Sonographer Shortages - Journal of Diagnostic Medical Sonography
Sonographer Shortages - Journal of Diagnostic Medical Sonography
Sonographer Shortages - Journal of Diagnostic Medical Sonography
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10.1177/8756479303253946<br />
ARTICLE<br />
JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4<br />
SONOGRAPHER SHORTAGES / Craig<br />
JDMS 19:261–271 July/August 2003<br />
JDMS 19:261–271 July/August 2003<br />
FOCUSING ON THE ISSUES<br />
<strong>Sonographer</strong><br />
<strong>Shortages</strong>:<br />
A Day Late and a<br />
Dollar Short?<br />
MARVEEN CRAIG, RDMS<br />
Part II<br />
In Part I <strong>of</strong> this topic, we presented the views <strong>of</strong><br />
sonographers from many different clinical and<br />
commercial sonography settings. Without exception,<br />
they viewed the lack <strong>of</strong> accredited programs,<br />
the uneven geographical spread <strong>of</strong> existing accredited<br />
programs, and the small number <strong>of</strong> graduates<br />
as one <strong>of</strong> the major contributing factors to today’s<br />
shortage <strong>of</strong> skilled sonographers. Part II is devoted<br />
to the opinions <strong>of</strong> sonography educators. They<br />
share the concerns expressed by their colleagues<br />
and <strong>of</strong>fer their own possible solutions.<br />
I believe that the sonographer shortage stems<br />
from the health care scare <strong>of</strong> six to eight years ago<br />
when departments were downsizing and not replacing<br />
staff that had resigned. The illusion <strong>of</strong> the security<br />
<strong>of</strong> working in a hospital was shattered when<br />
hospitals and clinics started closing. This also led<br />
to a decrease in the number <strong>of</strong> people applying to<br />
sonography programs. I recall that for a few years,<br />
our program was not at full capacity because <strong>of</strong> a<br />
lack <strong>of</strong> qualified applicants. Another major problem<br />
that all imaging programs are facing is the fact<br />
that when we raised our entry requirements, poten-<br />
DOI: 10.1177/8756479303253946<br />
JDMS 19:261–271 July/August 2003 261<br />
tial sonography students had to begin taking prerequisite<br />
courses. This exposure to other career<br />
choices has resulted in some students leaving the<br />
health care track. This problem faces all imaging<br />
schools because this shortage is not just a<br />
sonography issue. We all need to find ways to keep<br />
potential sonography students interested so that we<br />
do not lose them to other career programs.<br />
We need to start educating our youth, as early as<br />
elementary school, that there is more to a hospital<br />
career than being doctors and nurses, and we need<br />
to keep reminding them until graduation. Every<br />
year, I visit the elementary school that my children<br />
attended, whenever they are studying the heart and<br />
how to take care <strong>of</strong> it. My talks are held in gym<br />
class, <strong>of</strong> all places! And while I am there, I show a<br />
video <strong>of</strong> normal and abnormal hearts and I tell them<br />
about sonography and how I learned to take these<br />
special pictures and movies.<br />
Our imaging program representatives attend career<br />
fairs at local high schools to promote imaging<br />
careers. We invite some <strong>of</strong> the local high school seniors<br />
to spend the day at Johns Hopkins, where they<br />
tour various departments and we provide talks and<br />
question-and-answer sessions to encourage them to<br />
consider a health care career. We also encourage<br />
people who want to know more about sonography<br />
to spend the day in a sonography lab. This has decreased<br />
the number <strong>of</strong> dropouts who thought<br />
sonography was merely a happy-to-see-your-baby,<br />
isn’t-it-cute pr<strong>of</strong>ession!<br />
Robert de Jong, RDMS, RDCS, RVT<br />
Baltimore, Maryland<br />
What has created the shortage <strong>of</strong> sonographers?<br />
Well, let’s drill down through the possible factors<br />
to see what lies at the bottom. First, it is supply and<br />
demand. We are all acutely aware that the demand
262 JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4<br />
is increasing steadily as sonography disseminates<br />
out <strong>of</strong> radiology and into other specialties. So, there<br />
is not enough supply to meet the demand. Why?<br />
Not enough capacity in the educational system that<br />
supplies sonographers. My impression is that the<br />
vast majority <strong>of</strong> sonography schools are filling<br />
their classes, so that would mean that the basic capacity<br />
<strong>of</strong> the existing educational system is insufficient.<br />
Why can’t schools just scale up their<br />
individual capacity to meet demand? Hands-onpractice.<br />
Education in sonography is heavily dependent<br />
on one-on-one practicum experience, and<br />
the availability <strong>of</strong> good practicum sites appears to<br />
be decreasing as a result <strong>of</strong> increasing clinical demand<br />
on sonographers in clinical settings. Excessively<br />
busy sonographers just do not have the time<br />
to devote to students. How to fix it? Schools need to<br />
increase class size. This will require solutions to<br />
several problems:<br />
Increased capacity for practicum education. It<br />
does not matter much if there is another body in a<br />
lecture; it matters very much in practicum. We<br />
need to convince hospitals, independent teaching<br />
facilities, and doctors’ <strong>of</strong>fices that they have to<br />
make a commitment to providing quality,<br />
structured practicum for students. Otherwise, this<br />
supply problem is just going to get worse instead <strong>of</strong><br />
better.<br />
Helping schools fill larger classes by making<br />
sonography more visible to the potential enrollees.<br />
Having diagnostic medical sonography classified<br />
as a separate pr<strong>of</strong>ession (thank you, the Society <strong>of</strong><br />
<strong>Diagnostic</strong> <strong>Medical</strong> <strong>Sonography</strong> [SDMS] and the<br />
dedicated sonographers who supported this effort!)<br />
is a tremendous help. High school counselors are<br />
now more likely to be aware <strong>of</strong> sonography as a<br />
pr<strong>of</strong>ession, but we need to aggressively support a<br />
“visibility” campaign that reaches juniors and<br />
