Forensic Pathology

[Togepi]

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I am an M1 looking into what I want to specialize as. Forensic pathology interests me greatly, but I am finding it hard to get information with regards to the field's current state. What are the requirements, how competitive is the field, and how is the job market faring?

 

[Future.miss.doctor]

I am an M1 looking into what I want to specialize as. Forensic pathology interests me greatly, but I am finding it hard to get information with regards to the field's current state. What are the requirements, how competitive is the field, and how is the job market faring?

I'm in a similar status. From what I heard, pathology is not competitive, and forensic pathology as a fellowship is even less competitive. Cant complain 😎

 

[coroner]

https://forums.studentdoctor.net/The undisputed, most in demand field in Pathology.

 

[Autopsy101]

Consider a student membership in the National Association of Medical Examiners or American Academy of Forensic Sciences ...
THENAME.ORG
American Academy of Forensic Sciences | A professional society dedicated to the application of science to the law

 

[HmanPath]

Overall the fellowships are not that competitive but, the "better" programs can be. There are plenty of smaller programs with one fellow per year that seem like would provide solid training as well. Make sure you really want to go into FP, it is not for everyone.

 

[Togepi]

How do you all suggest I find out if it's the right field for me?

 

[HmanPath]

I am not saying FP would not be a good fit, but try to keep an open mind as a med student. Try to get experiences in a lot of different fields. I know trial and error is not a fun process, but hopefully it will land you in a field that you enjoy.

 

[icpshootyz]

How do you all suggest I find out if it's the right field for me?

You'll need to spend time at an actual ME office to know. I personally thought all I wanted to do was forensics. It's the only reason I went to med school. During med school I did a post-sophomore year at the pushing of an adviser (not necessary, by the way), and during that year I did a full month at the ME office. It completely turned me off of forensics. But, I fell in love with dermpath. So either way I did pathology, just now I'm a dermatopathologist and not a forensic pathologist. But really you need to see what being an ME actually entails, and that means spending a significant amount of time at the ME office, on the order of weeks or a month. Unfortunately in med school that may be difficult. Maybe over the summer between first and second year, or before med school even starts. Otherwise you have to wait for fourth year rotations which are close to when you need to make real decisions about your future.

 

[Autopsy101]

Depending on your location, some ME offices do cases on Sat. and Sun. I did a lot of shadowing on weekends which was great because many of the more interesting cases come in at that time.

 

[pre med 2014]

You'll need to spend time at an actual ME office to know. I personally thought all I wanted to do was forensics. It's the only reason I went to med school. During med school I did a post-sophomore year at the pushing of an adviser (not necessary, by the way), and during that year I did a full month at the ME office. It completely turned me off of forensics. But, I fell in love with dermpath. So either way I did pathology, just now I'm a dermatopathologist and not a forensic pathologist. But really you need to see what being an ME actually entails, and that means spending a significant amount of time at the ME office, on the order of weeks or a month. Unfortunately in med school that may be difficult. Maybe over the summer between first and second year, or before med school even starts. Otherwise you have to wait for fourth year rotations which are close to when you need to make real decisions about your future.

out of curiosity, can you elaborate what part about forensics turned you away that it took a whole month? I'd imagine for most people being at 1 or 2 autopsies is enough to know if they can or can not handle it for a career... did a decomposition finally come in?

 

[icpshootyz]

out of curiosity, can you elaborate what part about forensics turned you away that it took a whole month? I'd imagine for most people being at 1 or 2 autopsies is enough to know if they can or can not handle it for a career... did a decomposition finally come in?

Had nothing to do with the smells or the actual autopsies, I still did Path which required plenty of autopsies. And I signed up for a month rotation, it wasn't like I got to quit when I decided I'd had enough. It just seemed so un-medical. More like a police job that required some medical knowledge than an actual medical field. The MEs went in each day, hacked and slashed as fast as possible through a bunch of autopsies, then went off and had to fill out paperwork or spend time dealing with depositions or court. Most of the autopsies were fairly meaningless - homeless found down, car/motorcycle accidents, etc. Rare homicides, and even those you basically just had to document the path of the bullet or knife. It didn't stimulate me at all like I thought it would. Wasn't for me. But, by doing that path year I did find my future career, so in a roundabout way it was worthwhile.

 

[KCShaw]

Pretty much ditto to most of the above in regards to competitiveness & job market. While I would caution that although there is a massive calculated shortage of FP's, that's not the same as saying there are jobs for every single calculated underserved area. The reality is that many underserved areas don't really care and aren't trying to do anything about it. Having said that, there are still *always* multiple advertised jobs in decent offices all around the country, and salaries have continued to creep up while accreditation is becoming more popular and generally leading to the pursuit of *lower* individual case loads, while other areas of pathology/medicine are taking hits.

