Factors That Influence Genetic Counselors' Professional Identity—A Qualitative Study

ABSTRACT

Genetic counselors describe their professional identity as who they are (personal characteristics and attributes), what they do (actions and skills), and what they possess (training and knowledge). A shared multidimensional perspective highlights the transferability of their skills across diverse roles and settings. This qualitative study aimed to identify factors that influence genetic counselors' perceptions and formation of their professional identities. Using Social Identity Theory as a theoretical framework, semi‐structured recorded interviews were conducted with 50 genetic counselors who were purposefully sampled to ensure diversity of personal demographics (gender, race/ethnicity, sexual orientation, disability, and caregiver status), as well as years, settings, and roles in genetic counseling practice. Transcripts were coded and subjected to codebook thematic analysis using NVivo. Professional identity was influenced by internal validation (sense of purpose in work, pride, and confidence), external validation (from other colleagues, work system, degree of autonomy, and patients), one's personal identities (demographics, life experiences, and persona), and connections with others (professional network, peer support, role models, and giving back). Alignment and misalignment of these factors and the perceived collective identity of the profession impacted genetic counselors' sense of belonging to the profession both positively and negatively, respectively. Continued efforts to diversify the profession, as well as expanded opportunities for genetic counselors to work in new settings and roles, require critical reflection and discussion about the collective identity of the genetic counseling profession. The findings of this study can inform the recruitment, training, credentialing, continuing education, and retention of genetic counselors to ensure that genetic counselors, regardless of their personal identities or their work roles or settings, develop and maintain a sense of belonging and commitment to the profession and its values. In turn, the support of professional identity formation can positively impact genetic counselors' job satisfaction, competency, and delivery of healthcare to their patients and the populations they serve.

What Is Known About This Topic

• Professional identity has been well studied in physicians and allied health professionals, but it has been understudied among genetic counselors.

• Genetic counselors describe their professional identity as who they are (personal characteristics and attributes), what they do (actions and skills), and what they possess (training and knowledge).

What This Paper Adds to This Topic

• We report the second part of the first comprehensive, empirical exploration of the factors that influence genetic counselors' professional identity.

• Genetic counselors report internal and external validation, connections with others, and alignment of personal identities as key factors that support or challenge their professional identity.

• Uncovering the factors that influence genetic counselors' professional identity can inform further research and discussions regarding the collective identity and public image of the genetic counseling profession globally.

1. Introduction

Professional identity (PI), as defined by Schein (1978), is a “constellation of attributes, beliefs, values, motives, and experiences in terms of which people define themselves in a professional role” (Ibarra 1999, 764). As professionals enter new roles through socialization with others in the workplace, their PI evolves and adapts (Ibarra 1999). Aligned with Abbott's (1988) model of professions, Adams et al. (2006) noted that the interdisciplinary nature of work in healthcare often serves as a way for professionals to differentiate themselves from others.

Since the establishment of the genetic counseling profession in the United States in the late 1960s, and its promulgation globally (Abacan et al. 2019), the scope of practice, roles, and work settings of genetic counselors (GCs) have changed dramatically. Initially GCs in the United States and globally most often worked in medical genetics clinics with MD‐trained geneticists or in clinics offering prenatal diagnosis (Abacan et al. 2019; Cohen 2019; Patch and Middleton 2018). As new roles and work settings evolved for GCs due to advances in genomics, they have moved out of the tertiary medical genetics clinic to specialty areas, such as oncology and cardiology, as well as non‐direct patient care settings, including public health, research, and laboratories (Patch and Middleton 2018). In these new roles and settings, a GC may be the only practitioner with specialized training in genetics and thus serves as the primary consultant or expert, offering opportunities to expand their scope of practice (Quinn 2023).

GCs working in areas outside of the medical genetics clinic may also be working in roles more closely aligned to other professions, such as marketing or sales. In these situations, the specific roles or behaviors of GCs may continue to shift to those of other professions with whom they work, potentially impacting their PI as a GC (Baty 2018, 2020) as well as the collective identity of the genetic counseling profession. The mainstreaming of genetics into healthcare, as GCs work closely alongside healthcare professionals from other disciplines or specialties (e.g., physicians, nurses), can support GCs' feelings of value and satisfaction in improving patient care but also may result in tensions regarding their scope of practice as compared to other health professionals and a sense of isolation from other GCs (Do et al. 2024).

Social Identity Theory (SIT) suggests that people evaluate themselves in relation to others by identifying with those they perceive as similar and part of their “in‐group,” a mechanism referred to as self‐categorization (Hogg and Terry 2000, 123). It is this self‐categorization that can either promote or hinder a sense of belonging to a professional group and thus one's PI (Tajfel and Turner 2004). Despite efforts in North America and other regions to diversify the GC profession across multiple dimensions, including gender, race, ethnicity, disability, and socioeconomic status, to better reflect the populations that it serves (Channaoui et al. 2020; Kanga‐Parabia et al. 2024), GCs remain rather homogeneous in terms of personal identities with the vast majority of respondents to the 2024 National Society of Genetic Counselors (NSGC) Professional Status Survey (PSS) identifying as women (92%), cis‐female (94%), heterosexual/straight (86%), White (87%), and without a disability, chronic illness, or other major medical condition or impairment (78%; NSGC 2024). One's PI may be strongly influenced by one's personal identities, particularly if they do not align with the historical, stereotypical image of the professional (Bhatia‐Lin et al. 2021).

Research has been conducted on the PI of other allied health professionals (Cornett et al. 2023; Fitzgerald 2020; Lewis et al. 2025), but it has been understudied among GCs (Stenberg et al. 2025). In one of the few empirical studies of GC PI, Carmichael et al. (2021) reported that genetic counseling students who identify as racial or ethnic minorities experienced a decreased sense of belonging, a key component of PI (Lane and Roberts 2020). However, a scoping review by Stenberg et al. (2025) found that among 41 articles related to PI of GCs, most addressed complementary topics like professional development or diversity, equity and inclusion in the form of personal accounts, addresses, or commentary. Thus, there is a significant gap in the literature regarding the factors that may support or hinder GCs' PI. Here we report selected findings from a larger study, which is the first comprehensive empirical study focused on the PI of GCs in North America. Building on prior work describing how GCs conceptualize and define PI (Schwartz et al. 2026), this manuscript focuses specifically on the factors that influence GCs' PI.

2. Methodology

2.1. Design

The larger study was designed to address two research questions: (1) how do GCs perceive and describe their PI? and (2) what factors influence the perceptions and formation of GCs' PI? This manuscript reports a focused analysis pertaining to the second study aim: to identify factors that influence GCs' perceptions and formation of their PI. Using qualitative interviews and codebook thematic analysis (Braun and Clarke 2022, 2023), common themes and subthemes were generated across participants. Codebook thematic analysis is an appropriate approach for this study given pragmatic issues, including the use of two coders—with L.S. serving as a mentor to K.S., a novice researcher—and the relatively large size of the participant group/data set, as well as the philosophical stance of the primary researcher (L.S.) being post‐positivist/social constructionist (Braun and Clarke 2022).

2.2. Recruitment

Interview participants were recruited using convenience sampling followed by purposeful selection. Eligible individuals were graduates of an ACGC‐accredited master's program in genetic counseling with a minimum of 2 years of professional experience. Participants were recruited through the NSGC Research Surveys mailing list sent electronically to approximately 4200 NSGC members on May 10, 2023, and May 24, 2023. The Intake Form collected contact details and demographic information relevant to the study aims and purposeful sampling, including professional background, work setting, practice area, and personal demographics. To enhance diversity, participants were intentionally oversampled from groups underrepresented both in the initial respondent pool and in the genetic counseling profession, first focusing on the categories of gender identity, sexual orientation, race/ethnicity, and then by disability and caregiver status. The process then focused on attaining a relatively even distribution among the remaining demographics, such as current position (direct or non‐direct patient care), age, degrees held, primary work setting, and practice specialty.

