← Risk register SOC 29-9092 · reviewed 2026-08-11

Genetic Counselors

3,740 US workers · median $100,040/yr · Healthcare

EXPOSED

The analytic half of this job — building pedigrees from intake forms, running Tyrer-Cuzick/BOADICEA risk models, pulling ClinVar and literature on a variant, drafting the clinic note and insurance pre-auth letter — is exactly what language models and lab decision-support tools now do at usable quality. What does not automate is sitting with a woman deciding whether to test her children for Huntington's, or delivering a VUS result to a family already primed for catastrophe, then owning that conversation clinically. Licensure exists in roughly two-thirds of states and ABGC certification gates hiring and billing, which slows substitution even where software could draft the answer.

10-year outlook: Demand keeps rising with genomic testing volume, but per-counselor caseloads grow as AI absorbs pedigree and variant prep — the job shifts toward high-stakes disclosure conversations and lab sign-off.

US employment, 2019–2025+56.5%
2,3903,740 workers

Dipped in 2020, then grew past where it started.

Median pay $81,880 → $100,040 -2.3% in real terms (nominal +22.2%, less ~25% US inflation over the period)

The job count is not the verdict

This line is counted by the Bureau of Labor Statistics — the one figure on this page that isn't a judgement of ours. Headcount moves on demand, offshoring, demographics and the business cycle, and automation is one term among several, often not the loudest.

So a falling line is not evidence that AI did it, and a rising one is not evidence that it won't. Both happen in this register: some occupations resist automation and shrink anyway, others are highly automatable and keep growing. The marked year is 2020.

BLS projection, 2024–2034

+9.3% 4,000 → 4,300 on the projections basis

Growing, and only partly exposed

The BLS expects +9.3% more of these jobs by 2034, and at 61/100 the work is only partly exposed — some tasks are automatable, the core of the job is not. Nothing here is in tension.

Different clocks. The score is what current AI could do to this work today. The projection is how many of these jobs will exist in 2034. Everything between the two — how fast employers actually adopt, whether demand grows in the meantime — is why they can point opposite ways without either being wrong.

~300 openings a year on average, including replacing people who leave.

One email if this score changes. Watch as many occupations as you like from the same address — no account, and nothing is sent on a schedule, only when a verdict actually moves.

Also known as — 14 job titles this covers

Titles reported by people doing this work, from the US Department of Labor's O*NET survey. If your job title is here, this page is about your work even though the name doesn't match.

Clinical ReviewerGenetic CounselorGenetic CoordinatorMedical Science LiaisonCancer Genetic CounselorCancer Program ConsultantPrenatal Genetic CounselorCertified Genetic CounselorPediatric Genetic CounselorChromosomal Disorders CounselorMitochondrial Disorders CounselorGenetic Counseling Medical SpecialistPrenatal and Pediatric Genetic CounselorReproductive Genetic Counseling Coordinator

Score — 61/100 resistance

Holding it up: trust premium (17/20). Weakest point: embodiment (7/20).

Five dimensions, 0–20 each, summed. Higher means more protected. The arithmetic is shown so you can check it: 11 + 7 + 12 + 17 + 14 = 61. · Scored 2026-08-11, and re-examined when evidence accumulates rather than on a schedule.

Task resistance 11/20

Mixed — a routine tier and a judgment tier Pedigree construction, variant curation against ClinVar/ACMG criteria, risk-model runs and the pre-test/post-test letter are all now drafted competently by software, but the pre-test counseling session, the disclosure of a Huntington's or BRCA1 result, and the decision-making conversation about prenatal termination remain irreducibly live work — roughly half the caseload hours resist, which is what puts this at 11 rather than 6 or 15.

Embodiment 7/20

Some physical or field component You sit in a clinic room or on telehealth for most of the day, but you draw or order the blood, hand over the buccal swab kit, do the physical presence work at a fetal-anomaly consult alongside MFM, and read facial dysmorphology in person — physical, but controlled and incidental, hence 7 not 13.

