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Where the heck is all the FP chat???!! It's been too quiet--I'm getting bored.... Heck, I'd even take some bad-mouthing from LA at this point...
🙂
Mindy
🙂
Mindy
Forensic Pathology...
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Sheesh. Im not bad mouthing FP, the service is ABSOLUTELY and UTTERLY essential to a civilized society with a functioning law enforcement arm.
What I have issue with is the hoops you and your associates are forced to jump through to practice your passion. 5 years of postgraduate education to be an employee of the state isnt just absurd, its an insult. There are too many community college educated sheriffs pissing on pathologists and telling them it's raining.
What is happening in FP with the merging of coroner services with sheriff departments is an utter shame, shame on a past history of respectable law enforcement. The running of coroner systems by non-FPs is also a shame. Generals lead armies because they have the skill. Cooks and barbers are not made supreme allied commanders, so why are GED-educated bureaucrats made coroners?? People who couldnt get jobs managing a Rite Aid are somehow qualified to boss around MDs...how did we let this happen?
IMO, all FPs should go on indefinite strike. Let stinking bodies fill America's streets as the morgues overun, let the smell of decaying rotting flesh jar our weakminded bathroom-sex intern-banging sorry excuse for politicians into action.
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For me, FP isn't academic enough to be worth considering. To me Academic Pathology:Forensic Pathology as Academic Internal Medicine:Community Practice Emergency Medicine.
However, I was thinking about one something someone said earlier about how tough it would be get by in SF/LA/NY as an FP. Well, if you were lucky enough to get to be the medical examiner when Lindsey Lohan O.D.s in Beverly Hills or the Olsen Twins die of anorexia in SOHO or Paris Hilton dies in a MVA on Sunset St in Hollywood or be the M.E. of the child Michael Jackson smothers while boffing him, you could be worth millions in a book deal/ film deal. It could make facing the whole coastal cost of living worthwhile.
However, I was thinking about one something someone said earlier about how tough it would be get by in SF/LA/NY as an FP. Well, if you were lucky enough to get to be the medical examiner when Lindsey Lohan O.D.s in Beverly Hills or the Olsen Twins die of anorexia in SOHO or Paris Hilton dies in a MVA on Sunset St in Hollywood or be the M.E. of the child Michael Jackson smothers while boffing him, you could be worth millions in a book deal/ film deal. It could make facing the whole coastal cost of living worthwhile.
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As far as I know, that's more for people who are very well established in the field (and often controversial). Like that guy who Anna Nicole Smith's family hired to do a second (or third) autopsy. But I don't think you can really count on this as a career opportunity.
Some people in every profession make a good living being expert witnesses.
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Okay that is the dumbest reasoning Ive seen yet here. I hope you were kidding.
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True, plus no one would ever by rights from the ME. Your report is a public report, and what are they going to do base a film around the post?
👎
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Well, I guess I asked for it...
1) My autopsy report is not public record. My death certificate is. This does vary by state. Regardless, I have way to much integrity to sell it for any reason, let alone a quick cheap buck.
2) Massachusetts happens to be a medical examiner state. Non-physician coroners are indeed in fashion in other states. Non-physicians are much cheaper than physicians, therefore I think it makes more sense to the government at least to have a coroner in rural, not well-tax-funded areas. LADoc is describing in particular the Californian death investigation system, at least in LA. I have stated before, and will restate, that I couldn't imagine doing my job without full pathology (AP & CP) training. It is a shame that there is not a more homogenized death investigation system in the US. It is under individual state jurisdiction.
3) Regarding academics: There are 1000 projects just screaming my name here at the OCME. My only holdback seems to be time. I am quite busy here so far as a fellow. Just because not many FPs are necessarily interested in academics, does not mean the field is not (potentially) academic. Not to mention the tons of teaching opportunities. What do you mean exactly, not academic enough for you?
Okay, time to go home...
Mindy
1) My autopsy report is not public record. My death certificate is. This does vary by state. Regardless, I have way to much integrity to sell it for any reason, let alone a quick cheap buck.
2) Massachusetts happens to be a medical examiner state. Non-physician coroners are indeed in fashion in other states. Non-physicians are much cheaper than physicians, therefore I think it makes more sense to the government at least to have a coroner in rural, not well-tax-funded areas. LADoc is describing in particular the Californian death investigation system, at least in LA. I have stated before, and will restate, that I couldn't imagine doing my job without full pathology (AP & CP) training. It is a shame that there is not a more homogenized death investigation system in the US. It is under individual state jurisdiction.
3) Regarding academics: There are 1000 projects just screaming my name here at the OCME. My only holdback seems to be time. I am quite busy here so far as a fellow. Just because not many FPs are necessarily interested in academics, does not mean the field is not (potentially) academic. Not to mention the tons of teaching opportunities. What do you mean exactly, not academic enough for you?
Okay, time to go home...
