Transient Workforce in Forensic Pathology: Challenges, Rewards, and Best Practices

Overview

A roadmap to successfully utilizing contract forensic pathologists, also known as locum tenens, will be presented by a Chief Medical Examiner and a Coroner with extensive experience in employing these useful contractors to perform forensic autopsies in today’s environment of increasing caseloads and challenging recruitments. The forensic pathologist workforce shortage is now a well-known issue being addressed in the longer term with increased recruitment efforts and other strategic planning by the field’s professional organization(s). However, in the short term, administrators must still find a way to get the work done while maintaining appropriate autopsy caseloads per forensic pathologist (whether for accreditation standards or simply to retain those forensic pathologists already employed). The workforce shortage makes recruiting additional forensic pathologists a challenging prospect in many locales. More forensic pathologists than ever are practicing in a contract capacity; recent data presented by the National Association of Medical Examiners indicated that 14% of currently practicing forensic pathologists work as locum tenens, and only just over 900 forensic pathologists are practicing in the United States. Caseloads have been in flux, rising in many jurisdictions because of the opioid (fentanyl) epidemic.  

Contract forensic pathologists who travel to an office to complete autopsies for a limited time for a fee can be a useful workforce adjunct to meet the increased caseload. Different business models may be applied to the use of locum tenens; these contractors may be used for a limited time to fill in for a position vacancy or extended leave, may be used indefinitely as part of the routine caseload coverage for an office, or may be used to cover an increasing caseload during the time lag in working through the budget process to obtain approval to recruit additional full-time forensic pathologists. Locum tenens may handle all cases for an office during their scheduled work period, a set number of cases, or only those cases not anticipated to require returning to testify. These contractors may be used for other professional tasks as well, such as backlog elimination (autopsy report completion), report completion for forensic pathologists who have resigned, or quality assurance reviews required for accreditation. Differing fee structures can also be designed, including fee-per-autopsy or fee-per-day, and offices vary as to which additional costs (such as travel, lodging, and incidentals) are reimbursed; timely case completion “bonuses” may also incentivize rapid turnaround time.  Workflow aid documents and policy training may be needed to ensure contractors are seamlessly incorporated into an office’s existing structure. Scheduling months in advance may be necessary to ensure adequate availability of locum tenens for caseload or specific leave time coverage. Advance consideration of who will complete case follow-up (such as phone calls or meetings) and how expert testimony will be handled after the fact is necessary. While there are many considerations and challenges to incorporating contract forensic pathologists, the rewards are also vast, and include increased capacity for caseload, improved office functioning and turnaround time, elimination of backlogs, and improved full-time forensic pathologist retention. 

Detailed Learning Objectives

1. Attendees will recognize different business models for using contract forensic pathologists (locum tenens) in busy Medical Examiner and Coroner offices.
2. Attendees will understand the challenges of utilizing locum tenens forensic pathologists, including scheduling, budgeting, workflow, case follow-up, and expert testimony.
3. Attendees will review the issues surrounding the forensic pathology workforce shortage which necessitates increased use of locum tenens in some locales.

Presenters

• Laura D. Knight, M.D. | Chief Medical Examiner and Coroner, Washoe County Regional Medical Examiner's Office, NV
• Melanie Rouse, DPA (c), ABMDI-F | Coroner, Clark County Office of the Coroner/Medical Examiner, NV