Genetics: PA vs. MD

[Dreamy747]

Hi,
I'm currently a freshman Biology (concentration in Genetics) / Pre-Med student. First and foremost, I know I want a career between medicine and genetics. I've considered genetic counseling before, but from what I've found it is not as hands on as I would like. So I guess my question comes down to the pathway that genetics would work best for. For the longest time I have wanted to be a clinical geneticist, however, sometimes I wonder if it is worth it between the debt/high rates of being sued/ and overall trend of the MCAT and medical school being sucky. I'm not sure if PAs can specialize in genetics or not. I was wondering if anyone focuses on genetics in the healthcare field and could help me to better decide my options. Thank you for your time.

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[libertyyne]

Hi,
I'm currently a freshman Biology (concentration in Genetics) / Pre-Med student. First and foremost, I know I want a career between medicine and genetics. I've considered genetic counseling before, but from what I've found it is not as hands on as I would like. So I guess my question comes down to the pathway that genetics would work best for. For the longest time I have wanted to be a clinical geneticist, however, sometimes I wonder if it is worth it between the debt/high rates of being sued/ and overall trend of the MCAT and medical school being sucky. I'm not sure if PAs can specialize in genetics or not. I was wondering if anyone focuses on genetics in the healthcare field and could help me to better decide my options. Thank you for your time.

Genetic counselors are hands on and do not require an MD. By hands on do you mean with patients or with pipettes?

Also I would refrain from using your own picture in the Avatar on an anonymous forum.

 

[Dreamy747]

Genetic counselors are hands on and do not require an MD. By hands on do you mean with patients or with pipettes?

Also I would refrain from using your own picture in the Avatar on an anonymous forum.

Thanks - I'll change it when I get back to my computer. From my understanding, genetic counselors more of interpreted results. However, it seems I'm wrong on that. My biggest thing is I want to be able to diagnose / treat / and prescribe treatments (whenever possible) to patients.

 

[gallons]

Thanks - I'll change it when I get back to my computer. From my understanding, genetic counselors more of interpreted results. However, it seems I'm wrong on that. My biggest thing is I want to be able to diagnose / treat / and prescribe treatments (whenever possible) to patients.

you are young so try PA and if it feels limited apply MD. Just do something.

 

[nellbot2000]

Genetic counselors do a lot of one-on-one with patients. I met with one at the beginning of my pregnancy, she was the only person I had contact with. I never interacted with an MD for genetic counseling.

 

[libertyyne]

What are some of the treatments geneticists prescribe?

 

[citykid92]

I actually have spent the past two years working in a genetics clinic and work closely with GCs and geneticists. The GCs spend a ton of time with patients: they take histories, run the visit before and after the doc comes in, explain results, etc. If you are interested in it, the GCs I work with all love their jobs and the job market is amazing. Demand is huge. The geneticists do physical exams, review history, come up with potential diagnoses and order genetic tests (all done at specialty labs). It's an interesting and super fast growing field. It's also pretty unique I think. People with genetic conditions usually require tons of medical care and the geneticist is like the QB. They make sure everything is being taken care of and see patients regularly for follow up, but after diagnosis the actual medical management is handled by relevant specialists.

Also, we don't have any PAs and I don't see how a PA would be helpful in a genetics clinic.

 

[Dreamy747]

Genetic counselors do a lot of one-on-one with patients. I met with one at the beginning of my pregnancy, she was the only person I had contact with. I never interacted with an MD for genetic counseling.

Thanks for your response! I think it would be interesting to work with expecting mothers, however, I'm not very sure what all goes on in the process. If you don't mind me asking, what do you mean by hands on? Did they draw blood/ construct family trees / etc?

What are some of the treatments geneticists prescribe?

At the moment, not much that I'm aware of. I know certain medications can help alleviate symptoms (such as hydroxyurea for sickle cell I believe) but I believe this amount will continue to increase.

I actually have spent the past two years working in a genetics clinic and work closely with GCs and geneticists. The GCs spend a ton of time with patients: they take histories, run the visit before and after the doc comes in, explain results, etc. If you are interested in it, the GCs I work with all love their jobs and the job market is amazing. Demand is huge. The geneticists do physical exams, review history, come up with potential diagnoses and order genetic tests (all done at specialty labs). It's an interesting and super fast growing field. It's also pretty unique I think. People with genetic conditions usually require tons of medical care and the geneticist is like the QB. They make sure everything is being taken care of and see patients regularly for follow up, but after diagnosis the actual medical management is handled by relevant specialists.

Also, we don't have any PAs and I don't see how a PA would be helpful in a genetics clinic.

By geneticists, do you mean clinical geneticists? That's the field that I've wanted to go into for a long time, but since it's a smaller specialty I have a harder time finding accurate information on it or doctors to shadow in the field. What are the major differences between what the two fields do? Some of the qualities you describe for GCs I thought were limited to only clinical geneticists. Thank you for your response!

I will second what many others above have said...

