Since Utah became the first state to offer genetic counselor (GC) licensure in 2002, several states have followed, with GC licensure currently available in 31 states. While GC licensure provides standardization among professionals and protection for the patients we serve, it can be an expensive and time-consuming process for genetic counselors who are required to obtain multi-state licensure (MSL). The number of genetic counselors seeking MSL has increased with the expansion of the genetic counselor role into commercial laboratories and the increased demand for telehealth services across state lines (especially in the wake of the COVID-19 pandemic). Language in GC licensure laws may not clearly delineate who is required to be licensed based on their job title, role, scope of practice, and employer. 

To better understand what impacts genetic counselors’ decisions to obtain MSL, a survey was administered in June 2020 to genetic counselors currently or previously employed at commercial laboratories about their opinions and experiences regarding MSL and employer policy. Responses from 150 genetic counselors were reviewed and analyzed. Genetic counselor roles were defined as follows: 

•    Direct patient care – A role that may involve many responsibilities but includes any degree of patient interaction, whether in-person or via telehealth. 
•    Non-direct patient care – A role that involves supporting patient care without direct patient interaction, i.e. genetic counselors that only communicate or interact with providers. 
•    Non-patient care – A business role related to larger organizational initiatives, i.e. marketing, sales, product development, leadership positions, etc.

Seventy-three percent (n=110) of respondents reported that they personally are required to obtain GC licensure in at least one state. Over two-thirds of participants indicated that their employer has an  MSL policy in place (n=103) and provides full reimbursement for licensure applications and renewal fees (n=83/103). Of the participants whose employers have an MSL policy in place, almost half (n=53) indicated this policy may be applied differently to individual genetic counselor employees, while the other half (n=50) specified that there is one uniform policy among all genetic counselor employees. Fifteen percent of all participants (n=23) reported their employer does not have a specific policy for GC licensure, while an additional 16% (n=24) did not know if their employer has a policy.

Participants with a known company MSL policy were asked to select which factors they believed influenced this policy. The most common factors chosen were job role (degree of patient interaction), location of patient residence (state), and legal compliance (internal legal counsel or state-specific legislative language). Most participants with direct patient care roles had GC licenses or active applications in their state of residence as well as the states of residence of their patients. This suggests that, despite the many known challenges of genetic counselor MSL, laboratory genetic counselors are compliant with state laws.

Other healthcare professionals have interstate compacts or license reciprocity, which provides a simplified path to licensure in multiple states. Participants were asked using a 5-point Likert scale whether they support an interstate GC license compact, whereby licensure in one state would confer a pathway to an expedited licensure application process in other participating states. No participants disagreed with this statement, and 96.7% (n=145) either somewhat or strongly agreed.

Based on this survey population, commercial laboratories may have differing policies as to which genetic counselor employees should be licensed. Genetic counselors may fulfill different roles within an organization that do not require GC licensure. However, it may be confusing for a genetic counselor to determine this based on the definitions provided by each state’s GC licensure laws. 

It is critical that any employer of genetic counselors providing patient care in multiple states has a clear policy about MSL. Ideally, if MSL is required, the employer would provide support in the form of administrative assistance, protected time to complete the applications, and financial reimbursement for any requisite fees. Medical boards in the process of writing new GC licensure laws should consider how these laws will impact those already licensed in multiple states. 

The time is now for genetic counselors seeking MSL to develop similar licensing resources as doctors and nurses, such as license reciprocity and interstate compacts. Ideally, a national GC license would eliminate the need for MSL, although it may be challenging to implement at this time. 

References
Tschirgi, M. L., Owens, K. M., Mackall, M. S., Allen, J., & Allen, R. (2022). Easing the burden of multi-state genetic counseling licensure in the United States: Process, pitfalls, and possible solutions. Journal of Genetic Counseling, 31(1), 41–48. https://doi.org/10.1002/jgc4.1467 
 

Matt Tschirgi, MS, CGC is Senior Manager, Genomic Services at Quest Diagnostics with over 14 years of prenatal clinical and industry experience. He is licensed in 31 states and has a professional interest in genetic counselor multi-state licensure. Matt is also affiliate faculty at Boise State University and the Founder of Genetix Consulting, LLC.

Rachel Allen, MS, CGC is currently a Medical Science Liaison at Sema4. She previously practiced as a genetic counselor at two hospitals in New Jersey and served as the Director of Perinatal Genetics for a private practice maternal-fetal medicine practice in New York. Rachel has worked as a Medical Science Liaison and Medical Science Liaison Supervisor at another laboratory for six years prior to joining Sema4.

Kailey Owens, MS, CGC is currently a Genomic Variant Scientist at Quest Diagnostics. She has previously worked as a laboratory genetic counselor and in the field of pediatric genetics. Her research interests include Fragile X syndrome, graduate student education, and variant classification.

Mia Salimbene Mackall, MS, CGC earned her Master of Science degree in Genetic Counseling from Brandeis University. She has over 9 years of Industry experience supporting Women’s Health genetic testing and is currently employed as a Clinical Training Manager at Natera, Inc. Her research interests include impact of licensure and professional development for laboratory genetic counselors.