By Liz Torrey

An echocardiogram — a procedure that uses sound waves to create pictures of the heart— is a frequently ordered test in American medicine.

The moving pictures created by an echocardiogram allow a doctor to see how a patient’s heart pumps blood, which is critical for evaluating symptoms, diagnosing heart disease or simply preparing for a surgery or other procedure.

Echocardiograms are a form of sonography, meaning they do not use any radiation, are painless and come with virtually zero side effects — so there’s almost no reason for a doctor not to order an “echo.”

There’s just one problem: There aren’t enough people trained to perform echocardiograms, both nationwide and in Virginia.

The need for this role within health care settings is growing, with the U.S. Bureau of Labor Statistics forecasting that the total number of cardiac sonographer positions will increase by 10% across the country by 2032. VCU Medical Center in Richmond is currently experiencing vacancies for this position.

“Of the two million patient interactions that take place at the hospital annually, one-third are for symptoms of cardiovascular disease. Echocardiograms are needed to provide many forms of cardiovascular care,” said VCU Health Pauley Heart Center Director Greg Hundley, M.D. “Our echocardiography program is fantastic. Team members work around the clock to keep up with the inpatient and outpatient needs at the hospital — and that’s not to mention our cardiac sonographers at Pauley Health Center clinics across the state.”

As the administrators of VCU Health’s echo team, Pauley Heart Center staff are keenly aware of this workforce shortage and are taking major steps to eradicate it through educational partnerships that will invest in a new generation of health care workers.

A partnership to advance educational opportunities and patient care

In 2022, with the support of funding from the Virginia General Assembly, the Pauley Heart Center worked with Rappahannock Community College (RCC) to establish a new two-year associate degree program in echocardiography. Two-year diagnostic medical sonography degree programs are available at a few other community colleges in Virginia, but only one, located in Northern Virginia, offers a degree program in heart sonography specifically.

While Hundley identified the shortage underlying the shortage of echo techs at VCU Health, he recognized a larger need for additional – and accessible – cardiac sonography training programs across Virginia.

“Dr. Hundley came to us and basically said, ‘Look, as a cardiologist, I see the writing on the wall,” said Ellen Koehler, dean of health sciences at Rappahannock Community College. “He explained that echo positions were going to grow exponentially in the coming years, and that there weren’t enough programs in Virginia that could train students fast enough to put a dent in the growing demand. Community college was where he saw the perfect fit for providing education and training to get people out there in the workforce to fill some of the needs that he saw coming.”

Hundley became familiar with RCC through his work on the board of VCU Health Tappahannock Hospital, which works closely with many of the health care training programs at the community college.

“[RCC’s Warsaw and Glenns] campuses serve students in the Middle Peninsula and the Northern Neck, and these are some of the areas in Virginia most in need of workforce development programs and economic opportunity,” Hundley said. “Collaboration across institutions seemed like an obvious solution to the challenges we’ve all been facing.”

Funding allocated from the Virginia General Assembly allowed RCC to invest in the sonography machines and other technology necessary to get the program up and running. Pauley Heart Center providers then supported Koehler and her team as they designed the program’s five-semester curriculum, degree path and coordinated a clinical site agreement that would allow the program’s students to do their clinical rotations at VCU Health. VCU Health also helped RCC to hire a program coordinator and instructor.

Finally, following program approval from the Southern Association of Colleges and Schools Commission on Colleges (SACSOC), RCC’s accrediting body, the program welcomed its initial cohort of eight students in the fall of 2023.

Hands-on learning students can apply to “real life”

Nature Cox, a 22-year-old from Westmoreland County, was part of the first cohort of RCC students to enroll in the sonography program. She had been leaning toward pursuing a radiology degree, until she heard that RCC was offering a new cardiac sonographer program.

“I’ve always been interested in the inner workings of the human body, but I got really into learning about the heart when I started to have my own heart issues. I have an implantable loop recorder. [Going through that process] was my first time ever seeing an echo and I was like, ‘Wow, this is pretty interesting,’” she said.

