often elected, and MEs are appointed... different kind of politics and not a fun part of the job, that I'll agree with.

Given this person's reply, perhaps I should add an option for this position.

 

[Euchromatin]

I wouldn't consider a career in forensics even if the compensation was twice what surgical pathologists were making. I did enjoy my forensics rotation a lot more than I expected I would and I find it interesting, but there are just too many things about it that I dislike. I feel fairly sure that I would get burned out from the physical work of autopsies, I find cases that involve any sort of torture/abuse very disturbing and I agree with previous sentiments about the unfortunate political aspects (i.e. being hired by/working under elected coroners in some jurisdictions, pressures from law enforcement, etc.).

 

[dr4n6]

As a long time boarded forensic pathologist but one that only infrequently does forensics, I think that money is only part of the equation. Yes, the salaries in the U.S. are far below average. I think that there are currently a couple of adverts posted on the forensic websites looking for board certified FP's that only barely crack the 6 figure level, but as was mentioned above there are other off putting aspects of the field that serve as a significant deterrent to residents. I know that I certainly got tired of being at the mercy of poorly trained law enforcement officials, my fellow hospital based pathologists that were too lazy to do their own autopsies and publicly elected coroners irrespective of the salaries involved. I don't think that if the salaries were suddenly on par with what hospital based pathologists make that there would be a huge influx into forensics-either you like it or you don't and the money is often secondary.

 

[BrainPathology]

Well, that is what the salary is in much of Canada, and there's still a shortage (though probably not as bad as in the US).



I'd have to disagree with that in my experience in a few places. Police I have dealt with genuinely listen to what we have to say and I've never felt pressured to call a case a certain way. And FPs never answer the who part of the crime anyway. There is politics because coroners are often elected, and MEs are appointed... different kind of politics and not a fun part of the job, that I'll agree with.

Given this person's reply, perhaps I should add an option for this position.

To me dealing with one or two of these is way too much.. it would ruin too much of my time. The way I wrote it may have implied that's ALL I dealt with but that wasn't the case. The couple that I did however, turned me off to dealing with that aspect at all, ever.

 

[mlw03]

To me dealing with one or two of these is way too much.. it would ruin too much of my time. The way I wrote it may have implied that's ALL I dealt with but that wasn't the case. The couple that I did however, turned me off to dealing with that aspect at all, ever.

Yep, I totally get and respect that some folks don't like that aspect to the job. I'm not looking for this thread to be a "I love FP" or "I hate FP" kinda thing, rather I want to see if it's the crap salaries that are the primary deterrent to path residents, or is it an intrinsic dislike of the specialty for most of them. Knowing this info will help the field deal with the oncoming worsening of the labour shortage.

As to the comment about some jobs barely cracking 100K... yeah, that makes me sick too. I have no idea how (if?) those positions are filled.

 

[bps]

Interesting... All this surprises me! I was sure that people don't go to FP because of money. Guess I was wrong. It is physically hard doing authopsies, but how often are you on service? And how long does it take you to do an autopsy? From what I saw on my rotation, they are done with work at 2pm (somethimes at noon)!!!!!! And they come to work at 9am I can deal with anything if I work this much!!!

 

[LADoc00]

The field of FP is interesting but the career side is HORRIBLE.

Often you end up not much more than a minion to a power crazed sheriff and when things go wrong for him, you will be the first warm body under the bus.

Even if the salary was sky high, I think it wouldnt attract a ton of people until we have a standardized autonomous branch of FP within law enforcement that is NOT controlled by either elections or a local sheriff.

 

[mlw03]

The field of FP is interesting but the career side is HORRIBLE.

Often you end up not much more than a minion to a power crazed sheriff and when things go wrong for him, you will be the first warm body under the bus.

Even if the salary was sky high, I think it wouldnt attract a ton of people until we have a standardized autonomous branch of FP within law enforcement that is NOT controlled by either elections or a local sheriff.

LA - I believe you're in Cali, which is its own world in FP with most of the smaller locales using sheriff-coroners. A standardized autonomous branch of FP within law enforcement that is not controlled by elections or a sheriff does exit, at least outside of California. We call it a medical examiner system, and I do generally favor ME systems over coroner systems. I do think the administrative structure is something candidates consider when choosing jobs.

 

[gbwillner]

I hear the career side is bad in part because of really bad burn-out. AP folks work into their 70's, but FPs go into suicidal depression and quit after 10-20 years.

I think FP can be fun and autopsy can be fun. It is the gestalt of all of medicine and solving a puzzle (sometimes). It seems you also have a lot more free time in your day because you only have work (ok, excluding all the paperwork) when people die.

I think FP reimburses well for the amount of work you actually do (as assessed by my talking to FPs). but it just isn't for everybody. Would more people do FP if it paid 250K starting? Yes, of course they would.

