Self-Regulation: Is It Worth The Effort?
- Sep 21, 2023
- 6 min read
Updated: Oct 28, 2023
Diagnostic medical sonography (DMS) is a unique imaging modality which uses sonographic pulsed waves to produce 2-Dimensional and 3-Dimensional images of soft tissue, fluid, and vasculature in humans (Campbell, 2013). DMS has created a particularly important niche in the obstetrics and gynecological medical space since its discovery in 1958 by Ian Donald, John McVicar, and Tom Brown in Glasgow (Campbell, 2013). DMS has grown beyond the confines of pregnancy and has expanded to include almost the entirety of the human body, including heart (echo), vascular assessments, cancer screening and surveillance, and musculoskeletal evaluation.
This is due to several contributing factors such as quick access to DMS exams, affordable diagnostic imaging tool, and no confirmed biological impact since there is no radiation, though sonographers and DMS users are well trained to uphold ALARA (As Low As Reasonably Achievable) safety principles preventatively to ensure safe thermal index (tissue heat) exposure (Minister of Health, 2001).
Governing Bodies for Sonographers
Despite its vast applicability and accessibility in Canada, DMS is not a registered profession (Sonography Canada, 2018). The implications are that there are no formal training requirements to practice DMS in Canada. Despite this lack of legislation, common regional and employment standards require DMS practitioners, known as sonographers (though this can include specially trained nurses, physicians, primary care aids, midwives, and x-ray technologists), to be a member of Sonography Canada.
This member run national governing body oversees the development of DMS as a profession in Canada while upholding the highest standards of practice, Codes of Conduct, Code of Ethics, and disciplinary review committees for Canadian DMS (Sonography Canada, 2018). Sonography Canada provides licenses, standardized testing, accreditation reviews for schools and ultrasound providers, and insurance for its members (Sonography Canada, 2018).
In addition to Sonography Canada, many Canadian sonographers are members of the American Registry for Diagnostic Medical Sonographers (ARDMS).
Dual membership allows sonographers to work anywhere within North America (Saskatchewan Association of Medical Radiation Technologists, 2013). ARDMS provides standard testing and licensing for specialized DMS exams which are not yet available through Sonography Canada making dual membership prudent for highly specialized DMS providers.
Regulation of DMS in Canada
Since 2010, passionate sonographers and advocates have worked at a provincial and territorial level to move the profession towards self-regulation (Sonography Canada, 2018). As a result, DMS is currently a recognized profession in Alberta, Ontario, and Quebec (Ministry of Education, 2023). In 2019, DMS became a registered profession in conjunction with College of Physicians and Surgeons of Ontario, the College of Nurses of Ontario, the College of Midwives of Ontario under the Regulated Health Professions Act, O. Reg. 107/96, the Controlled Acts Regulation (Controlled Acts, 2023)
Nova Scotia began its movement towards self-regulation in 2010 and has made significant strides for the profession (College for Sonographers and MRT, 2018). Manitoba in similarly underway towards self-regulation; in 2013 its members joined with Magnetic Resonance Technologists (MRT) and in 2021 the Minister of Health and Seniors Care referred the movement to the Health Professions Advisory Council for investigation, the results of which are pending (Canadian Association of Medical Radiation Technologists (2023). DMS has been seeking self-regulation in the province of Saskatchewan since 2006 with the Saskatchewan Association of Medical Radiation Technologists (SAMRT, 2006). Currently legislative negations are still being conducted, so to strengthen the process, DMS joined with other healthcare professions. British Columbia is quickly moving towards self-regulation though has reached several legal barriers (Foerster, V., 2015).
Little information is available for the Northern Territories, Prince Edward Island, Newfoundland and Labrador, and New Brunswick beyond provincial legislation and employee recommendation for governing body membership (Nurse Practitioners of New Brunswick, 2022).
Membership with Sonography Canada is a recommendation and not a legal requirement, however most reputable Canadian employers, specifically governmentally funded and operated health care providers, required membership (ACMDTT, 2019). In Alberta, the provincial regulating body is the Alberta College of Medical Diagnostic and Therapeutic Technologists (ACMDTT), under which DMS has been included since 2016 by the Health Professions Act (Province of Alberta, 2023). As a self-regulated governing profession there would be a legal obligation to uphold the professional values and conducts while maintaining public safety for all sonographers and medical professionals trained and certified to conduct medical sonograms (Adams, 2016).
Importance of Self-Regulation
Self-regulation provides a trifold professional responsibility for DMS practitioners and patients. Legally it provides exclusive title for sonographers and recognition as a profession, requiring accredited licensing and education through credible institutions (ACMDTT, 2023). It establishes a formal complaints process which upholds transparency and accountability through the governing body and ensures that all DMS providers maintain standard Code of Ethics, Code of Conducts, and provide competent, ethical, and safe diagnostic imaging from medical professionals (Sonography Canada, 2023).
The self-regulation of DMS protects the public, the registered practitioners, and the medical providers (Motluk, 2019). The profession is run by sonographers and public representatives to uphold and progress the profession, define standards of practice and professionalism, have regulatory bodies and accredited programs, maintain professional competencies and medical literacy among its members (ACMDTT, 2023).
