EXPOSED
The analytic half of this job — building pedigrees from intake forms, running Tyrer-Cuzick/BOADICEA risk models, pulling ClinVar and literature on a variant, drafting the clinic note and insurance pre-auth letter — is exactly what language models and lab decision-support tools now do at usable quality. What does not automate is sitting with a woman deciding whether to test her children for Huntington's, or delivering a VUS result to a family already primed for catastrophe, then owning that conversation clinically. Licensure exists in roughly two-thirds of states and ABGC certification gates hiring and billing, which slows substitution even where software could draft the answer.
Mixed — a routine tier and a judgment tier. Pedigree construction, variant curation against ClinVar/ACMG criteria, risk-model runs and the pre-test/post-test letter are all now drafted competently by software, but the pre-test counseling session, the disclosure of a Huntington's or BRCA1 result, and the decision-making conversation about prenatal termination remain irreducibly live work — roughly half the caseload hours resist, which is what puts this at 11 rather than 6 or 15.
Some physical or field component. You sit in a clinic room or on telehealth for most of the day, but you draw or order the blood, hand over the buccal swab kit, do the physical presence work at a fetal-anomaly consult alongside MFM, and read facial dysmorphology in person — physical, but controlled and incidental, hence 7 not 13.
Licensed human required and personally liable. ABGC certification plus licensure in about two-thirds of states gates hiring and CPT 96040 billing, and you carry your own scope of practice for what you disclose — but you do not order the test independently in many settings, the ordering physician or lab director signs the report, so you sit at 12 rather than the 17 a prescribing clinician holds.
The human relationship is the product. Patients disclose family secrets — non-paternity, a sibling's suicide, an abortion nobody knows about — because it is you asking, and a Huntington's predictive-test protocol deliberately spaces sessions weeks apart precisely so the relationship can hold the result; the counseling relationship is not adjacent to the deliverable, it is the deliverable.
Exists to be accountable for ambiguous calls. You decide whether a 16-year-old is competent to consent to predictive testing, whether to recommend against testing at all, how to frame a VUS so a family doesn't pursue prophylactic mastectomy on nothing, and whether to breach confidentiality to warn an at-risk relative — ambiguous calls with irreversible consequences, though ACMG/NSGC practice guidelines and tumor-board consensus constrain them enough to hold this below 17.
Has AI actually changed your work?