International Rotation: Canada

For my optional rotation block I had the wonderful opportunity to head home to Canada. My goal for this rotation was to learn more about the genetic testing environment within a socialized healthcare system. I completed my rotation at the Credit Valley Hospital in Mississauga, Ontario. This clinic serves a large and diverse population within the ever growing Toronto metropolis. The clinic staffs 8 genetic counselors and 3 geneticists who work in all areas of genetics.

During my four week rotation at Credit Valley Hospital in Canada, I observed many differences. Some of these differences were from clinic to clinic, others province to province, and many country to country. One of the most notable differences between Canada and the USA is testing approval. In Canada, there are no insurance companies that counselors must interact with to determine coverage of genetic testing for their patients. Instead, genetic testing that is not performed within the province requires approval from the ministry of health. This approval process requires a simple application and justification letter. If testing is sent for something common, and sent to a well-known lab in Europe or the USA, then approval will usually take a few weeks. 

Photo by: Paul Gierszewski

Currently, many common genetic tests are being performed within the province of Ontario. The government funds and pays labs within hospitals and universities to perform one or more specialized tests for the entire province, or a specific region depending on the test type. The hospital where I completed my rotation housed a lab that was responsible for prenatal tests in their local area. During my rotation I had the opportunity to attend a meeting with a commercial diagnostics company coming in to promote advanced first trimester screening. The meeting included lab staff, geneticists, and genetic counselors. It was interesting to see the counselors playing such an important role in this decision making process. How counseling plays out in the clinic, based on provincial guidelines, has the potential to result in lab cost savings. This experience made me realize how important it is to have genetic counselors sitting at the table and contributing to decisions being made regarding genetic testing. 

I also observed differences in testing guidelines between the USA and Canada. For example, the National Comprehensive Cancer Network guidelines are used as a reference, but the province has its own testing guidelines for breast cancers, lynch syndrome, and other conditions. Some of these guidelines were less conservative and geared toward a socialized health care system. For example, breast cancer panel testing was reserved for patients with very significant family histories compared to what I have observed in Pittsburgh so far. Observing these differences I noted the balance between what was best for the patient, what was medically necessary, and what was the best use of sometimes limited resources. The province of Ontario has a strict budget specifically set aside for genetic testing and so the balance between patient care and resources is a real one. 

Overall, this was an exciting and unique opportunity for an optional rotation that provided exposure to a healthcare system very different from that in the USA.
- Christine Munro, Class of 2017