Mindy
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I'm planning on going into forensics eventually. I enjoy medicolegal investigation of death and the responsibility it brings. There is plenty of research invovled in forensic path as well. Also, it has the potential for public health implications which interest me greatly. I've worked with several medical examiners at different offices and I've found them all to be intelligent, humble, and quite amazing teachers. My only hope is that I can emulate these qualities in the future.
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Yeah I am kind of kidding but I bet this book made a lot of extra cash for this guy that an FP in Chicago, Detroit or Orlando could never make.
http://ec1.images-amazon.com/images/G/01/ciu/42/fa/8dcdb220dca0bf22ae2e3010._AA240_.L.jpg
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double post
I am new to the network (as a member at least), although I've browsed many times. Soon I'll have to decide upon a location for my forensic fellowship training, so I am fishing for some seasoned opinions/info.
My question...which programs are considered the 'best' or 'cutting edge'? Specifically, is anyone interested in rating Miami vs. Richmond vs. Albuqurque?
Much obliged.
My question...which programs are considered the 'best' or 'cutting edge'? Specifically, is anyone interested in rating Miami vs. Richmond vs. Albuqurque?
Much obliged.
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Hi:
I have heard they are all good programs, met good pathologists from all of them.
My experience with the recent events in Boston though has taught me that you really have to be finely tuned into local politics and customs. What is great forensic pathology practice in one area of the country does not necessarily translate well to another area of the country. I don't mean that the autopsy changes, but the culture of your locale definitely does. The politics are different, and what you know about one system really may not transfer smoothly to another system. And understanding the political climate is really essential in forensics. And if this thought makes you uncomfortable, or you cringe and say "oh, I hate politics" a lot, don't even consider FP.
The reason I bring this up is that while any reasonable program with good cases and rational pathologists can train a forensic pathologist, it is really important to consider where exactly you want to end up practicing. And make sure that you are trained in a manner compatible with the office you enter, or else you and/or the office may be disappointed.
And one more thought...now that I am settling into the job and starting to know the ropes, I really am finding forensics as fascinating as I hoped. The human condition is marvelous. From the tragic, the touching, the strange, the ironic, and even the occassionally sweet, I don't think there is a better vantage than from the medical examiner's office.
Mindy
I have heard they are all good programs, met good pathologists from all of them.
My experience with the recent events in Boston though has taught me that you really have to be finely tuned into local politics and customs. What is great forensic pathology practice in one area of the country does not necessarily translate well to another area of the country. I don't mean that the autopsy changes, but the culture of your locale definitely does. The politics are different, and what you know about one system really may not transfer smoothly to another system. And understanding the political climate is really essential in forensics. And if this thought makes you uncomfortable, or you cringe and say "oh, I hate politics" a lot, don't even consider FP.
The reason I bring this up is that while any reasonable program with good cases and rational pathologists can train a forensic pathologist, it is really important to consider where exactly you want to end up practicing. And make sure that you are trained in a manner compatible with the office you enter, or else you and/or the office may be disappointed.
And one more thought...now that I am settling into the job and starting to know the ropes, I really am finding forensics as fascinating as I hoped. The human condition is marvelous. From the tragic, the touching, the strange, the ironic, and even the occassionally sweet, I don't think there is a better vantage than from the medical examiner's office.
Mindy
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Funny, just had a meeting with my group yesterday where we had concurrence that "political acumen and communication skills" were no.1 factors when looking for new associates, above training pedigree and even dermpath credentials.
If you have no political skillz, your only hope is to be hired and abused by Quest, Ameripath etc.
If you have no political skillz, your only hope is to be hired and abused by Quest, Ameripath etc.
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Good thing I'm accumulating political skillz then. I even have cell phone numbers for a few academic bigwigs, a couple of whom aren't at this institution! 😉
Unfortunately, I'm still a major nerd.
Unfortunately, I'm still a major nerd.
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LA: what is political acumen in an interview? I can imagine hoping for it in a new associate, but how do you assess it during one day of meeting someone?Communication skills are more easily gleaned....
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good ? actually. I have a partner who has mounds of political acumen and his advice was get references not from other pathologists but surgeons and hospital adminstrators. How did the candidate deal with the VP? The CFO of the Hospital? The CMO? The chief of surgery? etc.
Having connections to other pathologists is NOT political skillz, that is comraderie, which is fine but honestly I dont really care that Phil Leboit buys you a fruit cake every holiday. Does the local congressman or state senator know you by a first name? Ours does. Do have lunch with the CEO of the hospital?
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WOW! LA and I fall (mostly) on the same side of an opinion? Must be our random chance day...
😉
I really have to add in here that politics doesn't just go up. Try getting anything accomplished if your staff do not like you. It is really, in my mind, about being able to function with others--above, below, and on par--in a complicated socioeconomic system.
