soundeffects
The Advocacy Issue
A message from the CEO
I am excited to share the latest issue of Soundeffects news, which highlights the Australasian Sonographers Association’s (ASA) ongoing work in policy and advocacy.
In Australia and New Zealand, the ASA advocates on behalf of members to shape healthcare policy and build professional recognition for sonographers. By engaging with stakeholders, responding to reviews, conducting research, and proactively promoting key initiatives, the ASA ensures the profession evolves to meet the needs of both sonographers and patients. This work strengthens the profession and enhances patient care by ensuring practitioners uphold the highest standards.
Over recent months, the ASA has been actively addressing key issues to create a better future for sonographers and improve patient outcomes. We are eager to update you on our significant progress in this important space.
In this issue, you will find an overview of our efforts in seeking sonographer regulation for the profession, as well as our plans for the future. The sonographer workforce continues to be a top policy and advocacy priority for the ASA. We also delve into the current issues facing the profession and the steps the ASA is taking to develop effective solutions.
Dr Narelle Kennedy, AFASA, and Sarah Stevens-Gieseg provide us with an update on our policy and advocacy efforts in Australia and New Zealand, respectively. They offer a unique perspective on the issues and challenges within each region.
Don’t miss the article from Associate Professor Chris Edwards, FASA, as he discusses the growing role of AI in sonography practice and education. Anita Hobson-Powell highlights the importance of developing a scope of practice for our profession and defining minimum expectations for sonographers.
Finally, the ASA Sonographers Employment and Salary Survey offers valuable insights into the employment conditions and trends within the sonography profession. Expect a detailed look at key areas such as remuneration, working conditions, benefits, and continuing professional development, along with an analysis of the opportunities and challenges shaping the future of the profession.
Regards
Tony Coles CEO, Australasian Sonographers Association
ASA Policy and Advocacy Work in Australia and New Zealand
In Australia and New Zealand, the healthcare landscape is constantly evolving with technological advancements, changes in patient needs, and policy shifts.
On behalf of its members, the ASA engages in extensive policy and advocacy work to shape and influence healthcare policy and standards to benefit the sonography profession and improve sonographer professional recognition and autonomy. Effective policy and advocacy not only benefits sonographers but enhances patient care, ensuring that patients receive care from skilled practitioners who adhere to the highest ethical and professional standards.
The ASA’s policy and advocacy work takes several forms, including engaging with sector stakeholders, responding to policy reviews and consultations, undertaking research, and proactively advocating our ideas to help ensure that the profession evolves in a way that continues to meet the needs of both sonographers and patients.
Our work covers a wide range of topics. Some recent examples include:
Australian Government Scope of Practice Review
The ASA prepared a submission highlighting the important role of sonographers in the primary health care system and current systemic barriers to enable them to work to their full scope of practice and advocate for more flexible policies.
Australian and New Zealand Classification of Occupations
In direct response to ASA advocacy, the Australian Bureau of Statistics has revised its classification of occupations to list sonography as a separate health profession rather than classification as a ‘medical radiation practitioner’. The ASA argued for sonography to be recognised as a separate occupation, emphasising the unique skills and scope of practice of sonographers. The current situation has hampered
Effective policy and advocacy not only benefits sonographers but enhances patient care
workforce planning and data collection and so the change will enable the ABS to collect more accurate and detailed workforce data about sonographers.
NZ MRTB Practitioner Naming Policy
The NZ MRTB recently released proposed changes to its naming policy for practitioners in the event of a board order or direction resulting from an investigation under the Health Practitioners Competence Assurance Act. ASA indicated a balanced approach between public safety and practitioner reputation and privacy is required.
NZ MRTB Competence Standards
The ASA provided feedback on changes to new additions to the MRTB Competence Standards, which included a new standard on ‘informed consent’ and the need to consider Māori practices when providing health services.
My Health Record
Proposed changes to the My Health Record system will require health practitioners to share diagnostic imaging reports ‘by default’ with patients via My Health Record. Patients will also have access to information uploaded to their My Health records in real time rather than waiting seven days. ASA’s submission recommended clarifying roles and responsibilities for diagnostic imaging information sharing, support for education and training, and mechanisms to resolve interoperability issues.
Point of care ultrasound position statement
The ASA updated its position statement on point of care ultrasound to highlight the risks involved in POCUS as well as the risks associated with overconfident and underqualified practitioners.
Parliament of South Australia Select Committee on Endometriosis
This submission emphasises the role of sonographers in diagnosing and managing endometriosis, advocating for better access to ultrasound services to support patients and improve outcomes and the need for upskilling sonographers for those patients who have endometriosis.
AHPRA Consultation on Clinical Placements
The ASA provided feedback on AHPRA’s views on embedding good practice in clinical placements, simulation-based learning and virtual care in initial student health practitioner education.
Consumer fact sheet on nonmedical use of ultrasound
The Australian Commission on Quality and Safety in Health Care invited the ASA to provide comment on its draft consumer fact sheet on the non-medical use of obstetric ultrasound following consumer complaints received by the Commission.
Sector engagement
Another important element of ASA’s policy and advocacy is collective advocacy with key sector stakeholders. For instance, the ASA – together with the Australian Sonographer Accreditation Registry –recently wrote to the Ministers for Health and Education asking for the Australian 2024–25 Budget initiative Prac Payment Scheme to be extended to sonography students in recognition of the reality that sonography students often experience ‘placement poverty’ and live away from home for extended periods to obtain the necessary clinical hours to become qualified sonographers.
The ASA is also focused on ensuring that the sonography perspective is considered in broader
By actively participating in policy consultations, surveys and research, ASA members enable the policy team to identify issues of importance
health policy. In New Zealand, the ASA contributed to the Hauora Haumi Allied Health Report 2024 through the Ministry of Health’s Sonography Sector Reference Group. In Australia, the ASA has been meeting with Services Australia to enable sonographers to be eligible to obtain healthcare identifiers under Australian legislation. Individual healthcare identifiers
are a prerequisite for clinicians to access My Health Record, upload or share information on their patients or obtain a Medicare number.
The ASA also represents members on the Department of Health and Aged Care Diagnostic Services Imaging Committee and the Peak Imaging Coalition, which is comprised of diagnostic imaging bodies from Australia and New Zealand. We also regularly engage with health policy work undertaken by the National Rural Health Alliance and the Allied Health Professions Association, strengthening our ability to represent sonographers in broader healthcare policy discussions.
Member involvement
Pivotal to the ASA’s advocacy work is member input. By actively participating in policy consultations, surveys and research, ASA members enable the policy team to
identify issues of importance and relevance to the sonography profession, provide valuable insights that inform the ASA’s policy positions, and provide members with a voice in decisions that impact their profession. The ASA receives advice on policy and advocacy matters from the Sonography Policy Advisory Committee and the New Zealand Sonography Advisory Group. Members are invited to nominate for these groups through an annual expression of interest process.
All ASA members are also regularly invited to participate in policy work and consultations through opportunities in the fortnightly Cross Section newsletter. We also use these communication channels to keep members updated about our policy work.
If you have any questions about policy or have an interest in contributing to a particular area, please email policy@sonographers.org.
Regulation Update: Strengthening Professional Standards for Sonography
Sonographers play a critical role in the healthcare system, providing essential diagnostic imaging services that guide clinical decisions.
In recognition of that, the ASA has been a longstanding advocate for appropriate and consistent regulation of sonographers given the important role regulation plays in protecting patients, ensuring professional standards, and maintaining the integrity of healthcare services.
In Australia, approximately 25% of sonographers who also have radiographer or nuclear medicine qualifications are regulated under the National Registration and Accreditation Scheme (NRAS) legislation – administered by the Australian Health Practitioner Regulation Agency (AHPRA). This means that approximately 75% of sonographers fall outside the NRAS system.
For over 10 years, the ASA has advocated for all sonographers to be part of NRAS and for sonography to become an AHPRA-registered profession. This has been driven by concerns about patient safety and the need to ensure that all sonographers meet consistent minimum standards for ethical and professional practice, professional development and management of complaints.
Statutory regulation also aligns Australia with international standards, such as those in New Zealand, the United Kingdom, and Canada, where sonographers are already regulated. For instance, in New Zealand, all sonographers are regulated by the Medical Radiation Technologists Board (MRTB) which sets the legislative and professional standards they must comply with..
