This commentary in the Genomics Law Report’s ongoing series What ELSI is New? is contributed by Misha Angrist, Duke University Institute for Genome Sciences & Policy.
Dear Dr. Board-Certified Clinical Geneticist:
First of all, thank you! Sure, you could have bailed after pediatrics or internal medicine and made more money, but you chose to stick around for a couple more years, incur still more debt, and make less. Much less! (Fortunately, you are a doctor and not a financial adviser.) And a fine doctor you are, schooled in the ancient art of dysmorphology, which is probably as inscrutable to your molecular-fetishist colleagues as exon-capture protocols are to you.
Anyway, here you are, languishing at the bottom of the physician food chain. But hey, at least you have the psychiatrists for company!
I know: You rarely do procedures beyond physical exams (albeit terrific physical exams). Otherwise, mostly you talk to people. And order tests that generate bupkes for your office.
For patients with highly penetrant Mendelian disorders or syndromic conditions, you are a lifesaver. But of course, CMS can’t wrap its dysplastic little brain around this and so it doesn’t like to pay for your services. Meanwhile, genetic counseling has been around for decades, yet you still have no ingenuous way to bill for it. (God knows where you’d be without those trusty “physician extenders.”) To paraphrase Three 6 Mafia, “It’s hard out here for a geneticist.”
But I have good news: this is all about to change! Because this is your One Shining Moment! We are hurtling toward the $1000 genome! If you thought the line of patients coming in with their 23andMe reports was annoying, just wait until they show up with their raw sequence from Illumina! Heh. I kid because I care.
And because I know you’re up to the challenge. As Dr. McKusick said, you are the last generalist. You’re all about incorporating as many disparate forms of data as you can into diagnosis and treatment. You recognize that the time has come for your guild to begin to think about diabetes, MS, Alzheimer’s, arthritis and MI. You are ready to coach your community on the benefits of prevention and to begin to parse SNP chip data, CGH arrays and yes, whole-genome sequences.
And I feel certain that you’re ready to roll up your sleeves and start revamping your med school curriculum, your training programs and your pay scale in order to better your own lot and to recruit the most promising young physician-scientists in the world. Just imagine: a universe in which patients don’t need to wait six months or a year to see you!
Listen, it’s not the surgeons, oncologists and cardiologists who have the keys to the kingdom. It’s you, Doc! You’ve already forgotten more about phenotype than your gene-jockey neighbors will ever know. So come on, Doc, leverage that power!
Oh, and get this: one of your own is now Director of the NIH! I’d bet you dollars to donuts that no one wants you to succeed more than he does. Try him!
This is your time. Carpe diem, babe!