As my grandma always said: you treat the person who empties your wastebasket with the same respect you treat the person who gives you your paycheck.
Mindy
😉
I really have to add in here that politics doesn't just go up. Try getting anything accomplished if your staff do not like you. It is really, in my mind, about being able to function with others--above, below, and on par--in a complicated socioeconomic system.
As my grandma always said: you treat the person who empties your wastebasket with the same respect you treat the person who gives you your paycheck.
Mindy
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I couldn't agree more. If you're friendly with the ancillary staff, don't abuse them, and treat them with human decency, they can make your life so much easier. Conversely, if you act like an ass, they can make your life hell.
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First, if there's a program you think you might be interested in, I recommend calling them and (if possible) rotating with them. Of course, sometimes it's not that easy. With that in mind, I can comment some on the Miami and Albuquerque programs as someone who interviewed there and researched each.
First, both are considered highly reputable programs. You're not going to walk out of either and not know what you're doing. But, they approach training their fellows differently.
Miami treats its incoming fellows as junior staff; you're basically expected to take a case and handle it entirely yourself for as long as you can. If you run into a problem, there are plenty of very experienced and approachable people to ask questions of, but the expectation is that you do the work and are prepared to defend your conclusions. There is some graduated expectation, but largely you are given a case and trust. Each fellow has their own office. So, a lot of learning is by doing -- with supervision, feedback, and input of course -- but their aim is for you to finish and be able to handle yourself with confidence with zero support the day after you finish fellowship. Because of local law, you have to perform your own evisceration. They have superb in-house photography (digital!), each fellow has access to a high quality digital SLR camera for work, and you attend scenes (there is a vehicle available for this). Autopsy & scene photos are uploaded same-day to the software program used for reporting (apologies, I forget the name of the software package, which is used in several offices), and which they go over as a group at the end of each day. They have neuropathology and cardiac pathology trained medical examiners on staff. They were in the process of digitizing their old records, which are vast. And it bears worth specifically saying that Dr. Lew is one of the nicest people I've ever met, and is a co-author of the relatively recent "Forensic Pathology: Principles and Practice" book primarily accredited to Dr. Dolinak (Dr. Matshes being another author, not counting several additional contributors). The case load is from the Miami-Dade area; this includes not only the expected urban deaths, but also some rural deaths on the outskirts of the county. The salary is well above average, but unless/until you know the area well, so is the cost of living. Some of the facilities are older, but you wouldn't know it, and the office space is very nice.
Albuquerque handles cases from across the entire state, as well as the university hospital next door. Their autopsy technicians are mostly local students (grad, pre-med, etc.), meaning the turnover is high but the energy and interest level is also high -- this is NOT the case in many offices, and both they and I consider it a quirky bonus of the New Mexico program. They submit microscopic sections on every case but the turnaround on slides is on the order of weeks (I can't remember precisely, someone may correct that). They have a neuropathology trained ME on staff, and one whose focus is primarily research. The fellows share a large office. They have regular journal clubs. I can't recall how they handle a lecture series; I seem to remember they meet every week, but I'd have to dig up my files or give them a call for further details. They have numerous resident and student rotators, not least because of their reputation. Dr. Nine is also one of the grooviest ME's around, and enjoys teaching. When I was there they had managed new funding for toxicology, which was improving their previously poor turnaround times; this was something they hoped to make permanent, but I don't know how that panned out. They gave the impression of having an overall extremely well rounded program, with good facilities.
Richmond I don't know as much about, merely that it's a solid, somehow less-mentioned but still reputable place. I'd do a disservice to them and you to speculate further.
Other quality forensic path programs you've probably heard about, but which I'll throw out for consideration anyway: Baltimore, New York, Dallas
There is a large number of "smaller" programs, accepting only one fellow and handling lower volume. (And a few large programs with high volume but not much of a reputation.) Personally I aimed for a program that took at least 2 fellows (I wanted some comaraderie, and someone in my position I could discuss work with), had a solid reputation in what is a relatively small field, had a wide variety of cases, and on the order of 5+ ME's (for variety of expertise and approach), some with subspecialty training (primarily neuropath, cardiac, and pediatric). Different people may be after different things -- it pays to think about what trips your trigger the most (and least).
First, both are considered highly reputable programs. You're not going to walk out of either and not know what you're doing. But, they approach training their fellows differently.
