Echocardiography Workforce

ASE is committed to ensuring a robust cardiovascular ultrasound workforce to meet growing patient care demands. ASE advocates for reducing administrative burdens, particularly prior authorization requirements, that divert professionals from patient care while supporting initiatives to alleviate physician burnout and improve work-life balance. ASE champions recruitment and retention of echocardiographers and sonographers through enhanced training programs and professional development opportunities, including expanding Graduate Medical Education slots to train future echocardiographers. The Society also supports maintaining telehealth flexibilities that improve access to specialized cardiac care, protecting loan forgiveness programs that enable medical students to pursue cardiovascular specialties, and strengthening pathways for specialty physicians to practice in rural and underserved communities. These efforts ensure adequate physician capacity to maintain high-quality echocardiographic services nationwide, particularly in areas facing critical workforce shortages.

Increasing Graduate Medical Education Slots 

The US faces a critical physician shortage with the AAMC projecting a shortage of up to 86,000 physicians by 2036, driven by an aging population and growing healthcare demands. Medicare's artificial cap on Graduate Medical Education funding has remained largely unchanged for nearly 30 years, creating a bottleneck where more than 3,300 qualified medical school graduates lacked residency slots in 2022. This shortage particularly affects cardiovascular care, threatening access to essential echocardiographic services as demand for specialist services increases while training capacity remains constrained. 

ASE supports bipartisan legislation to add Medicare-supported GME positions: 

• Resident Physician Shortage Reduction Act of 2025 (S 2439/ HR 4731)  - would add 14,000 Medicare-supported GME positions over seven years starting in fiscal year 2026. This legislation would help train the next generation of cardiovascular specialists essential for echocardiography services. Expanding GME slots is critical for ensuring adequate physician capacity to meet growing demand for cardiovascular care while addressing workforce shortages that contribute to physician burnout and reduced patient access to cardiac diagnostics. 

Prior Authorization 

Medicare Advantage plans routinely use prior authorization to delay patient access to medically necessary care, creating substantial administrative burdens for specialty physicians and contributing to physician burnout. The HHS Office of Inspector General found that Medicare Advantage plans inappropriately deny medically necessary care that meets traditional Medicare coverage requirements and is supported by patient medical records. These delays harm patients and increase healthcare costs by leading to more visits to the doctor or emergency department, forcing many physicians to retire early or leave medicine entirely. 

ASE supports bipartisan legislation to reform prior authorization: 

• Improving Seniors' Timely Access to Care Act (S 1816/HR 3514) - would streamline and standardize Medicare Advantage prior authorization 
• Reducing Medically Unnecessary Delays in Care Act (HR 2433)- would require board-certified physicians in the same specialty make prior authorization decisions 

These reforms would ensure medical decisions are made between patients and their doctors without insurer interference, reducing administrative burdens on cardiovascular specialists while ensuring timely access to essential echocardiographic services for Medicare beneficiaries. 

ASE opposes the Medicare Wasteful and Inappropriate Service Reduction (WISeR) Model, which would introduce prior authorization into traditional Medicare Fee-for-Service. This model risks replicating the same harmful delays and administrative burdens that plague Medicare Advantage. ASE supports Congressional efforts to halt implementation until meaningful stakeholder engagement occurs and proper safeguards are established to protect patient access to care.

• WISeR Model Frequently Asked Questions

Telehealth 

Current Medicare telehealth flexibilities are continuously facing expiration, as there are no permanent policies, which threaten access to echocardiographic consultations and cardiovascular care for patients in rural and underserved communities. Without congressional action, Medicare patients will lose the ability to receive telehealth services from their homes, and geographic restrictions will be reimposed, forcing cardiac patients to travel long distances for routine echocardiographic follow-up care and specialist consultations. 

Additionally, ASE comments annually on Medicare Physician Fee Schedule proposed rules and consistently advocates for telehealth expansion, emphasizing the critical role of remote interpretation and consultation in echocardiographic services. The Society supports permanent expansion of telehealth and remote service flexibilities that have proven effective in maintaining care continuity and expanding access to specialty cardiovascular expertise, particularly for fetal echocardiography where remote consultation enables access to pediatric cardiology expertise without requiring high-risk patients to travel long distances to specialized centers. 

ASE supports bipartisan legislation for permanent telehealth legislation: 

• CONNECT for Health Act of 2025 (HR 4206/S 1261) - would permanently remove geographic restrictions on Medicare telehealth services and allow patients to receive care from any location, including their homes.

Public Service Loan Forgiveness 

High medical education debt creates barriers to entering cardiovascular specialties and echocardiography, particularly affecting recruitment to underserved areas where cardiac imaging specialists are most needed. Without adequate loan forgiveness options, qualified candidates may be deterred from pursuing cardiovascular medicine, worsening physician shortages in communities that depend on specialists for essential echocardiographic services. 

ASE supports protecting federal loan programs and forgiveness options:  

• Public Service Loan Forgiveness (PSLF) program - provides loan forgiveness for physicians working in nonprofit hospitals, public health departments, and community health centers  
• Graduate PLUS loan programs - enables medical students to access necessary funding for medical education  
• Maintaining current borrowing limits and eligibility requirements that allow health professions students to afford the full cost of medical education 

Supporting Rural Access to Cardiovascular Care

Rural communities face critical shortages of cardiovascular specialists, with non-metropolitan areas projected to meet only 68% of physician demand by 2037 (a 32% shortage). These shortages severely limit access to essential echocardiographic services for rural patients who often must travel long distances to receive cardiac care. Targeted incentives and visa pathways are essential to recruit and retain specialty physicians in underserved areas where cardiovascular specialists are most needed.

ASE supports legislation and policies to strengthen rural physician recruitment:

• Specialty Physicians Advancing Rural Care (SPARC) Act (S 1380/HR 4681) - would establish a loan repayment program of up to $250,000 over six years to incentivize specialty physicians to practice in rural communities facing critical physician shortages.
• Protecting H-1B Visa Pathways for Physicians - ASE opposes restrictions on H-1B visa programs that enable international medical graduates to practice in the United States. These physicians play a critical role in addressing workforce shortages and disproportionately serve underserved and rural communities.

These initiatives would help ensure rural communities have access to cardiovascular specialists capable of providing essential echocardiographic services while addressing the severe physician shortages that threaten cardiac care in underserved areas.