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ICARED Rural Primary Care Ultrasound Training: Why is this Important?

ICARED Rural Primary Care Ultrasound Training

Why is this Important?

 Healthcare in the United States is expensive, limited in availability and suboptimal in outcomes.  The United States spends more of its gross domestic product (GDP) on healthcare than any other industrialized country.  Currently, it spends 17.1 % of its GDP on healthcare.  Despite this enormous spending, the United States is near the bottom of most industrialized countries in indicators of healthcare quality such as life expectancy, infant mortality and chronic disease burden.

Some of the causes of this discrepancy are high utilization of specialist care, expensive diagnostic testing and disparities in access to care.  Despite the large number of uninsured and underinsured, 1 in 10 people in the United States have had an MRI and nearly 1 in 4 have had a CT scan.  This is more than double the average rate for other industrialized countries, all of which have systems for universal healthcare.

Point-of-care ultrasound is the use of ultrasound by a provider caring for a patient using a focused diagnostic protocol or imaging for procedural guidance.   Its use has been shown to decrease utilization of expensive diagnostic studies and improve quality outcome measures.  Additionally, there is evidence that many point-of-care ultrasound applications can be performed effectively by non-specialist physicians after focused training. 

Many patients have access to the health system only through primary care.  In South Carolina primary care is especially important as 36 of 46 counties are rural and 44 counties are underserved.  This is important because it has been shown that more comprehensive care provided in primary care is associated with lower overall cost to the health system.11  Ultrasound technology is rapidly becoming smaller and less expensive – many now fit in the pocket of a white coat and can be obtained at more affordable prices.  Therefore, primary care physicians will have increasing access to this equipment. 

Despite these benefits, primary care physicians are not currently well trained to use point-of-care ultrasound.  In 2015 only 5.6 % of family physicians reported using ultrasound for non-obstetric purposes and only 2.2 % of family medicine residencies had established point-of-care ultrasound curricula.    There was, however, a large degree of interest in developing training. Successful point-of-care ultrasound curricula have been implemented in other non-specialist residency programs.  Emergency Medicine residents are now required to obtain point-of-care ultrasound training as part of their core training. Additionally, successful point-of-care ultrasound curricula have been implemented in undergraduate medical education for years and now over twenty medical schools have such curricula.  As they graduate from these programs, many new primary residents will have experience with ultrasound and want to continue to develop these skills for their future practices. 

For all of these reasons, it is imperative that rural primary care providers in South Carolina become competent with point-of-care ultrasound applications.  Physicians trained in South Carolina residencies will be the state’s major source for filling rural primary care provider positions. The fact that very few primary care physicians currently use point-of-care ultrasound creates one of the largest barriers to resident training in that there is a lack of well-trained faculty.  Our program offers a solution to increase the rates of primary care residency faculty members and rural primary care providers training in point-of-care ultrasonography.