{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T06:20:39Z","timestamp":1769149239045,"version":"3.49.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2016,5,11]],"date-time":"2016-05-11T00:00:00Z","timestamp":1462924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2016,5,11]],"date-time":"2016-05-11T00:00:00Z","timestamp":1462924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["npj Genomic Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>With genomics influencing clinical decisions, genetics professionals are exponentially called upon as part of multidisciplinary care. Increasing demand for genetic counselling, a limited workforce, necessitates practices improve efficiency. We hypothesised that distinct differences in clinical workload exist between various disciplines of genetic counselling, complicating practice standardisation and patient volume expectations. We thus sought to objectively define and assess workload among various specialties of genetic counselling. Twelve genetic counsellors (GCs), representing 9.3 clinical FTE, in general or specialty (cancer, cardiovascular or prenatal) services at an academic health system developed a data collection tool for assessing time and complexity. Over a 6-week period, the data were recorded for 583 patient visits (136 general and 447 specialty) and analysed comparing general versus specialty GCs. Variables were compared with hierarchical linear models for ordinal or continuous data and hierarchical logistic models for binary data. General GCs completed more pre- and post-visit activities (<jats:italic>P<\/jats:italic>=0.011) and spent more time (<jats:italic>P<\/jats:italic>=0.009) per case. General GCs reported greater case discussion with other providers (<jats:italic>P<\/jats:italic>&lt;0.001), literature review (<jats:italic>P<\/jats:italic>=0.026), exploring testing options (<jats:italic>P<\/jats:italic>=0.041), electronic medical record review (<jats:italic>P<\/jats:italic>=0.040), insurance preauthorization (<jats:italic>P<\/jats:italic>=0.05) and fielding patient inquiries (<jats:italic>P<\/jats:italic>=0.003). Lesser redundancy in referral indication was observed by general GCs. GCs in general practice carry a higher pre- and post-visit workload compared with GCs in specialty practices. General GCs may require lower patient volumes than specialty GCs to allow time for additional pre- and post-visit activities. Non-clinical activities should be transferred to support staff.<\/jats:p>","DOI":"10.1038\/npjgenmed.2016.10","type":"journal-article","created":{"date-parts":[[2016,5,11]],"date-time":"2016-05-11T09:23:16Z","timestamp":1462958596000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Assessment of clinical workload for general and specialty genetic counsellors at an academic medical center: a tool for evaluating genetic counselling practices"],"prefix":"10.1038","volume":"1","author":[{"given":"Brandie","family":"Heald","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Rybicki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Clements","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Marquard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Mester","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Noss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Nardini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Polk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany","family":"Psensky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Rigelsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"Schreiber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Shealy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marissa","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charis","family":"Eng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2016,5,11]]},"reference":[{"key":"BFnpjgenmed201610_CR1","unstructured":"Genetic counseling. Am. J. Hum. Genet. 27, 240\u2013242 (1975)."},{"key":"BFnpjgenmed201610_CR2","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s10897-005-9014-3","volume":"15","author":"R Resta","year":"2006","unstructured":"Resta R. et al. National Society of Genetic Counselors' Definition Task Force A new definition of Genetic Counseling: National Society of Genetic Counselors' Task Force report. J. Genet. Couns. 15: 77\u201383. (2006).","journal-title":"J. Genet. Couns."},{"key":"BFnpjgenmed201610_CR3","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s10897-009-9216-1","volume":"18","author":"H Hampel","year":"2009","unstructured":"Hampel, H. et al. Genetic counseling practice analysis. J. Genet. Couns. 18, 205\u2013216 (2009).","journal-title":"J. Genet. Couns."},{"key":"BFnpjgenmed201610_CR4","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s10897-012-9505-y","volume":"21","author":"SA Cohen","year":"2012","unstructured":"Cohen S. A. et al. Report from the National Society of Genetic Counselors Service Delivery Model Task Force: a proposal to define models, components, and modes of referral. J. Genet. Couns. 21: 645\u2013651. (2012).","journal-title":"J. Genet. Couns."},{"key":"BFnpjgenmed201610_CR5","doi-asserted-by":"publisher","first-page":"1880","DOI":"10.1001\/jama.2014.14604","volume":"312","author":"H Lee","year":"2014","unstructured":"Lee, H. et al. Clinical exome sequencing for genetic identification of rare Mendelian disorders. JAMA 312, 1880\u20131887 (2014).","journal-title":"JAMA"},{"key":"BFnpjgenmed201610_CR6","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1111\/cge.12654","volume":"89","author":"SL Sawyer","year":"2015","unstructured":"Sawyer S. L. et al. Utility of whole-exome sequencing for those near the end of the diagnostic odyssey: time to address gaps in care. Clin. Genet. 89: 275\u2013284. (2015).","journal-title":"Clin. Genet."},{"key":"BFnpjgenmed201610_CR7","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1002\/ana.24251","volume":"76","author":"S Srivastava","year":"2014","unstructured":"Srivastava, S. et al. Clinical whole exome sequencing in child neurology practice. Ann. Neurol. 