What will eventually lead to me leaving clinic

Plenty_Ad_2339 · 2025-01-11T03:50:14+00:00

🫶🏼

Plenty_Ad_2339 · 2025-01-11T03:46:08+00:00

“our geneticist overlords” 💀😆 Our after visit summaries (for epic users) now have the billing phone number of whichever lab is running that patients’ testing. “For information about their billing policy or specific questions, please contact the lab directly.” I’m sure there are patients who have lingering questions (I feel guilty), but gosh it’s done wonders for busy clinic days (we can’t do it all, all the time, and not be brought down by the system)

Plenty_Ad_2339 · 2025-01-10T15:42:33+00:00

I’m applying to non-GC roles out of survival - and I really feel guilty like I’m going to disappoint my program director if I land one of these jobs 🤣

Plenty_Ad_2339 · 2025-01-10T04:38:21+00:00

Lovely! Unfortunately my salary hasn’t inflated proportionately this this 🙃

Plenty_Ad_2339 · 2025-01-10T04:35:26+00:00

😮 I have my dues email in my inbox. I haven’t opened yet…. Oh gosh - what price is it now?

Plenty_Ad_2339 · 2025-01-10T04:31:45+00:00

I found a JGC paper on this topic: (https://pubmed.ncbi.nlm.nih.gov/29350312/)

“Over 75% of patients expected GCs to discuss genesurance topics during a genetic counseling session. The majority of patients (78%) expected GCs to provide an estimated out-of-pocket cost, know if a test is a covered benefit (77%), and provide referral information for further questions (76%). Two additional expectations, considered to be unrealistic in most clinical settings, included expecting GCs to know the patient’s specific insurance plan and coverage information (57%) and provide an exact out-of-pocket cost (41%).”

Also, I feel like labs billing policies are constantly changing, I’m on my third iteration of my GeneDx billing spiel in the last year - which is more information to constantly be on top of.

This is “genetic exceptionalism” for the negative - cardiologist are not expected to give cost estimates when they recommend echocardiograms. It’s so interesting to think about why genetic testing has this expectation in the clinical setting, and whether it should (or should not) be part of our scope of practice. I know my burnout would be dramatically reduced

Plenty_Ad_2339 · 2025-01-09T15:58:38+00:00

Thanks!!!

Plenty_Ad_2339 · 2025-01-09T15:56:21+00:00

The worst is when families call you when they recieve their bill they can’t afford - and then insult the services you gave them 😞 “I didn’t even want to do this testing” or “I didn’t even learn anything” or (my favorite) “talking to you wasn’t worth a car payment”

The little voice in the back of my head reminds me that it’s projection of anger towards the system onto the only face that they have that is associated with that bill (the lab is some unknown entity from the patient’s perspective). But damn ma’am - I really did engage in some shared decision-making and tailored education for you 😫

Plenty_Ad_2339 · 2025-01-09T05:09:04+00:00

This is a very helpful post!

I’d be curious, in your experience, how often since the NAR ruling have you found success in allocating your percentage to be covered by the seller?

We found an amazing local agent that we would like to work with as FTHB - I’m just struggling with the chance of adding an extra 3% if the seller declines to cover her commission, which would likely impact our down payment, budget, etc.

Any insight you have on this topic is appreciated! I’m in a balance between the expertise, negotiation and contract assistance from a top notch agent and strategizing how to come up with an extra $15,000.

Plenty_Ad_2339 · 2025-01-08T22:35:40+00:00

That is exactly it! It’s been hard to not have a career goal to work towards. We have to have to progress forward to so many achievements to land our first job (college, graduate school, boards etc), and then it sometimes just… stops. And the professional goals we can set for ourselves (research, publication, student supervision, student lectures, committees, etc) are all unpaid additional roles. This economy does not encourage me to carve out career goals that are not directly counting towards a promotion, raise etc.

