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:

Number of Geneticists United States

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:


View Larger Map

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.

physician-geneticists

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:

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.

Comments

14 Responses to “Shortage of physician-geneticists in the United States”

  1. Lynn S. on December 28th, 2007 10:42 pm

    Yes, there is a shortage of people trained in genetics in the health care setting. I think there are about 2,000 genetic counselors.

    I would like to see some data that shows how many clinical gen. there are for each genetic counselor. I would imgagine that there would only be about 2 or 3 genetic couselors and only about 2 clinical gen. for about 3 million people in the Oklahoma to Arkansa area.

    There is also a shortage of medical techs and nurses.

    I think that if nurses were to be trained in genetics, it would help things out. Doctors that work with ped. patients can be trained in the area of genetics as well.

    A clinical gen. salary is around the $100k to $125k range. When a person is going into a good $150k+ debt during medical school and not being able to pay it back until after they are done with residency, it puts a lot of pressure on the person to chose a medical specialty that pays higher so they can pay back their debt and also make a decent living (if they live in an expensive city like New York, Boston, San Fran.).

    From my limited experience, I think one of the major issues comes with getting the correct diagnosis and proper genetic testing (getting the right test orderd and being able to understand the test result). A person not trained in geneticss will have a tough time doing this.

    I think the majority of new doctors coming out of medical school today can adapt to understand pharmacogenetic treatment. But they will still not be trained in interpreting a genetic test result and knowing which genetic test to order (I could be wrong though).

  2. Steven Murphy MD on December 29th, 2007 8:20 pm

    Jason,
    Great post. Are you sure there aren’t more than this? I had 730 according to the Pediatric Work Force Survey completed in 2005. As for Lynn S…I totally agree. We have a nurse geneticist at Yale seeing pediatric patients. It works very nicely as she is also an NP. Can you imagine? That few geneticists and they get paid that little. Doesn’t that defy the law of supply and demand? Or maybe there isn’t that much demand…..for now!
    p.s. Thanks for the mention.
    -Steve
    http://www.helixhealth.org
    http://www.thegenesherpa.blogspot.com

  3. jasonbobe on December 31st, 2007 10:16 am

    Hi Steve -

    The 509 seemed slightly low to me as well. This number is for geneticists that see patients. So, geneticists that manage laboratories (etc.) are not counted. Still seems slightly low doesn’t it? Another factor might be that this 509 number represents only geneticists that have maintained a relationship with the ACMG, which may not represent 100% of practicing geneticists.

    As you alluded, I do believe that demand for medical genetic interpretation at this point is low, so we’re not seeing stress on the professional infrastructure yet. I also believe “gen pop” screening is around the corner, driven by low cost access to genome sequences. Since we’re all mutants, those of us with access to genome sequences might consider consulting with a knowledgeable medical professional. This is where the shortage of trained professionals will become an issue.

    A few items on my wish list that may interest you include:

    (1) I would love to have this data broken-down by specialty.
    (2) Develop a demand/supply model for the year 2015, and assume that by this point ~50 million people in the U.S. will have obtained genome sequences of some sort, e.g. exomes. Based on allele frequencies of genetic disorders, can a back-of-the-napkin estimate for annual # consultations sought by patients be modeled? How does this stack up against population of geneticists with negative or flat growth (as it is now?).

    -Jason

  4. Judith Benkendorf, MS, CGC on January 2nd, 2008 4:41 pm

    Dear Jason:

    The American College of Medical Genetics (ACMG) found your blog, via Genome Technology Online. We never expected such publicity! We share your concern about the clear deficiency of qualified medical geneticists both in terms of the current workforce and the future pipeline.

    We would like to put the data you obtained from us into perspective:

    1) The zip codes represent only a subset of board certified clinical geneticists with MD, MD/PhD and DO degrees, residing in the US—those who have chosen to become members of ACMG. These data do NOT include any PhD medical geneticists nor do they include genetic counselors, both of whom may see patients.

    2) The zip code maps must be viewed with some caution. There are states with a large number of clinical geneticists located at research institutions who often spend little, if any, time seeing patients. One example is Maryland, which includes the National Institutes of Health.

    3) We estimate that there are ~1100 board certified MD geneticists in the US. These physician geneticists serve as the leaders of the medical genetics team and offer a broad range of clinical genetics services.

    4) There are approximately 2440 active, board-certified genetic counselors in the US. They represent the most rapidly growing professional cohort on the medical genetics team and are often cited as seeing the largest proportion of patients seeking genetic services.

    5) We share your view that the rapid pace of new knowledge in genetics is not reflected in the growth of the workforce, which is unevenly distributed throughout the United States—findings also documented by a federally-funded assessment of genetic services and the heath care workforce, completed about 3 years ago. The ACMG is actively engaged in a number of initiatives that address the maldistribution of genetic services in the US as well as the importance of access to up-to-date information at the point of care.