Selected participants were invited by the first author (L.S.) via email to complete a single 30‐min Zoom interview at a time and location of their choice.

2.3. Dataset Generation

All interviews were carried out by the first author (L.S.). Before initiating the interviews, L.S. disclosed her professional background, noting that she is an ABGC‐certified genetic counselor and a former master's program director, though she had not worked in clinical practice for many years. Methodological rigor was further supported by the inclusion of a second coder (K.S.), who initially joined the project as an applicant to genetic counseling graduate programs while working as a student research assistant under L.S.'s supervision. Both researchers maintained reflexive journals and met regularly to debrief throughout data analysis, as described in further detail in Section 2.4 below.

Interviews followed a semi‐structured protocol developed by the research team (see Appendix S1). The research team, like the purposefully selected participants, included individuals with varied racial and ethnic identities, ages, disability and caregiver statuses, and professional roles across diverse settings such as commercial and academic diagnostic laboratories and higher education. While this diversity supported thoughtful interpretation of participants' experiences, the team included fewer members in direct patient care roles and a higher proportion of individuals identifying as cisgender women, which is acknowledged as potentially shaping data interpretation and representation. Feedback on the interview guide was also obtained from four experts in PI.

Interview questions focused on the interviewee's motivation to become a GC and career path and thoughts regarding the definition of genetic counseling (Resta et al. 2006). A definition of PI, adapted from Cruess et al. (2015), was shared with each interviewee. Aligned with Social Identity Theory (SIT), we asked participants to reflect upon factors that have contributed most to their considering themselves to be a GC and why, including identification with membership in groups based on work setting, personal background, colleagues, and the NSGC.

The interview ended by asking each interviewee if there was a time when they did not feel like they were a GC or belonged to a community of GCs. The interview was recorded with permission from the participants, and the closed captioning feature of Zoom was used to generate a transcript. Reflexive notes were recorded by the first author (L.S.) following each interview.

2.4. Data Analysis

Zoom‐generated transcripts were verified and de‐identified by the second author (K.S.) and analyzed using NVivo (QSR International, v. 20.4.0). Deductive codes based on the interview guide and inductive codes identified in the data were applied iteratively, with earlier transcripts re‐coded as needed. K.S. and L.S. codeveloped the final codebook by double‐coding four transcripts and resolving discrepancies, resulting in seven primary codes and 68 inductive subcodes. The remaining transcripts were then independently coded by each researcher, with ongoing communication to support consistency and theme development. Coded data were aggregated in NVivo to identify patterns and themes relevant to the research questions. Both researchers used annotations and reflexive journals to address positionality and bias. The resultant themes were finalized during a debriefing session with the entire research team. A summary of the findings, along with a table listing themes, subthemes, codes, and illustrative quotes (Table 1) was distributed to all participants for their feedback.

TABLE 1.

Codes and illustrative quotes that align with themes and subthemes.

