Avera Cancer Institute, like many other organizations, struggled to keep up with the growing demand for genetic counseling. Their wait times for a non-urgent genetic counseling appointment had ballooned to 6 months. At the time, Avera employed only one genetic counselor who operated the program alone.

Though Avera recognized that they were understaffed, they had struggled to recruit additional genetic counselors. They attributed this difficulty in part to being located in South Dakota, which they believe many would-be applicants viewed as too rural or remote. Over the course of several years, the program received only three applicants to an open genetic counselor position.

Establishing the case for increased staffing

Avera’s genetic counselor recognized that they needed to secure additional funding to strengthen their recruitment efforts and support increased staffing. The genetic counselor compared their annual genetic counseling volumes and appointment wait times to the benchmarks published by the National Society of Genetic Counselors (NSGC). She documented that their genetic counselors’ annual caseload and wait times were higher than the national averages.

With the backing of these data, the genetic counselor made the case to oncology leadership to invest in recruiting staff for the genetic counseling program. She argued that they were not only letting down patients’ needs with such long wait times, but also missing out on the opportunity for program growth and downstream revenue. The ability to increase capacity to drive program growth justified investing money into recruiting sufficient staff for the program.

Avera’s first step to increase capacity was to invest in their genetic counselor recruitment efforts. Rather than simply increasing genetic counselor compensation, Avera designed a scholarship program to incentivize students to commit to work for Avera upon completion of their education. This program establishes a pipeline of genetic counselors for several years to come, making it a more sustainable, longer-term approach.

Avera offered a scholarship to students entering a genetic counseling master’s degree program. The scholarship typically covered 100% of the student’s tuition. In exchange, students that accepted the funding committed to work for Avera Cancer Institute for at least 3 years after obtaining their degree.

Avera requires that students who apply to the scholarship already hold an acceptance to a genetic counseling program. They marketed the scholarship to local colleges and to pre-master’s students who shadowed Avera’s genetic counselor.

Given the high cost of graduate school, Avera secured several scholarship applicants from not only the local college program, but also from schools outside the area.

The scholarship is particularly effective because it captures mostly local students at the early stages of their education, before they have moved away from the area. The program is attractive to genetic counseling students as it reduces their graduate student loan debt, which has notoriously high interest rates, and is thus a greater value to the student than the same amount of money in a salary increase or signing bonus.

Avera’s scholarship program was so successful in securing long-term commitments from genetic counseling students that they have discontinued it for the next several years.

In addition to the scholarship program, Avera created several positions for genetic counseling assistants (GCAs) to support the genetic counselors. Before creating a position specifically for a GCA, the program relied on medical assistants who were primarily staffed to the breast surgeon’s service and lacked genetic counseling expertise. Avera realized that a position dedicated specifically to the genetic counseling program could be staffed by individuals who had training as a GCA and would allow the genetic counselors to focus their time on more top-of-license tasks.

Because many GCAs are either current genetic counseling students or plan to eventually pursue a degree in genetic counseling, these positions doubled as a recruiting tool to hire future genetic counselors and evaluate their “fit” while working for the program.

Avera created a full time GCA position and several “as needed” part-time positions. The part-time positions are staffed by current undergraduate and graduate genetic counseling students from the local college.