The following is the fifth chapter in an NPR/ProPublica/Frontline report on death investigation in the United States.
Despite the ubiquity of forensic pathologists in pop culture, the field has had little appeal to most medical school graduates.
To become certified by American Board of Pathology, doctors must receive an extra year of training in autopsies at a coroner or medical examiner's office and pass a one-day exam. In addition, forensic pathologists are typically paid less than doctors in other specialties.
By most estimates the U.S. has only 400 to 500 full time forensic pathologists. It's a tiny cadre of professionals for a country where roughly 2.5 million people die every year.
Partially because of the shortage of qualified practitioners, many of the nation's busiest coroner and medical examiner offices employ physicians who are not certified.
A survey of more than 60 of the nation's largest medical examiner and coroner offices by ProPublica, PBS Frontline and NPR found 105 doctors who have not passed the exam – or more than 1 in 5 doctors on their full-time and part-time staffs.
Some have recently completed their training and have not had a chance to take the test, which is offered once a year. Others are long-time practitioners who have no plans to become certified.
But in numerous cases, the doctors are not certified because they have failed their exams.
The Arkansas State Medical Examiner's Office employs two forensic pathologists who have flunked their exams multiple times, according to chief medical examiner Charles Kokes. He described certification as a "personal goal," and said the doctors had no plans to take the test again.
In Kentucky, Chief Medical Examiner Tracey Corey acknowledged the state employs a doctor who is not even eligible to take the forensic pathology test because she failed the anatomic pathology exam, which is a prerequisite. "I'm comfortable having her work because I know her competence," Corey said.
The Sheriff-Coroner in Orange County, Calif., contracts with Juguilon Medical Corporation to provide autopsies. One of the company's doctors has failed the certification exam five times, acknowledged Anthony Juguilon, the company's chief, in an e-mail.
Some experts put little weight on board certification, but many leaders in the field say it's a critical elements – that you can't raise the overall quality of death investigation unless the people who do autopsy work are subject to consistent professional standards.
"What does it mean? It means that they have not demonstrated they have minimum knowledge of the field," said Vincent Di Maio, the former chief medical examiner for Bexar County, Texas. "And these people get hired."
Continue reading this NPR News investigation in partnership with ProPublica and PBS Frontline:
Chapter 6: Oklahoma's Lack of Resources Means Few Autopsies