MTemporary morgues were necessary again in 2020when COVID-19 lacked a vaccine and was killing many people Hospitals Funeral homes can’t keep up. But two years later, it was still in use in Baltimore—for a different reason. In February, according to newsletter Stories At the time, at least 200 bodies from the medical examiner’s office were sitting in refrigerated truck trailers parked inside a parking garage for weeks. There was simply nowhere else to put them – due to a shortage Forensic scientists.
There were so few forensic pathologists in town—doctors who perform autopsies to examine sudden, unexpected, or violent deaths—that a backlog of work on autopsies led to a backlog. Bodies could not be examined and laid to rest as quickly as they normally would. Dr. Victor Weeden, Maryland’s chief medical examiner at the time, says the rate of change in the profession was about 70% in 2021 and was getting worse. COVID-19 hasn’t helped, nor has the fact that homicides in Baltimore have reached a level the highest level in 50 years For the month of January, and Deaths due to overdose set a register In 2021. The office was underfunded and employees were underpaid, Weeden says, leading some workers to leave for higher salaries. The chief medical examiner’s office eventually called on FEMA to provide workers to clear the backlog. “With a relatively small number of employees stretched to the limit, anything else could make the whole system go faster. And that’s kind of what happened,” says Weeden, who later resigned in February and now works in Washington, D.C.
The crisis in Maryland was indicative of a widespread but little-known aspect of Exacerbation of the problem of shortage of doctors. Approximately 750 forensic pathologists work full time in the United States, but twice as many are needed to handle growing numbers of cases, says Dr. Kathryn Bennery, president of the National Association of Medical Examiners. The shortage has been going on for at least a decade, she says, but it’s especially severe now: On November 10, 55 job openings for forensic specialists were posted on the association’s website, while only about 40 became forensic board-certified. . Pathologists say every year.
An increasing number of deaths due to drug overdose, Violent crime escalatedAnd the COVID-19 pandemic has all demanded more from this small, specialized workforce. One 2019 Exploratory study It found that 37% of forensic pathologists perform more than 250 autopsies annually, the maximum number the association recommends completing. Forensic scientists say the increased workload can compound the stress of working in a field where they must constantly face the risk of trauma, which can lead to burnout and early retirement.
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Without measures to ease the workload of forensic pathologists, Weeden warns, they could skip autopsies and miss details, which could lead to consequences like counts of deaths that are less accurate than drug overdose crisisIncluding not specifying the combination of drugs in the patient’s system. “Every autopsy is a node of information,” he says. “If you don’t identify the real cause of death and simply call it a heart attack, you’re doing everyone a disservice.” He says it may also be to the detriment of families. “It’s really important for families to know why people died. An autopsy is really how you answer the lingering questions.”
Forensic pathologists play an important role in both private life and public health, says Dr. Joyce DeJong, who works in Michigan as a medical examiner: a physician in charge of investigating deaths and usually a coroner. Through autopsies, they provide answers to the families of people who die unexpectedly and, in some cases, with no apparent explanation. Autopsies are also necessary to help law enforcement sort out natural deaths from homicides. Often, they provide valuable data that informs public health action. The United States implemented safer Crib standards After medical examiners reported a large number of infant deaths, for example, and determined that parts of a particular cribs could come loose and trap infant heads.
Because of the current national shortage of coroners, these answers are taking longer than usual to arrive.
Shortages have forced some forensic pathologists to change their practices, Benneri says, with some offices taking longer than 60 to 90 days to return autopsy results. Some offices have also begun to forgo autopsies in cases where the deceased appears to have succumbed to a drug overdose. Such abbreviations increase the risk of losing important information – for example, if someone dies from a genetic abnormality while using drugs. “If we find some genetic conditions, or other conditions that may run in families, I think it’s important for the family to be aware,” Benneri says. “I think we will miss the natural disease processes that occur in individuals who use drugs.”
