Recently in Korea, autopsies, which can provide conclusive evidence in criminal investigation, have been increasing. However, the number of medical examiners, also known as forensic pathologists, has been decreasing.

According to the National Forensic Service (NFS), it takes more than 9,000 requests for autopsies and eye examinations from investigation agencies annually. However, only about 50 medical examiners, including a retiree across the nation, can perform an autopsy. Among them, those working at the NFS are 35. This means that one medical examiner performs 200 autopsies annually.

The Korean Society of Legal Medicine (KSLM) is desperately searching for a way to nurture medical examiners due to the shortage.

In Korea, doctors become forensic pathologists through an accreditation test system, not the specialist test system. Medical examiners are mostly pathologists due to the nature of their work, which mainly involves autopsies. Pathologists who major in forensic medicine for more than two years are selected through an accreditation test.

Recently, however, the number of trainee doctors applying for pathology has declined sharply, lowering the chance to produce medical examiners.

According to the Ministry of Health and Welfare, trainee doctors’ application rate for pathology fell from 66.1 percent in 2016 to 35 percent in 2019. During the same period, quotas for pathologists remained over 60. Still, the number of applicants from first-year residents decreased from 41 to 21.

KSLM said it set up three scenarios and examined their feasibility – they can either introduce a medical examiner specialist system or set special courses in pathology and let subspecialists who get a subspecialty license become medical examiners.

However, KSLM concluded that the three alternatives were not feasible.

“Forensic medicine’s related field is pathology. Most medical examiners are pathologists. They are a good source to major in forensics because they have skills for autopsies and eye examinations,” said professor Park Sung-hwan of forensic medicine at Korea University College of Medicine. “But applicants for pathology have become extremely rare.”

Even if the nation approves a forensic medicine specialist system, training them is another issue, Park said. He added that forensic medicine specialists should be sent to pathology departments for training, but they would not like it. “We need to think about how to pay those trainee doctors and who will take the initiative.”

KSLM brought up the idea of a subspecialist system, but it would not be easy to introduce, he went on to say.

Even if the system is introduced, subspecialists will be under the pathology department, which will not be much different from the current system. Park predicted that specialists in other departments would not be enthusiastic about forensic medicine, either.

“So, for now, three scenarios are not likely to help,” he said.

Forensic pathologists need 2 more years of study but get poorly treated

Experts said there was one solution to nurturing many medical examiners – solid job security.

After getting a specialist license, doctors have to study forensic medicine for two more years to become medical examiners. However, medical examiners are more poorly treated than other physicians.

According to the Ministry of Security and Public Administration, the average salary of a Korean doctor is 165 million won ($142,591). Still, the average salary of a medical examiner at the NFS is far below the figure. Thus, experts said that forensic pathologists at the NFS should receive higher pay with better welfare to produce more medical examiners in Korea.

“Medical examiners at the NFS are civil servants, and their work is very intense. Clinicians at the police hospital under the same Ministry of Security and Public Administration receive patient care incentives and enjoy better welfare. Still, forensic officers at the NFS cannot receive autopsy incentives,” Park noted. “This system discourages their morale, and they cannot help but feel relatively deprived.”

Increasing medical school quotas will not solve the problem because the number of doctors has already risen sufficiently, and increased physicians do not lead to more forensic medicine specialists, Park went on to say.

“As the number of doctors increased, doctors grew more anxious about their livelihood. They have no choice but to go to a well-paying department,” he said. “Thus, the nation should improve treatment for NFS medical examiners and raise their salaries dramatically.”

Park also emphasized that the NFS and forensic medicine classes of medical schools should create a virtuous cycle. He said that medical examiners at the NFS could become forensic medicine professors based on their field experience and expertise, or medical professors could become forensic officers to accumulate field experience.

However, there is no such system available in Korea.

Suppose a medical examiner at the NFS wants to work at a university. In that case, he or she is not even eligible for application because the university requires an SCI paper, Park said. NFS medical examiners are intensely working. He added that it is almost impossible to write five or six SCI papers while working at the NFS, which makes it difficult to have workforce exchanges between the NFS and universities.

Another expert suggested installing a forensic medicine class at each medical school.

Only 10 out of 41 medical schools have a forensic medicine class. The 10 schools include some national universities like Seoul National University (SNU), Kyungpook National University, Chonnam National University, Chonbuk National University, Pusan National University, Jeju National University, and some private universities like Korea University, Yonsei University, and Konkuk University.

Professor Yoo Seong-ho of forensic medicine at the SNU College of Medicine said that after introducing the forensic medicine department at Chonnam National University and Kyungpook National University, more graduates are becoming medical examiners. He said students needed “role models” to show them the future of medical examiners.

“I think creating a forensic medicine department at each medical school and securing faculty can be a realistic alternative,” Yoo said.

If medical examiners become extremely rare, the quality of forensic analysis will worsen, making it challenging to realize criminal justice in court, Yoo warned. “If the number of doctors able to perform an autopsy declines, it could hurt the advancement of medicine, too.”

The nation also needs to pay more attention to producing doctors for particular purposes, he went on to say. It will be great if medical students have to take forensic medicine as a mandatory course for graduation. When they do, it will be better if the medical professor who handles bodies leads the class.

“Wouldn't it be great if a doctor who performed an autopsy on a case in that area gave a lecture to the students,” he said. “I hope the Korea Association of Medical Colleges or the Ministry of Health and Welfare, or the Ministry of Education could designate forensic medicine as a mandatory course.”