Speech by Joan Baker,
Founding Chair of ARDMS
ARDMS 40th Anniversary Board Meeting
I am truly honored to have been asked to say a few words at this amazing event. Forty years is a working lifetime and before we get excited about the future I thought we might take just a few minutes to visit the past. It is said that you cannot know where you are going until you know where you have been. So please allow me to share with you our roots so that we can all embrace our future.
The ARDMS was a spin-off of the examination committee of the American Society of Ultrasound Technical Specialists (ASUTS) now known as the Society of Diagnostic Medical Sonography. The American Institute of Ultrasound in Medicine (AIUM) in 1971 under the presidency of Dr. Dennis White announced they wished to become more scientifically focused as they felt enough time had been spent by the organization on education. In 1972, Dr. Horace Thompson, who was the chairman of the meeting, came to L.E. Schnitzer and myself and asked if ASUTS would give some educational talks. However, he apologized that these would have to be given at 7 am as there was no other time available to dedicate to education. The ASUTS agreed, and to the surprise of Dr. White and the AIUM board it was standing room only for all four days of the conference.
Now that we had a start on education, the next necessary piece of the puzzle was to create a new occupation. The name "Ultrasound Technical Specialist" was not being well received. It required an explanation when it was used. In fact that was the intention when L.E. Schnitzer came up with the name in 1969; we were trying to avoid "Technician" or "Technologist," but that did not happen. I had come from the UK and was referred to as a radiographer so it made complete sense to me to become a sonographer when using sound. This was the birth of the Diagnostic Medical Sonographer terminology.
To establish a new occupation was not easy. In fact, the United States Office of Education discouraged the proliferation of allied health occupations. The occupation was finally created in 1973 and I represented the profession at a hearing of the United States Office of Education, which, I still say to this day, put 10 years on my life after my lengthy testimony. The demand for sonographers was escalating — one- and two-week training courses were popping up everywhere. The frustration with the shortage of educated sonographers led the commercial world to develop their own training programs in order to sell their equipment. The Society felt it needed to assume responsibility for protecting high educational standards to produce competent practitioners. I have often used a quote I learned from Diane Kawamura: “You train dogs and educate people.” Thanks, Diane, for those words of clarification.
I was appointed by ASUTS as the representative to the Manpower Division of the American Medical Association to address the issue of exams for technical specialists. On March 22, 1975, I persuaded the physicians to reinterpret a grandfather clause officially establishing the Registry as a separate organization. This meant filing the new organization's Articles of Incorporation and applying for a 501(c) (6) tax-exempt status from the IRS. I also served on the Allied Medical Professions and Services Committee to ensure that any examinations developed by the ARDMS would meet their guidelines.
This led to a norming examination in 1974 in Seattle at the annual convention of the AIUM. Physicians and nonphysicians were invited to take an examination that was intended to set a pass/fail rate for the first official certification examination. If my memory serves me correctly there were 12 nonphysician examiners and 12 MDs. The 12 sonographers were tested first by the physicians and then joined them as a team to test the rest of the candidates. This was an oral and hands-on examination and to be eligible to take it you had to have been a member of ASUTS on or before midnight Oct 6, 1974. This was the grandfather clause for the profession, worked out with the Manpower Division of the AMA. No one, including myself, was “given” our certification, everyone earned it. During the next two days, 200 registrants took the two part examination, hands-on portion and the oral film discussion. None of this would have been possible without the support of the manufacturers who came to exhibit at the conference. To imply that this was simple would be a gross understatement. In fact the only way to accomplish this was to act as a philanthropic dictator, communication was difficult and certainly not speedy, and snail mail was all we had. Its only benefit was it gave you time to think.
The future of ultrasound was in the balance and manufacturers of ultrasound equipment were under a lot of pressure to start ramping up sales because the stockholders were losing patience. The salesmen couldn’t sell unless they could attach a sonographer to the machine who could be immediately hired by the new equipment owner. This put a lot of pressure on Carolyn Gegor, the next chair of the ARDMS, to maintain the standard. This time period was known as the "Sonic Boom” and the blind were leading the blind through sonography. However, there were many great teams formed of physicians and sonographers who had genuine respect for one another and were able to move the field forward. Carolyn also had to deal with increased demand for the examinations and those that were not members of SDMS under the grandfather clause needed a written examination six months prior to the hands on examination. This involved setting up ten locations across the United States. The logistics of doing this were very much underestimated and all this including getting examiners was done with volunteers without reimbursement. More sonographers wanted to take the examinations than we could accommodate — in fact 400 took them the second time the exams were offered.
