Sonographer shortage

Sonographers are highly skilled health professionals who are strategically involved at the initial diagnostic stages of patient care and perform the majority of comprehensive medical diagnostic ultrasound examinations. Ultrasound as a specialty in qualified hands provides essential information to medical colleagues in a timely, cost effective, safe way, and will improve patient health outcomes if the profession has a well-directed training program in both theoretical and practical aspects.

In New Zealand, there is a severe shortage of sonographers with generalist and specialist skills, including cardiac sonographers. This shortage is nationwide, irrespective of geographic location.

The most significant barrier to addressing this shortage is the poor availability of sonographer clinical training placements. These placements are required for sonographers to become fully qualified and permitted to practise unsupervised. However, placements require significant investment of expertise, time, and material resources.

The shortage is further exacerbated in New Zealand, as Auckland University is the only university proving a course to train new general sonographers. Currently, there is no educational pathway in New Zealand to become a cardiac sonographer, leaving a crucial gap in this specialist workforce. This has been the case since the Australasian Society for Ultrasound in Medicine (ASUM) Diploma of Medical Ultrasound (DMU), which traditionally accounted for more than half of all New Zealand graduates, ceased in early 2019.

As a result of the small number of locally trained sonographers, New Zealand is becoming increasingly dependent on overseas-trained sonographers. This is a risky strategy and is unsustainable in the long term.

Bolstering the number of locally trained sonographers will provide more opportunities for innovative public health programs to ensure sonographers can serve communities where they are most needed. For instance, sonographers could be included more frequently as members of mobile multidisciplinary teams that visit rural districts to help identify health issues earlier, thereby improving health outcomes over the longer term.

Possible solutions

1. To reduce the reliance on overseas-trained sonographers, New Zealand should increase its locally educated workforce. Solutions include increasing the enrolment capacity at Auckland University, or establishing a second course at another institution to increase numbers of sonography graduates.

Consideration should be given to establishing an educational pathway in cardiac sonography to address this specialist gap.

2. To address the issue of placements, the New Zealand government should provide support for initiatives to assist both private and public health services across the country to improve the availability of placements. This might include incentivisation measures, such as a Practice Incentive Program, to help ensure the viability of sites that are providing student placements.

Why the contribution is important

In New Zealand, there is a serious shortage of sonographers with generalist and specialist skills. The most significant barrier to addressing this shortage is the poor availability of sonographer clinical training placements. This is exacerbated by limited educational opportunities, now restricted to one university, which is creating an overreliance on overseas trained sonographers.

Without change, access to sonographer expertise will become increasingly scarce in New Zealand.

by SladeCarter on November 16, 2022 at 11:20AM

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Based on: 8 votes

Comments

  • Posted by sheje965 November 16, 2022 at 12:48

    Thank you Slade for highlight some important issues around the sonographers in New Zealand. Personally I have had to apply multiple times to ensure a clinical placement which is highly competitive. There is plenty of applicants who would love the opportunity to become a sonographer's from varying medical backgrounds, however you have highlighted one of the issue in order to increase the sonographer numbers throughout the country, which is the number of clinical placements that are on offer. Thus the issue is not in having no applicants but having the resources across the public and private departments in order to train more sonographers to help fill the gap.
    I think the suggestions you have offered to help overcome this barrier by increasing the students taken from Auckland university or allowing another tertiary education provider to offer a course to help increase numbers are both great proposals.

    Sonographers are highly specialized and are in short demand therefore the importance of this article needs to be highlighted and actioned promptly.

  • Posted by May18 November 16, 2022 at 13:10

    Hi Slade,
    Thanks for posting about such an important topic.
    I wonder if the government would be able to help by offering support to sites that are wanting to train Sonographers, both the public and private sectors.
     I'm sure financial support would go a long way in being able to assist in training more NZ Sonographers. There is definitely not a shortage of people that want to train!
     Just the availability of training positions and support for qualified Sonographers and hospitals/private practice to be able to provide these positions to a student, as it is a significant time investment as well as financial burden to train.
    The NZ health sector desperately needs more Sonographers, particularly with our aging population and pressure to provide consistently good healthcare.

  • Posted by Braveheart November 16, 2022 at 17:22

    Thank-you Slade for raising awareness of such an important issue in providing diagnostic health services in New Zealand.
     If we could structure a pathway that would enable sonography students to be working and training in their communities, for their communities the retention of our workforce can only be improved. Technology has advanced over the past decade that enables us to provide essential services in the remotest of places. Working as part of a health provider team in local communities can only improve health outcomes and take the pressure off the central hospital system which is not coping despite the best efforts of the staff currently employed.

