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Joan,

Your recall regarding opposition to the use of 'sonographer' based on the
fact that RVT practice is not limited to the use of ultrasound (e.g.,
performance of H&Ps, plethysmography, blood pressure measurements, etc.) is
absolutely correct.  

However, this was not the only argument against merging vascular technology
under a heading of "sonography."  If memory serves, this specific issue was
discussed in some detail at an SVT membership meeting in 2002-2003.  I do
recall the issue of variance between practice expense for vascular
technologists and diagnostic medical sonographers was reviewed as was the
fee schedule impact.

The point of the PrimeTime Live program was one of education.  That is, it
is far more important to know that the persons performing and interpreting
examinations are competent than to review certificates.  You might recall
that a 'certificate' had been provided to the Director of the program after
she attended a corporate sponsored 'seminar.'  Clearly this meant nothing
(the point).  Additionally, you might recall two maternal-fetal cases - both
having been interpreted as being grossly abnormal, with an outcome in one
case that, after a last moment repeat examination averted an abortion, a
normal child was born (complete with a clip of a very normal little boy
playing in his yard) while the other case resulted in the abortion and the
resulting pathology report described a normal fetus.  Add to these the
number of studies that were done with a patient 'referred' with vascular
disease, the vast majority of which were grossly inaccurate and, if
believed, would have resulted in unnecessary surgery.

By and large, these fundamental issues are not resolved.  Statutory
requirements for demonstration of minimum entry level competency are almost
nonexistent (the few that are can be considered ineffective to-date) - a
congressional staffer mentioned that the reason ultrasound was specifically
excluded from the 'advanced imaging' accreditation requirements was
secondary to efforts by lobbyists representing AUA and ACOG.  While I can at
least come up with an argument from the AUA's point of view, I simply fail
to understand how ACOG can maintain such an apparently unethical position
(are not they complaining very loudly about malpractice costs?).  But maybe
I'm simply missing something ... 

As much as I appreciate Terry's position that words have meaning, I do not
share his distaste for what he refers to as the "T" word.  I also understand
the history of the word "sonographer".  However, IMHO, it is at least
equally, if not more, restricting and changing one suboptimal word for
another is simply not prudent.  

What I do is provide patient care and I fail to see how either of these
terms adequately describe my scope of practice.

Finally, I have never been in a position that afforded me the opportunity to
not be concerned about salary.  Furthermore, since the inception of RBRVS
and cost reports, I have been acutely aware of practice expense and the
impact on reimbursement - after all, this is the basis for our income and to
ignore it would have an adverse impact on the profession as a whole.  The
fact that differences exist that are measured by 'labels' is simply a
reality.  

/fww

PS: With regard to democracy and majority rule; this is a nice concept that
this country, and professional societies, seldom follow.  Two thirds of our
national government are not directly elected (Executive (elected by
Electoral College) and Judicial (appointed by President and confirmed by
Senate)) and it is a relatively recent event that the Senate became directly
elected (17th amendment, if memory serves - prior to that they were elected
by state legislatures).  In reality, only the House of Representatives was
designed to be directly elected (think maybe the 'founding fathers' really
did not trust the 'people'?).  And with regard to associations, I do not
recall any SVT vote to petition ARDMS to alter RVT to RDVS.  I suspect this
may have been a board or executive committee decision?  But maybe my memory
fails me ... 

/fww

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Joan P Baker
Sent: Monday, October 08, 2012 7:58 PM
To: [log in to unmask]
Subject: Re: Still Techs?? - be careful what you wish for ...

Frank I know how passionate you are about this issue and I remember the
arguments on both sides a few years ago. I know Terry is equally passionate
about words and how they are used in the English language. If I remember
correctly the defense for using technician or technologist was the fact that
vascular technologists/icians did other things than just "image". When I
gave the name to "sonographers" it was from my UK roots which said Sono =
sound  "grapher" those that make a graph" graph or picture/image with sound.
Vascular technology's involvement in indirect testing I was led to believe
was the reason this name change was rejected. The question now is do
vascular technologists still perform these indirect tests e.g.
(plethysmography)? 

When Prime Time Live had its expose which you featured in so very eloquently
we had to help the public differentiate between those that were qualified (
ARDMS) versus those that had never taken a certifying exam. The easiest way
was to call them sonographers if they were certified and technologist/icians
if they were not. We pushed for technician so that vascular could continue
using technologist when they were RVT's. As we all know in a country that
loves to abbreviate everything uses "Tech".

Personally I have never considered this an issue about salary nor have I
thought that anyone would lose salary because of their label. I think this
is something the SVU should consider if they see this as needing to be
revisited. A specialty should control its destiny after both sides are heard
and in good old democratic fashion vote with majority rule. 

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Franklin W.
West
Sent: Monday, October 08, 2012 7:13 PM
To: [log in to unmask]
Subject: Re: Still Techs?? - be careful what you wish for ...

Under the category of "be careful what you wish for and even more careful of
what you accept as a valid expert cite" ... OR ..."Do you really want an 8%
decrease in income?" {in the end, you will see that the practice expense for
Vascular Technologists is 8% greater than DMSs, not the reverse}

Bill is unequivocally correct - This issue was discussed at length by RVTs
at a number of SNIVT/SVT/SVU meetings.  Those who fail to study history are
doomed to repeat it ... 

