The Ada County Coroner's office is home to the only forensic pathologists in the state. Thirty counties south of the panhandle pay to send autopsies here. But the coroner's usual team of three pathologists conducting autopsies has been just two for about a year.

"During that time, one of them took a paternity leave," Ada County Coroner Rich Riffle said.

Autopsies aren't just for criminal investigations. Many times, they can bring closure to a grieving family or are needed to close an estate or get a life insurance policy benefit. Ada County is one of just six coroner operations nationwide to be dual-accredited by both the International Association of Coroners and Medical Examiners and the National Association of Medical Examiners.

The standard to complete cases is 90 days. Not meeting that standard can threaten accreditation, but so can pushing pathologists to meet it.

"To maintain and be within the accreditation standards that we adhere to," Riffle explained. "Our pathologists can only do certain amount of cases per year."

The staffing squeeze has led to more than three dozen cases moving beyond that 90-day standard, he said. A couple complex autopsies have been underway for about a year. Riffle's not worried yet about the delays affecting the office's accreditation; there is wiggle room, and accreditors often measure on longer timelines.

Criminal cases get prioritized, so the delays often impact families waiting for details on the death of a loved one.

Riffle has been bringing in retired pathologists from out of state to help since last summer, but it hasn't been enough to keep up and is "hellaciously expensive," he said.

"I think the lowest one I've seen was like $16,000 up to $55,000 per month because they charge per case. And then, of course, we had the airfare, lodging and car which is part of that as well," Riffle said.

Budget rules prevent personnel funds from being used to pay contracts, so Riffle has to find the money elsewhere in his budget. In February, he went to Ada County Commissioners asking for $75,000 in special funding to continue hiring contract pathologists.

County commissioners approved $100,000, but Riffle hopes to retain one of those contract pathologists as a part-time employee until this July when a new full-time pathologist has agreed to join the county. A part-time hire would allow the coroner's office to use the idle personnel funds - but he's not optimistic he'll get any bites. The hiring pool is all the same retired pathologists currently being hired on a contract basis.

Difficulty hiring a forensic pathologist isn't unique to Idaho.

"In 2024, we had 58 new graduates," said Dr. Reed Quinton, Mayo Clinic forensic pathologist and President of the National Association of Medical Examiners. "However, that barely keeps a steady state in regard to the number of pathologists that are leaving the workforce at the same time or retiring."

Recruiting medical students to become forensic pathologists has to happen early, he said, in some cases even before medical school.

"Most people coming out of pathology residency tend to gravitate towards some other field within anatomic pathology. So for instance, surgical pathology, which is looking at tumors, diagnosing tumors and how far they've spread," Quinton said.

And there's clinical pathology, too; running laboratories. Once students get in a particular track, "It's very unusual to have someone who is practicing medicine in a different field, who then switches back over to do forensic pathology," Quinton said.

The tight supply of forensic pathologists mean coroners like Riffle are getting creative to recruit.

Some areas offer student loan payment incentives to come work. That's not on the table in Ada County, but Riffle said he can promise manageable caseloads and few of the more gruesome investigations pathologists might have in more populated areas.

"They do see that," he said. "They say, 'okay, I can come, I can do this job that I really love, but it's not going to, you know, kick my ass while I do it,'" Riffle quipped. He leans on the Boise area's reputation as a vibrant, fast-growing region with a small-town feel and great recreation opportunities to entice candidates, too.

And the coroner's office is set to install a CT scanner this summer. Riffle said will make the facility among the most state-of-the-art in the northwest.

The new fulltime pathologist who recently accepted the job can't start until this summer. That's a common timeline for hiring, Quinton said, based on when medical students graduate and complete their training.

Riffle hopes he won't have to use the extra funding, and leftover funding from personnel lines at the end of the fiscal year should help balance that out, he said.

Once the county has a full roster of pathologists, Riffle expects to be caught up and back to closing cases in 90 days by the fall.