Theme	Subtheme	Codes	Illustrative quotes
Internal validation	Sense of purpose/importance of work	Part of who I am; serving as a patient advocate; not doing patient contact_counseling roles; pride in work as a GC; need to prove value to others; sense of duty to promote justice_equity; values align with the profession	P04: In 2017 I left my job. I was on medical leave, and then it expired, and then I had to leave, and it was very hard to not have that professional identity. It was like, “Who am I?” That's who I've been for so long, I mean it's more than 20 years. I don't know who I am, and I don't know what my value is. P21: There are certain moments you have, that certain training, where you realize the weight of what you're doing. Where you're holding a terminal diagnosis before the family gets it or you're sitting with somebody after they've lost an infant or something along those lines. And that heavy moment where you realize that this is a job that you shouldn't take lightly… that the weight of all of this needs to be respected and appreciated… That made me feel like, “Yeah. Okay. I can do this.” This is what it feels like to be a genetic counselor. P26: I would see patients who had retinoblastoma. But then maybe their mother was in the room and they'd had an eye nucleated because they'd also had retinoblastoma. So being able to see that process was important in recognizing this is meaningful to people and worth looking into and being a part of that story.
	Pride	Pride in work as a GC; interests align with the profession; motivation to participate in study; serving as a patient advocate	P08: So being a genetic counselor is something I'm really proud of. It's what I do in my work. It fulfills me. P18: I'm proud to be a genetic counselor because I feel the things that we supposedly stand for as a profession in terms of disability, advocacy, or women's right to choose fit very well with my personal beliefs. It's easy for me to walk into that space and just be a genetic counselor. P30: And so I have absolutely identified as a genetic counselor. Want to identify as a genetic counselor. If people understand what that is, and they know that's what I do, I'm proud of that. P41: I feel proud to be able to answer those questions and help [patients] if I can, or at least find them resources that can benefit the situation that they're in. So I definitely feel like it's part of me in a way that I'm not sure people can say of all careers and jobs. And I just love genetic counseling, and it makes me happy that that's part of who I am.
	Confidence	Confidence in ability as GC; lack of confidence in skills	P01: The first case I probably did by myself [in grad school] like doing an entire session, I think that's when I started to take on that identity. I think being able to have that full conversation with a patient and forgetting that my supervisor was in the room, and being able to accomplish all parts of a session by myself.
External validation	Other colleagues	Validation as important member of the team; feeling invisible; confidence in ability as GC; need to prove value to others; focus on DEIJ issues; pride in work as GC; feeling silenced_afraid by NSGC; applying skills to non‐direct patient care roles; lack of recognition as an expert; scope of practice limits; position title not GC	P05: I get comments at least weekly from doctors who maybe I just met or they're newer or they just interacted with me for the first time, and they're like, “Wow! I'm so happy we have this. I don't know how to order genetic testing. You're telling me you'll talk to the patients and you'll give me advice on how to order the testing?” and [I say], “Yes, I can!” So once they understand how I can actually be helpful, I think people, at least in my department, have been really appreciative of having me there. P22: As a solo GC you encounter a lot more other health professions, more than other genetic counselors, and for the most part I've been really thankful that colleagues have really been respectful of what I do, and my input. P43: The ob [colleagues] I've worked with always made me feel like they just relied on me to help them make a buck, free up their time… and sometimes that lack of respect… will just make you question what your career choice is because that's been one of my core things is. I want to feel respected, and I definitely feel like I dug into [my work] just as hard as if I would have been a doctor. P48: I'm very lucky to work with a team of non‐genetic counselors who value what I provide and bring to the table as far as expertise and experience. I think that is a very precarious relationship to have, and I know that there are a lot of people who don't have that respect and then get really discouraged.
	Work system factors	Scope of practice limits; burnout_work challenges_job dissatisfaction; lack of professional advancement opportunities; serving as a patient advocate; need to prove value to others; expanding to non‐traditional roles; required GC cert or license; reasons for GC position or choice; thoughts re GC definition; Being GC is not enough_could be greater; motivation for participating in study	P02: I continually and consistently hear the message, “You are so invaluable… You're so intelligent. Why didn't you go to med school? Why don't you go back to med school why couldn't you be a doctor? Then you can bill for your services, and you won't have trouble continuing to rise to the level of professor in the school of medicine.” And I know they mean well, but like that really damages my professional identity. What I hear you saying is, “My profession is not enough or it alone doesn't have value or worth it, because I can't bill. It doesn't matter.” That really sucks. It's frustrating. I can't make more money. P34: But I saw the patient. I wrote the note. I disclose the result. I communicated back to the referring provider, and then the referring provider messages my attending, who has a generic stamp that was like, “I agree with the assessment by the genetic counselor. I was available should they have had questions”, wrote disclaimer that, “Yes, this was a supervised encounter” because we don't have licensure in my state. P39: By the time I left I was in the middle of building a new genetics clinic, a cerebral palsy genetics clinic, based on some of the research that I had done, and I was developing a workflow time allocations for physicians and a schedule and all of that stuff, and that's a big deal. And that's a really big undertaking. It's a lot of work. And I felt it was my idea, by the way, and then I felt like I wanted to be valued, and I wanted to be paid for that. I was contributing at this much higher level to the institution.
	Autonomy/Scope of practice	Scope of practice; expanding to non‐traditional roles; current job_role; validation as important member of the team; reasons for GC position choice; able to explain genetics so others understand	P09: when I was working with medical geneticists… there was this sort of hierarchical system that we were all working in when you're doing case management for an MD and you're gathering records for an MD. It just roots you in your place. And it wasn't until… I got out of that clinical space and then started working with cardiologists and our metabolic disease physicians where it became way more team based. It became a bit of an equalizer in the sense that my medical geneticist colleagues were never looking to me for any kind of expertise. It's like you do the things for me that support me. P15: There is a provider that works at my location that… tends to use genetic counselors as more administrative assistants to tell them what to do… They will go and call and collect information and send it all back. And so that was a particularly degrading point in my career where it just didn't really feel like I had gone to school and gotten this expertise and that was being respected or even being integrated into the plan or process.
Patients	Values align with the profession; able to explain genetics so others understand; serving as patient advocate	P04: It's been more than once where I've had people that I saw for prenatal counseling come back to me in a subsequent pregnancy, and I've had them say, “I saved your voicemail from last time when you said you were calling with good news, and I've saved it all this time so that I could listen to it again because it just made me so happy.” I think being a genetic counselor isn't just being the savior or anything like that. It's not just being the good guy. But those kinds of things definitely make me glad to do what I do and contribute towards what I want to do. P32: I just feel right when I'm able to help somebody with some complex issues. So I get reward from them saying, “Oh, that was you. You did that in such a nice way” or “I totally get that and I can understand what works for me or not. And this was really helpful.” I get a big reward out of that because these are people who wouldn't get that anywhere else.
Alignment with personal identity	Demographic characteristics	Personal identity_characteristics; lack of diversity; fitting the dress code_conformity; not fitting into NSGC	P08: I feel like my race has a big part of my professional identity, and I feel a duty to come to the table with a justice and equity mindset… So I'm someone who takes my lived experience as a person of color, especially in this field that is such a homogeneous field, and I marry that with my values and principles and use that to kind of guide me through the space. P14: There's this very prototypical genetic counselor vibe and look that was going around in 2013, which was cardigan statement, necklace, straight white woman, and that never felt comfortable for me. I mimicked it a little bit to try to fit in, but it's like an ill‐sitting shirt as I got more comfortable in my own career and my own identity as a genetic counselor. P22: I've come to know quite a few Jewish genetic counselors, which has been great, but it's also helped underline for me this ethnic and racial disparity that we definitely do see in our field. I don't know if I'd consider myself under represented in health care; there is a good amount of Jewish representation. But I do definitely feel different than your prototypical image of a genetic counselor. P31: I was out sick a lot dealing with different medical issues, and I was not believed in school. And I carry that chip on my shoulder still of the genetic counseling community in general being unintentionally but fairly ableist. Those of us with so‐called invisible disabilities are very frequently dismissed… kind of gaslit for struggling more with different types of health and mental health factors that other people haven't and watching others not have a lot of empathy for that.
	Life experiences	Shared identity_experiences with patients	P09: My humility has been enhanced… having gone through my own stuff with parenthood. It has just changed me as a human being and not necessarily specific to the genetic counseling profession. Because you're dealing with humanity in our role, becoming a more humble person probably serves you well when dealing with other humans going through such vulnerable, difficult times. P39: I do have a family member also who's had a genetic condition. What's interesting is that I don't think that's the reason I went into [genetic counseling]… I think maybe that's the reason I was interested in genetics generally. I think it's just something that is really aligned in my life, and that then it ended up being something that I drew a lot of experience from, that in helping people and why I'm so passionate about it. But I feel like the passion was science first, and then I was able to relate to it later because of my personal experiences. P44: I do think [my life experiences] influenced my professional identity quite a bit. A lot of different factors. I think having a family member with an intellectual disability… I saw my role models. They were working and helping people [which] really influences me to have that sort of mindset.
	Persona	Personal identity_characteristics; interests align with the profession; values align with the profession; seeking help for burnout_challenges	P23: I've always been into science. I'm a people person… So genetic counseling, when we were first told in 1997 whatever it was, about this new field as lab science together with people. Oh, my God, that's fantastic! So that was a major sort of driver for me, but [also] my personality, my eagerness to help people and to educate people. P27: I do see myself as a caregiver. My parents have both passed away by now, but I still feel like I've got other people I need to care for out there, and I think that's just entrenched in me. And that's part of why I was drawn to genetic counseling. I think it's more my personality drew me to genetic counseling as opposed to genetic counseling made my personality. P30: The fundamentals of genetic counseling that you have to understand the science and be able to explain it to people has just always really suited my personality and what my interests are. And so I got very lucky that that worked out. I mean, I went from undergrad straight to graduate school straight to a job, and I've always worked as a genetic counselor.
Connection with others	Professional network	Connection with GCs; feeling isolated from GC community; Burnout_work challenges_job dissatisfaction; NSGC meeting needs; volunteering with NSGC; NSGC content not useful	P08: Having the connection with the rest of the profession helps me, on one hand, just stay up to date and stay energized and stay excited about being at the top of my scope and at the forefront of what exciting things are coming with our profession, and that interconnectedness is something that I value. P11: When I first left clinic and was no longer doing face‐ to‐face counseling, there was some of, “Am I still a genetic counselor sort of thing?” but I was working in a company that had like a hundred genetic counselors. There were so many of us doing lots of different roles, doing genetic counseling, doing sales, doing marketing, doing product, doing clinical support, or customer support, lots of different things. So there were always genetic counselors around. I shared an office with genetic counselors so it wasn't as acute, because there were a lot of us maybe struggling with the same thing, but we all had each other. P13: I think definitely in the times where I was alone in this new city, where there were no genetic counselors, I was a brand new genetic counselor myself looking still to figure out what it means. You do so much continuing your education in your first few years. School just can't possibly teach you everything you need to know. And so I definitely felt very isolated in that first year. P16: For me a lot of [an identity crisis] probably came from the isolation of being the only genetic counselor in an entire hospital for several years as we tried to build out this system. I didn't have that immediate and local network to rely on, “Am I doing this right? What are you thinking? How should we do this?” Who do I debrief with, even at the end of the hard clinic day? There wasn't that resource available to me.
	Peer support	Connection with other GCs	P03: When it comes to my identity as being mixed race or biracial… a lot of the work that I do is not just focusing on how we can support patients and the people that we do genetic testing on… it's also working within the context of wanting to support other colleagues who may also be feeling this sense of isolation. And so there definitely is a sense of togetherness that I found just through the communities like the [Minority GC Network], for example. which I think that my identity has helped to structure. P10: And so part of the reason why MGPN [Minority Genetic Professionals Network] is so important for us, because even at the last NSGC [conference] we had our group picture, and people were crying because they were like, “Oh, my God! This makes us feel like part of this profession!” And because we have this community and there's not a sea of white people all the time. P23: I had [other genetic counselors] who are doing these lectures, presentations, and probably not knowing how much they touch people in my situation [of being laid off], and people that I spoke to supporting me… I don't think they understand how much they helped during this time.
	Role models	Connection with other GCs; volunteering with NSGC	P07: We'll see the conversations with the colleagues where those areas have just made me a lot more comfortable, like, “I can do this if I wanted to or I don't think I would be very good at this role. I don't think I would like that very much.” Just bringing the awareness that there's so many more things we can do not in clinic. P09: Seeing those examples around me where genetic counselors have taken on new roles outside of what was the very traditional one‐way track that I was coming out of the training program with. It was, “Which clinic am I going to work in?” and that has hugely influenced me. Seeing genetic counselors who have PhDs become principal investigators and research. P14: You don't really have an identity yet as a genetic counselor… you're building it as you've transitioned from a student to year one of my practice. And “Who do I look up to? Who seems amazing that I'm working with or which of my classmates seem like they're doing really cool things?” You're trying to take pieces of those and emulate them. P25: I really love role models, and I've had a lot of good ones in my life. People that I looked up to. I tried to get involved in NSGC so that I could interact with colleagues on specific issues. So I was on several committees for a while and really enjoyed that.
	Giving back	Volunteering with NSGC; current job_role	P07: I'm the only genetic counselor working full time for my company… it was more lonely… I didn't feel as connected to the [GC] community, and that's why I started volunteering for more NSGC stuff. P11: I go and give talks to our local middle school and public and high schools about genetic counseling as ways to keep that connection. P21: I have really taken on a bigger role with students in their rotations… I am really passionate about making sure everyone feels included in our field, and I think professional identity goes into that quite a bit. P25: [Volunteering with NSGC] is a way to feel more connected to the profession. Because you feel like, “Hey, I’m volunteering to help make the profession better and try to help other counselors who might have the same questions.” P34: I've more or less maintained my membership in NSGC through all those years… because I do feel like part of the genetic counselor identity is giving back to the profession and helping sustain the profession. P42: I do feel like a genetic counselor cause I teach in a program.

