Over drinks at the last NSGC conference, the two of us had a chance to catch up. We had met 10 years ago when one of us (Kyle) was a student and the other (Praveen) managed the student rotation at the lab. What would typically be a time to chat about new jobs, family and industry tidbits, instead turned into a conversation that would reframe how one of us (Kyle) understood our profession and the careers within it.

Over the past 15 years, Praveen had noticed a trend in our profession: the rise of “macro” positions. This framework places the work within a job on a continuum from micro to macro. I hadn’t heard of this dichotomy before (trichotomy, actually). But as we talked, we found the framework resonated with the trajectories of our careers by pointing the way to how we liked to work, and which roles might be right for us as we navigate our careers. It also shed light on a tension in the genetic counseling community.

This idea of “micro” and “macro” jobs appears to come from social work and goes like this: Micro roles are defined by focusing on one-on-one encounters while macro roles focus on engaging small, medium and large groups. For genetic counselors, micro work might consist of counseling patients, researching and drafting lab reports, or working with students to affect individual outcomes. Macro work might entail addressing challenges across departments, clinical areas or policy at the state or national level to affect collective outcomes. There are also roles at the “mezzo” level, which operate between micro and macro roles and work with teams or small groups.

Essentially all genetic counselors complete their training and begin their career in a micro role. Most of these positions are on clinical teams that provide one-on-one care to patients and families. That’s also what draws most students to enter genetic counseling programs. Many of us could have gotten a different professional degree, but we didn’t (yet). We were drawn, at least in part, to the micro work that could have a large impact on a patient or family. Over time, people grow in their profession and can take on new roles at other levels (mezzo or macro) if they desire or do more challenging micro roles.

It's important to realize that while most of us — maybe all of us — like working across levels, many likely prefer work roles at a certain level and enjoy stepping outside that level in other professional capacities. For example, the counselor whose primary role is seeing pediatric patients may love their position at the medical center (micro) but may want the challenges of being an NSGC Board Member (macro). Alternatively, the counselor who works as a director of clinical operations at a commercial laboratory (macro) may also enjoy their part-time role teaching a class at their local GC program (micro).

But there is a tension here: trouble comes when we think we know what we want, or what we want conflicts with our role’s work. To explore the first problem (we think we know what we want), we’ll use Kyle’s experience: He was on a clinical team at a lab and loved the team, his managers and the (micro) role drafting reports and talking to parents and health care providers. But after five years, he wanted to do more and use different skills. He was recruited to another lab to work as the manager of scientific communications (mezzo). There, he used different skills, had more responsibilities and had a higher salary commensurate with the work. He enjoyed many aspects, but in less than a year missed engaging with individuals (micro).

For the other problem (what we want conflicts with a role’s work), we can use Praveen’s experience: He noticed a trend where genetic counselors — whether in clinical or industry settings — wanted titles and pay commensurate with macro roles, but to keep doing micro work with the same responsibilities. Many of us aren’t specifically trained for macro roles and must learn new skills, but we want the title or salary that comes with macro roles. This tension seems to have increased over the past 10-15 years as genetic counselors perform more jobs at the macro level.

This is reflected in our Professional Status Surveys (PSS). Over the years, different titles (individual contributor up to CEO), work locations (governments, private companies, academic institutions, etc.) and role types (direct care, “mixed”, and nondirect care) have steadily increased. One needs only glance at the salary tables to see that nondirect care roles, which have more macro roles, have higher average salaries.

This rise of these opportunities is exciting but also disorienting. We’ve never had so many options for work and to affect change via clinic, policy, sales/marketing and education. When thinking about your current or future role, consider these questions: At what level do you like to work, micro (individuals) vs. mezzo (small groups) vs. macro (large/multiple groups)? For which roles are you (currently) qualified? And does the role you’re looking for, or salary and title you’d like, make sense with the scope of the role? Knowing the answers to these questions will help you realize the roles where you’ll fit best (for now).

To be clear, we don’t think any level of work is better than another. We also believe all genetic counselors should continue to advocate for their benefits and pay regardless of their position. And we should continue to push the boundaries of where genetic counselors, with our unique training, are employed. We need genetic counselors operating at all levels to grow genetics and genomics in health care and realize its full potential. 

Photo by Rick Rothenberg on Unsplash

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