Forensic pathologist shortage could cause unexplained deaths

makeshift morgue is needed back in 2020when COVID-19 lacked a vaccine and killed so many people that hospital and the funeral home couldn’t keep up. But two years later, they’re still in use in Baltimore for a different reason. In February, according to News stories at the time, at least 200 bodies from the medical examiner’s office sat in refrigerated trucks parked inside a garage for week. There’s simply nowhere else to put them—because of a shortage forensic pathologist.

There are so few forensic pathologists in the city—medical doctors who perform autopsies to check for sudden, unexpected, or violent deaths—that autopsies are backlog. Bodies could not be examined and laid to rest as quickly as usual. Dr. Victor Weedn, chief medical officer in Maryland at the time, said turnover in the profession had reached about 70% by 2021 and was only getting worse. COVID-19 didn’t help and the fact that the Baltimore murders didn’t hit the mark either 50 years high for January, and overdose death put a record in 2021. The office is underfunded and employees are underpaid, Weedn said, which has led some workers to leave for higher wages. The chief medical examiner’s office eventually called on the Federal Emergency Management Agency to provide staff to deal with the backlog. “With relatively few employees stretched to the limit, anything else could bring the entire system down. And that’s what happened,” said Weed, who resigned in February and now works in Washington, DC.

The Maryland crisis is indicative of a popular but little-known aspect of the problem of lack of doctors is more serious. Dr. Kathryn Pinneri, president of the National Association of Medical Examiners, said about 750 forensic pathologists are working full-time in the United States, but double the number is needed to cope with the number of cases. infection is increasing. The shortage, she said, has been going on for at least a decade, but now it’s especially severe: on November 10, 55 forensic pathologists positions were posted on the association’s website, while only about 40 people become board-certified forensic doctors. pathologist every year, she said.

The number of deaths due to drug overdose is increasing increase in violent crimeand the COVID-19 pandemic both demand more from this small specialized workforce. a 2019 survey found that 37% of forensic pathologists perform more than 250 autopsies per year, which is the maximum number the association recommends they should complete. Forensic pathologists say the increased workload can add to the stress of working in a field where they regularly face the risk of injury, which can lead to burnout and absenteeism. early retirement.

Read more: Caring for carers after the pandemic

Without action to reduce the workload of forensic pathologists, Weedn warned that they could overlook autopsies and omit details, which could lead to consequences such as: less accurate death count from drug overdose crisis, including the failure to identify the drug mixture in the patient’s system. “Every autopsy is an information node,” he said. “If you haven’t determined the true cause of death and simply call it a heart attack, you’re harming people.” It can also cost families dearly, he said. “It’s really important for families to know why people die. Autopsy is really how you answer the lingering questions.”

Joyce deJong, who works in Michigan as a medical examiner, says forensic pathologists play an important role in both private life and public health: a physician. physician responsible for investigating deaths, who is usually a forensic pathologist. Through autopsies, they provide answers to the families of those who die, and in some cases, no clear explanation. Autopsies are also essential to help law enforcement classify natural deaths from homicide. Often, they provide valuable data that informs public health actions. America makes it safer baby crib standards for example, after medical examiners reported a series of infant deaths and determined that parts of some cribs could have come apart and jammed an infant’s head.

Due to the current nationwide shortage of forensic pathologists, these answers will take longer than usual to arrive.

Pinneri said the shortage has forced some forensic pathologists to change their ways, with some offices taking longer than the recommended 60 to 90 days to return autopsy results. deadbody. Some offices have also begun omitting autopsies in cases where the deceased seems to have succumbed to a drug overdose. Such shortcuts increase the risk of important information being missed—for example, if a person dies from a genetic defect while using drugs. “If we find some genetic or other condition that might run in families, I think it’s important for families to know,” Pinneri said. “I think we’re going to miss the natural disease processes that are going on in people who use drugs.”

