Interview with Natalie Clements - FASA Bunbury, Western Australia

With a career that spans more than 25 years and a passion for mentoring the next generation, Natalie Clements has become a cornerstone of sonography in Western Australia’s southwest. From her early days helping shape the state’s first medical imaging program, to leading busy regional departments, Natalie shares how regional practice has shaped her career and why investing in local training is key to the future of sonography in regional Australia.

Can you tell us about your journey in sonography and how it led you to working in Bunbury?

I was one of the first medical imaging students at Curtin University in Western Australia, and a student at SJOG Subiaco, then employed there full-time. I was enrolled in MRI Honours back when there was only one machine in the entire state. However, I saw the dark side of a dimmed ultrasound room and got that gel on my fingers, and I was permanently on the ultrasound roster. I worked closely with my 2 incredible sonographer friends, who guided me through my Diploma in Medical Ultrasound, alongside 4 very special radiologists.

My career took me to Geraldton Regional Hospital, where I did FIFO (fly in fly out) half a week and the rest of the week at SJOG Subiaco. Four months in, and I moved permanently to Geraldton, where I was the only sonographer and on call 24/7. Back then the teleradiology was pretty basic, especially on weekends, and I’d spend more time processing films in the dark room and uploading them than I did actually scanning the patient!

The move down south to Bunbury came thanks to my then-boyfriend, who was soon upgraded to husband. I worked at a new SKG Radiology, built a house on the beach and started a family with two gorgeous boys who have kept me busy ever since. Almost 25 years later, I am still here and loving every moment of this journey.

From your experience, what are the biggest health needs or imaging demands in your region?

From my experience, the biggest health needs and imaging demands in my region are quite pressing. Throughout my entire scanning career, I’ve never seen a time when we have had enough sonographers and enough appointment slots –there is simply never enough capacity.

Like many places, we are facing a significant shortage, but regionally, it’s reached a crisis point with waitlists stretching from 6 to 8 months as the norm.

Research shows that country allied health practitioners or GPs are more than 7 times more likely to return to their hometown after their studies.

However, I think it is a broader health issue and not just sonographer-related. Patients struggle to get timely appointments with GPs, often lack continuity of care with the same doctor, and end up relying on emergency clinics when they really need help. Wait times to see surgeons are long, which means more up-to-date imaging is required, and the cycle goes on.

As someone who grew up in the country and works with many rural sonographers, I’m aware of how important it is to encourage local students into this profession. Research shows that country allied health practitioners or GPs are more than 7 times more likely to return to their hometown after their studies.

That’s why I am passionate about connecting with the next generation of potential sonographers at local schools. We host dedicated health career evenings where students can even try scanning on a machine. I’ve given school career talks explaining what and how far ultrasound careers can go. I talk about ultrasound careers to any school-aged student I have as a patient. This year alone, we’ve hosted 13 students on work experience at our department, and I know of at least 4 local students that have continued to university to pursue ultrasound careers.

How does working in a regional hub influence the professional opportunities available to sonographers?

Working in a regional hub opens up a wide range of professional opportunities that you might not get in a metropolitan setting. Early in my career, I realised that regional and remote sonographers often become generalists by necessity – and become local educators to the broader healthcare team. I still remember the surgeon who had never seen intussusception on ultrasound, let alone 3 in one week! Or the groundbreaking news that I can see a stenosis in the common iliac artery – true story, I kid you not! These kinds of experiences show how much value we can add, especially when our work means patients don’t have to travel long distances for specialist imaging.

There is also a great sense of professional autonomy. You need to trust your skills, knowledge and judgement to deliver the best outcomes for the patients. You learnt to back yourself, as there was no one else to scan; you just had to get on with it back then, with a dog-eared anatomy book. Nowadays, there is an app for that, or google to answer any question. Mind you, you need a working internet or decent phone coverage. Even with modern tools, that self-reliance and confidence in your own ability is something that regional practice really builds.

