Solving America's Autopsy Crisis
The United States is experiencing a shortage of medical examiners, a problem exacerbated by the opioid crisis. In October of 2017, Dr. Brian Peterson, president of the National Medical Examiner’s Association, told the New York Times that “The national drug crisis has led to staff burnout, drained budgets and threats to the accreditation of many offices because they have to perform more autopsies than industry standards allow.”
Things haven’t improved since then. The New York Times February 25, 2020 article “Piled Bodies, Overflowing Morgues: Inside America’s Autopsy Crisis” reiterated Dr. Peterson’s concerns, this time providing a visceral look into America’s crowded morgues, noting that few solutions to this problem have been offered. Clearly, additional highly trained forensic pathologists are needed, but due to economics, it’s not a feasible solution in the short term.
When other medical fields face shortages of physicians, physician extenders such as nurse practitioners and physician assistants are often employed. But what about pathologists? Meet the physician extender you’ve never heard of: the pathologists’ assistant. Pathologists’ assistants are specialized mid-level providers with training equivalent to that of physician assistants. Forensic and autopsy pathology training are included in this curriculum, along with required clinical rotations at a medical examiner or coroner’s office. Under the supervision of a pathologist, pathologists’ assistants can perform all of the surgical and autopsy functions of a pathologist leading up to, but not including, the diagnosis.
While most pathologists’ assistants work in a hospital or lab setting, a few medical examiner’s offices have integrated them. The Wayne County Medical examiner’s office was the first office in the country to do so. By employing three pathologists’ assistants (whose combined salaries are likely equivalent to the salary of a single senior medical examiner), the office successfully reduced caseloads.
Why don’t more medical examiner’s offices follow suit? It’s a matter of education. The forensic community simply hasn’t realized their untapped potential. Some forensic pathologists aren’t even aware of the profession. A relative newcomer on the pathology scene, the first pathologists’ assistant training program was established in 1978, but the American Society of Clinical Pathology, the accrediting body for pathologists and laboratory professionals, didn’t provide an official pathologists’ assistant certification until 2005. Today there are 10 training programs in the United States and 12,300 pathologists’ assistants in practice, compared to the number of forensic pathologists, which number around 500. Plenty of pathologists’ assistants have an interest in forensics. It’s the reason why I and many others entered the field.
Pathologists’ assistants may not be the answer to the “autopsy crisis” but could provide a solution to some of the problems forensic pathologists face. While they cannot replace forensic pathologists, pathologists’ assistants can certainly alleviate the backlog of cases by reducing the buildup of bodies and facilitating workflow in a cost-effective manner.