In 2023, the ASA made a strong push to achieve NRAS regulation. Together with other stakeholders, the ASA made a detailed submission to federal and state governments presenting the case for statutory regulation. A public relations campaign was undertaken to highlight the risks to patients of an unregulated profession and held meetings with Ministers and government at the state and federal levels. Yet, despite these significant efforts, no government has committed to sponsoring the case for regulation. Government sponsorship is an essential prerequisite for sonography to become an AHPRA-registered profession.
In 2024, the ASA has decided to take a dual approach to its advocacy for sonography regulation. We will continue to advocate for statutory regulation but take a longer-term approach to achieve this goal. In the meantime, we will work with other key sector stakeholders to explore further opportunities to raise professional standards and enhance self-regulation.
Currently, self-regulation in sonography is fragmented with multiple bodies involved and undertaking different aspects such as the accreditation of sonography university courses and the assessment of overseas qualified practitioners. There are also key self-regulatory elements not yet in place. For instance, there is no scope of practice or complaints standard in place for all sonographers.
Through a combination of self-regulation initiatives and continued advocacy for statutory recognition, the ASA will continue to lead the way in shaping the future of sonography in Australia and New Zealand
In the absence of statutory regulation, self-regulation offers a powerful and more flexible alternative to maintain and improve professional standards. Setting and benchmarking those standards against equivalent AHPRA ones shows the sonography profession is proactive about its future and laying the necessary groundwork for a more seamless transition towards statutory NRAS regulation.
In the coming months, the ASA will be undertaking several projects to raise professional standards. One will be to work with members and other key stakeholders to develop a scope of practice. It will also be revising its code of conduct to align with the Australian National Code of Conduct for Health Care Workers and the NZ MRTB Code of Ethical Conduct. Taking this approach is timely. Two current reviews by the Australian Government highlight the increasing
focus on healthcare regulation at the highest policy levels. The Scope of Practice Review examines ways to remove barriers that prevent health professionals from working to their full scope. The NRAS Complexity Review is exploring changes to how new professions can join NRAS and how self-regulating professions can have greater opportunities and recognition within the NRAS framework. These reviews present opportunities for the ASA to further its case for sonography’s inclusion under NRAS.
At the same time, other health professions such as audiology are also under consideration for NRAS regulation, with the Queensland Government currently leading a regulatory impact assessment. As suggested by the SA Health Minister Chris Picton MP, this presents an additional opportunity for sonography to leverage and ride the wave towards statutory recognition of sonography.
NZ too is currently embarking on a period of review following a recent revision of the competence
standards for medical imaging and radiation therapy practitioners and an upcoming more in-depth review of the competence standards and scope of practice.
The ASA remains focused on its commitment to achieving statutory regulation for sonographers in Australia and to ensuring that the standards introduced are relevant and applicable for sonographers in both Australia and New Zealand. However, self-regulation is more than a stopgap – it is an opportunity for the sonography profession to showcase its dedication to excellence and commitment to patient safety and quality care. Through a combination of self-regulation initiatives and continued advocacy for statutory recognition, the ASA will continue to lead the way in shaping the future of sonography in Australia and New Zealand.
Dr Tony Coles CEO, Australasian Sonographers Association
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Policy and Advocacy in Australia
Q&A
with Dr Narelle Kennedy, AFASA, Chair of the ASA Sonographer Policy Advisory Committee.
The Sonographer Policy Advisory Committee provides advice to the ASA on policy and advocacy issues affecting ASA members, the sonography profession and the diagnostic imaging sector.
What are some of the key opportunities at the moment for Australian sonographers?
One key opportunity is the increasing use of ultrasound services in Australia. Medicare data reveals that ultrasound is the most frequently utilised diagnostic imaging service. This is expected to increase due to Australia’s ageing population and its cost-effectiveness compared to other imaging services. This means that the demand for sonographers will continue to grow, and the increased demand may lead to more opportunities for sonographers.
For example, there is a national focus on policies for health professionals to be working to their scope of practice. This has the potential for opportunities for sonographers to work to the top of their scope of practice. The recently completed Australian Government Scope of Practice Review proposes different system changes and practical improvements to help achieve this. One recommendation is the harmonisation of Australian drugs and poisons legislation, which would be important for sonographers who wish to provide MSK injections. Another key opportunity is for new, more flexible models of how health professions are regulated and structured. The ASA continues to advocate for sonographers to be registered health professionals under the NRAS while also pursuing other opportunities to enhance professional standards for sonographers, including a scope of practice. Simultaneously, current government inquiries are looking at how reforms can be made to the NRAS
system, including changes to how new health professions are added to the NRAS and greater recognition of those who are self-regulated.
What are some of the key challenges sonographers in Australia currently face?
The sonographer workforce shortage is a major challenge. Sonographers have been on the Skills Priority List across Australia for more than a decade. The shortage is due to increased demand for ultrasound examinations and is also influenced by workforce demographics – 53% of the current workforce work part-time, and an estimated 25% will reach retirement age in the next decade.
As a result, sonographers may face significant workplace pressures, including a limited amount of time to undertake scans and associated sundry activities. There are also ongoing physical demands, anxiety and mental health issues and musculoskeletal injuries due to their work.
A significant challenge for future sonographers is the limited availability of sonographer clinical training placements. Training places are limited due to the significant resource and financial cost associated with providing appropriate clinical supervision, which is burdened on the practice.
As a result, it can be very difficult for students to secure placements, and when they do, they may experience ‘placement poverty’ and live away from home for extended periods.
This shortage of sonographers directly affects patients’ access to timely, quality diagnostic ultrasound services, and in turn, delays and difficulty in accessing these services can result in increased costs to the patient and, consequently, the health system.
What is the ASA doing to support sonographers in Australia?
One of the key ways that the ASA aims to support sonography and sonographers is through research that helps build a detailed understanding of issues of importance and relevance to members. The biennial ASA Salary and Employment and Work Health and Safety surveys give key insights into salary, employment conditions and physical and mental health aspects of working as a sonographer. The ASA also recently commissioned UniSA to undertake a scan times research project, which found that a significant
proportion of sonographers reported dissatisfaction with scan appointment times, impacting scan quality and patient experience.
In turn, this helps inform our policy and advocacy. The ASA regularly represents the sonography profession at government and stakeholder meetings and outlines the perspective of sonographers through its regular submissions to the government.
The ASA has a committee of sonographers who meet regularly to discuss important issues affecting sonographers, called the Sonographer Policy Advisory Committee (SPAC). The members of this committee play an important and active role, providing expert input into a wide variety of policy and advocacy topics. Some recent activities include SPAC members attending workshops on the National Allied Health Workforce Strategy, the ASA submission to the Australian Government Scope of Practice Review, as well as reviewing ASA policy documents and position statements on point of care ultrasound, artificial intelligence and student clinical placements.
Looking forward, what do you see as the main opportunities for the ASA to support sonographers in Australia?
As the peak organisation representing sonographers, I see several opportunities including, firstly, ongoing engagement with key government and regulator stakeholders to ensure the voice of sonographers is heard and work towards sonographer regulation and, secondly, increased collaboration with other health sector stakeholders to address some of the major challenges sonographers and patients face. Finally, the ASA will continue to represent and promote Australian sonographers in everything they do, including consultations, professional development opportunities, professional guidelines and standards, research projects and surveys.
All ASA members are encouraged and regularly invited to comment on or contribute to our submissions and policy work in ASA’s fortnightly Cross Section. I would recommend any member who is interested in policy and advocacy matters to email policy@sonographers.org.
Policy and Advocacy in New Zealand
Q&A with Sarah Stevens-Gieseg, Chair of the ASA New Zealand Sonographer Advisory Group. The ASA New Zealand Sonographer Advisory Group commenced in November 2022 and provides policy and advocacy advice to the ASA on issues of relevance to New Zealand.
Can you tell us about some of the major changes taking place in New Zealand’s health sector at the moment?
New Zealand’s health sector has gone through a lot of change over the past few years, with more to come.
In 2022, the nation’s health system was restructured and centralised with the creation of two new national entities: Health New Zealand (Te Whatu Ora) and the Māori Health Authority (Te Aka Whai Ora), instead of the previous model of 20 District Health Boards. These entities were given responsibility for planning, funding and the provision of publicly funded health services. This reform was a significant change from the previous model and was aimed at addressing ongoing inequitable health outcomes and access to services, particularly for Māori.
Significant work has taken place since 2022, but inconsistencies remain. Some refer to this as the ‘postcode lottery’ as cost, wait times, access to services, and quality of care can differ quite significantly depending on where you live.
