Jobs outlook

According to the U.S. Department of Labor’s Bureau of Labor Statistics (BLS), more than half of all sonographers work in hospitals, and most of the remainder work in clinics or physicians’ offices. The job forecast for sonographers is excellent because of the increased demand for diagnostic imaging among an aging American population. Continued demand is expected as health care providers increasingly use diagnostic sonography as a safer and more cost-effective alternative to other imaging procedures. Ultrasound imaging technology is expected to continue to evolve rapidly and create many new sonography procedures in parts of the body in which ultrasound traditionally has not been used. The Bureau of Labor Statistics projects an 18% growth in jobs through the year 2018 (http://www.bls.gov/oco/ocos273.xhtml#outlook).

Although hospitals will remain the principal employers of sonographers, employment in clinics and physicians’ offices is forecast to grow rapidly. This is due to a strong shift toward outpatient care and the technologic advances and lower cost of ultrasound equipment that now permit point-of-care diagnosis. Additional information about working conditions, training, qualifications, and more is available at the BLS website: http://www.bls.gov/oco/ocos273.htm. The Society of Diagnostic Medical Sonography also offers a “model job description” that is helpful in formulating post-graduate plans. The information can be accessed in the career section of the SDMS website: http://www.sdms.org

Hospitals are the principal employers of medical imaging services. With a mission to provide inpatient and outpatient treatment and diagnosis, a hospital requires the services of many skilled and unskilled individuals. A newly employed sonographer must become acquainted with and work cooperatively with many of them.

The term hospital describes an institution for the reception, medical treatment, and care of the sick or wounded. The original definition of the word derived from the term hospes, or guest, and referred to an inn offering hospitality to those in need of shelter and maintenance. In the past hospitals were generally nonprofit, charitable institutions, often operated by religious groups and administered by retired physicians. The best known type of hospital is the general hospital that deals with many kinds of disease and injury, including an emergency department to deal with urgent threats to health.

Regional or district hospitals are typically major health care facilities serving the population in a wide geographic area. They are larger facilities capable of handling a higher volume of patients and offer intensive care, long-term care, surgery, plastic surgery, and expanded labor and delivery services in addition to specialized imaging and laboratory services.

Teaching hospitals include trauma centers, children’s hospitals, rehabilitation centers, and certain specialty areas, such as psychiatry, cardiology, orthopedics, and oncology. Many teaching hospitals are affiliated with universities for medical research and the training of medical personnel.

Organization and Function

Hospital administration involves organizing and supporting patients’ total medical care during an in-hospital episode of illness. Hospitals are multifaceted organizations made up of many committees, departments, types of personnel, and services. They require highly trained employees, systems and controls, adequate equipment, necessary supplies and, of course, health care providers and patients. Most American hospitals are for-profit businesses and are structured similarly to large corporations with a hierarchy of authority and a board of trustees (Box 8-1).

Box 8-1   Hospital Hierarchy

Governing Board

Sometimes referred to as the board of trustees, the governing board has a fiduciary duty to protect the hospital’s assets through efficient operation. Trustees are responsible for establishing the hospital’s mission, by-laws, and strategic policies.

Hospital Administration

The Chief Executive Officer (CEO) is responsible for the following:

• Implementing the goals and decisions set by the board

• Representing the hospital to the community

• Coordinating the collective activities of all personnel

• Delegating the clinical care and administrative duties to highly trained individuals and teams

Administrative Support Services

Administrative support services are charged with overseeing the operation and function of the following departments:

• Accounting

• Admitting

• Housekeeping

• Human resources

• Information services

• Marketing/planning/fundraising

• Plant and materials management

• Public relations

• Purchasing

• Risk management

• Security

Medical Staff

The medical staff is a formally organized, self-governing unit under the direction and supervision of the medical chief-of-staff. The staff consists primarily of credentialed physicians with privileges who answer to peer review boards and are subject to reappointment. The medical staff does the following:

• Ensures the highest quality of medical care to patients

• Diagnoses patients’ condition and prescribes the best and most cost-effective treatments

• Oversees specialty departments that perform diagnostic functions such as imaging, laboratory assessments, and specialized treatments, for example, assistance with childbirth, and surgical and oncology services

Nursing Services

Also called patient care services, nursing services is the largest component of a hospital, providing around-the-clock health care, treatments, and support of patients. Members of the nursing staff represent a wide range of training and experience: registered nurses (RNs), licensed practical nurses (LPNs) and certified nurse’s aides (CNAs), ward clerks, orderlies, and transport staff.

