I got into the car outside the bus station in Lowell, Massachusetts, where my father was waiting to pick me up. He looked nervous when he handed me an envelope. Inside was my medical school decision letter. I was accepted. We let out a cheer.
Along with the acceptance letter was the projected cost of attendance: around $70,000 for the first year, climbing to nearly $90,000 by the fourth. I would need to borrow the entire sum. My parents, both nail salon workers, earned about $30,000 a year combined. I was the first in my family to attend college, and I already had undergraduate loans. By the time I would graduate from medical school, my debt would total more than $300,000.
I was only able to attend medical school because of federal student loans. I now work as a primary care physician in Massachusetts, just 40 minutes from where I grew up. I see patients at a clinic that serves mostly Vietnamese immigrants, patients like my parents. It has been deeply rewarding to give back in this way.
But under the bill Congress just passed, I likely never would have made it to medical school.
The “Big Beautiful Bill” imposes sweeping new limits on federal student aid. The House version, now adopted, caps federal borrowing for professional students at $150,000, including undergraduate debt, and eliminates Grad PLUS loans, which had previously allowed students to borrow up to the full cost of attendance. These caps will go into effect in 2026.
That amount might seem reasonable enough until you look at the actual cost of medical education. According to the Association of American Medical Colleges, the median debt for medical graduates with debt is about $200,000, with over 20 percent of students borrowing more than $300,000. The average total cost of attendance often exceeds that amount. These figures include students from all backgrounds, including those who receive substantial financial support from their families.
The burden is not evenly distributed. Students from low-income families like mine are far more likely to borrow and to borrow more. We rarely have access to family savings or wealth. For us, federal student loans are not a luxury or a financial tool. They are the only way to become a physician.
When these new caps are enacted, students from disadvantaged backgrounds will be forced to seek private loans with worse terms or may be priced out of medicine entirely. It’s a quiet narrowing of opportunity that will disproportionately affect the very students our profession needs most.
Research shows that students from lower-income and underrepresented backgrounds are more likely to go into primary care, and more likely to serve in rural and underserved areas. We also bring perspectives shaped by adversity, language, and culture—experiences that are sorely lacking in a profession where over half of medical students come from families in the top income quintile.
Capping federal loans won’t meaningfully reduce tuition. It won’t create a fairer system. What it will do is make medicine even more inaccessible to those without family wealth. It will worsen the shortage of primary care doctors. And it threatens to make the future physician workforce less diverse, less community-minded, and less connected to the patients who need us most.
To become a physician, I needed a chance. Federal loans opened the door for me to serve my community. This legislation will slam that door shut for the next generation.
Tom Phan is an internal medicine physician.
