You, there beyond the words of this page. Oh, how I wish I could step beyond this limited medium and have a one-on-one conversation with you, as this matter is of the utmost importance to me. Unfortunately, I can do no such thing. As a result, I must lay out the groundwork by which this spewing of feelings will work henceforth. We medical students are fond of only wasting our time in places we deem fit. This editorial serves only to free my mind of the burden all these words have had on my mind while also hoping (likely in vain) that this constellation of impenetrably sound, certainly foolproof, and flawless arguments makes you stop and think for even just a moment about the way things are and how they should be in and around medical education.
I am not here to spit facts at you in some ill-fated attempt to sway your feelings about all this. Today, the even-kilter opinion is far and few between, and most that make it even this far already support what you presume I am about to say, or you hate everything you think I am about to say. As a father, husband, and medical student all in one, changes of this nature can upend everything for me if they continue down the course it appears we are on. What motivates me to write this, though, is how deeply I care for the great many people already affected by these changes and the many more who will be. What then has happened that has stirred me so?
Public Law 199-21, colloquially known as the One Big Beautiful Bill Act (OBBBA), was signed into law on the Fourth of July, 2025, and it amended the Higher Education Act in ways that hold grand implications for the many programs under the HEA. I cannot help but feel outraged and misled at the suggestion that this will in some way help to curb the rising tides of medical school tuition, partly because this has happened before.
A major point of discourse for student loans from the late 1990s to the early 2000s centered around the connection between subsidized loan limits and the growing tuition of many undergraduate programs. It does not take a tenured education economist to point out that limits on undergraduate loans did nothing to stop college tuition from continuing to balloon all the way to where they are in the present day. It is to the point that many a Dave Ramsey-type can be found on the internet calling people fools for taking out $50,000 of student loans to get “useless degrees.” But that poses a question for all of us: At what dollar amount does a medical school tuition make the Doctor of Medicine a useless degree?
It is easily verifiable that a medical school education can exceed even $300,000 today, especially in the most attractive places to go to school. The limits on yearly and lifetime loan caps imposed here, particularly for students seeking PLUS loans, are a direct assault on the return on investment of the medical doctorate. I know some will immediately roll their eyes at the hoity-toity medical student bemoaning the idea of having to allocate more on student loans out of their prospective mountain of money we are all entitled to as physicians, but please unroll them for just a moment.
Consider for a moment that your idea of medicine and even law may well be colored by survivorship bias. That for every story of a multimillionaire spine surgeon in Texas with three offices, there is a story of an OB/GYN in Northern California working for an FQHC still trying to chip away at their student loan totals. Just because physicians are, on average, rather smart does not also mean they are financial wizzes. Yet, we are getting to a point where the circumstances of tuition prices are necessitating that we are—lest we continue down a path of too many hyperspecialized doctors all clustering around major population centers while leaving the rest (usually our poorest and most vulnerable citizens) to fend for themselves. I wager that this bill does nothing and will do nothing to make this better.
It is also not lost on me who this bill hurts most. While ideas like return on investment apply to any prospective medical student, it would be foolish not to rightly identify Black, Hispanic, Asian, Native American, Eastern European, Middle Eastern, African, and all foreign students as at risk for most harm under these statutes. Now, that might sound rather like…well, everyone, now doesn’t it? This also includes those not cut from the upper echelons of the socioeconomic crust.
I know this line of argumentation angers some, and I get it. However, it is plainly evident that those with fewer resources now face a much steeper economic hill to stay in medical school, which was already difficult to reach academically. These aggrieved are also disproportionately minorities. I will ask you another question: Is it right for one to face so many barriers—not just on the way into medical school, but all along their journey through it as well? If so, for whom does it benefit? Frankly, if I were sick, I would want the best and brightest person available with an M.D. to be there treating me. Not just the best and brightest person who could afford to make it there.
There is still more to discuss on this topic, and I encourage you to explore the parts of what I’ve said that resonated with you. Still, I would like to leave you with a bit more to chew on. While these changes have rightly placed a focus on the students, there are so many more who stand to be harmed. I urge you to think also of the educators working in schools with and without M.D.s, now potentially facing a wave of downsizing programs. Of the student affairs deans and the financial aid chairs. Of the janitors and the lunch staff.
Most of all, though, I urge you to think of the youth. Of that kid out there who dreamed of helping people in some nebulous sense and thought medicine would be a cool way to do so. They will still be out there—of that I am sure. But how many will be turned away? How many potential wonder drugs and surgical innovations will go unpondered? You, there beyond the words of this page, think of the silent cost, if you will.
Caleb Andrus-Gazyeva is a medical student.