All of these groups answer to the nurse manager of each individual unit, who ultimately answers to the director or supervisor of nursing.

Allied Health Services

Allied Health Services comprises a number of departments that perform support functions in the areas of diagnosis and treatment. These specialty departments include pharmacy, surgery, nursery, labor and delivery, diagnostic imaging, and emergency.

Clinical Support Services

Clinical support services include the pharmacy that works closely with the medical staff and social services, which, in turn, help coordinate any necessary community-based services and sometimes handle discharge planning. Also part of the clinical support services are the hospital dietitians who play a therapeutic role in providing patient food and nutrition consistent with a physician-prescribed treatment plan.

Information Services

One of the core hospital services is the medical record department, which is charged with maintaining, cataloging and storing records on all admitted patients.

Hospital Operations

This division encompasses all the services necessary to keep the physical plant running such as maintenance, laundry, central supply, housekeeping, food services, mail room, and communication services.

At the top of the chain of command, overseeing all of the hospital activities and answering to the board is the administrator, or chief executive officer (CEO). Surrounding this individual is a large support staff who administers the daily business affairs of the institution.

Upon employment, a sonographer’s first experience with administration is likely with the human resources (HR) department and then with the services of the accounting department, which issues payroll checks. If sonographers require personal medical services at any time, they may interact with the insurance and accounts-payable division.

The purchasing department of the hospital also falls within the administrative services. Sonographers may work with these employees when requesting or evaluating diagnostic ultrasound equipment.

Sonography services may be part of the radiology department, the nuclear medicine department, the noninvasive imaging department, or be an adjunct to other departments such as cardiology, the vascular lab, or obstetrics (Figure 8-1).

As staff sonographers become contributing employees in their departments, they also may consult or be consulted by risk management, quality improvement, or corporate compliance representatives of the hospital to review or develop policies and procedures for a department.

Office Practices

It was inevitable that technologic advances would be incorporated into physicians’ clinical practices. The only limitations were cost and difficulty of operation. Today sonographers may find a greater need for their services in private office settings. Just as the clinic evolved as a smaller version of the hospital, so too does the office practice mirror the clinic in miniature form.

Working as a sonographer in a private practice allows for clinical specialization and the promise of a unique and personalized learning experience. It also offers a relatively low-stress environment compared with the sometimes-intense environment of a hospital. Moreover, it generally does not require on-call duty. The one exception to that may be in office practices that specialize in infertility procedures.

Depending on the structure of the office hierarchy, the sonographer may work independently or be expected to conform to office policies and procedures. The duties of the office sonographer include the following:

• Assisting/performing routine follow-up examinations and first-visit scans

• Acquiring results and giving them to the appropriate physicians

• Charting results and information of patient progress on weekly status checks

• Obtaining all signed permission slips for invasive or other treatment procedures

• Assisting the physicians with procedures

• Maintaining communication with the receptionists, physician, and office staff regarding patient add-ons, patients on treatment breaks, and changes in treatment plans

The operational, clinical, and personal inventories in a private practice are much smaller, and activities are limited to examining ambulatory office patients referred by a select group of physicians.

Mobile Ultrasound

The most obvious difference between a mobile setting and the more traditional hospital-based or clinic-based laboratory is that the sonographer must be able to perform studies and properly maintain the equipment without any onsite assistance. Mobile ultrasound services may operate in metropolitan city medical practices, nursing homes, rural hospitals, and clinics or within the confines of the mobile transport vehicle itself.

Many large mobile ultrasound companies provide specially adapted and equipped company-owned vans when the equipment to be used is large or bulky. In addition to performing patient examinations, mobile sonographers may be responsible for the following:

• Equipment and vehicle maintenance (e.g., gasoline, repairs, and administrative tasks such as keeping track of insurance/warranty policies and telephone pagers)

• Billing clients

• Maintaining their own time cards

• Delivering/transmitting the diagnostic images for interpretation, if their client hospitals have no qualified physician interpreters on staff

With the introduction of smaller, portable ultrasound units, some companies have dispensed with the vans and either provide automobiles to employees or reimburse them for gas, mileage, and maintenance in exchange for using their own vehicles.

