The last decade has been boom times for genetic counselor employment. According to the 2020 NSGC Professional Status Survey (PSS), the number of genetic counseling jobs has doubled since 2010. Students are recruited for positions before they have graduated. The average starting salary for a genetic counselor right out of school is $12K a year greater than the entire profession’s average salary was in 2010. The highest salaries now exceed $200K. A genetic counselor with 5 years of experience can expect to make nearly as much as I do with 37 years of experience. If I were to go back to genetic counseling school and start my career a second time, I would probably be born again as a new counselor with a higher salary than what I currently earn (Hey Program Directors, think about what a headache it would be to have me in your next class!). And the 2020 PSS projected an even rosier outlook for the coming decade.
And then our parade got rained on by a storm of evil little droplets of RNA+protein. The US medical care system is facing the paradox of going broke while the urgent demands on medical services have never been more critical. By one prediction, the US health care system will lose two hundred billion dollars in the 4 month period from March to June. Those lap chole’s, knee and hip replacements, cardiac stents, and c-sections really drive hospitals’ bottom lines. It’s hard to believe that the rest of the year is going to look much better. I doubt that the US government will demonstrate the competence, unity, or interest to meaningfully mitigate the health care system’s financial woes, unless maybe New Zealand allows us to borrow Jacinda Ardern for at least 4 years.
It is not likely that genetic counselors will escape unscathed. So last week I informally surveyed the NSGC listservs (aka forums) about how the pandemic has impacted genetic counselors’ jobs. Here are a few replies about what some genetic counselors have experienced so far (anonymity preserved):
- Partial furloughs
- Reduction in hours
- Pay cuts
- Reduction in non-salary benefits
- Mandatory paid time off
- Drops in referrals
- Changes in job responsibilities from patient care to research and other duties
- Job offerings withdrawn
It’s hard to know how prevalent these problems are because the “research” design and data have more limitations than a teenager who skipped school to go drinking with her boyfriend and wrecked her mother’s brand new car. But they do get your attention.
Like the virus itself, the impact on employment seems to hop, skip, and jump across the country. Some genetic counselors reported no effects at their institutions. To which I would add – at least, not yet. The health care system has just recently come up for air and many employers have not had the chance to fully assess the financial fallout. Early reports from well-respected commercial laboratories, who employ around 20% of genetic counselors, are worrisome too. Myriad reports that revenue has dropped 20-75% across its battery of tests. Invitae has seen testing volumes start to drop and has laid off some staff. These may very well be temporary setbacks and sales may rebound once the whole Covid thing cools off, whenever that might be. But they are not exactly encouraging signs. I am also curious to hear from our international colleagues about the pandemic’s impact on genetic counseling jobs outside of the US.
Once the worst of the pandemic is over, recovery is not likely to be a smooth and rapidly rising curve, even if – fingers crossed and offerings to St. Roch – the virus doesn’t return with a vengeance. Unemployment in general will be high and fewer people will have health insurance, and thus there will be fewer dollars to spend on medical care.
Genetic counseling positions may not be high on the priority list of administrators if or when they look to restore lost positions in the future. In the grand tradition of administrators everywhere, they will look to cut costs and may replace only a portion of the lost genetic counseling positions. Hospitals and clinics may decide to shift genetic counseling responsibilities to other staff, such as medical assistants or nurse practitioners, or farm out genetic counseling positions to lab-based counselors, telehealth services, or even chatbots and videos. Older counselors may be nudged towards retirement. Expect paring back of support staff; executives always seem to forget that receptionists, schedulers, and the like are critical to running a hospital and cutting their salaries amounts to a hill of beans in overall budgets. Layoffs just about always come back to bite employers on the ass, and still they act surprised to find teeth marks on their buttocks.
The effects may even be felt in research funding. The NIH slated ten billion dollars for genetic research in 2020. Next year legislators and funding agencies may be more interested in diverting research funds to infectious disease research, prevention, and epidemiology. It’s hard to imagine someone running for political office on a platform of more money for genetics research and less for infectious disease research.
Oddly enough, current genetic counseling students may be better positioned than more experienced counselors. The salaries of genetic counselors with 5, 10, 20 years of experience can get pretty pricey for employers looking to save money. Why not hire somebody fresh out of school who would be paid a lower salary than a veteran?
I am not sure what the response of the profession can or should be. I think I have to leave that up to wiser minds than I possess. Perhaps the NSGC wants to start documenting the coronavirus job impact in a systematic way and plan a targeted PR push during the pandemic recovery focused on the value of genetic counselors in delivering health care. Training programs may think about scaling back admissions until the impact becomes clearer. Maybe the Accreditation Council for Genetic Counseling (ACGC) wants to slow down the approval of new programs. Genetic counselors may need to be more flexible about what they consider to be their scope of practiced and how genetic counseling services should be delivered.
Or maybe none of this will come to pass and by September we will resume our lives with some semblance of normalcy and a minimum of economic and existentialist wear and tear. I know I sound like Mr. Gloom and Doom, which is not really the voice you want to hear in these dire times. I understand why you might want to cover me in Greek fire, shoot me from a mangonel out and over the city walls, or disembowel me (my imagery is heavily influenced by a book I am reading about The Crusades, or as they are known in the Middle East, The Latin Invasions). So you can take heart in that fact that, like almost all predictions, there’s a pretty good chance I will be wrong yet one more time. But we shouldn’t stick our heads in the ground in an attempt to protect ourselves when the sky really is falling.
Thank you to Emily Singh for help with graphics.