Becoming a Forensic Medical Examiner – Education & Licensing

Medical examiners, a career that once existed far from the public eye, have become much more well-known thanks mainly to their popular culture representations, such as Dr. Saroyan from the television show Bones. By examining the bodies of people who have expired, a medical examiner can uncover the secrets of their death, sometimes with alarming precision.

People interested in this field will find that it has many rewarding aspects, from the salary to the exciting work the career offers. Most commonly, the term medical examiner is used synonymously to refer to a forensic pathologist. A forensic pathologist is a specialized type of medical doctor with advanced training in the field of pathology and additional training in forensic pathology (determining the cause and manner of death). It is also essential to distinguish a medical examiner from a coroner, who may or may not have any medical training.

Those in the field perform post-mortem examinations of human bodies. They look into sudden and unexpected deaths and violent incidents to determine the cause and time of death. The forensic pathologist or medical examiner may look into the deceased’s medical history, examine the crime scene and statements from witnesses, and analyze evidence found on the body, such as gunpowder residue or bodily fluids. Familiarity with other fields, such as radiology, toxicology, and even ballistics is beneficial.

The medical examiner prepares reports, including a death certificate, and often works quite closely with law enforcement on cases. In addition, this specialist may testify in court and present their findings before a judge and jury.

Read on to discover this field’s career outlook, salary, responsibilities, and credentials.

Meet the Expert: Michelle Stram, MD, ScM, FCAP

Dr. Michelle Stram is a former senior medical examiner at the New York City Office of the Chief Medical Examiner (NYC OCME). She completed her residency training in anatomic and clinical pathology at the University of Pittsburgh Medical Center (UPMC) followed by fellowships in forensic pathology and forensic neuro/cardiovascular pathology at the NYC OCME, where she subsequently stayed on staff as a city medical examiner. She is an active member of the College of American Pathologists (CAP) and serves on its Council on Informatics and Pathology Innovation.

ForensicColleges.com: What do you wish the public understood about forensic medical examiners?

Dr. Stram: One of the misconceptions that I have encountered is that many people think that forensic medical examiners are only interested in and involved in deaths that are related to trauma. Although documenting injuries and determining exactly how an injury caused death is a very important part of what we do, we have a much larger role in many natural deaths and public health more broadly. We also have a very important role to play in providing vital statistics, such as information on deaths due to opioid overdoses.

Most people realize that forensic pathologists have a role in cases where there is physical trauma or chemical injury, such as car accidents and accidental drug overdoses, but they may not realize we play an important role in determining the cause of death for children and young adults who die suddenly and unexpectedly. Sudden and unexpected deaths in young people can be some of the most challenging cases that we encounter, and we will do everything that we can to try to provide answers for grieving families.

For example, we may have a case where a young person who is playing basketball suddenly collapses, and despite the best efforts of first responders and the emergency room staff, that young person dies. If, during the autopsy, we identify a cardiac condition that can be inherited and which is responsible for that young person’s death, some jurisdictions (such as the NYC OCME) can perform additional specialized postmortem testing. In the NYC medical examiner’s office, they can perform postmortem molecular genetic testing.

In some cases, the forensic pathologist (working with the molecular genetics laboratory) can identify an underlying genetic cause for the previously undiagnosed heart condition, which could impact the decedent’s family members.

In these cases, the autopsy and all of the special testing that we do are not only important for determining the cause of death, but they can also have lifesaving implications for the family. With the information that we can provide, the family members who are at risk for the heart condition can undergo targeted testing and appropriate clinical follow-up to help hopefully prevent any other sudden and unexpected losses for a family.

I would also want people to know that there are many ways to practice forensic pathology. You can be a medical examiner in a big city like NYC or LA, but you can also work in small offices (or more rural places) that might have medical examiners working in part of the hospital (like in some places in North Carolina or Minnesota). Some forensic pathologists might spend years practicing in a large medical examiner’s office, then leave that position to run a non-forensic hospital autopsy service, where they spend a lot of time teaching pathology residents, medical students, and pathology assistant students, helping to get the next generation exposed to the field and excited about going into this specialty.

Many forensic pathologists move in and out of these different forensic or academic positions during their careers and may make these changes multiple times. The types of cases you will see in forensic pathology may also differ by where you practice, and within the US, there are many places you can work (Hawaii, Guam, Alaska, urban, rural, etc.) and in many different types of systems (city medical examiner systems, state medical examiner systems, coroner systems—all of which will offer different experiences).

One of the other elements that people may not appreciate about forensic pathology is that depending on where and how you want to practice, there are many opportunities for us to spend a lot of time speaking with families. For example, in cases where someone loses a brother or sister to a suicide or an accidental drug overdose, we may be able to help them better understand what happened and put them in touch with resources and services to help the family through these very challenging losses.

ForensicColleges.com: What advice would you give to aspiring forensic medical examiner students?


Dr. Stram: To be a really good forensic medical examiner, you need to be a really good doctor. All of the physiology, pharmacology, and medicine you learn in medical school will help you build the background you will need to understand physiological derangements and pathology in your cases in the future. You will also want to become an excellent general pathologist because many of the cases you will encounter as a forensic pathologist are natural deaths. Someone may die from advanced cancer, diabetes, or an infection that was not diagnosed in life, and you need to be comfortable working these cases up and reaching the correct diagnosis.

