Introduction by Croakey: Workforce pressures, scope of practice, and critical regulatory issues are some of the topics up for discussion at the 31st Annual International Conference of the Australasian Sonographers Association (ASA) in Naarm/Melbourne from 13-15 June.
The conference, with the theme ‘Educate, Evaluate, Celebrate’, will also have a big focus on communication with patients and person-centred care.
Below, Marie McInerney previews the conference for Croakey Conference News Service.
Marie McInerney writes:
The risks to mother and baby health from a boom in so-called ‘reassurance’ or ‘souvenir’ ultrasounds for pregnant women have underscored a number of critical regulatory, scope of practice and workforce shortage issues for Australian sonographers.
In contrast to routine medical ultrasounds recommended during pregnancy, the non-medical ultrasounds are being offered in private practices and often by comparatively untrained operators, promising to offer peace of mind to anxious mothers, to reveal a baby’s gender or provide a three- or four-dimensional memento of the unborn baby.
Health Minister Mark Butler recently told ABC TV’s 7.30 show that the growing practice had gone under the radar of the Department of Health and Ageing because these are non-medical procedures that don’t involve Medicare benefits or private insurance payments.
But the practice has hit the headlines and alerted health regulators lately, amid media reports of allegations that some women have been given a wrong diagnosis while other scans had missed heart and skeletal abnormalities in developing babies.
There’s also concern that women may miss out on advised medical ultrasounds because they think they have already been properly examined during a ‘reassurance’ screen.
Australasian Sonographers Association (ASA) chief executive Dr Tony Coles says he is concerned patients may be unaware that a non-diagnostic ultrasound does not provide information on the health and development of the baby in utero, leading to false assurance.
Moreover, there are no requirements for a non-diagnostic scan to be performed by a qualified professional, he said.
Coles has called for all sonographers to be registered under the Medical Radiation Practice Board of Australia (MRPBA), overseen by the Australian Health Practitioner Regulation Agency (Ahpra), to protect patients and restrict who could call themselves a sonographer.
Only sonographers who are also radiographers are currently registered with Ahpra.
“Registering sonographers under the MRPBA would not only provide protection of title for sonographers, but it would also provide greater reassurance to patients that the sonographer undertaking their scans is compliant with national standards, including recency of practice and criminal history checks,” Coles said.
“Sonographer regulation would also bring the profession into line with other medical imaging professions, such as radiographers and nuclear medicine technologists.”
It’s a call backed by Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australian Medical Association, and is being considered by Butler as part of an independent review about complexity in the National Registration and Accreditation Scheme (National Scheme).
In its submission to the National Scheme review, the Australasian Sonographers Association warned that when a sonographer fails to produce quality images or identify pathologies, there are currently no enforceable standards of practice to measure the quality of ultrasound examinations provided by Australian sonographers.
It also warned that complaints handling for sonographers is “fragmented and ineffectual”, saying there is a “growing list of situations where complaints are raised against a sonographer, the complaint is insufficiently investigated, and the situation becomes a criminal prosecution to be resolved”.
In a statement this week, Ahpra said it shared Minister Butler’s concern about “potential predatory practices” by some sonographers offering ‘reassurance’ or ‘souvenir scans’ and reports that some may be offering unqualified clinical advice while providing these scans.
“We are concerned to hear reports that some businesses and sonographers are offering verbal warnings to parents that there may be a problem with their unborn child that is not documented nor reported,” Ahpra said, adding that it was monitoring the practice.
Large gathering
These and other important regulatory, professional, clinical, workforce and medico-legal issues will be up for discussion at the 31st Annual International Conference of the Australasian Sonographers Association (ASA) in Naarm/Melbourne from 13-15 June.
The annual event boasts the biggest gathering of sonographers in the world, with a program that balances technical advancements, professional development, and emerging trends in ultrasound.
This year more than 2,000 participants will attend – 1,200 in person and the remainder online, a hybrid delivery aimed particularly to accommodate sonographers in rural and regional areas and others who might not be able to take time away from work.
A Sound Stage will feature TED talk-style sessions with expert speakers and live scanning demonstrations, while high level panel discussions will consider issues such as: ‘Is the burden of sonography too great?’ and ‘Mitigating risks through a legal lens’.
The need for better care of Aboriginal and Torres Strait Islander patients is also on the agenda, with a session on culturally safe communication.
Conference organiser Paula Kinnane, ASA’s General Manager of Professional Development, Clinical Standards and Research, says the scope of the agenda highlights the diverse skills covered by sonographers, including obstetric, vascular, breast, musculoskeletal and cardiac imaging.
“If you tell someone you’re a sonographer, the first assumption they have is that you scan babies all day,” Kinnane told Croakey.
“I work in maternal fetal medicine, so in my case that’s true, but it’s not for a lot of sonographers. We learn to scan from head to toe, from eyeballs to testicles and everything in between!” she said.
Retention concerns
A big focus of this year’s conference will be on workforce pressures.
The problem is not at the recruitment end.
Kinnane says there is no shortage of interest in joining the profession, a demand reflected by the requirement for an Australian Tertiary Admissions Test (ATAR) result of up to 95.5 at some universities to study sonography.
But there is a huge struggle to find clinical training places for students, who are required to do approximately 2,000 clinical hours before graduating, versus the 600 hours that nurses, for example, do.
And retention is a major and growing issue, exacerbated by the pressures of the COVID-19 pandemic.