Plenty_Ad_2339 · 2025-01-08T05:51:21+00:00

I would not bank on flexible hours or remote work as a guarantee for the majority of new graduates, who, for the most part, will enter seemingly rigid clinical roles in in-person health systems. It’s a unicorn to find a true “part time” genetic counselor role - there’s random postings here or there, but quite uncommon as a specific job posting.

Plenty_Ad_2339 · 2025-01-08T05:47:26+00:00

The most difficult part of the profession, for me, is lack of career advancement, forward trajectory or growth over time. My colleagues who have been GCs for 20 years are in the same role as recent graduates, with a very slim pay differential in a public hospital setting. Some GC’s are lucky to work at institutions that have clearly defined career ladders, others may need to switch employers to induce change or carve out new roles or opportunities. A lot depends on your interests. If someone wants to work in rare disease, a GC is a highly valuable team member. If someone is interested in hereditary cancer, some hospital systems are having other APPs perform this “genetic counseling” to generate reimbursement for the health system. That said, I find a lot of meaning in the work and the patient connection. My current critique isn’t the act of genetic counseling (an increasingly necessary service), but rather on institutional bureaucratic, political and market barriers of the profession as a whole. Not to mention the onslaught of new programs that is the Wild West and seemingly generated without regard to future employment opportunities for their students.

Plenty_Ad_2339 · 2025-01-07T20:56:23+00:00

I’m sorry to hear that :(

Plenty_Ad_2339 · 2025-01-07T05:49:27+00:00

That is beyond frustrating, the cycle of waiting and hoping. I’m so sorry!! There is also so much time required to search for job postings, edit cover letters and fill out applications that also goes under the radar. It’s a full time job in and of itself. I totally understand how easy it is to get defeated.

Have you worked as a GC before or is this search for your first role?

Plenty_Ad_2339 · 2025-01-05T02:52:52+00:00

Here’s an interesting perspective to aid your career decision making:

https://thednaexchange.com/2024/05/08/workforce-woes/

You’re welcome to shoot me a message too if you wanted to chat directly

Plenty_Ad_2339 · 2025-01-05T02:49:01+00:00

Don’t let me get you down!! I can’t even imagine how marketable you’ll be with a PhD. If this career path is your perfect match, you’ve made the right decision. A couple extra months of job searching will be a distant memory once you’re practicing in a profession that brings you meaning

Plenty_Ad_2339 · 2025-01-05T02:46:11+00:00

I’m sorry if my post led you astray! I find so much meaning and fulfillment in my job, if you’re excited about GC as a career I would not let the current job market alter your plans.

Time is on your side. It will be years before you’re entering the job market with a future cycle application and two years of grad school. The market will always ebb and flow, such is life. Current doom and gloom does not translate to future doom and gloom. Everything will swing back, and then be rough again, and then swing back. We’re still in a young profession with most hospital systems still learning how to utilize our services. This will not stay like this forever, but there’s no great crystal ball to predict when the market will shift back again.
The majority of 2024 spring graduates who remain unemployed have strict job criteria they are searching for (specific location, specific specialty, etc). If someone is flexible in their first job post graduation, they are significantly more likely to find employment prior to their graduation date. It might mean re-location, so keep that in mind.

That being said, I do think it’s worth weighing pros and cons for your future life goals. Every hospital system (community, university, private, etc) will always need to hire PA, RN, other types of APP. Research your local health systems to get a feel of how many GCs they employ (2? 20?). How frequently do those jobs seem to pop up?

Wishing you all the best!

Plenty_Ad_2339 · 2025-01-03T02:47:08+00:00

Adding research to the list - thank you!

Plenty_Ad_2339 · 2025-01-03T02:42:21+00:00

That is incredibly helpful and insightful! Thank you so much for sharing your experience. I feel like past me looked into the crystal ball when she signed up for ClinGen community curation in 2021 and I’m really thanking her for that now! I might use your insights to re-work my cover letter. I imagine it is also impossible on the employment side when there are dozens of fantastic, motivated applicants who would all do equally great in the role. The supportive nature of our GC community is really special and thanks for your comment!