The public can feel safe knowing that DMS providers and sonographers are highly skilled, trained professionals who have met legal standards at entry to practice and continue their education as professionals (Sonography Canada, 2018). In provinces where DMS is a regulated profession, there are registries available to the public which list all legally qualified practitioners (Ontario Regulations, 2023). In the event of a potential breach in Code of Ethics and Standards, the public has the right to a formal complaint procedure through the provincial governing body or through Sonography Canada for members (Controlled Acts, 2023). Self-regulation ensures patient safety and the advancement and advocacy of DMS in Canada.
Limitations with Self-Regulation
Despite the legal and professional benefits to self-regulation, it is a slow, cumbersome process and which may not merit effort. First, as sonographers make up a small number of health care providers, DMS is often forced to merge with other services to ensure patient safety remains top priority and execution of the profession (Motluck, 2019). This can imply that DMS is subjected to rules and regulations not tailored to the unique requirements of the profession or are being represented by other health care disciplines with limited knowledge of DMS. Self-regulation can limit entrance of professional individuals into the field, particularly regarding specialized DMS providers such as midwives, emergency room trained responders, and nurses (Adams, 2016). It is also prudent to note that other countries including the United Kingdom and Australia, have revoked these privileges due to a lack of upholding public safety; these countries have moved towards a cis-regulation where professionals and members of the public sit together on the board and collaborate towards a cohesive representation of professional and public needs (Bosk et al, 2011)
References
Adams, T. L. (2016). Professional Self-Regulation and the Public Interest in Canada. Professions and Professionalism, 6(3). https://doi.org/10.7577/pp.1587.
Alberta College of Medical Diagnostic and Therapeutic Technologists (2019). Diagnostic Medical Sonographer Self-Regulation in Alberta: Frequently Asked Questions [facts sheet]. https://acmdtt.com/wp-content/uploads/DMS-Self-Regulation-FAQ.pdf
American College of Medical Diagnostic Technologists (retrieved Sept 20, 2023). Diagnostic Medical Sonography. https://acmdtt.com/about-us/specialties/diagnostic-medical-sonography/?doing_wp_cron=1695005374.0441610813140869140625
Bosk, C.L., Dixon-Woods, M., Yeoung, K. (2011). Why is UK Medicine No Longer a Self-regulating Profession? The Role of Scandals Involving “Bad Apple” Doctors. Social Science and Medicine, 73(10): 1452-1459. https://doi.org/10.1016/j.socscimed.2011.08.031.
Campbell, S. (2012). A Short History of Sonography in Obstetrics and Gynecology. Facts, Views and Vision in Obgyn,5(3):213-29.
Canadian Association of Medical Radiation Technologists (2023). CAMRT-MB Self-Regulation Resources. https://www.camrt.ca/manitoba/advocacy/camrt-mb-self-regulation-resources/
College for Sonographers and MRT (2018). FAQ about the College for Sonographers and MRTs [fact sheet]. https://nscmirtp.ca/assets/documents/faq_on_self_regulation.pdf
Controlled Acts (2023, Sept 18) O Reg 107/96, <https://canlii.ca/t/563bc>
Health Canada. (2023, April 1). Health Professions Act. Province of Alberta. Retrieved September 18, 2023, from Alberta King's Printer:
Foerster, V. (2015). Review of Ultrasound in BC. Laboratory, Diagnostic and Blood Services Branch, BC Ministry of Health.
Minister of Health (2001). Guidelines for the Safe Use of Diagnostic Ultrasound. Health Canada. https://www.canada.ca/content/dam/hc-sc/documents/services/environmental-workplace-health/reports-publications/radiation/guidelines-eng.pdf
Ministry of Education (2023). Occupational Profile Canada: Medical Sonographers. Canadian Information Centre for International Credentials. https://www.cicic.ca/938/occupational_profile.canada?&id=62#:~:text=The%20profession%20of%20a%20medical,is%20usually%20required%20by%20employers.
Motluk, A. (2019). Self-Regulation in Health Care Professions Comes Under Scrutiny. Canadian Medical Association Journal, 91(33): 926–927.
Nurses Association of New Brunswick (2022). Standards for the Practice of Primary Health Care Nurse Practitioners. https://www.nanb.nb.ca/wp-content/uploads/2018/12/NANB-NPStandards-Dec2018-Amended-Sept22-E.pdf
Ontario Regulations. (2023 August 31). Registration Under Medical Radiation and Imaging Technology, O. Reg. 866/93. https://www.cmrito.org/static-resources/acts-regulations-by-laws/acts/.
Saskatchewan Association of Medical Radiation Technologists (2013). Governance Policy. https://samrt.org/assets/samrt-governance-policy-manual-(sept-8-2023).pdf
Sonography Canada. (2018, June 6). Important Information About the Regulation of Diagnostic Medical Sonographers. https://sonographycanada.ca/news/important-information-about-the-regulation-of-sonographers-in-ontario#:~:text=Sonographers%20are%20now%20regulated%20with,force%20on%20January%201%2C%202018.
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