Will Changes to the Student Loan System Worsen Physician Shortages?

Pre-Med & Medical School High School Student Topics
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The bill — which passed the House May 22 and is with the Senate, as of June 10 — would enact sweeping cuts to Medicaid and other healthcare programs. The bill would also eliminate the Grad PLUS loan program for graduate students, including medical students. It would also cap federal loans for graduate and professional students to $150,000 and limit eligibility for the Public Service Loan Forgiveness program by no longer allowing loan repayment made during medical residency to count toward forgiveness. Students would still be allowed to take as much debt from private loans as they want.

The Association of American Medical Colleges found medical students graduate with an average debt of $206,924 in 2023. Supporters of the bill say the changes could lower tuition costs and limit taxpayer exposure. Medical associations have also spoken out against the bill over concerns it would add barriers to medical education and residency, and could worsen opportunities for clinical training in rural and underserved areas.

Teaching hospitals and medical schools have said the provisions could worsen the physician shortage by limiting the number of students able to afford school.

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IIRC, the %age of medical school students who come from higher income families is already very high. By limiting loans this way, there are many lower income students who simply won’t be able to afford to attend.

And some of these students actually want to work in some of our more rural hospitals, or providing primary care…or both.

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My first reaction is similar. I expect that medical schools will still be able to fill their classes with qualified students. It would not surprise me if the average net worth of the parents of students in medical school were to increase, for the simple reason that students with relatively wealthy parents will be the ones who can afford to attend medical school.

I do wonder about the impact on students who are already in medical school, and who are borrowing heavily to complete medical school. Will there be students who are already 2 or 3 years into medical school, and find it difficult to find the money needed to finish? I do not know the answer to this.

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My son-in-law has just completed his second year in medical school, and applied (and was approved) for yet another loan from his medical school. His total debt for 3 years of medical school will be $300K at 9%. His father is an anesthesiologist but is not helping pay for medical school, because he just finishing paying for college for one child – who graduated a year ago – and has another child who still is a year away from completing his undergraduate degree. So while my son-in-law’s parents have a pretty good net worth, as a practical matter it is not going to have an impact on my son-in-law getting through medical school.

I understand that situations vary from family to family.

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When my son-in-law entered medical school, he was counting on the Public Service Loan Forgiveness program to reduce or eliminate his medical school debt. We’ll see how that shakes out.

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We know doctors who are a couple of years out from finishing PSLF and just hope they will be able to do so.

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not sure one can answer the OP’s question without getting political, as this is clearly a political decision.

Since the link is behind a paywall…

…is just opinion with zero data/citations to support. Not saying that there won’t be any impact, but the demand for med school admissions is so high, that the slots of the low income students who choose not attend without federal – as opposed to private loans – can easily be replaced with full pay students. (And we can always invite more foreign medical grads.).

I would guess that most medical students won’t have much of an issue of obtaining private loans. (back to the old days: higher interest rates and no forgiveness).

If this is enacted, the big hit will be to the Master’s cash cows.

See above

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24% of med students come from families in to top 5% of household incomes. 80% come from families in the top 40% of households.

Physicians and other high income professionals will very likely become ineligible PSLF. Those who are already enrolled in PSLF will not allowed to use payments made during residency (when their incomes are low) to count toward their 10 years of repayment. (Though any payments made during residency will be applied toward reducing their loan balance.)

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which is good public policy to many voters. But again, that is political and the mods may want to move this thread.

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What world do these supporters live in, who think medical education costs can be lowered? Are they confusing med school with undergraduate colleges that built lazy rivers? Or are they thinking, let’s go back to the medical education from 50 years ago?

I don’t get “taxpayer exposure”, too. :neutral_face: You already can’t declare bankruptcy because of student loans…

PSLF is necessary for young physicians to take up positions in rural areas, in medical deserts, in low-paying fields that are nevertheless necessary.

My solution is that each state should have a public med school that is tuition-free for those residents who sign up for years commensurate with length of education in underserved areas of the state. No PSLF needed. Funded by the money saved from having to contract with loan providers and head hunters for medical deserts, etc. Family/Rural medicine programs similar to this already exist BTW so it wouldn’t be revolutionary :wink:. Texas also does an excellent job with med school costs for its residents.

