Hi all - I essentially haven't been on this thread since I made my last post in 2013, but I was PM'd for an update. As I didn't realize others had also posted in recent years also with interest, I figured I would reply here in case it helps someone else out there.
I am now an attending, and I can say beyond a shadow of a doubt I am 100% satisfied with my career choice, and if you're even remotely interested in genetics, absolutely consider this for sure. If you want to be part of an amazing revolution in the way we practice medicine across all specialties in the next 10-20 years and definitive job security on all levels, absolutely consider medical genetics. Forget things like radiology (Seriously: what was once so coveted is one of the worst job markets I've ever seen. Due to things like tele radiology where places and outsource overseas, every single person I know from my class who went into this, unless they were doing interventional rads, has basically not been able to find a job, and had to do additional fellowships because they couldn't find jobs) or ER (no way the pay grades will continue the way they have, who wants to be doing night shifts still when you're mid career?). Medical genetics is an amazing field that has changed so dramatically over the last 5 years, I think most pre-meds, medical students, and residents aren't aware of the scope of what we do now or what capabilities exist. This is actually an interest of mine, to help get the word out there about how great this field is, because the demand for geneticists is skyrocketing. This is not just about sending a karyotype for Down syndrome anymore, believe me.
First, an update about a practical thing. When I last posted, I basically said the time frame for training in med genetics was the same whether you do combined peds-genetics residency versus regular peds (or whatever primary specialty - doesn't have to be peds, can be IM, OB etc.) then dedicated genetics residency. This is no longer true - last year the ACGME changed this so the combined program is now 4 years like med-peds, not 5. Therefore, you could potentially shave off a year by doing a combined program. However, the pros/cons of course still exist as I mentioned previously (e.g. constantly flip flopping versus focusing on one specialty at a time, 2 boards at once or one first then the other etc., getting to train at multiple programs vs. staying put at one place etc.). So that's really personal choice.
Now, for the real info. Why has medical genetics exploded and why is this where medicine is going? Simply this: the fact everyone has DNA whether you like it or not, people will continue to have babies, technology, and this little thing called the Human Genome Project (HGP). Many of you may not have recalled much of this, but the HGP took thousands of scientists, millions of dollars, and THIRTEEN years to complete essentially the basic "map" of the entire human genome. The first draft was completed in 2001, then the final version in 2003.
Now, what if I told you, within the span of the last 5 years or so, the technology has become so advanced, we have the capability of mapping an entire human genome…in less than a month…from just a few drops of blood…from a pregnant mother…on her baby...without ever touching her baby…before the baby is born?!
That's right. You can take a few cc's from a pregnant mother, and with the help of the father's DNA, you can map the fetus's entire genome, because the blood crosses the placenta. Is it possible to know right then and there, before the child's born, whether they carry a variation in a BRCA1 or BRCA2 gene putting them at a huge risk for breast cancer when they're adults? Yes. What about if they're at risk for developing dilated cardiomyopathy? Yes again. What about familial Alzheimers? Absolutely. Does that mean we should? Do people even want to know this information? I can't even tell you how difficult the answer to that is, and how complex these ethical issues have become. Personally, I think no, and as a genetics community we don't recommend this now. Will it happen anyway?…to be determined, but you want to be part of this debate.
And if you haven't heard of the 3 parent babies, you need to stop everything and go read this now, and read about the technology in the links.
http://www.scientificamerican.com/article/when-will-3-parent-babies-come-to-the-u-s/
I am happy with my job for a number of reasons. First, I am a thinker. I like puzzles and solving interesting cases. This is not unlike fields like rheum, neurology, etc. where you have complex patients and have to put the story together. So if you're more into acute procedures all the time like surgery or a very high paced environment like the ED, maybe not for you. However, for me, I love that nearly every case I see is different which keeps me constantly thinking and learning, and I'm never bored. Our "standards" are often children with developmental delay and hypotonia, but really my clinic has run the full gamut of all kinds of things walking through the door. A child with a history of dilated vasculature and concern for connective tissue disease. A family with a family history of XYZ disorder and need for carrier testing. A child with hearing loss, syndromic and non (yes there are different causes). We get referrals from all subspecialties because we are learning more and more about genes that cause human disease, and guess what? They cross all specialties. There are genetic causes of cardiac congenital defects, cardiomyopathy, arrythmias, cancer syndromes, dermatoses, nephrotic syndrome and congenital kidney disease, rheumatologic disease, the list goes on. For this reason, regardless of your specialty, you will start to come across genetic testing more and more. Multiple specialties turn to us to help interpret this testing because it's popping up in their fields, but they don't have the full understanding of what some of the genetic pieces really mean.
