The experiences of non-direct patient care genetic counselors in South Africa-A qualitative study.

Having first emerged in the 1970s, genetic counseling is a relatively young profession in South Africa (SA). Historically, genetic counselors (GCs) in SA have been employed through academic and public health institutions, with only a few practicing in private healthcare. Recently there has been a noticeable shift in the employment trends of GCs worldwide and in SA, transitioning away from patient-facing roles and gravitating toward practice in new or expanded roles. It is, therefore, becoming more common to find GCs employed in laboratory, research, and industry settings. These roles typically involve far less direct patient care, redefining the role of a GC. Although this trend has been researched elsewhere, mainly in the United States of America (USA) and Canada, it has yet to be explored locally. Therefore, this qualitative study aimed to explore the perspectives and experiences of GCs employed in non-direct patient care (NDPC) such as laboratory, research, and industry-based settings in SA. Using semi-structured interviews, this research gathered data from qualified GCs employed in NDPC positions. Reflexive thematic analysis revealed three themes: No choice but to pivot, Quality of life, and Professional identity. These findings offer new insights into an unexplored topic and offer an in-depth understanding of NDPC GCs based in SA, their motivations that drive this trend, and the evolving professional landscape of genetic counseling in SA. They address the scarcity of patient-facing employment opportunities for qualified GCs, advocate for the inclusion of exposure to roles outside of clinical practice during training and highlight the potential to guide workforce policies to address the employment gap.