The landscape of the genetic counselor workforce has shifted dramatically in recent years, in large part due to new opportunities for genetic counselors in genetic testing laboratory settings. According to the Professional Status Survey conducted by the National Society of Genetic Counselors, the number of genetic counselors who report a laboratory as their primary work setting has doubled in the past 4 years and nearly tripled in the past 10, with 21% of genetic counselors reporting a laboratory setting as their primary workplace in 2016. And this likely under-represents the percentage of genetic counselor who are employed by laboratories, as many who work for labs but see patients in clinics likely report their primary work setting as clinical.
In an analysis of genetic counselors licensed in the state of Washington (presented at the NSGC meeting in 2016) we noted that 42% of genetic counselors were employed by commercial laboratories in 2015 as compared 22% in 2011. At the same time, the percentage of genetic counselors licensed in Washington state in clinical positions decreased from 60% in 2011 to 42% in 2015.
While genetic counselors play important roles in laboratory settings, what does this shift in employment mean for the field of genetic counseling? What does it mean for patient care at a time when genetic counseling services are more needed than ever?
Many hospitals are struggling to recruit and retain genetic counselors for their practices and are looking for alternatives when there aren’t independent genetic counseling services locally available. One option many medical practices are relying on is genetic counseling services provided by the testing laboratories.
While lab-based genetic counseling services are filling an important need, there is a conflict of interest inherent in this arrangement. Genetic counselors’ primary objective has historically been to help patients navigate difficult medical genetic information and decisions, supporting their autonomy. But as laboratory employees, genetic counselors must also consider their employer’s interests, which includes increasing the uptake of genetic testing.
Challenges regarding conflict of interest in research and healthcare are not new, however this is an area of increasing concern in genetics.
For more on this topic check out our commentary recently published in Genetics and Medicine and read our recent post, published on Harvard Law Bill of Health blog, written with our colleagues Marsha Michie and Megan Allyse.
An important part of our mission at Genetic Support Foundation is to address issues related to conflict of interest and to provide options for independently developed educational resources for patients and providers and genetic counseling services that are free from the commercial bias.