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actually, yes one can. It’s not easy, but a bk judge has the authority to cancel anything, even IRS debt.

perhaps, but PLSF is not limited to taking up positions in a rural area. It also covers Residents in NYC, as well as any doc making bank and working in a “non-profit”. Regardless, the feds have/had another program specifically targeted toward forgiving debt for docs working in a rural area. (The Trump Admin has just put that on hold, however.)

I’ve often told my California friends that they should send thier premed kid to UTexas (or TAMU or Rice) for undergrad, graduate, apply for a health/STEM-related Masters, obtain state residency and then apply to Med school

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This will also impact professions that require an advanced degree - masters, aud, dpt, etc.

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I think the biggest concern expressed is not that there wouldn’t be enough med students, but that med students will flock to higher paying specialties,causing even bigger shortages of primary care and other lower paying specialitie. There is currently a shortage of pediatricians, FM, internists, and OB/GYNs nationally.

RE: states offering scholarships for service in rural areas. A dozen or do states already do this. So does the VA and IHS. FQHC (federally qualifying health clinics) in underserved rural and urban area also offer loan forgiveness/ scholarships. For 2 or 4 years of service. However, there are catches. Doctors must be in FM, general IM, pediatrics or OB/ gyn. ( Only the VA has the discretion to offer physicians in other specialties the scholarship.) and the forgiveness rate is $40K/ year

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Unfortunately in- state med school admission rates for Utah are quite low. Nearly as bad as CA. Texas does better, but their in state admission rates are just mediocre.

Students would do better moving to one of the Dakotas and establishing residency there. Or West Virginia.

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sorry about the confusion. My use of UT was for University of Texas, not Utah. (fixed it above)

And that’s a fair concern. But where are the [scientific] studies to support it? (And as we know from AP Stats, a few anecdotes per graduating class is not data.)

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Pediatrics, internal medicine and family medicine already all fail to fill all their offered residency positions with regularity.

Per the NRMP in 2025, 805 FM positions failed to fill; 357 categorical IM positions failed to fill and 147 pediatric positions failed to fill. (Those filling the positions include USMDs, USDOs and US-IMGS and non-US IMGs. Vacancies listed are post-SOAP vacancies.)

Pediatrics rebounded from a disastrous 2024 Match which left over 250 residencies slots unfilled.

US medical grads aren’t flocking into primary care specialties.

FM residencies*
28% USMD
27% USDO
11% US-IMG
15% non-US IMG

IM (categorical) * **
34% USMDs
17% USD)
10% US-IMG
33% non US-IMG

Pediatrics*
47% USMDs
20% USDO
8% US-IMG
27% non-US IMG

*Note 1 --total will not = 100% because of vacant positions

**Note 2-- a categorical IM residency is required to later sub-specialize in cardiology, gastroenterology, endocrinology, pulmonology, critical care, infectious diseases, endocrinology, oncology, rheumatology, hematology, hepatology, nephrology, transplant medicine, sleep medicine and host of other even more specialtized subspecialties.

The US in only managing to get by in primary care because of the number of FMGs coming to the US.

Pediatrics, general internal medicine and family medicine have the lowest starting and median salaries of all specialties.

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That’s a great start, now we need to compare to data from before 2006, before GradPlus loans were created up to the COA. Before then, federal loans were capped at $18.5k per year (about $31k in today’s dollars).

Are you suggesting then, that PSLF loan forgiveness is not working? (And it probably could not, as everyone going into the top paying specialties are also eligible for loan forgiveness, and may even get more forgiveness as they tend to have longer low-paying residencies.)

fwiw: here is the match results from a DO school that I picked out randomly (only as I knew its name): 56% of grads went into Primary care, many of them are rural hospitals.

“Access to graduate education was unchanged. Programs more affected by graduate loan expansion did not see significant increases in enrollment relative to the reference group. Nor did Grad PLUS improve access to graduate education for underrepresented groups; if anything, the share of white students in affected programs increased. Similarly, the researchers find no significant effects of Grad PLUS on degree completion or long-run earnings outcomes.
…
The main presumed benefit of Grad PLUS—increased access to graduate education—may also be a fiction. The researchers find no significant impact of Grad PLUS on enrollment, which suggests that the limited federal graduate loan program that existed in 2006, combined with a robust private market, adequately met demand for graduate education finance. Private lenders were glad to lend to students enrolled in high-return graduate programs; most students even enjoyed lower interest rates in the private market than Grad PLUS offered.”