Terry is equally correct that the US DOL median income for DMS is $64,380
per year.  The cite is
http://www.bls.gov/ooh/healthcare/diagnostic-medical-sonographers.htm

Quick Facts: Diagnostic Medical Sonographers

2010 Median Pay                                              $64,380 per
year - $30.95 per hour 
Entry-Level Education                                       Associate's
degree
Work Experience in a Related Occupation      None
On-the-job Training                                          None
Number of Jobs, 2010                                      53,700
Job Outlook, 2010-20                                       44% (Much faster
than average)
Employment Change, 2010-20                         23,400

Terry is, however, very INCORRECT in his comment regarding the median income
for "RVT" - this is simply NOT a survey that is performed by the DOL.  The
quote Terry cites is from:
http://www.bls.gov/ooh/healthcare/cardiovascular-technologists-and-technicia
ns.htm 

Quick Facts: Cardiovascular Technologists and Technicians and Vascular
Technologists 
 2010 Median Pay                                             $49,410 per
year - $23.75 per hour  
Entry-Level Education                                      Associate's
degree
Work Experience in a Related Occupation     None 
On-the-job Training                                          None 
Number of Jobs, 2010                                       49,400 
Job Outlook, 2010-20                                        29% (Much faster
than average) 
Employment Change, 2010-20                        14,500

As such, this supposedly appropriate category is in reality an incredibly
inaccurate merging of a variety of positions including invasive and
noninvasive cardiac and peripheral vascular technicians and technologists
(theoretically no less than eight distinct positions).  Some of these
positions are almost exclusively found in hospital settings while others
vary widely in terms of setting ... and while I've met some folks that have
multiple credentials and perform, e.g., "babies, bellies, etc.", I cannot
say I have ever met anyone that works in a setting performing invasive
cardiac and vascular procedures as well as noninvasive cardiac and
noninvasive peripheral vascular studies as a technician and technologist.

The DOL data is considered so invalid and unreliable that HCFA (now CMS)
encouraged involved medical specialties to fund an independent survey of
Registered Vascular Technologists (this was further supported by HCFA when
it was noted that more than 50% of the Medicare Carriers at the time
required non-physician certification and/or laboratory accreditation for
vascular procedures).

To make a very long story short, a result with a much greater real world
impact in measuring income can be found in the Resource Based Relative Value
Scale "Direct Practice Expense Inputs" for the Medicare Physician Fee
Schedule, which includes the following 

$0.50 per minute ($62,400 per year) for Diagnostic Medical Sonographers
$0.54 per minute ($67,382 per year) for Vascular Technologists 

Clearly I have a bias given I am really not interested in a significant
reduction in personal income ... or, for that matter, a scope of practice
that limits my ability to provide appropriate patient care.  As such, I will
remain a Registered Vascular Technologist and Registered Vascular Specialist
... and if I am not given a choice, I will opt to simply use these devices
under a state license (i.e., RN) that already provides the option ... But
that's just me ... 

/fww

PS:  Along with Terry's request, if you're not interested in an eight
percent decrease in income, please raise this issue with Dale and Kevin ...
PPS:  A personal opinion - those two surgeons on the ARDMS EC may have known
something ... this is not an ACR vs SVS issue, although Terry's comments
might infer that ... or even one of distaste for a word ... this has real
world implications that can harm those that practice vascular technology ...

-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Bill Johnson
Sent: Sunday, October 07, 2012 6:31 PM
To: [log in to unmask]
Subject: Re: Still Techs??

Bill Johnson, Port Townsend, WA
I know the word "tech" is much maligned, or at least not credited.
And the issue of "technician" vs "technologist" never caught traction, in
spite of years of discussion on the SNIVT/SVT/SVU Boards.  I admit I am
proud to be a lowly "tech" and the service I have provided our patients.
But, regardless, I agree with Terry.  While the issue of compensation is
important, I think the issue of recognition is also important.
So, Terry, what do you propose we do?  I would sign your petition, but then
no one might take notice since I am only a "Registered Vascular
Technologist."  Catch 22?

On 10/7/12, Jim Mosley <[log in to unmask]> wrote:
> Just so everyone is informed, what would you recommend as the best way 
> to
pursue this through the ARDMS?
>
> Excellent idea, by the way. I'm all for advancing our profession.
>
> Sent from my iPhone
>
> On Oct 7, 2012, at 1:54 PM, Terry DuBose <[log in to unmask]>
wrote:
>
>> Several years (after the meeting in New Orleans) ago the SVT, now SVU 
>> petitioned the ARDMS to change the vascular credential from RVT to 
>> RDVS so it would be in line with echocardiographer and get rid of the 
>> "T" word.
>> However, there were two vascular surgeons on the ARDMS Executive 
>> Committee that killed the petition.
>>
>> Those guys are gone from the ARDMS and it seems time for the vascular
>> community to raise this issue again.   If you look at the pay for RDMS
>> and
>> RVT in the USA Dept. of Labor's OCCUPATION OUTLOOK HANDBOOK (OOH) you 
>> will see that DMS are listed with a median pay of $64,380 per year, 
>> while the RVT
>> median pay of $49,410 per year.   I believe the primary cause of this
>> discrepancy is the designation of "vascular technologists."
>> http://www.bls.gov/ooh/healthcare/diagnostic-medical-sonographers.htm
>> http://www.bls.gov/ooh/healthcare/cardiovascular-technologists-and-te
>> chnicians.htm
>>
>> If you agree, please raise this issue with the new ARDMS Executive 
>> Committee Chair, Kevin Evans, and the ARDMS CEO, Dale Cyr.
>>
>> Good luck, Terry
>>
>> [log in to unmask]
>> Terry J. DuBose, MS, RDMS
>> Associate Professor Emeritus
>> Diagnostic Medical Sonography
>> University of Arkansas for Medical Sciences [log in to unmask]
>> 512-826-8833
>> ***************

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