Mobile sonographers must be exceptionally experienced and particularly independent. Typically, they have no one to consult with on questions while out in the field, so their clinical and administrative judgment must be excellent. They also must be physically fit to transport large ultrasound equipment in and out of the vans or automobiles at each stop. Finally, they must be skilled drivers, experienced in all-weather driving conditions.

Logistics is one of the most important aspects of a mobile service. For smooth functioning, the mobile sonographer requires the help of a competent coordinator to log scheduling calls, chart sonographer assignments, and handle calls from the field.

Freelancing

Skilled sonographers may be recruited to perform after-hours scanning in private practice offices or to operate as full-time per diem or independent agents. In some instances sonographers also must provide the ultrasound instrument and arrange for its transportation and upkeep. Malpractice and liability insurance coverage is highly recommended. The freelance sonographer shares many of the same obligations and benefits of the mobile sonographer. In addition to being well-trained, extremely experienced, and capable of working independently, they also must possess an entrepreneurial spirit and good business and public relations skills.

Traveling Sonographers

Sonographers who sign on with temporary staffing agencies must be able to adapt readily to many different types of equipment and to interact with many different departments and coworkers. As a rule, “travelers” are paid higher salaries to compensate for having to travel, staying in hotels or apartments, eating out, and being away from family and friends.

Some staffing companies may not be willing to hire a new graduate, preferring sonographers with several years’ experience. However, in high-demand, low-supply employment cycles, recently graduated sonographers should investigate this type of career. They may find a company that can provide a first assignment, and the experience gained would be invaluable.

The best way to start researching this type of job is to make a list of staffing companies that advertise in medical journals or professional organization newsletters or on the Internet. By calling many companies, you can begin to narrow the list on the basis of your needs. The following checklist suggests questions to ask a staffing agency recruiter:

• For how long has this company been in the staffing business?

• Where are most assignments located?

• What type of salaries and benefits are offered?

• How long must a sonographer work before receiving benefits?

• What types of accommodation are provided (single/roommate housing in apartments or motels)?

• What is the daily food allowance?

• What transportation allowances are offered (e.g., airfare, rental car)?

• What experience level does this company require (e.g., years of experience, formal education, registry credentials)?

• Is the current traveling sonographer available to take questions about this type of job?

For someone who likes variety and the opportunities to travel to new places, meet new people, and be in control of one’s own schedule, the traveling sonographer’s job may be a good fit.

Commercial Ultrasound: Clinical Applications Specialists and Sales

The commercial world of ultrasound may be the best of all worlds because it offers sonographers a chance to use their ultrasound skills and education as they speak to and instruct physicians and other sonographers. The expanding use of contrast agents in some clinical studies has opened a new career option for sonographers in the pharmaceutical industries. However, the two most common jobs are those of clinical applications specialist or in sales. Both of these occupations are a possible next step for sonographers who feel they have reached the “ceiling” in clinical work. Nevertheless, depending on the sonographer’s education and previous work experience, as well as the demands of the marketplace, a recent graduate may be considered.

Sales staff and clinical applications specialists have the opportunity to see and use the latest technology and possibly play a part in the design of new-generation equipment. Candidates for either job need good communication and presentation skills, including being articulate and listening carefully. Commercial ultrasound requires asking customers open-ended questions (why, what, when), listening closely to their issues and concerns, and trying to find solutions among the company’s products. A sense of humor, great stamina, and the ability to work under pressure are necessary to meet the extensive travel demands of both jobs. In the commercial world, performance is measured by productivity (i.e., quotas), rather than the number of patients scanned.

The transition from clinical to commercial ultrasound presents a steep learning curve and requires developing new attitudes and an outgoing personality. Many sonographers begin their commercial careers as clinical applications specialists, but those who stay with commercial ultrasound may move next into developing customer education programs or sales. From sales, the career ladder eventually can lead to management and marketing.

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