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Western isn’t a random DO school. It’s one of the most competitive-for-admission DO schools in the US. It’s located in Pomona, CA and largely draws its students from the CA pool of med student hopefuls. Many CA pre meds choose to attend a DO program rather than attend an OOS med school. Its students have admission stats that are comparable with those of many MD programs. Western had a 2.3% admission rate, average GPA 3.76, average MCAT 507. (Full disclosure: my daughter used to supervise/teach Western’s med students and residents rotating thru her hospital when she lived in CA.)

Now here comes the question: why do 56% of their students go into primary care?

Is it because they chose a osteopathic med school because DO programs have a reputation of sending a large percentage of their students into primary care?

Is because of the DO “stigma”?

Is it because their board scores aren’t high enough to get serious consideration for the more competitive specialties?

Is it because as an osteopathic med school, Western has limited facilities and opportunities for the students to engage in basic research and gain publications that are a de facto requirement to enter the most competitive specialties?

Is it because osteopathic med schools often require students to find and arrange their own rotation sites for electives thus leading to weaker or less hands on exposure to surgical and highly competitive specialties?

Is because many DO students don’t take the USMLE boards that competitive specialties require for consideration? (Osteopathic med schools require their students to take COMLEX exams instead of USMLEs. DOs need to take both the COMLEX and the USMLE if they want to be considered for certain programs/specialties. The overlap is between the 2 exams is pretty high, but the each exam covers topics not included on the other. Also the scoring system for each exam is completely different.)

Is it that most of the students chose to accept a rural primary care residency in order to remain in California, near family instead of pursuing an OOS post in more competitive specialty?

Many of the primary care matches are at formerly DO-only programs. Why is that?

Are the students choosing programs they’ve rotated thru previously and thus have an advantage when it comes to Matching? (Partial answer: yes, one of the programs that has multiple primary care matches is a rotation site for Western. Its students have an advantage there because the program already knows them and how well they fit into their program.)

Some or all of the above?

You really can’t infer anything from a single year’s Match List.

The NRMP has Match data goin back to the 1980s that is publicly available. All you need to do is google it. However, the data is not comparable because older data does not include USDO seniors and grads because DO programs held their own separate Match until 2020. Older NRMP data also does not include information about US IMGs or non-US IMGs. Also in 2021, the NRMP instituted an “all in” policy that mandates if a hospital/clinic uses the NRMP for any specialty match, that program MUST use the NRMP Match for all of it specialties. Prior to this, a residency site could opt to privately hire some or all of their residents and not report their results to the NRMP. There are still a few programs that don’t use the NRMP match to hire residents.

I don’t have the time or energy right now to do a deep dive into the data, but a quick look at the aggregate 2000-2005 and 2006-2010 data showed that FM had a 3% decline in the number of USMD seniors applying to it between 2004 and 2005. That decline was maintained in 2006. (So not a 1 year fluke.)

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I think you need a business or own property you live in in order to get Texas residency for TMDSAS admissions purposes. Just going for undergrad or grad school isn’t enough, I don’t think.

Also the main bottleneck for physician numbers is the number of residency spots, not the number of US MD or US MD+DO grads. Residencies can almost always fill their spots with IMGs if necessary during SOAP

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TMDSAS residency requirements

  1. graduation from TX HS

OR

  1. establishing a TX domicile

To establish a TX domicile:

  1. Live in Texas for 12 consecutive months by the application deadline; and
  2. Establish and maintain domicile for 12 consecutive months prior to the application deadline, by doing one of the following:
  • Be gainfully employed in Texas (Definition)
  • Sole or joint marital ownership of residential real property in Texas by the person seeking to enroll or the dependent’s parent, having established and maintained a domicile at the residence
  • Own and operate a business in Texas
  • Be married for one year to a person who has established domicile in Texas

NOTE: one cannot establish a TX domicile by moving to TX and being a full time student

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