Miami treats its incoming fellows as junior staff; you're basically expected to take a case and handle it entirely yourself for as long as you can. If you run into a problem, there are plenty of very experienced and approachable people to ask questions of, but the expectation is that you do the work and are prepared to defend your conclusions. There is some graduated expectation, but largely you are given a case and trust. Each fellow has their own office. So, a lot of learning is by doing -- with supervision, feedback, and input of course -- but their aim is for you to finish and be able to handle yourself with confidence with zero support the day after you finish fellowship. Because of local law, you have to perform your own evisceration. They have superb in-house photography (digital!), each fellow has access to a high quality digital SLR camera for work, and you attend scenes (there is a vehicle available for this). Autopsy & scene photos are uploaded same-day to the software program used for reporting (apologies, I forget the name of the software package, which is used in several offices), and which they go over as a group at the end of each day. They have neuropathology and cardiac pathology trained medical examiners on staff. They were in the process of digitizing their old records, which are vast. And it bears worth specifically saying that Dr. Lew is one of the nicest people I've ever met, and is a co-author of the relatively recent "Forensic Pathology: Principles and Practice" book primarily accredited to Dr. Dolinak (Dr. Matshes being another author, not counting several additional contributors). The case load is from the Miami-Dade area; this includes not only the expected urban deaths, but also some rural deaths on the outskirts of the county. The salary is well above average, but unless/until you know the area well, so is the cost of living. Some of the facilities are older, but you wouldn't know it, and the office space is very nice.
Albuquerque handles cases from across the entire state, as well as the university hospital next door. Their autopsy technicians are mostly local students (grad, pre-med, etc.), meaning the turnover is high but the energy and interest level is also high -- this is NOT the case in many offices, and both they and I consider it a quirky bonus of the New Mexico program. They submit microscopic sections on every case but the turnaround on slides is on the order of weeks (I can't remember precisely, someone may correct that). They have a neuropathology trained ME on staff, and one whose focus is primarily research. The fellows share a large office. They have regular journal clubs. I can't recall how they handle a lecture series; I seem to remember they meet every week, but I'd have to dig up my files or give them a call for further details. They have numerous resident and student rotators, not least because of their reputation. Dr. Nine is also one of the grooviest ME's around, and enjoys teaching. When I was there they had managed new funding for toxicology, which was improving their previously poor turnaround times; this was something they hoped to make permanent, but I don't know how that panned out. They gave the impression of having an overall extremely well rounded program, with good facilities.
Richmond I don't know as much about, merely that it's a solid, somehow less-mentioned but still reputable place. I'd do a disservice to them and you to speculate further.
Other quality forensic path programs you've probably heard about, but which I'll throw out for consideration anyway: Baltimore, New York, Dallas
There is a large number of "smaller" programs, accepting only one fellow and handling lower volume. (And a few large programs with high volume but not much of a reputation.) Personally I aimed for a program that took at least 2 fellows (I wanted some comaraderie, and someone in my position I could discuss work with), had a solid reputation in what is a relatively small field, had a wide variety of cases, and on the order of 5+ ME's (for variety of expertise and approach), some with subspecialty training (primarily neuropath, cardiac, and pediatric). Different people may be after different things -- it pays to think about what trips your trigger the most (and least).
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couldn't you say this about any relatively small subspecialty, ie electrophysiologist cardiologist or interventional neuroradiologists? i've never heard of anyone in medicine unionizing because the ultimate union weapon, the strike, isn't really available to doctors because no doctor is going to let a patient die because they're on strike. but ME's don't have that, so maybe LA is onto something here.
KCshaw, thanks for that great post. if i end up going the forensic route in a few years that'll be great info (although no way i'd to go miami... i couldn't live there, even for just a year).
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LA: Many FPs, including Boston, actually are in a union.
Here's the Boston experience thus far:
Autopsies 2 - 3 days per week. Fridays are "fellow" day, meaning I can do what I want with a focus on academic pursuits. Paper days on the remainder. I function relatively independently, with sign-off and "defense" of all of my cases to my colleagues. I do 2 to 3 autopsies per day on my autopsy days. My goal is to hit 250 posts squarely for the year. I eviscerate all of my cases
I have a great office with a huge window, and subsequent fellows will share the office with me. But there is a large divider, so in essence, it will feel a bit like 2 separate offices. So far we are taking 1 fellow per year, so our next opening will be in 2009 (though we may have someone lined up for that year as well.)
I go to scenes sporadically. I haven't exactly decided if I enjoy it or not. I can go essentially whenever I want to them. As an office on whole, we tend to only do "removals" at scenes rather than "investigations", and rely on the police for investigation. When an ME shows up, though, we are generally welcomed into the investigation. Often I find that the police expect me to have a lot to say, when really all I am usually thinking is "yup, he's deceased, now let's get him back to the morgue so we can see what's wrong with him..."
We are also increasingly active in disaster planning (have a big city-wide drill kicking off early tomorrow.)
In any case, I am having a really fun and exciting year so far.
Mindy
Here's the Boston experience thus far:
Autopsies 2 - 3 days per week. Fridays are "fellow" day, meaning I can do what I want with a focus on academic pursuits. Paper days on the remainder. I function relatively independently, with sign-off and "defense" of all of my cases to my colleagues. I do 2 to 3 autopsies per day on my autopsy days. My goal is to hit 250 posts squarely for the year. I eviscerate all of my cases
I have a great office with a huge window, and subsequent fellows will share the office with me. But there is a large divider, so in essence, it will feel a bit like 2 separate offices. So far we are taking 1 fellow per year, so our next opening will be in 2009 (though we may have someone lined up for that year as well.)
