Sonographer Shortages - Journal of Diagnostic Medical Sonography

10.1177/8756479303253946 

ARTICLE 

JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4 

SONOGRAPHER SHORTAGES / Craig 

JDMS 19:261–271 July/August 2003 

JDMS 19:261–271 July/August 2003 

FOCUSING ON THE ISSUES 

Sonographer 

Shortages: 

A Day Late and a 

Dollar Short? 

MARVEEN CRAIG, RDMS 

Part II 

In Part I of this topic, we presented the views of 

sonographers from many different clinical and 

commercial sonography settings. Without exception, 

they viewed the lack of accredited programs, 

the uneven geographical spread of existing accredited 

programs, and the small number of graduates 

as one of the major contributing factors to today’s 

shortage of skilled sonographers. Part II is devoted 

to the opinions of sonography educators. They 

share the concerns expressed by their colleagues 

and offer their own possible solutions. 

I believe that the sonographer shortage stems 

from the health care scare of six to eight years ago 

when departments were downsizing and not replacing 

staff that had resigned. The illusion of the security 

of working in a hospital was shattered when 

hospitals and clinics started closing. This also led 

to a decrease in the number of people applying to 

sonography programs. I recall that for a few years, 

our program was not at full capacity because of a 

lack of qualified applicants. Another major problem 

that all imaging programs are facing is the fact 

that when we raised our entry requirements, poten- 

DOI: 10.1177/8756479303253946 

JDMS 19:261–271 July/August 2003 261 

tial sonography students had to begin taking prerequisite 

courses. This exposure to other career 

choices has resulted in some students leaving the 

health care track. This problem faces all imaging 

schools because this shortage is not just a 

sonography issue. We all need to find ways to keep 

potential sonography students interested so that we 

do not lose them to other career programs. 

We need to start educating our youth, as early as 

elementary school, that there is more to a hospital 

career than being doctors and nurses, and we need 

to keep reminding them until graduation. Every 

year, I visit the elementary school that my children 

attended, whenever they are studying the heart and 

how to take care of it. My talks are held in gym 

class, of all places! And while I am there, I show a 

video of normal and abnormal hearts and I tell them 

about sonography and how I learned to take these 

special pictures and movies. 

Our imaging program representatives attend career 

fairs at local high schools to promote imaging 

careers. We invite some of the local high school seniors 

to spend the day at Johns Hopkins, where they 

tour various departments and we provide talks and 

question-and-answer sessions to encourage them to 

consider a health care career. We also encourage 

people who want to know more about sonography 

to spend the day in a sonography lab. This has decreased 

the number of dropouts who thought 

sonography was merely a happy-to-see-your-baby, 

isn’t-it-cute profession! 

Robert de Jong, RDMS, RDCS, RVT 

Baltimore, Maryland 

What has created the shortage of sonographers? 

Well, let’s drill down through the possible factors 

to see what lies at the bottom. First, it is supply and 

demand. We are all acutely aware that the demand

262 JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY July/August 2003 VOL. 19, NO. 4 

is increasing steadily as sonography disseminates 

out of radiology and into other specialties. So, there 

is not enough supply to meet the demand. Why? 

Not enough capacity in the educational system that 

supplies sonographers. My impression is that the 

vast majority of sonography schools are filling 

their classes, so that would mean that the basic capacity 

of the existing educational system is insufficient. 

Why can’t schools just scale up their 

individual capacity to meet demand? Hands-onpractice. 

Education in sonography is heavily dependent 

on one-on-one practicum experience, and 

the availability of good practicum sites appears to 

be decreasing as a result of increasing clinical demand 

on sonographers in clinical settings. Excessively 

busy sonographers just do not have the time 

to devote to students. How to fix it? Schools need to 

increase class size. This will require solutions to 

several problems: 

Increased capacity for practicum education. It 

does not matter much if there is another body in a 

lecture; it matters very much in practicum. We 

need to convince hospitals, independent teaching 

facilities, and doctors’ offices that they have to 

make a commitment to providing quality, 

structured practicum for students. Otherwise, this 

supply problem is just going to get worse instead of 

better. 

Helping schools fill larger classes by making 

sonography more visible to the potential enrollees. 

Having diagnostic medical sonography classified 

as a separate profession (thank you, the Society of 

Diagnostic Medical Sonography [SDMS] and the 

dedicated sonographers who supported this effort!) 

is a tremendous help. High school counselors are 

now more likely to be aware of sonography as a 

profession, but we need to aggressively support a 

“visibility” campaign that reaches juniors and 

seniors in high schools throughout the country. 

However, this will be pointless if there are not 

enough schools to accommodate interested 

candidates. It’s sort of like the chicken and the egg 

riddle. Both have to be addressed. 

