Assessment of clinical workload for general and specialty genetic counsellors at an academic medical center: a tool for evaluating genetic counselling practices

Abstract

With genomics influencing clinical decisions, genetics professionals are exponentially called upon as part of multidisciplinary care. Increasing demand for genetic counselling, a limited workforce, necessitates practices improve efficiency. We hypothesised that distinct differences in clinical workload exist between various disciplines of genetic counselling, complicating practice standardisation and patient volume expectations. We thus sought to objectively define and assess workload among various specialties of genetic counselling. Twelve genetic counsellors (GCs), representing 9.3 clinical FTE, in general or specialty (cancer, cardiovascular or prenatal) services at an academic health system developed a data collection tool for assessing time and complexity. Over a 6-week period, the data were recorded for 583 patient visits (136 general and 447 specialty) and analysed comparing general versus specialty GCs. Variables were compared with hierarchical linear models for ordinal or continuous data and hierarchical logistic models for binary data. General GCs completed more pre- and post-visit activities (P=0.011) and spent more time (P=0.009) per case. General GCs reported greater case discussion with other providers (P<0.001), literature review (P=0.026), exploring testing options (P=0.041), electronic medical record review (P=0.040), insurance preauthorization (P=0.05) and fielding patient inquiries (P=0.003). Lesser redundancy in referral indication was observed by general GCs. GCs in general practice carry a higher pre- and post-visit workload compared with GCs in specialty practices. General GCs may require lower patient volumes than specialty GCs to allow time for additional pre- and post-visit activities. Non-clinical activities should be transferred to support staff.

Gendered health care labour markets? A case study of anatomical pathologists and haematologists in KwaZulu-Natal, South Africa

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Translating genomic testing results for pediatric critical care: Opportunities for genetic counselors

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Risk communication in genetic counseling: Exploring uptake and perception of recurrence numbers, and their impact on patient outcomes

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“…In this study population, discussion of recurrence numbers constituted the second most common indication for genetic counseling. 19 In an earlier study in this same clinic, discussion of recurrence numbers was the most common indication for genetic counseling, this suggests that reasons for referral are evolving. 4 Importantly, after counseling regarding the complex etiology of psychiatric disorders, and risk reduction strategies, fewer than half of all patients receiving psychiatric genetic counseling opted to discuss specific recurrence numbers with nearly 1 in 5 patients (18%) ultimately making a decision about this that differed from the initial indication for referral and/or desire expressed during initial contracting.…”