Federal Borrowing Limits and Physician Associate/Assistant Education: A National Survey of Pre-Physician Associate/Assistant Students, Physician Associate/Assistant Students, and Practicing Physician Associates/Assistants

INTRODUCTION: The One Big Beautiful Bill Act eliminates the Grad PLUS program and establishes annual and aggregate federal student loan caps beginning July 1, 2026. Physician associate/assistant (PA) programs are currently classified as graduate-level for federal aid purposes, potentially subjecting PA students to lower borrowing limits than other health professions. This study examined perceptions of federal loan caps and anticipated impacts on PA education and workforce. METHODS: A cross-sectional, anonymous, web-based survey was administered in January 2026 to pre-PAs, PA students, and practicing PAs across the United States. Items assessed demographics, borrowing patterns, perceived affordability, and anticipated behavioral responses under a proposed $20,500 annual federal loan cap. Descriptive statistics, chi-square analyses, independent samples t-tests, and multivariate logistic regression were performed. RESULTS: Among 4,000+ respondents, concern regarding restrictions was high; 72% of PA students and practicing PAs reported being very or extremely concerned. Overall, 90.8% anticipated decreased applicant volume and 89.6% predicted reduced diversity under a $20,500 annual cap. Logistic regression (N = 3,106) indicated that each additional economic disadvantage factor increased odds of reporting discouragement from pursuing PA education by 20% (odds ratio = 1.20; 95% confidence interval: 1.12-1.29). Underrepresented in medicine respondents were disproportionately represented in the highest educational cost and borrowing categories (p < 0.001). DISCUSSION: Respondents anticipate negative implications of federal borrowing caps for PA applicant volume, diversity, and service to underserved areas. Financial vulnerability appears central to perceived feasibility of PA education under proposed loan limits, raising equity and workforce sustainability concerns.