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20 Questions: Judy Melinek, MD, Pathology

Created October 22, 2014 by Juliet Farmer

Dr. Judy Melinek is a board-certified forensic pathologist in San Francisco, CEO of PathologyExpert Inc., an associate professor of pathology at University of California San Francisco, and co-author (with her husband, T.J. Mitchell) of the New York Times Bestseller Working Stiff: Two Years, 262 Bodies and the Making of a Medical Examiner (Scribner, 2014). Melinek received her bachelor’s degree in biology magna cum laude from Harvard University (1991), and her MD with honors from UCLA School of Medicine (1996). Dr. Melinek completed an internship with the Department of General Surgery at Beth Israel-Deaconess Medical Center in Boston (1996); a pathology post-sophomore fellowship (1993-94), pathology residency (1997) and chief residency (2001) at the Department of Pathology, UCLA; and a forensic neuropathology fellowship with the Office of Chief Medical Examiner, City of New York (2001-2003), where she examined the remains from the World Trade Center and American Airlines Flight 587. She attended both a basic forensic pathology course (2001) and a neuropathology course (2003) at the Arms Forces Institute of Pathology in Bethesda, and a digital forensics photography class at Imaging Forensics in San Francisco (2010).

Dr. Melinek’s prior work experience includes serving as assistant medical examiner/coroner at Santa Clara County Office of Medical Examiner-Coroner and adjunct clinical instructor at Stanford University Medical Center (2003-04), and assistant medical examiner at Office of the Chief Medical Examiner in San Francisco and assistant clinical professor at UCSF (2004-2013). Dr. Melinek is a peer reviewer for Academic Forensic Pathology and The American Journal of Forensic Medicine and Pathology. She is a member of the National Association of Medical Examiners (NAME), and she is board certified in forensic pathology and anatomic & clinical pathology from the American Board of Pathology. She has been published in Academic Forensic PathologyAmerican Journal of Medical PathologyPan-Pacific EntomologistJournal of Forensic SciencesArchives of Pathology & Laboratory MedicineJournal of Clinical InvestigationTransplantationAmerican Journal of SurgeryJournal of Immunology, and Cellular Immunology.

When did you first decide to become a physician? Why?
My father was a doctor, and I wanted to be a doctor ever since I was about two years old, because I wanted to be just like him. He had all these medical textbooks around the house and would let me go through them. I found the human body fascinating and my Dad had all the answers to everything about my own body, so I figured if I went to medical school I would learn it all too.

How/why did you choose the medical school you attended?
I visited many medical schools in my senior year in college and loved UCLA, mostly because I always wanted to live in California and my boyfriend (now husband) wanted to work in the film industry, so it seemed like the best choice for me. I was lucky I got in off the waiting list.

What surprised you the most about your medical studies?
How boring and memorization based it could be. I had excellent teachers, but I had spent the last four years of my college education doing a lot of analytical work in biology and immunology, so getting back to memorizing and regurgitating (which is necessary if you are going to understand the basics of anatomy and pharmacology) was tedious.

Why did you decide to specialize in pathology?
My pathology professors taught us in the second year of medical school and they knew everything. They had to know anatomy, physiology and the basic procedures and treatments of every disease in every specialty and subspecialty, because everything from all departments in the hospital eventually went to pathology. It was the most comprehensive field of medicine.

If you had it to do all over again, would you still become a pathologist? (Why or why not? What would you have done instead?)
Definitely. I love pathology. It is fascinating, and every day is a challenge. I am constantly learning and growing. I never get bored.

Has being a pathologistmet your expectations? Why?
Yes, definitely. I can make a good living doing what I love. It is the ideal job for me.

What do you like most about being a forensic pathologist? Explain.
I like the position of being the “answer man” – the doctor all the other doctors go to to get the answers. All other specialties rely on us for the diagnosis and after death, when they can’t figure out what happened, we are there to tell them.

What do you like least about being a forensic pathologist? Explain.
The part I like least about being a forensic pathologist is dealing with folks who are unethical or disorganized. As a forensic pathologist, I rely on the attorneys and police officers I work with: their reports, their schedules and their investigative skills. If they are overworked, stressed, unpleasant or disorganized, it can affect and influence the quality and reliability of my work, and can ruin an otherwise pleasant day.

