Purpose of review: Although major advances have been made in understanding the genetic basis of both rare and common disorders, the number of trainees entering medical genetics in recent years has been dwindling. This review summarizes some possible reasons for this decline and suggests approaches to increase the number of people who enter the field. Recent findings: In October 2004 a 'summit meeting' was held at the Banbury Conference Center to discuss the problem. The meeting was attended by leaders in medical genetics from the United States and Canada. Several suggestions were made at the meeting that have resulted in new initiatives to alter medical genetics training and recruit additional trainees. Summary: Major initiatives are being launched that will position medical genetics to work in collaboration with other specialties to lead the integration of genetics into medical practice. © 2005 Lippincott Williams & Wilkins.