    The ACMG would be pleased to work with you or any other groups wishing to help members of the public locate a qualified medical genetics professional.

    Best regards,
    Judith

  5. jasonbobe on January 2nd, 2008 11:50 pm

    Hi Judith -

    After a re-read of my post there is no doubt I did a poor job articulating the data I plotted on the maps. I’ve updated the post above, although its clear I need to revamp the maps from top to bottom! I’ve also added links to your papers on the genetics workforce.

    Best,
    Jason

  6. Simon Lin, MD on January 3rd, 2008 1:20 pm

    Hi Jason,

    Great post.

    You estimated that ~50 million Americans will get a genetic test of some sort by 2015. It seems high to me. How did you come up with that number?

    Thanks!

    - Simon
    http://retail-genomics.blogspot.com/

  7. jasonbobe on January 3rd, 2008 1:33 pm

    Hi Simon -

    50 million wasn’t scientifically derived.

    Its my gut, but there was a logic. I’m assuming that DNA sequencing trends will look similar to the growth of the PC market.
    I figure 2007 for personal genomics was kind of like 1980 for PCs. Growth over the next decade will be similar to growth in PCs in the 80s, although faster.

    PCs 1980-1995: sparkline
    DNA 2007-2015: sparkline

    Back of the napkin!

    Jason

  8. Mary on January 3rd, 2008 3:59 pm

    This got me wondering how many people have voluntarily participated in the National Genographic Project.

    It appears that in the first 18 months of the project there were just under 80,000 people who participated.

    PDF: https://www3.nationalgeographic.com/genographic/pdf/PLOS_paper.pdf

  9. jasonbobe on January 3rd, 2008 4:03 pm

    A U.S. News and World Report article published today says:

    “The National Geographic Society’s Genographic Project, which has been collecting DNA from volunteers since 2005, has about 225,000 samples of mitochondrial DNA, which traces maternal lineage.”

    J

  10. Simon Lin, MD on January 5th, 2008 6:50 pm

    23andme and deCodeMe have started their sales since November 2007. Has any real sales number or indicators come out?

    I would predict Genomic Testing could be one of the hottest Christmas gift someday…

    Simon
    http://retail-genomics.blogspot.com/

  11. Judith Benkendorf, MS, CGC on January 10th, 2008 1:50 pm

    Dear Jason:

    Thank you for your follow-up communication and for making the additions/corrections to your website. We appreciate your presenting the most accurate available data about the medical genetics workforce.

    As you know Medical Genetics was recognized as the 24th primary specialty of medicine by the American Board of Medical Specialties in 1993. At the same time, the American College of Medical Genetics (ACMG) was established as the professional organization that represents the board certified clinical geneticists and the great majority of the clinical laboratory geneticists (directors of clinical molecular, cytogenetic and biochemical genetics clinical laboratories in the US) who are involved in genetic testing for heritable traits. Clinical laboratory geneticists may hold MD, PhD, or both MD and PhD degrees and MD geneticists may see patients as well as direct a clinical laboratory, making it difficult to arrive at the precise workforce estimates you are seeking.

    Because the number of PhD geneticists you listed after my first posting seemed low, I consulted our colleagues at the American Board of Medical Genetics (www.abmg.org) and was provided the information below. Since the inception of the ABMG in 1980—and through the 2007 examination cycle— they have issued the following numbers and breakdown of certificates:

    Medical Genetics Specialties Number of Certificates
    MD Clinical Genetics 1,253
    PhD Medical Genetics 152
    Clinical Biochemical Genetics 261
    Clinical Cytogenetics 620
    Clinical Molecular Genetics 435
    Clinical Biochemical/Molecular
    Genetics (1990/1993 only)
    49
    Subspecialty Certificates
    Molecular Genetic Pathology
    9

    The ABMG has awarded 2,772 certificates to 2,341 individuals. We know that not all of these geneticists are alive or actively involved in patient care in the US. So, the numbers I have provided you in my posting are our best estimates (the number of genetic counselors being provided by the American Board of Genetic Counseling in late December 2007). As of two days ago, ABMG estimated that the number of medical geneticists with PhD degrees only is ~770 (270 more than you presently list).

    We thank you for coming to the American College of Medical Genetics with your interest in workforce issues. We are indeed the professionals who are trained to translate genetics into health, and we share your keen interest in the issues surrounding the size, geographic distribution and future of this dynamic professional workforce.

    Best regards,

    Judith Benkendorf, MS, CGC
    Project Manager
    American College of Medical Genetics
    9650 Rockville Pike
    Bethesda, MD 20814-3998
    301.634.7127 (phone)
    301.634.7275 (fax)
    jbenkendorf@acmg.net
    http://www.acmg.net
    Medical Genetics: Translating Genes into HealthTM

  12. jasonbobe on January 10th, 2008 2:14 pm

    Great! Thanks again Judith!

  13. Trackbacks on April 19th, 2014 2:26 am

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