What was it like finding a job in your field–what were your options and why did you decide what you did?
There are many jobs in the field of forensic pathology. There are only about 500 board-certified forensic pathologists in the US, which is about two thirds of the number needed to do all the forensic death examinations. Many offices have openings they can’t fill, so finding a job is fairly easy. What is difficult is that jobs are on a county by county level, so frequently changing jobs means having to relocate.

Describe a typical day at work–walk me through a day in your shoes.
I leave the house at 7:15 a.m., arrive at work at 8 a.m. and sit with colleagues to review the daily case list (the list of deaths that have happened in the past 24 hours and were brought in to the office). At 9 a.m. I get into the morgue and start examining the bodies. I usually do anywhere from one to three autopsies a day. External examinations take about 15 minutes and the rest of the dissection is 30 to 45 minutes per body. I take lunch at 12 p.m. From 1 p.m. to 4 p.m. I dictate cases, type reports, return phone calls, and meet with attorneys or police. About once a month I will go out to a crime scene and about twice a month I am called on to testify in court or in a deposition. 

On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take? 
I work 40 to 60 hours per week. I sleep seven to eight hours per night. I take six weeks of vacation, but about four of them are “working” vacations, where I take paperwork with me or take calls from clients answering questions about cases. I can do this from the beach in Hawaii or from abroad as long as I have a cellphone and WiFi connection. Once a year for one week I go “off the grid” to a family camp near Yosemite. My office manager manages calls and puts off clients for that one week and I warn folks in advance so I can meet their expectations.

Do you feel that you are adequately compensated? Why or why not?
I feel very well compensated now, as I am an independent contractor and can work as much or as little as I want. The best compensated positions are ones with the security of a government job but that give you the flexibility and time to do some private practice consulting work.

If you took out educational loans, is/was paying them back a financial strain? Please explain.
I didn’t take educational loans, because my father left me a small inheritance when he died and I used that to pay for my college and medical school education. I had no money left when I was done, but I was debt free.

In your position now, knowing what you do – what would you say to yourself when you were beginning your pathology career?
You are on the right track. Keep doing what you are doing and you’ll be fine.

What information/advice do you wish you had known when you were beginning your pathology studies?
That the board exams are really no big deal if you study a little bit every day of your residency. Get the board review materials from other residents early on and spend 10 minutes a day looking at something boards related. Then when it becomes time to sit down and study in the last 10 months before the exams, the material will be somewhat familiar.

From your perspective, what is the biggest problem in health care today?
I think that a health care system that is designed based on reimbursement for procedures and interventions incentivizes unnecessary treatments. We need to create economic incentives to promote preventative care and draw more practitioners into primary care, rather than subspecialties.

Where do you see your specialty in five years?
I see more Federal guidelines for death investigation coming as a result of the National Academy of Sciences report on the forensic sciences. I am concerned that these guidelines and standards will be unfunded or underfunded, and will create a situation where doctors are held to standards that they don’t have the resources to meet.

What types of outreach/volunteer work do you do, if any?
I teach at UCSF and am a clinical instructor in neuropathology. I also volunteer my forensic services pro-bono to Parents of Murdered Children and the Innocence Project. I have been known to bring donated organs and my lectures on pathology to schools in the San Francisco Bay Area for free when invited, and have spoken to third and fifth graders all the way up to college-level students about careers in the forensic sciences.

Do you have family? Do you have enough time to spend with them? How do you balance work and life outside of work?
Yes, I’m married with three kids. I feel I have plenty of time to spend with them. My husband is a stay-at-home dad and a writer, and he spends most of the time with the kids. I have a home office and will occasionally work on weekends when the kids are busy at soccer games and activities, or after hours when they are asleep, so that I have time with them when they are awake and free. It’s a wonderfully flexible schedule since I am CEO and I get to set it.

What is your final piece of advice for students interested in pursuing a career in your speciality?
If you are interested in forensics at all I suggest you do forensics rotations in New York City, Miami, Baltimore or the New Mexico Office of the Medical Investigator (OMI) in Albuquerque when you are in the first or second year of pathology residency. That way the program directors will get to know you; you will get to see what the day-to-day work is like; and you will have a leg up on getting into that particular fellowship program. Many fellowships only take fellows who rotated through the office for a month as residents. Research those programs early in your career and check them out so that you don’t miss out on a fellowship opportunity.

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