Cuyahoga County medical examiners address forensic pathologist shortage crisis

CLEVELAND -- “We have three hold overs, homicide, suicide, out of county,” said one of Cuyahoga County’s eight forensic pathologists during the medical examiner’s office morning meeting -- or ‘viewing’ as the professionals call it.

On this particular day there are nine cases to discuss. Some days it’s less, on Mondays it’s usually more. Overdoses and violent crime are often part of the non-stop work for medical examiners as the industry cases a critical shortage of forensic pathologists.

“I think the estimates are we need about 1,000 to 1,100 forensic pathologists in the country and I think there’s about 500 or just under 500,” said Cuyahoga County Deputy Medical Examiner Todd Barr.

Compared to most county or state offices, Cuyahoga County is well-staffed to handle the workload, but that’s not the case everywhere.

“Just in Northeast Ohio we’re kind of experiencing a very big challenge,” said Cuyahoga County Medical Examiner Dr. Thomas Gilson.

“The forensic pathologist who served Mahoning County passed away, the forensic pathologist out in Trumbull County passed away, and the forensic pathologist who was in Stark County retired from her job, so filling in that gap is somewhat challenging,” Gilson said.

Cuyahoga County is now picking up the caseload from counties where forensic pathologist positions are left unfilled. Gilson said the critical need for forensic medicine professionals puts sound, unbiased, reliable death investigations at risk.

“When a shortage is kind of dictating how you are going to practice that is not really a good model to embrace because it encourages practices that cut corners,” he said.

Forensic pathologists are board certified physicians who do autopsies to find legal or criminal evidence.

“It’s a field that’s not well understood,” said Barr. “It’s also interactive with law enforcement with the judicial system with family members, we go out on scenes."

Medical examiners are often key witnesses at trial, and in many cases their work helps prosecute and convict criminals as well as exonerate the innocent.

“The medical examiner has input and interaction in all the judicial systems,” said Dr. Jonathan Arden, president of the National Association of Medical Examiners.

Arden explained the medical examiner's impact is beyond murder trials, especially following the massive number of overdose deaths duet to the opioid crisis.

“There is now an abundance of criminal prosecutions for people who have sold or provided drugs that resulted in deaths of other people,” Arden said.

But most citizens aren’t aware that medical examiners identify public health trends by tracking why and how people are dying. Arden said medical examiners and forensic pathologists were the first group to identify the opioid crisis as a public health crisis.

“You can look sideways out from people who passed away and came here to impact the lives of people who are still probably at risk for the same kind of issue,” said Gilson.

Having a fully-staffed medical examiner’s office in Cuyahoga County allows Gilson to spend time identifying alarming trends in public health like infectious disease, violent crime and overdoses.

“I can look at all those people who overdosed fatally and backtrack into interventions,” Gilson said.

Arden said if the medical examiner isn’t present to do autopsies, death investigations and track health data there will be a serious problem for society. It is already at risk because so few people are going into the field.

According to a study done by the Department of Justice, there are 300 pathology residents in programs at hospitals each year, but out of them only 41 go into a forensic pathology fellowship, and out of those only 27 become board certified.

“Finding answers for families is a wonderful feeling and the medicine involves almost every aspect of medicine,” said Shawn Silver, a pathology resident at University Hospitals.

Silver is working toward becoming a forensic pathologist and his goal is to work for a medical examiners office. He’s doing his fellowship at the Cuyahoga County office.

“I think the reason why most people in medical school don’t really consider it is exposure. We’re really not exposed to a lot of pathology courses in medical school,” Silver said.

But many in the industry know the sad reality is that the relatively low salary for a board certified physician is what keeps medical students from pursuing the career.

“Your earning capacity as a public sector employee is much less than if you were a private sector employee doing pathology at a hospital,” Gilson said.

Arden says salaries for forensic pathologists are usually 50 percent to 60 percent lower than their private-sector counterparts, who have equivalent training.

The National Association of Medical Examiners is working to attract more people to the field by pushing for higher salaries, getting visa waivers for foreign medical students and create student loan forgiveness programs.

There is also a push locally this month the Cuyahoga County Medical Examiner’s Office is holding its first-ever citizens academy where people are invited in to learn how the office works.

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