Residency in Medical Genetics

[DNA Doc 13]

Hi, thanks for your question.

It is neither expected nor required to subspecialize after the 5-year medical genetics residency. I think the reasons vary... for me it was personal interest in the field and a desire to "distinguish myself" as an expert in a field where little expertise already existed. It is often possible to get additional training during your residency as there is a lot of time for electives. So for example, if you knew that you wanted to specialize in metabolic diseases, you could do all of your electives in metabolics. You still have to do a bit of extra time I think, but not more than a year if you play your cards right. I also know people who did a 6 month or 1-year fellowship in Bioethics during residency. With the move to competency based training (instead of time-based), that should be even more possible than before, if you are a strong resident.

In Canada, neurogenetics is not currently a recognized specialty of either neurology or genetics. People calling themselves "neurogeneticists" either have a special interest in neurological diseases (without any formal training), or have done a "do-it-yourself" fellowship. I know both neurologists and geneticists who have done this. Basically you find a supervisor with research funding and you do a project under them as a research fellow for a year (so you can get paid), and they let you do clinics with them. I haven't heard of any "official" fellowship programs in Canada, but I know a few people who have done these "unofficial"/research fellowships at CHEO and SickKids.

[rosetta123 5]

Hi DNA Doc! I'm in my third year now and have had a strong interest in genetics since before starting medical school. I've read through this thread numerous times over the years, so happy to see you back! One of my biggest questions relating to a career in genetics is around the job prospects. I'm glad to see the demand for genetics consults is only continuing to increase. I'm wondering whether the large majority of job opportunities remain in major cities. When I've asked geneticists and other physicians about this they have related that it may be challenging to work in a smaller centre where you may be the only geneticist due to the lack of colleagues for collaboration and potentially more limited laboratory abilities. This is a concern for me as I hesitate to limit myself geographically to major cities only. I'd love any insight you may have on this! Thanks!

[DNA Doc 13]

Hi!

There's no such thing as a small-town geneticist (you simply would not have enough work to make money). But some medium-sized cities have geneticists... in Ontario especially (Oshawa and Peterborough, for example). Less common in other provinces. The majority of jobs will be in cities with medical schools/academic hospitals. Most provinces have "outreach" programs where city-based geneticists travel a few times per year to see patients. For example in Ontario there is a Northern Regional Genetics Program (https://nrgp.on.ca/). I suppose it might be possible to work full time for an outreach if you don't mind travelling. In Ontario you can also do "e-consults" - other doctors submit their "mini-consults" online and you get paid to answer them. I don't think the demand for this is high enough for full-time work though.

The world is changing quickly though... more and more people are working remotely now that we have telemedicine and home video visits (like https://otnhub.ca/ in Ontario). If this becomes more widespread, genetics could reach more underserved communities. 

If genetics is what you really want to do, my advice would be not to worry too much about where you're going to practise. You have a lot of years ahead of you to figure that out. You also might be surprised... I too once thought I didn't want to live in a big city, but then I fell in love with Toronto and stayed for over 6 years! 

 

[rosetta123 5]

On 4/1/2020 at 8:43 AM, DNA Doc said:

Hi!

There's no such thing as a small-town geneticist (you simply would not have enough work to make money). But some medium-sized cities have geneticists... in Ontario especially (Oshawa and Peterborough, for example). Less common in other provinces. The majority of jobs will be in cities with medical schools/academic hospitals. Most provinces have "outreach" programs where city-based geneticists travel a few times per year to see patients. For example in Ontario there is a Northern Regional Genetics Program (https://nrgp.on.ca/). I suppose it might be possible to work full time for an outreach if you don't mind travelling. In Ontario you can also do "e-consults" - other doctors submit their "mini-consults" online and you get paid to answer them. I don't think the demand for this is high enough for full-time work though.

The world is changing quickly though... more and more people are working remotely now that we have telemedicine and home video visits (like https://otnhub.ca/ in Ontario). If this becomes more widespread, genetics could reach more underserved communities. 

If genetics is what you really want to do, my advice would be not to worry too much about where you're going to practise. You have a lot of years ahead of you to figure that out. You also might be surprised... I too once thought I didn't want to live in a big city, but then I fell in love with Toronto and stayed for over 6 years! 

 

Thank you so much for this detailed response! It's exciting how things are changing and I'm intrigued to see how clinical genetics evolves in the future. Lots of food for thought in terms of outreach and telemedicine. I will certainly keep what you said in mind!