seniors in high schools throughout the country.<br />
However, this will be pointless if there are not<br />
enough schools to accommodate interested<br />
candidates. It’s sort <strong>of</strong> like the chicken and the egg<br />
riddle. Both have to be addressed.<br />
Larry Waldroup, BS, RDMS<br />
Philadelphia, Pennsylvania<br />
Why is there a shortage <strong>of</strong> sonographers? From<br />
an educational standpoint, I would have to say that<br />
getting facilities to commit to taking students is difficult,<br />
although for the most part, we have been<br />
lucky with our clinical sites in the Phoenix area.<br />
However, once they take a student and their staffing<br />
changes, what level <strong>of</strong> obligation does the site<br />
have to continue mentoring? Or, what is the level <strong>of</strong><br />
commitment from the “new” or “temp” person to<br />
work with a student? Not all clinical facilities are<br />
100% staffed with registered sonographers, so<br />
there also are issues <strong>of</strong> sonography students working<br />
with those who are not registered.<br />
Sometimes, it is the student who makes it difficult<br />
for those who follow. A site may take a student<br />
in the hope/promise that he or she will stay after<br />
program completion. Then, at the first opportunity,<br />
the student/graduate bails and goes to work somewhere<br />
else.<br />
What has caused this shortage? The old supplyand-demand<br />
adage is truly at work here. If you can<br />
work for a hospital at $X/per hour, and an outpatient<br />
site <strong>of</strong>fers you $Y/per hour without call, you<br />
are going to work at the place that <strong>of</strong>fers the most<br />
money and the best hours.<br />
Sometimes, the most money is earned by taking<br />
jobs here and there on a per diem basis or working<br />
at the lucrative jobs as a contract worker, traveler,<br />
and so on. These types <strong>of</strong> jobs <strong>of</strong>fer a lot more flexibility<br />
to the employee who can pick and choose<br />
hours as well as call and working conditions. There<br />
are many jobs out there but not enough registered<br />
sonographers to go around.<br />
For example, consider the vascular sonographers<br />
in some Medicare states where an exam<br />
must be performed by a registered technologist in<br />
order to bill Medicare. This stipulation has created<br />
a shortage <strong>of</strong> vascular sonographers, and there are<br />
not enough schools and too few graduates to meet<br />
the ever increasing demand. To meet this demand,<br />
our program has been working for the past six years<br />
with local hospitals and clinics to form partnerships<br />
with the college. Sites must agree to sponsor a student(s),<br />
and in return, the student has a top-notch<br />
clinical site and the promise <strong>of</strong> a job at the end <strong>of</strong><br />
their education. All sites must meet the criteria required<br />
by the college in terms <strong>of</strong> registered<br />
sonographers on staff, the number and types <strong>of</strong> exams,<br />
and so forth. This approach has helped us to
increase the number <strong>of</strong> incoming students and program<br />
graduates.<br />
However, there are other deeper issues that I see<br />
in the educational area regarding shortages. This<br />
holds true for all occupational programs, particularly<br />
those in diagnostic imaging. Right now, there<br />
are around eight faculty job openings in our<br />
sonography program: clinical instructors and/or<br />
program director positions. We are advertising for<br />
one such position, and the nibbles so far are from<br />
wonderful people who have no teaching experience.<br />
The word on the academic street is that these<br />
jobs are going begging because there is so much<br />
more money to be made in the real world than in the<br />
classroom. Also, we work long and hard for our<br />
salaries, which leaves little time (if any) to upgrade<br />
our skills and/or earn any additional dollars. The<br />
minimum academic standards for program directors<br />
in other imaging pr<strong>of</strong>essions are changing to<br />
require a master’s level <strong>of</strong> education. Most people<br />
in the occupational areas are age 45+ and leaning<br />
toward retirement—food for thought from those <strong>of</strong><br />
us in the teaching trenches.<br />
Kathleen Murphy, MBA, RDMS<br />
Phoenix, Arizona<br />
I think several things factor into the current<br />
sonographer shortage. First, to some extent, the job<br />
itself has lost a little <strong>of</strong> its appeal. <strong>Sonographer</strong>s<br />
still have to take call, whereas other allied health<br />
fields staff for 24 hours. Many allied health fields<br />
<strong>of</strong>fer more enticing shifts, such as three 12-hour<br />
shifts and four days <strong>of</strong>f. I do not know <strong>of</strong> any<br />
sonography departments in our area that <strong>of</strong>fer these<br />
shifts, and certainly no physician <strong>of</strong>fices either.<br />
Salaries are <strong>of</strong>ten an issue—especially when compared<br />
to nursing. Even in Las Cruces, nurses can<br />
earn up to $60,000/year as a staff nurse.<br />
Another issue that may have an impact is the<br />
subspecialization <strong>of</strong> sonography. Many sonographers<br />
are happy to do one specialty exclusively<br />
but, after a while, want to do more. They may move<br />
to another specialty or change fields altogether.<br />
Those facilities <strong>of</strong>fering a variety <strong>of</strong> exams keep<br />
their staff more interested. Potential students <strong>of</strong>ten<br />
SONOGRAPHER SHORTAGES / Craig 263<br />
ask me about the variety in our field before they apply.<br />
Of course, there also is the musculoskeletal injury<br />
issue, which goes hand in hand with the “onespecialty”<br />
issue. <strong>Sonographer</strong>s are being forced to<br />
reduce their work hours or leave the field altogether<br />
due to injury. So, coupled with the fact that fewer<br />
people are going into this field, sadly, those with<br />
some experience are also being “injured out.”<br />
The shortage seems to be self-perpetuating in<br />
that potential students/employees observe how<br />
busy the departments are (due to being short<br />
staffed) and are hesitant to enter the field, thinking<br />
how hard they will have to work and for what<br />
amount <strong>of</strong> money. These are not just my opinions<br />