Following the elections of late 2023, and the formation of a new coalition government, a further change occurred with the Māori Health Authority being disestablished, with staff and functions being absorbed into the Ministry of Health and Te Whatu Ora/Health NZ.
Subsequently, the government have replaced the Board of Health NZ with a Commissioner, Dr Lester Levy, and four deputy commissioners. Dr Levy has indicated he intends to overhaul the health system, including changing the size and structure of Health NZ.
In 2024, we have experienced significant cost-of-living pressure for households and a tight fiscal agenda for the government and employers. The focus of the government prioritises fiscal control. This year has seen redundancies of support staff and the cancellation of several hospital infrastructure projects. Health service providers (particularly those in the public sector) are working with tight budgets and limited resources.
What are the main challenges sonographers in New Zealand currently face?
In a post-COVID environment, sonographers are under pressure. Demand for ultrasound services continues to increase, however, delivering these services can be difficult due to significant workforce shortages combined with limited funding and resources. For example, the government payment for obstetric scans has risen just 3% in 16 years. Demand for public sector services is often oversubscribed, causing delays or forcing patients to pay what can be high surcharges in private clinics. Due to the low government subsidy for obstetric scans, for example, many private clinics no longer offer this service.
Despite its comparatively small population, New Zealanders are quite geographically dispersed. Outside the major metropolitan centres, there are many areas of the country where it can be particularly challenging to support patients, including those in regional and remote communities. Māori and Pacific Island communities, elderly patients, or those who find it difficult to travel to larger centres, as well as those needing specialist care, can all be at risk of poor access to timely and affordable services.
In addition, there is currently only one education provider – the University of Auckland – delivering accredited sonographer qualifications. This means there is a limit to the number of domestically trained sonographers available, making us highly reliant on overseas-trained sonographers, with around twothirds of new sonographers each year coming from overseas. These sonographers typically need to undergo a period of supervision to become familiar with the health system and culture. On the positive side, the University of Auckland has recently commenced a cardiac ultrasound post-graduate qualification, meaning sonography students seeking to become cardiac sonographers now have an avenue to study domestically.
Are there any significant differences for sonographers between New Zealand and Australia?
While there are many similarities, there are also notable differences for sonographers in New Zealand.
In New Zealand, all sonographers are regulated under the MRTB. Some sonographers can report their ultrasound examinations in line with workplace titles, protocols, and employment contracts. In addition, while domestic training opportunities are limited, students benefit from having more structure around student placements and many also receive financial support from employers during their training.
While both countries face a shortage of sonographers, New Zealand’s shortage is likely more acute, and the country is highly reliant on overseastrained sonographers. We also face competition for our sonographers from overseas.
New Zealand’s health sector has gone through a lot of change over the past few years, with more to come
New Zealand has a simpler political structure than Australia, and changes can happen quite quickly. This can be both an opportunity and a challenge. Culturally, I think we recognise the importance of diversity and representation so that we can better care for all our patients.
Finally, I think New Zealanders are naturally quite innovative and collaborative and sonographers and radiologists often work together to develop creative local solutions – many of these have potential for wider application.
What is the ASA doing to support sonographers in New Zealand?
The ASA continues to grow its membership base in New Zealand and look for ways to better support sonographers. In late 2022, it formed the New Zealand Sonographer Advisory Group (NZSAG), which regularly provides policy and advocacy advice and support to the ASA to ensure the voices of New Zealand sonographers are understood and represented to government, regulators and key stakeholders. The NZSAG is a dedicated group representing a wide range of sonographers. Important current issues include identifying and addressing workforce challenges, improving the cost and access to ultrasound exams, and responding to issues raised by the regulating authority.
The ASA has and continues to liaise with the relevant government stakeholders and the Chief Allied Health Officer. It was involved in the government’s Sonographer Reference Group, providing input into
the national allied health workforce report Hauora Haumi Allied Health Report 2024, released earlier this year. This report highlights the contribution, barriers and opportunities for each allied health profession, including sonography.
Looking forward, what do you see as the main opportunities for the ASA to support sonographers in New Zealand?
I see several opportunities, including:
• continued engagement with key government and regulator stakeholders to ensure the voice of sonographers is heard
• increased collaboration with other health sector stakeholders to address some of the major challenges facing sonographers and patients
• continuing to represent New Zealand sonographers in everything they do, including consultations, professional development opportunities, professional guidelines and standards, research projects and surveys, etc.
The Sonographer Workforce
The sonographer workforce remains one of the key policy and advocacy priorities at the ASA. In this article, we take a closer look at some of the current challenges and work the ASA is doing towards developing solutions.
Key features of the sonography workforce
When considering the current workforce challenges, it’s helpful to begin by identifying the key features of the sonography profession.
Three-quarters of sonographers work in the private sector, including private clinics in a hospital setting, and one-quarter in a public hospital or department. It is common for sonographers to work in multiple locations, with around 60% doing so either for the same employer or for a different employer. A significant proportion of sonographers work in part-time, casual or locum positions, particularly in Australia (62%). In New Zealand, 45% do so. Overall, 80% of sonographers are female (90% in New Zealand).
In Australia, there are currently 19 accredited sonography courses delivered by seven education providers. Most sonographers are domestically trained, with only a small number of overseas-trained sonographers approved each year to work in Australia. In New Zealand, there are currently two accredited courses offered by one provider. New Zealand relies heavily on overseas-trained sonographers to meet demand, with two-thirds of new registrants each year coming from overseas – many of whom are required to complete a period of supervision and familiarise themselves with local protocols and culture.
The most significant workforce challenge is the workforce shortage, which has been ongoing for two decades and is expected to continue
Based on age and years of experience, the ASA estimates one-quarter of sonographers will reach retirement age in the next decade. The ASA 2024 Sonographer Employment and Salary Survey suggests that more than 35% intend to leave the profession in the next ten years.
With 7,820 accredited sonographers in Australia and 747 in New Zealand, there is currently one sonographer per 3,470 residents in Australia, and one per 7,150 residents in New Zealand (equivalent to 29 and 14 sonographers per 100,000 head of population, respectively).
Current workforce challenges
The most significant workforce challenge is the workforce shortage, which has been ongoing for two decades and is expected to continue.
In an ASA survey of major employers undertaken in early 2024, respondents estimated a 20–30% undersupply, most acute among experienced sonographers, clinical supervisors, and managers. Employers indicated that almost half the positions advertised were not filled.
The shortage has implications for patients, sonographers and employers.
Employers report having to close exam rooms and delay appointments; increased stress and injury for sonographers; higher costs associated with attracting, retaining or upskilling staff; and an increased reliance on locums to cover gaps. The ASA 2024 Workforce Health and Safety Survey indicates that many sonographers are working additional hours, missing scheduled breaks, and experiencing work-related pain, anxiety and exhaustion. Left unaddressed, these issues may cause sonographers to leave the workforce earlier than planned.
In addition to impacting patients, employers and current sonographers, the shortage also has a compounding effect on the future workforce. Training sonography students requires time and resources, both of which are in short supply, particularly in the private sector, where most clinical training placements occur. As a result, there is currently a significant shortage of placement positions and clinical supervisors.
Most students undertaking a post-graduate accredited sonography course are required to find their clinical
The Sonographer Workforce
Many of the workforce challenges facing sonographers are multifaceted and complex. Overcoming the challenges will require sector-wide collaboration and commitment
training placements to complete the recommended minimum of three days per week over two years. For those who do not have existing connections to an imaging department or practice, it can be particularly challenging. This is significant given the increasing number of sonography students coming from nonradiography backgrounds.
Employers who advertise clinical placements are often inundated with applicants. While arrangements vary, it’s not uncommon for students to undertake an unpaid placement, at a location away from their usual residence, placing many students under financial and general stress. In Australia, there is the added challenge that while many stakeholders are involved – including educators, employers, and sector bodies such as ASAR and ASA –there is no single entity providing central oversight of clinical placements and no central framework in place outside of the course and sonographer accreditation. This means there is a wide variety of arrangements that exist – which can be challenging for students, educators and employers alike.
In New Zealand, where sonographers are regulated under the MRTB and where only one university currently provides sonographer training, there is greater oversight and support for students. It’s also more common for students to receive financial support from their employers. In some regions, there are local initiatives in place where public and private sector employers collaborate to share students.
In the workforce, many sonographers also face limited career progression opportunities and lack recognition for specialist or leadership roles including clinical supervision, which can impact their retention. Finally, while workforce statistics continue to improve with time and resources, further work is needed to ensure detailed, up-to-date sector information is available to support policy development, ideally in a format that aligns with other allied health professions and the wider imaging profession to support national and regional workforce strategies.
