“I like science and I want to help people.” In my experience as a faculty member, this is overwhelmingly the (paraphrased) answer of many prospective genetic counseling students when asked, “Why genetic counseling?” during interviews. A driving force for many who enter this field is the natural desire to support people, in some form, as they navigate the impact genetics can have on their health and families. That was certainly a personal motivation and an aspect that brought me fulfillment as a clinical cancer genetic counselor (GC) in my first position after graduation⁴.

After five years, I made the difficult decision to transition into a position as a laboratory GC, with my new role focusing primarily on lab stewardship, utilization management, and report customization. One of my greatest hesitations was the fear of losing the sense of purpose that my positive interactions with patients would routinely bring. Seeing that “lightbulb” moment while explaining a complex topic, witnessing the relief after delivering good news, having patients verbalize the positive impact a session had on them — those were the experiences that made me excited to go to work and staved off the creep of burn-out. I was even taught during school to save cards or kind emails from patients to reflect on during difficult days, when I needed a reminder of why I pursued this career.

My training also focused heavily on the psychosocial aspects of the profession: reading body language, supporting a patient during a tough conversation and communicating a difficult concept. Would I be wasting all that psychosocial training by moving into the laboratory space, face-to-face with a computer instead of a human for most of the day? I felt that I must not be alone in weighing these concerns and fears when considering a transition out of a patient-facing role or choosing an industry job right after graduation, despite the clinic-heavy focus of many program curricula.

Now that I have been in my lab position for over a year, with the learning curve not feeling so insurmountable and the ground finally feeling settled beneath my feet, I am working on being more intentional about identifying the fulfilling aspects and ways my psychosocial training remains impactful. I developed mental techniques to feel connected to the patients I am assisting, despite only reading names, ages and histories on a screen. I take a moment when reviewing records to absorb the patient’s story and to consider what their journey was like or what a genetic diagnosis may mean for them. Just reminding myself that each order represents a real person goes a long way in instilling purpose in my case work. When identifying and correcting a misorder or directing a clinician to more appropriate test selections, I think of the positive impact this will have on the family paying for a test or receiving the result. While reviewing reports, I imagine reading this information as a patient or a parent and customize the language appropriately.

I have started to identify what I need to feel inspired by my non-clinical work. But I wish someone had told me from the start that I was not alone in feeling hesitant and adrift at first. When faced with a transition from the clinic (or from graduate school) to the laboratory, I encourage connecting with colleagues with similar experiences to help prepare for the change. They can provide guidance on reframing intangible skills to be relevant to a non-patient facing role, and just as training programs educate students on skills to succeed and thrive in the clinic, a balanced effort should be made to highlight techniques to maintain a sense of fulfillment outside the clinic.

Programs should not only teach that these positions are possibilities and equip students with technical skills pursuant to current ACGC Practice-Based Competencies³, but also how to excel and be happy in such a job. Leadership should endeavor to connect students with a variety of laboratory experiences both for exposure to the work and to foster interpersonal connections with supervisors in non-clinical roles, who may become valuable resources for those who choose a similar career path now or in the future. And this is only becoming more common; there are documented increases in the transition of GCs from direct to non-direct patient care positions. The 2024 NSGC Professional Status Survey (PSS) shows that 25% of responding GCs currently work in non-direct patient care positions, with an additional 19% in mixed positions. A combined 17% of respondents work in commercial or noncommercial laboratories². These numbers have increased over the years, with the 2012 PSS identifying less than 8% of respondents with “non-clinical” roles in a commercial or noncommercial laboratory¹.

My current position has a component of student supervision for a laboratory rotation with a nearby program. I strive to be honest with students when they ask about the differences between my two jobs, highlighting my struggles in both positions and the moments that have brought me joy. I wish I had similar conversations with colleagues before embarking on the next steps of my career; I would have felt better prepared and equipped to manage the transition. Most importantly, while I may not be able to connect with a few patients daily across a consult table, I know that I can now assist with many more cases per day in the lab or help identify and correct process issues or inconsistencies that can help tens or hundreds of patients pursuing that testing in the future. When framing my daily tasks in such a light, I am reminded of the purpose and impact of my work in the laboratory.

References

1. National Society of Genetic Counselors (NSGC). (2012). Professional Status Survey: Work Environment. p.4. Retrieved from https://www.nsgc.org/Policy-Research-and-Publications/Professional-Status-Survey/Archived-Professional-Status-Survey?folderId=152&view=gridview&pageSize=10
2. National Society of Genetic Counselors (NSGC). (2024) 2024 Professional Status Survey. https://www.nsgc.org/Policy-Research-and-Publications/Professional-Status-Survey
3. Practice-Based Competencies for Genetic Counselors. (2023). Accreditation Council for Genetic Counseling. Retrieved from https://www.gceducation.org/wp-content/uploads/2023/12/ACGC_PracticeBasedCompetencies_2023.pdf
4. Solimine, J. (2019). Genetic Testing After a Terminal Diagnosis-Providing Purpose. JAMA Oncol. 2019 Jul 1;5(7):936-937. doi: 10.1001/jamaoncol.2019.0846. PMID: 31145417.

Julie Solimine, MGC, LCGC is a laboratory molecular genetic counselor at ARUP Laboratories. She previously worked as a clinical cancer genetic counselor and training program faculty member for the University of Maryland School of Medicine.