3. Results

3.1. Participants

Of the 82 respondents initially completing the intake form, 55 were purposefully chosen to be interviewed as described in Schwartz et al. (2026), with one declining the invitation and four failing to respond. The select demographics of the resulting 50 interviewees, including how these percentages compare to the 2023 NSGC PSS (NSGC 2023), are presented in Table 2. The age of the participants skewed young, with the majority (58%) being under the age of 39 years. Ninety percent were women, 78% were heterosexual/straight, and 80% were White. Sixty‐eight percent (68%) reported not having a disability or chronic illness, and 48% were neither a parent or guardian to a child under 18 nor a caregiver. Additional demographic information of the participants is provided in Table S1. Interviews averaged 28 min in length (range 15–63 min).

TABLE 2.

Select demographic information of interview participants (N = 50).

Intake form questions and responses	Interview participants		2023 NSGC PSS
	n	%	%
What was your age as of December 31, 2022?
20–29	8	16	29
30–39	21	42	39
40–49	11	22	20
50–59	9	18	8
Over 59	1	2	3
Prefer not to answer	0	0	n/a
Which of the following best describes your gender identity?
Woman	45	90	93
Man	3	6	5
Transgender woman	0	0	0
Transgender man	0	0	< 1
Nonbinary	1	2	1
Prefer not to answer	1	2	1
Which of the following best describes your sexual orientation?
Heterosexual/Straight	39	78	86
Bisexual	6	12	5
Homosexual/Gay	1	2	2
Asexual	0	0	1
Pansexual	1	2	1
Queer	1	2	2
Prefer not to answer	2	4	3
Which of the following best represents your race and/or ethnicity?
White	40	80	89
Other (mixed race a )	5	10	2
Asian	4	8	9
Middle Eastern or North African (MENA)	0	0	2
Hispanic or Latine	0	0	3
Black, African American, or of African descent	0	0	2
American Indian, Alaskan Native, or Indigenous Peoples of Canada	0	0	< 1
Native Hawaiian or Other Pacific Islander	0	0	< 1
Prefer not to answer	1	2	< 1
Do you have a disability, chronic illness, mental illness, or other major medical condition or impairment?
No	34	68	79
Yes	16	32	19
Prefer not to answer	0	0	2
Are you a parent, guardian, and/or caregiver?
No, I am neither a parent or guardian to a child under 18 nor a caregiver	24	48	59
Yes, I am a parent or guardian to one or more children under 18	22	44	37
Yes, I am BOTH a parent/guardian AND a caregiver	2	4	2
Yes, I am a caregiver for an ill or elder person or a person with a disability	1	2	2
Prefer not to answer	1	2	1

Note: n/a = Where possible, comparable statistics are listed from the 2023 NSGC PSS, however, some categories were not collected in the same manner or at all in the PSS.

^a Mixed race = Asian (Indian) + White (1); Asian + White (1); Indian/White (1); White/MENA (1); Mixed race (1).

3.2. Themes

Four main themes, internal validation, external validation, alignment with personal identity, and connection with others, and 14 subthemes were identified. The themes and associated subthemes are described below and illustrated in Figure 1. All themes were factors that were either present and supported PI or were absent and hindered PI as a GC. Additional illustrative quotes are provided in Table 1.

FIGURE 1.

Themes and subthemes of factors that influence genetic counselors' professional identity.

3.2.1. Internal Validation

Nearly half of all participants noted their PI as a GC being influenced, both positively and negatively, by feelings and beliefs derived from within themselves; a theme we called internal validation. The sources of internal validation were categorized by subthemes, including a sense of purpose, pride, and confidence, as detailed below.

3.2.1.1. Sense of Purpose/Importance of Work

Having a sense of purpose, as well as the importance and the meaningfulness of their work supported the PI of 14 participants, including P04 who said, “Just to make an influence on somebody, to feel like you've helped them. It's definitely part of what makes me feel like a genetic counselor.”

For many participants, the same sense of purpose that bolstered PI also contributed to emotional burnout when not adequately supported or recognized:

Coming to terms with that understanding how highly specialized some of these issues of genomic medicine can be, and the power and the responsibility that comes along with that, is perhaps a component of our profession that isn't discussed as much as it should be, because it also is what leads to burnout… people being driven by that feeling, along with their own sense of perfection… But that's one of the components of being a genetic counselor that I reflect on the most often is the responsibility of the position that I've created for myself, and that I thus need to accept and balance and because that weight is what drives me more than anything. (P31)

Being unable to work as a GC, due to job loss or being unable to find a job, significantly impacted a number of participants' sense of PI as a GC, like P25 who shared:

When I got laid off from [company] I was devastated. Like my ego was through the floor. Because I'm a genetic counselor. This is all I know. This is the definition of who I am. That's how I think of myself, and if I'm not a genetic counselor then what the hell am I? So it was a very important identity to me.

3.2.1.2. Pride

Seven participants specifically referred to pride in being a GC when discussing their PI, like P47:

When I tell people I'm a genetic counselor, I feel like it represents a cutting‐edge field. I feel like it represents advocating for patients, and those are probably the two biggest things that I'm proud of to use that phrase to define myself.

3.2.1.3. Confidence

For 16 participants, confidence in their abilities as a GC supported their PI.

I'm a clinical genetic counselor. So it is those instances where I'm talking with patients, and I can tell that after we've had our appointment or our conversation that they understand better what's going on than before they came to the appointment. But also moments where a neurologist I'm working with doesn't quite understand what they're ordering, or they want to order a test that doesn't really make sense with the background knowledge, and I'm able to explain to them why that may not be the best choice. Or if I am able to catch something on a family history. Just instances where I am exerting my expertise and feeling I do have a role on a team that nobody else on that team really occupies. (P05)

Alternatively, some participants discussed a lack of confidence in themselves as negatively impacting their PI as a GC. P08, who initially failed the ABGC certification examination, shared:

I was not the only one in [the city] to fail my exam, but I was the only one to lose my job. So that feeling like a failure, feeling ashamed, feeling I wasn't good enough to be a genetic counselor. That challenged my confidence in a lot of ways. And so much in grad school … I felt a lot of my personal identity was tied to being a genetic counselor. My personal value was being a genetic counselor and through the experience of failing my exam and feeling worthless.

The rapidly changing nature of the field and genomic technologies were also noted as impacting one's confidence.