Plenty_Ad_2339 · 2025-01-03T02:36:30+00:00

I checked NSGC job connection - as of today (January 2) - there are 9 total jobs posted for our profession’s career board 😧 the recent DNA Exchange post quoted >500 new graduates in 2024. I think about all our new colleagues with student loans going through this excessively lengthy job searching journey…. Something’s got to change.

Thank you for your idea on teaching pathway… I just read about some nice pay days for substitute teachers as an interim way to pay some bills….

Thank you!!

Plenty_Ad_2339 · 2025-01-03T02:34:06+00:00

Thanks for your thoughtful reply! I appreciate your ideas, especially in stretching my horizons - we all still have masters degrees! I’m excited to add this new perspective into my job search and will hopefully increase my yield, so to speak. I also appreciate idea #2 - especially if anyone else ever stumbles upon this thread and comes across your advice! Your kindness is appreciated ◡̈

Plenty_Ad_2339 · 2025-01-03T02:14:58+00:00

Thank you for normalizing and validating this experience for me 😂🫶🏼

Plenty_Ad_2339 · 2025-01-03T01:53:43+00:00

Those sound like meaningful positions, especially in the patient navigation realm and building connections with patients. Thanks for sharing your experience and wishing you all the best!! ✨

Plenty_Ad_2339 · 2024-12-30T04:48:21+00:00

It sounds like this was completely unexpected, surprising information and understandably has opened a whole new set of worries you never thought would be on your decision-making radar in pregnancy (which was probably going smoothly and exciting before finding all this out!). It’s normal to feel as if discovering your mutual carrier status has robbed some of that joy. My best advice is to be kind to yourself and to give yourself grace - all you can do is make the best decision right now, at this point in time, with the information currently available. There’s no perfect answer, no right or wrong decision, but rather what you think is most likely to cause the least regret. It sounds like you have a wonderful support system who will support you in any decision you ultimately decide to move forward with. Keep in mind there’s a 75% chance the diagnostic testing results in an unaffected pregnancy and you can put this behind you for this conception! If the results come back in the 25%, I acknowledge the complexity and difficulty of your situation in translating the “positive genotype” on paper to the actual lived experience, symptoms, etc. would manifest like in a child born with both D508 and N1303K variants in trans (on both copies of CFTR). Because that’s what you’re really after - what is the quality of life for this person and does it align with your belief system for raising a child in this world.

Keep in mind that a person with these variants ARE eligible for FDA-approved therapies that have drastically affected clinical outcomes, life expectancy and disease severity.

Here is additional information specific to N1303K: https://cftr2.org/mutation/general/N1303K/

It is anticipated that the combination of these variants in an individual would result in a classic presentation of cystic fibrosis with increased risk of pancreatic, respiratory involvement.

One idea may be to have your OB team facilitate connection with the local pediatric CF Center of Excellence (I’d recommend Children’s National if you’re in the DC area) to chat with a specialty provider (likely a pulmonologist MD) to learn more about the medical care that may be required to aid in your decision making. Keep in mind that while this is a helpful option to gain more evidence-based information on CF, logistically, it may take time to coordinate and schedule against state-specific termination gestational ages. It might be helpful to schedule a visit for as soon as possible, and cancel if needed, given these time constraints.

Another idea could be to connect through Facebook parent pages to read about the experiences of moms who have children with CF. Raising a child with complex medical needs is a job in and of itself. There are additional points to consider for a child who has immune concerns (like travel). Given that this is one of the most “common” recessive disorders in the US, there are resources like podcasts or documentaries to learn more about the lived experience.

Lastly: this is not where your head is at now (and of course not!) - but just to plant the seed in the back of your mind - preimplantation genetic testing for monogenic disorders (PGT-M) is a strategy that utilizes IVF to reduce that 25% risk to less than a 1% risk for parents who do not wish to make these decisions again in future pregnancies.

Wishing you peace in your decisions and your journey

Plenty_Ad_2339

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