but based on comments I get from applicants and<br />
students.<br />
To meet this demand, I think we need to be very<br />
creative in how we <strong>of</strong>fer education to nontraditional<br />
students. This may come down to the Joint<br />
Review Committee–<strong>Diagnostic</strong> <strong>Medical</strong> <strong>Sonography</strong><br />
(JRC-DMS) looking at how to accredit programs<br />
that are more creative. Until we have enough<br />
staff in sonography departments to cover the major<br />
shifts, we will not be able to staff for 24 hours. I<br />
also think we have to <strong>of</strong>fer incentives to facilities to<br />
encourage them to become clinical sites. Many<br />
sites have quit taking students because they are too<br />
busy to mentor them. I even heard that one institution<br />
closed its sonography program because there<br />
was no support from the hospitals. These facilities<br />
will also be shorthanded if we cannot provide<br />
enough internships for students. So it seems like a<br />
never-ending cycle.<br />
Carolyn T. C<strong>of</strong>fin, MPH, RDMS, RVT, RDCS<br />
Las Cruces, New Mexico<br />
El Centro College has continued to take 10 students<br />
each year for the past l6 years. All <strong>of</strong> our<br />
graduates are hired by clinical affiliates, where<br />
they have had clinical rotations. I am surprised at<br />
how many new sonography programs have started.<br />
There is a new program in Austin that takes 75 students<br />
a year on revolving three-month intervals.<br />
That seems to me like an overabundance <strong>of</strong>
264 JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4<br />
sonographers for the marketplace to absorb. In our<br />
area, nurses are being cross-trained to do vascular<br />
and OB-GYN sonography. I know there are specific<br />
courses for nurses in annual conferences and<br />
seminars. I see the number <strong>of</strong> new accredited programs<br />
in the JRC-DMS report.<br />
I keep wondering if we are going to have problems<br />
similar to those that physical therapy has had<br />
with saturating the marketplace. If so, we could see<br />
salaries go down and sonographers on every corner.<br />
This is equally as scary to me as the problem <strong>of</strong><br />
not enough sonographers. I do believe that several<br />
reasons for an increased demand is due to the price<br />
<strong>of</strong> equipment going down and more private physicians<br />
<strong>of</strong>fering sonography in the <strong>of</strong>fice setting. I<br />
have talked with friends in commercial ultrasound<br />
companies who tell me that the companies are<br />
downsizing and having money problems. Is this<br />
going to filter down to sonography labs?<br />
I keep remembering a statement by my favorite<br />
mentor: “The questions remain the same ...itis<br />
just the answers that are different.” I wonder if the<br />
marketplace reaction to this “sonography shortage<br />
crisis” will result in a “sonography glut.” What will<br />
we say when we look back on this and see it from a<br />
different perspective?<br />
Jan Bryant, MS, RDMS, RT(R)<br />
Dallas, Texas<br />
I think the main cause <strong>of</strong> the shortage <strong>of</strong> qualified<br />
sonographers around the United States and the<br />
world is the fact that the pr<strong>of</strong>ession literally has exploded<br />
in the past 30 years. Before 1972, there were<br />
not any certifying examinations and few, if any, educational<br />
programs. Yet today, it has been pointed<br />
out that “the ultrasound market, worth over 3.1 billion<br />
dollars in 1997 is the most dynamic sector <strong>of</strong><br />
the diagnostic imaging market and is now the largest<br />
imaging modality, according to a new report,<br />
‘Ultrasound: The World Markets,’ from Clinical<br />
Reports” (“In the News: The Booming Ultrasound<br />
Market,” RT Image 1998;11:16).<br />
This huge increase in the medical usefulness <strong>of</strong><br />
sonography, coupled with the operator dependence<br />
<strong>of</strong> the modality, has created an educational bottle-<br />
neck for the pr<strong>of</strong>ession. Because sonography is the<br />
most operator dependent <strong>of</strong> diagnostic imaging<br />
modalities, it requires clinical education in a oneon-one<br />
clinical instructor-to-student ratio. This is<br />
similar to learning to ride a bicycle; one can read<br />
about it, watch a world-class bicyclist racing, and<br />
talk to an experienced bicyclist, but you have to get<br />
on the bicycle to learn to ride it. And most will<br />
wobble and fall at first.<br />
Unfortunately, many in medicine believe<br />
sonography to be much easier than it is. Physicians,<br />
nurses, and others watch a skilled sonographer scan<br />
and think, “I can do that.” A skilled sonographer<br />
makes it look very simple, but the casual observer<br />
does not realize the cognitive and psychomotor education<br />
that is required for success. To become a<br />
skilled sonographer, one has to get a lot <strong>of</strong> “transducer<br />
time” under the tutelage <strong>of</strong> an educated<br />
sonographer.<br />
A part <strong>of</strong> the shortage is due to the lack <strong>of</strong> clinical<br />
education sites with skilled clinical instructors.<br />
Our program stays at a maximum number <strong>of</strong> students<br />
for our clinical sites, and the only way we can<br />
expand our program is by acquiring new clinical affiliations.<br />
We have almost no luck in getting private<br />
<strong>of</strong>fices to serve as clinical education sites.<br />
They seem to think it will slow up their schedule<br />
and cut into their pocketbooks. They cannot seem<br />
to understand that being a clinical education affiliate<br />
causes their staff sonographers to sharpen their<br />
skills and knowledge because <strong>of</strong> the interactions<br />
with the students. Also, they get to know the working<br />
habits <strong>of</strong> the students and who will be good potential<br />
students. Also, our clinical instructors get<br />
CMEs for working with the students. It seems that<br />
everyone is concerned about the shortage, but<br />
many do not want to help educate the students.<br />
Unfortunately, the “educational bottleneck” is<br />
<strong>of</strong>ten being filled by unaccredited schools that either<br />
do not understand or do not want to spend the<br />
time it takes to provide the comprehensive clinical<br />
education required to become a successful<br />
