In the prophet business, they laugh at you when your predictions are wrong and chase you out-of-town – or worse – when your predictions prove to be correct. So, at the risk of being tarred and feathered or be made to wear a Scold’s Bridle, I venture twelve questions about possible future scenarios for the genetic counseling profession. Feel free to add a Comment with your own questions (and see how hard it is to be a prophet).
- Will our primary role be to serve as interpreters of test results for laboratories and ordering physicians? With the increasing growth of genetic laboratory services and a widespread lack of genetic sophistication among most ordering clinicians, laboratory demand for genetic counselors may far exceed employment in clinics. Besides, why should hospitals spend money on salary and benefits for genetic counselors when lab genetic counselors can provide the expertise?
- Might we become consultants for online genetic testing companies, helping plan, develop, and sell their products? This could be a future where genetic testing is arranged over the Internet through a handful of megalabs, an oligopoly that controls the market. Such lab equivalents of Alibaba and Amazon, would sell gene products – clinical and otherwise – to an international market, where there is no clear-cut distinction between consumer and patient. This is not such an outlandish possibility; consider the connection between 23andMe and Google.This scenario sounds like the basis for a Philip K. Dick nightmare novel.
- Could we evolve into educators/communicators for the public rather than individual patients? With genetics predicted to be incorporated into everyday medical care, there is no way we can provide genetic counseling to everyone. But we could become a universal resource, developing and providing educational materials and expertise for clinicians, patients, courts of law, film makers, and just about anybody who has a genetic question.
- With institutions wanting to provide cost-effective care with as few employees as possible, along with the ongoing trend of hospital mergers and consolidations, could we become self-employed specialists who serve in consulting roles across multiple health care settings? We might strap on our NSGC issued jetpacks to hop from campus to campus of regional mega-hospitals to deliver genetic consultations on a moment’s notice.
- Will we change our profession’s focus from genotype counseling to phenotype counseling? In the past, a visit to the genetics clinic was necessary to sort through the appropriate genetic testing for patients, since it would be far too expensive to run every genetic test possible. With affordable multi-gene panels and whole exome/genome sequencing, it will no longer be economically necessary to see a geneticist to order “the right tests.” Just throw the whole plate of DNA strand spaghetti against the wall and see what sticks. The job of genetic counselors will then be to figure out what phenotype(s) could be expected from the array of test results.
- Will we become health/life style coaches? This is a natural progression from what we are doing now in cancer and cardiovascular clinics. Based on genetic test results we make recommendations for health care and life style. Followed to the logical outcome, this model could be applied to almost any disease with a substantive, actionable, and identifiable genetic component.
- Will we be charged to be guardians of the public’s genetic health? With the introduction of Down syndrome screening of all pregnancies, universal carrier screening, and expanded newborn screening, there will be growing social pressure to “control and cure genetic disease.” This future could easily slide into creepy eugenic territory and provide Nathaniel Comfort material for several more books about the often vague distinction between relieving individual suffering and “population improvement.” This is not such an outlandish idea; James Neel, the great geneticist and a major figure in the early days of medical genetics, titled his magnum opus Physician To The Gene Pool.
- Will we be private entrepreneurs who offer our services directly to the public in shopping malls, pop-up counseling clinics, and mobile GeneTrucks, bringing our services to the public in non-traditional settings?
- Can we be all of the above and still maintain our unique professional identity?
- How will training programs properly prepare students for so many futures?
- Will there be a perception of less of a need for psychosocial skills? Will we lose sight of the basic truth that any interaction between two human beings is always a psychological interplay?
- Will the exploration of the human genome fail to live up to its promise and hype, it’s low hanging fruit already plucked, and the current fad of genetic medicine replaced by some other medical breakthrough? Who knows, maybe gut microbiomes or epigenetic changes will be the next darling. Would the genetic counseling profession wither on the vine?
Special thanks to Emily Singh for her expertise in realizing the graphics in this posting.