I work at a top ten medical school (research powerhouse) and the genetic counselors that work on our cancer studies are awesome. They all do a lot of clinical work (obviously, the genetic counseling portion of their jobs), but are also very involved with various research projects, educational programs for the university and the community, giving lectures, mentoring GC students, etc. so if you are looking for a role that is clinical, but has other applications too it could be a very good choice.

Thank you! I didn't realize they were not just confined to clinical work. I think I would prefer to focus on the clinical aspect of it, however, variety is always nice. For the cancer studies, do they only help with cancers of a genetic origin?

 

[Sardinia]

By hands on do you mean with patients or with pipettes.

Neither. I wanna touch the alpha helix with my bare hands.

 

[libertyyne]

Neither. I wanna touch the alpha helix with my bare hands.

Have you thought about sperm banks?

 

[Matthew9Thirtyfive]

Just sharing my experience too. My wife was 36 when we had our second child, so we met with a genetic counselor. We actually did not even see a medical geneticist. The GC went over everything with us: took both our family histories and then went over our risks and what testing options were available (our risk was very low, so we didn't get any).

My daughters' pediatrician is also a medical geneticist though. I've seen some of his papers, but he is essentially a general pediatrician who knows a lot about genetics.

 

[----x----]

I work in an oncology and hematology clinic that employs 2 genetics counselors.

The counselors are usually booked out 4-6 months, they are busy. In general they take extensive personal and family histories from patients, decide on whether genetic testing is indicated, and then walk the patient through possible testing options which should be covered by insurance. They then meet with the patient to explain the results.

The most common testing for our clinic is with breast and ovarian cancer patients, screening primarily for BRCA 1/2 mutations. Frequently, a physician will refer to genetic counseling for a couple reasons. One is because they are unsure what testing will be covered by insurance, so want an expert to know what is approved in the patient's setting because it's complex. Many oncologists know a patient would benefit from a My25 risk panel given their family history/young age at diagnosis, but they aren't sure if it's covered and if not, it's extremely expensive. They also aren't always up to date on what the less common mutations signify (PALB2 mutation is a negative prognostic indicator, but what does that mean for us?), so a genetics counselor can be helpful. Another reason is if the case itself is more complex and they aren't sure what type of genetic testing would be beneficial. BRCA 1/2 can also give a predisposition toward pancreatic cancer - as can lynch syndrome, and other genetic disorders. Should we screen our pancreatic cancer patient, or their family? This is a grey area, refer to genetics.

For simpler things like looking for a thalassemia in a patient with microcytic anemia, or genetic testing on solid tumor tissue to determine possible treatment options, a genetics referral is not required.

The genetics counselors don't prescribe a medication or treatment, they provide information, but they may outline the national guidelines for patients in that setting. The physician later goes into further detail regarding their recommendations based on the genetic testing. For example, some patients with a BRCA1 or BRCA 2 mutation will undergo prophylactic bilateral mastectomy and TAH-BSO.

Genetics counselor degree programs are usually a 2 year masters degree. If your primary goal is working in genetics, I wouldn't recommend against becoming a genetics counselor. Learn more about it, see if you can shadow one, contact a local program for their alumni contacts. The only reason I'd pursue medical school instead is if there was something you really want to pursue that would only be possible through becoming a physician; from what you've said so far, I'm not sure there is. If the choice is between becoming a PA or a genetics counselor, that choice seems easy.

 

[citykid92]

By geneticists, do you mean clinical geneticists? That's the field that I've wanted to go into for a long time, but since it's a smaller specialty I have a harder time finding accurate information on it or doctors to shadow in the field. What are the major differences between what the two fields do? Some of the qualities you describe for GCs I thought were limited to only clinical geneticists. Thank you for your response!

Yes I do. Our office has several clinical geneticists - all trained as pediatricians who then did a fellowship in genetics. It definitely is a very small field (part of the problem is a lot of time training and very low pay for a specialist) and may geneticists are more interested in research / industry (test developments, gene therapy, treatment for genetic diseases) than they are in clinical work. In the clinical setting, GC's are really counselors as the name implies. They have a strong background in genetics and know a lot about medical genetics, but their focus is really on guiding the patients through the genetics evaluation, being the primary point of contact for patients, etc. For cancer genetics / prenatal / other sub-fields of genetics that are highly centered on family history / known risk factors, the GC's are often entirely in charge of seeing pt / ordering testing and the doc just signs off on the note at the end. For these types of visits, there are clear guidelines for risk factors / proper testing, etc so the doc doesn't need to get too involved. GC's also are in great demand at testing companies (helping with tele-counseling, analysis of results, etc) and you can just work in industry no problem if you want to do that. They also often serve as essentially research coordinators for clinical genetic research. The field is booming right now so you can really make the career what you want.

The clinical geneticists like I said are much more involved in diagnosis of patients. For any patient referred for something based on family history / known risk factors, it is the geneticist who is completely in charge of examining patient, reviewing records from other specialists, and coming up with potential diagnoses and testing options. They also do in-patient consults for newborns with possible genetic/metabolic conditions, consult for patients with known genetic conditions who get admitted to the hospital, and serve as PI's for research projects and such.