In 1977, the examinations were given to 700 to 800 registrants. To accommodate this growth was amazing, given that everyone had a full-time job as well as putting on these exams all over the country; it is hard to apologize for success. In November 1977 Joan Korfhagen in pediatric cardiology from Cincinnati Children’s became chair of ARDMS. Dr. Dick Meyer was very supportive of Joan and her role as chair of the ARDMS. He made it possible for her to have some time to address the issues she faced. The ARDMS records were contained in larger and larger boxes as they moved from chair to chair by the time they reached Cincinnati, they were in trunks. The danger of losing all the Registry’s records was a great concern to everyone since there were no duplicate sets.
It was also obvious that ARDMS needed a central office but these things are often easier said than done. It was more than a full-time job to organize the written and practical/oral examinations, let alone try and find a place for a central office, and then staff it. To offset the expenditures, an application fee was instituted. There were 45 centers organized for the written examinations and candidates were assigned to the center nearest to the individual's home. Thirteen centers were established for the practical/oral examinations to be taken by qualified candidates six months later.
Financially, the ARDMS needed to increase revenue so they could repay a loan from the ASUTS—the list of registered sonographers was made available for a fee to those interested in contacting the group for jobs, courses, or seminars. Yearly Registry renewal fees were initiated. An accountant was hired to assure that the ARDMS was conforming to acceptable financial practices.
The bylaws and a constitution were then formalized.
Around the time of the founding of the ARDMS, Senator Edward Kennedy proposed that a National Commission on Health Certifying Agencies (NCHCA) be created to oversee health professions. The ARDMS became a charter member and helped to develop the constitution and bylaws at the first organizing meeting held in Miami in December 1977. This made it possible to write rules for the ARDMS that were consistent with regulations set up by the NCHCA. Other allied health fields had great difficulty with this as their rules were in place, and they did not want to change them, but they had no choice if they wanted to join NCHCA.
Joan Korfhagen hired the University of Cincinnati's computer department to handle electronic scoring and recordkeeping. The selection of examination centers was computerized for the 1979 examinations. Proctors' logs required that examination booklets be numbered as a security method to account for all booklets, which were disappearing at an alarming rate.
The cardiology department at Children's Hospital was an initial central office site. However, a more spacious office was eventually chosen in the Vernon Manor Hotel, which allowed Board members on-site accommodations. An executive secretary was also hired.
Several testing agencies were interviewed to improve the credibility and reliability of the examination instrument. These agencies included the American College of Testing (ACT) in Iowa, the Standardized Achievement Test (SAT) group in Princeton, and the National Board of Medical Examiners (NBME) in Philadelphia. Board members and item writers attended all-day seminars in Iowa to accomplish this goal. The collaboration significantly enhanced the examinations and provided protocols to develop a new pool of questions for future examinations.
Joan’s tenure as chair and the years she served on the Board as representative for the Pediatric Echocardiography examination, as chair-elect, and later as consultant to the central office, launched the ARDMS to become an important certifying body in the allied health care arena. She transformed the organization's reputation to that of a highly regarded and professionally run credentialing body. As a testament to her achievement, the Joan C. Korfhagen award was created to bestow on the individual with the highest score on the Pediatric Echocardiography examination.
I would like to thank everyone who came after us original four and went on to build the Registry into what it is today. It was not easy for others who might follow after we completed our terms and I am sure you would not consider it easy today. In fact, there were times when we all feared for its future. I am in awe of what this has become from such humble beginnings. The number of hours that have gone into this is mind boggling. But we would like to salute you, because without you we would not be here celebrating with you. Also, congratulations to the staff, all 62 of you now (the four of us are jealous), and especially to Dale, who I am proud to say, was one of my many graduates. But he was also one of the high flyers that you knew would be successful no matter what role he would play.