Strict new caps on federal student loans scheduled to take effect July 1 are causing would-be physician assistants to reconsider training, groups representing the profession said, threatening a pipeline the federal government has simultaneously bet on to address rural healthcare shortages.
The Republican-led One Big Beautiful Bill Act, passed last July, will end the Grad Plus federal loan program and cap annual federal graduate loans at $20,500. Loans for professional education — degrees the Department of Education classifies as “professional” — will be capped at $50,000 per year. The Education Department deemed physician assistant programs “graduate,” not “professional,” meaning PA students are subject to the lower cap.
The median cost of physician assistant training is about $103,000 for up to 27 months of training, according to Sara Fletcher, executive director of the PA Education Association, which represents institutions that train physician assistants. At SUNY Downstate, in-state tuition for its PA program runs more than $58,000; out-of-state tuition tops $113,000. Students typically also rely on loans for living expenses, since training requires 60 to 80 hours of work per week.
“My credit score was a 400,” said Todd Pickard, president of the American Academy of Physician Associates, which represents more than 200,000 PAs nationally. He graduated from his PA program in 1997. “There was nobody privately that was going to give me a dime. And my parents are not rich people, so they weren’t going to say, ‘Here’s $100,000 — take it.’”
A coalition of 24 Democratic attorneys general, one nonpartisan attorney general and two governors sued the administration in May over the changes, seeking a permanent injunction. In June, nursing associations, the AAPA and the PA Education Association followed suit, seeking an emergency injunction. Pickard spoke to the Guardian a day after a federal judge in Washington heard arguments in the case. “We got swept up in this big net without any real analysis and decision-making,” he said. “I think they decided they wanted to get out of the loan business.” The groups expect a decision imminently.
The timing creates a contradiction within the same legislation, according to Pickard and other advocates. When Republicans passed the One Big Beautiful Bill Act, they cut nearly $1 trillion from Medicaid to pay for tax cuts. To offset the impact on rural hospitals, the law also established a $50 billion Rural Health Transformation Program that relies in part on allowing physician assistants, nurse practitioners, pharmacists and dental hygienists to expand their scope of duties.
Physician assistants can prescribe medication, conduct physical exams, interpret diagnostic tests and perform some procedures. About a quarter work in rural settings, according to one study, where they tend to fill shortages in family medicine. Ten Republican-led states, from Alabama to South Dakota, now employ more physician assistants than doctors, according to Becker’s Hospital Review. Donald Trump’s White House physician is a physician assistant: Army Col. James Jones, the first PA to hold the role.
“On the one hand, you have the Trump administration saying we need more PAs and we need them to be doing good work and the work that they can,” Pickard said. “But then on the other hand, the DOE says, ‘Well, we don’t want to invest in the full cost of PAs.’ Those two things don’t jibe.”
Education Secretary Linda McMahon has argued before Congress that capping student loans will bring down tuition costs. The PA Education Association’s Fletcher pushed back: “Tuition costs are set by institutions. It’s a bigger system issue than just a PA program.”
For students unable to borrow enough from the federal government, the new caps effectively force them to seek private loans. Federal graduate and professional loans carry an average interest rate of around 8%; private loans range from about 3% up to 17.95%, according to the Education Data Initiative. Unlike federal loans, private lenders require extensive underwriting, making borrowing more difficult and expensive for applicants with low credit scores.
Pickard said he has not had an opportunity to meet with anyone from the administration, despite repeated attempts. He said he is pitching Fox News and Newsmax in hopes of getting a segment on the changes. “I’d love to sit down and talk to Donald Trump,” he said.