Larry Waldroup, BS, RDMS 

Philadelphia, Pennsylvania 

Why is there a shortage of sonographers? From 

an educational standpoint, I would have to say that 

getting facilities to commit to taking students is difficult, 

although for the most part, we have been 

lucky with our clinical sites in the Phoenix area. 

However, once they take a student and their staffing 

changes, what level of obligation does the site 

have to continue mentoring? Or, what is the level of 

commitment from the “new” or “temp” person to 

work with a student? Not all clinical facilities are 

100% staffed with registered sonographers, so 

there also are issues of sonography students working 

with those who are not registered. 

Sometimes, it is the student who makes it difficult 

for those who follow. A site may take a student 

in the hope/promise that he or she will stay after 

program completion. Then, at the first opportunity, 

the student/graduate bails and goes to work somewhere 

else. 

What has caused this shortage? The old supplyand-demand 

adage is truly at work here. If you can 

work for a hospital at $X/per hour, and an outpatient 

site offers you $Y/per hour without call, you 

are going to work at the place that offers the most 

money and the best hours. 

Sometimes, the most money is earned by taking 

jobs here and there on a per diem basis or working 

at the lucrative jobs as a contract worker, traveler, 

and so on. These types of jobs offer a lot more flexibility 

to the employee who can pick and choose 

hours as well as call and working conditions. There 

are many jobs out there but not enough registered 

sonographers to go around. 

For example, consider the vascular sonographers 

in some Medicare states where an exam 

must be performed by a registered technologist in 

order to bill Medicare. This stipulation has created 

a shortage of vascular sonographers, and there are 

not enough schools and too few graduates to meet 

the ever increasing demand. To meet this demand, 

our program has been working for the past six years 

with local hospitals and clinics to form partnerships 

with the college. Sites must agree to sponsor a student(s), 

and in return, the student has a top-notch 

clinical site and the promise of a job at the end of 

their education. All sites must meet the criteria required 

by the college in terms of registered 

sonographers on staff, the number and types of exams, 

and so forth. This approach has helped us to

increase the number of incoming students and program 

graduates. 

However, there are other deeper issues that I see 

in the educational area regarding shortages. This 

holds true for all occupational programs, particularly 

those in diagnostic imaging. Right now, there 

are around eight faculty job openings in our 

sonography program: clinical instructors and/or 

program director positions. We are advertising for 

one such position, and the nibbles so far are from 

wonderful people who have no teaching experience. 

The word on the academic street is that these 

jobs are going begging because there is so much 

more money to be made in the real world than in the 

classroom. Also, we work long and hard for our 

salaries, which leaves little time (if any) to upgrade 

our skills and/or earn any additional dollars. The 

minimum academic standards for program directors 

in other imaging professions are changing to 

require a master’s level of education. Most people 

in the occupational areas are age 45+ and leaning 

toward retirement—food for thought from those of 

us in the teaching trenches. 

Kathleen Murphy, MBA, RDMS 

Phoenix, Arizona 

I think several things factor into the current 

sonographer shortage. First, to some extent, the job 

itself has lost a little of its appeal. Sonographers 

still have to take call, whereas other allied health 

fields staff for 24 hours. Many allied health fields 

offer more enticing shifts, such as three 12-hour 

shifts and four days off. I do not know of any 

sonography departments in our area that offer these 

shifts, and certainly no physician offices either. 

Salaries are often an issue—especially when compared 

to nursing. Even in Las Cruces, nurses can 

earn up to $60,000/year as a staff nurse. 

Another issue that may have an impact is the 

subspecialization of sonography. Many sonographers 

are happy to do one specialty exclusively 

but, after a while, want to do more. They may move 

to another specialty or change fields altogether. 

Those facilities offering a variety of exams keep 

their staff more interested. Potential students often 

SONOGRAPHER SHORTAGES / Craig 263 

ask me about the variety in our field before they apply. 

Of course, there also is the musculoskeletal injury 

issue, which goes hand in hand with the “onespecialty” 

issue. Sonographers are being forced to 

reduce their work hours or leave the field altogether 

due to injury. So, coupled with the fact that fewer 

people are going into this field, sadly, those with 

some experience are also being “injured out.” 

The shortage seems to be self-perpetuating in 

that potential students/employees observe how 

busy the departments are (due to being short 

staffed) and are hesitant to enter the field, thinking 

how hard they will have to work and for what 

amount of money. These are not just my opinions 

but based on comments I get from applicants and 

students. 