At first you knew everything right, because you train and everything. Here's what you know, but things change so much over time. Then do you still feel like a real qualified genetic counselor when everything's changed so much? And now, even when you try to give results to somebody you're, “Oh, wait! It's that particular variant… Did I not look at that right?” … You're supposed to be an expert in your field, and maybe there's some information that you haven't verified in the last 10 years. It starts to make you feel a little bit insecure. (P04)

3.2.2. External Validation

Conversely, 38 participants described factors that were categorized as external validation influencing their PI as a GC in either a positive or negative manner. External validation came from other colleagues, most often from non‐GCs, but also from patients. Work system factors, including the lack of resources or inability to bill for services, negatively impacted participants' PI as detailed below.

3.2.2.1. Other Colleagues

Thirty‐three participants shared feeling validated as an important member of the team as positively impacting their PI. Several participants noted that serving as the genetics expert on the team, both in and outside of a clinical setting, reinforced their PI as a GC.

The non‐counselors that I work with in some ways remind me that I am a counselor because it's not infrequent that I'll in conversation be, “Okay, I'm gonna put my genetic counselor hat on now and think about like how this result might do or let's think through this” or when we talk about return of results or whatever. So in some ways they remind me that I am a genetic counselor. (P17)

Yet other participants, like P27, noted feeling that their value on the healthcare team was not being recognized, which negatively impacted their PI:

I struggle with that identity in the setting where I am now. I feel like I'm always having to advocate for genetic counseling, which is a little frustrating. I've been there for a while, and they'll say things out loud like, “Why do we need a genetic counselor?” And then they'll say to the nurse, “Hey, could you order this genetic test panel?”, and she comes to me and she goes, “Can you help me with that?” So I mean, it's a little frustrating there. So I don't think I get a lot of validation from those colleagues.

A diminished sense of validation as an integral member of the team was not limited to participants working in a clinical setting. P13, who works as a product manager in a laboratory shared:

Even when I'm in my current position, I have to advocate there should be a clinical person helping build a tool that's for clinicians. If it's just built by engineers, there's nuances that are missed, or the importance of why something is being included to really be able to implement it appropriately or use it in the right way… It's about having the confidence to stand up and raise voices and point out areas that are needed ultimately to give better care, better education, better access to a group of individuals.

Several participants noted that they receive the most validation and appreciation for their expertise from nongenetics colleagues, such as P28, a product manager in a laboratory, who shared that her PI as a GC was solidified when she moved from a clinical to a non‐direct patient care role:

But as far as my identity as a genetic counselor, I will say I've never felt more like a genetic counselor or understood my role as a genetic counselor more than since I've been in industry …I've heard people say, “Oh, it's great having a genetic counselor as a product manager at the company, because at least somebody who gets it is guiding the testing.” I didn't know my identity at all when I was in clinic.

3.2.2.2. Work System Factors

For 19 participants a lack of external validation from the system in which they worked, be it difficulty with billing for services or a lack of resources, contributed to a decreased sense of PI, like P02 who said:

I guess [being a genetic counselor] means I'm the content expert on genetic information. And yet I don't have the privileges that a geneticist has, and that is challenging in academic medicine when I don't have a geneticist to work with. Do not get me wrong. I'm not trying to color outside my lines or get out of my lane, but I don't have the person I need to help me do that job. And so I do have somewhat of a professional identity crisis.

Others shared their salary not reflecting their value, which negatively impacted their PI:

By the time I left, I had so much experience, and my pay didn't increase at a fair rate compared to how much I was learning and how much I was contributing. And I realized that. And so I felt underpaid. By the time I left I felt undervalued. I felt dispassionate about what I was doing and unfulfilled. (P39)

3.2.2.3. Autonomy/Scope of Practice

Seven participants described autonomy to practice within one's scope as another external validation factor linked to work system dynamics.

The roles that I've found myself in there've been different expectations from different providers… There's definitely been cases where the genetic counselor has been more of like an intake person and myself included. And so we take the pedigree, we do an intro to the family about what to expect, and then the provider walks in, and we do the note … And there's been other times where I have essentially full autonomy to either talk to patients or lead the discussion or bring up the pertinent points… And so when it comes to my identity, the moment within each job has been super unique to the provider and the context that I've worked in. I definitely prefer one of those to the other. (P03)

3.2.2.4. Patients

Four participants noted external validation from patients for whom they made an impact supported their PI, like P33 who noted:

It's been really fun to kind of see the next generation of my patients and to hear people say, “You know I found that letter you wrote for me.” … to hear the impact that I've made or that people remember what I told them. Years and years, sometimes decades later, that solidified my professional identity as not necessarily somebody that just slips into your life, does one appointment and is gone. But somebody who can make an impact that is more substantial than that.

3.2.3. Alignment With Personal Identity

Another significant influence on one's PI was whether or not one's personal identity aligned with those of their patients, as well as the perceived collective identity of the genetic counseling profession. Participants described their personal identities in terms of their race and/or ethnicity, gender, sexual orientation, or disability status, which were combined into the subtheme, demographic characteristics. Other participants referred to characteristics or attributes they see in themselves, including personality traits, as aligning or misaligning with their perception of most members of the genetic counseling profession. For some participants, life experiences that resonated with those of their patients reinforced their PI as a GC.

Participants frequently used terms such as belonging and fit to describe how closely their personal identities matched the norms they associated with the profession. This sense of alignment, or misalignment, shaped their experience of PI and reflects a central concept of Social Identity Theory.

3.2.3.1. Demographic Characteristics

As a result of purposeful sampling, overall, our participants more often had personal identity characteristics underrepresented in the genetic counseling profession (2023 NSGC PSS), as more self‐identified as not a woman (10% vs. 7%), not heterosexual (22% vs. 14%), and/or had a disability or chronic illness (32% vs. 19%). Although more of our participants self‐identified as non‐White as compared to the 2023 NSGC PSS (20% vs. 11%), there were still a number of race/ethnicity identities that were not represented, including Hispanic or Latine. Twenty participants noted these demographic characteristics as impacting their PI as a GC. P03, who described himself as a mixed‐race man, shared:

I should point to the elephant in the room. I'm a man. I'm specifically a mixed‐race man, so Black and White. And so those have definitely impacted my identity within the field. I would say my racial identity more than my gender identity has been a bit more impactful. So when it comes to my identity as a male that has definitely impacted my success in the field because it is a unique viewpoint… And so I think that my professional identity has been shaped by my personal identity.

P50 noted, “In some ways, I feel like [my personal identities as a woman] do fit with the genetic counseling professional identity, the average professional identity. And then in some ways, some of those factors [brown, queer, lower income bracket growing up] push me away from feeling within the GC bubble.”

For some participants, having a personal identity that did not align with the collective of the profession reinforced their sense of purpose toward the profession, like P08:

I've gotten a lot of opportunities I think because of my being a person of color. But whether those are opportunities to truly make a difference or opportunities to just have another person of color at the table who may not be listened to, that is something that I just really have to be aware of. When I'm working with the rest of the profession it is like, “What am I bringing to the table? And how is what I'm bringing to this table gonna move the needle?”

Multiple participants noted feeling that they had to hide their personal identity, be it sexual orientation or a hidden disability, due to how they felt it would be received by other GCs:

I do know that having, in particular, a fairly significant mental health disability …[and] having gone through changing medications and having it make me crazy while I've also been trying to balance this job, that's incredibly intellectually and emotionally challenging, it's a very, very difficult experience to have that very few other people have. I don't know a single other genetic counselor [with the same mental health disability], and I'm not really out about having that specific diagnosis. People just know that I have mental health stuff, because there's a lot of stigma out there against [specific disorder], and I think it would impact a lot how people saw me in a way that would not be beneficial to me … probably there are others and like me they've realized it's smarter not to say that out loud. It's less brave. It's smarter to keep that part quiet. (P31)

Similarly, P14 noted:

Where I feel I'm part of the group but I'm a little on the fringe is because the other aspects of my identity that are important to genetic counseling personally, like first anxiety, autism, being bisexual, are things that people wouldn't know unless I disclose to them. So in my identity as a genetic counselor, I always feel a little bit of that burden of call it, “Secrets”. Like everyone who is important in my life knows, but I can't always acknowledge those pieces of me without having to deliberately disclose to someone, and that just is unnecessary.

