The case for integrating genetic counselors into primary care: A paradigm shift for our profession

Abstract

The integration of genetic counselors (GCs) into primary care represents an opportunity for a transformative shift in healthcare delivery, bridging the gap between the historical medical genetics delivery model and the increasing need for genetic services. This paradigm aligns the holistic ethos of primary care with the specialized expertise of genetic counseling and frontline access to preventive care, addressing critical barriers in genetic services. Current genetic service delivery models, concentrated in tertiary care settings, face limitations, including access disparities, fragmented care, and inefficiencies that disproportionately affect underserved populations. Embedding GCs within primary care leverages GCs' unique skills to enhance personalized healthcare delivery, improve risk assessment, and facilitate the implementation of precision medicine. GCs in primary care can streamline referrals, manage routine genetic concerns, and provide genetic continuity of care across the patient's lifespan. This integration ensures that genetic insights are contextualized within patients' day-to-day healthcare, fostering equitable and efficient access to genomic medicine. We explore the potential impact of primary care genetic counselors (PCGCs) on healthcare systems, emphasizing the alignment of their scope of practice with primary care principles such as accessibility, comprehensiveness, and continuity. By addressing evolving patient needs and collaborating with primary care teams, PCGCs can increase patient access, reduce system inefficiencies, alleviate pressures on specialty genetics services, and improve health equity. This paper advocates for a collaborative model where GCs are embedded within primary care, enabling proactive, prevention-focused interventions and enhancing patient outcomes. By integrating genetics into primary care settings, we reimagine genetic healthcare delivery to maximize the benefits of genomic medicine for all individuals. This paradigm shift underscores the urgency of addressing systemic barriers and advancing the role of GCs in healthcare to improve patient and clinician experiences, better population health, and achieve greater health equity.

Keywords: genetic counseling; health equity; healthcare delivery; precision medicine; primary care; workforce.

FIGURE 1

Pathway to genetics. The above considers the personal journey of a patient and the barriers they may face, notwithstanding additional overarching systematic barriers influencing accessing genetics care. There are multiple levels of barriers, such as personal, institutional, and societal factors which all interplay together creating a complex problem. Multiple solutions are required to truly address the systemic issues in terms of accessing genetics, but starting with adding primary care genetic counselors (PCGCs) is one step in the right direction. Adapted from Papautsky and Patterson (2021).

FIGURE 2

Mutual goals of genetic counseling and primary care. Genetic counseling aligns with primary care in several ways. Many of the areas where genetics is already deeply involved, such as perinatal care or cancer‐related concerns, can be seen as routine primary care.

FIGURE 3

Ethos of Primary Care Genetic Counseling: A Framework Rooted in Core Genetic Counseling Principles. The core values of genetic counseling form the foundation for primary care genetic counseling, adapted to prioritize accessibility, comprehensiveness, and continuity. Accessibility reduces barriers, enabling timely identification of genetic risks and proactive prevention. Comprehensiveness addresses genetic and health concerns holistically, fostering coordinated, whole‐person care. Continuity sustains long‐term follow‐up, adapting to patients' evolving needs and integrating genetic insights into care plans. Together, these elements create a framework for proactive, equitable, and integrated genetic counseling in primary care.