When someone dies, there are many reasons why it may be necessary to examine the body to determine the manner (natural, accident, suicide, homicide, undetermined) and cause (physiological condition, illness, or injury) of death, usually requiring an autopsy to be performed. Perhaps the circumstances surrounding the person’s death were suspicious, there was foul play or a suspected homicide, or maybe the deceased’s family simply wants to understand how their loved one died. When an autopsy is needed, the person who performs the exam is often a medical examiner.
Even when cases go cold, this role is very important to document a moment in time that would help with an investigation in the future. It could even be the work of a medical examiner that may be why a case reopens.
Read on for more information about the job of a medical examiner: what they do, how much they make, what it takes to become one, and how their work affects investigations when the deceased is the victim of a crime.
What Is a Medical Examiner?
A medical examiner (ME), also commonly referred to as a forensic medical examiner, is usually an appointed position filled by a professional with special training in human pathology. People in this role are often called upon to perform post-mortem examinations in instances of unnatural deaths. According to Wikipedia, the types of deaths that commonly require intervention by a medical examiner include:
- Inmates incarcerated in a public prison
- Persons in custody of law enforcement
- Those where no attending physician is present
- Those immediately following some type of medical procedure
- Those where neglect is suspected
In the United States, death investigations typically follow either a medical examiner system or a coroner system. While some jurisdictions use a combined system. The University of New Mexico Office of the Medical Investigator reports that 23 U.S. states have medical examiner systems, while another 18 have combined systems (ME and coroner), leaving only nine states with coroner-only systems. While the roles are sometimes confused because of their overlapping duties, medical examiners are not the same as coroners.
Coroners are usually elected or appointed government officials who may or may not have medical training. Some are attorneys, and many are people with no special education or training in any relevant discipline. Duties and qualifications vary widely by state and/or county, but coroners are almost always responsible for ordering death investigations and determining manner, cause, and time of death. Some coroners do not perform autopsies themselves but instead work with certified forensic pathologists who do the exams and file reports with their findings.
Medical examiners, on the other hand, are usually medical professionals, many with extra training specific to forensic pathology (forensic pathologists). Most U.S. jurisdictions require MEs to hold a medical degree, but there are exceptions. For example, certain counties in Wisconsin waive the educational and training requirements for this office. Medical examiners can also order autopsies, and it is common that they perform the procedures themselves.
What Do Medical Examiners Do?
A medical examiner’s role covers a wide variety of responsibilities, which vary by jurisdiction. Some duties are direct applications of their medical training, such as performing post-mortem examinations to determine how a person died. Other duties require medical examiners to use their experience and expertise to provide support for law enforcement investigations and/or judicial proceedings in cases of crimes that result in the death of a person or persons.
A typical day in the life of a medical examiner may include one or more of the following activities:
- Inspecting organs, tissues, and bodily fluids
- Collecting evidence, including DNA samples, in cases where foul play is suspected
- Studying toxicology
- Looking for signs of trauma to determine manner and cause of death
- Filing reports, issuing death certificates, and keeping records up to date
- Confirming identities for unknown deceased persons
- Providing crime scene investigation support
- Testifying in court as an expert witness
The role of medical examiners—particularly those with specialized training in forensic pathology—in the civil and criminal justice systems is critical. When authorities are investigating a possible criminal offense, particularly a homicide, the evidence a medical examiner collects can provide new leads for detectives or help focus investigations toward a specific suspect based on DNA left on the body of the victim. Even more fundamental, the final determination of the manner and cause of death provided by a medical examiner’s report frequently dictates whether or not a criminal prosecution can be pursued in the first place.
How Much Do Medical Examiners Make?
With such a wide range of required qualifications and responsibilities for medical examiners, compensation in the field varies considerably by location, experience, and specialized training. In Indiana, for example, the average medical examiner’s salary is $110,279, with a range from $87,174 to $139,697, according to salary.com. By contrast, forensic pathologists (medical examiners with additional training) make an average salary between $105,000 and $500,000 according to ExploreHealthCareers.org.
Because most medical examiners are physicians, average salaries for doctors are also relevant when trying to determine the estimated pay for a medical examiner or forensic pathologist. Doximity’s 2021 Physician Compensation Report shows that Charlotte, North Carolina; St. Louis, Missouri; and Buffalo, New York, are the three highest-paying metro areas for physicians overall. Conversely, the three lowest-paying metro areas for physicians include Baltimore, Maryland; Providence, Rhode Island; and San Antonio, Texas. According to the same report, the average salary for physicians working in a government setting in 2021 was $264,546. A 2020 report by Doximity showed the pathology specialty had an average compensation of $340,873.
In addition to location, experience, and job responsibilities, medical examiner salaries may also be affected by the current workforce shortage of forensic pathologist professionals. According to research conducted by Victor W. Weedn, MD, JD, and M.J. Menendez, JD, and published by the National Association of Medical Examiners, reduced funding for autopsies has drastically reduced the performance of autopsies in hospitals and other settings, which has contributed to a reduction in interest from medical residents to go into the forensic pathology specialty. With a supply of these specialized physicians dwindling, those with forensic pathology training may be able to command higher salaries in roles that still perform autopsies, such as for death investigations ordered by medical examiners and coroners.
How Do You Become a Medical Examiner?
