LAUSR

The genetic counselor profession is a rapidly evolving entity with numerous forces affecting growth, diversification, and direction. The genetic counselor workforce has been, and remains, a priority for the National Society of Genetic Counselors (NSGC), and the current strategic plan outlines workforce as one of the three strategic initiatives, BDirect the evolution and adaptation of the genetic counselor workforce.^ In order to tackle this complex issue, identifying and understanding the various forces that may impact the genetic counselor workforce is imperative. This has proven to be challenging given the nature of the genetic testing landscape and available data. As chair of the Workforce Working Group (WFWG), I had the opportunity to work collaboratively with representatives from the major US professional genetic counseling organizations (American Board of Genetic Counseling, Accreditation Council for Genetic Counseling, NSGC, Association for Genetic Counseling Program Directors, and American Society of Human Genetics) to delve deeper into the genetic counselor workforce issue. In 2016, the WFWG commissioned a Washington D.C.-based health economics and consulting firm to conduct a workforce study of clinical genetic counselors (CGCs) in the USA with the goal of projecting supply and demand for CGCs through 2026 (Hoskovec et al. 2018). Through this process it became clear that data derived from the work of the professional genetic counseling organizations provides a framework for the supply of genetic counselors now and in the future. However, predicting the demand for CGCs across the spectrum of work environments genetic counselors are employed in was significantly more difficult. For this reason, publications such as BCommercial Genetic Testing and the Future of the Genetic Counseling Profession^ are important additions to the genetic counselor workforce body of literature. The commentary BCommercial Genetic Testing and the Future of the Genetic Counseling Profession^ by Wolff and Wolff (2018) provides insight into the financial health and business side of four publicly traded genetic testing companies. While the commentary includes only a sampling of genetic testing companies, it provides information not previously reported in the context of potential influence on genetic counselors. Given the increasing percentage of CGCsworking in a commercial laboratory setting, 17.2% of respondents in the 2016 NSGC Professional Status Survey (National Society of Genetic Counselors 2016), an understanding of the business strategies and financial health of companies employing genetic counselors is meaningful. This insight can arm the genetic counseling profession with information needed to further adapt to this particular work environment and perhaps more accurately predict the demand for GCGs within genetic testing companies. Wolff and Wolff (2018) address the need for the genetic testing companies to become, and remain, profitable. While this is expected as a goal for most companies, it is possible that the profitability of commercial genetic testing laboratories and the business decisions required to attain profitability may not be well understood by all who are impacted by it. Wolff and Wolff (2018) suggest that, as these genetic testing companies make decisions to both attain profitability and set themselves apart from competitors, there could be a direct impact on how genetic counselors are utilized. They predict that if genetic counselor activities are funded in certain ways (i.e., investor funding) and profitability is not sufficient, the support for genetic counselors, both those in counseling and noncounseling roles, may decrease. While this risk is certainly something to consider when addressing future CGC demand, it is also important to consider the alternative. Genetic counselors continue to expand their roles across the healthcare spectrum, and there has been work in the genetic counseling * Jennifer Hoskovec [email protected]