Three participants specifically noted the “homogeneity” of the genetic counselor profession impacting their sense of PI, like P42:

[My personal identities] influenced my professional identity a lot. So I'm biracial and queer. I'm Asian and White, which is relevant. I feel like in the spaces I've been in before genetic counseling I've never felt like a minority in any sense cause they've been a lot more diverse… and it's interesting entering like our field, which obviously is notoriously homogeneous… I feel so much more “other” than I have literally anywhere else.

3.2.3.2. Life Experiences

Personal lived experiences impacted the PI of 11 participants, particularly when they saw similarities in their experiences and those of their patients. For example, P06 shared:

My identity as a genetic counselor changed a lot when I became a mom. That was actually a turning point in my comfort in clinic … In my first pregnancy I became a patient unexpectedly with a baby with multiple congenital anomalies, and the tables turned… that's a huge part of me and my professional identity.

And P19 noted how her life experiences influenced her decision regarding the area of genetic counseling in which she wished to work:

Being a mom influenced my professional identity. I have a much deeper understanding of what it means to be pregnant, to give birth, to love a kid before you know a kid, and it moved me away from wanting to do that professionally. I moved towards other [specialties] that didn't feel so vulnerable for my personal identity, especially when I was a new mom… I don't know if I'd still feel that way, but I certainly did as a new mom feel that part of my identity really was part of my decision‐making.

3.2.3.3. Persona

Twenty participants referred to traits, characteristics, or interests, often using the term “personality,” when describing how their personal identity impacted their PI as a GC, including what motivated them to pursue and continue in the career. For most, a love of science and interest in helping others was seen as most aligning with the profession:

One of my personality traits that shows up in a lot of ways in my story is that I'm really curious, and I get bored pretty easily. And so, it drew me to genetic counseling in the first place because it seemed like a field that was always changing… I'm wanting to understand things more, and I don't know where I'd put curiosity in the identity category, but I think it's a large part of my professional identity and trajectory. (P19)

Yet some participants noted a difference in their personality from what they viewed as typical of a GC, like P03: “When it comes to like the persona of a genetic counselor, I think that a lot of the colleagues that I've worked with or that I've gone to conferences with or even a lot of my classmates, when work is over the genetic counseling switch doesn't shut off. And for me, I'm more than a genetic counselor.”

Similarly, P09 noted:

There are lots of people in the field who their identity as a genetic counselor really permeates into their personality. They wear DNA earrings, and they are super interested and nerdy about genetics‐related things so they read genetics books … or are very enthusiastic about the field in the ways of which it colors outside of their professional life. And I have never related to those folks …genetic counseling is my job, and when my job is done for the day, genetic counseling does not enter any other part of my life.

Yet seeing other genetic counselors with similar personality traits also provided a sense of connection for some participants:

I always feel when I'm with a group of genetic counselors I am with my people, if that makes sense, because I feel our personalities tend to be similar in so many ways in that we are a group of people that are intellectually curious and also kind and empathetic and supportive, and so it's those personality characteristics more so than gender and ethnicity… That's what I connect with … I definitely did choose the right profession. I'm with the right group of people. (P35)

Participants described tension with the collective identity of the profession due to the lack of diversity within the field of genetic counseling. Even for those who felt their personal identities aligned with the collective identity of the field, this tension resulted in concern about other colleagues' sense of belonging and PI, as noted by P18:

When I find that there's people who don't feel like they belong in our profession that upsets me because I feel like I do belong. I would like them to also feel like they belong. And so I would say that that has some impact on my professional identity and wanting to create a space where it's not just me that feels comfortable, but they also do.

While not necessarily impacting their own PI, participants also raised concerns about how the image of GCs was portrayed to the public, as described by P50, who referenced the stereotype of GCs being women who wear cardigan sweaters:

The homogeneity of the genetic counseling profession really seems to have impacted what it means to be a genetic counselor and other people's perception of what genetic counseling should be, how that should look, the people that are providing it, and the skills that we should all share beyond just general [practice‐based competencies]. It's also a type of personality, or people talk about the “Cardi party” back in the day, and identity‐related skills or characteristics that don't necessarily apply to professional competencies. And so, while there are a lot of ways I feel I identify with the genetic counseling profession and what I associate with the GC profession, there's also many ways where I feel I do not jive or fit within the average definition people may share as genetic counselors.

3.2.4. Connection to Others

Another prominent theme present among participant responses as impacting their PI as a GC was their connection to others, both GC and non‐GC colleagues. Professional networks, peer support, role models, and obligations to give back contributed to GCs' PI.

3.2.4.1. Professional Network

Thirty‐eight participants described having a professional network in which they could remain up‐to‐date regarding topics and issues relevant to their work, which supported their PI. These networks included national organizations, such as NSGC, local conferences of genetic counselors, and other genetic counselor colleagues in their workspace.

Being a part of the community throughout, like attending conferences for NSGC or other smaller conferences, working in genetic counseling clinics, it's contributed to my identity. And then in my new job, continuing to try to keep connected with that sense of genetic counselor identity, reaching out to people within my organization who are genetic counselors and work in the clinical genetics space … There is a lot in common regardless of what space we might work in, shared experiences and ways we may approach a topic, which helps in having conversations there. (P01)

Similarly, P04 shared:

When you work with people you certainly tend to normalize your experiences with them, to see what makes sense and what doesn't make sense. There's not a lot of professional supervision after you get out of grad school, and so you don't always really know if you're doing the right thing. But then you talk to other people, and it's like, “Oh, you're doing the same thing. Is this what you would have said, what would you have done in a situation?” And then you start to feel validated like “Yes, I'm doing this right.”

For P14, NSGC was an important professional network that was impactful beyond their annual conference:

Even though I don't go to NSGC as a conference, usually because it's not that useful to me anymore, NSGC as an organization is my identity home amongst the professional organizations, because it's populated mostly by people who understand the perspective of how I was trained and have shared experiences.

The sense of a professional network was not restricted to fellow GCs. As P11 described, working on a team of non‐GCs served as a professional network:

[Working in a startup you are] thrown together in very interesting ways … you're wearing multiple hats. The lines are very blurry. The hierarchy is non‐existent. You get really influenced and learn a lot from software engineers and from wet lab folks and the general counsel that I didn't have any exposure to when I was in the hospital setting. It's a different cast of characters… … working toward a shared mission, shared vision, shared passion. Because there's always challenging times, and so having somebody else say, “Oh, yeah this is rough. I had to work all weekend to get this done. I just had this really difficult case. Can I talk it through with you?” Those are connections that keep you grounded in who you are and what contribution you're making.

Yet a participant who was working in a research position expressed a lack of a professional network:

I really do feel a bit like I don't belong anywhere. I have a great relationship with my clinical colleagues, but I feel in their eyes they don't totally see me as a genetic counselor, and then in the more academic place where I'm working, I feel people don't see me as a peer there because I don't have a PhD. So it's really hard to have that professional identity and find a place for a community where I belong, because I feel that I really don't fit in with anybody or that anybody sees me as belonging necessarily to their community. (P20)

3.2.4.2. Peer Support

Seven participants referred to their connection with others as providing emotional support, which was categorized as peer support, such as P02 who was the only GC working in her state and therefore expressed feelings of isolation and burnout:

The connection to the greater community … when I go to [the NSGC Annual Conference], I definitely get my batteries charged. I get excited about things. I feel validated. I can share frustrations. I can speak to somebody who actually understands what I'm saying… and just hearing some voices of other GCs, I would get choked up, “Oh, my God, I'm okay. There's others out there.”

