HR-1 is Shutting the Door on Future Physicians—Starting with Medical Students like Andrea

Two weeks ago, dual degree students at a Pennsylvania medical school received an alarming email: federal loan funds could no longer be used to support their dual degree programs. For many students, the message’s implications were confusing. For fourth-year medical student Andrea Jakubowski, its consequences left her scrambling.

Just weeks earlier, Andrea believed the sweeping loan restrictions under recent federal legislation, HR-1, might not reach her cohort in time to affect her. She was wrong.

Now, three years into her Doctor of Osteopathic Medicine (DO) program and halfway through her Master’s in Public Health (MPH) program, Andrea is among the first medical students directly harmed by the legislation. Her experience offers an early warning of what may come for thousands of others.

A Sudden Financial Collapse

Andrea’s path reflects the kind of physician the health care system urgently needs. She is pursuing a dual degree in osteopathic medicine and public health, driven by an interest in environmental factors, such as how air quality and pollen exposure shape patient outcomes.

Her MPH work includes a capstone focused on parental hesitancy toward the HPV vaccine. This type of research strengthens public health systems and improves preventive care—but the financial model supporting that work is unraveling at an accelerated pace.

With federal loans no longer covering her dual degree credits, Andrea and the other students in her cohort have lost their most reliable funding source. The alternatives are bleak. Research into private lenders has pushed Andrea to consider double-digit interest rates, which could leave her with overwhelming debt before residency even begins.

For many students, those terms are simply not manageable.

Vice Chair of the Pennsylvania Medical Society Board of Trustees, Ashley Wilkerson, MD, says the implications go far beyond immediate financial strain. “Debt colors every decision a physician makes—directly or indirectly,” she explains. “When you’re facing six figures of debt, it influences the specialty you choose, where you practice, and even whether certain career paths feel possible.”

HR 1’s Structural Damage to Medical Education

Andrea’s experience is not isolated—it reflects broader structural changes built into HR-1.

The federal law:

• Eliminates Grad PLUS loans for new borrowers

• Imposes a $200,000 lifetime borrowing cap

• Introduces a new lifetime aggregate cap of $257,500 on all federal student loans borrowed across an academic career

• Limits annual borrowing to $50,000 

  
  

These caps do not reflect the needs of aspiring physicians. The median cost of medical school already exceeds $280,000 at public institutions and approaches $400,000 at private schools. HR-1 does not reduce tuition; it only limits how students can pay for it.

The result is a widening gap between cost and access. Students with financial support from family may continue forward. Others must rely on high-risk private loans or leave medicine entirely.

As Dr. Wilkerson notes, the policy creates a gap without a solution. “HR-1 created this divide, but it provided no meaningful way to fill it. Organizations and schools are still trying to figure out how to help students—but there isn’t a clear path yet.”

Andrea is already seeing the impact. A peer she met in undergrad—a bright student passionate about pediatric cardiology—decided not to pursue medical school because of repayment concerns.

“The gap already exists,” Andrea says. “What you can afford, whether you can get help, even preparing for the MCAT. And now it’s only going to widen.”

HR-1 does not just increase financial pressure. It changes who can realistically enter the profession. Students from low- and middle-income backgrounds face multiple challenges, such as:

• Limited access to credit or co-signers

• Higher interest rates from private lenders

• Greater dependence on loans from the start

  
  

Without federal protection, these students are more likely to be pushed out before they begin their training.

Dr. Wilkerson underscores the urgency: “We may lose bright, motivated students before they even matriculate. If they can’t secure the affordable loans they need to start medical school, they’re lost to the profession entirely.”

Andrea reflects on her own path, saying: “If I had known this would happen, I may have thought twice.”

 

Long-Term Consequences for Health Care

The effects of HR-1 extend beyond individual students. By restricting access to medical education, the law threatens to shrink and reshape the future physician workforce.

Students pursuing dual degrees are especially vulnerable. These programs produce physicians who bridge clinical care and public health—bringing perspectives that are increasingly critical in modern medicine.

“What we lose can’t be measured in dollars,” Dr. Wilkerson says. “Physicians with dual training bring a combined expertise—people who speak both the language of medicine and public health. They help us better design care systems, reach underserved populations, and address disparities.”

Without that pipeline, the consequences could ripple across the entire health system. The likely result: fewer physicians, greater burnout, and declining diversity in the field.

No Safety Net

HR-1 is especially damaging because it offers no meaningful support to offset these restrictions. There are no expanded grants, no targeted relief for under-resourced students, and no adjustments for the high cost of medical education.

Instead, students face a stark choice: take on extreme private debt or walk away.

Dr. Wilkerson describes the implications bluntly: “We’re already hearing from students who don’t know if they can afford to graduate. There’s no way to sugarcoat that—it’s just awful.”

She adds that the long-term outlook is deeply concerning. “If nothing changes, we’re going to see fewer students entering medicine and less diversity in our workforce—and we know that affects both the quality of care and where care is delivered.”

A Workforce That No Longer Reflects Its Patients

The impact on diversity may be among the most profound consequences.

“These changes will impact our ability to deliver the best care to patients,” Dr. Wilkerson says. “We need physicians from diverse backgrounds to care for a diverse population. If students can’t afford training, they won’t even consider medicine—and we lose those perspectives.”

That loss extends to the communities most in need. Many students hope to return home to serve underserved or rural populations—but that becomes less feasible under heavy debt burdens.

“We lose students who want to go back and make a difference in their own communities,” she explains. “If they can’t afford the training, they can’t achieve those goals.”

A Call to Action

Andrea emphasizes the need for advocacy. “We need people to understand that this affects the entire health care system,” she says. “Young physicians need to make noise.”

Dr. Wilkerson agrees that action is critical—and urgent.

“I encourage physicians to reach out to both state and federal legislators and share what we’re seeing,” she says. “We need them to understand the real-world impact—students questioning whether they can finish their degrees or pursue primary care—and work with us to fix the gaps created by HR-1.”

She also points to the role of organized medicine and philanthropy. Supporting scholarships and loan programs, she says, will be essential to helping students like Andrea stay on track.

Organizations such as The Foundation of the Pennsylvania Medical Society offer lower cost loan alternatives for Pennsylvania medical students. While federal loan rates for 2026–2027 reach as high as 8.07% for Direct Unsubsidized Loans and 9.07% for Direct PLUS/Graduate PLUS Loans, Foundation loans offer borrowers a fixed interest rate of 6% for 2026-2027, not to exceed 6.5% during repayment with no fees and delayed interest accrual until January 1, 2027.

The Stakes Are Already Here

Andrea’s story is not hypothetical—it is happening now. A highly motivated, community-focused student pursuing a dual degree and volunteering to improve access to care is now unsure whether she can afford to graduate.

“That should be a never event,” Dr. Wilkerson says.

But under HR-1, it is quickly becoming reality.

The consequences are no longer theoretical. They are cutting off the next generation of physicians before they have even begun.