“Ultrasound’s unique skillset needs recognition”

Ultrasound has long struggled to be recognised as a professional role worthy of a protected title. The protracted battle for identity and recognition as a statutory registered profession will be all too familiar to most sonographers. Despite this backdrop, I, like most sonographers with a radiography background, feel well represented by the Society of Radiographers. So, although independent recognition is clearly important, I don’t see it as being the biggest issue for a sonographer!

The real problem comes in trying to describe an increasingly diverse profession within a single Agenda for Change (AfC) pay band.

Most sonographers are essentially reporting radiographers and are therefore correctly remunerated at Band 7. However, many staff are transitioning beyond the boundaries of independent reporting, into interventional procedures formerly only performed by radiologists.

While this role extension is to be applauded, and makes for a stimulating and rewarding professional career, the pay structure has yet to catch up. This can cause wide disparities in practice, with some Band 7 staff working in very closely managed frameworks, with relatively binary outcomes and clear referral mechanisms. Meanwhile other staff are diagnosing, counselling and making independent, on-the-spot decisions to deliver ultrasound-guided therapeutic injections or biopsies on the back of their clinical findings.

This isn’t to suggest there is no way to progress within ultrasound. There are opportunities for staff to develop into advanced practice and consultant Band 8 roles. However, these come with mandatory development across the four pillars (clinical, education, management and research). 

Development in these areas doesn’t suit everyone and, if you excel clinically but find the idea of presenting to an audience or writing a research paper terrifying, it can easily feel like you’re left with nowhere to go professionally. Not least because developing across the four pillars inevitably takes you away from clinical practice.

The outcome of this is that some sonographers elect to take on interventional practice while continuing to be paid at AfC Band 7. Over time, normalising the Band 7 ultrasound role to include interventional procedures is counterproductive and increases the pay gap between radiographers and radiologists, who are undertaking the same procedures.

It feels like the Band 8 progression metrics employed by most trusts are heavily borrowed from nursing – the focus being on development of the four pillars, with some employers even insisting on mandatory elements to include non-medical prescribing and discharge management. Skills that are, frankly, irrelevant to most sonographers.

So, what can be done? Obviously, the ultimate goal would be a realignment of pay boundaries to recognise the unique skill set involved within ultrasound. I suppose my hope is that this article might just start people thinking and talking about this disparity. If “sonographer” is ever to become a protected title, it needs a pay structure that is fit for purpose.

Rowan Hicks is a consultant sonographer at the Royal Cornwall Hospitals NHS Trust.