I go to scenes sporadically. I haven't exactly decided if I enjoy it or not. I can go essentially whenever I want to them. As an office on whole, we tend to only do "removals" at scenes rather than "investigations", and rely on the police for investigation. When an ME shows up, though, we are generally welcomed into the investigation. Often I find that the police expect me to have a lot to say, when really all I am usually thinking is "yup, he's deceased, now let's get him back to the morgue so we can see what's wrong with him..."
We are also increasingly active in disaster planning (have a big city-wide drill kicking off early tomorrow.)
In any case, I am having a really fun and exciting year so far.
Mindy
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I was wondering if anyone who had done some research or interviewed at some of the various forensic pathology fellowships could comment on what they felt the strengths were of the various programs.
I saw that Miami, Richmond, New Mexico, Dallas, and New York were mentioned, what about some other cities that I associate with high crimes rates such as St. Louis, Detroit, and Chicago?
Also, how competitive do you feel forensic path fellowhips are? Obviously, I'd assume they are much less competitive than say dermpath -- but do residents generally end up getting the program of their choice?
And finally, do you feel that the residency program one comes from has much weight in obtaining a forensics fellowship? ie, would someone from Hopkins or Wash U be a more competitive applicant or do you think that residency programs that have forensic fellowships tend to favor their own residents? Basically, if I'm ultimately interested in forensic pathology, should I look towards residency programs that have forensic fellowships or would I be better off going to a "bigger name" university or does this even matter based on the competitivness of the fellowship programs. I know that's a lot of questions, but any input from those with some knowledge in this area would be appreciated.
I saw that Miami, Richmond, New Mexico, Dallas, and New York were mentioned, what about some other cities that I associate with high crimes rates such as St. Louis, Detroit, and Chicago?
Also, how competitive do you feel forensic path fellowhips are? Obviously, I'd assume they are much less competitive than say dermpath -- but do residents generally end up getting the program of their choice?
And finally, do you feel that the residency program one comes from has much weight in obtaining a forensics fellowship? ie, would someone from Hopkins or Wash U be a more competitive applicant or do you think that residency programs that have forensic fellowships tend to favor their own residents? Basically, if I'm ultimately interested in forensic pathology, should I look towards residency programs that have forensic fellowships or would I be better off going to a "bigger name" university or does this even matter based on the competitivness of the fellowship programs. I know that's a lot of questions, but any input from those with some knowledge in this area would be appreciated.
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(For the moment I'm going to defer the question about other cities/fellowship programs until I have more time.)
Fellowships in forensic pathology do go unfilled (*46 of 80 filled for the '06-07 academic year, with similar numbers since '03-04), and there is a very wide mix in the applicant pool. It doesn't really compare to dermatopathology at all -- we don't compete with internal medicine or surgery residents for forensic path fellowships. But the most competitive forensic fellowships still fill sometimes 2 years ahead, and the most reliable way to get an offer is, historically, to either be a local resident or at least do a month elective there far enough in advance. With the top ~5 or so programs filling early that only covers about 15 of the 80 accredited positions -- there's no doubt that some good programs go unfilled, either by selective choice or bad luck. Occasionally selective top tier programs will even go unfilled, so it pays to ask around, early and often. (*Numerical data compiled by VCU & UAB residents with help from the ACGME, as forwarded to the path residency director email list.)
Training at a big name pathology program can certainly help, but forensic path is a different world from tumor pathology (how some "big name" programs got their name). What it really says, to me, is that you came out of medical school as a strong candidate, and made it through a reputable program -- presumably you're a bright, hard working person with a reliably solid foundation in general pathology (and likely to pass your boards if you haven't already). What I would want to know next is whether you have the mentality for the unique field of forensic pathology -- and that is best judged over time.
So..how much does one thing matter over the other? Unfortunately it's a balancing act. You want to go to a strong residency program: you might decide forensic path ain't your thing after all, and frankly you want -- need! -- a top quality general path background anyway. But it may not have much of an autopsy service (though most BIG programs do) or a nearby busy forensic office or fellowship (but again, most big programs in big cities do). Personally? I'd look for the most reputable program that actually looks like a good program you'd enjoy being in for 3-4 years, and do an elective at any of the several top tier forensic offices.
Bottom line is if you're personable, easy to work with, have had some experience with forensic path (a month somewhere, which most residencies require), and have good recommendations from your own program, you have a reasonable chance of landing a fellowship somewhere, if not necessarily at a large highly reputable office.
