Challenges to the Sonography ‘Profession’

The month of October was, amongst other things, Ultrasound Awareness month. This gives us the opportunity to consider some of the opportunities and challenges facing the profession of Sonography.

The first challenge is in the regulation of what a Sonographer is, and who can practice and call themselves a Sonographer. Unlike other healthcare professions such as Physiotherapists, Doctors, and Radiographers – Sonographers are not currently regulated by a professional body meaning anyone can legally call themselves a ‘Sonographer’.

Why is this a problem?

Having a regulated profession means there are set standards of competence, development, and behaviours that professionals must adhere to. Not having a regulated profession causes challenges to employers as they must assure themselves that individuals have the required pre-requisites and skills.

There are increasing options in entry routes to Sonography and an increase in the number of overseas workers coming to fill vacancies, these are urgently needed; however due to the lack of regulation there is a challenge in assuring that those routes adhere to the same standard as those who are trained on traditional post-graduate routes.

These are accredited by the Consortium for the Accreditation of Sonographic Education (CASE), which is made up of a group of professional bodies who have expertise in Ultrasound practice and having this standard gives assurance to employers as to their training.

Sonographer Regulation

Sonographer regulation has been an area of debate for some time and currently it is not imminent. Employers must make their own decisions as to who is competent, there is guidance out there to help, such as on NHS Employers.

Employers can assure themselves in the recruitment phase by having competency questions, live-testing and recruiting to values and behaviours.

Once employed it is imperative that there is an effective preceptorship, frequent supervision, audit, continual professional development, clear standards of practice, effective appraisals all overseen by evidence-based policies and guidance to ensure that Sonographers are working in a safe and effective way.

Growing the Workforce

The second challenge is in the number of Sonographers required to address the changing needs of the population. In the Southwest, there are unique challenges due to the changing of our demographic. We are a region that has the oldest percentage of over 65’s in the UK (26%), in 2037 we will have one of the oldest in the world, with up to 34% of people being over 65.

An aging population presents new challenges – as people get older their health needs increase, both in terms of appointment visits and length of stay in hospital. As these two things increase the requirement for diagnostics increases and the number of scans that are completed rise.

As we increase the number of scans, we require more staff. To cope with this increase, the workforce will need to grow by 50% –  levels which have never previously been achieved.

This will require novel methods of training and recruitment, which are hindered by a lack of professional regulation. A traditional entry route for Ultrasound is to become a Radiographer or other healthcare professional, which takes 3 years on a typical undergraduate BSc. Programme, then a student will attend a MSc. level qualification for at least a year – assuming they get funding or self-fund. This all takes time and is a barrier for someone wishing to work in Ultrasound but not within another profession first.

Direct Entry

There are increasingly more direct entry and apprenticeship routes which will be faster, more cost-effective, and more attractive for potential Sonographers. Currently if an employer would like to employ an individual who has gone down this route, they must ensure that their insurance will cover them and proceed without professional registration – which causes further problems with referring for additional tests and working under patient group directions (a system allowing the administering of medicines without prescribing). Employers have preferred the traditional routes.

This is an area of huge opportunity for employers to add to their numbers of Sonographers but it requires understanding and support from the wider healthcare system. There is also the requirement for consideration of how we are training our future workforce, and time for consideration of the use of technologies such as simulation and where we will train them, within what timescales and what specific areas of ultrasound.

There are further opportunities to consider what level of training is needed to complete some ultrasound exams, and whether there could be a model of iterative training and competence which will be increased over several years, allowing Sonographers to become useful in terms of capacity quicker.

Advanced Practice

Further opportunities for Sonographers include the increasing advent of advanced practice historically undertaken by Consultant Radiologists or other medical professionals.

The advantages for patients and Sonographers are huge in terms of the increased number of staff who can offer access to biopsy and interventions, with the aim of achieving cancer wait times and fast-track investigations. These routes also allow Sonographers to address the four-pillars of practice, allowing them to develop their own skills which will aid in retention of the current workforce.

There are clear challenges and great opportunities for the Sonography workforce, and the next five years will likely bring great changes to the profession, it will be interesting to reflect and see what has changed and review to consider what might be possible in the following five years.