sonographer. This is the reason that I only recommend<br />
programs accredited by the Commission on<br />
Accreditation <strong>of</strong> Allied Health Education Programs<br />
(CAAHEP).<br />
Some creative ideas or steps to meet this demand<br />
might be making clinics understand that if they will<br />
not accept students, we are not going to be able to
fill this void with qualified individuals. We also<br />
need more <strong>of</strong> the existing programs to become accredited<br />
so that we know they are following accepted<br />
educational standards. The bottom line is<br />
that we need more accredited programs.<br />
Terry J. DuBose, MS, RDMS<br />
Little Rock, Arkansas<br />
I think a lot <strong>of</strong> legitimate, accredited sonography<br />
programs are probably hampered by budgetary restraints:<br />
“We will hire another faculty member as<br />
soon as you increase student enrollment to pay for<br />
this faculty member.” Sound familiar? Many educational<br />
institutions are operating on tight budgets,<br />
and it is difficult to expand their student enrollment<br />
because <strong>of</strong> this.<br />
Anthony L. Baker, BS, RDMS, RVT, CNMT<br />
Little Rock, Arkansas<br />
I think the current shortage is due to several<br />
issues:<br />
1. the “aging” <strong>of</strong> sonographers who have been in<br />
the field for decades and are now retired;<br />
2. the number <strong>of</strong> us who moved into supervisory<br />
nonscanning positions, commercial work, or<br />
education and left our clinical positions behind;<br />
3. the hot jobs a decade or so ago, which enticed<br />
people to move into the world <strong>of</strong> computers—<br />
hardware, s<strong>of</strong>tware, programming, and Web<br />
design (these college-age kids saw big money<br />
and a more attractive <strong>of</strong>fer than health care);<br />
4. the changes in health care, switching to the<br />
world <strong>of</strong> business with managed care but<br />
without placing any emphasis on allied health or<br />
even nurse training;<br />
5. the closure <strong>of</strong> most hospital-based education<br />
programs;<br />
6. the lack <strong>of</strong> advertising/marketing (I know it<br />
sounds cold, but information technology jobs<br />
and education are advertised big time. Let’s face<br />
it, if the word does not get out, how can these<br />
folks know about sonography?); and<br />
SONOGRAPHER SHORTAGES / Craig 265<br />
7. repetitive stress injuries and physical and mental<br />
fatigue after too much on-call and nonsupportive<br />
administrators.<br />
How to change it? We actually advertised our<br />
sonography programs for the first time—“Make a<br />
Sound Investment in Your Future.” We did, and do,<br />
<strong>of</strong>fer monthly open house information sessions at<br />
which I spend an hour giving a presentation titled,<br />
“<strong>Sonography</strong>—What It Is.” I talk about all <strong>of</strong> the<br />
pertinent organizations: CAAHEP, JRC-DMS, and<br />
the American Registry <strong>of</strong> <strong>Diagnostic</strong> <strong>Medical</strong><br />
<strong>Sonographer</strong>s (ARDMS). I ask, “Do you know<br />
who scanned you? Who interpreted your exam?”<br />
Then, I talk about the various educational options<br />
in the United States and Maryland. Yep, I mention<br />
our direct competition since we are all here for the<br />
same goal.<br />
We are lucky that our local Sunday paper writes<br />
a great article weekly on a specific allied health<br />
field. I was interviewed in late December, allowing<br />
me to really get a message out there. I also tell folks<br />
who call me looking for “something in health care<br />
but not nursing” to consider checking out radiology,<br />
mammography, magnetic resonance imaging<br />
(MRI), computerized tomography (CT), nuclear<br />
medicine, and so forth. I know our pr<strong>of</strong>essional<br />
fields are doing the best they can, but sonography<br />
needs more positive press coverage.<br />
We also talk to our students regularly about ergonomics<br />
and taking jobs you like, not just going<br />
for the “big bucks.”<br />
Jann Dolk, MA, RDMS<br />
Baltimore, Maryland<br />
There is a reason that the average age <strong>of</strong> a<br />
sonographer in this country is around 43. The developments<br />
and techniques in our labs, as well as<br />
most <strong>of</strong> the features currently available on our machines,<br />
are the result <strong>of</strong> early pioneers in<br />
sonography dedicating their time and energy toward<br />
developing the technology. This left a large<br />
gap in time, while the field <strong>of</strong> sonography matured,<br />
during which we did not recruit as we should have<br />
and are now paying for it. This gap, in many instances,<br />
is being force-filled by employers requir-
266 JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4<br />
ing employees to cross-train in multiple<br />
sonography modalities, even at times from unrelated<br />
pr<strong>of</strong>essions. In addition, we have created a<br />
dynamic new field that has seen an incredible increase<br />
in utilization, as the medical community realizes<br />
our capabilities—not to mention competition<br />
for available personnel by new labs starting up.<br />
This has only emphasized the already short-staffing<br />
situations most labs are enduring.<br />
Another contributing factor is the shortage <strong>of</strong><br />
long-established, accredited educational programs<br />
producing a sustainable, steady flow <strong>of</strong> qualified<br />
sonographers. However, if we start more schools,<br />
educate qualified sonographers, and fill positions,<br />
it will not be long before the demand is met, and the<br />
new graduate will have difficulty finding a good<br />
job. We have all seen examples <strong>of</strong> this in other pr<strong>of</strong>essions<br />
where the job market was flooded, leaving<br />
individuals with advanced degrees flipping burgers.<br />
The result could be the closure <strong>of</strong> schools and<br />
years <strong>of</strong> experience being lost to future students.<br />
This brings us to the next question: what creative<br />
ideas or steps can you think <strong>of</strong> to meet this demand?<br />
Even though we are experiencing severe<br />
staff shortages in some areas <strong>of</strong> the country, there<br />
are still a limited number <strong>of</strong> jobs available. I know<br />
this may sound contradictory, but consider that<br />
hospitals recruit and hire hundreds or even thousands<br />