Several participants shared their interest in providing peer support to others, particularly those who shared their personal identities:

Looking out at my peers in the genetic counseling community … there aren't as many people of Asian origin or other ethnicities. I wanted to help out in any way I could for others who might be interested or have questions. (P01)

3.2.4.3. Role Models

Twenty‐one participants felt their PI was supported when seeing other GC colleagues as role models.

[Other GCs] had a huge impact on my identity as a genetic counselor. I've had a lot of great mentors in my profession that have been great examples of helping with professional development and being involved with the profession, staying connected to colleagues, and challenging me to learn and grow and develop new skills. (P35)

Several participants spoke about seeing other GCs forging new paths, be it in other clinical specialties, industry, or research, as positively influencing their PI. Some expressed a lack of these role models resulting in their feeling that their professional opportunities were limited to the clinical setting, like P09:

Private industry was non‐existent for genetic counseling [during my traning]. Hospital‐based or academic labs did employ genetic counselors but very few. It was mostly you were graduating and going and working in the clinic. So that was what my training reflected; that's what it was preparing me for. And it also meant that because those roles didn't exist, I wasn't getting exposed to anything but clinical roles during my training, because there wasn't opportunity for placements anywhere else. And I wasn't connecting with genetic counselors who were taking on those non‐traditional roles.

And P14, who had mental illness, spoke to a lack of having role models with invisible disabilities impacting her PI:

There wasn't anyone that [I and a peer GC also with mental illness] knew of in the broader field that was really out there as someone who we could emulate and say, “Here is how I'm living openly as a genetic counselor with a not visible disability of some type.” And so we had to figure out that aspect of our professional identity on our own and did keep it very quiet.

3.2.4.4. Giving Back

Fourteen participants described giving back to the profession by volunteering for NSGC, teaching or supervising students within a master's in genetic counseling training program, or representing the profession in other ways (e.g., providing lectures to high schools and colleges or writing articles for NSGC's Perspectives) as strengthening their connection to the profession and thus their PI.

When I was not working with a bunch of genetic counselors, I was doing a little bit more adjacent product work… and wanted to give back. And I also really saw an opportunity to help shape NSGC, so I got much more intentionally involved with it in areas that I thought were impactable. So I joined [NSGC committees] … Along the way I've realized how much benefit I get out of it being more connected to the profession and being more easily identified as a genetic counselor. (P11)

4. Discussion

Interviews with 50 genetic counselors revealed factors that influence the perceptions of their PI by supporting or hindering their sense of being a GC. Both internal and external validation played a significant role, as did one's connection with others through professional networks, peer support, role models, and giving back to the profession. Participants' personal identity (e.g., demographic characteristics, persona, and lived experiences), as well as their perceptions of diversity, inclusion, and belonging within the field, and the alignment of these factors with the field's collective professional identity (PI), influenced their own PI.

Overall, our findings align with factors noted to influence GC PI that were raised in nonempirical research articles and empirical studies on topics tangential to PI, like professional development and DEIB (diversity, equity, inclusion, and belonging), reported in a scoping review by Stenberg et al. (2025). For example, 17 of 41 articles detailed by Stenberg et al. (2025) were part of a defining moment series published in the Journal of Genetic Counseling (JoGC) in which themes of internal validation, including subthemes confidence and sense of purpose, were described. Positive external validation, through increased autonomy, an expanded scope of practice, and greater respect from colleagues, was reported by Atzinger et al. (2007) and Davis et al. (2020). Interviews of GCs about their PI formation at the NSGC Annual Conference published after the Stenberg et al. (2025) review also revealed that validation through affirmation from others strengthened a sense of belonging and PI (Mills and Barcinas 2025).

PI is in part derived by making comparisons, positive or negative, between oneself and others within the profession (ingroup) and outside of the profession (outgroup), respectively (Hogg and Terry 2000), and it is this self‐categorization that can either promote or hinder a sense of belonging to a professional group and thus one's PI (Tajfel and Turner 2004). Aligned with Social Identity Theory (SIT), our study's participants shared factors that have contributed to their PI that included identification with membership in groups when they discussed their personal identities, including race/ethnicity, gender, and disability status, as well as life experiences such as being a parent. The impact of comparing oneself to others within the profession, particularly for those participants who saw their own personal identities as different from that of the profession's collective identity, resulted in a reduced sense of belonging to the profession, negatively impacting their PI as a GC.

More recently, Mills and Barcinas (2025) explored how the PI of early‐career GCs was impacted by attendance at their first NSGC conference as certified GCs. Similar to our findings, Mills and Barcinas (2025) found that alignment, or lack thereof, between one's personal identity and perceived collective identity of the genetic counseling profession significantly influenced one's sense of belonging in the profession. Personal experiences and identification as a member of a minority group within the field for some participants, in both our study and Mills and Barcinas (2025), served to strengthen one's sense of PI as a GC. Yet the lack of diversity in the field and perceived stereotypical persona of the GC professional more often negatively influenced one's PI for many participants in our study and others (Bao et al. 2020; Carmichael et al. 2021; Mills and Barcinas 2025).

Participants of our study shared how the meaningfulness of their work positively influenced their PI, similar to other professionals (Iatridis et al. 2021). Yet GCs often manage highly stressful and emotionally laden circumstances (Allsbrook et al. 2016; Bernhardt et al. 2009; Stanley et al. 2026), and thus are at risk of burnout, which may be mitigated by a well‐developed and supportive PI (Edwards and Dirette 2010; Sabancıogullari and Dogan 2015). Caleshu et al. (2022) noted that lack of external validation, including work system factors, such as limited resources and autonomy, and lack of recognition of value from colleagues, also contributed to burnout among GCs. These same factors were described by our study's participants as negatively impacting their PI as a GC. Monti et al. (2025) measured medical students' PI, mental health, and burnout using validated instruments. While they were unable to confirm a causation, they did note that a high level of PI was significantly correlated with better mental health and lower burnout. Therefore, we can speculate that enhanced external validation in the form of additional resources, like administrative support, and greater recognition of the value and autonomy of GCs on the healthcare team, allowing them to work at the highest level of their scope of practice, may improve their PI and in turn reduce burnout.

Globally, several authors have noted that the mainstreaming of genomics into nongenetics specialties, including oncology, cardiology, and private practice, offers both opportunities and challenges for GCs (Amendola et al. 2021; Benjamin et al. 2020; Do et al. 2024; Patch and Middleton 2018; Sane et al. 2015; Yanes et al. 2024). PI evolves and adapts as professionals enter new roles through socialization with others in the workplace (Ibarra 1999). Serving as the genetics expert among nongenetics‐trained colleagues may allow GCs to work more autonomously and at the top of their scope of practice, and GCs in our study often noted that non‐genetics colleagues offered external validation that supported their PI.

Despite significant advances in the professionalization of the field of genetic counseling (Baty 2018, 2020), many participants expressed concerns with what they perceived to be the public image of the genetic counseling profession, particularly how it may impact others' view of the profession, such as prospective students, employers, and their colleagues. Insufficient public understanding of the profession, lack of validation for the unique and critical role GCs play on the healthcare team, work system factors (e.g., lack of autonomy, inability to bill for services), as well as the stereotypical image of GCs being White, cis‐gendered, heteronormative, nondisabled, women of high socioeconomic class, all contributed to these concerns.

Dutton and Dukerich (1991), in their seminal case study, noted that “organization members use an organization's image, which is the way they believe others see the organization, to gauge how outsiders are judging them (p. 520).” A negative organizational image can result in individual members having a reduced sense of self. Similarly, ten Hoeve et al. (2014) discussed how nurses' collective PI of the field differed from that of the image of nursing held by the public, resulting in reduced self‐concept and PI of nurses. Pasca et al. (2022) found among a sample of US adults that knowledge about and attitudes toward the genetic counseling profession were low, which may contribute to a reduced sense of PI among GCs, particularly when coupled with factors mentioned by our participants like lack of autonomy or disregard from non‐GC colleagues.

