Whether coroners are elected or appointed depends on the state. Most coroners in the United States are elected at the county level, often on a partisan ballot. Roughly 20 states rely primarily on elected county coroners, about 23 states and the District of Columbia use appointed medical examiners instead, and the remaining states use some combination of the two or fold the duties into another county office.
How Elected Coroners Get the Job
In states that use a coroner system, the coroner is usually elected to serve a single county. The office appears on the ballot alongside the sheriff, county clerk, and other county positions, and in most places candidates run under a party label. Terms typically run four years, matching the standard cycle for county offices.
Because it is an elected position, the qualifications tend to be light. In many counties you need to be a legal adult, a resident, and sometimes a registered voter. That is it. Fewer than a third of states with elected coroners require any formal training in death investigation, and a medical degree is almost never required. Kansas, Louisiana, North Dakota, and Ohio require coroners to be licensed physicians, but they are outliers.
The upshot: in most elected-coroner counties, anyone who meets the residency and age rules can run, and the job is shaped as much by local politics as by professional background.
How Appointed Coroners and Medical Examiners Get the Job
Where the position is appointed, the appointing authority varies. Some appointments come from county boards or commissions, others from a mayor, and in states with a centralized system, from a state agency or the governor’s office.
Appointment almost always brings professional requirements with it. When a jurisdiction replaces an elected coroner with an appointed medical examiner, the job stops being a political office and becomes a professional one. Medical examiners must be licensed physicians, and most are board-certified in forensic pathology, meaning they have completed medical school, a pathology residency, and a fellowship in forensic pathology. The appointment process weighs credentials and experience rather than electability.
Why the Selection Method Matters
The titles “coroner” and “medical examiner” get used interchangeably, but they describe different roles, and the way each is chosen is a big part of the reason.
A coroner is typically an elected official whose work is more administrative than medical. Coroners coordinate death investigations, handle the legal paperwork, and decide whether an autopsy is needed. When one is needed, most coroners contract with an outside forensic pathologist to perform it, because they lack the medical training to do it themselves.
A medical examiner is a physician who personally conducts the medical investigation. Medical examiners perform autopsies, order toxicology, examine tissue samples, and make the medical determination of cause and manner of death. They are appointed on their credentials, not elected by voters.
This gap in training has practical consequences. An NPR investigation found dozens of autopsies with serious mistakes across more than a dozen states, including pathologists who missed bullet wounds and signs of strangulation. A panel of experts described coroners without medical training as “the weak link” in the death investigation system, noting that competent death investigation depends on skills and infrastructure that cannot be replicated without a medical foundation.
The Sheriff-Coroner Arrangement
Some places combine the coroner’s duties with the sheriff’s office. California is the most prominent example, where the sheriff also serves as coroner in the vast majority of the state’s 58 counties. The arrangement exists mostly to save money, and it puts one office in charge of both law enforcement and the independent determination of how people die, including in cases where officers are involved.
Research from USC Dornsife found that counties where the sheriff serves as coroner underreport officer-involved homicides compared with counties where the roles are separated. A sheriff-coroner has the legal authority to overrule the findings of county pathologists, so a death that a pathologist classifies as a homicide can be reclassified by the same office whose deputies were involved. A 2016 audit of one California county identified at least four officer-involved deaths where the sheriff overruled pathologist findings; that county later voted to strip the sheriff of coroner duties and install an independent medical examiner. San Diego and San Francisco have also replaced the sheriff-coroner model with an independent, physician-led office.
Which Direction Things Are Moving
The long-term trend runs toward appointment. Since 1970, nine states have transitioned from coroner systems to medical examiner systems, with Alaska the most recent in 1996. The shift continues at the county level as well, where individual jurisdictions replace elected coroners with appointed medical examiners even when their state has not required the change. The pattern is familiar: a high-profile case exposes the limits of having a non-physician oversee death investigations, and the community decides professional qualifications matter more than electoral accountability for this particular office.
The argument is not settled. Supporters of elected coroners say the ballot keeps the office answerable to the public. Critics say death investigation is a medical and scientific function that belongs with trained professionals, not with candidates. What that means for you is geographic: your neighbor one county over may have a board-certified forensic pathologist investigating deaths while your county has an elected official whose day job has nothing to do with medicine. To find out which system covers you, check your county’s website for the office title. “Coroner” usually signals an elected position with minimal medical requirements. “Medical examiner” signals an appointed physician. A combined “sheriff-coroner” tells you the same office handles both law enforcement and death investigation.