In 2015, the Academy Awards announced their slate of nominees for the four major acting categories. To activist April Reign’s chagrin, all 20 nomination slots were occupied by white actors and actresses. With a single tweet, Reign launched the #OscarsSoWhite campaign, calling the Academy out for its extreme lack of diversity. Unfortunately, this phenomenon is not exclusive to film accolades; the field of genetic counseling has a similar problem with a lack of diversity.
The 2022 Professional Status Survey conducted by the National Society of Genetic Counselors (NSGC) indicated that 93% of respondents identified as women, 89% identified as straight, and 89% identified as white. The dominance of straight, white women has been the demographic makeup of the field since its conception. What factors have contributed to this maintenance of the status quo, and how can the field begin to address and rectify this lack of diversity?
"Despite decades of efforts to increase ethnic and racial diversity among genetic counselors, African Americans, Hispanics and American Indians, currently constituting almost one-third of Americans, remain only meagerly represented among genetic counselors at a level far under that seen in other health professions...Increasing the diversity of the genetic counseling workforce stands not only to expand access to genetic services but also to improve the quality of genetic care provided to the American public."
Mittman, I.S., Downs, K. Diversity in Genetic Counseling: Past, Present and Future. J Genet Counsel 17, 301–313 (2008). https://doi.org/10.1007/s10897-008-9160-5
Barriers to Diversity and Inclusion: Graduate School Admissions
One of the most notable bottlenecks to the inclusion of more diverse voices in the genetic counseling space is the ultra-competitive and expensive graduate school admissions process. According to 2022 Genetic Counseling Admissions Match Statistics collected by the Association of Genetic Counseling Program Directors, around 50% of applicants who registered for the match were cut from the process at the interview stage due to not receiving an interview invitation from a program, and of those who did receive interviews, only around 50% successfully matched. This means that the overall percentage of applicants who matched last cycle was approximately 25%, or 1 in every 4 applicants.
The numbers become even more intimidating when broken down by program. For the current 2023 cycle, for example, the University of Washington received around 320 applications for their genetic counseling program, and will only accept around 16 students, meaning the program acceptance rate is a startlingly low 5%. This low acceptance rate is true of most programs, as the few programs and relatively small cohort sizes cannot keep up with the increasing interest in the field.
Because the admissions process is so competitive, applicants are encouraged to apply to many programs to increase their chances of matching. According to a 2022 survey conducted by the GC Chat Discord, successfully matched applicants applied to around 8 programs. Because each program has an application fee, applying to this number of programs can be a notable financial barrier to underrepresented applicants. From the available application fees of programs from the 2023 admissions cycle, the median cost of submitting an application was $75. For 8 programs, this total would come out to $600, plus the cost of registering for the match, $100. If successfully matched, applicants still must consider program tuition.
In summary, the competitiveness of graduate admissions along with the financial strains of submitting applications and paying for programs act as notable barriers for the inclusion of underrepresented applicants into the field of genetic counseling.
What Graduate Programs Are Doing to Embrace DEI
Genetic counseling graduate programs have become aware of the barriers facing minority students as they pursue this career, and are making an effort to make genetic counseling more accessible. One initiative most graduate programs have undertaken is the removal of the GRE as a requirement for admission due to the monetary cost it adds to the application process, as well as the standardized test’s inherent bias as a predictor of race, gender, and socioeconomic status more than it is a predictor of success in graduate school.
Graduate schools have also pursued initiatives such as the Alliance to Increase Diversity in Genetic Counseling (AID-GC), which funds the graduate school tuition costs of underrepresented applicants through a grant provided by the Warren Alpert Foundation. The programs participating in this alliance include the University of Pennsylvania, Sarah Lawrence College, Boston University, Rutgers University, and the University of Maryland. Applicants can apply for this funding by submitting a supplemental essay with their graduate school application.
Going beyond funding, NSGC created a detailed Justice, Equity, Diversity and Inclusion (J.E.D.I.) Action Plan that addresses six key areas: Communication & Transparency, Education & Training, NSGC Annual Conference, Partnership & Outreach, Policy & Changes, and Wide-sweeping Changes. Many graduate programs are joining the J.E.D.I. action plan by offering monthly seminars to their graduate students to encourage cultural competency in their practice. NSGC’s specific plans and progress can be checked on their 2022 report.
A Seat at the Table: Looking Toward the Future
Especially in healthcare, it is of utmost importance that patients have access to providers that represent their background. In genetic counseling, we have identified that this is currently not the case. What can we do to address the extreme lack of diversity and barriers to inclusion in this field?
The answer may lie in the pursuit. In his autobiography When Breath Becomes Air, the late Dr. Paul Kalanithi proclaimed that “You can't ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” The same principle is true when thinking about diversity. Justice, Equity, Diversity, and Inclusion are not badges to achieve or destinations in and of themselves. Rather, it is an endeavor that students, graduate programs, and professionals should constantly be working toward and improving upon. Ensuring that every person from all backgrounds and walks of life has a seat at the table and voice within genetic counseling should be the duty of not only minority groups themselves, but of the privileged who can afford to rock the boat. Advocate Genetics takes this charge seriously, and we strive to take every opportunity to include diverse voices and perspectives in our work, and to find opportunities to support the careers of underrepresented pre-GC and GC students.
After the #OscarsSoWhite campaign of 2015, groups underrepresented in film recognition were hopeful for a more representative nomination slate in 2016. That is why it was even more of an insult when the same outcome came of the next Academy Awards - all 20 major acting nomination slots were again composed entirely of white actors. The field of genetic counseling can and must do better.