When a younger student asked to meet with fourth-year University of Washington medical student Brianna Cowin, she expected questions on what school will be like and the best ways to study.
“But his main question for me was, ‘Can I get a job? Can I work a job and still do medical school?’” Cowin said. “That’s just not possible.”
Medical students are warning that President Donald Trump's Big Beautiful Bill will impact the future of health care, especially in rural communities, after it establishes a cap on loans for professional programs. The bill states the loan cap will limit students to $50,000 a year, with a total limit of $200,000, despite the national loan average for medical students being approximately $228,000 dollars.
Additionally, the Grad PLUS loan program, which has previously allowed graduate and professional students to borrow up to their school’s total cost of attendance, will be eliminated for new applicants.
Leila Harrison, vice dean for admissions for Washington State University, said they have 71 students who are part of WSU’s College of Medicine. Last year, they had a class of 67, with 44% of them having debt equal to or more than $200,000 dollars.
She also said 60% of their medical students use the Grad PLUS loan program to fund their studies.
“Most medical students are not employed while going through medical school. Therefore, if they don’t have reserves, familial or scholarship support, they are dependent on borrowing,” Harrison said.
Similarly, John McCarthy, the University of Washington’s assistant dean for rural programs, said through the university’s School of Medicine, about 64% of 275 graduates in 2024 had more than $200,000 in loans, with 72% of them taking out loans from the Grad Plus program.
This year, 280 students are part of the program. Both years, 60 students have been located in Spokane, he said.
“I think the impact on students will be significant. They can get private loans, but if you come from a rural area or a disenfranchised background, you don't necessarily have anybody that's going to co-sign on your loan, and you're going to need a co-signatory on the loan, because you don't even have a job,” McCarthy said.
Spokane Republican U.S. Rep. Michael Baumgartner, who voted for the bill, did not respond to requests for comment for this story.
In a prior interview about the legislation’s Medicaid cuts and potential effects on rural hospitals, Baumgartner noted that Congress added a $50 billion fund to help offset costs for rural facilities. He said his team would work with the state and local providers to ensure rural communities receive support. Baumgartner has stressed that the nation needs to make hard choices because of its significant debt.
'I'm scared for my future colleagues'
McCarthy said there was a time when the university thought to require rural clinical rotations for medical students.
But with the majority of them requesting to be placed in rural areas, they didn’t have to.
“We have about 80% to 90% of students spending some time in rural areas, and we have some students that would like to work in rural areas,” McCarthy said.
Harrison also said WSU medical students rotate in a range of rural communities throughout their third and fourth years of medical school, providing crucial assistance in the medical field for those areas. This includes Moses Lake, Othello, Colville, Pullman, Omak, Tonasket and Davenport.
"We admit students from Washington or with strong ties to Washington, with 30 of 39 counties represented in our student body since 2017. They are reflective of Washington's communities, with many coming from rural, first-generation and low socioeconomic status backgrounds," Harrison said.
Growing up in rural Oregon, Danielle Pettigrew, a second-year medical student at the University of Washington, said rural healthcare is where her heart lies.
She said her mother’s a nurse, so she would spend most of her childhood in the hospital.
“I loved going into the hospital, which is a really weird thing for a child to say,” Pettigrew joked. “I thought the volunteer greeter at the hospital was the coolest old man I ever met.”
“But also my mom showed me the beauty of taking care of people,” she said.
Pettigrew said she is part of the University of Washington's TRUST Program, which guides students through a special curriculum that connects underserved and rural communities in Washington, Wyoming, Alaska, Montana and Idaho.
The program is part of an effort to help meet workforce needs in the region, the university’s website states. Pettigrew plans to do a bulk of her clinicals in Moses Lake, where she lives.
“I started seeing patients in the Moses Lake clinic, just on a very basic level, before I even started school. I got to go in for a week and see a couple babies be delivered, and watch some cesarean sections – and then I get to go back there various weeks and days. Throughout my whole first year, I went back at least 10 different days where I was in the clinic, and then this summer, I spent a month there,” she said.
While she’s excited to serve a variety of patients in the area, she also realizes the uncertainty that lies for her and other medical students.
“I'm not worried about it this year or next year, but I am worried about it when it comes time to repay those loans. Some of the repayment programs have gone away or changed in such that maybe we will still be accruing interest during residency, because we can't afford to pay enough on our loans every month to even cover the interest that they're accruing,” Pettigrew said.
“It may force people to change what specialty they're interested in," she continued.
Cowin echoed Pettigrew’s concerns, adding that if rural hospitals were to close, it would impact how and where students would do their clinical rotations, most specifically prospective medical students.
Cowin, who is also part of the university’s TRUST program, said she has spent much of her time in Chelan and Grand Coulee for her training.
“I fell in love with rural health care through my time in Chelan, and I'm going to be a rural family medicine physician,” she said. “But if the universities are not able to get students into those areas and have these experiences, they’re going to have way less primary care physicians that want to work there, which is only going to worsen a situation.”
Cowin said the cap on student loans will deter students from working in the medical field. She emphasized it has already become a concern for some first-year students.
“They were like, ‘Could I work nights somewhere, and then do stuff during the day?’ The answer is no, you can’t,” Cowin said.
Max Eckhardt, financial educator for Washington State University, said the major impact will begin next year when the incoming class no longer has the same options as the current students.
"We have worked to meet with the students to explain the changes to funding and ensure that they have a path forward to completing their degree. As we continue to hear more from the Department of Education on the specifics of the bill, we are continuing to update students as well," Eckhardt said.
McCarthy also said UW medical students will be recommended to meet with financial counselors to help navigate loan issues or concerns.
“As a medical student, the impacts, if I had to put a word on it, are scary. I'm scared for my future colleagues, and I'm super worried about the impacts on any marginalized community, including rural communities," Pettigrew said.