To meet this demand, I think we need to be very 

creative in how we offer education to nontraditional 

students. This may come down to the Joint 

Review Committee–Diagnostic Medical Sonography 

(JRC-DMS) looking at how to accredit programs 

that are more creative. Until we have enough 

staff in sonography departments to cover the major 

shifts, we will not be able to staff for 24 hours. I 

also think we have to offer incentives to facilities to 

encourage them to become clinical sites. Many 

sites have quit taking students because they are too 

busy to mentor them. I even heard that one institution 

closed its sonography program because there 

was no support from the hospitals. These facilities 

will also be shorthanded if we cannot provide 

enough internships for students. So it seems like a 

never-ending cycle. 

Carolyn T. Coffin, MPH, RDMS, RVT, RDCS 

Las Cruces, New Mexico 

El Centro College has continued to take 10 students 

each year for the past l6 years. All of our 

graduates are hired by clinical affiliates, where 

they have had clinical rotations. I am surprised at 

how many new sonography programs have started. 

There is a new program in Austin that takes 75 students 

a year on revolving three-month intervals. 

That seems to me like an overabundance of


sonographers for the marketplace to absorb. In our 

area, nurses are being cross-trained to do vascular 

and OB-GYN sonography. I know there are specific 

courses for nurses in annual conferences and 

seminars. I see the number of new accredited programs 

in the JRC-DMS report. 

I keep wondering if we are going to have problems 

similar to those that physical therapy has had 

with saturating the marketplace. If so, we could see 

salaries go down and sonographers on every corner. 

This is equally as scary to me as the problem of 

not enough sonographers. I do believe that several 

reasons for an increased demand is due to the price 

of equipment going down and more private physicians 

offering sonography in the office setting. I 

have talked with friends in commercial ultrasound 

companies who tell me that the companies are 

downsizing and having money problems. Is this 

going to filter down to sonography labs? 

I keep remembering a statement by my favorite 

mentor: “The questions remain the same ...itis 

just the answers that are different.” I wonder if the 

marketplace reaction to this “sonography shortage 

crisis” will result in a “sonography glut.” What will 

we say when we look back on this and see it from a 

different perspective? 

Jan Bryant, MS, RDMS, RT(R) 

Dallas, Texas 

I think the main cause of the shortage of qualified 

sonographers around the United States and the 

world is the fact that the profession literally has exploded 

in the past 30 years. Before 1972, there were 

not any certifying examinations and few, if any, educational 

programs. Yet today, it has been pointed 

out that “the ultrasound market, worth over 3.1 billion 

dollars in 1997 is the most dynamic sector of 

the diagnostic imaging market and is now the largest 

imaging modality, according to a new report, 

‘Ultrasound: The World Markets,’ from Clinical 

Reports” (“In the News: The Booming Ultrasound 

Market,” RT Image 1998;11:16). 

This huge increase in the medical usefulness of 

sonography, coupled with the operator dependence 

of the modality, has created an educational bottle- 

neck for the profession. Because sonography is the 

most operator dependent of diagnostic imaging 

modalities, it requires clinical education in a oneon-one 

clinical instructor-to-student ratio. This is 

similar to learning to ride a bicycle; one can read 

about it, watch a world-class bicyclist racing, and 

talk to an experienced bicyclist, but you have to get 

on the bicycle to learn to ride it. And most will 

wobble and fall at first. 

Unfortunately, many in medicine believe 

sonography to be much easier than it is. Physicians, 

nurses, and others watch a skilled sonographer scan 

and think, “I can do that.” A skilled sonographer 

makes it look very simple, but the casual observer 

does not realize the cognitive and psychomotor education 

that is required for success. To become a 

skilled sonographer, one has to get a lot of “transducer 

time” under the tutelage of an educated 

sonographer. 

A part of the shortage is due to the lack of clinical 

education sites with skilled clinical instructors. 

Our program stays at a maximum number of students 

for our clinical sites, and the only way we can 

expand our program is by acquiring new clinical affiliations. 

We have almost no luck in getting private 

offices to serve as clinical education sites. 

They seem to think it will slow up their schedule 

and cut into their pocketbooks. They cannot seem 

to understand that being a clinical education affiliate 

causes their staff sonographers to sharpen their 

skills and knowledge because of the interactions 

with the students. Also, they get to know the working 

habits of the students and who will be good potential 

students. Also, our clinical instructors get 

CMEs for working with the students. It seems that 

everyone is concerned about the shortage, but 

many do not want to help educate the students. 

Unfortunately, the “educational bottleneck” is 

often being filled by unaccredited schools that either 

do not understand or do not want to spend the 

time it takes to provide the comprehensive clinical 

education required to become a successful 

sonographer. This is the reason that I only recommend 

programs accredited by the Commission on 

Accreditation of Allied Health Education Programs 

(CAAHEP). 

Some creative ideas or steps to meet this demand 

might be making clinics understand that if they will 

not accept students, we are not going to be able to

fill this void with qualified individuals. We also 

need more of the existing programs to become accredited 

so that we know they are following accepted 

educational standards. The bottom line is 

that we need more accredited programs. 

