Genetic Counseling Assistants: Success Stories on How We Can All Win - - PDF document

9/17/2018 1

Genetic Counseling Assistants: Success Stories on How We Can All Win

Roxanne Acquaro, MS, LCGC Sara Pirzadeh‐Miller, MS, CGC

GCA Program Development Seriously…everyone wins!

Roxanne Acquaro, MS LCGC Genetic Counseling Supervisor UPMC Children’s Hospital of Pittsburgh

9/17/2018 2

Disclosures

• I have no COI or disclosures
• Differentiate the role of a genetic counselor

from that of the genetic counselor assistant.

• Discuss the evolution of the genetic

counseling assistant position in a pediatric genetics program.

• Outline some changes in service delivery

models being utilized in our clinic as response to the GCA program.

Learning Objectives

9/17/2018 3

The Precipitating Factors

• Our division was experiencing significant

difficulty with:

• Staffing (not only GC)
• Waitlist
• Insurance authorizations
• Patient satisfaction
• Job satisfaction

Some solutions

• Hire more staff

– MDs – GCs – Authorization specialists

• Create a new staff designation

– Genetic Counseling Assistant

9/17/2018 4

Genetic Counseling Assistants

• Actually not unheard of in the world of

hospital administration. (COTA, PTA, CNA)

• Establish roles
• Submit justification
• Conduct candidate search
• Breathe a sigh of relief

Job Description

• Actual description developed by HR with

guidance from multiple departments

• Needed to be broad enough to be an umbrella

for responsibilities across clinical and research applications

• Finding the common GCA functions and

setting reasonable expectations

9/17/2018 5

Justification for funding

• FTE vs casual vs PT ask
• Ratio‐ is there a magic number
• Recruitment asset

– Job satisfaction – Pipeline

• Metrics to measure success
• Access
• Patient Satisfaction
• Efficiency

Drawing the Lines

• GCs wanted to carve out more time for:

– Psychosocial assessment and support in the clinic setting – Teaching students – Deep dive into complex molecular results – Desk time to interface with families; quicker responses to phone calls and emails

9/17/2018 6

Drawing the Lines

• GCAs could be trained to:

– Call patients to do intake evaluation prior to visit – Assist genetic counselors by communicating normal test results to patients and physicians by phone and/or in writing. – Assist in maintaining departmental databases – Generate normal lab results letters – Create and update patient pedigrees – Assist with follow‐up on pending lab work and testing that has not been completed

Candidate Selection

• Revolving door?
• Past experience?
• Motivation/Goals?
• Timing of departure?
• Salary?

9/17/2018 7

Intentions

• Structure program to address the initial

metrics for justification:

– Access – Patient Satisfaction – Efficiency

Reality

• It took us 6 months to begin working towards
• ur initial goals.

– Training, training, training – Staffing remained problematic requiring us to use GCAs to fill more immediate needs – Authorization and Administrative teams were creating bottle neck – Back log of work from “the dark times”

9/17/2018 8

Altruism

• Genetic Counseling Programs are extremely

competitive.

• Applicants are frequently passed over if they

have not had hands on experience/exposure.

• Our new hires deserved an investment from

the GC staff

• Time in clinic
• Ride alongs
• References/ Proof reading

Outcomes

• Still a work in progress
• Early Data suggests:

We Actually All Won!

Mostly… Maybe… I’m Pretty Sure…

9/17/2018 9

Outcomes

• Access

– Wait list‐ still a thing – Bottle neck‐ not a thing

• Efficiency

– Clinic time reduction 15% – No Show rate reduced 7%

• Recruitment Asset

– 6 new GCs – GCA will transition to FT GC in April

Feedback

“…being a GCA also allows me to synthesize material I learn in class and gives me the opportunity to apply it in a clinical setting. I expect that my work position will also ease my transition from graduate student to genetic counselor, since I will have had almost two years of experience doing many of the daily tasks that are expected of genetic counselors. “ ‐‐ Rebecca Clark, Class of 2019

http://pittgcprogram.blogspot.com/2017/11/genetic‐counseling‐assistant‐experience.html

