I want to make something clear from the very beginning, because this point often gets lost when taking this perspective on this topic.

Nurses, physician assistants, occupational therapists, physical therapists, medical assistants, and every allied-health professional are indispensable to our health care system. They are professionals whose expertise saves lives, keeps clinics running, and provides the continuity of care that physicians alone cannot sustain. Their work is rigorous, their training is demanding, and their contributions deserve profound respect.

All that being said, we are focusing too much on the language of “professional” when the real crisis is the ongoing federal attack on health care pipelines that is not based on reducing loan burden, but kicking Black and non-Black people of color and low-income students out of health care.

Since the passage of the “Big Beautiful Bill” in July 2025, sweeping changes to federal student loans have begun reshaping the pipeline into medicine and the health professions. The elimination of the Grad PLUS program and the introduction of strict loan caps fundamentally alters who can pursue advanced training.

When the bill passed, it was still unclear which degrees would be considered “professional.” After months of confusion, that interpretation has now arrived, and it is devastating.

Under the new federal rules, degrees like nursing, occupational therapy (OT), physical therapy (PT), and physician-assistant studies are being reclassified as “non-professional.” This drastically lowers the number of students eligible for federal loans, pushing them towards high-interest private loans. And these degrees are not cheap.

• A BSN degree can cost $40,000 to over $200,000.
• PA school tuition has increased by 5.3 percent annually over the past five years, with the total cost ranging from $20,000 to $100,000 per year.

These are not cheaper or “alternative” pathways. They are expensive, intensive, full-time programs. And now we are telling the very students who want to serve their communities that they must assume unregulated private debt or give up altogether.

It’s also important to understand the demographics shaping these fields. Women overwhelmingly make up these programs, and we’re finally seeing meaningful increases in enrollment among Black women and other women of color. In nursing, for example, Black, Latina, Asian, and immigrant women represent some of the fastest-growing segments of the workforce. PA programs show a similar rise in the number of women of color as schools begin recognizing the importance of providers who reflect the communities they serve. These professions have become crucial entry points into health care for students without generational wealth, for first-generation college students, and for those who simply cannot afford the time or cost of a traditional medical degree.

These pathways have only recently begun to open not because the system welcomed these students, but because they advanced despite every structural barrier placed in front of them. And now, just as they are gaining long-overdue access, the door is being slammed shut again. Cutting off funding to the very programs where Black and brown women are finally gaining ground is no coincidence. It is a continuation of America’s long pattern of embracing diversity only when convenient, then quietly tightening the gate the moment it threatens existing hierarchies.

And all of this is happening during a national health care shortage. One in five Americans live in a primary-care shortage area and the U.S. will need more than 1 million+ new nurses by 2031 just to replace retirements. And for many patients, especially low-income patients or those in rural or urban-underserved areas, their primary care provider is a PA or nurse practitioner, not a physician.

I saw this reality firsthand when I lived in San Francisco. Even with excellent insurance through UCSF’s Blue & Gold HMO, the next available appointment with a primary care physician was six months away. At the time, I was experiencing severe physical and emotional symptoms that I would later learn were PMDD: symptoms that left me suicidal and terrified of my own body for two weeks every month.

If I had been forced to wait five months for help, I genuinely don’t know what would have happened to me, or whether the sense of control I clung to would have held. The only reason I received care when I needed it was because a postdoc in my lab recommended One Medical, where I was assigned a PA as my primary provider. For the three years I lived in San Francisco, she was the person who kept me safe, believed me, diagnosed me, and made sure I received the treatment that stabilized my life.

That level of access existed because someone like her could afford to become a PA. Now imagine a future where she can’t. Imagine patients just like me left waiting months in crisis because the very workforce that held our health care system together has been priced out of existence.

That is what’s at stake.

So, let’s be clear: This is not about titles. It is about racism, classism, and the deliberate narrowing of who gets to participate in health care at all. The title on your badge doesn’t matter if you cannot afford the program that earns you the badge. Because “Professionalism” is meaningless when the profession is reserved for the wealthy.

If we want nurses, PAs, OTs, PTs, and other allied-health workers to exist at all, we must fight for them now.

Because without them, our entire health care system will collapse, and millions will pay the price.

Naa Asheley Ashitey is a medical student.