Boston, MA — Researchers from the Harvard Pilgrim Health Care Institute have produced the first national estimate of how many medical students would be affected by new federal loan restrictions imposed by the 2025 One Big Beautiful Bill Act (OBBBA). Their findings suggest the reforms are likely to place substantial financial barriers on aspiring physicians, potentially reducing workforce diversity and worsening existing physician shortages.
The study, “Federal Loans Among US Medical Students, 2008-2020,” was published on November 26 in JAMA .
With the U.S. leading the world in medical school costs, students increasingly depend on federal loans to finance their education. This new study cautions that the combination of rising tuition and OBBBA loan restrictions may force medical students toward private lenders with higher interest rates, discourage them from choosing lower-paid but essential specialties such as primary care, or deter them from entering medicine altogether, disproportionately impacting underrepresented students.
“The average cost of attending medical school has greatly increased in just over a decade,” said Tarun Ramesh, research fellow at Harvard Pilgrim Health Care Institute and lead author of the study. “Federal loan restrictions could leave many medical students, especially those from low-income backgrounds, without affordable options to complete their training.”
Using national data from the National Postsecondary Student Aid Survey, the researchers analyzed federal loan usage, annual borrowing, and total debt among medical student—examining differences by characteristics such as age, sex, income, state of residence, and awareness of loan forgiveness programs. Key findings include:
Low-income and out-of-state students were most likely to exceed both annual and lifetime loan caps. “Graduate PLUS Loans have been a financial lifeline for nearly half of all medical students,” said Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute, and senior author of the study. “Eliminating this program will create substantial financial barriers for students and most likely reduce diversity in the physician workforce.”
The research team hopes that highlighting the likely real-world impact of the OBBBA’s restrictions on lower-interest federal student loans will prompt policymakers and medical schools to consider the new law’s implications for medical education and physician workforce diversity. They urge exploration of targeted solutions such as loan forgiveness or tuition reduction programs to offset the barriers the new federal restrictions may create.
About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky , X , and LinkedIn .
JAMA
Federal Loans Among US Medical Students, 2008-2020
26-Nov-2025