The cardiac sonographer workforce impacts upon the inequity of provision of echocardiography within New Zealand

Abstract

AIM: To identify population based regional provision of echocardiography provision within New Zealand (NZ) public hospitals. The relationship between the cardiac sonographer workforce size, demographics and capacity will be explored to better understand the regional provisions.

METHODS: In March 2013 surveys were distributed to 18 public hospitals with a sonographer led echocardiography service, return rate was 100%. Questions related to sonographer workforce size and demographics, workflow processes and echo volumes. Information on District Health Board (DHB) population was obtained from government public access websites. Multivariable linear regression was performed using DHB population characteristics and workforce demographics to determine their potential contribution to echocardiogram volume. Workforce capacity was calculated from scan duration, annual scan volumes, workforce size and availability and compared to predictions using international models.

RESULTS: There are 84 cardiac sonographers in NZ, 14 of them trainees. The total full-time equivalent (FTE) of cardiac sonographers is 70.4; echo FTE was 61.9 with 75% of the workforce performing echo as the only component of their role. Thirty-one (44.3%) qualified sonographers and 10 trainees (71.4%) are titled cardiac sonographer or echocardiographer. Sixty-eight (81%) cardiac sonographers have a cardiac physiology background. Thirty-five (50%) qualified cardiac sonographers hold Australasian echo qualifications.

Significant regional differences in echocardiogram volumes per 100,000 population were seen amongst DHBs but not between surgical and regional centres (surgical median 1802, regional median 1658, p=0.18). There were also wide regional differences in the workforce size (FTE) per 100,000 of population served unrelated to centre type (median 1.4, range 0.9-2.7). In multivariable modelling, the population based scan volumes were predicted by DHB demographics (socioeconomic status, Māori/Pacific ethnicity and age) and workforce demographics (workforce size, centre type, trainee proportion). There were regional differences in both population-based clinical capacity and scan duration, with no clear relationship to centre type. The NZ workforce capacity is similar to predictions using a UK model, and consistently less than the USA model for all scan types.

CONCLUSION: This study demonstrates regional differences in the provision of echocardiography services in NZ by population-based echo volumes. The echo volumes are impacted by both DHB demographics and the cardiac sonographer workforce size, demographics and clinical capacity. This study also provides an update on the cardiac sonographer workforce which will be essential for planning the future growth.