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May 21

Ultrasound Practitioners

Ultrasound Practitioners

By Joyce Ward, CNMT, RT(N)

With the rapid growth in the number and types of ultrasound procedures being conducted, a growing number of experts believe there is a need for someone to perform and/or interpret ultra sound examinations.

Anticipating that an “ultrasound practitioner” could fill this role, the Society of Diagnostic Medical Sonographers (SDMS) has established an Ultrasound Practitioner Commission (UPC) to explore the viability of such a position, suggest suitable didactic education and clinical training programs for it, and work with interested universities.

“As envisioned by the UPC, the ultrasound practitioner would not work as an independent professional,” said Rebecca Hall, PhD, RDMS, vice president of the SDMS and chair of the UPC. “Instead, the practitioner would work as part of the team with physicians to enhance the whole practice, much like a nurse practitioner or physician’s assistant. Indeed, educated at a master’s degree level, the ultrasound practitioner would be a mid-level provider whose scope of practice would be similar to that of nurse practitioners or physician assistants,” Dr. Hall said.

Ultrasound practitioners might work in rural areas or in urban medical practices. There might be a number of sonographers working in the practice, with the ultrasound practitioner reading some or all exams, but being indirectly supervised by a physician, who would cosign all reports. “Just as nurse practitioners and physician assistants can perform and bill for many procedures, ultrasound practitioners also would be able to charge for their services,” said Dr. Hall.

Proponents of the idea argue that the time has come for the establishment of ultrasound practitioners. As the most widely used imaging modality in the world, ultrasound is also the most dependent on operator skill. Many physicians have been tempted to take up the transducer and scan their own patients; however, most have found that, even when they have the skill to perform the study, sonography is time consuming. Consequently, most physicians must rely on the skill and knowledge of the sonographer to assess the patient’s problem and properly demonstrate findings.

“Just by doing a general survey, the sonographer is going to make a clinical assessment of that patient,” said Dr. Hall, who is also assistant professor and clinical director of the Ob-Gyn Resident ultrasound program at the University of New Mexico Health Sciences Center in Albuquerque, N.M.

She explained that the physician generally reads from selected images that the sonographer has chosen to represent the relevant findings or pathology. Therefore, most physicians rely on the sonographer’s input when reading the ultrasound films. In some practices, physicians have the sonographer fill out a preliminary report.

“The sonographer’s role in assisting in the diagnostic process was backed up by the Sonography Benchmark Survey 2000, conducted by the SDMS and the SDMS Educational Foundation,” stated Terry J. DuBose, MS, RDMS, director of the Diagnostic Medical Sonography Program at the University of Arkansas for Medical Sciences, in Little Rock. The university is exploring the idea of establishing an ultrasound practitioner program.

“Seventy-eight percent of the 9,709 respondents to the survey indicated that they write impressions,” said DuBose, “while almost 69 percent indicated that they discuss patient and ultrasound findings directly with the referring physician.”

DuBose noted that a 1994 survey conducted by the American Registry of Diagnostic Medical Sonographers found that 96 percent of vascular sonographers and 85 percent of general sonographers provide preliminary interpretation of test results either verbally or in writing to physicians.

Practitioner Models
In exploring formation of an ultrasound practitioner’s position, the UPC looked at the success of master’s level radiography practitioners in the United Kingdom. There, radiographers use “red dots” to point out areas of concern on X-ray films. Some radiographers, all of whom have the equivalent of bachelor’s degrees, go on to the master’s level program, completion of which permits them to read skeletal films. Various studies have showed that the sensitivity and specificity of these specialists is equal to or better than that of general radiologists.

The UPC has also examined the established educational programs for nurse practitioners and physicians assistants. The commission is endeavoring to incorporate the best qualities of these programs into the proposed ultrasound practitioners program.

Two things they like about physician assistant programs center on their continuing education requirements–PAs must obtain 100 credits in three years and take a recertification exam every six years. The commission expects that the ultrasound practitioner will be required to take national certification and recertification exams; however, the specific certifying agency must still be determined, as must the number of continuing education credits that will be required of ultrasound practitioners.

The UPC is also seeking to standardize the experience and educational level of the ultrasound practitioner. Although PA programs teach the same basic skills, the educational level of graduates varies. There are certificate programs, associate-level programs, bachelor’s-level programs and master’s-level programs. “The SDMS wants all ultrasound practitioners to have at least a master’s degree, similar to the requirement for nurse practitioners, as well as to have at least five years’ experience working as a registered sonographer. To get into an ultrasound practitioner program, candidates would have to have at least a bachelor’s degree,” Dr. Hall said.

“By standardizing the program we will know that everyone has a certain level of background,” said Dr. Hall. “That may not make some people who are highly experienced but do not have a bachelor’s degree very happy. It may eliminate some very good ultrasound professionals because they cannot go back to school. All medical specialties have undergone these changes as their professions have evolved, however. Instead of going backward and saying that in the year 2010 we will eliminate associate-level ultrasound practitioners, we are starting off and developing the program around a master’s-level education.”

For sonographers who wish to complete a BA in anticipation of the ultrasound practitioners’ degree, required courses are delineated on the SDMS Web site at www .sdms.org.

“Other issues must still be addressed before ultrasound practitioner programs become a reality,” indicated Dr. Hall.

“It is not only the educational requirements and the national board exam, but also liability and licensure for each state, that must be worked out,” she said. “Then there is the question about who can bill. The fact is that the PAs and NPs can bill for their services, and they probably bill about 80 percent of what the physicians bill for the same services. This will probably sound appealing to the insurance companies, but we have not dealt with [that aspect] yet, so it would be premature to say this is the way it will go.”

Additionally, because of the time required to establish a sufficient number of formal programs, Dr. Hall stated that until 2010, sonographers who complete a master’s level program that includes the required coursework would be able to take the exam for ultrasound practitioner. After 2010, however, only those who graduate from an approved program will be able to sit for the exams. Both, however, would require the clinical component in order to be eligible.

“I believe that recognition of more advanced sonographers will result in better health care, as well as a higher standing in the medical profession,” said DuBose. “It will also attract more into the field and help to retain those already in it. This will result in better health care, because more experienced sonographers will be retained, and it will give the public a method of recognizing those with more experience and skills.”

Joyce Ward is the technical editor at ADVANCE. She can be reached at jward @merion.com.

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