Fellowships in forensic pathology do go unfilled (*46 of 80 filled for the '06-07 academic year, with similar numbers since '03-04), and there is a very wide mix in the applicant pool. It doesn't really compare to dermatopathology at all -- we don't compete with internal medicine or surgery residents for forensic path fellowships. But the most competitive forensic fellowships still fill sometimes 2 years ahead, and the most reliable way to get an offer is, historically, to either be a local resident or at least do a month elective there far enough in advance. With the top ~5 or so programs filling early that only covers about 15 of the 80 accredited positions -- there's no doubt that some good programs go unfilled, either by selective choice or bad luck. Occasionally selective top tier programs will even go unfilled, so it pays to ask around, early and often. (*Numerical data compiled by VCU & UAB residents with help from the ACGME, as forwarded to the path residency director email list.)
Training at a big name pathology program can certainly help, but forensic path is a different world from tumor pathology (how some "big name" programs got their name). What it really says, to me, is that you came out of medical school as a strong candidate, and made it through a reputable program -- presumably you're a bright, hard working person with a reliably solid foundation in general pathology (and likely to pass your boards if you haven't already). What I would want to know next is whether you have the mentality for the unique field of forensic pathology -- and that is best judged over time.
So..how much does one thing matter over the other? Unfortunately it's a balancing act. You want to go to a strong residency program: you might decide forensic path ain't your thing after all, and frankly you want -- need! -- a top quality general path background anyway. But it may not have much of an autopsy service (though most BIG programs do) or a nearby busy forensic office or fellowship (but again, most big programs in big cities do). Personally? I'd look for the most reputable program that actually looks like a good program you'd enjoy being in for 3-4 years, and do an elective at any of the several top tier forensic offices.
Bottom line is if you're personable, easy to work with, have had some experience with forensic path (a month somewhere, which most residencies require), and have good recommendations from your own program, you have a reasonable chance of landing a fellowship somewhere, if not necessarily at a large highly reputable office.
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St. Louis: (http://www.pathologytraining.org/view_program.asp?strInstProgID=799 , http://path.slu.edu/index.phtml?page=education)
Key points: "..approximately 2600 deaths annually reported to the office there are approximately 125 homicides, 60 suicides and 330 accidents," a neuropathologist and a cardiac pathologist (of 4 listed ME's), and take 1 fellow per year. They are credited with writing a NAME position paper on fatal abusive head injuries in children in 2001, among several other papers. Unfortunately the SLU site doesn't have a page dedicated to the forensic path program, but the pathologytraining.org site has a decent summary of key points.
Detroit: (http://www.pathologytraining.org/view_program.asp?strInstProgID=338)
Key points: "..approximately 2600 autopsies annually, approximately 500 of which are homicides," 7 board certified forensic pathologists, two forensic toxicologists, had been accredited for 2 fellows. I think their homicide estimate is a little high, but may be an estimate of cases suspicious for homicide when the autopsy starts, not once the entire investigation is complete, or may be data from the 90's. According to cityrating.com there were 366 Detroit "murders" in 2003; however, it gets a lot more press because the -rate- is often one of, or the, highest in the country. I don't know how good the actual training is, though. ACGME lists them as having probationary status in 2004 for review in 2005, but it's not clear what that was based on.
Chicago: (http://www.pathologytraining.org/view_program.asp?strInstProgID=257)
Key points: In-house toxicology, fellows perform ~300 autopsies, they take 1 fellow per freida but are accredited for 4 per ACGME (?), have 14 ME's, and searching from cookcountygov.com eventually said they do about 4500 autopsies per year. They have the workload to take at least a couple more fellows, so I'm kinda curious if they don't (money vs teaching interest vs not enough good candidates, etc.). In principle this should be a good place to train, but in practice I don't know much about the teaching or people who have come out of there, other than Dr. Denton is generally thought of respectably.
Baltimore: (http://www.pathologytraining.org/view_program.asp?strInstProgID=300)
Key points: In-house toxicology (about a week turnaround time), now at I believe 15 ME's including a neuropathologist, work closely with reknowned cardiac pathologists & additional neuropathologists (non-ME's), perform ~4500 autopsies (most websites report ~4000, but this has increased yearly for some time), and cover the entire state. A new facility is expected to open late 2009 or 2010. Collaborative research with the University of Maryland. Take a large number of regional medical students and pathology residents. Weekly conferences -- review of cases with either cardiac pathologist or neuropathologist, and a separate lecture series. Fellows also go to focused short-courses in forensic path, anthropology, toxicology, and a rotation through the crime lab. Despite the overall large case load, fellows get paper-days when necessary (it's no meat market). The ME's are interested and helpful. They have up to 4 total fellows, one rotating from the armed forces medical examiner (aka AFIP, aka National Capital Consortium Program).
