Lesson 1: Always be ready to leave your job.

Dr. Root’s advice had caused me to reconsider my decision. Was it really smart to enter a profession with so much seeming to go against it? Would I be doing well for my family and myself?

After consideration, I realized that I was capable of practicing any specialty in medicine I wanted. I was well-trained and competent. I saw no reason why I should compromise my integrity. I decided at that time that if I was asked to perform below standard or if I was asked to do something I knew was not right, I would quit my job and do something else in medicine for a living.

I did not realize it at the time, but I later found out that this is the key to success as a medical examiner: to always be ready to leave your job.

Why should this be? Well, it is simple. Forensic pathologists in the United States—and perhaps elsewhere—are currently and have always been in short supply. Very few people want to do forensic pathology full time as a career. There are only about 600 board certified forensic pathologists in the nation. Among those, I would imagine that those with leadership capabilities are even fewer. Because of this short supply of qualified individuals, the bargaining power of the qualified and capable forensic pathologist is tremendous.

The manpower shortage of forensic pathologists is the “trump card” for the savvy medical examiner. It is far more costly for an employer to replace a capable and honest forensic pathologist than it is to accede to his or her requirements.

Here is the typical scenario. Often, when an office loses a chief medical examiner because of scandal or for any other reason, the position typically remains open for a long period of time. Eventually, when the position is filled, the governmental entity sponsoring the office ends up paying the new chief far more than the old one—even up to twice the old salary in some cases! On the other hand, the pathologist who was let go will typically end up in a situation far better than the one he or she left, even when the reason for leaving was because of scandal.

Those of us who have been around for a while have seen this scenario play out throughout the country over and over again. I take great comfort in this. I realize that if I were to leave my job, I will likely be much better off for having done so! Leaving my job might even be a promotion!

Consequently, I am not afraid to leave my job. During my tenure in Jackson County, Missouri, I had offered to leave several times. One time, I even offered to leave on a local television newscast!

A few budget sessions ago, the County felt it was necessary to make an across-the-board budget cut affecting all departments. My office faced an $80,000 budget cut. We would not be able to function optimally with this cut, because we only asked for the amount of money we needed to function optimally and no more (see Lesson 6). I remember sitting across the table from the finance director when I told her: “I hope one day to retire as a forensic pathologist with my reputation intact. If you cut the budget, I will not be able to operate at professional standard. I will be putting my career and the well-being of my family at risk, and I am not willing to do that. If the budget is cut, I will leave!”

They did not cut my budget. It would have cost the county far more to lose me than they would save with the cut.

If one aspires to a career as a medical examiner, he or she must be willing to leave if the situation requires it. My family is fully aware of this. Although it is never pleasant to leave familiar surroundings and friends, my family realizes that leaving is always an option. We have done what we can to prepare for this financially. If I threaten to leave, I must be willing to follow up on my threat, and believe me, I am fully prepared to follow up on it!

Always being ready to leave your job is the key to maintaining integrity and professional competence in a politicized system.

What if you are currently in charge of a system that will not give you what you need to operate optimally? Several of us accept to work in jobs where those who supervise us tell us that “their hands are tied” and there is nothing that can be done to increase our salary or budget. How do you know when to stay and when to leave?

One thing is for certain. If you find yourself presiding over a dung heap, you have stayed too long!

When my wife and I were teaching our kids to drive, we took the time to teach them how to recognize when they were in the “bad part of town.” While driving, if they see broken-down sidewalks with weeds in the cracks, buildings in poor repair, metal bars on shop windows, pawn shops, adult entertainment bookstores and bars, and youth dressed in typical urban attire hanging out on street corners, they should recognize that they are likely in a high crime area, and they should look for ways to leave as soon as possible!

I am reminded of the “East Point Lady”—an elderly southern woman I autopsied during my days in Atlanta. Although a “suburb” of Atlanta, East Point is a high crime area with many of the characteristics I mentioned above. Still, this little southern lady could never leave East Point. She grew up in her East Point house and could not see herself living anywhere else. Unfortunately, I had to autopsy her because she was murdered in that house during a robbery.

The East Point lady is an example of one who stayed too long. Too many medical examiners also find themselves as victims when they stay too long in politically corrupt and substandard jobs run by inept politicians. There is no need for this to happen if one is always ready to leave the job!