This story is a part of KERA Health Check-ups. More information is available at the end of the article.
A potential change to federal policy could limit how much students can borrow for different degree programs – a KERA listener wants to know how that could affect health disparities in Texas.
The U.S. Department of Education's proposed rule going into effect in July would narrow which programs can be considered "professional degrees," which come with a higher student loan borrowing limit of $200,000. Under the proposed rule, which hasn't been finalized, nurses aren't eligible – meaning they can only borrow $100,000, or up to $20,500 per year.
Teneisha Howard, president of the Metroplex Black Nurses Association and a nursing professional development specialist, said the rule is misaligned with the "reality of our health care needs" given the looming nursing shortage in Texas.
"We're going to see the gap we have been working so hard to close open back up tremendously at a rate that we might never be able to close it," she said.
What's happening with the professional degree list?
The concept of "professional degrees" was introduced as part of the Higher Education Act of 1965. The definition is used by DOE to determine which programs should qualify for higher loan limits because the requirements for practice require more than a typical bachelor's degree.
"It's important to acknowledge that nurses were never on the list to begin with," said Serena Bumpus, the CEO of the Texas Nurses Association. "[DOE] just didn't have any controls essentially around who was getting the higher limits."
Prior regulation treated the list of professional degrees as non-exhaustive, leaning on the phrase "including, but not limited to." However, the federal tax and spending bill passed last year required DOE to identify which programs will be eligible for higher federal student loan limits.
Under the draft rule, there would be 11 fields that could receive a professional degree – including medicine, law and theology. Ten of the fields were part of the Higher Education Act definition from the 1960s – but clinical psychology was added to the list during the negotiation process which concluded late last year.
In a statement to KERA, a DOE spokesperson said the change is "currently subject to ongoing rulemaking."
Nurses raise concerns about potential disparities
While there are several programs that could be affected by the proposed rule, many nurses and health care experts have raised concerns that not including nurses could make nursing education inaccessible.
For nurses, advanced degrees are required for advanced practice and academic or educational positions. Howard said many students from "underrepresented and economically disadvantaged backgrounds" rely on federal loan programs to access graduate level education.
"This reduced loan eligibility is going to particularly affect minority students and first-generation graduate students, which is then going to continually widen the disparities in advanced practice representation," she said.
Howard said a lack of diversity in advanced practice could mean the profession won't be able to provide culturally competent care.
"Everyone is not the same and everyone comes from different backgrounds and experiences," she said. "Somehow, we have truly lost that in nursing and in compassionate care and empathy with our patients, and it's causing harm."
Worries about nursing shortages
Many nurses said they're worried about how the proposed rule could affect the future of nursing.
Texas has one of the most severe nursing shortages in the country. The Texas Center for Nursing Workforce Studies projects there will be a deficit of 57,000 full-time registered nurses, or RNs, by 2032.
A master's or doctoral degree isn't required to become an RN. About 80% of nurses in the workforce don't have a graduate degree, according to DOE.
However, Bumpus said that doesn't mean the new loan limits won't worsen the shortage in the state.
"We have a significant faculty shortage that's nationwide," Bumpus said. "But specifically here in Texas it requires a master's and a doctorate degree to teach in our nursing programs. If we don't have enough master's or doctorally prepared nurses to do that, we will not be able to expand the pipeline of nurses here in our state."
Texas is also one of the fastest growing states in the country. Bumpus said the need for care is only going to continue to increase.
"We will also need more advanced practice nurses, so these are family nurse practitioners, nurse midwives, certified registered nurse anesthetists," Bumpus said.
All of those require a master's degree, but most are moving towards needing a doctorate in nursing.
Howard said advanced practice nursing plays a critical role in Texas, where the large rural population can sometimes rely on nurse practitioners to fill other workforce shortages – like primary care physicians and OBGYNs.
"We all know that rural areas tend to not have as many clinics and hospitals in close proximity for the amount of residents that they have," she said. "A lot of these nurse practitioners who work in rural areas are really the primary source for health care…. Not being able to have the funding to pursue these types of degrees is really going to hurt our rural areas throughout the United States."
Howard also noted for students who can't afford advanced education without the higher loan limit, all of these concerns could contribute to higher rates of burnout.
"It's just going to have nurses leave our profession much sooner and continue to widen that nursing shortage gap," she said. "That's going to leave the next generation of our community without health care, essentially."
But do nursing students need higher loan limits?
DOE said its data indicates that 95% of nursing students borrow below the lower loan limit of $100,000.
Bumpus said there are several factors that can lead to nursing students needing to borrow beyond that amount.
"Nursing is not set up like, say, physical therapy, for example, where you get a baccalaureate degree and then go straight into a doctor program," she said. "A lot of people will take a stepwise approach and they'll get a master's degree first and then they'll go back and get a doctorate degree."
The "stepwise" approach can mean a higher overall cost to reach a doctoral degree.
Bumpus also said what program a student is in can play a significant role in how much they have to borrow.
Certain advanced practice programs are more likely to have a higher cost, like nurse anesthetist programs – which Bumpus said is a "rigorous and full-time program." That may require students to take on student loans to supplement their income while they're in the training program.
"I recognize that part of the reason [DOE is] doing this is to try to get schools to reduce their tuition rate," Bumpus said. "But some of the private schools are more expensive for people to attend, and that is where our students get accepted. A lot of times when you're ready to advance yourself, you're going to go where you've been accepted."
DOE said the rule is still subject to changes after the public comment period concluded last month. But, both Howard and Bumpus said that hasn't lessened their concerns about what this could mean for health care in Texas.
"This has a potential to have a huge downstream effect on our ability to just grow the nursing profession in the future," Bumpus said.
This story was inspired by a KERA audience member as part of KERA Health Check-ups. Health Check-ups are designed to answer KERA listener questions about health topics and make the complicated world of health policy and access more understandable. If you have a question for our health reporter or want to help shape KERA's health coverage, fill out this form.
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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