Los Angeles: (http://www.pathologytraining.org/view_program.asp?strInstProgID=185)
Key points: "..approximately 5,000 necropsies are performed of which 1,300 are investigated as homicides," "exposed to at-scene investigations, gross/microscopic/lab pathology conferences, resident lectures," according to freida they only take 1 fellow per year (this seems oddly low, like Chicago) but are accredited for 6 per ACGME. Again, I'm not sure about their homicide number. Rumor has it this is a meat-market, but I can't substantiate that.
I *have* heard that the last couple of years have been pretty sparse in terms of quality fellow candidates, and some of the bigger programs are selectively not filling. If you're interested in the field, make contact with the big programs if that's the sort of place you'd like to train -- might get lucky.
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Thanks for the info. I'll look more into all of those programs. I'm still not sure what impact the presence or lack of a forensic fellowship will have on my choice of residency, but getting a solid foundation in general pathology like you mentioned will be my top priority. Of course, how to judge a program's ability to provide that brings up a different issue enitrely.
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that's interesting to hear about Albuquerque. I worked down the hall from OMI for awhile (at the veterinary diagnostic lab) and always thought it would be fun to play down there.
but NM has so many issues. it just seems like 80% of what you would see would be EtOH or opiates.
but NM has so many issues. it just seems like 80% of what you would see would be EtOH or opiates.
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To be honest, a large number of cases anywhere you go these days are likely to be drug or EtOH related deaths. I don't know what NM's homicide numbers are (don't be fooled by homicide "rate," which is essentially meaningless with regard to forensic path training -- a low rate in a high population area may still mean fellow exposure to 150+ homicides, while a higher rate in a very low popuation area could mean <30 actual homicides, and it doesn't count other cases which may come to you from nearby counties, etc.), but the fact that they take cases from across the state is a plus.
Some people aren't particularly interested in hospital autopsies, but they cover the local hospital cases as well, which adds another group of case-types to their mix. Variety I think is still very important in fellowship training; not every case is a homicide -- most aren't, but you still need to arrive at the best possible answer, and the breadth of your past experience only helps. At any rate -- even though it may be viewed by some as sorta the Outback of the U.S., in the forensic pathology world NM is a well reputed program.
Some people aren't particularly interested in hospital autopsies, but they cover the local hospital cases as well, which adds another group of case-types to their mix. Variety I think is still very important in fellowship training; not every case is a homicide -- most aren't, but you still need to arrive at the best possible answer, and the breadth of your past experience only helps. At any rate -- even though it may be viewed by some as sorta the Outback of the U.S., in the forensic pathology world NM is a well reputed program.
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I definitely agree that a large number of forensic cases anywhere will be drug & alcohol related. New England's drug of choice is heroin. We see very little amphetamines, which I find fascinating.
Massachusetts is a state ME with offices in Boston, Holyoke, Worcester, and soon the Cape. In Boston (where I and subsequent fellows work out of) we end up seeing maybe around 5 homicides or so a week. I end up doing a good proportion of these cases, given that I usually have the option of doing whatever cases I want to. Generally I am in the morgue 3 days a week, and more often than not there is a homicide.
While I definitely think a fellowship should expose their fellows to an appropriate number of homicides, fact is many of them are often pretty straightforward. A good program will give you a wide variety of exposure to a lot of types of deaths. The fact is though people probably die in strange ways all over the US, so I doubt any one (sizeable) office has a capital on it anyway.
Mindy
Massachusetts is a state ME with offices in Boston, Holyoke, Worcester, and soon the Cape. In Boston (where I and subsequent fellows work out of) we end up seeing maybe around 5 homicides or so a week. I end up doing a good proportion of these cases, given that I usually have the option of doing whatever cases I want to. Generally I am in the morgue 3 days a week, and more often than not there is a homicide.
While I definitely think a fellowship should expose their fellows to an appropriate number of homicides, fact is many of them are often pretty straightforward. A good program will give you a wide variety of exposure to a lot of types of deaths. The fact is though people probably die in strange ways all over the US, so I doubt any one (sizeable) office has a capital on it anyway.
Mindy
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I have a Fp question. I'm a PGY1 path resident in a AP/CP program and have decided to go into FP. I would like to get AP/FP board certification so I went on the ABP web site and found the following:
Anatomic Pathology and Forensic Pathology2 full years of approved training in anatomic pathology in a program accredited for such training by the ACGME, 1 full year of approved training in forensic pathology in a program accredited for such training by the ACGME, and 1 additional year of approved training in another area of pathology such as neuropathology, toxicology, or chemical pathology. ABP approval for the additional year should be obtained before the individual begins the additional year.
My question is what programs are "accredited for such training by ACGME"? I know UTSW has a forensic track but they are the only one I came across while applying for residency. How can I find out what other programs offer this training? I emailed the ABP. Thanks for any advice.
Anatomic Pathology and Forensic Pathology2 full years of approved training in anatomic pathology in a program accredited for such training by the ACGME, 1 full year of approved training in forensic pathology in a program accredited for such training by the ACGME, and 1 additional year of approved training in another area of pathology such as neuropathology, toxicology, or chemical pathology. ABP approval for the additional year should be obtained before the individual begins the additional year.