What is the ASA doing to help overcome the workforce challenges?
With the demand for ultrasound services expected to continue, the workforce challenges must be addressed to ensure an ongoing sustainable sonographer workforce. As the peak body for sonographers, the ASA continues to support and advocate for the profession in a number of ways, as outlined below.
• Clarifying and quantifying key issues by seeking member input through surveys such as the Sonographer Employment and Salary Survey; engagement with ASA Committees and Special Interest Groups; and working with stakeholders to gather and share industry information.
• Raising awareness and encouraging discussion through our member publications, website and marketing activities; disseminating survey and project findings; and through our annual international conference.
• Developing clinical and professional development guidance and resourcesin collaboration and consultation with key stakeholders. This includes work on career development, clinical supervision, scope of practice, code of conduct and investigating scan times.
• Developing policy guidance and resources through relevant government and industry consultations, professional membership bodies and sector forums, and meeting with government, industry stakeholders and decision makers. We also prepare position statements, articles and guidelines on key topics, highlighting issues and recommendations to advance the profession.
Many of the workforce challenges facing sonographers are multifaceted and complex. Overcoming the challenges will require sector-wide collaboration and commitment. The ASA will continue to engage with members and work with stakeholders to develop and deliver solutions to support a sustainable sonographer workforce into the future.
AI in Sonography
The Rise of AI
Associate
Professor Chris Edwards, FASA, member of the ASA’s SPAC, discusses the importance and role of AI in both sonography practice and education.
Some tools may work in the background to improve image quality but others will require direct interactions with the sonographer
Lately, it’s been hard to escape discussions about artificial intelligence (AI) and its potential to reshape our lives. Conversations often focus on its influence on work and whether it will meaningfully impact the role of sonographers. How will it affect education and the training of future professionals? Beyond our field, the media is full of warnings about rogue AIs fuelling social unrest by spreading misinformation or aiding criminals in creating elaborate scams. Recently, AI-generated content – images and videos – has flooded the internet. While some of it is amusing, much of it has little value, earning the nickname ‘slop’ or ‘AI-generated spam’. The recent surge in public interest in AI can be traced back to the release of OpenAI’s ChatGPT in November 2022. However, the technology behind it – specifically the transformer, the ‘T’ in ChatGPT – has been around since 2017.1 Over the past year, there has been a rapid rise in user-friendly interfaces, making the technology accessible to a much broader section of the public. Today, numerous tools allow users to generate high quality text and create images and videos with an ever-expanding range of possibilities. In September, Google released an audio add-on to NotebookLM2, their personalised AI collaborator, allowing users to create a podcast from text-based inputs. Could this be a handy study tool? Imagine students uploading their ultrasound physics notes and listening to AI-generated podcasters discuss parallel beamforming on their commute, complete with ‘ums’ and ‘ahs’. There’s even evidence suggesting that, in specific contexts, AI can explain content more effectively than professors.3
Applications that use transformers will continue to evolve. A transformer is an AI model trained via machine learning on vast amounts of data. The training employs a technique called ‘backpropagation’, a type of feedback loop that improves the model’s accuracy.
During backpropagation, the model calculates the error between predicted and actual outputs and then uses this error to adjust parameters to improve model performance over time. This could be text in the case of large language models (LLMs) or images and videos.
Some of the work currently done at QUT, analysing ultrasound images, uses a type of transformer called a Swin Transformer. The Swin Transformer, short for Shifted Window Transformer, is designed to deal with the complexity of image processing. Unlike text, where information flows sequentially, images are spatially located. For example, in medical images, the diagnosis isn’t just in individual pixels but in how these pixels relate to one another across the entire visual field. Ultrasound images are particularly complex and include various acoustic features that relate to one another, such as their echotexture and position in the image. The correct characterisation of an image may even include features that extend across frames.
Once training is complete, the model doesn’t ‘relearn’ each time it gets a new prompt; instead, it leverages its pre-learned knowledge to respond in real time. It does this quickly because it’s designed to process information in parallel rather than sequentially, making it highly efficient. Some commercial ultrasound systems have already deployed this technology with onboard AI assistants to highlight particular anatomy or the correct scan plane. For example, targeting a nerve before a pain block or identifying fetal structures during obstetric scanning.
Professional Context – AI’s Role in Sonography Practice
Predicting how this technology will ultimately impact the sonographer’s role is challenging. Some tools may work in the background to improve image quality but others will require direct interactions with the sonographer. Suppose one were to view AI from a purely technical or capability standpoint – for example, a system that
employs machine learning to predict an output from text, images, audio or video. With the current level of AI technology, it is perhaps reasonable to suggest that, in a short period, an ultrasound system will be equipped with advanced image analysis tools, possibly automatically labelling anatomy and highlighting a range of pathologies. Further, it may be able to analyse sets of images or videos and compute a report. Regarding audio, perhaps our machines may be equipped with an inbuilt audio interface that will interact with the patient directly, reassuring them that everything is in hand and answering any questions they may have in a professional, empathetic tone. The system may even prompt you if the patient mentions some relevant clinical history, conveniently prefilling these details into an electronic worksheet before you have left the room. What about wholly automated systems using advanced robotics? The world was promised the widespread adoption of driverless cars; Morgan Stanley in 2013 predicted this would occur in 2026.4 Current predictions have now gone beyond another two decades. This is partly due to the messiness and unpredictability of real life and the difficulty of designing models to cope. In the case of driverless cars, sudden changes in the weather, roadworks, and, of course, other human drivers engage in irrational behaviour on the road. Healthcare is similarly complex, filled with ambiguity, human emotion, and multiple competing elements. AI models must be robust enough to handle these realities. In sonography, this means dealing with everyday realities like extremes of body habitus, low patient acuity, and challenging patient interactions. Sonographers currently address these issues using techniques such as non-standardised plans and advanced communication skills tailored to each patient’s condition and clinical history. Various systems will be developed and deployed as technology advances. Following how these systems are implemented and adapted to current healthcare challenges will be interesting. What is clear is that AI systems that make predictions or assist with decisionmaking cannot be viewed simply in a transactional sense; they are not like calculators involving a simple input and output; it is an interaction that consists of a relationship between the user and the patient (both humans) and the machine. As mentioned above, the success of these systems will be dependent on various patient characteristics but also on how AI relates to individual practitioners. This is about knowing if the tool produces the correct response in the correct setting. In this way, the success of the AI will depend on the practitioner’s experience just as much as its ability to interpret the ultrasound machine’s output. In one scenario, an expert sonographer may quickly identify
As AI becomes more integrated into sonography and education, the focus must remain on maintaining the integrity of the profession and upholding community trust in practitioners.
an error in the AI output, whereas a student or newly qualified sonographer may take the output on trust. AI interactions will require a delicate balance between trust and scepticism. Successfully integrating AI into sonography will mean navigating this new reality.
Sonography Education – Balancing AI Tools and Integrity
The impacts of AI in the sonography profession are likely to be gradual. However, their effect on education, including sonography education, has more immediate implications. Generative AI (GenAI), the term used to describe AI that can create new content, is capable of completing many student tasks with high accuracy, making it one of the most disruptive technologies ever seen in education. The latest ChatGPT release, o1-preview, designed explicitly for advanced logic and reasoning, is reported to perform at the PhD level.5 Multiple authorities are wrestling with the impacts. A parliamentary senate injury report, ‘Study Buddy or Influencer’, was released in August 2024, recommending GenAI in education be made a national priority.6 The Tertiary Education Quality and Standards Agency (TEQSA), the national regulatory body of universities, has requested urgent action, asking all institutions to report on how they manage GenAI, particularly how they address the risk of GenAI to award integrity.7
Universities themselves also understand the reputational risks and potential for significant community backlash, for example, graduates from a particular university who enter the workforce without the competence to perform the job effectively and safely. This is especially critical in fields like sonography and other health degrees, where universities selfcertify their students. Once they graduate, there is no post-qualification check to ensure that the skills they reportedly gained meet community expectations. With these considerations in mind and TEQSA having one eye firmly on risk, an urgent overhaul of assessment practices is underway. Of course, some assessments are designed to assist and promote learning, and AI tools will become welcome additions. Other, high-
stakes assessments designed to verify student learning, which directly leads to certifying a degree like sonography, will require rigorous direct supervision –for example, a return of traditional hall-style written exams to verify knowledge acquisition, oral assessment tasks to demonstrate understanding and showcase communication skills, and face-to-face practical evaluations to demonstrate technical skills. Many online assessment methods developed during COVID-19 are now obsolete. Numerous tips and YouTube videos are circulating on how students can use AI tools during online assessments, even when the assessor is present via Teams or Zoom. Some may have already seen videos of job candidates using AI tools to convert an employer’s questions into text responses displayed on a hidden monitor during interviews.
