One unique
aspect of the Pitt Genetic Counseling Program is its emphasis on public health.
Students can pursue a dual degree with a MPH in Public Health Genetics and MS
in Genetic Counseling or certificate in public health genetics in addition to
their genetic counseling degree.
However, all genetic counseling students receive some training in public
health, which allows them to appreciate the application of genetic counseling
to population health. This week, some of our students share why public health
is important to the field of genetic counseling.
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| The 10 essential public health service |
Just like the way our genes work, nothing we
do as genetic counselors happens in isolation. Our jobs places us within the
complexity of family medicine issues, and our training in a public health
setting helps prepare us for that. As genetic counselors, we must be constantly
aware of how the aspects of our services, including genetic testing access,
interpretation, and billing affect the broader community. By joining committees
and working groups, genetic counselors can help improve this service landscape
by suggesting CPT codes for test billing purposes, refining diagnostic criteria
to improve test efficacy, and engaging with labs and insurance companies to
form contracts and working agreements to expedite authorization and coverage.
At Pitt, even non-dual degree genetic counseling students dive into public
health training and concepts, with the opportunity to customize the experience.
My thesis, for instance, involves measuring the positive predictive value of
clinical epilepsy panel testing criteria. By doing this, we’ll be able to tweak
the criteria to improve overall yield and make them better suited to finding a
genetic etiology in patients. The goal is that these refined criteria can serve
as a template for health insurance policy and improve patient cost and
experience in the future.
-Andrew Fazenbaker, 2nd year genetic
counseling student
It’s hard to name an aspect of our lives that
isn’t, in some way, related to public health. Genetics is no different. Public
health can be important in bringing people to medical attention. Newborn
Screening programs help identify newborns with serious and treatable conditions
so treatment can be started as early as possible. Initiatives around CDC Tier
One conditions help identify at-risk relatives through cascade screening for
Hereditary Breast and Ovarian Cancer, Lynch syndrome, and Familial
Hypercholesterolemia. Public health is
also responsible for people having access to care, and learning about public
health makes us more equipped to advocate for good public health policies. For
example, genetic counselors are not currently recognized as medical providers
by the Centers for Medicare/Medicaid Services. If genetic counselors were
recognized as Medicare providers, they could accept referrals directly and see
Medicare patients without having to be under the supervision of a physician. In
June 2019, a bill (H.R. 3235) was introduced to the House to change this. This
would remove barriers for many patients and allow for easier access to genetic
counseling. This bill is a prime example of how public health is important to
genetic counseling - if it weren’t for genetic counselors practicing public
health skills by writing and advocating for this bill, it would never have
gotten to the House. (Stay tuned to see if it passes!)
-Vickie Bacon, 3rd year dual degree
student
When I was applying to genetic counseling
programs, Pitt stood out to me because of its emphasis on public health. I love
the one-on-one patient interactions, but after working in a genetics clinic for
a year I felt that changes are needed at a broader, population level. There is
a shortage of both genetic counselors and medical geneticists, and millions of
Americans with inherited conditions whom doctors could better care for if their
conditions were identified. The CDC lists three “tier 1” conditions (two
hereditary cancer syndromes and one high cholesterol condition); if a person is
found to have one of these conditions, action can be taken to decrease
morbidity and mortality. More than 90% of Americans with these conditions are
undiagnosed; the signs are there, but they are not being identified and
referred for genetic services. The CDC lists specific steps to identify these
individuals on a population level. When one person is diagnosed, relatives are
at risk and can be tested. I strongly believe that the health care community
can do a better job of identifying these individuals before they are diagnosed
with stage 4 cancer or have a heart attack. Those of us being trained in public
health genetics are learning skills that will help us use our genetics
knowledge to improve health on a population level.
-Claire McDonald, 2nd year dual
degree student
Being educated in both public health and
genetic counseling is important to me because it lets you see the bigger
picture. Even though one-on-one communication with patients is a major part of
why I chose genetic counseling, I also knew there was so much more that needed
to happen to be truly effective at making an impact. And I don’t mean “bigger
picture” in the sense that when you identify a genetic condition in one individual,
you then have to expand your scope to look at the risk of their relatives,
although this is important as well. “Bigger picture” is looking at the
structural and systemic problems that are negatively impacting public health,
and for me that means problems with access to genetic services. Having this
access-focused public health mindset leads me to think about the patients who
would clearly qualify for a genetics consult but never make it into the clinic
at all. What’s stopping them from coming in? Is it that they don’t know about
their options for genetic testing? Do their doctors not know what resources and
referrals are available or not have a sufficient background in basic genetics
to recognize when one of their patients could benefit from a referral to
genetic counseling? Are the patients aware, but they don’t have the means to
capitalize on a referral, either due to transportation issues, lack of
insurance, or another barrier entirely? Once we start to think about these
problems, we can start to work on overcoming them so that we can make a
positive change in the health of our patients and the population as a whole.
-Trinity Sprague, 2nd year dual
degree student
Relatively speaking, the role of genetics in
medicine is still new and expanding. There are already so many opportunities
for public health interventions to maximize the impact of new technology and
research. At the same time, I have no doubt as the field grows and changes,
there will be new, unexpected ways that genetics will change the nature of
healthcare. This is why it is essential to bring in a public health mindset
from the very beginning, while the profession of genetic counseling is
evolving. That is the best way to make sure that as advancements occur, they
can be efficiently and rapidly brought to the population at large in equitable
and affordable ways. It is easier to devise these strategies when professionals
are already thinking about it in the beginning of the process, rather than
trying to work their way backwards from it.
-Pooja Solanki, 2nd year dual
degree student
