The AMA is deeply concerned that provisions of the 2025 budget-reconciliation bill, as currently drafted, would make medical school unaffordable for a majority of students—even those who might be the most highly qualified applicants. If unchanged in the U.S. Senate, the potential impact of these student-loan changes would be to worsen a growing physician workforce shortage that is already making it difficult for people to access timely care in vast areas of the country, especially in high-demand specialties.
The high-stakes field of medicine demands education, expertise, acumen and coordination that is best delivered by a physician. With requirements to complete four years of medical school, three to seven years of residency, and from 10,000 to 16,000 hours of clinical training, physicians are undoubtedly the most qualified and crucial part of a patient’s health care delivery team.
But this level of education and training comes at a premium. Medical school is already the most expensive type of post secondary education in the nation—more than 70% of medical students graduate with an average education debt of $212,341. The cost to graduate from a public, in-state medical school topped $286,000 in 2024; and for private institutions, that figure exceeded $390,000.
Changes now under consideration by Congress could make the path that aspiring medical students follow to become physicians more difficult by erecting new financial barriers. As a result, the AMA recently provided comments (PDF) on how the proposed legislation would impact our country. In this letter, the AMA specifically addresses proposed changes to Federal Direct Unsubsidized Loans and Federal Direct Graduate (GRAD) PLUS loan programs.
The House reconciliation bill would place a cap of $150,000 on the amount a student could borrow for professional school under the Direct Unsubsidized Loan program, which is well below the average amount needed to pay for medical school. Other provisions of the same bill would eliminate both subsidized loans and GRAD PLUS loans while simultaneously limiting the ability of parents to take out loans on behalf of their children.
The bill passed by the House also provides that time spent in physician residency training would no longer qualify as a public service job, thus making residents ineligible for the Public Service Loan Forgiveness (PSLF) program. This is particularly impactful since nearly 90% of medical school graduates carrying student debt last year who intended to enter into a loan forgiveness program said in their graduation questionnaire that they wished to participate in the PSLF program.
If time as a resident does not count toward loan forgiveness, fewer physicians will be incentivized to work for qualifying employers, which will diminish access to care in rural and underserved communities. Denying PSLF eligibility to residents will harm patient care in those areas in greatest need.
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Access to care at risk
Patients, particularly in rural areas, are having difficulty finding a physician and getting timely appointments. An access issue that is predicted to worsen with our nation’s growing shortage of physicians, Many overlapping factors are contributing to this shortage, which is projected to reach 86,000 over the next decade, partially driven by an aging physician population With nearly half of all physicians practicing today age 55 or older, and one-fifth over 65.
An accompanying steady U.S. population growth plus a surge in the number of seniors—a nearly 55% increase in those age 75 or older by 2036—will increase the demand and complexity of needed care. Patients desire and deserve access to care from physicians. Recent AMA surveys found that 91% of patients view physicians’ education and training as vital for optimal care and 95% said it is important for physicians to be involved in their diagnosis and treatment.
At a time when our nation needs more physicians, Congress should be taking action to lessen the barriers for new physicians, not increasing the financial burden of their education.
Mitigating the financial burden
The AMA believes that the cost of a medical education should never pose a barrier to a career in medicine, and we continue to collaborate with our partners in the Federation of Medicine, and through public- and private-sector advocacy efforts, to ease the financial burden medical students face.
This includes promoting stable funding for medical education programs to limit tuition increases, promoting financial literacy, and urging expansion of service-based scholarships such as those offered through the National Health Service Corps Program, among others.
Physicians are the foundation of our nation’s entire health care system, and we must make every effort to strengthen that foundation going forward. The student-loan changes now under consideration in Congress could reduce the pipeline of future physicians by making medical school unaffordable for many prospective students, limiting the borrowing and repayment options for physicians in training, and deterring physicians from serving in critically underserved regions.
Congress should recognize the vital contributions and unique role of physicians in our society, and provide support for medical education that aligns with the financial and educational burdens physicians face as they provide the care that Americans want and deserve.
