Opportunities and impediments for a consolidating and expanding profession: Genetic counseling in the United States

Genetic counseling in the United States is consolidating and expanding its professional identity at a point in time when major biotechnological advances are rapidly being incorporated into clinical genetic practice and major shifts in the American health care system are being carried out under a mandate of cost-containment. External factors—biomedical advances, political and economic contexts, managed care organizations, health economics criteria and exclusionary strategies of related health care occupations—combined with internal factors—training and certification requirements, specialization, leadership talent and ability to adapt to changing conditions—will strongly influence the structure and scope of genetic counseling services in the coming years.