A little-noticed provision in the sweeping One Big Beautiful legislation, enacted by the GOP over the summer, significantly limits the amount of federal student loans that students pursuing professional degrees can borrow. This includes those attending medical school, as well as students in other health fields such as nursing and public health. The Education Department has classified graduate education in these areas as non-professional education, a decision described by officials as technical and regulatory rather than a value judgment.
Starting next July, a federal loan program known as Grad PLUS will cease issuing new loans. Consequently, medical students will be subjected to a cap of no more than $50,000 per year, with an overall limit of $200,000 over four years. With many private medical schools already costing upwards of $300,000—including living expenses—these new financial restrictions are likely to prompt significant reconsideration among prospective students regarding their school choices and financial planning. Vineet Arora, vice dean of education at the University of Chicago's Pritzker School of Medicine, noted that the new borrowing limits could further decrease the already limited number of students from middle and lower-income families entering the medical field.
In addition to these student loan restrictions, a recent federal regulation posted on October 30—currently facing a court challenge—adds new conditions to the Public Service Loan Forgiveness program. This program allows health workers who serve in high-need areas and make payments for ten years to have their debt erased. The new policy states that loan forgiveness will not be available for individuals employed by organizations engaging in certain illegal activities, including those related to immigration, gender-affirming care, or terrorism aimed at influencing federal policy. The decision on which organizations will be deemed ineligible rests with the Education Secretary.
According to Atul Grover, a former policy leader at the Association of American Medical Colleges (AAMC) now serving as a visiting scholar at Stanford, these financial barriers will likely lead to a more affluent and less diverse health care workforce in the future. Despite arguments from supporters like Senate HELP Committee chairman Sen. Bill Cassidy that these changes will lower tuition costs and reduce student debt, many fear that limiting access to loans will deter students from lower-income backgrounds from applying to medical school.
Since the landmark June 2023 Supreme Court ruling that prohibits the consideration of race in admissions, enrollment among Black and Latino medical students has already seen a decline. This trend, coupled with the new policy changes, poses a threat to the availability of young doctors in underserved communities. While some new doctors may still choose to practice in these areas, others may opt for more lucrative specialties to manage their debt, exacerbating the current physician shortage projected to reach up to 86,000 by 2036, according to the AAMC.
The AAMC emphasized that higher financial barriers will significantly diminish the pool of qualified applicants, especially those from low-income, rural, or first-generation backgrounds. This creates a concerning cycle where fewer medical students today translates into fewer practicing physicians in the future.
These changes will not only affect aspiring doctors but also students pursuing degrees in dentistry, advanced pharmacy, psychology, and other professional fields. However, advanced nursing degrees and health practitioners like occupational and physical therapists are excluded from these new loan limits, which will set annual borrowing caps at $20,500. Organizations representing these professions are actively seeking policy changes before the regulations are finalized but have faced challenges in their advocacy efforts.
The American Nurses Association has voiced strong opposition to these new loan limits, asserting that restricting funding for graduate education threatens the foundation of patient care, especially amid a historic nurse shortage. In rural and underserved areas, advanced practice registered nurses play a crucial role in ensuring access to high-quality care.
Making graduate training in health professions less accessible could alter the composition of the health care workforce. A diverse workforce is essential for delivering effective health care, as supported by evidence from the National Academies of Science, Engineering, and Medicine's report, Ending Unequal Treatment. This report highlights that a health care workforce reflecting America's demographics can lead to improved health outcomes. Shared experiences and cultural concordance between patients and providers can enhance communication, which is critical for managing chronic conditions.
Recent data indicates a troubling trend: following the Supreme Court ruling, Black or African American enrollment in medical schools has dropped by 11.6%, while Latino enrollment has decreased by 10.8%. In contrast, enrollment among Asian and White students has risen. While various universities are implementing pipeline programs to encourage young students to explore careers in health and science, these efforts must navigate the complexities of new diversity, equity, and inclusion (DEI) regulations.
Despite the intention behind the recent policy changes, many in the education field argue that simply restricting borrowing will not effectively lower education costs. With ongoing pressures such as potential cuts to NIH support and rising taxes on university endowments, the path to affordable education remains unclear. Advocates argue that making education more accessible is vital—not just for students but also for the health of future patients.