Genetics and Primary Care
I am becoming more and more interested in the potential role of genetic counseling in the primary care setting. The findings of a “Personalized Medicine and Wellness Survey” released this week only serve to add fuel to my “genetics in primary care” fire. The results show that people are more likely to turn to their doctor for information about genetic testing than to pursue it on their own. The researchers conclude that makers of genetic tests will be more successful penetrating the market if they target doctors, rather than consumers themselves.
There are several obvious limitations of the survey (i.e. small sample size, selection bias). But, I still find it interesting, especially given the controversial direct-to-consumer advertising campaign for hereditary breast cancer testing that was launched by commercial lab Myriad Genetics last fall. Many within the genetics community perceived this campaign as Myriad’s attempt to bypass the “bottleneck” effect created by limited genetic counseling resources, and increase profits by encouraging consumers to seek out the genetic test on their own (although a doctor’s order is still required). If you subscribe to the belief that genetic testing of this nature should always be preceded by appropriate education and detailed consideration of the potential implications of the test (as I do), then the above scenario is very problematic.
So, the good news is that people do turn to their doctors for information about genetic testing. The bad news is that many doctors, especially family doctors, are already over-worked, over-stretched and under paid. Expecting family doctors to stay on top of emerging genetic technology and research and find time to relay this knowledge to their patients is not, in my opinion, the most feasible option. I personally believe that genetic counselors should set up to the plate. Perhaps I can enlist Sean to help with the marketing…
HER NATURE HIS NURTURE 
Genetic counselors do step up to the plate. Problems: they are only licensed in 7 states, they are not recognized by Congress, CMS, or many payers (or even their own hospital employers) as valid healthcare providers because they aren’t licensed. Genetic counselors are fighting battles on two fronts- trying to get laws changed at the state and federal level to be recognized healthcare providers, and trying to handle the burgeoning number of people needing services.
I agree that licensure is a huge obstacle that we must pass, and I recognize the years of dedication and hard work that is going into making licensure a reality in areas across the US and Canada.
I am not convinced, however, that we have to be licensed before we can participate in the primary care setting. Much the same way that GC’s have reached out to new areas the past (for example, cardiology departments), it would require some flexibility and creativity on our part. I believe that there is a valuable contribution to be made, even within the existing legislative framework.
I realize that this is not a new topic, but I think this is becoming an ever more appropriate and relevant discussion. I’d love to hear more about people’s ideas or experiences in this area.
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We are still far from anything close to primary care genetic testing – 10 years ago, this is stool too expensive. And at the same time, the industry becomes more computerized, so we can expect that whenever it will made to family doctors, they will use it as simple, press-button-get-result diagnostic tool.