Risks must be countered with rewards. In the professional world, it is not unreasonable to expect the question of why you used an AI tool to become ‘why not’, especially when there are workflow and efficiency gains and improvements to overall patient care.
Therefore, it is incumbent on educators to encourage the use of tools for relevant tasks. In the sonography context, this might be written communication tasks where students produce artefacts (reports, oral case presentations, ePoster) to showcase and share their knowledge with colleagues.
The use of AI in learning is also an untapped resource. Feedback literacy, an emerging topic in education to improve student learning outcomes, is one area in which AI may assist. The idea focuses not on how
supervisors frame feedback for students but on teaching students to respond positively and integrate feedback into their practice. Feedback comes in various forms; sometimes, it is for evaluation; other times, it is an aid to help the student improve; and at different times, it is for praise on a job well done. All of which are important for growth. How students manage their emotional responses to these three is an important skill to develop. More research is needed, but perhaps AI chatbots may be a good source of feedback literacy development – just a thought.
As AI becomes more integrated into sonography and education, the focus must remain on maintaining the integrity of the profession and upholding community trust in practitioners. While these tools offer potential, ensuring that they enhance rather than replace human judgement and accountability is essential to preserving the core values of patient care and professional competence.
References
1. Vaswani A. Attention is all you need. Advances in Neural Information Processing Systems. 2017.
2. Google. NotebookLM, <https://notebooklm.google/>. 2024.
3. Chiasson RM, et al Does the human professor or artificial intelligence (AI) offer better explanations to students? Evidence from three within-subject experiments. Communication Education. 2024;1–28. https://doi.org/10.1080/0363 4523.2024.2398105
4. Shanker R, et al Autonomous cars: Self-driving the new auto industry paradigm. Morgan Stanley blue paper. 2013;1–109.
5. OpenAI. Introducing OpenAI o1-preview, <https://openai.com/index/introducingopenai-o1-preview/>. 2024.
6. Parliament of Australia. Inquiry into the use of generative artificial intelligence in the Australian education system ‘Study Buddy or Influencer’, <https://www.aph. gov.au/Parliamentary_Business/Committees/House/Employment_Education_ and_Training/AIineducation/Report>. 2024.
7. Tertiary Education Quality and Standards Agency. Artificial intelligence request for information – next steps. 2024.
Why is a Scope of Practice Important?
Consultant Anita Hobson-Powell discusses the merits of defining the minimum expectancies for sonography by developing a scope of practice for sonographers.
The Australasian Sonography Association has taken a pivotal step in the future of supporting the regulation of the profession by engaging Advancia Consulting to support the development of a scope of practice (SOP) for sonographers across Australia and New Zealand. While advanced scopes of practice have been established for the professions, there was a notable absence of a comprehensive core SOP that defines the minimum expectancies for sonography. Sonography practices vary globally, with no global standards of practice in place.1 This results in variations in how sonographers operate and are recognised.
Most countries operate under a self-regulating framework, while some are governed by legislative protection. New Zealand and Ontario, Canada, have legislation and title protection for sonographers.1 In Australia, the government’s regulation approach follows the principle of right touch regulation, which emphasises proportionate regulation based on public risk. In Australia, only 25% of sonographers are currently registered under the NRAS due to their dual qualifications as both sonographers and radiographers. Despite extensive advocacy efforts by the ASA over the past decade, sonography has not met the Government’s criteria for inclusion in NRAS due to the scheme’s rigorous assessment measures aimed at public risk mitigation. The unintended consequences of health professionals not being included in the NRAS have become evident through the recent Scope of Practice Review led by Prof Mark Cormack. As such, the recently commenced NRAS Complexity Review led by Ms Sue Dawson is exploring options at more formalised standards for self-regulating professions moving forward. For those professions that have been classified as self-regulating, the professional entities
and/or certifying entities (such as ASA) are striving to align their standards with the NRAS standards. This alignment includes professional competency standards and defined scopes of practice.
Entities entrusted with the responsibility of selfregulating a profession must establish a robust regulatory framework that remains agile, adapting to evolving landscapes while ensuring both public safety and maintaining trust. Professional bodies or regulatory bodies will often develop a package of documents and guides to formally document their professions’ full or part SOP. These documents commonly included SOP frameworks, competency standards, codes of ethics, codes of professional conduct, professional practice standards, clinical practice guidelines, professional capabilities and educational program accreditation standards.2 Broadly speaking, an SOP defines the functions, responsibilities, activities and decisionmaking capacity of a profession based on their education, knowledge and skills.
SOP plays an important role for the governing bodies defining professional capabilities and responsibilities for the professions, which in turn guides educational curricula and helps employers define job descriptions. If a healthcare professional has a defined SOP, the practitioner must abide by this SOP for their and the public’s protection. Without a defined SOP, confusion and assumptions can arise within the profession and among other healthcare professionals.3 Research conducted by Miles and colleagues across 32 countries found that 36% of sonographers surveyed believed their healthcare professionals did not fully understand their roles.1 A well-defined SOP provides a framework ensuring that sonographers are recognised for their competencies. An SOP is often misunderstood and incorrectly applied, primarily because there is a lack of consensus on what defines an SOP for a healthcare professional.2,3 Compounding this, it is important to understand there are different types of SOPs. The most commonly referred to is the ‘core’ SOP, which defines the minimum level of clinical capabilities expected of a professional upon entering the workforce.1,2 An extended scope was considered to be the scope exceeding what is considered to be the traditional scope but is supported through regulatory or legislative changes. The expanded scope is considered any scope increase irrespective of the authoring environment. Finally, advanced practice is an increase in the current scope into the remit of other professions or linked to performance measurement, being a specialisation or expert status.2
The SOPs of all medical and health professions, whether documented or not, have evolved. The evolution of SOPs has been impacted by changes in
healthcare practices, models of care, population health needs, workforce maldistribution and technological advancements.3,2 While the evolution of SOPs is inevitable and necessary, changes create tension. The tension lies between detailing what current practices are and the evolution of what future practices should be.2 What could be considered novel or expanding SOP could become core practice.
There is a consensus that an individual’s SOP is not static and will evolve throughout their career. Upon successful completion of a recognised entry-level qualification, an individual practitioner is considered to have the requisite knowledge, skills and attributes to practise as a ‘medical or health professional’ aligned with their core SOP. However, as they gain more experience, pursue further education, and engage in professional development as individuals, SOP can expand, reflecting their cumulative experience.2
This is why a health professional needs to be aware of their own individual SOP and the broader SOP for their profession. By doing so, they ensure that they are practising safely, lawfully and effectively while also ensuring that their professional indemnity insurance covers their activities.4 Failure to maintain professional competencies for the profession can result in a narrowing of an individual’s SOP relative to their peers.
Continuing professional development plays an essential role in shaping a sonographer’s SOP. While continuing professional development is often viewed as a regulatory burden, it plays an important role in maintaining and expanding competencies, ensuring the professional stays abreast of new technologies, procedures and best practices. The outcomes of expanding one’s SOP are not always measured via competency assessment and/or formal credentialing.2 Instead, a decision-making framework can help guide whether new activities fall within an individual’s SOP, ensuring safe and effective practice.
The Australasian Sonography Association will inform members of their progress in developing a formal SOP for the profession.
References
1. Miles N, Cowling C, Lawson C. The role of the sonographer – An investigation into the scope of practice for the sonographer internationally. Radiography 2022;39–47.
2. Downie S, Walsh J, Kirk-Brown A. How can scope of practice be described and conceptualised in medical and health professionals? A systematic review for scoping and content analysis. International Journal for Health Planning Management. 2023;1184–1211.
3. Wiggins D, Downie A, Engel R, Grace S, Brown BT. Factors that influence the scope of practice of the chiropractic profession in Australia: a thematic analysis. Chiropractic & Manual Therapies. 2024;32(18).
4. Health & Care Professions Council. Scope of Practice. [Online]; 2024. Disponible en: https://www.hcpc-uk.org/standards/meeting-our-standards/scope-ofpractice/
5. Schuiling KD, Slager J. Scope of practice: freedom within limits. Journal of Midwifery and Women’s Health. 2000;465–471.
