Many of us have spent time in our jobs educating administrative, clinical, billing, and human resource personnel within our institutions on the function and scope of practice of a genetic counselor. In some systems, we are hindered and unable to practice fully because we do not fit into any of our institutions’ existing staff categories.

The genetic counseling profession has long fought for recognition of our profession. The creation of the American Board of Genetic Counseling (ABGC) was an initial step toward distinguishing our role and ensuring that any certified genetic counselor has met a certain level of knowledge, skill, and ability to practice as a genetic counselor. This is one way for the public to know they are seeing a qualified provider.  In addition, NSGC has and continues to advocate for the creation of state licensure for genetic counselors. State licensure increases protection for the public by establishing a scope of practice and standards for practitioners governed by a state medical or licensing board. It defines who can use the title “Genetic Counselor” and provides an infrastructure to ensure that those providing care in the state meet a minimum set of educational and practice standards.  

In some medical centers, genetic counselors have privileges.  Privileges may be granted by a committee that reviews the qualifications of a health care provider who has applied to participate in a system. Privileges also define scope of practice within the specific medical center and may indicate if the genetic counselor can place orders for genetic testing. To attain privileges, some medical centers require at least board certification and others may also require state licensure. Some genetic counselors have been credentialed by institutions or health systems, or by payers. Under credentialing, a committee reviews the qualifications of a health care provider who has applied to participate in a health system. Similar to privileges, to become credentialed, some medical centers require at least ABGC certification and others may require state licensure. Licensure, privileging, and credentialing are all ways genetic counselors can become more visible in the medical community and acknowledged as highly specialized providers. Many medical professionals have all three of these requirements in addition to being Medicare providers. This seems to be a standard for recognition in the medical field.

In the health system where I was employed, genetic counselors are mostly considered administrative staff, which greatly limited our ability to fully function within our scope of practice. The closest staff category, in this health system, that could fit our scope of practice is that of a midlevel provider, also known as an advanced practice provider (APP). However, genetic counselors do not have all the defined qualifications needed to be an APP. Both genetic counselors and APPs have certification, state licensure, and health system credentialing but APPs are recognized providers under the Center for Medicare and Medicaid Services (CMS) and are thereby able to be reimbursed for services provided to Medicare patients. Genetic counselors need the last qualifier to be considered an APP. This may not be true in all healthcare systems, but it is for my center. Becoming a Medicare provider would increase our medical recognition and would be a big step towards becoming categorized as an APP.

NSGC is advocating for federal recognition of genetic counselors by the CMS through the Access to Genetic Counselor Services Act (H.R. 2144 / S. 1450). Federal recognition is a very important step for our profession, which will help to define us as independent providers. In many cases this will allow us to be designated as mid-level providers or APPs within our healthcare systems, enable us to be credentialed and allow our institutions to bill for our services. These factors will increase our real and perceived value within our health systems and amongst our healthcare provider colleagues.

NSGC is leading the way to help us grow our footprint in health systems and other communities by working towards recognition of our profession on the local, state, and federal levels. I encourage you to learn about and support these efforts if they are new to you and get involved. Not only will this benefit the profession, but it may also benefit you in a real and tangible way. This is a very important step for our profession, which will help to define us as independent providers.

The author wishes to thank Colleen Campbell, PhD, MS, LGC & Kristen Shannon, MS, CGC for their encouragement and editing expertise.

Valerie H. LaCroix, MSc, LGC practiced primarily as a reproductive genetic counselor for over 30+ years before she recently retired from her position at Dartmouth Health (aka Dartmouth Hitchcock Medical Center). She is an American who graduated from McGill University genetic counseling program. After graduation, she worked briefly in Montreal Canada, Burlington VT, and Charlottesville, VA before she spent the rest of her long career at Dartmouth Health.