When a patient complained to Mark Deutchman, MD, of pain in their upper right abdomen, he pulled out his trusty point-of-care ultrasound device.

With dozens of possible causes, Deutchman spent a few minutes passing the wand over the patient’s stomach, finally hovering under the liver. Several gallstones appeared.

He referred the man to a surgeon, avoiding bloodwork, results wait time, and a referral to radiology for imaging.

“It decreases the diagnosis to essentially when the patient’s right in front of you,” said Deutchman, a professor of family medicine at the University of Colorado Anschutz in Aurora.

Over the past two decades, experts have predicted the device would become the “21st-century stethoscope,” and the new standard in primary care and family medicine, with head-to-toe applications. But those premonitions have not come to fruition and use in the US lags behind other countries.

But a new cadre of primary care clinicians is becoming equipped to use the tech because of residency training requirements and workshops.

As an early adopter since 1980, Deutchman is one of the leading voices advocating for POCUS in primary care. He recently helped author a guide to POCUS credentialing within family medicine practices, including identifying application targets, determining how to bill, and perhaps most importantly, defining training requirements.

“Training is what holds many back since ultrasound is a very operator-dependent skill and is interpreted as it is being performed,” Deutchman said.

Clinician interest has grown over the last few years, said Ryan Paulus, DO, assistant professor of family medicine at the University of North Carolina at Chapel Hill School of Medicine, and program director of a POCUS certificate program. In 2025, more than 70 clinicians applied but only 36 spots were available.

“Anecdotally, the interest is there,” Paulus said.

But a one-off workshop may not be enough to use the technology in practice, Deutchman said. In a survey of residents and alumni of a family medicine program that included the training, only 36% of clinicians reported feeling “somewhat comfortable” using POCUS. More than half did not feel they had enough experience to use the machine and interpret images. Other surveys have shown similar rates of using the device after training.

Paulus and colleagues recently created a blueprint for more intensive, ongoing education, including applications broken into five tiers. The base level includes procedures such as imaging for knee effusion, bladder volume, and abscess/cellulitis. Tier five includes paracentesis and retinal detachment, the most difficult applications.

Despite slow adoption, Paulus said use should increase in the next decade as the more than 800 family residency programs comply with the 2024 requirements from the Accreditation Council for Graduate Medical Education, necessitating that residents learn POCUS in clinical care.

Common Uses

POCUS in primary care was first used for obstetrics and gynecology purposes: for dating of the fetus, checking the position before delivery, and inserting intrauterine devices (IUD) in those with a high cervix. 

This was the case for Joy Shen-Wagner, MD, a physician at Prisma Health Center for Family Medicine in Greenville, South Carolina. During a routine gynecological exam more than a decade ago, Shen-Wagner used POCUS to check on the placement of her patient’s IUD after complaints of not feeling the strings.

“Lo and behold, she was just pregnant, and she had no idea, well into the end of her first trimester,” Shen-Wagner said. “If I hadn’t [used POCUS], I think it could have gone on for a while without her knowing, because she still had the IUD there.”

The experience prompted Shen-Wagner to start a fellowship focused on POCUS use. She said she now uses the device once a day.

Other common uses include ultrasound guidance for musculoskeletal injections and evaluating an abscess for possible drainage, said Megan Lykke, MD, assistant professor of family medicine at the University of Colorado Anschutz School of Medicine in Aurora.

“I can feel a mass if they’re complaining of a lump. Is it fluid? Is it not fluid?…Is this either a cyst or an infection or is this more of a solid mass? And then from there, I may be able to drain it myself with a needle or if it’s something more solid I can get them the appropriate care that they need,” Lykke said.

Even if more imaging or tests are needed, Paulus said in-office imaging can rule out a possible diagnosis or provide preliminary answers, alleviating “patient stress and worry.”

POCUS can be especially valuable in treating patients who live in areas without specialists or imaging centers, said Lykke, who does most of her clinical work at federally qualified health centers on Colorado’s western slope.

“If you have to send someone an hour or more to get an image, that is very costly and takes a lot of time. Sometimes, they won’t even do it, or they don’t have transportation,” she said. “Being able to provide timely bedside evaluation allows for delivery of care that is less burdensome for patients and available when it is needed most.”

No financial conflicts of interest were reported.

Kelsey Mesmer, PhD, is a freelance journalist and journalism professor at Saint Louis University in St. Louis.