Terry J. DuBose, MS, RDMS 

Little Rock, Arkansas 

I think a lot of legitimate, accredited sonography 

programs are probably hampered by budgetary restraints: 

“We will hire another faculty member as 

soon as you increase student enrollment to pay for 

this faculty member.” Sound familiar? Many educational 

institutions are operating on tight budgets, 

and it is difficult to expand their student enrollment 

because of this. 

Anthony L. Baker, BS, RDMS, RVT, CNMT 

Little Rock, Arkansas 

I think the current shortage is due to several 

issues: 

1. the “aging” of sonographers who have been in 

the field for decades and are now retired; 

2. the number of us who moved into supervisory 

nonscanning positions, commercial work, or 

education and left our clinical positions behind; 

3. the hot jobs a decade or so ago, which enticed 

people to move into the world of computers— 

hardware, software, programming, and Web 

design (these college-age kids saw big money 

and a more attractive offer than health care); 

4. the changes in health care, switching to the 

world of business with managed care but 

without placing any emphasis on allied health or 

even nurse training; 

5. the closure of most hospital-based education 

programs; 

6. the lack of advertising/marketing (I know it 

sounds cold, but information technology jobs 

and education are advertised big time. Let’s face 

it, if the word does not get out, how can these 

folks know about sonography?); and 


7. repetitive stress injuries and physical and mental 

fatigue after too much on-call and nonsupportive 

administrators. 

How to change it? We actually advertised our 

sonography programs for the first time—“Make a 

Sound Investment in Your Future.” We did, and do, 

offer monthly open house information sessions at 

which I spend an hour giving a presentation titled, 

“Sonography—What It Is.” I talk about all of the 

pertinent organizations: CAAHEP, JRC-DMS, and 

the American Registry of Diagnostic Medical 

Sonographers (ARDMS). I ask, “Do you know 

who scanned you? Who interpreted your exam?” 

Then, I talk about the various educational options 

in the United States and Maryland. Yep, I mention 

our direct competition since we are all here for the 

same goal. 

We are lucky that our local Sunday paper writes 

a great article weekly on a specific allied health 

field. I was interviewed in late December, allowing 

me to really get a message out there. I also tell folks 

who call me looking for “something in health care 

but not nursing” to consider checking out radiology, 

mammography, magnetic resonance imaging 

(MRI), computerized tomography (CT), nuclear 

medicine, and so forth. I know our professional 

fields are doing the best they can, but sonography 

needs more positive press coverage. 

We also talk to our students regularly about ergonomics 

and taking jobs you like, not just going 

for the “big bucks.” 

Jann Dolk, MA, RDMS 

Baltimore, Maryland 

There is a reason that the average age of a 

sonographer in this country is around 43. The developments 

and techniques in our labs, as well as 

most of the features currently available on our machines, 

are the result of early pioneers in 

sonography dedicating their time and energy toward 

developing the technology. This left a large 

gap in time, while the field of sonography matured, 

during which we did not recruit as we should have 

and are now paying for it. This gap, in many instances, 

is being force-filled by employers requir-


ing employees to cross-train in multiple 

sonography modalities, even at times from unrelated 

professions. In addition, we have created a 

dynamic new field that has seen an incredible increase 

in utilization, as the medical community realizes 

our capabilities—not to mention competition 

for available personnel by new labs starting up. 

This has only emphasized the already short-staffing 

situations most labs are enduring. 

Another contributing factor is the shortage of 

long-established, accredited educational programs 

producing a sustainable, steady flow of qualified 

sonographers. However, if we start more schools, 

educate qualified sonographers, and fill positions, 

it will not be long before the demand is met, and the 

new graduate will have difficulty finding a good 

job. We have all seen examples of this in other professions 

where the job market was flooded, leaving 

individuals with advanced degrees flipping burgers. 

The result could be the closure of schools and 

years of experience being lost to future students. 

This brings us to the next question: what creative 

ideas or steps can you think of to meet this demand? 

Even though we are experiencing severe 

staff shortages in some areas of the country, there 

are still a limited number of jobs available. I know 

this may sound contradictory, but consider that 

hospitals recruit and hire hundreds or even thousands 

of nurses and other ancillary staff, while 

most do not require the services of more than two to 

ten sonographers. As an option to starting more 

schools, we could develop an accredited distancelearning 

program with regional and local clinical 

sites for testing and evaluation purposes. Ultimately, 

this would enable educational institutions, 

due to increased funds, to further improve the quality 

of the programs they can offer. Labs could then 

hire apprentices to participate in these programs. 

