U.S. shortage of forensic pathologists is straining justice and families

The shortage of forensic pathologists in the United States has reached a critical point, according to a STAT opinion by Gregory McDonald. He writes that the staffing gap is affecting justice, public health, and families, while also slowing the work of medical examiner offices across the country.

McDonald cites the National Association of Medical Examiners in noting that only about 850 forensic pathologists are currently practicing nationwide. That is roughly 400 fewer than the number needed to meet current demand, he writes, as more than 3 million Americans die each year. With the need for autopsies and medicolegal death investigations continuing to rise, many states are dealing with delays that affect both legal and public health work.

The article says some regions are especially strained. In certain areas, a single medical examiner may be responsible for hundreds of deaths each year. That workload can create bottlenecks that slow criminal cases, complicate insurance claims, and leave families waiting months and sometimes years for answers.

McDonald says the shortage is not new. He recalls his time at the Philadelphia County Medical Examiner’s Office more than 20 years ago, when only four forensic pathologists served a city of nearly 1.5 million people. Those four physicians handled the full range of forensic pathology duties, including performing autopsies, determining cause and manner of death, responding to and investigating death scenes, and providing expert testimony in court.

He says even then, the field was dealing with persistent and far-reaching workforce shortages. Today, he notes, the Philadelphia office has nine full-time and two part-time pathologists for about 1.5 million people. The comparison is meant to show how the workload has changed, but also how the staffing shortage remains a long-running problem.

Forensic pathology, as described in the piece, is central to both legal and public health systems. Autopsies and death investigations can help answer questions for families, support criminal investigations, and provide information that may matter beyond an individual case. When there are too few specialists to complete that work quickly, the consequences can spread across institutions and households.

The article also points to barriers that keep new physicians from entering the field. McDonald says burnout and low pay are among the factors discouraging recruitment. He presents these workforce issues as part of the reason the shortage has persisted and deepened over time.

The result, he argues, is a national system under stress. Medical examiner offices may have to manage large caseloads with too few staff, and the delays that follow can affect courts, insurers, and grieving families alike. In that sense, the shortage is not only a staffing issue within medicine, but also a problem with consequences for public accountability and closure.

McDonald frames the issue as one that deserves attention because of how many different areas it touches. Justice can be slowed when investigations take longer. Public health can be affected when deaths are not fully examined in a timely way. Families can be left waiting far too long for answers about what happened to a loved one.

The opinion does not present a detailed policy solution, but it makes clear that the gap in forensic pathologists is large and ongoing. Based on the figures it cites, the U.S. is short by hundreds of specialists, and some offices are carrying workloads that are difficult to sustain.

As McDonald describes it, the shortage has become a critical-level problem that is felt not only in morgues and medical examiner offices, but also in courtrooms and homes. The piece argues that without more people entering the field, the delays now affecting death investigations and related legal processes are likely to continue.