There is no doubt that the geneticist is running the show and the GC is working for them. That is not to talk poorly about GC's, they really do awesome work and the office would never work without them, but you should know how each role fits into the office/hospital dynamic. I hope that was helpful. Let me know if you have other questions.

 

[Dreamy747]

Just sharing my experience too. My wife was 36 when we had our second child, so we met with a genetic counselor. We actually did not even see a medical geneticist. The GC went over everything with us: took both our family histories and then went over our risks and what testing options were available (our risk was very low, so we didn't get any).

My daughters' pediatrician is also a medical geneticist though. I've seen some of his papers, but he is essentially a general pediatrician who knows a lot about genetics.

Thank you! I'll have to look into a similar route as your daughter's pediatrician, I think I would enjoy that.

Genetics counselor degree programs are usually a 2 year masters degree. If your primary goal is working in genetics, I wouldn't recommend against becoming a genetics counselor. Learn more about it, see if you can shadow one, contact a local program for their alumni contacts. The only reason I'd pursue medical school instead is if there was something you really want to pursue that would only be possible through becoming a physician; from what you've said so far, I'm not sure there is. If the choice is between becoming a PA or a genetics counselor, that choice seems easy.

Thank you! That was very informative. I'm going to try to shadow one this summer, so hopefully that will help. Hopefully I'm able to find both a genetics counselor and a clinical geneticist.

Yes I do. Our office has several clinical geneticists - all trained as pediatricians who then did a fellowship in genetics. It definitely is a very small field (part of the problem is a lot of time training and very low pay for a specialist) and may geneticists are more interested in research / industry (test developments, gene therapy, treatment for genetic diseases) than they are in clinical work. In the clinical setting, GC's are really counselors as the name implies. They have a strong background in genetics and know a lot about medical genetics, but their focus is really on guiding the patients through the genetics evaluation, being the primary point of contact for patients, etc. For cancer genetics / prenatal / other sub-fields of genetics that are highly centered on family history / known risk factors, the GC's are often entirely in charge of seeing pt / ordering testing and the doc just signs off on the note at the end. For these types of visits, there are clear guidelines for risk factors / proper testing, etc so the doc doesn't need to get too involved. GC's also are in great demand at testing companies (helping with tele-counseling, analysis of results, etc) and you can just work in industry no problem if you want to do that. They also often serve as essentially research coordinators for clinical genetic research. The field is booming right now so you can really make the career what you want.

The clinical geneticists like I said are much more involved in diagnosis of patients. For any patient referred for something based on family history / known risk factors, it is the geneticist who is completely in charge of examining patient, reviewing records from other specialists, and coming up with potential diagnoses and testing options. They also do in-patient consults for newborns with possible genetic/metabolic conditions, consult for patients with known genetic conditions who get admitted to the hospital, and serve as PI's for research projects and such.

There is no doubt that the geneticist is running the show and the GC is working for them. That is not to talk poorly about GC's, they really do awesome work and the office would never work without them, but you should know how each role fits into the office/hospital dynamic. I hope that was helpful. Let me know if you have other questions.

Thank you! From this, clinical genetics is what I want to do. I want to actually be able to diagnosis genetic disorders, not just explain the disorders. I'm going to attempt to do more research this weekend, but I will definitely let you know if I have other questions. Thank you so much!

 

[RWeber]

Hi,
I'm currently a freshman Biology (concentration in Genetics) / Pre-Med student. First and foremost, I know I want a career between medicine and genetics. I've considered genetic counseling before, but from what I've found it is not as hands on as I would like. So I guess my question comes down to the pathway that genetics would work best for. For the longest time I have wanted to be a clinical geneticist, however, sometimes I wonder if it is worth it between the debt/high rates of being sued/ and overall trend of the MCAT and medical school being sucky. I'm not sure if PAs can specialize in genetics or not. I was wondering if anyone focuses on genetics in the healthcare field and could help me to better decide my options. Thank you for your time.

Hi,

I am the mother of a future geneticist as well as a Neonatal Nurse Practitioner. I work with Geneticists in the NICU all the time and they are very hands on. They work with families who discover they are carrying a child with a syndrome while they are pregnant to advise them as to what to expect as well as possibly terminate the pregnancy. They follow the baby once born, help the Neonatologists run further tests to find other issues associated with the syndrome and then follow the baby as an outpatient. In the lab, geneticists discover tests for early identification of syndromes during pregnancy. Good luck, hope this was helpful. Roberta

 

[RandomChance]

Shadow. Shadow. Shadow.

Get experience in the field.. in all of these fields. Get hands on. You're a freshman, apply to some genetics labs, shadow physicians, ask local genetic counselors if you can shadow some of their work. It sounds like you don't really have a firm grasp on what they do... and neither do I.. so go observe one first hand! It'll probably be a more eye-opening experience for you than any of the text you're going to read here. There's a reason that ~50 hours of physician shadowing is an unspoken requirement for medical schools - because it is the best experience at showing you what the job actually entails.

 

[On_The_Way_Up]

Genetic counselors are hands on and do not require an MD. By hands on do you mean with patients or with pipettes?

Also I would refrain from using your own picture in the Avatar on an anonymous forum.

Wait, that’s not your own picture?