ASA Sonographers Employment and Salary Survey Report
The Sonographers Employment and Salary Survey was made available online for ASA members and non-members in Australia and New Zealand from 2 July 2024 until 31 July 2024. Nine hundred and seventy-three responses were received.
Key findings
› The average hourly pay rate for sonographers increased by 9.6% from $64.80 in 2021 to $71.00 in 2024.
› Sonographers in private practice earned higher average hourly rates than those in public hospitals across all specialities, at $69.10 and $71.50 respectively.
› Satisfaction with remuneration is significantly lower among sonographers working in public hospitals, at just 30% compared with 48% in the private sector.
› Sonographers in private practice reported higher satisfaction with their workload (64%) and work scheduling (65%) than those in public hospitals (57% and 54%, respectively).
› Over half of sonographers (52%) reported working part-time in their main role in 2024, and this was more common among Australian sonographers (54%) than in New Zealand (42%). This trend aligns with the ongoing shift from full-time to part-time roles.
› While average scan times remained stable between 2021 and 2024, significant variations exist depending on speciality and setting.
› Overall satisfaction with the time allocated per scan decreased from 70% in 2021 to 66% in 2024. While down from 80% in 2021, sonographers in public hospitals (74%) tend to have higher satisfaction with the time they have been allocated per scan than those working in private practice (65%).
› In 2024, 57% of sonographers in public hospitals worked overtime, compared to 44% in private practice.
› Sonographers in public hospitals also reported working on-call during weekends (61%) and
weekends (57%) at a higher rate than those in private practice (21% and 14% respectively).
› The number of sonographers in public hospitals holding multiple jobs increased from 27% in 2021 to 31% in 2024.
› The proportion of sonographers whose primary role is in a public hospital but who hold a secondary role in private practice increased significantly from 38% in 2021 to 54% in 2024. This shift may indicate that sonographers are seeking higher pay or more flexible work conditions offered in the private sector.
› While the proportion of employers offering financial support for CPD has remained largely unchanged from 2021, there has been a significant increase in the uptake of this support.
› Feedback highlights ongoing stress and morale issues among sonographers, primarily driven by high workloads, time pressures, staffing issues and the expectation to perform multiple tasks within limited time frames. Overall, 54% of respondents said that stress levels at their workplace had increased over the last year, and 50% said morale had fallen.
Demographics
› Nearly four in five responding sonographers are female.
F 79% M20%
A majority of sonographers work in major cities. Threequarters (67%) are based in a metropolitan area, one in three work in a regional town (29%) and 4% work in rural or remote communities.
Nearly two-thirds of sonographers indicated that their highest sonography qualification is a post-graduate diploma (64%) in ultrasound. A further 12% hold a Master’s in Ultrasound by coursework or research or a PhD or doctoral degree in a sonography-related topic. Fifty-six per cent of sonographers have a background as a radiographer.
As well as being highly educated, sonographers are very experienced. The average experience level across
respondents was 15.9 years, with a third (33%) having over 20 years of experience working as a sonographer. A further 27% have been working as a sonographer for between 10 and 20 years.
Respondents working in obstetrics & gynaecology are the most experienced, with an average of 19.5 years working as a sonographer.
Employment Profile
While most sonographers most commonly work in private practice (74%), a quarter are employed in the public system, which is consistent with 2021 results. Within Australia, 59% of Australian sonographers work in private practice, independent of a hospital, and 23% in a public hospital. These are higher (64% and 28%, respectively) for sonographers based in New Zealand.
Around two in three sonographers provide general sonography services (68%), consistent with 69% in 2021. Obstetrics & gynaecology (10%) and cardiac (12%) sonography are the most common specialist areas, with around one in twenty (5%) specialising in vascular sonography.
A significantly higher proportion of New Zealand sonographers specialise in obstetrics & gynaecology (22%) than in Australia (10%).
on multiple employers, despite primarily working in a single location. There continues to be an upward shift in the number of sonographers in public hospitals with multiple jobs, increasing from 18% in 2019 and 20% in 2021 to 23% in 2024.
Employment Arrangements
The shift to part-time employment is firmly established, with over half of sonographers continuing in part-time roles in 2024. Consistent with 2021, more than half (52%) of sonographers indicated they worked part-time in 2024, with Australians (54%) significantly more likely to work part-time than those based in New Zealand (42%).
By contrast, a higher proportion of New Zealanders work on a full-time basis (55%) than do those in Australia (38%), with 40% overall indicating that they work fulltime, consistent with 2021.
The proportion of sonographers working on a casual basis, or as a locum, continues to remain stable at 8% in 2024.
Consistent with 2021, 77% of overall respondents were employed as a clinical sonographer in 2024 (which corresponds to 77% in Australia and 74% in New Zealand). Of the remainder, similar proportions were employed as a supervisor (8%), manager (7%) or student sonographer (6%).
Work Location
Over four in five sonographers worked for a single employer, although often across multiple workplaces. New Zealand sonographers continue to be more likely than Australian sonographers to work in multiple locations for a single employer (48%, compared with 41%). Those based in metropolitan locations are significantly more likely to work across multiple locations for a single employer (45%) than those in regional and rural areas (33%).
Overall Workforce Composition, 2010-2024
Public hospital sonographers are increasingly relying
A fall in the proportion of sonographers working full-time in public hospitals between 2021 (45%) and 2024 (41%) has led to a more balanced distribution of the workforce across the public and private sectors. In 2024, two in five respondents worked full-time in both public hospitals and private practice, while a little over half worked part-time in both public hospitals (53%) and private practice (52%).
Across all specialist areas, the proportion of sonographers working on a full or part-time basis has remained relatively stable over the last three years. Obstetrics & gynaecology sonographers are the most likely to be working on a part-time basis (61%), compared to 43% for cardiac sonographers. Generalists are the most likely to be working full-time (43%), compared to 37% for cardiac sonographers and 30% for sonographers working in obstetrics & gynaecology. Cardiac sonographers are more likely than all others to work on a casual or locum basis (20%).
Public sector employment continues to approach the
MAIN AREA OF PRACTICE
private sector trend of greater reliance on part-time and casual roles.
however, time spent on supervision and training has increased slightly from 9% in 2021 to 11%.
Sonographers in private practice allocate a significantly higher proportion of time to core sonographic services (81%) than those in public hospitals (68%). In contrast, sonographers in public hospitals spend a higher proportion of their time on clinical supervision (16%) and non-ultrasound imaging services (3%) than those in private practice (10% and 1%, respectively).
Percentage of Time Spent on Work Duties,
One in five respondent sonographers have a secondary sonographer role in 2024. While previously a second role was usually performed in the same setting, this trend has shifted, with 55% of all secondary roles being in private practice.
Sonographer Workload
Sonographers worked an average of 30.0 hours per week in 2024, consistent with 29.8 in 2021.
In their primary role, the average hours worked each week in public hospitals shifted down to an average of 29.8 hours in 2024. By comparison, the average hours worked by those in private practice increased to 30.1 hours, moving them above the hours worked by publicly employed sonographers for the first time. General sonographers work slightly longer hours than those in more specialised fields. This group reported working an average of 30.9 hours per week in their primary role, compared to 27.4 for obstetrics & gynaecology sonographers, 28.2 for cardiac sonographers, and 28.6 for those with a different specialisation.
On average, sonographers in New Zealand work longer hours than their Australian counterparts per week, at 31.9 hours and 29.7 hours, respectively. Within Australia, sonographers in New South Wales (28.0) work significantly fewer hours on average per week than those based in Queensland (31.9) or Victoria (31.1).
When including secondary roles as well, sonographers work an average of 32.2 hours in total in 2024, consistent with 2021, suggesting many sonographers work multiple jobs to achieve their desired number of hours, particularly sonographers whose main role is in a public hospital.
Consistent with 2019 and 2021, a majority (77%) of sonographer time is allocated to core sonographic services in 2024. Very little time continues to be allocated to administrative management or other tasks,
Sonographer Feedback About Workload
Many sonographers spoke about the stress and pressure sonographers experience due to high patient volumes. They relayed the challenges in managing patient care and maintaining high quality standards due to heavy workloads which make it difficult for sonographers to provide the thorough and compassionate care they strive for.
‘We keep expanding the list of things that we are required to look at/documentation required, with no associated increase to time allocated for the scan and admin’ (GENERAL, PUBLIC).
