A national survey of autopsy cost and workload

We mailed survey questionnaires to a random sample of medicolegal offices throughout the USA. The survey asked how many forensic pathologists were used, their American Board of Pathology forensic examination (Board) status, how many autopsies they performed, and, if payment were fee-for-service, what fees were paid for medicolegal autopsies. Response rate was 61%, with 188 offices returning questionnaires. The average fee, was $518 with a standard error of $27. The number of fee-for-service autopsies was split evenly between Board qualified and Board ineligible pathologists, accounting for about one-third of medicolegal autopsies nationwide. Although smaller offices used more pathologists ineligible for forensic Boards, they paid a premium for such qualification. Larger offices used more forensic Board qualified pathologists, but paid them less than those ineligible to take the examination! Overall there was no significant premium paid for Board qualification. The average fee paid is far less than the published estimates of the cost of an autopsy. The low fees paid may reflect: (1) the value of the teaching experience supplied to medical students and/or residents; (2) pathologists performing medico-legal examinations as community service; and (3) the lower marginal cost of additional autopsies.