I also agree that the best way to figure out if it's for you is to do a substantial rotation in it. While it's not inaccurate to say that most cases are fairly "routine" and at their core not particularly difficult, there are also questions that are harder to answer even in routine cases, and of course there are the difficult ones. Some are unsatisfying in that a good conclusion can't be reached. Some are quite satisfying. The same can be said of most specialties & subspecialties, IMO. It's definitely a unique niche, and is not for everyone.

As for requirements, you have to at least do "anatomic pathology" which is a minimum of 3 years of residency. Most people still do 4 years in order to get combined anatomic & clinical pathology; there are a few reasons for that, including pressure from residency programs (most want you to stay 4 years, as it helps them with their service obligations), hedging bets on the possibility you won't end up doing FP in which case having CP is generally believed to be considered a bonus by employers, etc., then of course the 1 year FP fellowship. Every reputable job requires getting at least initial certification in FP by the American Board of Pathology (almost all state "within 2 years of hire", on the assumption that you can start the job as a newly finished fellow, but still have to go on and pass the FP exam). A very few are dropping the requirement that you do the 10 year recertification through ABP, so long as you maintain something like from NBPAS, but that does not have wide acceptance at this point (yet?).

 

[Future.miss.doctor]

if you don't mind me asking, in what type of location did you do this rotation? Was it in a big city? Suburban? High/low poverty? Because I would imagine there would be a greater variation than what you described in the bigger ME offices, but I'm just speculating. I shadowed a FP in a small city in Canada and on a single day there was a burn victim, drowning, suicide, OD, and a decomposed body, mind you this was after a long weekend and the cases had piled up.

Had nothing to do with the smells or the actual autopsies, I still did Path which required plenty of autopsies. And I signed up for a month rotation, it wasn't like I got to quit when I decided I'd had enough. It just seemed so un-medical. More like a police job that required some medical knowledge than an actual medical field. The MEs went in each day, hacked and slashed as fast as possible through a bunch of autopsies, then went off and had to fill out paperwork or spend time dealing with depositions or court. Most of the autopsies were fairly meaningless - homeless found down, car/motorcycle accidents, etc. Rare homicides, and even those you basically just had to document the path of the bullet or knife. It didn't stimulate me at all like I thought it would. Wasn't for me. But, by doing that path year I did find my future career, so in a roundabout way it was worthwhile.

 

[icpshootyz]

if you don't mind me asking, in what type of location did you do this rotation? Was it in a big city? Suburban? High/low poverty? Because I would imagine there would be a greater variation than what you described in the bigger ME offices, but I'm just speculating. I shadowed a FP in a small city in Canada and on a single day there was a burn victim, drowning, suicide, OD, and a decomposed body, mind you this was after a long weekend and the cases had piled up.

Boston. Not saying I didn't see some interesting stuff, I just didn't find it nearly as engaging as I thought I would. And it got incredibly repetitive by the end of the month. I prefer everything about surg path and dermpath to forensics. But obviously to each his/her own.

 

[pre med 2014]

Had nothing to do with the smells or the actual autopsies, I still did Path which required plenty of autopsies. And I signed up for a month rotation, it wasn't like I got to quit when I decided I'd had enough. It just seemed so un-medical. More like a police job that required some medical knowledge than an actual medical field. The MEs went in each day, hacked and slashed as fast as possible through a bunch of autopsies, then went off and had to fill out paperwork or spend time dealing with depositions or court. Most of the autopsies were fairly meaningless - homeless found down, car/motorcycle accidents, etc. Rare homicides, and even those you basically just had to document the path of the bullet or knife. It didn't stimulate me at all like I thought it would. Wasn't for me. But, by doing that path year I did find my future career, so in a roundabout way it was worthwhile.

What do you mean homeless found down? I hope you don't mean to imply that an autopsy on the homeless is meaningless! This kinda statement devalues a human worth and deprives them of dignity. Surely if a college student was found dead on campus or it was one of your relatives you would not say the autopsy is meaningless. Now I actually think I know what you mean and not accusing you of suggesting we can assume what killed a homeless man is --blank-- I think you mean to say some autopsies are mundane or meaningless because the cause of death seems so obvious. This thought process is what allowed a serial killer nurse murder about 30 ICU patients with arsenic poison via IV. Everyone kept assuming the patients died because of what they were there for in the ICU. It wasn't until about the 30th patient that died under this particular nurses care in a relatively short period of time that someone became suspicious and a proper autopsy was conducted only do detect arsenic poisoning as cause of death in that patient. The guy then admitted to killing 30 others, exhumation of the bodies was carried out and sure enough arsenic was in all the bodies!

