“Professional” Program Redefinition Endangers the US Healthcare Workforce

Cory Ellen Gatrall

Nurse practitioners are a lifeline for the millions of Americans who live in healthcare deserts: 87% are trained as primary care providers, and 80% care for Medicaid patients. Yet an obscure committee now promises to strip them of access to educational funds, putting the healthcare system, the nursing workforce, and patients at risk.

When Lyndon B. Johnson signed The Nurse Training Act of 1964 to address the already critical nursing shortage, he applauded an “enlightened Congress” for recognizing “the new needs of the profession, as well as the growing needs of all of our people.” A very different Congress authorized the Trump administration’s One Big Beautiful Bill Act (OBBBA) last summer, and on July 1, an already condemned Department of Education will cut federal loans for graduate nursing programs in half, despite the continuing urgent need for nurses.

On January 30th, the Department of Education opened public comment for 30 days on its proposed rule to narrow borrower eligibility for “professional degree” loan limits. As of next summer, only eleven degree program pathways – Pharmacy, Dentistry, Veterinary Medicine, Chiropractic, Law, Medicine, Optometry, Osteopathic Medicine, Podiatry, Theology, and Clinical Psychology – will qualify as “professional” for the purposes of student borrowing, allowing graduate loans up to $50,000/year or $200,000/lifetime. All other programs will be limited to $20,500/year or $100,000/lifetime.

Nursing organizations quickly warned that this reclassification could wreak havoc on nurse practitioners, the nation’s largest Medicare-designated provider specialty, whose program costs regularly exceed the new limits.^[1] The Department of Education responded scornfully, accusing “certain progressive voices” of “fear mongering.” The administration patronizingly said that its exclusion of nursing from “professional degree” graduate programs is “not a value judgment.” Their response is simultaneously insulting, inaccurate, and beside the point: the reclassification narrows the definition of “professional degree” to further a pronatalist agenda that will limit the work lives of women and people of color and exacerbate the existing healthcare crisis.

The Reimagining and Improving Student Education (RISE) Committee repeatedly emphasized in deliberations that it was honoring the intent of the Congress that first authorized the 1965 Higher Education Act. However, it ignored the context in which that law was passed. The authors of the Act did not imagine that “professional” was a static category when they identified qualifying criteria for “professional degrees,” such as program length and whether it was preparing someone for licensure. They prefaced their list of eligible programs with a few important words: “examples of a professional degree include, but are not limited to . . .” These words were cut by the RISE Committee.

Without that essential preface, the list of programs reverts to a pre-1965 understanding of the professions. It highlights organized groups of experts with specific educational pathways that were, unsurprisingly, overwhelmingly white and male. The credentialing and gatekeeping that had created elite cadres of “experts” had also created barriers to the entry of women and people of color into healthcare. Passed as part of Johnson’s Great Society legislation alongside the Manpower Training Act (not to mention Medicare and the Voting Rights Act), the Higher Education Act was designed to overcome just these structural barriers.

It came at a moment when nursing and other women-dominated professions were quickly expanding. The Nurse Training Act had established loans, grants, and new advanced degree programs to bolster the nursing workforce desperately needed for the postwar United States. Nurses poured into PhD programs to become faculty who could in turn prepare the next generation to provide care in newly specialized and highly technological environments.^[2] In the same period, nurse practitioner programs arose to mitigate healthcare shortages as Medicare allowed more people than ever to access primary care.^[3] In prefacing the 1965 list by saying “examples of a professional degree include, but are not limited to,” the 89^th Congress acknowledged that the country was changing, and that “women’s professions” were on the rise.^[4]

Since that time, the nurse practitioner workforce has grown exponentially. Today, 461,000 NPs provide essential healthcare in the US, many of whom require more than the proposed loan limit amounts to complete their education. A 2025 study found that primary care practices that employed NPs were more likely to be located in low-income and rural communities.^[5] In the plainest of terms, nurse practitioners cost less to employ than physicians and offer high-quality care to vulnerable populations. In the face of such obvious need and such evident potential for harm, we must analyze the decision that makes it more difficult for nurses to advance in their profession.

The RISE committee’s new definition bypassed the recommendations of some of its own members in limiting the eligibility of degrees to those specifically named in its list. Their changes were also inconsistent: they added clinical psychology to address concerns around veterans’ mental health, while psychiatric nurse practitioners remain ineligible. This only highlights that the exclusion of degree programs heavily populated by women from the “professional” category is neither coincidental nor accidental. The changes are among the proposals made in Project 2025’s “Department of Education” chapter, authored by Lindsey Burke.^[6] Burke writes on the Heritage Foundation website that reducing federal subsidies for higher education is a “key strateg[y] for increasing the married birth rate.” If you keep women out of higher education, she reasons, they might as well have (more) babies.

At the close of the committee negotiations, Under Secretary of Education Nicholas Kent told the group, “We believe we have developed a proposal that is logical, that can withstand legal scrutiny . . . you don’t have to love it, but you can just live with it.” He may be correct about the first two points. The proposal follows a pronatalist, ahistorical logic that, in the current legal environment, might even hold up. But nurse practitioners, 89% of whom are women and 21% of whom are people of color, cannot “just live with it.” The health care system that relies on nurse practitioners for cost-effective care cannot “just live with it.” And most importantly, the millions of Americans who depend on nurse practitioners for their primary and specialty care cannot “just live with it.”

Cory Ellen Gatrall

Cory Ellen Gatrall is a registered nurse who has worked in labor/delivery/postpartum as well as abortion care, and a PhD nursing student. Her current research focus is the historical development of the culture concept in nursing and nursing education.

• Cory Ellen Gatrall

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