Federal loan changes could impact future access to medical education in Washington

At Washington State University's Elson S. Floyd College of Medicine, students are training to meet the health care needs of communities across the state especially in rural and underserved areas. With each incoming class capped at 80 students, the school emphasizes in-state recruitment and service, drawing students from 30 of Washington's 39 counties since 2017.

But upcoming federal loan changes may alter who can afford to pursue that path.

A law signed in July and commonly referred to as the Big Beautiful Bill includes a cap of $200,000 on total federal borrowing for medical students and eliminates access to Grad PLUS loans. While implementation details are still being finalized, the changes could significantly affect how future students finance their education.

A mission focused on Washington

WSU's medical school admits only students from Washington or with strong ties to the state. It was designed to address physician shortages in underserved regions and has already begun seeing results. Of the earliest cohorts who have completed residency, 65% are currently practicing in Washington, and another 30% report plans or hopes to return.

Rural clinical training is central to the program. During their third and fourth years, students rotate through communities including Moses Lake, Colville, Omak, Tonasket, Chelan, Othello, Pullman, and Pend Oreille County-gaining valuable experience in rural health care settings. Nearly half of the College of Medicine's graduates pursue primary care specialties.

Financial realities of medical training

Like many medical schools, WSU's students rely heavily on federal student loans to finance their education. In the Class of 2024, more than 44% of students graduated with $200,000 or more in debt.

Nationally, approximately 40% of medical students use Grad PLUS loans to cover costs beyond the federal Direct Loan limit. At WSU, that figure is even higher with 60% of medical students using Grad PLUS loans.

This is in part because WSU's MD student body more closely reflects the socioeconomic makeup of the U.S. population than the national average for medical schools.

While 43% of MD students across the U.S. come from the top earning quintile-despite only 14% of the general population belonging to this group-just 13% of WSU's MD students come from this highest income bracket. Conversely, WSU enrolls 10.4% of MD students from the lowest earning quintile, double the national average of 5%, and much closer to the national population rate of 14%.

Among WSU College of Medicine's Grad PLUS borrowers:

• 47% come from low-income backgrounds

• 34% are first-generation college graduates

• 22% grew up in rural communities

"Most medical students are not employed while in school," said Leila Harrison, PhD, MA, MEd, Vice Dean for Admissions, Student Affairs, and Alumni Engagement. "If they don't have family support, savings, or scholarships, they rely on borrowing to cover their cost of attendance."

Potential effects of loan changes

Eliminating Grad PLUS loans and capping total federal borrowing could impact who is able to pursue medical education. Applicants without financial support or access to private loans may be deterred from applying. Those who do pursue alternative funding sources may face higher interest rates, longer repayment periods, or the need for co-signers.

These financial pressures could also influence career decisions. Higher debt burdens often push graduates toward higher-paying specialties or urban practice settings, reducing the recruitment pool of physicians entering primary care and returning to rural areas.

Currently, nearly 50% of WSU College of Medicine graduates choose primary care, critical for addressing health disparities in communities across Washington.

Workforce impact already visible

WSU's model to train students from Washington, for Washington is showing early success. The college graduated 67 students in the 2023-2024 academic year and 71 in 2024-2025. While the student body is designed to hold approximately 320 students across four years, that number fluctuates slightly due to leaves of absence for research or personal reasons.

"We're seeing strong evidence that our graduates want to stay and serve in Washington," Harrison said. "Our goal is to ensure that path remains open to all students regardless of their financial background or access to resources."