<strong>of</strong> nurses and other ancillary staff, while<br />
most do not require the services <strong>of</strong> more than two to<br />
ten sonographers. As an option to starting more<br />
schools, we could develop an accredited distancelearning<br />
program with regional and local clinical<br />
sites for testing and evaluation purposes. Ultimately,<br />
this would enable educational institutions,<br />
due to increased funds, to further improve the quality<br />
<strong>of</strong> the programs they can <strong>of</strong>fer. Labs could then<br />
hire apprentices to participate in these programs.<br />
Under this format, apprentices would have exposure<br />
to standardized didactic training and clinical<br />
protocols, as well as instructors with years <strong>of</strong> experience,<br />
while earning their degree. Even the smallest<br />
community hospital would be able to educate<br />
high-quality sonographers in a variety <strong>of</strong> modalities<br />
while maintaining the workflow, increasing efficiency,<br />
and creating career ladders for qualified<br />
individuals. This not only results in meeting the<br />
need <strong>of</strong> retirement transition and/or increased<br />
workload demands but also standardizes the delivery<br />
<strong>of</strong> services in labs across the country.<br />
Obviously, the two biggest hurdles to overcome<br />
are time and public awareness. Since we cannot<br />
shorten the time required to train new<br />
sonographers, I think our focus needs to be on public<br />
awareness. The vast majority <strong>of</strong> the general population<br />
has not even heard <strong>of</strong> sonography, and to<br />
those who have, the immediate connotation is<br />
“baby on board,” not cardiac, vascular, breast, or<br />
any <strong>of</strong> the other numerous applications <strong>of</strong><br />
sonography. Job fairs, public service announcements,<br />
a television spot during the Super Bowl—<br />
these are things that will educate the public. I think<br />
a good example has already been set by the drug<br />
companies with their commercials, “Do you have<br />
this problem? See your doctor to find out if the blue<br />
pill is right for you.” The military created the “it’s<br />
not just a job, it’s an adventure” theme because its<br />
numbers were slipping.<br />
The medical community knows who we are.<br />
What we need is good advertising and marketing<br />
departments that target John Q. Public, to let them<br />
know who we are and what we do. That will get<br />
young people interested in our field. Shows such as<br />
20/20 and Oprah get us publicity, but not necessarily<br />
the kind we want or need.<br />
So, I guess my suggestion is tw<strong>of</strong>old: first, let’s<br />
get all the societies such as the SDMS, Society for<br />
Vascular Ultrasound (SVU), American Society <strong>of</strong><br />
Echocardiography (ASE), American Institute <strong>of</strong><br />
Ultrasound in Medicine (AIUM), and so forth to<br />
develop a unified marketing department. We could<br />
solicit funds and grants from governmental, commercial,<br />
and corporate entities, such as hospitals<br />
and manufacturers, as well as contribute a portion<br />
<strong>of</strong> our dues to advertise and show the world who we<br />
are and what we do. Second, we need to organize<br />
and standardize our labs, set up a network for students<br />
to do clinical rotations in, and start recruiting<br />
and educating qualified apprentices and provide<br />
them an opportunity to grow with a future they can<br />
look forward to in an exciting and dynamic field.<br />
Terry J. Zwakenberg, BS, RVT, RDCS<br />
Columbia, South Carolina
I am concerned that the shortage <strong>of</strong> sonographers<br />
is partly due to the number <strong>of</strong> sonographers<br />
who have ended their careers due to occupational<br />
injury. This is exacerbated by the fact that the average<br />
age <strong>of</strong> a sonographer is 42 years. Data show<br />
that 80% <strong>of</strong> sonographers are between ages 30 and<br />
50, and they are about evenly distributed between<br />
these age groups—in other words, 40% between<br />
ages 30 and 40 and 40% between ages 41 and 50.<br />
This is a pending serious situation since we shall be<br />
losing the most experienced sonographers in our<br />
pr<strong>of</strong>ession to premature retirement, which will<br />
only make this situation worse.<br />
However, this is not the only cause for the shortage.<br />
I think the shortage is also a result <strong>of</strong> lower reimbursement.<br />
Departments are trying to do more<br />
with less; they are understaffed out <strong>of</strong> choice to<br />
save money. It is not too long ago that we saw<br />
downsizing caused by reduced reimbursement. To<br />
our concern, we also saw certified sonographers<br />
being let go in favor <strong>of</strong> uncertified technicians simply<br />
because they cost less in salary. Some <strong>of</strong> those<br />
qualified sonographers left the field out <strong>of</strong> disgust<br />
for what was going on in the human resource departments.<br />
Still today, we hear that radiology managers<br />
think that x-ray techs can be cross-trained<br />
into sonography in a matter <strong>of</strong> weeks. I know <strong>of</strong><br />
some situations in breast centers where sonographers<br />
have been asked to do this cross-training<br />
and replied by saying, “Why don’t you cross-train<br />
me to take mammograms?” and that is stated to be<br />
impossible. Our technique <strong>of</strong> scanning looks so<br />
easy to do to the untrained eye and is so misunderstood<br />
by those outside <strong>of</strong> our field. That makes it<br />
our responsibility to educate those around us as to<br />
what is really involved in being a sonographer.<br />
Finally, the shortage is also caused by the fact<br />
that anything to do with medicine is no longer<br />
deemed glamorous in the eyes <strong>of</strong> the graduating<br />
high school senior. Every branch <strong>of</strong> medicine—including<br />
medical schools—is seeing fewer and<br />
fewer applicants. Physicians are not recommending<br />
to their children that they go into medicine;<br />
they are telling them to go into business—particularly<br />
the computer aspects. Young people hear a lot<br />
more about medicine in the classroom today, but it<br />
comes in the form <strong>of</strong> AIDS education, the rate <strong>of</strong><br />