The ASA’s 2024 Employment and Salary Survey revealed that 38 percent of Australian and New Zealand sonographers plan to leave the profession within the next decade, with 19 percent intending to exit within the next five years.
“It’s an astronomical rate (of departure),” Kinnane says, noting that feedback to the survey highlighted ongoing stress and morale issues, primarily driven by high workloads, time pressures, staffing issues and the expectation to perform multiple tasks within limited timeframes.
Occupational health
The ASA has reported that musculoskeletal disorders are a significant and growing challenge for sonographers, with 85 percent experiencing work-related pain within the past year, and one in five having potentially career-ending injuries.
The growing burden has been driven in many cases by treating patients with high BMI, where sonographers tend to use increased compression, force, and extended scan time, says Kinnane, who has had two shoulder reconstructions and two wrist surgeries as a result of workplace injury.
“The public is not aware of how physical a job it is,” she said.
One timely clinical focus at the conference will be on endometriosis, with the pending 1 November introduction of two new items in the Medicare Benefits Schedule. These will enable extended consultation times and increased rebates for scanning and treatment of women suffering endometriosis and complex gynaecological conditions like chronic pelvic pain and polycystic ovary syndrome.
“The gender Medicare gap is well known and it is frustrating that ultrasounds of female anatomy often require more time, equipment, and staff, yet receive reduced rebates,” Kinnane said.
Communication and consent
Under the theme of “Educate, Elevate, Celebrate”, the conference will also have a big focus on communication with patients, seeking to provide better care, and also address risks around issues of consent and other complex legal and medical issues, particularly around trans-vaginal imaging.
Presenter Alison White, a Senior Lecturer and Accredited Medical Sonographer, based at Griffith University in Brisbane, says sonographers often see patients at vulnerable times in their lives and conduct intimate examinations which, unlike x-rays, can take more than an hour.
Yet it is quite often a one-off interaction, making it more challenging to establish trust with patients who may be anxious and distressed.
“That’s quite a different therapeutic relationship than for many other healthcare professionals, such as nurses, who have a longer period of time to generate that trust with patients,” she told Croakey.
One of her presentations to this year’s conference will be on reflective practice and resilience, including dealing with compassion fatigue.
“Regardless of whether you work in public or private healthcare sector, there is an increasing demand for ultrasounds within Australia and with that, obviously, there’s an increased workload,” she said.
“When you’re faced with a big workload every day, it’s really easy to become physically, emotionally and mentally burnt out, and the consequences of that is a decrease in the quality of patient care,” she said.
“Also your level of self-care decreases because you’ve become so exhausted, you’re less likely to enact practical strategies to actually look after yourself.”
White will also highlight the need for the profession to consider the issues arising from an ageing population, including the increasing age gap between the majority of the sonographers over the next 10 to 20 years and their patients.
“That’s going to require very nuanced training for newer sonographers coming into the profession, because when we’re looking at a generational age gap of up to three or four generations between the healthcare provider and the patient, that can be a barrier to build trust.”
Extended scope of practice
Communication is a key issue for Kate Russo, a senior lecturer at CQ University and specialist sonographer at the Women’s and Children’s Hospital in Adelaide, who will also present at the conference.
Russo has been advocating for extended scope of practice for sonographers, similar to practice in the United Kingdom, and supports sonographer ‘reporting’ – not only performing ultrasound examinations, but providing a diagnostic interpretation – for appropriately experienced and trained sonographers.
Russo educates sonographers on how to communicate unexpected news to pregnant patients, ensuring they are compassionately made aware there is a concern with the pregnancy and if follow-up is needed.
“If you don’t let them know, then they’re reliant on waiting until they get to their healthcare provider and may not have a timely referral to fetal medicine or cardiology,” she explained.
She also emphasises the importance of preparing patients for potentially challenging news. When patients are referred for a second opinion scan, they need to be informed rather than just told they need ‘extra pictures’.
“This allows them to bring a support person to their next appointment and make arrangements, such as ensuring someone is available to pick up their children from school as these appointments are longer. Without this preparation, patients may either think nothing is wrong or spend time fearing the worst,” Russo said.
“They need to actually start being on that journey, preparing for challenging news, but this must be done sensitively and appropriately.”
Russo also believes that the growing use of reassurance scans by pregnant women in part arises because of accessibility or other gaps in mainstream care and the desire to bond with their unborn baby.
She highlights the complexity around scope of practice and regulation, noting that it’s not just “rogue operators” raising risks in ultrasounds.
With machines becoming cheaper, they are increasingly used by doctors, midwives, physiotherapists, and other professionals in various applications, she said.
“This perception that ultrasound is safe because it’s non-ionising radiation forgets about the fact that it’s so operator dependent,” she said. “Consumers are not necessarily aware of the ultrasound qualifications of the operator which may be a weekend course compared to the two year postgraduate degree undertaken by sonographers.”
Russo will also talk to the conference about the importance of person-centred care and communication, particularly for transgender and gender diverse individuals.
She advocates for sonographers to provide safe, gender-affirming care, as discrimination and negative experiences often prevent LGBTQIA+ members from accessing healthcare. “We need to ensure our communication and environment are appropriate to avoid causing harm,” she said.
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This is super alarming and absolutely needs to regulated. Also really appreciate and emphasise the point about how sonographers need training for how to share unexpected news. Sharing this in a sensitive manner is an absolute must, else women are led to believe there is nothing wrong. I left my 20 week scan thinking everything was fine, only to be called by my GP the next day as I was boarding a flight to Canada to tell me my baby was not viable.