Second, the job security is excellent as I've mentioned previously. There has never been such a high demand. Right now there are basically two groups of folks - those who are part of an older generation who trained before there were formal regulated genetics residency program, and those of a more recent generation who came into this during this ridiculous growth period thanks to the sequencing technology that literally turned the field upside down. Many of the older generation are starting to retire, and right now there are still very few graduates per year. The top programs always fill, but the remainders are hit or miss. Most places are not aiming to fill, so they'd rather not have someone than a poor candidate. When I graduated, the jobs probably outnumbered grads 3:1 or more, and the list is growing, and will continue to grow. Due to this (rising demand, decreased candidates available), this has helped boost salaries (definitely comparable to other non-surgical specialties and rising).
Side note: at the end of the day, NEVER choose a specialty for money. Seriously. You must like what you do first and foremost, because otherwise, you will be miserable. Medicine is a very, very very long road. It takes so long to even finish training, when you get to the end, you need to ultimately like what you're doing. I had folks tell me not to do peds due to the decreased salaries, and I am so glad I resisted and stuck to my guns, because you couldn't pay me enough to be a general surgeon and be get paged to operate at 3:15 am. Fine when you're young, but even 10 years out it draining…I can't even imagine repeating residency right now, which was taxing enough.
Third: You can go in any direction with genetics. Want to be a researcher? Sure. Want to be primarily a clinician? Definitely. Want to be both? Definitely possible. Academics is where most of the jobs are, but private, industry and lab opportunities continue to grow. If you have particular interest in biochemical genetics (think of all the rare disorders you learned about in med school but probably haven't seen - galactosemia, PKU, MSUD, lysosomal storage disease like Niemann pick and all the others you probably cursed while trying to memorize for Step 1), even better for you, because there is an unbelievable demand for physicians with this interest due to newborn screening. When you have every single child being born in the US receiving newborn screening, this creates automatic demand for physicians who can take care of them, and there is a critical shortage right now. That's not my primary interest, but you will end up being cross trained in this by necessity as biochemical genetics and general genetics/dysmorphology are typically covered by the same folks (though in larger institutions they function separately).
Fourth: Every major institution, both public and private, is going towards "genomic medicine" and "personalized medicine". This is particularly the case in the cancer realm with targeted therapies, but really there are many conditions for which we are doing enzyme replacement therapy (Gaucher, Fabry, many more), and treatments are being developed for things which everyone once thought wasn't possible. Look up Eteplirsen to help treat muscular dystrophy through a mechanism called "exon skipping".
http://www.nature.com/nrd/journal/v14/n4/full/nrd4587.html
And many other things are being developed.
Fifth: It's a great lifestyle in general. There are very few genetic emergencies, unless you're at an institution that's very biochemical heavy. And even so all call you take is essentially home call - your sickest kids are basically in the NICU and PICU, and management can be done over the phone. And if you're at a private practice with just general genetics or working for industry it could definitely be more like an 8-5 kind of job. I have several friends who are in positions like this and love it.
Bottom line is, this is a great field, and where medicine is going. If you're still interested after reading this, then I've done my job.
Side note: if you're still interested in genetics, but are not sure you want to do the whole long medicine route, consider the field of genetic counseling as well. They also have an amazing job outlook and our roles overlap a lot. We work very closely with genetic counselors, and they are essential for helping us provide the best care to patients (I am definitely so grateful to my amazing team, and they are also super high in demand!). Check out their national organization:
http://www.nsgc.org.
And this is ours:
https://www.acmg.net and the site to our medical board
http://www.abmgg.org
Hope this was helpful to someone and best of luck with whatever field you choose!