To alleviate the shortage of forensic doctors, the first priority is to recruit young doctors to join the field, Benneri says. It can be a hard sell: Becoming a forensic pathologist requires about nine years of post-college education (medical school, a pathology fellowship, and a year of training in forensic pathology).
An additional challenge, says DeJong, is that medical school students can’t imagine spending their careers with deceased patients and must convince them that it’s a viable (and attractive) career option. You often tell them that, compared to other specialties, forensic pathologists tend to work reasonable hours—although they may sometimes be called upon to examine crime scenes in the middle of the night. Diversity can also be an attraction: one day, you might be doing an autopsy on a murder victim — the next, an elderly person who died of natural causes. So is the satisfaction of helping people in the worst moments of their lives. DeJong says she gets an email every year from a father thanking her for explaining the sudden death of his child.
All of the medical students at Western Michigan University, where she works, have seen at least one autopsy during their four years of medical school, DeJong says, as she tries to prove that forensic pathology can be fascinating and rewarding. She says she recently showed students the autopsy of an elderly person who was found at the bottom of three steps. It looked like a simple case of a heart attack, until the doctor reached into the brain of the deceased to reveal subdural bleeding – a sign that the person died after being hit on the head. Such information can be important for both family and general health. “I think there is valuable information in knowing how many older people die from falls, and what we can do to help,” says Dejong.
Forensic scientists have discovered new ways to make their work more efficient. For example, some offices—including DeJong’s—have purchased CT scanners for forensic pathologists for the first time in the past few years, allowing forensic pathologists to detect evidence such as trauma faster. Increasingly, offices have also digitized their records, allowing forensics professionals to do parts of their jobs remotely.
Maricopa County, like many other parts of the country, has had a greater need for autopsies in recent years: In 2021, more than 6,000 bodies were accepted for examination, up from fewer than 4,000 in 2010, according to County 2021 Annual Report. An important driver is the increase in drug-related deaths, which rose from 783 in 2010 to 2,171 in 2021. However, Maricopa County has accelerated its reporting despite receiving more cases: In 2021, the average case completions were at 52 days, down from 135 in 2016. Maricopa County Chief Medical Examiner Dr. Jeffrey Johnston credits a series of programs with reducing the workload and helping Maricopa County attract talent in a challenging job market. Because forensic pathologists are typically public sector employees, their salaries tend to be lower than those of other specialists. Students leave medical school with an extension Average debt is $203,0000, which increases the pressure to join a high-paying profession, says Johnston. To attract these students, Maricopa offered an incentive in 2017: a rebate of up to $100,000 in student debt, depending on how long they work for the county. “It helps us stand out from other places, and we know it lightens the load,” says Johnston.
During the pandemic, Maricopa also experimented with two new strategies to strengthen its workforce. The county has hired forensic pathologists residing in other offices to work in Maricopa on a part-time basis, and has hired medical assistants to review medical records and prepare reports in cases where an autopsy is not necessary. Johnston says that physician assistants have reduced the workload of forensic pathologists by about 20%, and helped give them peace of mind that they don’t need to sacrifice the quality of their work to keep up with a caseload.
“It created a lot of conflict with families who want to close, and with other government officials who need things,” says Johnston. “We kind of got off this roller coaster that we used to be on.”
At the national level, the problem is still far from resolved. Even if more students pursue the profession, Dejong says, the shrinking workforce of both physicians and forensic scientists means there won’t be enough people to fill the need. In the long term, she says, it will be important to use new technologies, such as investing in new technologies and hiring more trained assistants to help with tasks like autopsies. While some forensic scientists might balk at the changes, she says, the field is already using these techniques — and they’re not going away.
We’re not going to get enough forensic pathologists. “It won’t,” says Dejong, so people in her field should figure out how to do their jobs with fewer resources. She says that many depend on her. “We don’t perform surgeries, we don’t write prescriptions. Our work products are really the answers.”
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