9/17/2018 10

Future Direction

• Patient Satisfaction

– Student Thesis

• Expansion

– All new patient intakes – Time in the clinic – Consent documents

Genetic Counseling Assistants: An Integral Part of the Evolving Service Delivery Model

Sara Pirzadeh‐Miller, MS, CGC Assistant Director, Cancer Genetics UT Southwestern Medical Center Dallas/Fort Worth, TX

9/17/2018 11

Disclosures

• Advisor: Invitae Genetic Counselor Advisory

Board

• Advisor: GeneMatters, LLC
• Discuss the evolution of the GCA position in a cancer

genetics program

• Outline changes through program impact and service

delivery models being utilized in clinic as response to GCA program

• Expand on how to build GCAs into programs through

data

Objectives

9/17/2018 12

UTSW Cancer Genetics Program

500 1000 1500 2000 2500 3000 3500 4000 4500 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Annual Patient Volume

UTSW Cancer Genetics Program

9/17/2018 13

GCA: Beginnings

• Making the case

– Program needed increased efficiency – how best to accomplish? – Business plan/5 year vision – Presented options

• more GCs hired, increase admin staff, concept of GCA, etc

– Pros/cons of hiring GC, admin staff, GCA – Cost benefit of assistant – Who we would define as GCA

• B.S. or B.A., good science background, resume that is prepared for grad school

– Title designation: what to call? – Experience of other institutions – How much does your institution support your program?

Recruiting

• Getting the word out

– Institution website‐ Announcements/Job posting/ E‐blast to clients – Social media

• Facebook
• Twitter
• LinkedIn

– Networking/Word of Mouth – Contacting regional GC Program Directors

9/17/2018 14

Evolution of GCA

• Ongoing case to hire more GCAs
• Showed the 7:2 ratio yield 25% increase of new patients,

with more growth dependent on lower ratio – this is working!

J Genet Couns. 2017 Aug;26(4):716‐727. doi: 10.1007/s10897‐016‐0039‐6. Epub 2016 Nov 10.

Program Impact

– Mentorship for GCs (satisfy GC clinical ladder) – Increase in patient volume – GC workload efficiency – Implementation of alternate service delivery

• GCA integration made these much more efficient– telephone,

group sessions, telemedicine

– CPRIT grant – assistant written into funding source

• Roles: coordinate all patient workflow through state grant, screen

patient lists for high‐risk that need GC consult/follow‐up, check results, construct basic letters, call out negative results

9/17/2018 15

Institutional Lessons Learned…

• High turnover rate due to GC program acceptance (of 12 GCAs, 11

accepted on 1st application)

• Rigorous training – primarily result disclosure
• Major time commitment for helping mentor/prep for grad school

– Now scheduling specific rotation time in our clinics (not just other specialty clinics)

• Created a GCA curriculum for training – GCA education hour!

– Has now become education for many more in our center and beyond

• Mentorship has been a big plus to our GCs
• Hiring GCAs that don’t want to be GCs?

– Pro: longer stay – Con: inequivalent efficiency/production?

• GC retention due to support staff

More Lessons Learned…

• Over time and with larger GCA staff, altered coverage

schedule and tasks

– Instead of covering specific GC, now task‐based – Just started GCA calls to complete CGC questionnaire before GC appointment for all clinics

• Give GCA ‘trainer’ experience – but not too much
• The stronger the candidate, the efficiency increases!!
• Exit surveys/feedback to elevate experience

9/17/2018 16

• Hire a diverse and

complimentary group

• Varied leave dates if possible
• Determine if overtime is
• ptional
• Create tiered

mgmt./supervision within GCAs

• Look at workload and shift
• rganization
• Diversify use of GCA
• Group resources and identify
• ther depts who could use GCA
• High attrition rate
• First time hires
• Newly created positions
• Interviewing a candidate

who may tell you an end date

• Develop SOPs and update

as needed

• Evaluate your

responsibilities quarterly

• Create self monitoring and

accountability

• Involve GCAs in hiring of

peers

Roles and Responsibilities Unique Position Elements Time Management Innovate Approaches