Participants reported factors that positively and negatively contributed to their PI. To strengthen PI among GCs, it is important to focus on promoting factors that contribute positively while minimizing those that contribute negatively. Positive factors that individual GCs and professional organizations like NSGC can contribute include validating the work of GC colleagues, advocating for GC scope of practice and reimbursement, creating a sense of belonging through sincere engagement rather than tokenism, and supporting professional networking through mentorship and peer support. Negative factors that seemed to have the greatest influence on diminishing participants' individual PI were the lack of diversity within the field, as well as its public image. In their commentary regarding the nursing profession, van der Cingel and Brouwer (2021) argued that dominant images of the nursing profession of the past, which have become stereotypes, can negatively affect the future growth and advancement of the profession. The same may be true for the genetic counseling profession.

4.1. Limitations

Limiting recruitment to current NSGC members may have introduced selection bias, as the views of GCs who are no longer members were excluded. This includes groups whose perspectives were not represented in the study: individuals whose professional affiliations may more closely align with other specialties or work settings underrepresented among NSGC members; practicing GCs who ended their NSGC membership because the organization did not meet their professional needs; and individuals who have exited the genetic counseling field altogether.

Our purposeful sampling of respondents to the intake form was intended to maximize the diversity of those who were interviewed and to elevate voices of individuals otherwise underrepresented in the field of genetic counseling. However, as noted in our previous article (Schwartz et al. 2026), this process resulted in oversampling of participants based on certain demographics. As compared to the 2023 NSGC PSS, our participants were more often in non‐direct patient care roles (54% vs. 27%), were more likely to be over the age of 40 years (42% vs. 31%), less likely to be heterosexual/straight (78% vs. 86%), less likely to be White (80% vs. 89%), and more likely to be a parent and/or caregiver (52% vs. 41%). Those who are especially marginalized in the genetic counseling profession, including those who identify as Hispanic/Latine, Middle Eastern and North African (MENA), Black/African American, or Indigenous Peoples, likely have very different experiences, which is a limitation of our study. A higher percentage of our participants reported having a disability or chronic illness (32%) as compared to the 2023 NSGC PSS (19%). Of note whether or not a disability or chronic illness was visible was not asked in the intake form or during the interviews, which were conducted via Zoom. Therefore, it is not known whether members of the profession with visible disabilities would describe factors that impact their PI differently than our participants. Further analyses stratified by various demographics, including current position type, gender, age, and disability status, are planned and may reveal differences to the findings we presented in this and our other paper, which did not account for demographics.

4.2. Future Directions

Data analysis in our study was conducted holistically, without consideration of participants' demographic factors such as age, gender, race/ethnicity, disability status, or caregiver status, which may have impacted our findings. For example, early career GCs in Mills and Barcinas' (2025) study described perceived generational differences, particularly in terms of DEIB discussions. Exploration of how our current findings may converge or diverge when analyzed based on various demographics is planned.

Our participants discussed how they saw other GCs as serving as professional networks for shared learning and exchange of common experiences, which supported their PI. Yet as GCs move into new roles and interdisciplinary practice settings in which they are the only GCs, they may have feelings of isolation and loss of connection to their professional networks, and thus experience a diminished sense of PI (Do et al. 2024). Future research that explores changes in PI as GCs shift into these settings and its influence on GCs' PI will be valuable.

Do et al. (2025) reported their implementation of Communities of Practice (CoPs) specifically designed for GCs in Australia. More than a professional network, CoPs are often formalized and structured, and they are intentionally designed to offer members opportunities for collaboration, networking, and professional development. As such, CoPs can be particularly useful for practitioners who are entering new roles and settings not typically occupied by GCs (Do et al. 2025). Do et al. (2025) reported that their CoP was valuable to its members in terms of emotional support, clinical practice, and navigating relationships with non‐GC coworkers. While Do et al. (2025) did not study the impact of the CoP specifically on PI, they noted that CoPs have been found to support PI (Li et al. 2009), and therefore, additional research into the impact of CoPs on the PI of GCs would contribute to this growing body of literature.

Our study focused on GCs working in the United States or Canada. While GCs in North America are required to maintain their American Board of Genetic Counseling (ABGC) and/or Canadian Board of Genetic Counseling (CBGC) certification through continuing education, in other regions of the world, such as Australasia, GCs are required to participate in professional, reflective practice supervision (Martin et al. 2021; Sewell et al. 2024) to maintain their certification. Reflective practice supervision involves regular, confidential, protected time between a health professional and a trained supervisor who is not in an evaluative or hierarchical position (McEwen et al. 2025). This contractual relationship, which differs from mentorship, aims to allow health professionals the opportunity throughout their career to regularly discuss and reflect upon their clinical practice, professional development, workplace issues, and interpersonal relationships with colleagues (Martin et al. 2021; McEwen et al. 2025), all factors we've identified as influencing GC PI. Exploring the factors that influence PI among GCs from other regions across the world, including those in which reflective practice supervision is required, may provide insight as to its impact on PI.

5. Conclusion

We have presented the second set of findings from the first empirical study of PI among GCs conducted on a diverse sample of participants in terms of personal demographics, including gender, age, race/ethnicity, sexual orientation, disability status, and service as a caregiver. Factors that influence GC PI align with those found in other literature in genetic counseling (Mills and Barcinas 2025; Stenberg et al. 2025) and other health professions (Cornett et al. 2023; Fitzgerald 2020; Lewis et al. 2025). As the genetic counseling profession grows and diversifies in demographics, experiences, and professional roles, identifying the elements of identity that remain shared across the profession can help maintain cohesion, clarify core values and reinforce a collective sense of purpose. At the same time, intentionally supporting individuals as they build and refine their own PIs is critical for fostering confidence, belonging, and long‐term career sustainability. Prioritizing these efforts will ensure that the profession remains adaptable, unified, and well‐positioned to meet the changing needs of patients, communities, and the broader healthcare system.

Author Contributions

Lisa Schwartz: conceptualization, data curation, formal analysis, funding acquisition, methodology, project administration, supervision, writing – original draft. Kaye Stenberg: data curation, formal analysis, writing – review and editing. Andrea Casey: conceptualization, methodology, resources, supervision, writing – review and editing. Jennifer Fitzpatrick: conceptualization, resources, writing – review and editing. Mia S. Mackall: conceptualization, writing – review and editing. McKinsey L. Goodenberger: conceptualization, writing – review and editing. Aishwarya Arjunan: conceptualization, writing – review and editing. Sarah Witherington: conceptualization, writing – review and editing. Isha Kalia: conceptualization, writing – review and editing. Rachel Mills: conceptualization, methodology, supervision, writing – review and editing.

Funding

This work was supported by the Jane Engelberg Memorial Fellowship, an endowment from the Engelberg Foundation to the National Society of Genetic Counselors Inc.

Disclosure

No Artificial Intelligence Generated Content (AIGC) tools were used to prepare this manuscript other than tools to improve spelling, grammar, and general editing.

Ethics Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. This study was reviewed and granted an exemption by The George Washington University Institutional Review Board (#NCR234727).

Consent

Informed consent was obtained from all participants included in the study.

Conflicts of Interest

The authors L.S., K.S., A.C., J.F., M.L.G., I.K., and R.M. declare no conflicts of interest. A.A. is an employee and shareholder of GRAIL. S.W. is an employee and shareholder of Quest Diagnostics. M.S.M. is an employee and shareholder of Natera.

Supporting information

Table S1: Additional demographic information of interview participants (N = 50).

Appendix S1: Semi‐structured interview protocol.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.