Position statement: The role profile of echo specialist physiologists

Published 14/09/2023

In common with the careers of several groups of health care professionals, the role of an echo specialist cardiac physiologist has developed considerably over the last 32 years since the BSE was formed.

In addition to core scanning/reporting responsibilities, the careers of many experienced echo-specialist physiologists have developed to include elements of Advanced or Consultant-level practice; for example within physiologist-led valve clinics (PLVC), stress, contrast or bubble lists, intraprocedural trans-oesophageal echocardiography (TOE) or complex adult congenital heart disease (ACHD) lists. Consequently, cardiac physiologists are increasingly taking on components of clinical roles traditionally performed by physicians. Professor Alison Leary and Geoff Punshon’s UK Echocardiography Workforce Report (Leary & Punshon, 2023) details proposed pathways for advanced roles.

Despite this shift, the standard description of a cardiac physiologist’s role has not kept up with this change in clinical scope of practice. Accordingly, the disparity between desired career development and the availability of a clear career development pathway to support advanced/consultant level practice is one of the key reasons cited for the current workforce retention issue of cardiac physiologists in the NHS and subsequent reliance on a high locum spend to maintain core service levels.

To bridge this gap, this document proposes several potential novel descriptions for the role of an echo-specialist cardiac physiologist. It is anticipated that whilst each job description will be unique, bespoke to the skill set and ambitions of an individual alongside the requirements and limitations of an institution, at its core will be a service-level commitment and, if desired, elements of advanced/consultant -level practice. Furthermore, an individual’s job description should not be static, but instead undergo an annual process of job plan review within the wider departmental structures available to support this.

Service-level core role

Scan lists of unselected inpatients and outpatients, produce factually correct, evidence-based reports directly addressing the referral indication and send these reports to the referring clinician for action.
Identify patients presenting with acute or suspected acute pathologies, or severe or acute symptoms, and escalate these via local pathways to an appropriate clinician for prompt review or treatment.
Suggest additional investigations where required.
Due to the workforce shortage, the core role may also include some training and supervision of junior staff, and review, feedback and countersignature of reports drafted by junior staff and trainees.

This role would fulfil the criteria for band 7 on the Agenda for Change (AFC) matrix.

Departments demonstrating good practice should additionally identify experienced members of their band 7 echocardiography teams to deliver wider aspects of a high quality and patient centred echocardiography service, including components of the Echocardiography Quality Framework (Masani, 2018) (Figure 1).

In addition to performing outpatient and inpatient echocardiography lists, a minimum of 20% of a full-time band 7 echo specialist physiologist’s job plan should be focussed on contributing to the wider echocardiography service. This proportion of time away from clinical scanning allows the echocardiographer space for continued professional development (CPD) and service improvement, whilst also providing personal enrichment, career development and enhancing overall satisfaction. It has the additional benefit of protecting echocardiography staff from musculoskeletal disorders caused by prolonged scanning times.It is recognised that in some (particularly smaller) centres staff may be rotational and rostered in other areas within Cardiac Physiology, as well as echocardiography services, and this should be taken into consideration.

The purpose of job planning is to ensure enough clinical capacity to meet the expected demand on the clinical service, seven days a week, 52 weeks per year, while balancing the development needs of people and organisations.

Job planning provides the opportunity for echocardiography staff and their managers to agree the proportion of each role that will be attributed to clinical care and other specified supporting clinical activities. It is an opportunity for echocardiography staff to describe the activities they are delivering that may not be patient-facing but that add value for patients. Job planning enables the effective and efficient use of resources in a way that brings mutual benefits to organisations, patients and clinical staff in planning and delivering high quality care. At its heart is a drive to provide patient-centred care that meets local populations’ needs and improves outcomes.

Figure 1 - Echocardiography Quality Framework

Example AfC Band 7 Job Plans

For a 5 day week

Max scan suggested 8/day (9-5, two sessions); 45 min scan*; 5/7 per week scanning; 46wk/yr. Approx 1400 scans/year.

*note that sessions with trainees require longer timeslots depending on trainee level of experience and that the capacity of the senior echocardiographer to undertake additional work during this time is highly variable depending on the stage of training of the trainee. Sufficient time must be allowed for daily huddles/staff meetings.

Mon

Tue

Wed

Thu

Fri

Echo List (IP)

CPD, Triage or Patient satisfaction survey work

Echo List (OP)

Echo List with trainee

Echo List (OP)

Echo List with trainee

Trainee feedback

Echo List (OP)

Staff meeting and trainee feedback

CPD,Triage, formal trainee assessments

Roster planning

Echo List (IP)

Trainee feedback

Echo list with trainee

Mentorship/appraisal time

For a 4 day week

Max scan suggested 10 /day (8-6, two sessions); 45* min scan; 4/7 per week scanning; 46wk/yr. Approx 1400 scans/year.

Mon

Wed

Thu

Fri

Echo list with trainee

CPD/triage/patient satisfaction survey work

Echo list (IP)

Echo list with trainee

Echo List (OP)

Roster planning

Echo list with trainee

Trainee feedback

Echo list with trainee

Mentorship/appraisal time

CPD/Triage/trainee assessment

Staff meeting

Advanced-level roles

In addition to an ongoing commitment to service delivery, many echocardiographers hold advanced roles within a department. These may include aspects of service leadership, research or educational roles and/or delivery of advanced echocardiography services such as physiologist-led valve clinics (PLVC), complex adult congenital heart disease (ACHD) lists, stress, contrast or bubble lists or intraprocedural TOE.

This group require time (equivalent to ‘Supporting Professional Activity’ (SPA) time in a Medical Consultant’s job-plan) to allow them to develop and nurture these specialist roles. In addition, several of the core sessions within their job plan may involve the delivery of these advanced roles.

It would be expected that these roles fulfil the criteria for band 8 on the AFC matrix.

Training/Educational lead role

Mon

Tue

Wed

Thu

Fri

Echo list with trainee (simulator-based)

SPA: Delivering educational material

Supervising echo lists with 2 x trainees

Formal assessments (Including STP/ETP Onefiles)

Supervising echo lists with 2 x trainees

Echo List with trainee

Trainee feedback and /or assessment

Echo list with trainee

Senior staff meeting

SPA: Developing educational material/attending Train the Trainer

Trainee feedback

Echo list (IP)

Mentorship /appraisal time

Echo list (OP)

Trainee feedback and/or assessments

Triage lead role

Mon

Tue

Wed

Thu

Fri