Loading ...

The US Department of Education (DOE) late last year eliminated Grad PLUS loans and set new student loan caps for graduate and professional degree programs as part of the President Donald Trump’s One Big Beautiful Bill Act.

Currently, Grad PLUS loans cover up to the full cost of tuition with no lifetime caps. Under the new rules, graduate students will have the option to borrow a lifetime total of $100,000, and professional degree students can borrow up to $200,000.

In this context, professional degrees would include:

• Pharmacy
• Dentistry
• Veterinary medicine
• Chiropractic
• Law
• Medicine
• Optometry
• Osteopathic medicine
• Podiatry
• Theology
• Clinical psychology

Many medical programs, including public health, nursing, physician associates (PAs), and registered dietitian nutritionists, were left off the professional degree list. The exclusion from this list and the recent updates to student loan limits left many medical professionals confused and disheartened.

“When I first heard that nursing programs were being excluded from a list of professional degree programs, I was very frustrated and angry to hear this. To be honest, it felt very insulting,” Jennifer L. Armendariz, RN, a family nurse practitioner certified in lifestyle medicine based in El Paso, Texas, told Medscape Medical News in an email.

Armendariz is not alone. Over 236,000 nurses and patients signed the American Nurses Association’s petition asking the DOE to include nursing as a professional degree.

The department is moving forward with its plans in April released its final rule on the matter, with an effective date of July 1.

“I think it’s really important for the Department of Education to understand that by saying a post-baccalaureate degree is not a professional [degree] really undermines the profession of nursing as a whole. I worry that when the public hears this, it could actually create an even bigger divide in the healthcare system,” Armendariz said.

The department has said the fact nursing is not on the professional degree list is not a reflection of how the Trump Administration views nurses.

“The definition of a ‘professional degree’ is an internal definition used by the department to distinguish among programs that qualify for higher loan limits, not a value judgement about the importance of programs,” the agency said in a news release. “It has no bearing on whether a program is professional in nature or not.”

Loan Caps Could Make Physician Workforce Less Diverse

Students pursuing MD and DO degrees qualify for higher lifetime loans, but a recent study published in JAMA found that even medical students in these “professional degree” programs will face a financial burden due to the new federal student loan caps.

According to the findings, in 2020, 14% of medical students had taken out more than $200,000 in federal student loans. 

While some medical students could take out private loans, this option won’t work for everyone, Hao Yu, PhD, an associate professor of population medicine at Harvard Medical School in Boston and senior author of the study, told Medscape Medical News.

“These private loans will charge higher rates and will be very selective in choosing the students that they want to serve as their clients. You can imagine that some students with relatively low family income might not be able to borrow from these private sources. That has unfortunate implications for the diversity of our physician workforce,” Yu added.

Federal Loan Cap May Exacerbate Physician Shortage

Limiting access to federal student loans will not only make the healthcare workforce less diverse, but it will likely worsen the impending physician shortage crisis.

The Health Resources and Services Administration has projected that the US will have a 15% shortage of infectious diseases physicians, and a shortage of 87,150 full-time equivalent primary care physicians by 2037.

“Those types of physicians have relatively low salaries, and it’s hard for them to attract young talent to join the training programs,” Yu said.

The types of loan restrictions imposed by the One Big Beautiful Bill Act will reinforce “that vicious circle because [medical students] need to pay the loan, they need to go into a high-salary specialty. Now, it is more likely that students will forgo those types of [low-paying] specialties: primary care or infectious diseases,” Yu said.

The DOE said in its news release that the federal student loan caps would help “drive down the cost of graduate programs and reduce the debt students have to take out.”

The DOE did not respond to Medscape’s request for comment regarding how this would work.

“They want to reduce tuition costs, but this is not the way to do it. I do think there should be a conversation around tuition and tuition costs, but this vehicle that they’re trying to use is really just going to decrease the pipeline of people in healthcare,” Todd Pickard, DMSc, PA-C, president and chair in the American Academy of Physician Associates and executive director at The University of Texas MD Anderson Cancer Center, Houston, told Medscape Medical News.

Healthcare Facilities May Face Hiring Challenges

With these shortages, hospital administrators and managers may soon struggle to find enough qualified clinicians to hire.

“In the next 5 years, when there are fewer people for me to hire, because fewer people went into that field because they were disincentivized to do so, what am I supposed to do then? As an employer, I don’t have an answer, so it’s really a concern,” Pickard said.

The available prospective hires may want higher salaries or loan repayment since they will have a higher debt burden, he added.

“This whole approach is not going to reduce healthcare spending. It’s not going to increase patient care, quality, or safety. It’s not going to make tuition at professional schools go down. So my question would be ‘What are you actually trying to accomplish with this? Because what you think that you’re trying to accomplish, you’re not,” Pickard said.

Patient Care Might Suffer

Patients are the ones who may ultimately suffer the most from the federal student loan changes. In 2019, 25% of Medicare visits were delivered by nurse practitioners and PAs, a number that is only expected to grow.

“Our ability to maintain safe staffing, expand access to care, and meet the needs of aging and increasingly complex patient populations depends on a robust pipeline of nurse practitioners and nurse educators. When that pipeline narrows, the entire system feels the strain — from longer wait times to reduced service lines to increased turnover,” Charles Yingling, DNP, dean and professor in the Orvis School of Nursing at the University of Nevada, Reno, Nevada, told Medscape Medical News in an email.

Patients in rural areas may feel this strain even more. These areas heavily rely on PAs and nurse practitioners since there are not enough primary care physicians to meet the needs of these communities. Nurses and PAs also fill gaps for specialty services: Over 80% of rural anesthesia providers are certified registered nurse anesthetists.

Members of dozens of professional organizations, including the American Organization for Nursing Leadership, the American Academy of Physician Associates, and the Emergency Nurses Association, have signed a petition asking the DOE to reconsider the proposed definition of “professional degree” programs.

“Advanced nursing degrees serve critical patient care needs and deliver a high return on investment. The language we use matters. Not recognizing nursing as a professional degree limits access to education funding and jeopardizes our ability to meet workforce needs today and in the future,” Claire M. Zangerle, DNP, MBA, RN, American Organization for Nursing Leadership, said.

Armendariz, Yu, Pickard, Yingling, and Zangerle reported having no disclosures.