A Scoring System to Balance Genetic Counselor Work across Different Clinics
Health Services and Implementation
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Primary Categories:
- Genetic Counseling
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Secondary Categories:
- Genetic Counseling
Introduction:
Unlike most institutions, genetics counselors (GC’s) at the University of Alabama at Birmingham (UAB) are based in clinical genetics services, regardless of specialty (i.e. cancer, prenatal, etc). In addition, each GC works in multiple clinical settings, and a typical full-time GC schedule is comprised of 14 half-day clinics per month regardless of their mix of clinic types. While this structure has many benefits (Robin and McClinchey, 2023), it does have the challenge of creating an equitable clinic workload among GC’s due to the variable nature of clinical responsibilities in each specialty setting. To address this issue we sought to develop a clinic weighting system that would facilitate creation of an equitable distribution of work among all GCs, regardless of clinic type.
Methods:
Our initial step was to create and distribute an anonymous survey to clinical GC’s at UAB. Each clinic type was assessed for time spent on various tasks – preparation, time in clinic, documentation, results interpretation and disclosure, and coordinating follow up and referrals. The survey included a multiple choice time range estimate for each task. In addition, the psychosocial impact was scored for each clinic by a subjective report of stress level (score 1-5). One extreme outlier was eliminated and responses for each clinic type were averaged, thus generating a ‘score’ for each clinic. Each GC’s clinic load score was calculated and compared to a 130 clinical hours per month standard. This standard was determined by comparing all scores and finding the average GC had a score between 130-136 clinical hours per month (pre-adjustment).
Results:
The average time spent completing clinical responsibilities varied between specialties. General adult genetics clinic required 12.4 total hours per clinic, pediatric clinic required 12.3 hours, general prenatal required 8-8.75 hours, and general cancer required 8.7 hours. Free text responses provided additional insight to the unique challenges that contribute to variability, such as the need to coordiante follow up testing or interpreting and managing complex results. As a result, clinic load was adjusted by redistributing 1-2 clinics for 11 genetic counselors so that all counselors would be near the 130 standard. These adjustments were well received by the GC’s with minimal pushback. To date, these changes have been viewed positively, and a follow up survey on the impact of this new system will be carried out at 6 months and 12 months post-adjustment.
Conclusion:
We found that the time required to staff a clinic varied between clinic types, which had led to an unequal distribution of responsibilities due to each GC’s unique clinic load. Using this scoring system we were able to identify and quantify this disparity and adjust schedules to equalize each GC’s clinical workload. Unfortunately this study did not account for non-clinical tasks such as student/resident supervision. Further research is needed to determine if clinic load adjustments impact psychosocial scores and overall feelings of wellbeing or burnout among genetic counselors, but balancing workloads equitably is certainly a positive step to address these concerns.
Unlike most institutions, genetics counselors (GC’s) at the University of Alabama at Birmingham (UAB) are based in clinical genetics services, regardless of specialty (i.e. cancer, prenatal, etc). In addition, each GC works in multiple clinical settings, and a typical full-time GC schedule is comprised of 14 half-day clinics per month regardless of their mix of clinic types. While this structure has many benefits (Robin and McClinchey, 2023), it does have the challenge of creating an equitable clinic workload among GC’s due to the variable nature of clinical responsibilities in each specialty setting. To address this issue we sought to develop a clinic weighting system that would facilitate creation of an equitable distribution of work among all GCs, regardless of clinic type.
Methods:
Our initial step was to create and distribute an anonymous survey to clinical GC’s at UAB. Each clinic type was assessed for time spent on various tasks – preparation, time in clinic, documentation, results interpretation and disclosure, and coordinating follow up and referrals. The survey included a multiple choice time range estimate for each task. In addition, the psychosocial impact was scored for each clinic by a subjective report of stress level (score 1-5). One extreme outlier was eliminated and responses for each clinic type were averaged, thus generating a ‘score’ for each clinic. Each GC’s clinic load score was calculated and compared to a 130 clinical hours per month standard. This standard was determined by comparing all scores and finding the average GC had a score between 130-136 clinical hours per month (pre-adjustment).
Results:
The average time spent completing clinical responsibilities varied between specialties. General adult genetics clinic required 12.4 total hours per clinic, pediatric clinic required 12.3 hours, general prenatal required 8-8.75 hours, and general cancer required 8.7 hours. Free text responses provided additional insight to the unique challenges that contribute to variability, such as the need to coordiante follow up testing or interpreting and managing complex results. As a result, clinic load was adjusted by redistributing 1-2 clinics for 11 genetic counselors so that all counselors would be near the 130 standard. These adjustments were well received by the GC’s with minimal pushback. To date, these changes have been viewed positively, and a follow up survey on the impact of this new system will be carried out at 6 months and 12 months post-adjustment.
Conclusion:
We found that the time required to staff a clinic varied between clinic types, which had led to an unequal distribution of responsibilities due to each GC’s unique clinic load. Using this scoring system we were able to identify and quantify this disparity and adjust schedules to equalize each GC’s clinical workload. Unfortunately this study did not account for non-clinical tasks such as student/resident supervision. Further research is needed to determine if clinic load adjustments impact psychosocial scores and overall feelings of wellbeing or burnout among genetic counselors, but balancing workloads equitably is certainly a positive step to address these concerns.