Analyses of time-based effort have historically determined that clinical genetic services are labor-intensive.1-3 The limited analyses have focused primarily on geneticists’ efforts in a pediatric model. One study examined real-time work flow of medical geneticists and genetic counselors (GCs), and found that the average amount of professional time was 7 hours for new patients and 3.5 hours for follow-up cases.3 In a more recent study, cancer GCs of the National Society of Genetic Counselors (NSGC) were surveyed on their clinical practices.4 Participants were given an example of the typical patient encountered in a cancer genetics clinic and asked to estimate the amount of time they would spend on an initial patient encounter. Half of the respondents estimated they would spend more than 60 minutes with the patient.4 They also reported that approximately 50% of GCs had some level of direct physician involvement in their patient care, and in most cases (81.6%) for billing purposes.4
With the inception of CPT code 96040 and licensure, GCs have an avenue for professional recognition within their scope of practice. Furthermore, increased awareness of cancer genetic counseling services has created a higher demand for appointments. Thus, expansion of these services is required and must be achieved in a manner that efficiently provides care, without sacrificing quality, in the context of limited workforce.
No prospective studies have examined the time and labor efforts of cancer GCs. This study investigated the actual time spent on patient-related activities (visit and pre- and post-visit time) for GCs providing services in a traditional cancer genetics clinic with a medical geneticist (GC/MD) compared with cancer clinics staffed only by a genetic counselor only (GCO). This study sought to address the hypothesis that time spent per patient encounter for GCs would be lower in the GCO visits versus the GC/MD visits.
The authors wish to thank Emily Edelman, MS, CGC, for her input on the study design and helpful discussions.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors. Dr. Eng is the Sondra J. and Stephen R. Hardis Chair of Cancer Genomic Medicine at the Cleveland Clinic and is an American Cancer Society Clinical Research Professor, generously funded in part, by the F.M. Kirby Foundation.
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