The genetic counseling profession in Austria: Stakeholders' perspectives

In contrast to most European countries, genetic counseling in Austria, Germany, and German-speaking Switzerland is exclusively carried out by medical doctors. In this study, we investigate the perspectives of key clinician stakeholders in Austrian genetics services regarding prerequisites, opportunities, and challenges of implementing master's trained genetic counselors. Semi-structured interviews with open-ended questions and thematic analysis were carried out with nine participants, mostly medical geneticists at different hierarchy levels from three Centers for Medical Genetics in Austria. Several Austrian medical geneticists strongly object to the implementation of non-physician genetic counselors, and representatives of 3/6 medical genetic centers declined to be interviewed. Semantic framing was identified as a critical factor: In German medical language, patient consultations carried out by medical geneticists are generally called 'Genetische Beratung' (genetic counseling), and many medical geneticists see themselves primarily as 'Genetische Berater' (genetic counselors). 'Genetic counseling' is specified as an exclusively medical task in Austrian law. There is apprehension that the introduction of non-physician genetic counselors could reduce quality and undermine the position of medical genetics as a clinical specialty. The situation in Austria resembles that in Germany. Our study highlights the need for a clear definition of roles, expertise, and scope of practice of different genetic professionals. The integration of genetic counselors into Austrian genetics services is most likely acceptable in multi-professional teams, closely affiliated with medical genetic services, and under the medico-legal oversight of medical geneticists.