Sorry, this will be a bit long-winded. My dream job was to be a genetic counselor. I loved learning about genetics, and people told me I would make a good therapist, so I thought it was a great fit. I got good grades throughout undergrad and grad school, and got decent reviews from my rounds through several hospitals before graduation - the only note was that I wasn't great at building rapport, which is the first part of the session where you make basic small talk with the patient to try to get them to open up to you. All in all, I was confident I'd be fine. At my first job, though, things were a lot more complicated; my workload was way higher than anything I had to deal with during grad school, my supervisor had no idea what my job was actually for, and my rapport building skill ended up being worse than I thought.

Genetic counseling generally consists of talking with patients to get their feelings about whatever genetic condition is potentially affecting them and/or their family, then helping them process those feelings, and ultimately determine if genetic testing is right for them. When it's handled correctly it drastically helps patient outlook and confidence moving forward with their diagnostic odyssey, but it's not often handled correctly in practice. Doctors mostly want to just tell a patient they needed genetic testing, which is mostly what happened in the past couple of decades, since genetic counseling is a relatively new field. But now the hospital requires a genetic counseling visit before a genetic test can be ordered. So, the doctors will tell the patient they were ordering them a test, but that they had one other appointment they needed to attend before it could go through. This caused 2 major issues:

• First, it confused the patients. They often thought they were just there for a blood draw, and were unprepared for a counseling session, which further exacerbated my rapport building issue; I'm a great counselor, but if I can't get the patient to actually open up and start talking to me about their worries, everything falls apart, causing the patient to leave annoyed and feeling like I wasted their time. This happened often enough to make me feel worthless, and like I was causing undue stress for people during an already difficult time in their life.
• Second, it annoyed the doctors, who felt like I was nothing more than an extra step clogging up their workflow. This was more damaging than it seems at face value, because hospitals have an unspoken hierarchy; doctors are the moneymakers for the hospital, so when they're annoyed, the higher-ups are very motivated to address that. As a genetic counselor, whose sessions are complimentary and not billable, I was at the bottom of that hierarchy, so my needs barely mattered. Pair that with the fact that my supervisor had no idea what my role was, and wasn't willing to learn, I had multiple meetings that essentially told me I need to get genetic testing for all patients, which specifically goes against patient autonomy, which is one of the great pillars that genetic counselors are meant to uphold.

Ultimately, I immediately felt burnt out, disrespected, unhelpful, and unwanted. I spoke to many classmates from graduate school, thinking maybe it was just my specific hospital that had these problems, but they all reported the same scenario. Most of them decided to stick it out, but I left. And now, many of them are struggling with mental health issues as a result of trying to preserver in these harsh working conditions. I have a lot of respect for them being able to continue providing this essential service for their patients, but I'm happy I left.