September 1999


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Bonnie Johnson <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Fri, 24 Sep 1999 12:14:58 -0700
text/plain (136 lines)
I should have made myself more clear in that reporting to a "Sonography"
service line does not have to mean every specialty moves into one location
physically.  It would mean that each specialty area would report to a single
administrator/Sonographer.  They should remain in specialty departments and
running specialty laboratories.  That is where the quality is and as long as
the hospital is making money they are happy regardless of where it is
located. The physicians are happy because they get to have their own
specialty labs, but the radiologists will be UNhappy that they do not get to
have ALL of the reading fees.  However, it could work out to be a better
working relationship between the Sonographers and the MD's if they realize
that the Sonographers are self governed and have representation.
Vascular/Echo/US Sonographer's would be patient advocates and be responsible
for monitoring their own accuracy as well as that of the MD's. (Most of us
do this anyway but others get the credit(ie;MD's)!).

I believe there should be specialists, cross training into one additional
specialty may make sense, particularly in smaller hospitals, but spreading
ones self too thin is bad medicine no matter what you are doing.  It is also
my opinion that Sonographers should have to apply, and be accepted, for
cross training and not forced into it if quality is going to be maintained.

In the spirit of Bill S. comments re: "vas, card, and rads all in a room
together" - I would have to agree - "when pigs fly".  That is why WE need to
be the patient advocate - no one else is.

Bonnie L. Johnson, RDMS, RVT
UCSF Stanford Health Care
Director, Vascular Laboratory Services
Division of Vascular Surgery
Stanford, CA

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]]On Behalf Of Bill
Sent: Friday, September 24, 1999 9:58 AM
To: [log in to unmask]
Subject: Re: Combining services of vascular labs to Radiology

     Kathey, et.al. This is a great subject for discussion so here goes
     my 2 cents. I will admit to my bias upfront for vascular sugery.
     Vascular surgeons are the end users of the information and its been
     my almost universal experience that in surgery based labs, the
     information is overall more useful that that coming out of the
     average radiology based lab. The surgeon needs more information
     than just a degree of stenosis. Certainly radiology based labs are
     not inherently bad and there are many good ones, particularly those
     with interventionalists who can effectively use the information we
     can provide. We work well with our radiologists. That bias
     admitted, here goes.

     You may be asking two questions. Is the Vascular Lab simply going
     to radiology administratively but otherwise stays intact? It would
     seem to me that the heart of the matter goes back to
     cros-straining (intended) This mythical beast arose from managers
     wanting to maximize efficiency and patient through-put with some
     emphasis added by certain Pew Commission recommendations regarding
     Allied Health. While in theory, a super sonographer who can do
     everything is very valuable, in most scenarios it is not that
     feasible in practice. In a hospital setting, workloads between
     "departments" tend to paralell each other, so when one department
     needs the help, the super sonographer is already swamped and unable
     to cross over. If one only regards efficiency, then this super
     sonographer is valuable in a small lab that does a wide variety of
     procedures. (Should they be doing a wide variety???)

     Lets look at a crosstraining scenario. I take an experienced RDMS
     sonographer and cross train them into vascular. Could we agree that
     it may take me perhaps 6 months? I will take that efficient
     productive sonographer and make them virtually non-productive for 3
     months and semi productive for 3 months, slower than an experienced
     person for maybe two years, and others need to absorb the work this
     person normally does in general ultrasound. I become half as
     productive for 6 months because I have to spend time training. This
     is a large financial gamble the employer takes and most managers I
     talk to have no concept of this. If all works well and all parties
     stay with the same employer for the next 5 years, this maybe makes
     sense. If someone leaves in two years, they likely lose significant

     Finally and most importantly, the issue is quality. I think it is
     not unreasonable to be a pure specialist. I am better at vascular
     than the super sonographer, I am faster, I am more efficient. As
     long as I can get enough work/hours/money, I am happy and the
     employer has the best possible employee. I don't think I want my
     mother's calf veins scanned by a super sonographer who only does 3
     veins a week because they spend much of their time doing gall
     bladders, and whatever. How about fetal US? I want the person
     scanning my kid to be a specialist and only a specialist! I am a
     vascular technologist and I am crosstrained already. I look at
     arteries and veins in all parts of the body, lymph nodes, baker's
     cysts, kidneys, thyroids (many more thyroids than any general
     sonographer ever sees) etc.

     To roughly quote Bill Johnson "Cross training.....hell I am not a
     tennis shoe!"

     Ideally, I think that if we want to get into a larger "department"
     then a Sonography department, separate from radiology is the way to
     go. Include US, Vascular and Echo. Can you imagine, radiologists,
     sitting next to vascular surgeons, next to cardiologists....all in
     the same room, discussing a case?......Yeah that could happen.
     Those interested, please e-mail at the address below as I have some
     prime Florida real estate for sale. Really!

     Bill Schroedter
     [log in to unmask]

______________________________ Reply Separator
Subject: Combining services of vascular labs to Radiology
Author:  UVM Flownet <[log in to unmask]> at Internet
Date:    9/23/99 2:32 PM

Dear Flownet, This must be "in the air" as today, I have gotten two calls
about the benefits and disadvantages of combining vascular labs to Radiology
departments. I know this is a sensitive subject, but I am curious as to your
opinions, advice, pros and cons to this issue. I have worked in both arenas
and also during one of the mergers. I have my opinions, but would like some
objectivity. Is this another plan that looks good on paper, but leads to the
demise of well established practices? Let's hear it... Thanks for your help.
Kathy Palmieri, RVT
Kathleen Palmieri, RVT
Cardiovascular Technology Resources
Skaneateles, New York