That first semester was hard, Cox says, but the material she was learning was intriguing, and that kept her going.

“I already have an associate degree, but not in a medical field, so that itself was an adjustment. This program requires a lot of study time — but I don’t find it difficult to study because what we’re learning is so interesting, and you can apply it to real life,” Cox said.

Echocardiograms are a procedure that allow health care providers to look at images of a patient’s heart. Students at Rappahannock Community College are learning how to take these images as part of a two-year degree program. (Rappahannock Community College) 

Students ultimately earn an associate degree in applied science, which means they also take classes in English, math, anatomy and physics in addition to their echo training coursework.

“Ultrasound is all sound waves, so we study physics as our base to learn how the machinery works,” said Harsha Sharma, RDCS, RDMS, the program’s director. “Once you understand that, you can manipulate the machinery to do great imaging.”

“The equipment that we have to work with at RCC is really, really great,” said 19-year-old Virginia Reinhardt, who is in her second semester of the program. “I feel like they’ve put a lot of thought into the program, and Ms. Sharma — really the whole school — will do anything and everything to help us succeed.”

Students travel to a variety of sites in central and eastern Virginia — including the VCU Health hospitals in Richmond and Tappahannock — for their clinical rotations. RCC even provides small scholarship stipends to students to offset the cost of gas and parking. Koehler says the program, designed with the help of Virginia McGhee, MSN, RN, CEN, nurse manager of Pauley’s noninvasive cardiology program, aims to give a hands-on experience to students with “less and less time in the classroom and more and more time in clinical settings” as the semesters go on.

“We have students coming in from all over our service area, and our service area is huge, but some of them have to travel a long way to go clinical,” Koehler said.

Reinhardt is currently attending clinicals at VCU Medical Center in Richmond, while Cox had her first clinical rotation at VCU Health Tappahannock.

“I really like the fast-paced environment so far,” Reinhardt said. “I like seeing all the different patients, age groups, pathologies. When we do portable echos on inpatient rotation, we go around to the different floors of the hospital and it’s really cool to learn about all the different levels of care. And we get to practice the scans that we’ve learned in class.”

The coursework and managing clinicals may sound tough, but Cox encourages others to seek out unique educational partnerships like the one between RCC and Pauley Heart Center.

“I just want to say,” Cox added, “to anyone who might feel discouraged from joining the program because they think it’s a lot of work — it’s not that bad. I work full time, and I help take care of my family — I have a father with a disability. And I’m still managing!”

RCC purchased enough equipment to enroll 20 students in the program annually, and the college is working on short and long-range plans to ensure the program’s continued success — first and foremost, the hiring of a clinical coordinator. More than 100 students are in the program’s pipeline as of January 2024, Koehler and Sharma say.

“The population that we serve are working folks who are trying to make their lives better,” Koehler said. “This degree is one huge, winning lottery ticket — if students are interested, and they get through the program, they will make a very decent living in our rural service area.”

In the U.S., the median pay for a cardiac sonographer position is $78,210. The salary expectation for new graduates of the RCC program is a base of $65,000 to $75,000, and up to $90,000 with overtime and on-call work. Both Cox and Reinhardt plan to look for cardiac sonographer positions in hospitals after graduation.

Koehler hopes this program creates more opportunities for graduates to continue to invest in their communities, particularly in rural areas.

“If we can keep some of our students in these positions in the Northern Neck, that would help our communities,” Koehler said. “Families won’t have to travel all the way to Richmond to get the kind of cardiovascular care they need.”

For the same reason, Hundley is hoping to grow Pauley’s partnerships with Virginia’s community colleges to create additional cardiac sonography and other cardiovascular care workforce development programs.

“There are so many Virginians who could benefit from this and other cardiac technology training programs — both on the provider side and the patient side,” he said. “We’re excited to see what the future will bring.”