What makes genetics program desirable for hiring

9/17/2018 17

Genetic Counseling Assistants: An Integral Part

• f the Evolving Service Delivery Model
• Purpose

– To determine the efficacy of the GCA position as an integral piece of sustainable service deliver model within the field. – Explore the attitudes of expanding the field of genetic counseling into a tiered profession by incorporating GCAs.

J Genet Couns. 2017 Aug;26(4):716‐727. doi: 10.1007/s10897‐016‐0039‐6. Epub 2016 Nov 10.

Respondents and Surveys

• Study was IRB approved by UT Southwestern
• 4 surveys sent July 2015:

– Program Directors with or without without GCA = 27% – Genetic Counselors = 79% – Genetic Counseling Assistants = 61%

9/17/2018 18

Genetic Counseling Assistants (GCA)

• 13 females/1 male
• Background: 93% Bachelor’s Degree

– 35% biology, 29% genetics, 14% psychology

• 100% reported ‘on the job training and supervision

prepared for GCA tasks’

• 85% felt ‘very prepared/prepared’ for GC training program
• 92% want a GCA to work with them in the future
• 71% (10/14) were accepted to GC program on first or

second try after GCA employment

– 2/14 no plan to apply – 2/14 not accepted first try and possibly try again

GCA

• Preparation for GC

– Best: Comfort with patient contact, understanding clinic flow/logistics (including familiarity with labs/insurance), feeling prepared for GC field (even if only worked in cancer), pedigree construction – Least: other specialties outside of cancer, truly understanding insurance

• How position could have better prepared for GC: more shadowing time, involvement

in research, more career development training

How did you feel going into GC program?

9/17/2018 19 GCA: Which responsibilities are applicable to your job description?

Comments on GCA responsibilities:

All said administrative and data entry, 92% test shipment, 85% contacting patients for follow up info One respondent said GCAs should not give any results One called it ‘GC boot camp’ Most said every task given ‘felt appropriate’, one said ‘calling result/writing letters was helpful’

Genetic Counselors: Requirements/Recruiting GCAs

• 85% required BS/BA
• Recruiting

– 100% approach prospective students/90% talk to PDs and advertise position

• Implementation issues

– 66% administration funding

• Time commitment

– Most 1 year, but others have changed to 2 given training time

9/17/2018 20

Genetic Counselors

• Should GCA be ‘stepping stone’ to GC or

stand‐alone career (or both)?

Genetic Counselors

• Efficiency with GCA

9/17/2018 21

GCs: Which responsibilities are appropriate for GCA?

Interestingly similar to GCA response All said responsibilities of data entry and shipping test kits >90% said admin, research, ordering supplies

Program Directors with GCAs

• Does GCA background help accelerate education?

– 44% said it would not; 44% said maybe

• Negative aspects to retraining skills of GCA?

– Comments on ‘they think they already know how to do everything’, most said no

• Concerns with GCA position development nationally?

– ‘Watering down’ GC profession – Title confusion – More want GCA definitions – Not a ‘shoo in’ to GC program – 5/9 said ‘no concern’

9/17/2018 22

PD with GCAs: Preparedness of GCA

0 = not prepared 7 = very well prepared

Summary of GCA study

• Efficiency of using GCA

100% genetic counselors stated that GCA made them more efficient

• Attitudes toward GCA

Majority of genetic counselors felt GCA “stepping stone” for GC career or it could be it own career path Concerns from PDs regarding tiered profession, confusion of roles and scope

9/17/2018 23

Questions?

Roxanne Acquaro, MS, LCGC Sara Pirzadeh‐Miller, MS, CGC