Norfolk, Virginia While studying and paying for college to complete her requirements for medical school, twenty-eight-year-old Michaela Bonner has been working 12-hour shifts as an emergency medical technician in Norfolk, Virginia, for the past four years.
However, Bonner fears her dream of becoming a doctor is now financially unattainable because of President Donald Trump’s flagship tax and spending package, which prohibits students from taking out unsubsidized federal loans for medical school that exceed $50,000 per year.
“Well, we really need you,” I’m told. In a recent interview, Bonner stated, “It’s not that I want to quit, and you’ve done all this work leading up to this point, and that’s true as well. We have a physician shortage.” But now when I am unable to pay off my entire living expenses with loans, there are no institutions in place that I can depend on to help me.
The tax and spending law contains clauses that fundamentally change how college student loans are administered. Current student loan repayment schedules for loans issued on or after July 1, 2026, are suspended under the law. The law also ends Grad PLUS loans, which have assisted individuals in covering the full cost of attendance and their higher education degrees, on that date. There will be grandfathering in for existing loans.
According to federal law, borrowers who are currently enrolled in income-based loan repayment plans for students, such as SAVE or IBR, have until July 1, 2028, to transfer to a different plan. For students participating in the Biden-era SAVE scheme, interest collecting will start up again on August 1.
However, students in medical or law school who want to apply for unsubsidized federal loans—where the borrower bears the full burden of interest payments rather than the government—will only be eligible to borrow $50,000 annually, with a lifetime ceiling of $200,000. There is a $100,000 lifetime cap for those pursuing postgraduate degrees in subjects like philosophy or history.
Now that I can’t use loans to cover my entire living expenses, there are no structures in place that I can rely on to help me.
Aspiring medical student Michaela Bonner
Depending on whether the institution was private or public and whether the student was a resident or nonresident, the average annual cost of medical school for the 2024–25 academic year varied between around $42,000 and $72,000, according to the Association of American Medical Colleges.
According to some conservative Republicans, students should put in more effort to pay for their own higher education, such as medical school. Others argue that the caps return the burden of controlling tuition increases on colleges and universities. However, opponents of this measure claim that the loan limitations will worsen the physician shortage and solely hurt students, particularly those from lower-income families.
States have attempted to alleviate physician shortages in recent years by putting different policy solutions into place. At least nine states have facilitated the process of obtaining medical licenses for physicians who had their training abroad since 2023. States have also taken part in interstate licensing compacts, which permit physician assistants and nurses to operate across state lines as long as they hold a license from one of the participating states.
According to the National Conference of State Legislatures, a body that monitors state regulations, more than 20 states have passed legislation addressing student loan forgiveness.Georgia enacted legislation that will allow doctors practicing in underprivileged and rural communities to take advantage of a cancelable loan scheme.Additionally, Idaho established the Rural Nursing Loan Repayment Program, which provides nurses with $25,000 in forgiveable loans following three years of rural employment.
States are facilitating cross-state collaboration for physician assistants.
The national physician shortfall may surpass 100,000 by 2034, according to McKenzie Richards, a health care policy fellow at the conservative think tank Cicero Institute who has been researching the rate of physician shortages, who spoke to Stateline. By the end of 2024, that figure was more like 64,000 doctors.
According to Richards, if the student loan reforms make the physician crisis worse, states will be searching for further policy options.
“I think it’s really important to be looking at policies that states can adopt to get out of this right now because we know what’s going to happen in just five years,” she said.
According to Richards, the idea behind capping [federal loans] is to incentivize educational institutions to reduce tuition costs. Perhaps they should be admitting more students, as this would greatly aid in the passage of more doctors.
According to economist Lesley Turner, an associate professor of public policy at the University of Chicago, other students will be in a similar situation.
Turner told Stateline that certain pupils would be more negatively impacted than others. Since those [students] in more costly programs typically take out larger loans, those students will have to turn back to private student loans or other forms of funding for their graduate studies.
According to Shannon Jimenez, dean of the Arkansas College of Osteopathic Medicine, many students were already doubting their ability to attend medical school prior to the student loan caps.
Jimenez told Stateline, “I anticipate that this bill, this cap, will force people to leave primary care and enter specialties in order to help pay off those higher interest rate loans.” Caps, she continued, will probably discourage students from lower socioeconomic backgrounds from pursuing primary care, which is crucial in states like Arkansas, where she claims there is an unequal distribution of doctors.
Since they are more likely to work in underprivileged areas and enter primary care, many schools, including ours, aim to draw in these students. As a result, it will tie our hands in several ways.
A new contract permits social workers to practice across state lines in the midst of a mental health crisis.
According to Richards of the Cicero Institute, the inequalities will be felt more acutely in larger and more rural regions. For instance, by 2030, it is anticipated that Louisiana will lack about 5,000 physicians in various specialties, including nearly 400 primary care physicians. Similar to the situation in neighboring Arkansas, over one-third of Louisiana physicians are already approaching retirement age.
According to Jimenez, it is illogical for institutions to simply reduce tuition.
Our costs are primarily determined by what we must pay our professors, and that won’t decrease because we still operate in a relatively market-driven economy and must compete with other institutions in the area, she added. Attendance at her institution costs between $80,000 and $85,000 per year.
Bonner, the EMT, is currently enrolled at Old Dominion University to study biomedical sciences after graduating from Regent University with a degree in political communications. She claimed to already have $20,000 in loans and to have paid out of pocket for the remaining college tuition. She hasn’t been able to save much because she is taking care of herself.
She d planned to take the medical school entrance exam next spring, but now worries about how she d pay for living expenses while attending. “You have to take out loans for living expenses because medical school schedules don’t allow for working,” she said.
A lot of people, I feel, would be panicked if you had worked for eight to 10 years of your life and found out that all the systems that you were banking on in a really academically challenging space are disappearing, Bonner said.
Although I can’t see a clear road forward, I’m working to create one.
You may contact Stateline reporter Shalina Chatlani at [email protected].
Statelineis part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions:[email protected].