hepatitis C and how easily it is transmitted, and the<br />
consequences <strong>of</strong> smoking, doing drugs, and drink-<br />
SONOGRAPHER SHORTAGES / Craig 267<br />
ing. Certainly, these are valid educational topics<br />
but not an attraction for those considering healthrelated<br />
fields as a career choice. Who wants to devote<br />
a career to dealing with people with these<br />
problems?<br />
I do not know how creative the following ideas<br />
are, but I think they are worth mentioning.<br />
We need to be willing to educate others, especially<br />
from accredited programs. If we do not provide<br />
the manpower necessary to give the students<br />
access to our modality, it will be provided by others.<br />
<strong>Sonographer</strong>s who have graduated from<br />
schools within the past five years refuse to take students<br />
into their departments because they complain<br />
they are too overworked and do not want to be<br />
bothered teaching. All I can say to them is, “How<br />
lucky you are that someone did not feel that way<br />
when you needed to be mentored.” I am starting to<br />
see a willingness among the older, more experienced<br />
sonographers to take students as a way to<br />
lessen the number <strong>of</strong> cases they have to do per day<br />
because they are hurting, and this is a way they can<br />
stay in the field they love. We need more <strong>of</strong> these<br />
willing sonographers; <strong>of</strong> course, I wish they were<br />
not injured.<br />
We need to become ambassadors and be willing<br />
to hold career fairs and approach local schools—<br />
especially the science or biology teachers—and <strong>of</strong>fer<br />
to teach a class for them and tell the students<br />
about the rewarding side <strong>of</strong> sonography. Yes, that<br />
means some fetal videos: not for entertainment but<br />
for recruitment!<br />
We need to get funding for education. I am on a<br />
committee on manpower for the Washington State<br />
Hospital Association, and I am the only nonnurse<br />
and the only college representative on the committee<br />
(except when my coworker Ann Polin and I attend<br />
together). I have learned a lot from attending<br />
these meetings and watching how nurses get funds<br />
for what they need. They approach things very differently<br />
than the rest <strong>of</strong> us. To start with, they do<br />
not talk about how hard they are working or how<br />
many patients they have cared for that month or last<br />
year. They talk about the ones who could not be<br />
cared for because there were no nurses to staff the<br />
floor and the amount <strong>of</strong> revenue the hospital lost<br />
because <strong>of</strong> this (calculated from an average patient<br />
day and the money generated by that patient in<br />
tests, etc.). So they are talking about lost revenue,
268 JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4<br />
not revenue that is already in the bank! This is a lesson<br />
we need to learn, and this is data we need to<br />
start collecting. How many times does the receptionist<br />
say, “We can do your sonogram next week<br />
or the week after,” and the nurse or doctor’s <strong>of</strong>fice<br />
hangs up and calls someone else? How many<br />
sonographers are working overtime and giving up<br />
their lunch hours to accommodate add-on patients<br />
at the expense <strong>of</strong> their own health? We may need to<br />
create a crisis to solve a crisis. We need to speak<br />
more positively about our field. I know it is hard<br />
when we are so busy and understaffed, but we cannot<br />
recruit on a negative campaign; no one is interested<br />
in joining a pr<strong>of</strong>ession <strong>of</strong> complainers or<br />
because they feel sorry for you. We have to sell the<br />
pr<strong>of</strong>ession as an upbeat, happy, and rewarding<br />
field.<br />
Joan Baker, MSR, RDMS, RCDS, FSDMS<br />
Bellevue, Washington<br />
I believe the shortage in sonography has been<br />
created by the improvements in sonographic technology,<br />
the need for competence (in correlating<br />
clinical data with presenting symptoms and the<br />
sonographic findings), and the necessarily stringent<br />
guidelines set by the accrediting bodies. Let<br />
me elaborate.<br />
As technology improves (e.g., higher frequency<br />
transducers, allowing visualization <strong>of</strong> more superficial<br />
structures, better penetration capabilities, and<br />
faster diagnosis), more exams are being requested<br />
<strong>of</strong> the sonography department. Musculoskeletal departments<br />
are sending sports injuries such as Achilles<br />
tendon tears, rotator cuff injuries, and others.<br />
We are better at looking for and assisting in the removal<br />
<strong>of</strong> foreign bodies. Pediatric applications,<br />
such as pyloric stenosis, hip dysplasia, and tethered<br />
spine, are on the rise, as well as imaging <strong>of</strong> the neonatal<br />
head. Vascular imaging is also on the rise. Improved<br />
equipment for the detection <strong>of</strong> peripheral<br />
vascular disease and the high sensitivity for carotid<br />
disease and venous thrombosis brings more and<br />
more patients to sonography. In years past, the<br />
angiography department got many <strong>of</strong> these exams.<br />
With all <strong>of</strong> these increases in the technology and<br />
uses <strong>of</strong> sonography comes the need for education.<br />
It becomes a tiresome task to choose what we<br />
should and should not teach in the program, not to<br />
mention coverage in the medical community while<br />
sonographers are being taught. Younger radiologists<br />
are entering practice with a better understanding<br />
and appreciation for sonographic imaging.<br />
They know it is inexpensive, mobile, and reliable.<br />
They are willing to perform invasive procedures<br />
with ultrasound guidance instead <strong>of</strong> CT, MRI, special<br />
procedures, or—for surgeons—surgery.<br />
Competence is a very critical element.<br />
<strong>Sonographer</strong>s are the first to image and therefore<br />
see what is afflicting patients who have disease.<br />
The ability to correlate knowledge <strong>of</strong> clinical findings<br />
(labs and other diagnostic exams), presenting<br />
symptoms, and sonographic findings requires great<br />
skill. All sonographers need to possess the ability<br />
to put the whole picture together. We are dealing<br />
with real lives. Empathy, understanding, patience,<br />
