President Trump’s proposed budget would make deep cuts in government health plans and medical research, and, critics say, could also make finding a doctor more difficult: It restricts loans that students rely on to pursue professional graduate degrees, making the path to becoming a physician harder even as doctor shortages loom and the American population is graying.
The domestic policy bill, which passed in the House last month, would cap direct federal unsubsidized loans at $150,000 — far less than the cost of obtaining a medical education — and phase out the Grad PLUS loans that help many students make up the difference.
Medicine, dentistry and osteopathic medicine are among the most expensive graduate programs.
Four years of medical education costs $286,454 at a public school, on average, and $390,848 at a private one, according to the Association of American Medical Colleges. Medical school graduates leave with an average debt of $212,341, the association found.
The price of a four-year program in osteopathic medicine is $297,881 at a public school, on average, and $371,403 at a private school, according to the American Association of Colleges of Osteopathic Medicine. The average indebtedness of their graduates is $259,196.
The proposed loan caps “will either push students and families into the private loan market, where they take on more risk and have less consumer protection, or simply push people out of higher education altogether,” said Aissa Canchola Bañez, policy director at the Student Borrower Protection Center, a nonprofit advocacy group.
Private student loans are also not eligible for Public Service Loan Forgiveness programs, which many students rely on to manage their debt. Students from low-income families may have difficulty qualifying for private loans.
In a letter to congressional leaders, the American Medical Association asked lawmakers to carve out exceptions in the law for medical education, saying that the current bill would deter good candidates from applying to medical school, discourage physicians from working in underserved areas and make medical school unaffordable for all but the very wealthy. Critics said it could also drive more doctors away from lower-paying primary care fields, an area of acute need, and into more lucrative specialties.
Conservatives have argued for decades that the availability of federal student loans allowed tuition costs to balloon — a proposition rejected by the American Association of Medical Colleges, which instead blames the rising cost of living. Studies examining the relationship between loans and tuition have varied in their conclusions.
Sara Robertson, the press secretary for the Republicans on the House Education and Workforce Committee, said the proposed loan limits “will drive down the cost of medical school and thus reduce the need for students to borrow in the first place.”
She said private lenders would offer students lower interest rates than the government’s Grad PLUS program would. The private market, though, has shrunk markedly since the Great Recession, according to Lesley Turner, an associate professor of public policy at the University of Chicago and an author of an unpublished paper that linked loans to rising tuition.
In an email, Dr. Turner said it wasn’t clear that “the same level of nonfederal funding would be available today.” Because of inflation, she noted, the $150,000 limit for medical students is “substantially reducing the amount these students can borrow, even compared to the status quo before the Grad PLUS program.” The program was started in 2006.
Ms. Robertson said schools could also help close the gap. “Nothing in the bill prevents colleges from providing additional financial aid to low-income students pursuing medical school,” she said.
That is not an option for schools of osteopathic medicine, most of which are private and not attached to universities with foundations, and which currently enroll almost one-third of the nation’s future doctors, said David Bergman, senior vice president of government relations and health affairs for the American Association of Colleges of Osteopathic Medicine. And many academic medical centers, which have lost millions of dollars in research grants abruptly pulled by the Trump administration, are facing severe financial strain.
A vast majority of medical students rely on loans, not just those from low-income backgrounds, Mr. Bergman noted.
Ending federal involvement in administering and subsidizing student loans was one of the goals laid out in Project 2025, the Heritage Foundation’s conservative blueprint for overhauling the government. It argued that leaving student loans to private lenders and ending federal loan forgiveness programs would “allow for market prices and signals to influence educational borrowing.”
President Trump’s policy bill would allow medical residents to defer not only their loan payments but also the interest on those payments, a provision that many medical professionals have supported. But the legislation would prohibit residents from counting those low-paid years of training as public service, limiting their eligibility for a popular loan forgiveness program that encourages young doctors to work in underserved areas.
As a result, “access to much-needed medical care for patients in rural and underserved communities will be diminished,” the American Medical Association’s chief executive, Dr. James L. Madara, wrote in the letter to House Speaker Mike Johnson and the House Democratic leader Hakeem Jeffries.
The changes will disproportionately affect low-income students with backgrounds that are underrepresented in medicine, who may face more difficulty obtaining private loans, said Dr. Virginia Caine, president of the National Medical Association, which represents Black physicians and which advocates health equity. In turn, she said, it will limit those students’ ability to return to serve in their communities.
“Only rich students will survive,” she said, noting that, on average, Black medical students already graduate with more educational debt than their peers.
A higher debt burden and inability to secure loan forgiveness may also drive students away from lower-paying specialties like primary care, despite an anticipated shortage of primary care physicians, Dr. Caine said.
By 2037, the United States is expected to face a shortage of 187,130 physicians, including 87,150 primary care physicians like internists and pediatricians who play a pivotal role in the early detection and management of chronic disease, according to the federal Health Resources and Services Administration. (There are currently 933,788 professionally active physicians.)
Already, some 75 million Americans live in areas where it is difficult to get access to primary care. The ratio of primary care providers is projected to decline to 76.8 per 100,000 people by 2037, from 81.6 per 100,000 in 2022.
The proposed budget would also cut off funds used to train new pediatricians, who are already in short supply: It entirely eliminates funding for graduate medical education at 59 of the nation’s children’s hospitals, where more than half of all pediatricians and pediatric specialists are trained. The program trained 15,860 medical residents and fellows in 2022-2023, according to the Children’s Hospital Association.
The irony of slashing loans for medical school, many officials said, is that medical students are more likely than many other graduates to be able to repay them.
“We have a default rate that ranges from 1.1 percent to 1.4 percent,” Mr. Bergman said. “This is not a problem that needs to be fixed.”
Roni Caryn Rabin is a Times health reporter focused on maternal and child health, racial and economic disparities in health care, and the influence of money on medicine.
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