LAUSR

Almost 50 years ago, Sarah Lawrence College awarded the first Master of Science degrees in the fledgling field of genetic counseling (Stern, 2009). The first board exam was given in 1981; the Journal of Genetic Counseling launched in 1992 (Stern, 2012). Having achieved these early milestones as the 20th Century rounded to a close, genetic counseling is fledgling no longer. In this century, the field has entered a phase explosive growth. In the United States and Canada, the number of programs grew from fewer than 30 to over 50 in a span of ten years. Expansion is not merely a question of body count. Described in Science in 2016 as ‘primarily a Canadian and U.S. field’, (Pain, 2016) genetic counseling is now practiced in over 28 countries (Ormond et al., 2018). A quick glance at the National Society of Genetic Counselors (NSGC) Professional Status Survey shows that our range of expertise has expanded along with our numbers. While prenatal and cancer remain the most common areas of practice, the number of GC’s working in cardiology has grown from 1.5% in 2008 to 12% in 2018, with similar growth in such fields as neurology and metabolic medicine. Other fields have crept into the mix, including the new practice of ‘genomic medicine’ (NSGC Professional Status Survey: Executive Summary 2018; (NSGC Professional Status Survey: Executive Summary 2008). In the United States, a concerted effort is underway to pass laws that would enable genetic counselors to work and bill independently of their physician partners. In 2002, Utah was the first state to license genetic counselors (Roberts et al., 2017); today over half of all states have some form of a genetic counseling licensure law (NSGC Policy and Publications: States issuing Licenses for Genetic Counselors 2020). In 2018, a bill was introduced in Congress that would give genetic counselors coverage under Medicare and Medicaid for a range of services at 85% of the physician fee schedule(H.R. 3235, the ’Access to Genetic Counselor Services Act of 2019, 2019). The NSGC has been actively involved in supporting both state and federal legislative efforts (Hooker, 2020). Past our early milestones, experiencing a growth spurt and engaged in a struggle for independence: no doubt about it, the field of genetic counseling has reached its adolescence. What will adulthood look like? This article, based on talk given at the 2019 World Congress of Genetic Counseling, will offer some thoughts on the changes and challenges that face genetic counseling in the decade to come. To ground the discussion in a wealth of anecdote, I would like to look back on ten news stories from the past five years. Some of these were front page news; others were barely a blip. Quite possibly the ‘biggest’ story in genetics of the past decade – the birth of twin girls from genetically modified embryos – did not even make the list. My admittedly subjective selection criterion: each of these stories represents trends and changes that I see as harbingers of the future. I discuss them here in roughly chronological order.