Liability shield 12/20

Licensed human required and personally liable ABGC certification plus licensure in about two-thirds of states gates hiring and CPT 96040 billing, and you carry your own scope of practice for what you disclose — but you do not order the test independently in many settings, the ordering physician or lab director signs the report, so you sit at 12 rather than the 17 a prescribing clinician holds.

Trust premium 17/20

The human relationship is the product Patients disclose family secrets — non-paternity, a sibling's suicide, an abortion nobody knows about — because it is you asking, and a Huntington's predictive-test protocol deliberately spaces sessions weeks apart precisely so the relationship can hold the result; the counseling relationship is not adjacent to the deliverable, it is the deliverable.

Judgment & accountability 14/20

Exists to be accountable for ambiguous calls You decide whether a 16-year-old is competent to consent to predictive testing, whether to recommend against testing at all, how to frame a VUS so a family doesn't pursue prophylactic mastectomy on nothing, and whether to breach confidentiality to warn an at-risk relative — ambiguous calls with irreversible consequences, though ACMG/NSGC practice guidelines and tumor-board consensus constrain them enough to hold this below 17.

Confidence: medium · reviewed 2026-08-11 · how scoring works

What this job involves — and which parts are yours

The verdict above describes this occupation as a whole. Almost nobody does the typical version of a job — tick what's actually in your week and see how your own mix sits.

AI already does these at usable quality

These still need a person

Active moats on the surviving side: licensure, trust, judgment

How to future-proof this job

Training paths for your skill gaps: edX — performance measurement and evaluation free to audit · Khan Academy — reading and vocabulary, all levels, free free · Coursera — customer service and client-facing skill courses free to audit · Learning How to Learn — the most-taken course on Coursera, and free free to audit · MIT OpenCourseWare — operations management free · Coursera — quality control and inspection courses, auditable free free to audit

All 35 skills ranked by how many jobs they open →

Where this experience transfers — occupations you could move toward

Computed from U.S. Dept. of Labor O*NET skill and knowledge profiles: high overlap with what you already do, a materially higher resistance score, no large jump in required training, and no licence you would have to start a new pipeline to get. Targets that pay meaningfully less, that are themselves COOKED, or whose own headcount is falling are excluded — a move into a shrinking trade is not an escape.

Clinical and Counseling Psychologists SAFE · 71/100 · you already have ~82% of the skill profile

Skills to close: Monitoring, Reading Comprehension, Service Orientation, Learning Strategies

Speech-Language Pathologists SAFE · 83/100 · you already have ~73% of the skill profile

Skills to close: Operations Analysis, Quality Control Analysis, Learning Strategies, Monitoring

Occupational Therapists SAFE · 79/100 · you already have ~70% of the skill profile

Skills to close: Operations Analysis, Learning Strategies, Monitoring, Quality Control Analysis

What would move this back up — beyond any one person

The moves above are yours to make. This is the other half: what would have to change in the world for the occupation itself to score higher. None of it is in any one person's gift, but it is where the floor actually comes from. Scores here are not a one-way ratchet. Only two of the five dimensions — task resistance and embodiment — track what machines can do. The other three track law, what buyers will pay for, and who is answerable, and those move in both directions, often in response to the same pressure AI creates. If every lever below landed, this occupation would score around 75/100 — SAFE.

5 specific changes that would raise this score
  • already happening task resistance +3

    Task-mix shift: the pedigree/risk-model/ClinVar-lookup/letter-drafting tier is genuinely separable from the disclosure tier. If labs and health systems formally reassign the analytic tier to software plus genetic assistants (already happening at Myriad, Invitae-successor operations and telehealth GC vendors), the residual job is predictive-testing decisions, VUS and incidental-finding disclosure, reproductive decision-making and family cascade coordination — which current models do not do at usable quality