Regardless, all areas of medicine have mundane aspects. Would you rather do peds to see 5 kids a day coming into the ED for a $500 visit for the sniffles and a tylenol cause the parents worry too much?

 

[KCShaw]

There are a lot of people who find the concept of forensic path interesting, cool, and all that -- but not the reality. When I was on the interview trail for pathology, there was *always* at least one other person voicing interest in FP there on my interview day. Now, maybe they scheduled us that way on purpose, I don't know. But certainly some who start out with an interest in FP don't end up going for a fellowship in it, and end up doing something else. Some of them watch their loans balloon on them and just realize the money ain't there compared to a lot of other options, some decide it's not as "cool" as they thought it would be, some fall in love with something else, some are affected by the holier-than-thou attitude against it by a significant percentage of attendings, etc. The first and the last points I think would largely be resolved by a significant salary bump across the board, and while that's slow going and there is a way to go, my impression is it's shown more upward motion than other subspecialties, FWIW.

This is not anything unique, particularly in medicine. We "gain" some in FP this way too -- some fall in love with it who didn't think they would, or find it more interesting/compelling/whatever than other things they were considering. Heck some may even decide it's financially better than what they thought was their dream career in academics, or whatever. That's just the way of things.

 

[icpshootyz]

What do you mean homeless found down? I hope you don't mean to imply that an autopsy on the homeless is meaningless! This kinda statement devalues a human worth and deprives them of dignity. Surely if a college student was found dead on campus or it was one of your relatives you would not say the autopsy is meaningless. Now I actually think I know what you mean and not accusing you of suggesting we can assume what killed a homeless man is --blank-- I think you mean to say some autopsies are mundane or meaningless because the cause of death seems so obvious. This thought process is what allowed a serial killer nurse murder about 30 ICU patients with arsenic poison via IV. Everyone kept assuming the patients died because of what they were there for in the ICU. It wasn't until about the 30th patient that died under this particular nurses care in a relatively short period of time that someone became suspicious and a proper autopsy was conducted only do detect arsenic poisoning as cause of death in that patient. The guy then admitted to killing 30 others, exhumation of the bodies was carried out and sure enough arsenic was in all the bodies!

Regardless, all areas of medicine have mundane aspects. Would you rather do peds to see 5 kids a day coming into the ED for a $500 visit for the sniffles and a tylenol cause the parents worry too much?

Yay, a soapbox holier-than-thou rant. You done now? Guess what - I didn't go into Peds. Move along.

 

[jupiterianvibe]

What do you mean homeless found down? I hope you don't mean to imply that an autopsy on the homeless is meaningless! This kinda statement devalues a human worth and deprives them of dignity. Surely if a college student was found dead on campus or it was one of your relatives you would not say the autopsy is meaningless. Now I actually think I know what you mean and not accusing you of suggesting we can assume what killed a homeless man is --blank-- I think you mean to say some autopsies are mundane or meaningless because the cause of death seems so obvious. This thought process is what allowed a serial killer nurse murder about 30 ICU patients with arsenic poison via IV. Everyone kept assuming the patients died because of what they were there for in the ICU. It wasn't until about the 30th patient that died under this particular nurses care in a relatively short period of time that someone became suspicious and a proper autopsy was conducted only do detect arsenic poisoning as cause of death in that patient. The guy then admitted to killing 30 others, exhumation of the bodies was carried out and sure enough arsenic was in all the bodies!

Regardless, all areas of medicine have mundane aspects. Would you rather do peds to see 5 kids a day coming into the ED for a $500 visit for the sniffles and a tylenol cause the parents worry too much?

Of all the things to get worked up over, you chose this.
!?

 

[pre med 2014]

Yay, a soapbox holier-than-thou rant. You done now? Guess what - I didn't go into Peds. Move along.

Lol I didn't mean to sound holier than thou, you got me there. Just getting defensive over you saying there is no point to autopsies

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[Future.miss.doctor]

Lol I didn't mean to sound holier than thou, you got me there. Just getting defensive over you saying there is no point to autopsies

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Saying that there is no point to autopsies is not the same as saying some autopsies are too repetitive. The fact that most people dropping dead on the streets tend to have similar causes of death repelled the poster from FP. He/she also said to each their own (some might enjoy doing these routine case, others may not). He/she never stated there is no point to doing these autopsies.

