The rapid adoption of point of care ultrasound (POCUS) and echocardiography has challenged healthcare organizations to consider whether to require practitioners to be privileged. On the one hand, unrestricted use of POCUS may enhance patient care through early detection of pathology or allowing objective assessment of therapies. On the other hand, misinterpretation by incompletely trained providers could cause harm to patients and subject healthcare entities to liability. The peculiar challenge of POCUS is that, at times, its use is akin to the clinical examination, while at other times it more closely resembles conventional radiographic or echocardiographic examination. This raises questions with regard to professional qualifications, documentation, billing, archiving of images, reporting, supervision, and quality control. Currently, there is little consensus as to what should be required. This is further complicated by the fact that POCUS is practiced across a wide range of medical specialities. In this chapter, we review the published experience and recommendations regarding training and privileging and explore some possibilities for the future.