and other “s<strong>of</strong>t skills” need to be part <strong>of</strong> the<br />
sonographer’s makeup. Not everyone can be taught<br />
these skills. I could go on and on, but you get the<br />
picture.<br />
The accrediting body (JRC-DMS) has set criteria<br />
for approved learning. The lack <strong>of</strong> schools and/<br />
or students entering the field may well be due to the<br />
guidelines we, in education, must follow. I am not<br />
saying they are unreasonable, but they do limit the<br />
possibilities <strong>of</strong> moving greater numbers through<br />
the educational process. For example, students<br />
must complete a clinical internship to graduate<br />
from their programs. Clinical sites are required to<br />
do a specific number <strong>of</strong> exams per year, and <strong>of</strong><br />
those exams, a specific number must be abdomen,<br />
OB-GYN, and so on, if they are to qualify. In large<br />
cities, finding clinical sites that meet this criterion<br />
is not terribly difficult, but in smaller cities such as<br />
ours, it is most difficult. We have sites throughout<br />
Wisconsin and Minnesota. In past years, we have<br />
had to go to Michigan, Indiana, South Dakota,<br />
Kansas, and even to Montana. This coming year,<br />
we will add Iowa to that list. Without this clinical<br />
education, student interns would not survive in the<br />
workplace, so it is necessary.<br />
We at Chippewa Valley Technical College really<br />
struggle with how to increase numbers coming
into and graduating from the program. We are well<br />
aware <strong>of</strong> the shortage in the United States. I get<br />
calls almost daily, asking when we will be graduating<br />
students and asking if I know anyone who is<br />
available for hire. It is a true dilemma. I just wish I<br />
had an answer.<br />
Tina Salava, RT(R), RDMS, RVT<br />
Eau Claire, Wisconsin<br />
Currently, there is a nationwide shortage <strong>of</strong><br />
qualified (ARDMS-registered) sonographers. As is<br />
the case with many workforces, the job market for<br />
sonographers is cyclical. Due to the increased use<br />
<strong>of</strong> sonograms, this is the worst shortage ever.<br />
<strong>Sonography</strong> has historically suffered from an identity<br />
problem. It was not until the fall <strong>of</strong> 2001 that<br />
the Department <strong>of</strong> Labor recognized sonography as<br />
an occupation. If career counselors’ list <strong>of</strong> health<br />
care occupations and the published statistics <strong>of</strong> projected<br />
job shortages do not include sonography,<br />
how will people know about the field? We traditionally<br />
do not hear children saying, “When I grow<br />
up I want to be a sonographer.” Most people with<br />
whom I come into contact have entered the field as<br />
a second or third career. They want to help people<br />
and want to have a stable job with a salary on which<br />
they can support themselves. In the 1990s, the big<br />
career hype was in computers and the “dot.com”<br />
companies. Health care was not considered to be on<br />
the cutting edge as the place to work or where you<br />
could make a six-figure salary. We all heard the<br />
stories about young people working for dot.coms<br />
who were making huge salaries and planning to retire<br />
in their 30s with their stock options. As we now<br />
know, not too many <strong>of</strong> them ever made those millions.<br />
Scanning is an acquired skill that cannot be<br />
learned overnight or by reading a book. The clinical<br />
aspect <strong>of</strong> sonography education takes time, and<br />
many people have families to support while they<br />
are going to school and cannot afford not to work.<br />
This further dissuades people from entering the<br />
field. We cannot afford to lower the standards and<br />
have people working without at least one year <strong>of</strong><br />
supervised clinical education.<br />
SONOGRAPHER SHORTAGES / Craig 269<br />
Hospitals, like every other business, have been<br />
looking at ways to lower their costs. During past<br />
shortages, hospitals paid a stipend to have students<br />
rotate to their facilities. It may be time, once more,<br />
for hospitals to make an investment in education. If<br />
there is a local CAAHEP program, why not <strong>of</strong>fer to<br />
take a student? It is a great way to have first choice<br />
<strong>of</strong> the graduates, and it helps with filling future<br />
openings. Hospitals can sponsor a student by paying<br />
for all or part <strong>of</strong> that student’s education and<br />
have him or her repay the facility by signing a contract<br />
to work there upon graduation. Another option<br />
is by initiating departmental education and<br />
upgrade programs. Offering an employee the opportunity<br />
to upgrade by sending him or her to a<br />
CAAHEP-accredited program to learn sonography<br />
has great appeal. It would be valuable to have the<br />
employee take as many courses as possible before<br />
leaving for the clinical component portion <strong>of</strong> the<br />
program; some programs may even <strong>of</strong>fer their<br />
courses online. The student will have to relocate for<br />
the clinical aspect <strong>of</strong> the program, but when he or<br />
she returns to the hospital, that person will bring<br />
back a wealth <strong>of</strong> knowledge, protocols from other<br />
facilities, and a host <strong>of</strong> new and different techniques.<br />
The institutional benefits would far outweigh<br />
the initial costs by increasing the quality and<br />
quantity <strong>of</strong> sonography examinations performed. A<br />
lasting benefit to having registered sonographers in<br />
your institution may be realized when it is eligible<br />
to become a clinical site and mentor future<br />
sonographers.<br />
Kerry Weinberg, MPA, RT, RDMS, RDCS<br />
New York, New York<br />
The shortage <strong>of</strong> sonographers is due to the number<br />
<strong>of</strong> formal educational programs available. We<br />
cannot expect the current number <strong>of</strong> programs to<br />
produce enough sonographers to fill the current<br />
need. Even with the insufficient number <strong>of</strong> programs<br />
that are operating, some are limited to small<br />
class sizes because <strong>of</strong> clinical space. Also, in the<br />
past five years, the length <strong>of</strong> programs has increased.<br />
This is not a bad thing, but it does mean<br />
that we see fewer graduates in a year’s time.