 

[thebouque]

Lol I didn't mean to sound holier than thou, you got me there. Just getting defensive over you saying there is no point to autopsies

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Our dermpath friend never said that there was no point to autopsies, he just pointed out that he didn't find them very stimulating and that FP is not as ''medical'' as the other path subspecialties. A lot of people have an idea of a given field and they are disappointed when they see what the field's actually like. It happens more often in FP because it's more well known to the general public than the rest of pathology, especially with CSI etc. Most of the time, these people like the ''wow'' factor of a forensic autopsy, or think that most cases are a puzzle waiting to be solved. In reality, when the wow factor fades away (pretty quickly) and when you realize that there's as much routing as in any other field (ie: most cases are not puzzles), that's when reality kicks in.

Maybe dermpath doesn't sound as glamorous as doing forensic autopsies, but it's an extremely interesting, intellectual and highly rewarding field.

 

[Future.miss.doctor]

I understand that most cases are not puzzles in FP, but how often would you say a FP encounters a medically stimulating "puzzle"?

 

[thebouque]

I understand that most cases are not puzzles in FP, but how often would you say a FP encounters a medically stimulating "puzzle"?

BDuring my 2 months at a medical examiner office in the heart of one of the biggest Canadian cities that performs 5-10 autopsies daily, I saw none. But beauty is in the eye of the beholder, maybe you would've found something stimulating.

Edit: as a comparison, during my dermpath rotations, I encountered interesting cases daily, (porphyrias, lots of autoimmune bullous diseases, lots of cutaneous lupus, leucocytoclastic vasculitides) in addition to the extremely interesting routine (nevi, bcc, actinic keratoses, and yes melanomas/atypical nevi that can be super challenging to diagnose).

 

[pre med 2014]

I understand that most cases are not puzzles in FP, but how often would you say a FP encounters a medically stimulating "puzzle"?

I realize this question is not directed at me but I find investigating cases for suicide vs foul play are usually a good puzzle but I'm not sure how frequent such cases come up

Btw you should watch the HBO Autopsy episode on Kurt Cobain. Season 6 episode 2 I believe










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[KCShaw]

A percentage of what would be "medically" interesting/difficult cases just don't make it to the ME, and the rest of medicine simply doesn't care, having fled what might be learned from such autopsies, partly out of fear and partly out of resource re-allocation. There is no doubt that some of the middle aged folks with HTN, DM, COPD, etc. who die aren't actually dying from those diseases or primarily from those diseases, but unless there are extenuating circumstances most of those folks aren't going to get an autopsy.

As for some of the other challenges we face, sure, it's almost daily that we have to consider whether a case as presented is what it purports to be. The overlap of medicine with para-medical investigation and law isn't for everyone, and while I personally feel I would get bored being locked into subspecializing in one organ system (which have their own "bread and butter" subset of fairly routine cases), some folks find those particular nuances invigorating. I'm good with that. There are also days when I kinda wish I was much more bored. It can be quite frustrating to get stuck on a case and be unable to do anything further either because X just can't be done with a decedent/postmortem samples, or because resources just aren't there, or whatever the issue may be, and sometimes dealing with families or lawyers isn't fun. On the other hand it's pretty cool to find or figure out something totally unexpected.

 

[pre med 2014]

On the other hand it's pretty cool to find or figure out something totally unexpected.

like finding out Michael Jackson was actually bald

 

[postbacpremed87]

If you know you want to do Forensics should you do the 3 year AP path?

 

[deleted314957]

If you know you want to do Forensics should you do the 3 year AP path?

ONLY if you are 100% CERTAIN that you want to do F.P. with the following caveat:
I think it is highly unlikely that someone who is yet to begin a path residency
can make an INFORMED decision that they want to commit to a career in F.P.
Therefore, I think people, with rare exceptions, are better served doing AP/CP.

 

[KCShaw]

While I think AP/CP has benefits from an educational background point of view and has applications in FP, and when I started in this subspecialty my intention was to eventually champion that notion to the point of making it a requirement for FP, the current system is such that it's difficult to recommend. Med school costs are too high and the reimbursements/salaries too low for the benefit of CP to weigh out. That 1 year now is worth a lot more than it first looks like when you're trying to figure out when you can retire. However, most residency programs will coerce you into doing AP/CP anyway, as they need warm bodies around for the service rotations and training someone new takes time, and they will..not inaccurately..tell you that many employers (outside of FP) want people with AP/CP because they want the option to put you on call for CP. There are jobs that don't require this, tho I'm not sure what the trend has been the last several years, but ultimately it becomes a market issue -- how worth it is it to you to limit your number of job opportunities? This is a point one could drive around in circles for a while, but at the end of the day, assuming one is doing FP, then AP only is fine. But as we've talked about, there are certainly those who start out with interest in FP but end up diverging into something else.. so, I agree it's a decision not to be made lightly.