Lynn Godmilow, M.S.W. Director, Genetic Diagnostic Referral Service University of Pennsylvania School of Medicine Philadelphia, Pennsylvania What do you do? My responsibilities center on the operation and coordination of our DNA diagnostic laboratory. I am the front-line person who speaks with the physicians, genetic counselors and patients who call for information about DNA testing. It is my job to help sort out what the needs are, whether testing is appropriate, whether or not the patient is getting adequately counseled about the testing and to answer any questions the caller may have about the testing process. I handle these questions for the laboratory in the Department of Genetics as well as the one in the Department of Pathology & Laboratory Medicine. Each lab performs different tests for different conditions. The second and very large part of my job has been to set up and help manage our BRCA1 and BRCA2 testing service. This involves a lot of what is mentioned above -- the family pedigrees of prospective testees are faxed to me for consideration and counseling about what, if any, testing is indicated. Since we are still learning about what the results of these tests mean as well as what they don't mean, I spend a lot of time talking with the referring genetic counselors about how to counsel the patients on their test results. The third part of my job is related to my involvement with the Neurogenetics Service. I screen new patients who have scheduled visits with our two neurogeneticists to try and determine why they are coming and what questions they would like answered. This involvement allows us to be much more efficient in meeting patient needs and frequently the patients will tell me things they would never mention to the doctor at their appointment. As an offshoot of my involvement with neurogenetics, I helped establish and now coordinate our presymptomatic Huntington's disease testing program. I am the contact person for individuals interested in pursuing presymptomatic testing. I meet with all the patients to obtain a complete family pedigree and to provide genetic counseling. I also participate in the disclosure visit with the psychologist when we give the patient his/her results. What is your educational background? I have a B.S. in psychology from Pennsylvania State University and a Master's of Social Work in casework from the University of Pittsburgh. Do you have any special credentials? I am a member of the Academy of Certified Social Workers, and I am a Diplomate of the American Board of Medical Genetics and American Board of Genetic Counseling. What was your career path? I started out in social work doing mainly casework for local service providers, such as Montgomery County (Pennsylvania) Child Welfare Services. I made the move to hospitals when I accepted a job as a social worker in the Department of Pediatrics at Mount Sinai Hospital in New York. This position led to my entry into medical genetics, and eventually I became the department's Coordinator of Medical Genetics. From there, I moved on to the American Oncologic Hospital in Philadelphia, where I worked as a Genetic Counselor/Coordinator of Medical Oncology. This led to the position I currently hold. How many hours per week do you work? I would estimate that I spend nine to ten hours a day at my desk in the medical school and another one to two hours at home two or three nights a week. Things like grant proposals and manuscripts are difficult to do during the day when I am being interrupted by the telephone. There are weeks that are much longer and some few that are mercifully shorter. What led you to this field? I was working in the social service department at Mount Sinai Hospital in New York when a large grant was awarded to the Chief of the Genetics Division in Pediatrics to expand clinical genetic services. The first few graduates of the genetic counseling program at Sarah Lawrence were just beginning to look around for jobs, but because I was already in the medical center and was the social worker in the Intensive Care Nursery, Cystic Fibrosis Clinic and the Cleft Palate Center, I was offered the job of genetic counselor/coordinator. The rest is history. What do you enjoy most about your job? The field of human genetics and genetic testing and counseling is constantly changing and expanding and no two days are alike. I get to work with patients one on one, to relate to and help my professional colleagues, to be involved in research, and to be on the cutting edge of a revolution in medicine. I worry about the direction medicine seems to be taking in this country, especially with regard to genetics, and I hope that I will be able to be part of an effort to keep us all on the straight and narrow. What is it that worries you? I'm concerned that the Human Genome Project and other similar research projects dealing with the discovery of new genes is getting way ahead of our consideration of how we are going to use this information and prevent it from being misused. As someone involved with two different presymptomatic genetic testing protocols (Huntington's disease and breast/ovarian cancer), I am confronted on a daily basis with patients who are extremely worried about how this information can be obtained for them and kept confidential. Many choose not to be tested because of their concerns that the test results could affect their future insurability and employability, and in general may lead in the future to their being identified as an unhealthy person whom others may shun in many different spheres. There are many in the Ashkenazi Jewish population, for example, who are beginning to be rather concerned about all the genes that are being identified in this population which lead to increased risk of disease. As members of a group who have already experienced significant discrimination for far flimsier reasons, they are not comfortable being in the spotlight of the genetic revolution. What do you enjoy least about your job? Dealing with the financial end of counseling and testing and provision of services. Our health care system is currently being run by the insurance industry and not the care providers. Insurance companies -- despite their expensive advertising slogans to the contrary -- are businesses and businesses exist to make money, not to be benevolent providers of service. Many of the tests we offer are very expensive and frequently beyond the reach of many who would like to consider having them. Even the cost of counseling to discuss whether or not testing should even be a consideration is beyond the means of many. What are your feelings about the job outlook for this field? I have mixed feelings about the future job opportunities in this field. On the one hand we are coming into an age when more and more genetic tests, especially predictive genetic tests, will be available and genetic counselors are the best trained and most reasonably priced professionals to help patients and groups of at-risk individuals understand all the issues surrounding genetic testing. This is encouraging and suggests that there will be more jobs for genetic counselors than the current training programs can deliver. However, the pessimistic side of me worries that in a profit-driven, managed care environment, the insurance companies are not going to care whether or not the patients have been "adequately" counseled. They will assert that since they are already paying the physician to care for the patient, it will be his or her responsibility to explain the nuances of testing. Anyone close to medicine today knows that the average physician cannot afford an hour to sit and discuss with a patient the ramifications of testing for BRCA1 or cystic fibrosis or Huntington's disease. What advice would you give to someone interested in this field? I would say that this is an exciting field with many opportunities to learn and grow and, despite my reservations about the future of medicine in general, I would whole-heartedly endorse it as a very good career choice. Genetic Counseling Related careers: There are many directions genetic counselors have taken. Some have gone on to medical school, some have run laboratories, some have held administrative and teaching positions. Salary range: The latest professional survey by the National Society of Genetic Counselors published in the fall of 1996 detailed a mean salary in the United States of $42,545 with a minimum of $28,000 and a maximum of $76,500. Back to Interviewee List