You, who exists beyond the text of this page. Oh, how I long to transcend this constrained medium and engage in a direct dialogue with you, as this issue holds tremendous significance for me. Sadly, I am unable to do so. Therefore, I must establish the foundation upon which this outpouring of emotions will proceed from here on. We medical students are only accustomed to spending our time in venues we believe are worthwhile. This opinion piece aims solely to liberate my mind from the weight these words have imposed on me while also wishing (possibly in vain) that this array of sound, unquestionably solid, and impeccable arguments prompts you to pause and contemplate, if only briefly, the state of affairs and the necessary changes within and around medical education.

I am not here to bombard you with facts in some misdirected effort to sway your emotions regarding this matter. Nowadays, balanced viewpoints are scarce, and most who reach this point already agree with my presumable perspective or abhor everything they believe I am about to express. As a father, husband, and medical student simultaneously, alterations of this nature could disrupt my life significantly if they persist along the current trajectory we seem to be following. What inspires me to pen this, however, is my profound concern for the numerous individuals already impacted by these shifts and the many more who will be affected. What, then, has transpired to provoke such feelings in me?

Public Law 199-21, informally referred to as the One Big Beautiful Bill Act (OBBBA), was enacted on July 4, 2025, and it revised the Higher Education Act in ways that carry significant consequences for the various programs under the HEA. I can’t help but feel indignant and deceived at the notion that this will somehow alleviate the rising costs of medical school tuition, partly because we’ve seen this situation before.

A key topic of discussion regarding student loans from the late 1990s to the early 2000s revolved around the link between subsidized loan limits and the increasing tuition of numerous undergraduate programs. It doesn’t take a seasoned education economist to highlight that restrictions on undergraduate loans did nothing to prevent college tuition from continuing to soar to its current levels. It has reached the extent that many individuals resembling Dave Ramsey can be found online chastising people for accruing $50,000 in student loans for supposedly “worthless degrees.” Yet this raises a question for all of us: At what price does medical school tuition render the Doctor of Medicine degree worthless?

It is easily verifiable that the cost of a medical education can surpass $300,000 these days, particularly in the most desirable locations for schooling. The yearly and lifetime loan limit restrictions placed here, especially for students seeking PLUS loans, are a direct attack on the return on investment for the medical doctorate. I recognize some will quickly scoff at the pretentious medical student lamenting the notion of needing to allocate more in student loans from their anticipated considerable earnings as physicians, but I kindly ask you to reconsider.

Reflect for a moment that your perception of medicine and even law may be influenced by survivorship bias. For every narrative of a multimillionaire spine surgeon in Texas with multiple offices, there exists a tale of an OB/GYN in Northern California laboring in an FQHC and still striving to reduce their student loan balances. Just because physicians are, on average, quite intelligent does not imply they are financial experts. However, we are approaching a point where the realities of tuition costs demand that we become financially savvy—unless we continue down a path of having too many hyperspecialized doctors clustering around major urban areas, leaving the rest (typically our most impoverished and vulnerable citizens) to manage on their own. I speculate that this legislation will achieve nothing and will contribute nothing toward improving this situation.

It is also apparent to me who this law impacts the most. While the concept of return on investment applies to any potential medical student, it would be unwise not to accurately recognize that Black, Hispanic, Asian, Native American, Eastern European, Middle Eastern, African, and all international students are most at risk under these regulations. Now, that might come off as… well, inclusive, doesn’t it? This also includes those not belonging to the upper tiers of the socioeconomic hierarchy.

I realize that this line of reasoning frustrates some, and I understand why. However, it is clearly obvious that those with fewer resources now face a significantly steeper financial challenge to remain in medical school, which was already tough to enter academically. Those who are aggrieved are also