‘Do not have adequate breaks between patients or time off screens. No time to catch up at end of a shift to finish reports or review cases or follow up cases. Non stop rush’ (OBSTETRICS & GYNAECOLOGY, PRIVATE).
‘There is always pressure to do shorter scans, however, I resist due to wanting to protect my shoulder for career longevity and to make sure the patient gets a thorough scan. The pressure remains though! (GENERAL, PRIVATE).
‘Workload demands are ever increasing, especially within the public hospital system. It remains very hard to stand up for yourself with regards to scanning time’ (GENERAL, PUBLIC).
Scan Times
Overall, sonographers perform an average of 14.2 scans per day. Sonographers working in private practice perform a significantly higher number of scans per day than those working in public hospitals (15.2 compared with 11.5), noting that public hospitals generally have more complex scans to perform. Among generalist sonographers, the average number of scans performed per day in a public hospital was 12.4 (up from 11.9), with an allocated scan time of approximately 31 minutes. In private practice, they performed an average of 16.2 scans (consistent with 2021), with an average allocated scan time of 27 minutes.
Cardiac sonographers in private practice performed 10.3 scans per day (up from 10.1 in 2021), with an average time allocated per scan at about 39 minutes. Whereas in public hospitals they conducted an average of 8.0 scans per day (up from 7.3 in 2021) where average allocated scan times were much higher, at 49 minutes. The average number of scans performed by obstetrics & gynaecology sonographers fell in both public and private settings (from 12.3 to 11.7 per day and 14.0 to 13.8 per day, respectively).
Sonographer Satisfaction with Scan Times
While there was little change to the time allocated per scan, and most respondents felt that the allocated time was adequate, satisfaction with scan times has dropped to 66% (down from 70% in both 2021 and 2019). Satisfaction with scan times in New Zealand was higher (73%) compared with Australia (66%). Many expressed concerns about the length of time given for certain scans, particularly in complex cases where more time is required.
In public hospitals, there was a gap in reported satisfaction with scan times among specialities –with most general sonographers satisfied (82%) while satisfaction among obstetrics & gynaecology sonographers has dropped significantly (from 69% to 41% – making them the least satisfied on this measure). Satisfaction among other specialities also dropped from 84% to 69%. Changes and variations in satisfaction levels among private practitioners are less pronounced, and private obstetrics & gynaecology sonographers reported significantly more satisfaction with scan times (67%) than in public hospitals (41%).
‘30 min scans can be hard with complex morphology’ (CARDIAC, PRIVATE).
‘Complexity of scans has increased over the last few years with no increase in scan time’ (GYNAECOLOGY, PRIVATE).
‘I believe our 60-minute slots allow for complex cardiac studies to be completed with quality and time for report writing’ (CARDIAC, PUBLIC).
The clinical workload is increasing and the stress levels as well, as wages go up so does the performance pressure
(GENERAL, PRIVATE)
Pay Arrangements
In 2024, hourly rates continue to be the most common pay arrangement for sonographers, with over four in five paid on this basis. Only one in ten received an annual salary in 2024, rising to a significantly higher 25% of cardiac sonographers. The number of those paid per scan has remained consistent at 3%, with cardiac sonographers (23%) again more likely to be paid by this method than those in other fields.
Pay Arrangements, 2010-2024
Wages
Sonographers hourly rates have increased by 9.6% since 2021, with wage growth in New Zealand outpacing Australia.
In Australia, pay rates increased from $65.10 in 2021 to $70.90 in 2024, representing an annualised growth rate of 2.9%. Pay rates for New Zealand sonographers increased from $61.10 to $71.70, representing an annualised increase of 5.7%.
The average hourly rate for sonographers increased 9.6% from $64.80 in 2021 to $71.00 in 2024. This continues the steady growth over the last 13 years, increasing by $20.50 since 2011. Despite the increase, overall satisfaction with remuneration by those paid an hourly rate has fallen slightly from 48% in 2021 to 43% in 2024.
Average Hourly Rate, 2010-2024
Private practice sonographers earn a higher hourly rate than their public hospital peers, with the most pronounced gap for cardiac sonographers, who earn $12.50 more per hour when working in private practice. Cardiac sonographers are generally paid less than all other specialities, whether in a public or private setting. Sonographers in private practice are more likely to be satisfied with their remuneration (46%) than those earning an hourly rate in public hospitals (29%).
There is a clear correlation between experience and remuneration, with hourly rates increasing rapidly for the first 10 years, before stabilising and then increasing again after around 20 years of experience.
Only 10% of respondents were paid an annual salary in 2024. However, this increases to 17% of those working full-time. The average annual full-time salary has increased to $123,869 (8.9% from $113,703 in 2021).
Early career salaries (0–3 years) average $88,273 per year, after which salaries increase significantly to over
$120,000, then generally stabilise around this figure for the remainder of their career.
A very small number (30) of respondents stated that they were paid per scan in their primary role in 2024. More than half of these were paid between $50 and $75 per scan. The overall average payment per scan for sonographers increased to $74.90 in 2024 (up from $65.20 in 2021).
Work Volume
The proportion of sonographers working overtime in an average week in both Australia and New Zealand has converged at 47%. Overtime is less common in rural and remote areas (44%) compared to city and metropolitan areas (49%).
Cardiac sonographers who work overtime do an average of 5.9 hours (up from 3.5 in 2021) per week, much higher than generalist sonographers (2.5 hours).
Overtime Rates
Time and a half is the most common rate paid for overtime, with 46% in public hospitals and 38% in private practice. Thirteen per cent of respondents doing overtime in public hospitals were paid double time compared with 8%. Twelve per cent of those in public hospitals and 17% in private practice said that they did not receive any compensation for overtime hours in 2024.
On-call Arrangements
The proportion of sonographers doing on-call work is also stable at around three in ten, with New Zealand sonographers less likely to be on call than those in Australia (21% compared to 33%).
The weekend remains the most common time to be on call, at 31% in 2024 (28% in 2021).
Sonographers in public hospitals are much more likely to do overtime, with over three in five (61%) working on call on weekends, and 57% doing so on weekdays.
In contrast, only one in five (21%) respondent sonographers in private practice are on call on weekends (up from 18% in 2021), and 14% on a weekday.
The number of hours sonographers are on call varies considerably, with the overall number of hours continuing to decline over time, and those in private practice typically working fewer on-call hours.
Of those public hospital sonographers who are on call, over half (56%) are on call for more than 36 hours per month, while over 42% of sonographers in private practice who work on call typically did so for less than 12 hours per month in 2024.
Proportion of Sonographers Working Overtime, 2017-2024
Australians were more likely to work on call for more than 36 hours (47%) than those based in New Zealand (24%).
The most common minimum hours paid for a callout in public hospitals regardless of hours worked is three hours (62%), whereas a minimum of two hours is much more common in private practice. Ten per cent of private practice are not paid for call-outs and 19% were unsure about the rate they receive for this work.
While the most common on-call rate for weeknights continues to be 1.5 times the normal rate, there has been a steady increase in the proportion paid double time up from 34% to 36%.
At 66%, the most common on-call payment rate for weekends is ‘double time’ (2 times their normal hourly rate) – broadly consistent with 64% in 2021.
Performance Bonus
General sonographers and those working in private practice were most likely to receive performancebased bonuses in 2024. Consistent with 2021, 21% of respondents were eligible to receive a performancebased bonus in 2024, though it is more prevalent in Australia (23%) than in New Zealand (7%).
The most common basis for bonuses continues to be an individual sonographer achieving a set number of scans (75%, similar to 73% in 2021), with overall business or departmental performance used to determine bonuses in just 10% of cases.
Employment Benefits
Australian sonographers are more likely to have a performance-based bonus structure, and only 29% of them are satisfied with the range of benefits available. Whereas around half (49%) of New Zealand sonographers are satisfied with the offering. Instead of a bonus, they are more likely to be offered a broader range of benefits, including annual membership fees (90% compared with 12%), professional accreditation (94% compared with 25%), professional indemnity insurance (62% compared with 13%), and support for additional study (73% compared with 32%).
Salary sacrifice benefits were available to 34% of sonographers, but this was much more common in Australia (36%) compared with 13% in New Zealand. Cardiac sonographers were much less likely to indicate that their employer paid for additional annual leave (53%), annual professional accreditation (10%) or annual membership fees (6%) compared with those in other practice areas.
While the gap is narrowing between the private and public settings concerning the employee benefits offered, a significant disparity remains for salary sacrifice and salary packaging, which is offered to the majority (73%) in public hospitals compared with just 21% in private practice. Support to conduct research was also more prevalent in public hospitals (13%) compared with 8% of those in private practice.