The variety of pathology I encountered was incredible – often more complex or rare than I expected. One case that has stayed with me was a twin pregnancy where one baby had anencephaly. I followed that journey through all the growth scans, and eventually, the mother made it far enough along to go to Perth for delivery and organ donation. It was a powerful reminder of the role we play in people’s lives. Of course, the workload can be intense, especially with on-call and barely a day away from the ultrasound machine. The sense of community in the hospital made all the difference. Everyone supported each other, and I always felt part of the team. Looking back, those experiences pushed me out of my comfort zone in the best way –and gave me far more than I ever expected.

What role does professional development and mentorship play for sonographers outside metropolitan centres?

Professional development and mentorship are incredibly important for sonographers working in regional areas. One of the few positives to come out of COVID has been the growth in online learning and virtual meetings. While telehealth meetings existed before, the pandemic really opened the door for us to connect more easily. Now there’s nothing stopping regional sonographers from joining meetings, conferences or presentations from anywhere in the world – on just about any topic. There are entire websites dedicated to on-demand learning, and I can watch sessions from the ASA Annual International Conference when it suits my schedule. It’s amazing how hard it used to be to find enough educational activities, and now they’re everywhere!

I’ve also been able to be involved with the ASA and ASAR committees, which wouldn’t have been possible without tools like Zoom and Teams. Giving back to the profession in this way has been incredibly rewarding.

Mentorship has always played a big role in my development as a sonographer. I was lucky enough to have the support of numerous sonographers as a support network. These days, I can send images for review in real time, even before the patient leaves the department – making clinical decisions easier. It’s exciting that this is being developed into a resource and will be more accessible to everyone. Locally, we’ve also taken the initiative to support each other by forming the ASA group South West WA.

It came about purely from the need for more professional development and mentorship. We hold regular case study nights, which are informal and engaging, and it’s been great to see quieter members grow in confidence with each meeting. The discussions are always lively, and the group includes sonographers from across the region, including those who work in FIFO or DIDO roles.

What do you think makes practising sonography in regional Western Australia unique compared with other parts of the country?

Ultrasound in regional Western Australia is unique because of the vast distances we cover to provide services. Sonographers often travel long hours to reach communities, which means patients don’t have to make the journeys themselves to Perth.

Some of my patients travel hundreds of kilometres to have scans, and then, if required, we try to fit in any other needle biopsies or injections on the same day. It is a big commitment, and it shows how dedicated we are to delivering high quality care no matter where we are.

Despite working in regional or remote areas, we maintain the same standards of scanning and service that you would expect in Perth. There is a real sense of purpose in knowing we are providing essential healthcare to communities that might otherwise have limited access.

Even with modern tools, that self-reliance and confidence in your own ability is something that regional practice really builds.

On a personal level, the daily commute for me is driving through a Tuart forest, then along the beach, currently checking for whales or the resident dolphin pods. I live 20 minutes from the wineries of the Geographe region and 40 minutes from the wineries or beaches of the Margaret River region.

Work is 5 minutes from the best shoe shop in Australia, the local beach and the IKEA of food – the Bunbury Farmers Market!

Looking ahead, what innovations or system changes could strengthen ultrasound services in regional areas?

To start this wish list – first and foremost, we still need reliable mobile phone coverage and faster internet services throughout rural, regional and remote WA. Since so much of our reporting happens electronically, improving connectivity is essential and long overdue.

Artificial intelligence will definitely play an important role in the future. Beyond assisting with diagnosis, I can see AI helping to streamline patient management; for example, automatically generating the appropriate follow-up requests and even booking the next available appointments when a certain pathology is detected on the scan. This would make the health system more efficient and help patients receive more timely care, especially in areas where access to specialists is limited.

To support regional sonographers and encourage junior sonographers, we need to look at regional placements and HECS debt write-off, like medical officers have available to them from the government. To enable this, those junior sonographers would need support in training, professional development and for workforce retention. Remote supervision and mentoring have to play a critical role by enabling real-time scan sharing and audiovisual communication to enable a remote but instant connection to experienced mentors. It will provide clinical guidance and enhance diagnostic accuracy and learning, but will also help to reduce professional isolation. This support would build confidence, improve job satisfaction and contribute to retaining skilled sonographers in areas where they are most needed.