Workforce Implications of Increased Referrals to Hereditary Cancer Services in Canada: A Scenario-Based Analysis

Abstract

Over the last decade, utilization of clinical genetics services has grown rapidly, putting increasing pressure on the workforce available to deliver genetic healthcare. To highlight the policy challenges facing Canadian health systems, a needs-based workforce requirements model was developed to determine the number of Canadian patients in 2030 for whom an assessment of hereditary cancer risk would be indicated according to current standards and the numbers of genetic counsellors, clinical geneticists and other physicians with expertise in genetics needed to provide care under a diverse set of scenarios. Our model projects that by 2030, a total of 90 specialist physicians and 326 genetic counsellors (1.7-fold and 1.6-fold increases from 2020, respectively) will be required to provide Canadians with indicated hereditary cancer services if current growth trends and care models remain unchanged. However, if the expansion in eligibility for hereditary cancer assessment accelerates, the need for healthcare providers with expertise in genetics would increase dramatically unless alternative care models are widely adopted. Increasing capacity through service delivery innovation, as well as mainstreaming of cancer genetics care, will be critical to Canadian health systems' ability to meet this challenge.

Keywords: clinical genetic services; genetic counselling; genetic testing; genomics; health human resource planning; needs-based planning; workforce planning.

Figure 1

Describes the structure of the needs-based hereditary cancer workforce requirements model, including six clinical pathways providing different levels of service to specific patient sub-populations (Table S2). FTEs: Full-time equivalents; GC: Genetic counsellor; GMD: Medical doctor with expertise in genetics.

Figure 2

Projected need for Canadian cancer genetics providers in 2030, by scenario. This figure shows the effect of increased volume of patients on the number of genetics healthcare providers required in 2030, and then further effects when panel testing is replaced by genome wide sequencing and increased mainstreaming. Scenario values derived from Delphi study estimates [14] (see Table S5). GC; genetic counsellor, GMD; medical doctor with expertise in genetics, and GWS; genome-wide sequencing (genome or exome sequencing).

Figure 3

The impact of alternative service delivery models on workforce requirements. Shows the impact of innovations in the hereditary cancer service delivery model on the number of genetics healthcare providers required in 2030 (see Table S5 for details on how scenarios are defined). GC; genetic counsellor, and GMD; medical doctor with expertise in genetics.