atrics (59 percent), followed by internal medicine (12 percent), obstetrics (10 percent), and ''other" (16 percent). As genetic tests for presymptomatic and predispositional assessment become more widely available, therefore, there may not be enough physicians trained to provide the necessary specialized genetics services, including the education and genetic counseling that will be essential if and when more widespread genetic testing and screening develop in the future. This will require close attention over the next three to five years.

Another growing area of concern involves the effects of market forces on the training and career paths of genetics professionals. Anecdotal evidence suggests that commercial laboratories are drawing personnel away from academic laboratories. This poses problems for the future training of genetics professionals, since commercial facilities are less likely to provide advanced clinical training than academic centers. For example, the committee heard reports that commercial laboratories recently have begun to buy genetic testing laboratories in academic institutions and to discontinue fellowships and other advanced genetics training in those laboratories.

Although there is a need for trained genetics personnel for research and laboratory testing, the readily available funding for research training appears to be leading more genetics students to enter career paths leading to potential research careers rather than to clinical genetics careers.

The total number of human genetics training programs increased slightly between 1984 and 1992, from 99 to 111 (see Table 6-2) (Riccardi and Smith, 1986; Friedman and Riccardi, 1988; Murray and Toriello, 1990; Blitzer, 1992). Approximately 40 percent of human genetics graduates have come from 10 percent of the human genetics training programs. The American Board of Medical Genetics (ABMG) accredits most U.S. human genetics training programs, although it accredits only the clinical training sites of the master's-level genetic counseling programs. ABMG certification by subspecialty is shown in Figures 6-1 and 6-2 and Table 6-3.