Under this format, apprentices would have exposure 

to standardized didactic training and clinical 

protocols, as well as instructors with years of experience, 

while earning their degree. Even the smallest 

community hospital would be able to educate 

high-quality sonographers in a variety of modalities 

while maintaining the workflow, increasing efficiency, 

and creating career ladders for qualified 

individuals. This not only results in meeting the 

need of retirement transition and/or increased 

workload demands but also standardizes the delivery 

of services in labs across the country. 

Obviously, the two biggest hurdles to overcome 

are time and public awareness. Since we cannot 

shorten the time required to train new 

sonographers, I think our focus needs to be on public 

awareness. The vast majority of the general population 

has not even heard of sonography, and to 

those who have, the immediate connotation is 

“baby on board,” not cardiac, vascular, breast, or 

any of the other numerous applications of 

sonography. Job fairs, public service announcements, 

a television spot during the Super Bowl— 

these are things that will educate the public. I think 

a good example has already been set by the drug 

companies with their commercials, “Do you have 

this problem? See your doctor to find out if the blue 

pill is right for you.” The military created the “it’s 

not just a job, it’s an adventure” theme because its 

numbers were slipping. 

The medical community knows who we are. 

What we need is good advertising and marketing 

departments that target John Q. Public, to let them 

know who we are and what we do. That will get 

young people interested in our field. Shows such as 

20/20 and Oprah get us publicity, but not necessarily 

the kind we want or need. 

So, I guess my suggestion is twofold: first, let’s 

get all the societies such as the SDMS, Society for 

Vascular Ultrasound (SVU), American Society of 

Echocardiography (ASE), American Institute of 

Ultrasound in Medicine (AIUM), and so forth to 

develop a unified marketing department. We could 

solicit funds and grants from governmental, commercial, 

and corporate entities, such as hospitals 

and manufacturers, as well as contribute a portion 

of our dues to advertise and show the world who we 

are and what we do. Second, we need to organize 

and standardize our labs, set up a network for students 

to do clinical rotations in, and start recruiting 

and educating qualified apprentices and provide 

them an opportunity to grow with a future they can 

look forward to in an exciting and dynamic field. 

Terry J. Zwakenberg, BS, RVT, RDCS 

Columbia, South Carolina

I am concerned that the shortage of sonographers 

is partly due to the number of sonographers 

who have ended their careers due to occupational 

injury. This is exacerbated by the fact that the average 

age of a sonographer is 42 years. Data show 

that 80% of sonographers are between ages 30 and 

50, and they are about evenly distributed between 

these age groups—in other words, 40% between 

ages 30 and 40 and 40% between ages 41 and 50. 

This is a pending serious situation since we shall be 

losing the most experienced sonographers in our 

profession to premature retirement, which will 

only make this situation worse. 

However, this is not the only cause for the shortage. 

I think the shortage is also a result of lower reimbursement. 

Departments are trying to do more 

with less; they are understaffed out of choice to 

save money. It is not too long ago that we saw 

downsizing caused by reduced reimbursement. To 

our concern, we also saw certified sonographers 

being let go in favor of uncertified technicians simply 

because they cost less in salary. Some of those 

qualified sonographers left the field out of disgust 

for what was going on in the human resource departments. 

Still today, we hear that radiology managers 

think that x-ray techs can be cross-trained 

into sonography in a matter of weeks. I know of 

some situations in breast centers where sonographers 

have been asked to do this cross-training 

and replied by saying, “Why don’t you cross-train 

me to take mammograms?” and that is stated to be 

impossible. Our technique of scanning looks so 

easy to do to the untrained eye and is so misunderstood 

by those outside of our field. That makes it 

our responsibility to educate those around us as to 

what is really involved in being a sonographer. 

Finally, the shortage is also caused by the fact 

that anything to do with medicine is no longer 

deemed glamorous in the eyes of the graduating 

high school senior. Every branch of medicine—including 

medical schools—is seeing fewer and 

fewer applicants. Physicians are not recommending 

to their children that they go into medicine; 

they are telling them to go into business—particularly 

the computer aspects. Young people hear a lot 

more about medicine in the classroom today, but it 

comes in the form of AIDS education, the rate of 

hepatitis C and how easily it is transmitted, and the 

consequences of smoking, doing drugs, and drink- 


ing. Certainly, these are valid educational topics 

but not an attraction for those considering healthrelated 

fields as a career choice. Who wants to devote 

a career to dealing with people with these 

problems? 

I do not know how creative the following ideas 

are, but I think they are worth mentioning. 

We need to be willing to educate others, especially 

from accredited programs. If we do not provide 

the manpower necessary to give the students 

access to our modality, it will be provided by others. 

