Best Careers 2009: Genetic Counselor

Overview. By the time you finish training to be a genetic counselor, you'll be able to find out, affordably and with considerable certainty, how your personal genome is likely to affect you. Are you at increased risk of heart attack, cancer, diabetes, Parkinson's, or myriad others, or are you a lucky one? And more important, you'll have new gene therapies to consider utilizing.

Genetic counselors are being hired to help customers address thorny questions: Do I want to know my genetic predispositions? (Less precise approaches to assessing those are already available.) If I do, and it turns out that, for example, my genome doubles my risk of breast cancer, should I have a preventative mastectomy?

Even before it was possible to sequence your genome, genetic counselors helped people and their families with critical decisions. Example: You're pregnant. A test reveals that your baby has the gene for a genetic disease that may or may not be serious. Should you abort? Or you've had a miscarriage and lost a second baby soon after it was born. Should you try to get pregnant again? Other typical clients include people or families with a history of congenital heart defects, mental retardation, and hearing or vision loss.

Some 90 percent of genetic counselors are satisfied with their job. And it's not surprising. Compared with other healthcare professions, your work tends to be more rewarding. You're not expected to cure difficult diseases but merely to help a person explore options and provide support. So most of your clients are pleased with what you've done. Also, you're not forced into 12-minute patient appointments. A session with a patient or family member often lasts an hour. Plus, the job market is growing.

And so are the career options. Traditionally, genetic counselors worked mainly on facilitating prenatal decisions. But since the decoding of the human genome, a growing number of tests can predict an estimate of the chance of developing specific diseases through the entire life span. In addition, genetic counselors are now used by pharmaceutical companies to screen and counsel participants in clinical trials and to assist with ethical decisions.

This profession's major potential downside is that there's little opportunity for promotion: Unless you become a professor, you're going to stay a counselor. However, genetic counselors can add variety to their work by writing articles or speaking to lawmakers and to patient and community groups.

If you'd like to be part of the genomic revolution but are more of a counselor type than a high-powered researcher, this career might fit your DNA perfectly.

A Day in the Life . You start the day accompanying a physician and medical geneticist on a visit to an inpatient with an unclear diagnosis. You observe the patient and the doctor's exam, and then the three of you walk to your small office to collaboratively develop the diagnosis. You have already conducted an in-depth interview of the patient and family, including their genetic history, so you end up doing much of the talking, but the final diagnosis is made by the physician.

Next, you meet the first of two pairs of prospective parents. In the first couple, both suffer from major depression and wonder if they should have children. Both members of the second couple have serious learning disabilities. As with many conditions that are only partly under genetic control, you can provide only rough estimates. You present the pros and cons of low-tech options such as adoption and higher-tech ones such as egg or sperm donation.

Next, you meet with a 40-year-old with a family history of heart disease. There's a new genetic test that predicts the likelihood of developing early cardiovascular disease. He worries that if he takes it and the results are positive, he will feel that he's a walking time bomb and that fear will outweigh the benefits of the additional preventive efforts he'd make.

You write reports on those sessions and E-mail them to the patients' physicians. Then you unearth support resources for a patient with Huntington's disease and end the day by meeting with a group of prospective mothers who have had multiple miscarriages, where you present to them and their partners the latest data on risk reduction and answer questions.