270 JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4<br />
I believe that we are at a stage right now to know<br />
that the answer to part <strong>of</strong> the shortage lies within<br />
the educators <strong>of</strong> our pr<strong>of</strong>ession. We have to become<br />
innovators on how we can deliver<br />
sonography education. We have to try new ways. I<br />
am not talking about lowering our standards; if<br />
anything, let us raise them, but let us find new<br />
ways. I believe that distance learning is the key.<br />
We have got to make formal education more<br />
available. We have got to tear down the classroom<br />
walls and take education to the student. The technology<br />
is there; we just have to apply it. As educators,<br />
we are always telling our students to think.<br />
Now it is time for us to think. No more blaming the<br />
ARDMS or any other organization. This is not their<br />
responsibility. This is ours, and we have to make<br />
our move so that they can make their move.<br />
First, we have to understand what distance education<br />
is or, what I also like to say, what it is not.<br />
For the past five years, I have been working on how<br />
we can deliver sonography education to students at<br />
a distance. I do not mind telling you that it was<br />
rough and questionable in the beginning. However,<br />
each year has taught me new things. I have found<br />
new technology and have built bridges between<br />
myself and the distant student. I am at a point now<br />
that I believe not only that it will work but also that<br />
distance education can do things that an on-campus<br />
program cannot <strong>of</strong>fer. I do not want to keep my experiences<br />
to myself. I am ready to share them with<br />
anyone who wants to listen. Just call me.<br />
Joe Rothgeb, RT, RDMS, RVT<br />
West Point, Missouri<br />
The shortage was created by multiple situations.<br />
These situations include but are not limited to the<br />
following:<br />
1. the reliability and cost <strong>of</strong> the sonography<br />
examination provides a rationale for why more<br />
examinations are being requested;<br />
2. more facilities have become providers <strong>of</strong><br />
sonography examinations;<br />
3. the types <strong>of</strong> examinations available have<br />
expanded, such as the growth in breast<br />
sonography and fetal echocardiography;<br />
4. educational programs striving to provide<br />
excellent clinical learning environments cannot<br />
expand enrollment due to a limited number <strong>of</strong><br />
affiliate clinical settings and the limited number<br />
<strong>of</strong> sonographers willing to have students in a<br />
department;<br />
5. sonographers are leaving clinical practice to<br />
accept positions as educators, supervisors,<br />
managers, application specialists, and so forth;<br />
and<br />
6. a number <strong>of</strong> sonographers are eligible for<br />
retirement.<br />
To meet the demand, the number <strong>of</strong> programs<br />
needs to increase and/or programs need to increase<br />
enrollment. Increasing enrollment will require a<br />
commitment by sonographers to invest their time<br />
and talent to provide clinical practice skills. When<br />
looking for additional clinical facilities, one<br />
response received <strong>of</strong>ten is that sonographers are<br />
being asked to do so much now that it is unfair to<br />
ask them to add the additional responsibilities <strong>of</strong><br />
teaching and supervising a student.<br />
COMMENTARY<br />
Diane Kawamura, PHD, RT(R), RDMS<br />
Ogden, Utah<br />
For quite some time, I have been hearing<br />
disturbing comments about our field. They<br />
correlate unpleasantly well with today’s topic.<br />
Here are some examples:<br />
We expect you to complete a patient<br />
examination every 30 minutes, regardless <strong>of</strong><br />
the type <strong>of</strong> examination. That also includes all<br />
<strong>of</strong> the pre- and postexam paperwork.<br />
We have been advertising for an RDCS for a<br />
year now with no luck. Unfortunately,<br />
because we grant a bachelor <strong>of</strong> science in<br />
diagnostic medical sonography (DMS), the<br />
faculty all have to have a BS or higher.<br />
My supervisor just told me that he couldn’t<br />
excuse me from taking call, even with my
doctor’s statement, because if he did it for me<br />
he would have to do it for everyone!<br />
I heard that the waiting period to get into the XYZ<br />
DMS program is four or five years! Some <strong>of</strong><br />
my classmates are switching majors because<br />
<strong>of</strong> it. I don’t think I can wait that long just to<br />
become a sonographer.<br />
We are so backed up with patient exams that our<br />
supervisor has instructed us to return to the<br />
department after we clock out to finish out the<br />
scheduled exams. He says there will be no<br />
overtime because the hospital has told him he<br />
has to cut costs. When I complained that it<br />
didn’t sound legal to do so, he suggested that I<br />
could find another job if I wasn’t willing to be<br />
a “team” player and that it would be<br />
inadvisable to use him as a reference!<br />
If a student is on the advanced placement list<br />
(has medical background), we will be able to<br />
consider him or her for enrollment in 2004;<br />
otherwise, that student will have to enroll in<br />
the generic program (has no medical<br />
background) in 2010.<br />
Our administration has authorized hiring recent<br />
graduates <strong>of</strong> a nonaccredited school to fill our<br />
songrapher vacancies. He says one <strong>of</strong> the<br />
registered sonographers should cover for<br />
them and sign our names as the performing<br />
sonographer on any <strong>of</strong> their studies that might<br />
be questioned for reimbursement.<br />
We have no shortage here. We’re overloaded<br />
with students, what with all the schools<br />
churning them out at the rate <strong>of</strong> at least 50 per<br />
year each! Of course, the colleges only turn<br />
out 20 or so per year . . . they’re the accredited<br />
schools.<br />
SONOGRAPHER SHORTAGES / Craig 271<br />
It is apparent that we are all in a “Catch-22”<br />
situation together. It is long past time to collectively<br />
ask ourselves where we want our field to be in the<br />
next five to ten years and to communicate this to<br />
our national organizations. Guided by this input,<br />
our elected leaders need to develop one or more<br />
plans specifically designed to get us where we want<br />
to be.<br />
The rank-and-file sonographers (1) must have<br />
an active say in the future <strong>of</strong> our field, (2) be kept<br />
up to date with what their organizations’ governing<br />
boards recommend, and (3) have the opportunity to<br />
approve and vote their choices. The information<br />
gathered and presented by these governing boards<br />
must include realistic projections <strong>of</strong> what it will<br />
take in terms <strong>of</strong> time, money, personnel, and service<br />
to enable the field <strong>of</strong> sonography and each <strong>of</strong><br />
us to reach our stated goals.<br />
Given this opportunity, each <strong>of</strong> us must decide<br />
whether we want to be part <strong>of</strong> the solution or part <strong>of</strong><br />
the problem. No matter where you are practicing,<br />
no matter how secure your job is, this issue ultimately<br />
will affect you. It will keep affecting you<br />
until we come together in the spirit <strong>of</strong> cooperative<br />
perseverance to correct the deficiencies that now<br />
exist and threaten our pr<strong>of</strong>essional survival.<br />
Correspondence: Marveen Craig, 11510 North<br />
Charoleau Drive, Tucson, AZ 85737. E-mail:<br />
cramar25@earthlink.net.