A solo Genetic Counselor (GC) is someone who serves as the only GC in their hospital, department, clinic, and/or office.

Since obtaining my Master’s in Human Genetics from Sarah Lawrence College in May 2025, I have been working as a solo GC at BronxCare Health System in New York, where I provide reproductive genetic counseling services in the Women’s Health Center.

The following includes 10 pieces of advice I wished someone shared with me before I began my career as a solo GC:

1. Upon first entering your role as a solo GC, your onboarding experience will differ from the structured training and supervision received during graduate training rotations or prior team-based roles. The reality is, colleagues in the institution/department won't know exactly how your job is done. Whether you replaced one GC or are the first GC the clinic has ever had, there will be a lot of figuring out how to do your job independently. When beginning your new job, your first instinct may be to restructure a clinic to meet ACMG guidelines or duplicate best practices observed elsewhere. It is important to remember that Rome wasn’t built in a day. Take time to get comfortable with the way things have been done, and slowly integrate change as you see fit. Remember that without you, there would be no genetic counseling services in your practice setting, so any services you administer are already extremely helpful to the providers.  
2. If you are replacing a GC, schedule a comprehensive meeting with them to review workflows, protocols and any other guidance or advice they have. If you are the first GC the institution/department has hired, speak with other GCs in your specialty that serve similar geographical areas as you to begin to establish a workflow.
3. If you are working without a geneticist, you are considered the institution/department’s expert in genetics. This truly has its pros and cons. On the one hand, coworkers often come to you for questions and immediately trust your judgement. On the other, it is important to be honest when you are not 100% sure about a case. Take the time to research, speak with other GCs, and get back to providers regarding their original question.
4. In the field of genetics, we focus a lot on technological advancements. NSGC conferences are often showcasing the “next best thing.” Being a solo GC means meeting institutions where they are at. Your institution may not be ready to make the next big jump. Your primary goal is serving patients given the resources available to you, however, you should continue to advocate and speak with department heads regarding policy changes as you see fit.
5. The doctors and other providers you work with may have opinions surrounding genetic counseling. Work with them, not against them. Even if you disagree, it is important to keep a relationship that is built on the foundation of trust and respect.
6. Administrators are your life savers. It is important to show them your appreciation. Reply with a thank you email for every request they complete because they make sure everything is running smoothly.
7. You may have to work with your institution’s lab to create a workflow for external genetic testing that cannot be ordered directly through the electronic medical record. This will involve education and a lot of patience, so give you and your colleagues some grace.
8. Don’t be afraid to educate your colleagues about caveats necessary for informed consent on any genetic testing they are routinely ordering for patients. Send out emails to the department, hold meetings, and be available for follow-up questions.
9. The million-dollar question: Who do you ask questions to if you’re the only GC in your practice setting? Of course, some of your colleagues have information on workflows, experience with genetic indications, and may generally understand the genetic counseling process, but this is why it is extremely important to build a network of GCs you can reach out to when you need help. Whether it’s a group chat of classmates working in the same specialty, GCs in a shared affinity group, or instructors from graduate school, figuring out who to reach out to for what type of question is super helpful.
10. It can feel lonely and isolating when it seems like other providers in the clinic can turn to each other for support and relate to each other’s daily experiences. You may have to put in some extra effort to create a relationship with colleagues. Just know - there are many GCs feeling the same as you. Connecting with GCs at other institutions in the area for coffee or happy hour can help you feel a sense of community even if it is not on a daily basis.

---