Sonographers who have graduated from 

schools within the past five years refuse to take students 

into their departments because they complain 

they are too overworked and do not want to be 

bothered teaching. All I can say to them is, “How 

lucky you are that someone did not feel that way 

when you needed to be mentored.” I am starting to 

see a willingness among the older, more experienced 

sonographers to take students as a way to 

lessen the number of cases they have to do per day 

because they are hurting, and this is a way they can 

stay in the field they love. We need more of these 

willing sonographers; of course, I wish they were 

not injured. 

We need to become ambassadors and be willing 

to hold career fairs and approach local schools— 

especially the science or biology teachers—and offer 

to teach a class for them and tell the students 

about the rewarding side of sonography. Yes, that 

means some fetal videos: not for entertainment but 

for recruitment! 

We need to get funding for education. I am on a 

committee on manpower for the Washington State 

Hospital Association, and I am the only nonnurse 

and the only college representative on the committee 

(except when my coworker Ann Polin and I attend 

together). I have learned a lot from attending 

these meetings and watching how nurses get funds 

for what they need. They approach things very differently 

than the rest of us. To start with, they do 

not talk about how hard they are working or how 

many patients they have cared for that month or last 

year. They talk about the ones who could not be 

cared for because there were no nurses to staff the 

floor and the amount of revenue the hospital lost 

because of this (calculated from an average patient 

day and the money generated by that patient in 

tests, etc.). So they are talking about lost revenue,


not revenue that is already in the bank! This is a lesson 

we need to learn, and this is data we need to 

start collecting. How many times does the receptionist 

say, “We can do your sonogram next week 

or the week after,” and the nurse or doctor’s office 

hangs up and calls someone else? How many 

sonographers are working overtime and giving up 

their lunch hours to accommodate add-on patients 

at the expense of their own health? We may need to 

create a crisis to solve a crisis. We need to speak 

more positively about our field. I know it is hard 

when we are so busy and understaffed, but we cannot 

recruit on a negative campaign; no one is interested 

in joining a profession of complainers or 

because they feel sorry for you. We have to sell the 

profession as an upbeat, happy, and rewarding 

field. 

Joan Baker, MSR, RDMS, RCDS, FSDMS 

Bellevue, Washington 

I believe the shortage in sonography has been 

created by the improvements in sonographic technology, 

the need for competence (in correlating 

clinical data with presenting symptoms and the 

sonographic findings), and the necessarily stringent 

guidelines set by the accrediting bodies. Let 

me elaborate. 

As technology improves (e.g., higher frequency 

transducers, allowing visualization of more superficial 

structures, better penetration capabilities, and 

faster diagnosis), more exams are being requested 

of the sonography department. Musculoskeletal departments 

are sending sports injuries such as Achilles 

tendon tears, rotator cuff injuries, and others. 

We are better at looking for and assisting in the removal 

of foreign bodies. Pediatric applications, 

such as pyloric stenosis, hip dysplasia, and tethered 

spine, are on the rise, as well as imaging of the neonatal 

head. Vascular imaging is also on the rise. Improved 

equipment for the detection of peripheral 

vascular disease and the high sensitivity for carotid 

disease and venous thrombosis brings more and 

more patients to sonography. In years past, the 

angiography department got many of these exams. 

With all of these increases in the technology and 

uses of sonography comes the need for education. 

It becomes a tiresome task to choose what we 

should and should not teach in the program, not to 

mention coverage in the medical community while 

sonographers are being taught. Younger radiologists 

are entering practice with a better understanding 

and appreciation for sonographic imaging. 

They know it is inexpensive, mobile, and reliable. 

They are willing to perform invasive procedures 

with ultrasound guidance instead of CT, MRI, special 

procedures, or—for surgeons—surgery. 

Competence is a very critical element. 

Sonographers are the first to image and therefore 

see what is afflicting patients who have disease. 

The ability to correlate knowledge of clinical findings 

(labs and other diagnostic exams), presenting 

symptoms, and sonographic findings requires great 

skill. All sonographers need to possess the ability 

to put the whole picture together. We are dealing 

with real lives. Empathy, understanding, patience, 

and other “soft skills” need to be part of the 

sonographer’s makeup. Not everyone can be taught 

these skills. I could go on and on, but you get the 

picture. 

The accrediting body (JRC-DMS) has set criteria 

for approved learning. The lack of schools and/ 

or students entering the field may well be due to the 

guidelines we, in education, must follow. I am not 

saying they are unreasonable, but they do limit the 

possibilities of moving greater numbers through 

the educational process. For example, students 

must complete a clinical internship to graduate 

from their programs. Clinical sites are required to 

do a specific number of exams per year, and of 

those exams, a specific number must be abdomen, 

OB-GYN, and so on, if they are to qualify. In large 

cities, finding clinical sites that meet this criterion 

is not terribly difficult, but in smaller cities such as 

ours, it is most difficult. We have sites throughout 

Wisconsin and Minnesota. In past years, we have 

had to go to Michigan, Indiana, South Dakota, 

Kansas, and even to Montana. This coming year, 

we will add Iowa to that list. Without this clinical 

education, student interns would not survive in the 

workplace, so it is necessary. 