  • Posted by PaulaE November 16, 2022 at 20:30

    I agree that there is an urgent need to address the issue of too few clinical training placements and we need to find a way to incentivise the growing private sector to increase training capacity and increase the colaboration with the public section as the sonographer shortages are limiting the ability of public hospitals to train, particularly as many sonographers move into private practise soon after becoming qualified.
    A training pathway needs to be established for specialist vascular sonographer as well as cardiac now that the DMU has ceased. We can not solely rely on other countries to do the specialist training for us.

  • Posted by LAB November 17, 2022 at 08:26

    As a foreign trained sonographer working in NZ, the biggest surprise for me was how few trainees there were each year. NZ can never meet the demands the of the current population growth with these levels and it is shocking that there is no training for cardiac and vascular sonographers available in the country.
    Perhaps it is time to look at how overseas training programs are doing things and rethink the current NZ training system. Just because this is how it has always been done, does not mean it is how we should move forward. A single training program for a country of this size is not sustainable. As Braveheart suggested - we could be training sonographers in their communities and encouraging them to stay and work there when qualified. There is so much potential in NZ for us to have a robust and diversely qualified sonography workforce, but immediate change needs to take place.

  • Posted by Jacovanderwalt November 17, 2022 at 10:54

    Thanks for highlighting this!
    Another obstacle for training in smaller departments and communities is the very significant time investment needed to supervise trainees. Most smaller hospital US departments and smaller private practices just do not have the staff numbers and time to provide full supervision for a trainee.

    Working together in districts and regions to share the supervision burden per trainee between hospitals and private providers is a way to open up more possibilities. That will however need active co-ordination, probably at regional level along with a funding /incentive plan.

  • Posted by raffaelm November 17, 2022 at 20:56

    Thanks for highlighting this issue - agree that training placements are a problem - there are no shortcuts to properly training sonographers, and it is expensive and intensive in time as well as money - thus the current system has the few DHBs doing the lions share of the training, but then finding it difficult to retain qualified staff due to the markedly better pay and conditions offered in private practice. The problem is exacerbated by the FTE allocation not increasing despite massively increased demand, leading to much work being outsourced to private practice - who in turn try and actively attract sonographers and creating a bit of a vicious circle. Maybe there could be a system where the cost of training and placements are shared between public and private practices. It would also be great for DHB staff to be scanning out in the community rather than just at the Hospitals - easy to do with PACS and remote reporting. Another issue I can see that needs to be addressed is that the Universities cannot always pay enough to attract the best sonographers as tutors. We do also need something to replace the vascular and cardiac DMU - and maybe also breast the rapidly developing musculoskeletal field - or a different approach altogether. Some overseas programmes include the basic s of these in their degree programmes - could we work on this?

  • Posted by topcat November 18, 2022 at 07:22

    Thanks for bringing this issue to the health workforce strategy committee.
    I agree that training is an issue in NZ but more than the training is the lack of supervised placements. Lot's of people start the theory papers and then cannot find placements either because the providers do not have the resources to train anyone new or else there are just not enough.
    The public and private sector across the country needs to come together with the government to try and hash out ways to address these issues. I would like to train in cardiac but there is nowhere in New Zealand providing the necessary course. I would also love to be mobile and scan in the community in the areas where people cannot or are afraid to go to hospitals.

  • Posted by lanke598 November 18, 2022 at 07:55

    Thanks Slade. As a current sonographer student the process of finding a trainee position is challenging to navigate. I have applied for trainee position but not been successful because others candidates are 75% of the way through there academic training. This leaves you in limbo and means that you need to constantly be in contact with training providers to identify when more positions will become available. Additionally, if you are a more appealing candidate for a trainee position after completing all of the academic papers, this means that it takes 4 to 5 years to train a single sonographer. A streamlined process where the public and private providers can come together to provide as many trainee positions as possible would be a big step towards increasing the number of sonographers in the years to come. Action needs to be taken as soon as possible to ensure that the supply of sonographers keeps up with the demand for this highly skilled profession.

  • Posted by Anonymous November 21, 2022 at 15:41

    This is a supply and demand problem. The supply of sonographers is insufficient because the private sector radiology providers do not train sufficient staff, instead they rely on the public sector to train them and then attract them with higher salaries and more attractive working conditions. This could be addressed by only awarding publicly-funded contracts (including ACC) to providers who train sufficient sonographers to meet their needs and preventing them from poaching staff from the public sector. This might require conditions on employment when leaving the public sector or reducing public hours. At the moment the majority of the burden of training is being borne by the public hospitals, only to have sonographers leave or reduce their hours on completion of the training.

    The other barrier to supply is the NZ model of training sonographers, where they need to become experts in almost every area of US, which requires about 2 - 2 1/2 years of full time training in US, which precludes some overseas applicants and deters trainees and qualified sonographers from maintaining a dual scope of practice, such as US and general radiography. A more flexible approach from MRTB may provide more flexible ways of training and working in NZ.
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