CPD Support
Of those who earned a bonus, the average amount received was $10,473, up from $9,475 in 2021. Fewer sonographers received bonuses in 2024 (66%, down from 75% in 2021). However, the average bonus received increased by 10.5%.
While the proportion of employers offering financial assistance for professional development has not shifted much in the last three years, there has been a sharp rise in the uptake of this support from below 30% in 2021 to well over 40% in 2024. This includes professional development activities (46%), conference leave (46%) or paying national conference registration fees (43%). One in three (34%) also used financial support to cover international travel and accommodation costs, and 24% for attending international professional development activities (up from 11% and 9%, respectively).
Are any of the following employee benefits paid for by your employer? Did you access or use this paid support in the last year?
Overall, over half of sonographers indicated that their employers fund, either partially or in full, leave (53%) and fees (56%) to attend national conferences, however, funding this leave is much more prevalent in public hospitals (56%) than in private practice.
Similarly, sonographers in public hospitals (44%) are more likely to have access to financial support (paid either partially or in full) to present at a conference than those in private practice (32%). Consequently, public sector sonographers were slightly more likely to use this support in 2024 (19% compared to 13% in private practice).
Some differences between practice areas were noted. Obstetrics & gynaecology sonographers were more likely than others to have their employer fund attendance at an international professional development activity (47%). Cardiac sonographers were less likely than others to have national conference registration fees covered (40%).
The majority of New Zealand sonographers have their national conference registration fees fully funded by their employer (76%), compared with just 18% of Australian sonographers, who are more likely to have their fees partially funded. Uptake of this funding was also much higher in New Zealand,
especially for conference leave (71%) and support to attend local (67%) and international (45%) professional development activities. This compares with just 41% of Australian sonographers using the funding for conference leave, registration fees and local professional development, and even less (16%) for international professional development.
Reasons for Not Accessing CPD Support
‘The cost of a conference attendance is now too expensive and only partially covered by my employer. I chose to do online CPDs and attend local meetings instead’ (GENERAL, PRIVATE).
‘I have either paid for webinars myself that were affordable or attended free educational activities’ (OBSTETRICS & GYNAECOLOGY, PRIVATE).
‘It’s way more expensive to travel interstate for conferences than just taking the leave. It’s much more complicated logistically with a young family too’ (GENERAL, PRIVATE PRACTICE).
‘I live in a rural area and find it difficult to access single-day workshops’ (GENERAL, PUBLIC).
The value of direct monetary CPD allowances provided to sonographers has increased since 2021, with the proportion of sonographers receiving between $1,000 and $2,000, increasing to 33% (from 25%), and those receiving over $2,000 increasing from 17% to 25%).
Annual Value of Monetary CPD Allowance, 2019-2024
New Zealand sonographers continue to receive a higher CPD allowance than those in Australia, with 71% receiving a CPD allowance of over $2,000 in 2024, compared with 7% in Australia.
Conference registration is the most common use of CPD allowances (87%), with an uptake of around 85% among Australian sonographers and 93% of those in New Zealand. Forty-four per cent of respondents use the allowance for compulsory CPD points.
Attracting Sonographers to the Profession
Remuneration and work/life balance continue to be the two most important factors in role-related decisions, with remuneration returning to the top in 2024 at 65% (up from 58%). Work/life balance remains a primary consideration for over three in five sonographers (63%, consistent with 61% in 2021), and this is much more important for sonographers in rural or remote areas (73%) than city or metropolitan sonographers (57%).
Role Attraction Factors, 2024
There has been little change in sonographers’ satisfaction with different elements of their work over the last five years, with over four in five continuing to be satisfied with the ultrasound equipment they
use (83%, up from 80%). However, fewer respondents indicated they were satisfied with the career path opportunities offered in the profession (down from 34% in 2021 to 28% in 2024).
While sonographers in both public hospitals and private practice reported high satisfaction with the ultrasound equipment they use (83%), satisfaction in other areas was not consistent. Private practice sonographers were more satisfied with their level of autonomy (77%), work schedule (65%) and remuneration (48%) than their colleagues in public hospitals (66%, 54% and 30%, respectively). The difference in satisfaction with remuneration is consistent with the higher average annual salary and hourly rates paid in the private sector. In contrast, sonographers in public hospitals (74%) did tend to report higher satisfaction with the time allocated per scan than those working in private practice (65%).
Sonographer Satisfaction by Employer, 2024
Comments About Job Satisfaction
‘For our expertise in a highly niche field with significant responsibilities, we are very much underpaid when compared to other professions’ (GENERAL, PRIVATE).
‘I feel like despite recently doing master’s and being able to bring in additional services to the company, I wasn’t rewarded with a raise increase’ (GENERAL, PRIVATE).
‘I find the job mentally and physically draining and have been considering leaving the profession. I deeply struggle with the lack of flexibility in the job and find I’m so overwhelmed while I’m at work’ (GENERAL, PUBLIC).
‘Demanding patients and lack of staff is making life as a sonographer difficult. I can’t wait to reduce hours further and retire’ (GENERAL, PRIVATE).
‘Workplace injury through scanning continues to be a significant problem. Even with care and support services in place, all of us suffer injury’ (GENERAL, PRIVATE).
Despite the challenges highlighted by respondents this year, many sonographers expressed satisfaction with their work and overall employment.
‘I am extremely lucky to work in such a supportive environment doing a job I love’ (OBSTETRICS & GYNAECOLOGY, PRIVATE).
‘It is a great career as long as the workload is reasonable’ (GENERAL, PRIVATE).
Workplace Environment
Overall, 35% of respondents reported an increase in the number of trainees (35%) and fully qualified sonographers (32%) at their workplace. Despite this, 43% of sonographers reported an increase in unfilled sonographer roles. This increased to 53% in public hospitals, where an increase in the number of both trainee and fully qualified sonographers was less prevalent. Only 19% of sonographers in New Zealand reported a rise in trainee sonographers in their workplaces in the last 12 months, compared with 37% in Australia.
Most sonographers (72%) indicated that there had been no change to the hours staff work at their workplace, and 16% reported that hours had increased. The increase in staff work hours was most pronounced in public hospitals, with 22% of sonographers in these settings saying staff work hours had increased over the last 12 months.
Overall, one-third of respondents reported an increase in workplace injuries, and this was higher in public hospitals (40%) than in private practice (27%). Approximately half of responding sonographers in both Australia and New Zealand reported that stress levels are higher and morale is lower at their workplace over the last 12 months.
I feel that sonographers everywhere I talk to are feeling pressured to work faster and they are fearful of reduced work quality and therefore patient care being compromised
(GENERAL,
PRIVATE PRACTICE).
Increase Workload and Staffing Indicators, 2019-2024
Comments About Workplace Environment
‘Corporatisation of our clinics has had a negative impact on staff morale’ (GENERAL, PRIVATE PRACTICE).
‘With staff that have left, approx 15 in the last 2 years and no replacement of staff, we are now overworked and feeling dissatisfied’ (OBSTETRICS & GYNAECOLOGY, PRIVATE).
‘Almost all sonographers have left to work in private settings as the pay in public is so poor. At the public site, we are understaffed daily’ (GENERAL, PUBLIC).
‘Focus on numbers has increased, rather than focus on patient care’ (GENERAL, PUBLIC).
‘Overall, patients are getting more complex and difficult to scan, but time allocations have not changed’ (GENERAL, PUBLIC).
‘The pressure to work faster and do more scans is definitely being felt’ (GENERAL, PRIVATE).
Future Plans
Over half of sonographers plan to stay in the profession for at least another 10 years. However, obstetrics & gynaecology specialists are more likely to be considering a departure within the next 2 years (15%) compared to 7% of both general and cardiac sonographers.
Sonographers in public hospitals and private practice exhibit similar career plans, with most expecting to continue working in the profession for more than 10 years. A slightly higher percentage of private practice sonographers (8%) plan to retire within the next 2 years compared to those in public hospitals (6%).
Although more sonographers have reported a remuneration increase over the last 12 months, few reported that the opportunities for advancement were improving. And despite increasing numbers of unfilled roles, three-quarters of respondents (76%) said there had been no change to their career prospects over the last 12 months.
The proportion of sonographer roles that remain unfilled in workplaces across Australia and New Zealand is approximately 1 in 15% and 14%, respectively.
soundeffects news is the biannual magazine of the Australasian Sonographers Association (ASA) Ltd.
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