We at Chippewa Valley Technical College really 

struggle with how to increase numbers coming

into and graduating from the program. We are well 

aware of the shortage in the United States. I get 

calls almost daily, asking when we will be graduating 

students and asking if I know anyone who is 

available for hire. It is a true dilemma. I just wish I 

had an answer. 

Tina Salava, RT(R), RDMS, RVT 

Eau Claire, Wisconsin 

Currently, there is a nationwide shortage of 

qualified (ARDMS-registered) sonographers. As is 

the case with many workforces, the job market for 

sonographers is cyclical. Due to the increased use 

of sonograms, this is the worst shortage ever. 

Sonography has historically suffered from an identity 

problem. It was not until the fall of 2001 that 

the Department of Labor recognized sonography as 

an occupation. If career counselors’ list of health 

care occupations and the published statistics of projected 

job shortages do not include sonography, 

how will people know about the field? We traditionally 

do not hear children saying, “When I grow 

up I want to be a sonographer.” Most people with 

whom I come into contact have entered the field as 

a second or third career. They want to help people 

and want to have a stable job with a salary on which 

they can support themselves. In the 1990s, the big 

career hype was in computers and the “dot.com” 

companies. Health care was not considered to be on 

the cutting edge as the place to work or where you 

could make a six-figure salary. We all heard the 

stories about young people working for dot.coms 

who were making huge salaries and planning to retire 

in their 30s with their stock options. As we now 

know, not too many of them ever made those millions. 

Scanning is an acquired skill that cannot be 

learned overnight or by reading a book. The clinical 

aspect of sonography education takes time, and 

many people have families to support while they 

are going to school and cannot afford not to work. 

This further dissuades people from entering the 

field. We cannot afford to lower the standards and 

have people working without at least one year of 

supervised clinical education. 


Hospitals, like every other business, have been 

looking at ways to lower their costs. During past 

shortages, hospitals paid a stipend to have students 

rotate to their facilities. It may be time, once more, 

for hospitals to make an investment in education. If 

there is a local CAAHEP program, why not offer to 

take a student? It is a great way to have first choice 

of the graduates, and it helps with filling future 

openings. Hospitals can sponsor a student by paying 

for all or part of that student’s education and 

have him or her repay the facility by signing a contract 

to work there upon graduation. Another option 

is by initiating departmental education and 

upgrade programs. Offering an employee the opportunity 

to upgrade by sending him or her to a 

CAAHEP-accredited program to learn sonography 

has great appeal. It would be valuable to have the 

employee take as many courses as possible before 

leaving for the clinical component portion of the 

program; some programs may even offer their 

courses online. The student will have to relocate for 

the clinical aspect of the program, but when he or 

she returns to the hospital, that person will bring 

back a wealth of knowledge, protocols from other 

facilities, and a host of new and different techniques. 

The institutional benefits would far outweigh 

the initial costs by increasing the quality and 

quantity of sonography examinations performed. A 

lasting benefit to having registered sonographers in 

your institution may be realized when it is eligible 

to become a clinical site and mentor future 

sonographers. 

Kerry Weinberg, MPA, RT, RDMS, RDCS 

New York, New York 

The shortage of sonographers is due to the number 

of formal educational programs available. We 

cannot expect the current number of programs to 

produce enough sonographers to fill the current 

need. Even with the insufficient number of programs 

that are operating, some are limited to small 

class sizes because of clinical space. Also, in the 

past five years, the length of programs has increased. 

This is not a bad thing, but it does mean 

that we see fewer graduates in a year’s time.


I believe that we are at a stage right now to know 

that the answer to part of the shortage lies within 

the educators of our profession. We have to become 

innovators on how we can deliver 

sonography education. We have to try new ways. I 

am not talking about lowering our standards; if 

anything, let us raise them, but let us find new 

ways. I believe that distance learning is the key. 

We have got to make formal education more 

available. We have got to tear down the classroom 

walls and take education to the student. The technology 

is there; we just have to apply it. As educators, 

we are always telling our students to think. 

Now it is time for us to think. No more blaming the 

ARDMS or any other organization. This is not their 

responsibility. This is ours, and we have to make 

our move so that they can make their move. 

First, we have to understand what distance education 

is or, what I also like to say, what it is not. 

