Opinion: The shortage of forensic pathologists is hurting justice, public health, and families

OpinionFirst Opinion The shortage of forensic pathologists is hurting justice, public health, and families Burnout, low pay are keeping new physicians from entering the field Manage alerts for this article Email this article Share this article By Gregory McDonaldJuly 13, 2026 McDonald is the chair of the Department of Forensic Medicine and Pathology at Philadelphia College of Osteopathic Medicine. Across the United States, the shortage of forensic pathologists has reached a critical level. According to the National Association of Medical Examiners (NAME), only about 850 forensic pathologists are currently practicing nationwide — roughly 400 fewer than the number needed to meet today’s demands, as more than 3 million Americans die each year. With the increased demand for autopsies and medicolegal death investigations, many states are facing delays in cases that impact justice and public health. In some regions, a single medical examiner may oversee hundreds of deaths each year, leading to bottlenecks that can slow criminal cases, complicate insurance claims, and leave families waiting months and sometimes years for answers.Advertisement I often think back to my time at the Philadelphia County Medical Examiner’s Office more than 20 years ago, when just four forensic pathologists were responsible for a city of nearly 1.5 million people. The four of us bore responsibility for the full scope of forensic pathology practice, which includes performing autopsies, determining cause and manner of death, responding to and investigating death scenes, and providing expert testimony in court proceedings. Even then, the field faced persistent and far-reaching workforce shortages. (Today, the office has nine full-time and two part-time pathologists for about 1.5 million people.) While this workforce shortage is not a new problem, it has reached a breaking point in recent years. The Covid-19 pandemic is not solely to blame, but it did expose and deepen existing cracks. As pathologists themselves fell ill or took time away to quarantine, already thin ranks were stretched even further. Many senior professionals chose to retire early, a decision likely accelerated by the stress and uncertainty those years brought. At the same time, the opioid epidemic fueled an unprecedented caseload, with fentanyl-related deaths and violence linked to drug use overwhelming medical examiners’ offices nationwide.Advertisement Together, these forces left communities to grapple with the consequences of delayed justice and unanswered questions. It’s also important to remember that the role of the forensic pathologist is something most people don’t think about until they have to. Forensic pathology lives in the margins, often seen as uncomfortable or even a little taboo. But when it does come into focus, it’s usually during one of the hardest moments in someone’s life: the sudden loss of a loved one, a criminal investigation, or the search for answers that won’t come easily. In some cases, it’s the forensic pathologist who must deliver the devastating news to next of kin, adding an emotional weight to a role already defined by difficult circumstances. It’s not a system people engage with by choice, but when they do, it becomes deeply and unavoidably personal. But the problem is not solely one of circumstance; it is also shaped by the economic structure of the field. Despite its vital role in public health and the justice system, forensic pathology is often compensated less than other medical specialties because it is practiced primarily within government agencies and lacks traditional insurance-based reimbursement, constraining salaries through public sector funding. After four to five years of medical training and residency, it’s understandable that many graduates would be drawn to other pathology subspecialties or clinical roles that offer higher compensation and more predictable schedules, often supported by insurance-driven revenue streams. Compounding this is the issue of visibility, or rather, invisibility. Medical students can complete their first two years, and sometimes more, without encountering a forensic pathologist or seeing the field meaningfully represented in their curriculum. In an environment where career paths are often shaped by early exposure, mentorship, and clinical rotations, that absence matters. Without someone to introduce the work, answer questions, or model what a career in the field looks like, the specialty fades into the background. It becomes less a deliberate choice and more something never seriously considered. If future doctors rarely see the field, how can they imagine themselves in it, let alone choose it?Advertisement The data can seem discouraging, but there are still many signs of progress being made. Across the country, medical educators and institutions are beginning to think creatively about how to strengthen the pipeline for future forensic pathologists. One way to do this is by focusing on those already in training — pathology residents who are just beginning their careers. When I was an anatomic pathology resident at the Philadelphia County Medical Examiner’s Office, I was overseen by a senior forensic pathologist, but I was able to do some of the work on my own. I worked on nonhomicide and less complicated cases to alleviate some of the strain that was being placed on the existing medical examiners. This option depends on jurisdiction, but it’s a way to engage residents early and highlight the importance of the field and its impact on families and communities. Longer-term solutions will require systemic investment. Increasing the number of accredited fellowship positions, securing more board-certified pathologists to train the next generation, and offering competitive compensation are all essential steps. Modernizing facilities and expanding funding across jurisdictions would help make the profession not only more sustainable but also more appealing to those choosing their medical paths. The solution to our national shortage begins in our classrooms and training programs. By elevating awareness of forensic pathology and offering structured, hands-on exposure, medical schools can help students see the profound impact this field has on communities. Gregory McDonald, D.O., is the chair of the Department of Forensic Medicine and Pathology at Philadelphia College of Osteopathic Medicine. Letter to the editor Have an opinion on this essay? 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