  • already happening judgment accountability +2

    Expansion of population and prenatal screening (cfDNA, newborn genomic sequencing pilots, employer/payer hereditary cancer panels) pushing high-ambiguity caseload — incidental findings, discordant results, non-paternity, penetrance uncertainty — onto the GC as the named decision owner rather than the physician

  • plausible liability shield +4

    Genetic counselor licensure completing across the remaining states (NSGC's Access to Genetic Counselor Services Act push, plus state bills like those passed in NY 2022 and Michigan) combined with CMS finalizing genetic counselors as independently billable Medicare providers — which would make a certified GC's signature, not an ordering physician's, the legally accountable one on the interpretation and disclosure

  • plausible liability shield +3

    A CAP/ACMG or state lab-licensing rule requiring a board-certified genetic counselor or clinical geneticist to countersign AI- or pipeline-generated variant classifications and reportable secondary findings before release to the ordering clinician

  • plausible trust premium +2

    Already near ceiling at 17. The only remaining route is a payer or accreditation requirement that pre-test counseling for predictive/presymptomatic testing be delivered by a human GC rather than a chatbot or video module — e.g. a Huntington's or BRCA testing coverage condition written into commercial policy

The limit. Embodiment has no plausible route — the work is conversation and records, and telehealth delivery is already normal. Total realistic headroom is bounded by the profession's small size: 3,740 workers means state-by-state licensure and CMS recognition depend on one advocacy organization's capacity, and a single adverse CMS decision on independent billing caps the liability_shield gain regardless of clinical reality.

These are conditions, not forecasts — what would have to happen, not what will. Specific rules, cases and bills are named so you can go and check whether they exist and where they stand; verify before relying on any of them. Nothing here is legal or financial advice.

Where this work is, and what it pays there

BLS metro figures for 18 areas. The verdict above does not change by city — the rubric judges what the work involves, not where it happens — but pay and headcount do, and the national median hides a very wide range.

Most of these jobs

New York-Newark-Jersey City, NY-NJ 390 $109,130 +9%
Boston-Cambridge-Newton, MA-NH 180 $97,240 -3%
Los Angeles-Long Beach-Anaheim, CA 130 $120,560 +21%
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 130 $106,010 +6%
San Francisco-Oakland-Fremont, CA 120 $177,990 +78%
Pittsburgh, PA 100 $99,030 -1%
Chicago-Naperville-Elgin, IL-IN 80 $95,880 -4%
Minneapolis-St. Paul-Bloomington, MN-WI 80 $102,010 +2%

Best paid

San Francisco-Oakland-Fremont, CA 120 $177,990 +78%
San Jose-Sunnyvale-Santa Clara, CA 80 $165,920 +66%
Los Angeles-Long Beach-Anaheim, CA 130 $120,560 +21%

Percentages are against this occupation's national median of $100,040. Counts are jobs in that metro, not vacancies. Metros where the BLS suppressed the cell are absent rather than shown as zero.

Who is actually doing this — nobody, on the record

We have no reported case of a named organisation automating this occupation. Not one deployment, not one announcement.

That is worth saying out loud next to a score of 61. The verdict above is about what the work exposes — what current AI could do to these tasks. It is not a claim that anyone has done it. For this occupation those two things have come apart completely: the capability argument is on this page, and the evidence column is empty.

Read that as a gap in the reporting we can see, not proof of absence — the dispatch runs on English-language feeds and misses plenty. If you know of a case, tell us, or add a field report from inside the job.

Quick take — do you do this job?

Has AI actually changed your work? One tap, anonymous, and the running tally is public. Nothing else is asked of you.

Self-reported and unverified — a sentiment signal, not a survey. One response per person per occupation; you can change your answer.

Field reports — what people say has changed

No field reports yet. A written account takes a paragraph rather than a tap, goes to an editor before it appears, and is the one thing on this page the rubric cannot produce on its own.

File a field report

Concrete beats general: a tool that arrived, a task that moved, a headcount decision you watched happen. Don't include anything that identifies you or your employer if that would put you at risk.

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