The path to becoming a medical examiner is long and challenging, but the rewards of doing interesting, meaningful work can make the journey worth it. It should be noted that even though medical examiners often gain satisfaction from providing such an important public service, the physical and psychological demands of the job can create stress that should be carefully monitored and managed.
As outlined by ForensicsColleges.com, to be eligible for most medical examiner posts, several qualifications are required:
- High school diploma or GED (4 years)
- Undergraduate degree (4 years)
- Medical degree (MD or DO) (4 years)
- Medical license (requires passing a series of medical board exams) (2+ years)
- Residency completion (3 years)
- Medical examiner fellowship (1 year)
- Professional networking (variable timeline)
For many, medical school alone is daunting enough to discourage them from pursuing a career as a medical examiner or forensic pathologist. But for those with the drive, discipline, and determination, becoming a medical examiner is well within reach. Those considering this line of work should objectively assess their tolerance for the heavy, potentially gruesome, and often disturbing subject matter. Performing autopsies and contemplating causes of death—sometimes tied to violent crimes—are not for everyone.
An interesting facet of becoming a medical examiner is the need for excellent communication and networking skills. While it may not seem like working primarily with corpses would require someone to be a good conversationalist, the ability to make close contacts with influential people greatly improves a person’s chances of being appointed to a medical examiner position. It’s not enough to be capable and well educated—to get the job, you also need to be capable of developing relationships with those who make the appointment decisions.
Short of becoming fully certified and appointed medical examiners, people with lower-level education who have an interest in forensics can take advantage of adjacent opportunities to get involved. With a Bachelor’s degree, you can consider becoming a forensic autopsy technician or even a coroner, which does not usually require advanced degrees or specialized medical training. With a Master’s degree, someone could seek out positions in a medical examiner’s office or pathology lab, among other options.
Top Medical Examiner Schools
For those interested in pursuing the education needed to become a medical examiner or forensic pathologist, there are several schools with specialty fellowship and training programs. A list published by Best Accredited Colleges highlights the top options:
- University of Colorado in Denver, one-year fellowship in forensic pathology with the Denver medical examiner
- University of Alabama at Birmingham, one-year forensic pathology fellowship with the Jefferson County medical examiner
- Emory University in Atlanta, one-year fellowship with rotations in the Georgia Division of Forensic Sciences Crime Lab
- University of North Carolina at Chapel Hill, one-year fellowship program with hands-on autopsy case management
- University of Texas Southwestern Medical Center, one-year fellowship program with exposure to courtroom testimony
- Wake Forest University, one-year fellowship with attendance at the American Academy of Forensic Sciences’ annual meeting
In addition, the National Association of Medical Examiners maintains a database of active forensic pathology training programs across the country.
After completing the educational requirements, aspiring medical examiners may opt for additional certification to strengthen their chances of receiving an appointment for an open position. The American Board of Medicolegal Death Investigators (ABMDI) offers certification for professional forensic medical examiners, and the American Board of Pathology offers board certification in forensic pathology.
Famous Medical Examiners and Their Most Memorable Cases
Those who work as medical examiners long enough are bound to encounter some particularly difficult, controversial, and/or memorable cases, particularly those that involve violent crimes or contentious prosecutions. In the true crime community, there are even a few “celebrity” medical examiners who have been involved in some of the country’s most well-known cases.
- Thomas Noguchi, known as the “coroner to the stars,” previously served as the Chief Medical Examiner-Coroner for the County of Los Angeles in California. During his tenure, he performed autopsies on several celebrities, including Marilyn Monroe, Robert F. Kennedy, Janis Joplin, and Natalie Wood, among many more. His career was bumpy, with multiple removals from his role as medical examiner for questionable judgment and management practices. His determination of Natalie Wood’s manner of death as an accident was later changed by the medical examiner that succeeded him.
- Michael Baden, a controversial figure in the forensic pathology community, formerly served as the Chief Medical Examiner of the City of New York. The most famous cases he has been involved with include the assassination of John F. Kennedy, the murder trial of O.J. Simpson, and the recent murder of George Floyd. Baden’s autopsy results are infamous for often contradicting the conclusions of other officials investigating the cases.
- Henry Lee, a world-renowned lecturer, professor, and forensic consultant, does not serve in a traditional medical examiner role. Instead, he has used his forensic science background and education to assist law enforcement as an advisor, expert witness, and Director of Connecticut State Police’s Forensic Laboratory. Lee has provided his insight on the high-profile murder cases of JonBenét Ramsey, Laci Peterson, and the murder trial of Casey Anthony, among others.
Medical examiner work is not easy, but it is important, and the shortage of professionals specializing in forensic pathology and seeking government appointments as medical examiners is an alarming reality that needs immediate intervention.
Whether dealing with cases that are famous or not, the criminal justice system relies on the work of medical examiners and forensic pathologists to decipher the circumstances surrounding unnatural deaths. Especially for cases that don’t receive a lot of media attention, the manner and cause of death determinations made by medical examiners may be the keys to obtaining justice for victims and answers for their families and loved ones.
To learn more about what it takes to become a medical examiner or how to get involved in the community, visit the National Association of Medical Examiners; or if you’re interested in other career paths that might lead you to help solve cold cases check out: What’s it Like to Have That Job: Forensic Genealogist, What’s it Like to Have That Job: Sketch Artist, What’s it Like to Have That Job: Notary Public, or What’s it Like to Have That Job: Coroner.
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