AYESHA RASCOE, HOST:
Organizations representing nurses and PAs - those are physician assistants and associates - are suing the U.S. Department of Education. They say a new rule capping annual federal student loans will not only harm their members but also aggravate healthcare shortages across the country. Todd Pickard is the president of the American Academy of Physician Associates, one of the groups suing. He's also a practicing PA in Texas. Welcome to the program.
TODD PICKARD: Well, thank you very much, Ayesha. It's my pleasure to be here.
RASCOE: Could you start by explaining what this new rule is and how it applies to nurses and PAs?
PICKARD: The Department of Education has decided that certain degree plans will qualify for what they call the professional loan limits, which is a higher tier of federal fund for loans. And the other group will be in the non-professional tier, which is a lower limit. And historically, PAs and nurses have fit in the professional category with the higher loan limits because we do meet the three-tiered test that Congress created years ago in statute about what defines a professional degree. So what this means is that folks will not be able to get the amount of loans that they need to cover their education and their living expenses while they are training.
RASCOE: How much is the average cost of a physician associate's education?
PICKARD: The median is somewhere between 90 thousand and 110 thousand a year. But for example, if you look at a school in Texas that's close to where I live, they look at the cost of not only tuition, but housing, food, supplies, books and everything else that the student has to have. And it's $160,000 to get through the entire program, which is about 2 1/2 years.
I think what people forget is that we're not just talking about tuition. When you're in PA school, you're working in the program 60 to 80 hours a week. You have to live off of your loans because you are unable to hold any kind of part-time job. And so it's really critically important to remember that. You know, when I graduated very long ago, in 1998 - I've been a PA for 28 years - my loans were $87,000. So applying the new loan limits today, I would be short about $37,000.
RASCOE: Yeah. And just to clarify, what are the new loan limits?
PICKARD: So for the lower tier, it is 20,500 per year and then a total of 50,000.
RASCOE: And what is a physician associate's role in healthcare today?
PICKARD: Oh, that's an amazing question. What don't we do?
(LAUGHTER)
RASCOE: OK, yeah.
PICKARD: PAs - I like to - I work in oncology, so I like to talk about PAs as the stem cells. Basically, we can turn into anything that is needed. We fill in gaps, and we can pivot and become whatever the healthcare system needs. But PAs make medical diagnosis. They formulate treatment plans. They prescribe. They write orders. They perform procedures. They educate patients. They refer to other professionals. They work in teams with physicians and nurses and others. Basically, when you are being seen by a PA, you are getting medical care that you would not be able to tell is different than anybody else giving you medical care.
RASCOE: Has this role expanded over the years, especially when, you know, places are dealing with, like, doctors shortages and what have you?
PICKARD: Absolutely. You know, when I started at my employer almost 30 years ago, there were probably about 15 PAs in the entire institution. We're - my institution is 27,000 employees. Five hundred of those are PAs. An additional 800 are types of advanced practice nurses. So it's interesting - at my institution, half of the medical providers are physician, and the other half of medical providers are PAs and nurse practitioners. So we have to have all healthcare providers doing the work that they can do. There's around 200,000 PAs currently practicing in the United States in every area, every specialty.
RASCOE: Given that there are doctor shortages across the country, especially in rural areas, what's your response to the argument that some students who are studying to be a PA or a nurse should try to be a doctor instead?
PICKARD: You know, that's a really interesting question, and I think it really comes down to people making choices about how they want to practice and what kind of career they want to have. What's interesting about PAs is that we have incredible job flexibility that physicians and nurse practitioners do not. They get tied into one specialty or one population of care, and PAs can go from pediatrics to surgery to general practice to emergency medicine. It's a calling to medicine but with this opportunity to say, hey, I'm very interested in doing all these different types of things. I don't want to be locked into just one type of practice for the next 50 years. So it's really about people making choices of what they want to do and how they want to live their lives.
Right now, the United States has a shortage of healthcare providers - period, the end. We have more people without insurance or under insurance. We have patients who are living longer. We have more mental health, more diabetes, more obesity, more hypertension, more cancer, which is what I'm specialized in. So this is a time when the government should be investing in healthcare, not divesting. You know, we need to make sure that we have PAs, nurses, nurse practitioners, pharmacists, physicians. We need everybody.
RASCOE: That's Todd Pickard. He's a PA in Texas and the president of the American Academy of Physician Associates. Thank you so much for speaking with us.
PICKARD: It's my pleasure. Thank you.
RASCOE: In a statement to NPR, Ellen Keast, the Ed Department's press secretary for higher education, noted the rise in tuition over the last two decades and says, the Trump administration is, quote, "ending a system that pushed students into debt and is promoting access to high-quality education that serves students, not institutional bottom lines." Transcript provided by NPR, Copyright NPR.
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