Lesson 20: Contract with outside forensic pathologists for coverage.

As forensic pathologists, we are members of a small subspecialty with a marked manpower shortage. Consequently, a pathologist leaving a small office for other employment can precipitate a crisis.

I have found myself subject to this kind of crisis more than once during my tenure as a chief medical examiner. Pathologists and deputy medical examiners coming and going are facts of life.

Replacing that departing pathologist also becomes a monumental challenge. I found out the hard way that no one wants to move to Kansas City, in spite of the fact that it is a wonderful place to live and to raise a family. Forensic pathologists seem to prefer living on the east or west coasts. As a result, I had covered the office by myself for long periods of time.

During a period of shortage, some may ask pathologists (or even non-pathologists) without proper training or credentials to do autopsies. This is dangerous. One cannot anticipate when a case will be critically important, requiring more expertise. The maxim, “A little knowledge is a dangerous thing,” could not be truer. A pathologist without the proper training may not recognize when he or she is in trouble and needs help.

Also, covering an office for long periods of time can lead to fatigue and then mistakes. After one long stretch of several months as the only pathologist in the office, I warned my investigators and other office staff to keep a close eye on me. I wanted them to tell me freely if they felt I was overlooking important evidence or taking short cuts. A failure to “sharpen the saw”—a term used by Stephen Covey to describe the importance of rest, recovery and recreation—may lead to serious mistakes1.

What does a chief medical examiner do to cope with a shortage of pathology help in the office?

As with most items, the capable and qualified chief medical examiner thinks ahead—way ahead. The chief looks for other capable and qualified forensic pathologists from elsewhere to serve the office in a locum tenens capacity.

Forensic pathology is a low-paying specialty, so many of our colleagues are in search for additional income. Some save up vacation and “comp” time to allow themselves time to “moonlight.” Providing an opportunity to make money—good money—is a way to provide a “win-win situation”—another Stephen Covey term—for both the chief needing help and the pathologist wanting extra income1.

Providing this type of part-time income is also a way to stave off having to add another full-time pathologist to the staff, even when the office is nearly fully staffed. A part-time pathologist under contract does not require county benefits, so the county government saves the money it would ordinarily pay in benefits. Even if your government were to pay for the airline ticket, the hotel room, the medical license, and even malpractice insurance for the locum pathologist, it would still save money in the end by not having to pay for benefits.

The chief who thinks ahead looks for pathologists he knows at professional meetings and provides the opportunity in advance. The chief should do this before the manpower shortage occurs.

Certainly, it is important to evaluate the candidate in the same fashion as if he or she was a candidate for a full-time position. An interested locum tenens forensic pathologist should forward a CV and references to you if you do not know him or her well. Even if you do, it is helpful to maintain his or her professional information in your file.

In Missouri, I had often testified in court from autopsy reports performed by a contract pathologist, saving the county the expense of having this pathologist appear in court. This arrangement always worked out well for both the prosecutor and the contract pathologist. I realize that not all jurisdictions make it easy for a pathologist to testify from the report of another pathologist, but I have always been surprised at the lengths a prosecutor will go to keep from spending money.

Contracting with outside forensic pathologists for coverage saves money, encourages good will with other colleagues, and provides the beleagured chief medical examiner help during a manpower shortage.

1 Covey SR. The Seven Habits of Highly Effective People. New York: Simon & Schuster, 1990.