Specialty Profiles

What it’s like in forensic pathology: Shadowing Dr. Caruso

As a medical student, do you ever wonder what it’s like to specialize in forensic pathology? Meet James Caruso, MD, a forensic pathologist and a featured physician in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out his insights to help determine whether a career in forensic pathology might be a good fit for you.

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“Shadowing” Dr. Caruso

Specialty: Forensic pathology.

Practice setting: Medical examiner’s office (county office).

Employment type: Employed by the County of Denver.

Years in practice: 30—25 spent on active duty in the U.S. Navy.

A typical day and week in my practice: Morning meeting to go over new cases and the events of the previous night. Autopsies are typically completed in the morning along with our forensic pathology fellow, pathology residents and medical students.

Some days I might have to testify in court, on others I may go to a death scene and help with the investigation. We have daily quality control meetings to present cases to each other, lectures are provided to the fellow, residents and students, and there are frequent meetings with attorneys (prosecution and defense) for upcoming trials.

My day is typically about 7 a.m. to 4 p.m., with one of the three staff taking after-hours call. One of the three of us will work the weekend, but in return will take two weekdays off as compensation.

The most challenging and rewarding aspects of forensic pathology: The diagnoses I make and conclusions I come to can either result in someone going to prison or being exonerated from criminal activity such as murder, vehicular homicide, and manslaughter. My decisions may also impact the payment of life insurance benefits as well as civil litigation.

The most rewarding aspect is providing closure for the families—giving them a cause of death in a case where death was totally unexpected. Also, identifying previously unknown decedents is particularly rewarding.

Three adjectives to describe the typical forensic pathologist: Meticulous, resourceful and observant.

How my lifestyle matches, or differs from, what I had envisioned: Early in my career, I was a primary care physician specializing in diving and hyperbaric medicine. During that phase, I spent weeks and even months away from home on deployments. In my current position, and now retired from the military, it is easier to have a family-career balance.

My hours are reasonable, call is pretty benign (an occasional scene to go to, but more often simply answering questions over the phone and approving organ donations). My colleagues here are both women with young families. They are able to break away from their workday and make it to school events, take the kids to medical and dental appointments, etc.

Skills every physician in training should have for forensic pathology, but won’t be tested for on the board exam: Solid interpersonal skills are essential. Most people, and even many physicians, believe pathologists do not need a “bedside manner.” Successful pathologists actually are very good at communicating. One of our primary roles is to communicate information to others, whether it is biopsy results to a clinical colleague or the cause of death to the next-of-kin.

Also, the fellowship is only one year long, so the physicians need to bring some real-life experience with them at the beginning of training. We deal with deaths on the job, drug overdoses, suicides, motor vehicle related deaths and, of course, homicides. Some insight into human nature and human behavior is essential. 

One question physicians in training should ask themselves before pursuing forensic pathology: Can I handle viewing extreme trauma and the associated disfigurement of the human body?

Books every medical student interested in forensic pathology should be reading:

  • DiMaio and DiMaio, Forensic Pathology.
  • Dolinek et al., Forensic Pathology.
  • Robins et al., Pathologic Basis of Disease.

The first two are comprehensive forensic pathology texts and will need to be completely digested to pass the board examination. The third book is introduced during medical school and residency.

A forensic pathologist must have a thorough grasp of the scope of disease processes, including natural disease. While most think that our job is all gunshot wounds and other trauma, 50 percent of the average caseload in a medical examiner’s office deals with deaths due to natural disease.

The online resource students interested in forensic pathology should follow:Interested students and physicians should visit the websites for the National Association of Medical ExaminersCollege of American Pathologists and American Academy of Forensic Sciences.

Quick insights I would give students who are considering forensic pathology: It is not one of the highest paying specialties in terms of salary and compensation, but recent gains have been made in that area. The job satisfaction level is excellent, there is no concern about insurance forms or reimbursement, and the lifestyle is generally considered to be one of the best among medical specialties.

More about choosing a specialty

The AMA provides a guide, “Choosing a Specialty: An AMA Resource for Medical Students” (PDF, AMA members only) that presents a clear, approachable overview of specialties and subspecialties and can assist you in choosing a career path.