I’m Back! or How I Never Really Left Genetic Counseling
By Alexis Carere, Class of 2010
A few times recently, I’ve been asked why I left genetic counseling, and it’s true that my ID badge now reads “postdoctoral fellow,” and that I often fail to complete the NSGC Professional Status Survey because I can’t quite make my responses fit the available options. Even so, I brush off the question, because six months after completing my doctorate in epidemiology, I feel more passionate about genetic counseling – and more committed to this part of my professional identify – than I ever have.
Before I had even heard of genetic counseling, I knew I wanted to be an epidemiologist – I just wasn’t sure how to get there. Historically, epidemiologists have been physicians, first treating individual patients, and then expanding their practice to the population. However, having in first-year university ruled out going to medical school on principle (what principle, I can’t remember), my own path to epidemiology was uncertain. By October 2007, I had a degree in genetics and was studying philosophy in London, Ontario, but I was still trying to figure out my next move. It can perhaps be attributed to fate, then, that in my Ethics seminar that month, we were assigned two papers by the epidemiologist Abby LippmanHand entitled “Genetic Counseling – The Postcounseling Period: I & II.” These papers, with their rich description of reproductive decision-making and the uncertainty of risk estimation, revealed a way to combine genetics, ethics, and epidemiology, and by Christmas I had applied to genetic counseling programs all along the East coast.
I graduated from UNCG in 2010, and took a job as a clinical cancer genetic counselor in St. John’s, Newfoundland. To say that I loved my work is an understatement – I was so happy at my new job, in fact, that I completely forgot to be bothered by the fact that I was living on a sparsely inhabited and abundantly rainy island in the North Atlantic Ocean, three-and-a-half hours by plane from my nearest friends and family. It was in spite of my happiness – motivated not by professional dissatisfaction, but by the more mundane forces of increasing age and expiring GRE scores – that 15 months later, I was back in the United States studying Epidemiology at Harvard.
The stereotype of doctoral students is that they are sleep-deprived, overworked, and miserable, and while the first two were nearly always true for me, for the most part I loved being back at school. In many ways, though, I was a fish out of water: I didn’t have a master’s degree in epidemiology, I had scraped by with the fewest number of college math credits possible, and most people in my program had never heard of genetic counseling. (For one course, I proposed a project on direct-to-consumer genetic testing, and the faculty feedback amounted to: well, this is neat, but who actually cares about this stuff? I felt vindicated when, a few days later, the FDA warning letter to 23andMe effectively shut down DTC-GT in the United States, and my professor emailed me to let me know that my research was all of a sudden quite relevant!) I also missed my clinical practice, and during my first two years at school, I frequently questioned my decision to quit a perfectly wonderful job (and salary) to go back to writing exams (and accumulating debt); moreover, I could no longer see that what I was doing had any positive impact on anyone, except perhaps the shadowy figures financing my loans.
These feelings eventually passed, and the later years of my doctorate were spent doing exciting research on DTC-GT and whole genome sequencing, speaking at conferences across North America, and making my voice and the voices of my hypothetical patients heard. Surrounded by physicians, epidemiologists, statisticians, economists, and social scientists, I brought a unique, patient-centered perspective to study design, results interpretation, and science communication, and it was one that was increasingly valued by my colleagues as they came to recognize the unique role that genetic counselors play in genomic medicine. As my confidence grew, I made a concerted effort to share my work with genetic counseling audiences, seek out genetic counseling collaborators, contribute to the training of new genetic counselors, and consider the clinical applications of my research; most importantly, I always introduced myself as a genetic counselor first, and an epidemiologist-in-training second.
Will Ferguson, a Canadian travel writer, has said about his experience living abroad: “I read and learned and fretted more about Canada after I left than I ever did while I was home. I absorbed everything I could on topics that ranged from Folklore to history to political manifestos… I ranted and raved and seethed about things beyond my control. In short I acted like a Canadian.” When I moved from London to Greensboro (and then, again, from St. John’s to Boston), I experienced a homesickness that not only made me long for Canada, but also amplified my national pride and interest in all things Canadian; Ferguson’s description of this phenomenon confirmed that I wasn’t alone in the experience. Now, as a genetic counselor who “left” the profession for a while to become an epidemiologist, Ferguson’s description resonates with me again. Pursuing a doctorate degree, joining industry, making a move into government or health policy – none of these things means that you are no longer a genetic counselor (even if your ID badge would suggest otherwise). And for me, stepping outside of the profession – where I had been comfortably surrounded by like-minded women and men who knew the value of what we do – served only to cement my allegiance with our little cardigan-wearing herd, and make me a fiercer advocate for genetic counselors in the clinic, in academia, and in research.
I’ve finally finished school (for real this time, I promise), and I am now a postdoctoral fellow at McMaster University in Hamilton, Ontario, where I research genetic determinants of dementia and see patients in a lipid genetics clinic. I have time to participate in NSGC/CAGC committees again, I am the Chair of a UNCG student’s capstone committee, and I’m working to build a career that combines genetic counseling and genetic epidemiology in a meaningful and productive way. So yes, it’s good to be back; the truth is, though, that I never really left.