Shortage of physician-geneticists in the United States
Update 1/2/07: I added a box toward the end which summarizes the genetics workforce in more detail. Caveat emptor: The maps featured in this post are preliminary works-in-progress and do not capture all physician-geneticists working in the United States, just those for which good data are available (board-certified physician-geneticists that see patients and are members of the ACMG).
There are very few health care professionals in the United States with extensive training in genetics. The most qualified professionals are board-certified physician-geneticists. According to the American College of Medical Genetics (ACMG), in the United States, there are approximately 509 physician-geneticists that see patients and are registered with the ACMG, which includes MDs,
PhDsMD-PhDs, and DOs. This number excludes PhD geneticists, genetic counselors, and physician-geneticists who are either not registered with the ACMG or do not see patients (see summary box toward the end).
For perspective, there are nearly as many professional astronauts in the world as there are board certified geneticists that see patients in the United States. These 509 geneticists are not distributed evenly across the United States. Four states have no physician-geneticists at all. California has the most, with 84. The following image shows the distribution of physician-geneticists by state:
If we divide the population of the U.S. by these 509 physician-geneticists, we get a back-of-the-napkin estimate of 600,000 U.S. citizens per board certified physician-geneticist that sees patients and registers with the ACMG (300M/500). This ratio varies significantly, depending on the state. For example, there are approximately 2.8M people per physician-geneticist in Arkansas, where there is only one ACMG-registered, board certified geneticist that sees patients in the entire state.
I’ve plotted this data on a map of the United States:
The limited supply of health care professionals with expertise in genetics should be considered a risk associated with obtaining a genome sequence. Services such as 23andMe, Navigenics, deCodeMe, DNA Direct, and Knome will certainly put pressure on the capacity of the existing professional infrastructure. Of course, some of these companies (and others) may also come to fill the void with innovative models for patient triage.
***Big thanks to the ACMG for providing zip code data that enabled me to generate the maps above. Update 1/2/07: Although all errors are mine! See comments.
Professional Genetics Workforce Stats
~1100 MD geneticists in the U.S.
~2440 genetic counselors in the U.S.
~500 PhD geneticists in the U.S.
*The 509 physician-geneticists described above include MDs, MD-PhDs, and DOs that see patients and are members of the ACMG.
Some background papers with more detailed information:
- Cooksey JA et al. The medical genetics workforce: an analysis of clinical geneticist subgroups. Genet Med. 2006 Oct;8(10):603-14.
- Cooksey JA et al. The state of the medical geneticist workforce: findings of the 2003 survey of American Board of Medical Genetics certified geneticists. Genet Med. 2005 Jul-Aug; 7(6):439-43.
This month I am doing an extended meditation about the risks of obtaining and sharing personal genome sequences. This exercise will be cathartic for me. Beyond that, I hope it may help to reorient the conversation about risks into something that one day might resemble practical guidance for individuals considering obtaining and sharing personal genetic information.