24: What is Forensic Pathology? Dr. Melinek Shares Her Story

Session 24

Today's guest is Dr. Judy Melinek, a New York Times bestselling author and a Forensic Pathologist based in California. She documented her journey through her fellowship training in her book, Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner.

One important thing to note is that Pathology isn't actually a required rotation in medical school, one reason that it's not commonly under the radar of most medical students. Listen to our discussion about the field of Forensic Pathology and how you can explore if this is something you're interested in.

[01:20] Working as a Forensic Pathologist

Dr. Melinek does some academic work. She is currently affiliated with UC Davis as a Research Associate. Forensic Science students from their Master's and undergraduate programs shadow her but she isn't presently on staff at any academic institution.

Most forensic pathology jobs tend to be for government agencies, either a coroner/medical examiner's office. Any academic affiliation usually tends to be in the clinical instructor's status teaching residents and medical students.

Dr. Melinek did her fellowship in Forensic Pathology from 2001 to 2002 and then she did another fellowship in Neuropathology from 2002 to 2003. In 2001, she started working as a Forensic Pathologist because even during fellowship, she got paid doing autopsies being part of the coroner/medical examiner's office, specifically working for the New York City Medical Examiner.

[02:49] The Road to Forensic Pathology

Dr. Melinek only figured out she wanted to become a forensic pathologist until later since she wasn't exposed to it as a specialty in medical school. She stresses this is something we need to further discuss and explore because it's a real failing in our medical education that pathology is relegated to second year academic discourse but there is no required pathology rotation in medical school like there is for internal medicine or general surgery. It's only something people have to discover on their own.

Dr. Melinek got exposed to Pathology in second year medical school just like all medical students and then they offered this post-sophomore fellowship in pathology, which is an extra year you take in medical school between second and third year and work in the pathology department. You're just like a resident and you get paid but you're not just a resident or MD yet. But it's an opportunity for them to expose people to pathology in a more hands-on level.

She basically did this post-sophomore fellowship in Pathology having wanted to take a gap year between college and med school. But she got in off the waiting list and she was afraid she would lose her spot if she decided to defer. So she found this as an opportunity to take a break but still be doing medicine and working at the same hospital she was training at. Dr. Melinek describes it as a great experience having been exposed to multiple different rotations in pathology including the blood bank, autopsy, and surgical pathology. Also during that time, she was allowed to do research and she actually decided to do research with the liver transplant team. That's when she fell in love with surgery and decided she wanted to be a surgeon. But everybody in Pathology convinced her to be a pathologist.

Upon finishing medical school, Dr. Melinek matched in Surgery and went to a General Surgery residency and lasted for only six months until she collapsed from exhaustion and decided she wanted to be a Pathologist realizing it was a better fit for her personally and professionally. Because of her impressive work, the pathology department at the UCLA Medical School had saved her a spot outside the match so when she quit surgery, they gave her a spot to start in July. Dr. Melinek claims it was the best decision she ever made.

[05:40] Post-Sophomore Pathology Fellowship and Demand

This type of fellowship is sponsored through ACGME and the American Board of Pathology. The organizations that accredit pathology residency programs allow a year of pathology while you're still in medical school and it accounts towards your residency. This existed when Dr. Melinek was still in medical school. (Upon checking on the internet, some institutions that offer this program today include UCLA, Stanford, Duke, and West Virginia University. Check with the institution you’re interested in getting into if they offer such program.)

Of the six post-sophomore fellows they had during her time, three ended up in Pathology. Dr. Melinek says this program helps people who are interested in the field to pre-select and also it cements their interest. It's an easy way to get people interested in it.

She adds that Pathology is easy to recruit for once you're exposed to it. It's such a wonderful field. It's so intellectually stimulating. People are really nice. It has pretty decent work hours and not as physically or emotionally grueling as some of the other specialties can be, especially surgery. Dr. Melinek thinks it's easy to recruit but the problem is it's not a required rotation in medical school so it's not in the radar of a lot of students. It's not something they think about.

As a result, there are only about 700 or so board-certified forensic pathologists practicing in the United States, which is half of what they need for the demand. She sees job openings that are open for months and even years because there is just not enough forensic pathologists to fill. Dr. Melinek therefore highly recommends the field for medical students to consider in terms of job security and opportunities.

[07:51] Surgery versus Forensic Pathology

Dr. Melinek got drawn to surgery because of it's hands-on nature and you get to fix things, as a practical person that she is. However, she wasn't attracted to the field's lifestyle and found it to be too exhausting. She was on call every other night and she had to watch her attending physicians cycle through multiple marriages and being there late at night for long hours, sacrificing their family times and their own mental health in exchange for the career, which she thought as unnecessary. She believes it's a financial burden and a cultural problem in the field and that you really don't need to train surgeons this way as there are more reasonable programs in general surgery.

What Dr. Melinek likes about pathology is the reasonable hours. She basically was drawn to it primarily because of that exposure she had in medical school though at that time she didn't have the passion for it that she had for surgery. She felt disconnected from patients and that she wasn't being a real doctor. People do criticize that which of course Dr. Melinek thinks is such a crap. Anyway, she felt disconnected from patient care and from the action and excitement that surgery had until she did her forensic pathology rotation at the New York City Medical Examiner's Office.

[09:22] The Work of a Forensic Pathologist

When she was a resident in Pathology, they did rotations in different fields and she went to the New York ME's office for a one-month rotation. There she fell in love with the field, being able to go to crime scenes, testify in court, and interact with police officers and with family members of those who had died. She finally got that variety and excitement she was missing.

Dr. Melinek wants people to understand that this is the pathology work. You're not just in a lab doing autopsies and looking at microscopic slides all day. You do a lot of field work, going out to scenes as well as a lot of work interacting with a lot of families on the phone. You testify in court at least once a month on average for her. You also interact with lawyers as you try to explain the science to them. Basically, you're built in as an academic and a teacher even though you're not officially in an academic environment. Dr. Melinek finds herself educating family members about the disease process that killed their loved ones over the phone. She finds herself teaching juries about science so that they can make a good decision about guilt or innocence about civil liability. She considers herself a teacher, just not in formal academic setting.

[10:55] Traits of a Good Forensic Pathologist

You have to be curious and to be the kind of person who digs more into something when it doesn't make sense or it sets off your BS meter. A lot of medical specialties are not going to have all the answers and you have to take the best pass forward given the limitations of your time and financial resources. But in forensics, you have time. They have an expression in forensics that is kind of tongue in cheek, "They're still be dead tomorrow." On the plus side, it means you can work on a case the next day and not have to rush it. The other aspect of that is you can put this off 24 hours and think about it. You can look up another article or contact your colleagues and wait. There's no rush in those cases for you to come up with conclusion. What's more important is for it to be rigorous, accurate, and defensible.

[12:12] A Day in the Life of a Forensic Pathologist

Dr. Melinek currently works three days a week at the Alameda County Sheriff/Coroner's Office and sometimes fill in on Mondays or Tuesdays if other people are sick or on vacation.

Her typical day at work is waking up at 6:00 to 6:30 am and gets a text from her boss informing her of the number of cases she has. She g