Protecting the workforce

To alleviate the shortage of forensic doctors, Pinneri said, the top priority is to recruit young doctors to enter the field. It can be a hard sell: becoming a forensic pathologist takes about nine years of graduate school (medical school, a pathology fellowship, and a year of training in forensic pathology).

Another challenge, according to deJong, is that medical school students can’t imagine dedicating their careers to deceased patients and must be convinced that it’s a viable (and appealing) career option. . Compared with other specialties, she often tells them, forensic pathologists tend to work more reasonable hours – although they may sometimes be called in to examine crime scenes on midnight. Diversity can also be an attraction: one day, you might have an autopsy on a murder victim — the next day, an elderly person dies of natural causes. The same goes for the satisfaction of helping people at the worst times in their lives. DeJong said she receives an email every year from a father thanking her for explaining his child’s sudden death.

deJong said that all medical students at Western Michigan University, where she works, watch at least one autopsy during her four years of medical school, and she tries to prove that forensic pathology y can be very engaging and rewarding. Recently, she showed students the autopsy of an elderly person found at the bottom of three stairs, she said. It seemed like a simple case of heart attack, until doctors examined the deceased’s brain and discovered a subdural hemorrhage—a sign that the person had died after being hit in the head. Such information can be important to both families and public health. “I think it’s valuable to know how many elderly people die from falls and what we can do to help,” DeJong said.

creative solution

Forensic pathologists have found new ways to make their work more efficient. For example, several offices—including deJong’s—purchased CT scanners for forensic pathologists for the first time in the past few years, helping forensic pathologists detect clues like trauma hurt faster. Increasingly, offices have also digitized their records, which allows forensic pathologists to perform parts of their work remotely.

Maricopa County, like many other parts of the country, has seen an increased demand for autopsies in recent years: in 2021, more than 6,000 bodies have been submitted for autopsy, up from less than 4,000 in 2010. , according to the county’s 2021 report. annual report. A significant driver has been the increase in drug-related deaths, which increased from 783 in 2010 to 2,171 in 2021. However, Maricopa County has accelerated its reports despite receiving numerous reports. more cases: by 2021, an average of 52 cases will be completed. days, down from 135 in 2016. Dr. Jeffrey Johnston, Maricopa County’s chief medical examiner, credits a range of programs that have reduced workloads and helped Maricopa County attract talent in a labor market. difficult action. Since forensic pathologists are often employees of the public sector, their salaries tend to be lower than those of other professionals. Students leave medical school with a average debt $203,000This adds to the pressure to enter a well-paying profession, says Johnston. To attract these students, Maricopa offered an incentive in 2017: up to $100,000 off their student debt, depending on how long they worked for the county. “That helps us stand out from the crowd, and we know that will ease the burden,” says Johnston.

Read more: Hope and grief in a US county with one of the highest suicide rates

During the pandemic, Maricopa also tried two new strategies to strengthen their workforce. The county has hired forensic pathologists based in other offices to work part-time in Maricopa and hire physician assistants to review medical records and prepare reports in cases where they are not needed. autopsy. Johnston says physician assistants have reduced the workload of forensic pathologists by about 20% and given them peace of mind that they don’t need to sacrifice the quality of their work to keep up with the block. number of cases.

“It causes a lot of conflict with families who want to shut down and with other public officials who need everything,” Johnston said. “We were almost out of the roller coaster we were on.”

Nationwide, the problem remains unresolved. Even as more students pursue this career, DeJong said, the shrinking workforce of both medical doctors and forensic pathologists means there won’t be enough people to meet the needs of the patient. bridge. In the long run, she said, it’s important to use new techniques, such as investing in new technology and hiring more trained assistants to help with tasks like autopsies. . She said, while some forensic pathologists may balk at the changes, the field is already using these techniques — and they’re not going away.

“We won’t have enough forensic pathologists. That’s not going to happen,” says deJong—so people in her industry have to figure out how to do their jobs with fewer resources. A lot of people are counting on them, she said. “We don’t do surgery, we don’t write prescriptions. Our work product is really the answer.”

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