On July 4, 2025, President Trump signed H.R.1 “One Big Beautiful Bill Act,” which has brought up many concerns related to accessing affordable healthcare and education. One stipulation of the larger bill targets the amount of loans students pursuing higher education can take out starting July 1st, 2026.
For students pursuing professional degrees like a medical degree, the amount of federal loans students can take out will be capped at a total of $200,000. The bill will also eliminate the Grad PLUS loans program and students pursuing medical degrees and specialties like family or rural medicine may no longer be eligible to have their loans forgiven under the Public Service Loan Forgiveness (PSLF) program.
This issue is not abstract or distant: it is unfolding in real time. Medical school application season is already underway, with interviews and acceptance letters being released as early as this month. For many applicants, especially those from first-generation and low-income (FGLI) backgrounds, this was supposed to be the culmination of years of sacrifice, debt, and delayed stability. Yet because of the “Big Beautiful Bill,” some will now have to make the impossible choice between attending medical school or deferring their dreams indefinitely.
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While the argument for these loan caps were to reduce the financial burden of graduate education, in fact, these caps would worsen this burden. The average cost to complete an MD/DO program ranges from $280,000 for in-state public institutions, to nearly $400,000-500,000 for private institutions.
The cost of the 1st year at the University of California, Davis School of Medicine is $87,713, with the estimated total cost of attendance for all four years around $354,000. At Vanderbilt University School of Medicine, the estimated cost for the 1st year is $116, 943 and $462,000 for all four years. This is also similar to the 1st year and total cost of attendance for all four years at A.T Still University College of Osteopathic Medicine. With these new student loan caps and without additional scholarships or other personal savings, students attending UC Davis who solely rely on student loans would only be able to afford paying for 2 of the 4 years required to complete the MD Degree. Students would only be able to pay for 1 of the 4 years in full, required to complete the MD Degree at Vanderbilt and DO Degree at A.T.
If these federal loan caps go into effect, this will make it very difficult for students to be able to afford to pay for medical school and force students to rely on private loans with drastic interest rates. Sallie Mae, one of the largest student loan providers has fixed interest rates up to 14.98% (for those with little/no credit or bad credit). This is drastically higher than the interest rates for the federal grad plus loan fixed at 8.94% this cycle and for Federal direct unsubsidized loan, an interest rate fixed at 7.94%.
And these loans are not simply used for tuition. Many medical schools prohibit students from working, forcing them to rely on loans to cover all living expenses: groceries, rent, health insurance, and the steep costs of registering for USMLE or COMLEX exams. Students also depend on loans to pay for third-party study resources like AMBOSS or UWorld; resources that have quietly become essential to succeeding in medical training
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I grew up in a low-income household where every opportunity came with a calculation: how much it would cost, and what we’d have to give up to make it happen. That kind of thinking doesn’t disappear once you get to medical school. My parents’ income didn’t suddenly change when I started an MD-PhD program, and being in one didn’t change my relationship to money either. If anything, it made the gaps more visible.
It’s important to note that not all MD-PhD programs are created equal, and not all are funded equally. The phrase “fully funded” hides a wide range of realities. Some programs, particularly those supported by the NIH’s Medical Scientist Training Program (MSTP), are well resourced, while others rely heavily on institutional or departmental funds that fluctuate year to year. The result is that stipends vary widely, from livable in some cities to barely survivable in others, and often fail to keep pace with the rising cost of living. Even among MSTP programs like my own, students are increasingly taking out loans to bridge the gap between their stipend and their actual expenses.
This problem isn’t unique to MD-PhD programs. Across the country, graduate students have gone on strike or unionized in record numbers, demanding livable wages, fair healthcare coverage, and recognition that their labor sustains the research and teaching enterprise of higher education. These movements from the University of California to Columbia University reflect a growing acknowledgment that stipends have stagnated while rents, food, and healthcare costs have soared. For students who grew up low-income, the strain is even sharper: we are asked to contribute to the advancement of science and medicine while being priced out of the very institutions that claim to train us.
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The culture of medicine and science assumes a financial cushion; a safety net built on generational wealth. And for decades, that assumption has held true as medical school classes have been dominated by students from the top two household income quintiles. But for students from low-income backgrounds, that cushion has never existed. We are expected to build it ourselves while keeping up with a system that was never built for us. The hidden costs of medical training hurt low-income students the most because they’re the ones no one talks about. These are the costs you’re expected to absorb quietly, creatively, as if resourcefulness could replace resources. We’re told to “find a way,” to be resilient, to be creative. But income is not about creativity; it’s about access, stability, and the privilege of not having to choose between your dream and your survival.
And just last year, we began to see evidence of how national policy shifts are compounding these inequities. Following the Supreme Court’s decision to strike down affirmative action, an AAMC brief published in November 2024 reported a sharp decline in the proportion of Black, Hispanic, Native, and Pacific Islander matriculants. If we continue down this path, we risk erasing an entire generation of aspiring physicians from underrepresented and working-class communities. The Big Beautiful Bill will only accelerate this decline, disproportionately affecting FGLI students who are already underrepresented in medical education and who often shoulder caregiving responsibilities and financial burdens their wealthier peers have never had to consider.
But the impact of these federal loan caps goes far beyond impacting students. This will have profound consequences for our entire medical system.
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As the U.S. continues to have a growing older patient population, the demand for physicians in primary care specialties will rise substantially. Forcing students to rely on high-interest private loans that will dramatically increase their debt burden, will more than likely push future physicians toward higher-paying subspecialties, furthering the already widening gap in the availability of primary care clinicians. The absence of an adequate primary care workforce will leave patients with longer wait times, reduced access to preventive services, fragmented care coordination, worsen disparities in marginalized communities and ultimately lead to a collapse of our medical system that will have devastating impacts for everyone.
In the wake of the COVID-19 pandemic, there has been a significant growth in the number of individuals who are distrusting of medicine and science, and for many communities who have been directly been victims of the harms our field has and continue to be complicit in, their fear and distrust is valid. But if we want to effectively fight this growing distrust, we need to make sure medicine remains inclusive to those who have personal insight into where this distrust comes from and how to rebuild trust. We must keep low-income students in medicine.
This is why the conversation cannot end with policy experts and think pieces. It must stay at the center of every pre-med advising session, every interview, and every medical school’s mission statement. Because right now, the rhetoric of inclusion is colliding head-on with the reality of exclusion engineered through financial policy.
At the beginning of medical training, students often take a vow rooted in the Hippocratic Oath of Do no harm. Imposing loan caps that effectively bar low-income students from becoming doctors violates that principle. If we are serious about protecting healthcare access and equity in this country, we must fight to overturn these caps before they irreparably damage the physician pipeline. And the overall health of our nation.
The hidden costs of medical training hurt low-income students the most because they’re the ones no one talks about.