 

[BlondeDocteur]

I would do FP in a heartbeat if I could make it part of my practice, and restrict it to pediatric cases. As an outsider I am very surprised to be honest that the distinct field of pediatric forensics doesn't exist, given that the causes of natural death in children are so different from adults, that pediatric traumatic deaths or murders are so sensational with a lot of press coverage, emotionally-charged trials, high stakes outcomes etc that you'd think the liability and the trial lawyers would want specialists, etc.

I really like FP and enjoy the medicolegal side of things- I'd like going to court, I'd like being on the stand, and I liked interfacing with law enforcement (during my FP rotation as a surgery resident). But I also really like the fancy schmancy cutting-edge research-driven side of pathology. I love the diagnostic puzzles, the complex cases, the new genetics techniques coming on-line and all that. So if I could be a sort of part-time FP while still being an academic pediatric pathologist, I'd love it.

I know some people have consulting arrangements where difficult cases are sent from the coroner's/ ME's office for outside expert opinion. There is a cardiac pathologist here at UCLA who routinely consults on possible cardiac death cases (adults primarily). I would like to do that sort of thing, but again if an actual part-time pediatric forensic path position were actually possible I would love it.

 

[dr4n6]

With respect to the issues raised about how much time FP's spend at the office or how much work we actually do perform, I can state that yes there were many days when I was working at a pure FP position where I would be done and out the door by the early afternoon. Overall, I would say that if I compared the total number of hours I spent working at an exclusively FP position if you included all the time spent on call, going to scenes ( which was always in the middle of the nite) and court time was probably about equivalent to the amount of time I spent working at a pure surgical path practice. And as mentioned, forensics is physically demanding work, so if you consider the pay scale on an hourly rate compared to a pure surgical path position forensics really is underpaid.

MLW-I have no doubt that the low paying positions are initially filled by unqualified individuals and certainly one can see that these low paying positions perpetually re advertise themselves with some regularity when the candidate that took the job either is fired for not passing boards or moves along.

 

[deleted314957]

Back in the 80's I was hired by a large P.P. group to help a partner in a solo community hospital practice who thought he was "overworked". As it happened, the local M.E.
(in a medical examiner system) needed an associate. That made it attractive to hire me. The M.E. cases were done in the hospital across the street from my prospective P.P. location. I had forensic boards but was very much into general hospital community-type pathology. The chief ME (independent contractor position, i,e 1099 position) and I split the work. NO weekends, even for homicides. My position was also independ contractor. One week I would have M-W-F and the next, Tu-Th. Some days I had no autopsies, some I had 3. We had a diener who essentially did the dissection on anything that had little medicolegal significance. Of course homicides and anything else that was "nasty" had very personal attention. This paid $90k/yr to me to start. (of course my employer PP group got the check. That was part of why they hired me.). In today's dollars this was about $180k/yr for a fairly small commitment of time away from the hospital practice. My biggest problem was the lawyer/subpoena/trial crap which had NO consideration for my time. The cops were no problem. I was able to charge for my expert witness/testimony time. To this day, I still get very old cases.. My time is $500/hr with a 2 hr minimum and then $350/hr. This includes case preparation and travel (in my case this is automobile and about an hour each way) and WAITING.

 

[Eostar]

FP salaries are not the problem. The problem is that despite the fact that FP is theoretically interesting, in practice it is a morose disgusting nightmare. Also most people who go to the trouble to get an MD want to actually practice medicine. FP is not the practice of medicine in any conventional sense. It has been suggested in the past that FP should not require an MD and I tend to agree with that. This is a skill that could be learned in a technical training program.

 

[LADoc00]

FP salaries are not the problem. The problem is that despite the fact that FP is theoretically interesting, in practice it is a morose disgusting nightmare. Also most people who go to the trouble to get an MD want to actually practice medicine. FP is not the practice of medicine in any conventional sense. It has been suggested in the past that FP should not require an MD and I tend to agree with that. This is a skill that could be learned in a technical training program.

This. I agree although I do find the field interesting, I dont really consider it a physician's job per se. Hence why I think the pay is so low.

 

[bps]

FP salaries are not the problem. The problem is that despite the fact that FP is theoretically interesting, in practice it is a morose disgusting nightmare. Also most people who go to the trouble to get an MD want to actually practice medicine. FP is not the practice of medicine in any conventional sense. It has been suggested in the past that FP should not require an MD and I tend to agree with that. This is a skill that could be learned in a technical training program.

Not possible. How can anyone else than MD recognize hypertrophic cardiomyopathy or MI? Or subdural hematoma...? Or 1000 other things? You don't need Pathology residency for this, but you need medical school!

 

[coroner]

It's easier for one to support not going into forensics because of actual drawbacks that do exist than to rationalize going into it for sky-high salaries because these do not exist. Virtually, that is...not counting Cyril Wecht. Most people already know of the challenges associated with the field i.e. bureaucracy, physically demanding work compared to sitting at a scope all day, lack of recognition as a physician, etc. that comes with the territory. So the naysayers claim, "You couldn't pay me enough to do that", but they've never seen a pay stub of an FP pulling down what an interventional cardiologist does. If that were the case, I'd be willing to bet a few would be coming out of the woodwork. There's a price for just about anything...