76, 473\u2013483 (2014).","journal-title":"Ann. Neurol."},{"issue":"6","key":"BFnpjgenmed201610_CR8","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1111\/cge.12732","volume":"89","author":"J. Thevenon","year":"2016","unstructured":"Thevenon J. et al. Diagnostic odyssey in severe neurodevelopmental disorders: Towards clinical whole-exome sequencing as a first-line diagnostic test. Clin. Genet. (e-pub ahead of print 12 January 2016; doi: 10.1111\/cge.12732).","journal-title":"Clinical Genetics"},{"key":"BFnpjgenmed201610_CR9","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/gm521","volume":"6","author":"WA van Zelst-Stams","year":"2014","unstructured":"van Zelst-Stams, W. A., Scheffer, H. & Veltman, J. A. Clinical exome sequencing in daily practice: 1,000 patients and beyond. Genome Med. 6, 2 (2014).","journal-title":"Genome Med."},{"key":"BFnpjgenmed201610_CR10","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1056\/NEJMoa1306555","volume":"369","author":"Y Yang","year":"2013","unstructured":"Yang, Y. et al. Clinical whole-exome sequencing for the diagnosis of mendelian disorders. N. Engl. J. Med. 369, 1502\u20131511 (2013).","journal-title":"N. Engl. J. Med."},{"key":"BFnpjgenmed201610_CR11","doi-asserted-by":"publisher","first-page":"15012","DOI":"10.1038\/npjgenmed.2015.12","volume":"1","author":"DJ Stavropoulos","year":"2016","unstructured":"Stavropoulos, D. J. et al. Whole-genome sequencing expands diagnostic utility and improves clinical management in paediatric medicine. npj Genomic Med. 1, 15012 (2016).","journal-title":"npj Genomic Med."},{"key":"BFnpjgenmed201610_CR12","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1007\/s10897-014-9697-4","volume":"23","author":"JL Williams","year":"2014","unstructured":"Williams, J. L., Faucett, W. A., Smith-Packard, B., Wagner, M. & Williams, M. S. An assessment of time involved in pre-test case review and counseling for a whole genome sequencing clinical research program. J. Genet. Couns. 23, 516\u2013521 (2014).","journal-title":"J. Genet. Couns."},{"key":"BFnpjgenmed201610_CR13","first-page":"559","volume":"41","author":"BA Bernhardt","year":"1987","unstructured":"Bernhardt, B. A., Weiner, J., Foster, E. C., Tumpson, J. E. & Pyeritz, R. E. The economics of clinical genetics services. II. A time analysis of a medical genetics clinic. Am. J. Hum. Genet. 41, 559\u2013565 (1987).","journal-title":"Am. J. Hum. Genet."},{"key":"BFnpjgenmed201610_CR14","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1097\/01.gim.0000242307.83900.77","volume":"8","author":"JA Cooksey","year":"2006","unstructured":"Cooksey, J. A., Forte, G., Flanagan, P. A., Benkendorf, J. & Blitzer, M. G. The medical genetics workforce: an analysis of clinical geneticist subgroups. Genet. Med. 8, 603\u2013614 (2006).","journal-title":"Genet. Med."},{"key":"BFnpjgenmed201610_CR15","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1097\/GIM.0b013e318182206f","volume":"10","author":"E McPherson","year":"2008","unstructured":"McPherson, E. et al. Clinical genetics provider real-time workflow study. Genet. Med. 10, 699\u2013706 (2008).","journal-title":"Genet. Med."},{"key":"BFnpjgenmed201610_CR16","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1007\/s10689-010-9326-9","volume":"9","author":"D Wham","year":"2010","unstructured":"Wham, D. et al. Assessment of clinical practices among cancer genetic counselors. Fam. Cancer 9, 459\u2013468 (2010).","journal-title":"Fam. Cancer"},{"key":"BFnpjgenmed201610_CR17","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.6004\/jnccn.2013.0129","volume":"11","author":"B Heald","year":"2013","unstructured":"Heald, B. et al. A time study of cancer genetic counselors using a genetic counselor-only patient care model versus a traditional combined genetic counselor plus medical geneticist care model. J. Natl Compr. Canc. Netw. 11, 1076\u20131081 (2013).","journal-title":"J. Natl Compr. Canc. Netw."},{"key":"BFnpjgenmed201610_CR18","first-page":"106","volume":"21","author":"LE Beaudoin","year":"2003","unstructured":"Beaudoin, L. E. & Edgar, L. Hassles: their importance to nurses' quality of work life. Nurs. Econ. 21, 106\u2013113 (2003).","journal-title":"Nurs. Econ."},{"key":"BFnpjgenmed201610_CR19","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1111\/j.1365-2648.2006.04134.x","volume":"57","author":"R Morris","year":"2007","unstructured":"Morris, R., MacNeela, P., Scott, A., Treacy, P. & Hyde, A. Reconsidering the conceptualization of nursing workload: literature review. J. Adv. Nurs. 57, 463\u2013471 (2007).","journal-title":"J. Adv. Nurs."},{"key":"BFnpjgenmed201610_CR20","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1891\/1078-4535.15.1.7","volume":"15","author":"AP Weydt","year":"2009","unstructured":"Weydt, A. P. Defining, analyzing, and quantifying work complexity. Creat. Nurs. 15, 7\u201313 (2009).","journal-title":"Creat. Nurs."}],"container-title":["npj Genomic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/npjgenmed201610.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/npjgenmed201610","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/npjgenmed201610.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T12:28:17Z","timestamp":1672835297000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/npjgenmed201610"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,5,11]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,11,30]]}},"alternative-id":["BFnpjgenmed201610"],"URL":"https:\/\/doi.org\/10.1038\/npjgenmed.2016.10","relation":{},"ISSN":["2056-7944"],"issn-type":[{"value":"2056-7944","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,5,11]]},"assertion":[{"value":"28 December 2015","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2016","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 March 2016","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2016","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"16010"}}