Genetic tests are booming, but can primary care providers keep up?
Healthcare always wants more data, but with genetic testing in full boom, there are worries that it might be getting too much data that it isn’t ready for.
“The vast majority of physicians are not prepared to understand, deliver, or manage genetic test results,” Geisinger professor Nephi Walton, MD, said at a meeting last year. “The things I see are a little bit scary…We need to educate physicians better and it’s got to start early on.”
A recent Health Affairs study found that some physicians, at least of a certain generation, are increasingly being exposed to genetics concepts during their education—but few feel prepared to work with patients on their genetics or to interpret the results of genetic testing.
The study administered a 45-point, roughly 5-minute-long survey to nearly 500 primary care providers (PCPs) between 2014 and 2016. The physicians came from academic, community, and federal health systems all in New York City—which could hurt generalizability, although it’s unclear in which direction (whether physicians in a gigantic city are more or less likely to be in touch with the latest healthcare techniques). Any limitations, the researchers note, are balanced by the study’s strengths: A very large, diverse cohort of PCPs answering a series of detailed questions.
A whopping 77% of physicians who took part had been in practice for 5 years or less—the 5 to 10, 10 to 15, 15 to 20, and 20-plus years’ experiences brackets were distributed about evenly in the single digits (7%, 4%, 4%, 7%, respectively). A majority were female and worked in academic medical centers.
The respondents did think highly of genetic testing’s clinical importance: three-quarters agreed that it was useful and 70% definitively agreed that it will improve clinical outcomes within the next 5 years. And 78% of them did report having some form of formal genetics education.
But actually putting the tests into action was a different story. Only 36% had actually ordered a genetic test for any of their patients, and that number was driven heavily by those in community medical centers. They were more than twice as likely to have ordered a genetic test for a patient, and almost thrice as likely to have returned genetic test results to a patient or referred a patient to a genetic specialist.
That gap isn’t as surprising as it seems, though. “Providers in community sites had more experience ordering testing and returning results, likely because nearly all were family physicians who ordered prenatal tests, whereas academic providers were nearly all internists who did not order these tests,” the study notes.
Only 40% overall reported that they were “knowledgeable about the genetic basis of common diseases” and 25% said they were “ready to take care of patients who had genetic testing for a common condition. Interpretation was a nonstarter for most: Only 14% said they were confident they could interpret genetic results.
The overall youth of the survey cohort may have contributed to the high number responding that they had received previous education in the field, and the authors noted that this may merit further explanation. Enthusiasm for genetics did not correlate with physician confidence in their own understanding of its implications.
“Therefore,” the authors conclude, “Improving primary care providers’ skills will require more than additional training and experience. It will likely also require developing and deploying systems to facilitate testing and the returning of results.”
One suggestion they make is to not just integrate genetic test ordering into electronic health records (EHR) systems, but perhaps even add EHR-based tools that can provide genetic analysis, insights, and decision support at the point-of-care—previous work has found the challenges of creating and integrating those tools aren’t insurmountable.
Of course, if there’s anything physicians are less confident in than their knowledge of genetics, it might be their EHRs.