For the past five years, I have been working on how 

we can deliver sonography education to students at 

a distance. I do not mind telling you that it was 

rough and questionable in the beginning. However, 

each year has taught me new things. I have found 

new technology and have built bridges between 

myself and the distant student. I am at a point now 

that I believe not only that it will work but also that 

distance education can do things that an on-campus 

program cannot offer. I do not want to keep my experiences 

to myself. I am ready to share them with 

anyone who wants to listen. Just call me. 

Joe Rothgeb, RT, RDMS, RVT 

West Point, Missouri 

The shortage was created by multiple situations. 

These situations include but are not limited to the 

following: 

1. the reliability and cost of the sonography 

examination provides a rationale for why more 

examinations are being requested; 

2. more facilities have become providers of 

sonography examinations; 

3. the types of examinations available have 

expanded, such as the growth in breast 

sonography and fetal echocardiography; 

4. educational programs striving to provide 

excellent clinical learning environments cannot 

expand enrollment due to a limited number of 

affiliate clinical settings and the limited number 

of sonographers willing to have students in a 

department; 

5. sonographers are leaving clinical practice to 

accept positions as educators, supervisors, 

managers, application specialists, and so forth; 

and 

6. a number of sonographers are eligible for 

retirement. 

To meet the demand, the number of programs 

needs to increase and/or programs need to increase 

enrollment. Increasing enrollment will require a 

commitment by sonographers to invest their time 

and talent to provide clinical practice skills. When 

looking for additional clinical facilities, one 

response received often is that sonographers are 

being asked to do so much now that it is unfair to 

ask them to add the additional responsibilities of 

teaching and supervising a student. 

COMMENTARY 

Diane Kawamura, PHD, RT(R), RDMS 

Ogden, Utah 

For quite some time, I have been hearing 

disturbing comments about our field. They 

correlate unpleasantly well with today’s topic. 

Here are some examples: 

We expect you to complete a patient 

examination every 30 minutes, regardless of 

the type of examination. That also includes all 

of the pre- and postexam paperwork. 

We have been advertising for an RDCS for a 

year now with no luck. Unfortunately, 

because we grant a bachelor of science in 

diagnostic medical sonography (DMS), the 

faculty all have to have a BS or higher. 

My supervisor just told me that he couldn’t 

excuse me from taking call, even with my

doctor’s statement, because if he did it for me 

he would have to do it for everyone! 

I heard that the waiting period to get into the XYZ 

DMS program is four or five years! Some of 

my classmates are switching majors because 

of it. I don’t think I can wait that long just to 

become a sonographer. 

We are so backed up with patient exams that our 

supervisor has instructed us to return to the 

department after we clock out to finish out the 

scheduled exams. He says there will be no 

overtime because the hospital has told him he 

has to cut costs. When I complained that it 

didn’t sound legal to do so, he suggested that I 

could find another job if I wasn’t willing to be 

a “team” player and that it would be 

inadvisable to use him as a reference! 

If a student is on the advanced placement list 

(has medical background), we will be able to 

consider him or her for enrollment in 2004; 

otherwise, that student will have to enroll in 

the generic program (has no medical 

background) in 2010. 

Our administration has authorized hiring recent 

graduates of a nonaccredited school to fill our 

songrapher vacancies. He says one of the 

registered sonographers should cover for 

them and sign our names as the performing 

sonographer on any of their studies that might 

be questioned for reimbursement. 

We have no shortage here. We’re overloaded 

with students, what with all the schools 

churning them out at the rate of at least 50 per 

year each! Of course, the colleges only turn 

out 20 or so per year . . . they’re the accredited 

schools. 


It is apparent that we are all in a “Catch-22” 

situation together. It is long past time to collectively 

ask ourselves where we want our field to be in the 

next five to ten years and to communicate this to 

our national organizations. Guided by this input, 

our elected leaders need to develop one or more 

plans specifically designed to get us where we want 

to be. 

The rank-and-file sonographers (1) must have 

an active say in the future of our field, (2) be kept 

up to date with what their organizations’ governing 

boards recommend, and (3) have the opportunity to 

approve and vote their choices. The information 

gathered and presented by these governing boards 

must include realistic projections of what it will 

take in terms of time, money, personnel, and service 

to enable the field of sonography and each of 

us to reach our stated goals. 

Given this opportunity, each of us must decide 

whether we want to be part of the solution or part of 

the problem. No matter where you are practicing, 

no matter how secure your job is, this issue ultimately 

will affect you. It will keep affecting you 

until we come together in the spirit of cooperative 

perseverance to correct the deficiencies that now 

exist and threaten our professional survival. 

Correspondence: Marveen Craig, 11510 North 

Charoleau Drive, Tucson, AZ 85737. E-mail: 

cramar25@earthlink.net.

Sonographer Shortages - Journal of Diagnostic Medical Sonography

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?