NSGC’s Board of Directors held a Hill Day on Tuesday, May 7. In preparation for meetings with Congressional offices, we reached out to genetic counseling program directors regarding the current status of 2024 graduating students hired into the genetic counseling workforce. In the last year, due to changes in the genetic testing market, there have been multiple companies that have merged, resulting in an increase in job layoffs. In addition, there have been reports of capacity limits in current clinics. With these factors in play, we wanted to better understand the current job market and the impact on both the genetic counseling workforce and patients seeking genetic counselor services.

NSGC Professional Status Survey (PSS) data from 2018-2022 on job acceptance rate before graduation showcases acceptance rates between 71%-90%. Between May 2-6, 2024, program directors generously shared the job acceptance rates around graduation for their 2023 and 2024 graduating classes, with ~70% of programs reporting data. Program directors reported in 2023, approximately 79% of students had accepted a job around graduation and in 2024, approximately 30% of students had accepted a job as of May 6. Based on what we are hearing, it seems like different parts of the country are having different experiences with the job market at this point in time. We also hosted a Town Hall with the Program Directors this week to hear their perspectives and student experiences. Please note, that these numbers do not reflect the overall employment rate for new graduates. Many graduates secure jobs after graduation and some delay the job search for a variety of reasons. But it does highlight changes in the job market and the importance of continuing to improve reimbursement for genetic counselor services.  

There are increasing reports of genetic counselor positions not being replaced; being replaced by advanced practice providers with limited or no genetics training but who can bill; or being replaced by medical assistants, who have a lower cost due to lack of advanced training. It appears that the growing demand for genetic counselor services now is challenging even large centers that have traditionally been able to cover the cost of genetic counseling positions as they struggle to fund new positions, especially in clinics with high proportions of patients covered by Medicare. Our queries to program directors returned reports of several institutions no longer accepting external referrals as the reduced number of genetic counselors can no longer meet the demand for services. These stories were painful, but important, to hear.

It is difficult to quantify layoffs and contraction or lack of growth in the job market due to the inability to bill Medicare fee for service beneficiaries. However, the impact to the job market is apparent in the number of students graduating this year who have secured jobs as of May 6. Juxtaposed against the growing demand for genetic services, this trend is concerning for patient access.

At the same time, expansion of genetic counseling into rural and underserved areas has been limited by the lack of reimbursement for services to offset the costs of funding genetic counseling positions. As seen in Figure 1 below, based on the ABGC list of certified genetic counselors in the United States, there are areas throughout the country where patients do not have access to in-person genetic counselor appointments — depriving them of information and guidance that can critically impact their medical care. Rural Medicare patients are particularly disadvantaged without access to large urban medical centers with more resources to provide genetic counseling. These patients are also unable to have telehealth genetic counseling reimbursed under Medicare, as genetic counselors are not recognized as providers by CMS.

Figure 1. Distribution of certified genetic counselors across the United States (ABGC data, May 2024)

It is not yet known if job market volatility has prevented people from entering the field of genetic counseling, but as job placement rates for genetic counseling training programs become publicly available, this trend may discourage applicants to genetic counseling training programs. This year there was a slight decline in the number of people registering for the genetic counseling graduate school match (2082 registered in 2023 and 1860 registered in 2024, an ~11% drop).

There is a disconnect between the available genetic counseling jobs and increasing demand for genetic counselor services due to the growing role of genetics in modern medicine. Patients, and especially Medicare beneficiaries, are paying the price. When the Board of Directors met with members of Congress earlier this month, the message was Congress should enact H.R. 3876 / S. 2323, the Access to Genetic Counselor Services Act, now. This would guarantee that Medicare patients are able to access important genomic treatment options that will most effectively benefit their health, and genetic counselors will be available to meet the needs of Medicare beneficiaries throughout the country, including in rural areas.  Despite the growing role of genetics in modern medicine, Medicare will not directly reimburse genetic counselors. This lack of direct reimbursement leads to long wait times and delayed care for Medicare patients and impedes creation of genetic counseling positions for patients outside of large, academic medical centers, as hospitals are unable to fund genetic counselor positions that lack partial or full reimbursement. Without this essential service, disparities in healthcare persist and become exacerbated, leaving some of our most vulnerable populations without access to information and treatment options that could save their lives, and the lives of their family members. 

Our overall impression is that the job market is smaller than it has been in the last several years. Improving genetic counselor billing and reimbursement remains (and always has been) a key component to expanding the number of positions. While we are hopeful that over the next few months everyone will secure jobs, we also know to ensure the future of our profession genetic counselors need to be reimbursed for their services.

While the Board had productive meetings during our Hill Day, there are more conversations that need to occur to encourage Members of Congress to take the urgent action needed to improve patient access to genetic counselor services and improve the genetic counselor job market.

Call to Action:

There are two ways NSGC members, colleagues, patients, families and students can help now.

1. Members of Congress were upset to learn that patients are being turned away from clinics due to too few genetic counselors to serve patients in an area. Therefore, NSGC would like to collect more reports of any of the following through by email to advocacy@nsgc.org;

• Institutions no longer accepting external referrals as the reduced number of genetic counselors can no longer meet the demand for services
• Any genetic counselor positions that are not being replaced with another genetic counselor when one leaves a clinic
• Genetic counselor positions being replaced by advanced practice providers wiho have  limited or no genetics training but who can bill
• Genetic counselor positions being replaced by medical assistants, who have a lower cost due to lack of advanced training

2. Members of Congress are most likely to listen to people and employers who live and vote in their districts. We need more Members of Congress (House and Senate) to hear your voice. Please use this LINK to send letters to your Representative and Senators. You can also share the link with colleagues such as physicians, patients, students and friends as there are unique letters each can send.

While we know the current job market is discouraging and NSGC cannot single handedly fix it, we do believe if we all pitch in and encourage Congress to pass the Access to Genetic Counselor Services Act NOW, the job market will turn around and continue to grow to meet the needs of patients.

We thank you in advance for your time, and we look forward to hearing from you and working with you to pass this critical legislation for both our profession and our patients.

Colleen and Angie

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