My question is what programs are "accredited for such training by ACGME"? I know UTSW has a forensic track but they are the only one I came across while applying for residency. How can I find out what other programs offer this training? I emailed the ABP. Thanks for any advice.
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You don't need to post the same question twice in two threads. I deleted the other one.
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I know "of" people who took that route into forensic pathology, but I've never spoken to anyone in-the-know about the details of making it happen. Keeping that in mind:
My impression for why it doesn't seem to be a commonly pursued pathway is twofold; one, most programs prefer to keep you around for 3 or 4 years, rather than only 2, and the other is that it doesn't save you time versus doing straight AP for 3 years + 1 year of FP fellowship. If you want a third reason, I think that would be because most programs accredited in forensic pathology probably prefer a more senior person joining them as a fellow and leaving them as fully FP eligible.
In other words, you may find some polite or passive resistance from some quarters as you pursue this. Also, if you didn't catch it from above, my interpretation of "accredited for such [forensic pathology] training by ACGME" means programs accredited for forensic pathology fellowship, and the additional year in another area of pathology also implies to me a second fellowship-type year. But I think you're doing the right thing in asking the ABP for clarification on that point. And I think it's something that, if you know you want to do it, you should try to set up early. I also think you shouldn't feel shafted if, for whatever reason (choice or otherwise), it doesn't work out -- although there is a certain appeal to it. This was something I considered though didn't research in detail, and ultimately decided that spending an extra year to do AP/CP was something I preferred. I don't regret that, but thinking about having had the option to do cardiovascular, neuro, or pediatric pathology this year instead makes me lick my chops a bit.
Best of luck, and give us (or me if no-one else seems that interested) an update on how it goes?
My impression for why it doesn't seem to be a commonly pursued pathway is twofold; one, most programs prefer to keep you around for 3 or 4 years, rather than only 2, and the other is that it doesn't save you time versus doing straight AP for 3 years + 1 year of FP fellowship. If you want a third reason, I think that would be because most programs accredited in forensic pathology probably prefer a more senior person joining them as a fellow and leaving them as fully FP eligible.
In other words, you may find some polite or passive resistance from some quarters as you pursue this. Also, if you didn't catch it from above, my interpretation of "accredited for such [forensic pathology] training by ACGME" means programs accredited for forensic pathology fellowship, and the additional year in another area of pathology also implies to me a second fellowship-type year. But I think you're doing the right thing in asking the ABP for clarification on that point. And I think it's something that, if you know you want to do it, you should try to set up early. I also think you shouldn't feel shafted if, for whatever reason (choice or otherwise), it doesn't work out -- although there is a certain appeal to it. This was something I considered though didn't research in detail, and ultimately decided that spending an extra year to do AP/CP was something I preferred. I don't regret that, but thinking about having had the option to do cardiovascular, neuro, or pediatric pathology this year instead makes me lick my chops a bit.
Best of luck, and give us (or me if no-one else seems that interested) an update on how it goes?
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I just got into two programs..Masters in Biomedical Forensic Science from Drexel and BU. I am torn between the two programs. Does any one know anyting about these schools or programs. THanks
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Unfortunately I don't know much about the forensic science programs out there, and the only person with that background that I speak to with regularity did it in Canada. I know some people who went to med school at Drexel, but that doesn't really help. In trying to think of other sources I keep getting distracted by the fact that the American Academy of Forensic Sciences annual meeting is being held in D.C. next week, and of course would be chock full of people who should be able to address that sort of thing.
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There's a lot of articles on Hayne & the Mississippi mayhem. To me, however, they highlight the inadequacy of hoops one has to jump through to be "legally" declared a forensic expert in some places (or that the hoops aren't so much hoops as schmoozing the right people, a far more frightening thing). I certainly agree, however, that placing government forensic labs and personnel (intentionally lumping together all the forensic science subspecialties) directly under the thumb of an elected &/or non-forensic/medical/law-educated individual is a proven problem. Politics & forensics will never be completely separated, but they cannot be intentionally bound so fiercely that the whim of the mob alters the scientific process.
The Mississippi embarassment is, unfortunately, perpetuated by what appears to be completely ignoring existing law -- and thus isn't likely to change from within. Frankly, until there is a federal influence, a national organization with enforceable power, or possibly a governor with guts, these kinds of problems are not going away. I favor a national organization with teeth, not just position papers and recommendations.
The Mississippi embarassment is, unfortunately, perpetuated by what appears to be completely ignoring existing law -- and thus isn't likely to change from within. Frankly, until there is a federal influence, a national organization with enforceable power, or possibly a governor with guts, these kinds of problems are not going away. I favor a national organization with teeth, not just position papers and recommendations.