Because many forensic pathologists I know are shifting back and forth between forensic pathology positions and hospital autopsy positions during the course of their careers, I advise students to strongly consider adding an additional specialty fellowship (such as pediatric pathology, neuropathology, or cardiovascular pathology) during their training—both because this will make them a better forensic pathologist (and an excellent resource for their FP colleagues without this additional training) and provide them with greater flexibility to pursue different hospital-based positions during the course of their careers.

I would also advise them to be forward-thinking and to consider how developing domain expertise in other subspecialties within pathology (such as molecular genetic pathology) may also be valuable and help move the field forward, especially as we think about undiagnosed genetic conditions that can cause sudden and unexpected death in young people and children.

Lastly, I would say it is important to maintain your ties with your friends in other branches of medicine and to include guest lectures from other fields outside of pathology, such as guest lectures from psychiatrists on depression/suicide, trauma medicine, toxicologists, and doctors in poison control, so you and your colleagues can stay up to date with where these fields are in the language that they use and their approaches to these cases. That dialog is incredibly valuable and worth investing time in developing, fostering, and maintaining.

Career Outlook For Medical Examiners

Although data specific to the medical examiner career is unavailable, a physician’s job outlook is quite good. According to the U.S. Bureau of Labor Statistics (BLS), there will be a growth rate of 4 percent between 2023 and 2033, which is the average for all occupations (BLS 2024). The demand for physicians remains steady as the healthcare field expands, and the BLS predicts that 34,500 new positions will open up in the coming decade.

Those interested in pursuing the field should look into some of the different professional organizations expressly for medical examiners, such as the National Association of Medical Examiners (NAME). The College of American Pathologists (CAP) has general information on pursuing a career in pathology, and also includes specific information and committees for those interested in a career in forensic pathology. The American Board of Medicolegal Death Investigators (ABMDI) offers certification for medicolegal death investigation. Finally, it is also possible to find information from the American Academy of Forensic Sciences (AAFS), which supports all manner of forensics scientists.

Forensic Medical Examiner Salary

The annual mean wage for physicians is $248,640 (BLS May 2023), and this figure considers all of the different types of physicians and surgeons. As of February 2025, the wage percentiles are as follows:

• Employment: 310,080
• Annual mean wage: $248,640
• 10th percentile: $66,260
• 25th percentile: $85,110
• 50th percentile (median): $236,000
• 75th percentile: $239,200 or higher
• 90th percentile: $239,200 or higher

The BLS does not include specific percentiles that are more than $239,200.

Here are the top-paying industries for physicians (BLS May 2023):

• Computer Systems Design and Related Services $375,620 per year
• Pharmaceutical and Medicine Manufacturing $318,150 per year
• Other Ambulatory Health Care Services $298,320 per year
• Offices of Physicians $294,230 per year
• Specialty (except Psychiatric and Substance Abuse) Hospitals $289,530 per year

Self-reported salary data offers a unique perspective for career-specific salary information for forensic examiners. For instance, PayScale (2024), a site aggregating self-reported salary data for a myriad of jobs, has collected details about how forensic pathologists (a similar position in the U.S.) are paid. According to 50 individuals who reported their pay, the median salary for forensic pathologists with forensic toxicology skills is $146,174 annually. Reported salaries range as follows:

• 10th percentile: $69,000
• 50th percentile: $146,174
• 90th percentile: $305,000

The best way to determine an accurately predicted salary for the job is to look at the various states and cities hiring medical examiners and then inquire about the specific compensation. Interestingly, the top-paying states for physicians are correlated to locations with a more affordable cost of living which is a rare occurrence. Here are the top-paying states for physicians (BLS May 2023):

• Montana
• North Dakota
• Wyoming

To estimate the cost of living, the Missouri Economic Research and Information Center (MERIC 2025) offers an up-to-date index. According to MERIC, no state mentioned above is in the top 10 most expensive states to live in for physicians and forensic medical examiners.

Medical Examiner Tasks and Responsibilities

Medical examiners are nearly always crouched over a body in television dramas, pointing out wounds and evidence to interested detectives and solving mysteries. While autopsies are a critical part of the medical examiner’s job, in reality, there are many daily tasks and responsibilities that this type of professional will need to be prepared to complete — and not all of them look good on television.

The work of a medical examiner can be pretty gruesome and, at times, isolating since medical examiner offices typically do not have several employees. Medical examiners must be comfortable dissecting bodies, removing organs, and dealing with families who experienced a very traumatic and violent death. In addition, they can expect to:

• Record all details about a body, including the weight of organs and other specifics
• Take samples of bodily fluids
• Take or supervise the taking of photos of the body
• Perform x-rays and CT scans of a body where required
• Travel to and investigate crime scenes in the case of unusual circumstances
• Communicate findings to law enforcement and victim’s families
• Consider medical history and relay undiagnosed illnesses, such as cancer, to family members
• Act as an advocate for a victim who can no longer advocate for themselves

Licensure & Certification for Medical Examiners

To become a medical examiner, one has to be a licensed doctor (MD or DO) and take a licensing exam regardless of the state where they work. The Federation of State Medical Boards (FSMB) lists state-specific requirements for initial medical licensure. Medical licensing is done on a state-by-state basis, and requirements vary. All require medical school, passing all four tests of the USMLE, and extensive training (residency).

In addition to licensing, many medical examiners will also want to look into certifications, as they can help improve the chance of finding a job.

Medical examiners may also consider earning board certification in forensic pathology from the American Board of Pathology.