A little-noticed provision in the sweeping "One Big Beautiful" legislation enacted by the GOP over the summer sharply limits the amount of federal student loans that students earning professional degrees — including medical school — can borrow.
It also imposes even stricter borrowing caps for other health fields including nursing and public health. The Education Department does not consider graduate education in those fields "professional" education, though officials described that as a technical and regulatory decision, rather than a value judgment.
The loan changes will hit next July when an open-ended federal loan program known as Grad PLUS will stop making new loans. From that point on, med students won't be able to borrow more than $50,000 a year — or more than $200,000 over the four years. Many private med schools already cost north of $300,000, including living expenses.
"That will automatically give a lot of people some pause to think about where they're accepted and what their finances are," said Vineet Arora, vice dean of education, at the University of Chicago's Pritzker School of Medicine.
Given that most medical students already come from the upper 40% of family income, Arora added, "we already have fewer medical students coming from sort of middle class and lower income families." Lack of access to loans, she said, may well skew it even more.
On top of those new restrictions, a federal regulation posted October 30 — already facing a court challenge — adds new conditions to the Public Service Loan Forgiveness program, which enables health workers who work in high needs areas and make payments for 10 years to erase debt.
The new Trump administration policy said loan forgiveness won't be an option for people working for an entity engaging in, among other things, illegal activities involving immigration, gender-affirming care, or "terrorism" aimed at "obstructing or influencing" federal policy. It will be up to the Education Secretary to decide which organizations will be ineligible.
These limits on how aspiring doctors or other health providers — nurses, occupational therapists, social workers, dentists and more — can finance their education likely foretell a more affluent, and less diverse, health care work force in the future, said Atul Grover, who recently stepped down from his long-time policy post at the Association of American Medical Colleges. He is now a visiting scholar at Stanford and a health sector consultant.
But champions of the legislation, including Senate HELP Committee chairman Sen. Bill Cassidy, who put forth a version of this legislation earlier this year, have argued that it will bring about changes in higher ed financing that will push down tuition costs and protect people beginning careers from "from drowning in debt."
These new loan changes come on top of a slew of recent court rulings and administration policies that crack down on diversity, equity and inclusion initiatives in higher ed.
Grover said the new policies will "disproportionately discourage and decrease the likelihood" that students from lower income families attend — or even apply — to med school.
"Once you tell them, 'Oh, you're going to have to borrow $300,000 to go to med school,' they're like, well, that's out, right?'" Grover said.
Narrowing who can afford medical education
Since the landmark June 2023 Supreme Court ruling banning consideration of race in admissions, Black and Latino enrollment to medical school has dropped.
That trend, and the new Trump administration policies, could mean fewer young doctors practicing in underserved communities, both rural and urban. Some new doctors will of course still choose to practice there, including some who themselves grew up in such communities. But many may feel like they have to choose high-paying specialties over primary care to get out from piles of loans.
The Association of American Medical Colleges said the new loan limits will likely worsen the physician shortage, already forecast to hit up to 86,000 doctors by 2036 — on top of existing shortfalls in underserved communities.
"If future medical students face greater financial barriers — especially those from low-income, rural, or first-generation backgrounds — we risk shrinking the supply of qualified applicants. Fewer students entering medical school now means fewer residents and practicing physicians later," the AAMC said in an emailed statement.
The AAMC declined further comment, as did several administrators and spokespeople for med schools.
Along with physicians, the changes will affect students in dentistry, and various advanced pharmacy and psychology degrees considered professionals, along with chiropractors and podiatrists, according to an Education Department memo.
But advanced nursing degrees, along with health practitioners like occupational and physical therapists, are not on that list. And for these "nonprofessional" graduate school tracks, the annual loan limits would be $20,500. Organizations representing those practices hope to win some changes in policy before the regulations are finalized but they have not been successful during months of debate.
"Misinformation on TikTok has caused confusion about the Trump Administration's ongoing actions to implement student loan caps for graduate students," The Department of Education's Press Secretary for Higher Education Elle Keast said in a statement Monday. "The Trump Administration is implementing long-needed loan limits on graduate loans to drive down the cost of programs."
Nurses disagree.
"At a time when health care in our country faces a historic nurse shortage and rising demands, limiting nurses' access to funding for graduate education threatens the very foundation of patient care," American Nurses Association president Jennifer Menik Kennedy said in a statement. "In many communities across the country, particularly in rural and underserved areas, advanced practice registered nurses ensure access to essential, high-quality care."
Benefits of a diverse health care workforce
Making graduate training in the health professions less attainable could change the makeup of the health care work force.
That runs counter to mounting evidence, outlined in a major National Academies of Science, Engineering and Medicine report last year called Ending Unequal Treatment , that a health care work force that looks like America is actually good for America's health.
It's not that a white doctor or nurse can't provide excellent care to a Black or Latino or Asian patient — or vice versa. That happens each and every day. But shared experience, the racial, linguistic and cultural matches between patient and provider known as "concordance," can improve doctor-patient communication. Some data show it improves patients' ability to manage chronic conditions like diabetes or hypertension.
"What the data says is that when we have a diverse and inclusive workforce that is representative of the populations that are served, that we actually see improved health outcomes," said Vincent Guilamo-Ramos, executive director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing, who served on the National Academies panel.
"Across all the health professions," he said, "we see that there's underrepresentation in terms of the people that need providers who can bring to their practice their sort of lived experience." That can include speaking languages in addition to English to enhance communication with patients.
According to data from the AAMC and its osteopathic medicine counterpart reported in JAMA Network Open, since the 2023 Supreme Court ruling incoming Black or African American student enrollment fell 11.6% and Latino by 10.8%. Asian and White student enrollment rose.
A number of universities run assorted "pipeline" enrichment programs to help high school students, or even younger kids, explore and prepare for careers in science and medicine. Some of those are still ongoing, and structured to avoiding running afoul of the DEI rules.
But an approach that med schools used after the Supreme Court, sometimes called "holistic admissions," ran into opposition from the Trump administration. The idea was to look broadly at med school applicants -- at those who may have overcome adversity for instance, not just those with the highest MCAT scores.
That was encouraged under the Biden administration. But President Donald Trump in August issued a "presidential memoranda" outlining how the Department of Education should crack down on "overt and hidden racial proxies."
"Greater transparency is essential to exposing unlawful practices and ultimately ridding society of shameful, dangerous racial hierarchies," Trump wrote.
Many health educators say the primary problem though, is the high cost of education for health fields.
Champions of the changes, including Cassidy and the Department of Education, argue that as borrowing is limited, the pressure will mount on schools to cut tuition.
But some in the education field say that while they too would like to see education become more affordable, they don't think these policies will achieve that. With NIH support under threat, taxes rising on endowments on some large prestigious universities,, and feuds between the administration and elite institutions relief is not likely, Guilamo-Ramos noted
But more affordable education, he said, would be good for students – and good for patients.
"One way that we can optimize health for everyone and save money is by ensuring that we have the best workforce, which means it being representative and then motivating people, all different kinds of people, to pursue careers in health and not only ones that would be the most lucrative."
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