 

[LADoc00]

So the naysayers claim, "You couldn't pay me enough to do that", but they've never seen a pay stub of an FP pulling down what an interventional cardiologist does. If that were the case, I'd be willing to bet a few would be coming out of the woodwork. There's a price for just about anything...

Sure Ill buy that. You can go on the internet and see otherwise beautiful young ladies do all sorts of absolutely degenerate crap for money to support your point.

And your point is? I dont think there is will be any pay raise in the works for FP across the board now or for the next decade so in the end I dont see a point of this thread.

For example, if all the FPs in the US just quit or died tomorrow, I dont think law enforcement would shed one tear and would probably just begin filling the positions with "physician extender" type manning which would probably the take the form of some sorry deputy who managed to scrap through Biology I with a C- at the local community college.

Im not saying this right, in fact Im downright ashamed to be in a nation where this attitude prevails, but that doesnt stop it from being reality.

 

[dr4n6]

I think LA Doc makes a great point with respect to the level of competency demanded by law enforcement of their FP's. In many offices around this country FP positions are filled by non-boarded and minimally qualified individuals and that seems to be satisfactory-until a high profile homicide is mishandled. Zero chance that a private practice group is going to hire a non-boarded pathologist to sign out unless that person is straight out of training and gets board certified shortly after employment.
I genuinely doubt that the level of compensation has little to do with the motivation to enter forensics-either you enjoy it or you do not and for many of us that do enjoy it the money is somewhat of a secondary issue.

 

[Ziehl-Neelsen]

It would take a serious amount of money (greater than 1 million per year so I could work for a short stretch and live off investments) or a scenario where FP was the only way to provide for my family.

I certainly respect and appreciate the bright FP staff I worked with during residency (though I felt there was a higher proportion of "dim bulbs" in FP than in most other subspecialties), but one of the things I like most about pathology is the diversity of practice--the ability to think about materno-fetal pathology, cutaneous pathology, immunology, pulmonary pathology, and hematology in a single day. I think the general pathologist gets to ruminate on the varied vastness of human medicine moreso than any other physician (partly because the public has little conception of what we do and does not demand subspecialization like they do in the clinical specialties), and I treasure that.

I enjoy the occasional medical autopsy (1 per quarter would be ideal) precisely as a vehicle to employ all the knowledge that a general pathologist has accumulated in the search for the cause of death. One of the things I dislike about FP is the gradual atrophy of all that varied knowledge about human medicine that the general pathologist practices: transfusion immunology, the molecular underpinnings of cancer, how the blood reflects the general state of the body, etc. And though practices differ, where I trained at a massive statewide ME system, the pathologists were so crushed with work that they did not submit cassettes on the majority of cases--everything went into the stock jar. One FP even told me that he looked at slides maybe 2 or 3 days a month. I couldn't deal with the gradual atrophy of a skill I've spent 10 years developing.

Finally, I actually think the lifestyle of an FP is pretty demanding for a "government job". Weekends--you cut. Holidays--you cut. Planned a week of vacation but the locums guy fell through--you cut.

 

[LADoc00]

I would consider FP..consider mind you...for a salary of 800,000 per year, 8 weeks of vacation/sick leave and a bare minimum "3.00% per year vested in 5 years" pension program. That 800K would have to have some sort of COLA formula too. I dont want inflation touching that 800.

Of course the reality is like 1/8 that.

 

[bps]

In Europe, FP are also working with patients- assessing the injuries (accidents, violence, work related)...
Why that is not practice in U.S.? Maybe that would help increasing the salaries.

 

[BlondeDocteur]

Emergency Medicine is developing a subspecialty called "Clinical Forensic Medicine," doing exactly that. I think FPs are way, way, way too removed from the day-to-day work of assessing injuries and treating patients to be of any use there, even though there is obviously a great deal of overlap in the knowledge base. Here is a random example:

https://www.drexelmed.edu/Home/Abou...cine/DivisionofForensicEmergencyMedicine.aspx

http://keck.usc.edu/en/Education/Ac...Division/Fellowships/Forensic_Fellowship.aspx

[side note: tattoo removal?!]

 

[jace's mom]

For the record, as a future forensic pathologist, I have absolutely no desire to treat living patients.

 

[bps]

No, you would just be a consultant. Just saying if something is an injury from knife. Or this was a rape...
You don't treat anything.

 

[jace's mom]

Okay, I see what you're saying. Hmm. Not sure what I think. I know FPs tend to be busy enough as it is; this might add to an already impossible schedule. Still, it sounds interesting, and there might be some who would like to do it.

 

[mlw03]

Every now and then FPs in North America will be asked to assess or discuss injuries in living patients, either in a clinical setting, or in court. It's not common, but it happens, and is generally optional. For example, an office may get a call from a prosecutor, asking for someone to discuss particular injuries sustained by an assault victim (who survived).