Aspiring doctors may need to find another quarter million dollars to go to school.

The federal funding gap created by the new federal loan caps under the One Big Beautiful Bill Act (OBBBA) may decide who gets to go.

Beginning July 1, 2026, new borrowers lose access to federal Grad PLUS loans, and professional-degree borrowing is capped at $50,000 per year and $200,000 total, including undergraduate debt. But tuition alone often exceeds the annual cap, and the total cost of attendance can exceed $450,000.

Federal loans may now only cover $200,000, but the rest of the cost does not disappear. For students who cannot absorb the difference, the gap becomes private debt, a service obligation, or a reason not to go.

A student without family wealth has to find a lender willing to underwrite a quarter-million dollars in private debt before that student has the salary of an attending physician. Many private lenders require a creditworthy cosigner. Private loans do not come with income-driven repayment. They do not come with Public Service Loan Forgiveness. They do not come with the same federal protections if life, training, illness, or the job market does not go according to plan.

And the debt grows during residency. The $200,000 federal portion, accruing interest at 7.94% during a four-year residency, grows to about $263,520. The remaining $252,000 gap, modeled at 10% interest with annual capitalization, grows to about $368,929. By the time the new physician finishes residency, the $452,000 education balloons to roughly $632,449.

That is why we have state schools, right?

In Washington, there are only two public medical school options: the University of Washington and Washington State University’s Elson S. Floyd College of Medicine. For an in-state resident at the University of Washington, the estimated cost of attendance is $97,004 per year, or $388,016 over four years. That is still $188,016 over the cap. And that is if the student can land the coveted in-state seat.

Before OBBBA, the federal government did not make medical school cheap, but it did make the cost financeable. A student admitted to medical school could borrow up to the cost of attendance through federal loans. The debt was large, but it stayed inside the federal system, with access to income-driven repayment, Public Service Loan Forgiveness, disability protections, death discharge, and the ability to survive the low-income years of residency. Now, for some middle- and low-income students, these new limits may put medical school out of reach.

And the problems are not limited to medical school. The finance gap reaches across the healthcare workforce.

Take advanced practice registered nurses. A Certified Registered Nurse Anesthetist (CRNA) degree is a coveted and in-demand path, with average pay commonly reported above $200,000 per year. But financing CRNA training is not any easier because, under the new law, nurse anesthesia is not treated as a professional degree for borrowing purposes.

The professional category is limited to medicine, osteopathic medicine, dentistry, pharmacy, veterinary medicine, optometry, podiatry, chiropractic, clinical psychology, law, and theology or divinity. Advanced practice nursing, physician assistant programs, physical therapy, occupational therapy, speech-language pathology, social work, higher education advanced degrees, and master’s in business administration and public health are all missing from the list.

That matters because the federal borrowing allowance for these degrees is even lower: $20,500 per year and $100,000 total, but the tuition often exceeds the limits.

For a CRNA student in Washington state, there is one accredited nurse anesthesia program, at Gonzaga University, a private institution. The estimated total cost of attendance is approximately $225,000. Federal borrowing would cover only $61,500 for the three-year program. Students would have to find another $163,500 to cover costs, and out-of-state options can be even more expensive.

Again, the policy does not lower the price of training. It changes who can finance it.

The student who needed federal loans to get through college starts with less room to borrow for the next step.

The country needs more healthcare providers at all levels. But the new borrowing structure narrows the path into those professions. It does not ask whether the student is capable, needed, or likely to serve in a shortage field. It asks whether the student can cover the money gap.