By Patrick Hewes, MS4
University of Washington School of Medicine
The day I got into medical school I was happy. I was also scared, and a little sick about it. I grew up fighting to get out of the foster system. I was homeless for part of high school. I worked three jobs, sometimes more, to get through undergrad. And now the reward for all of that was a bill bigger than any number I had ever had to think about, with the promise of more to come as the fees piled up, and a federal loan system that seems to change its mind every four years about whether it will ever let me out.
Loans are nothing new here. Nearly every doctor I have talked to had to take them out. It is almost a rite of passage at this point. But the deal my mentors got is not the deal in front of me, and the one in front of me is worse.
Here is where things stand. In Washington, medical school runs past $90,000 a year once you count the cost of actually living. Interest on federal grad and professional loans is up around 8 percent now, close to double what it was a few years back. Last year’s federal law put a hard ceiling on it: $200,000 total in federal borrowing for medical and other professional students, and it killed off the Grad PLUS loans that used to fill the gap above that ceiling, both kicking in for new borrowers in 2026. The repayment plans a lot of current borrowers were banking on got narrowed or scrapped. Add it up and you get a system that has turned predatory for anyone who is not already well off.
So students are stuck asking a question that used to be unthinkable: can I even afford to do this? And if the answer is yes, the next one lands right behind it. What do I have to give up to pull it off? For people coming from where I came from, the math is brutal. You can chase the specialty or the city job that pays, and finally stop lying awake over rent and debt. Or you can go back to the places that need doctors most, the underpaid and overlooked ones, and make your peace with carrying that debt for most of your career.
If we want medicine to stay a field that people of any income can enter, and not just the children of people who already made it, something structural has to give. Scholarships are good. I have been grateful for every dollar of them. But they are a bucket of water on a house fire, and they are hard to keep funded year after year. The real fix is upstream, in how we decide to treat students in the first place.
And Washington does not have to invent anything. There is a model right next door. UW’s medical school trains students for all five WWAMI states, which is where the acronym comes from: Washington, Wyoming, Alaska, Montana, Idaho. Four of those five built a real two-way deal around the school. Wyoming, Alaska, Montana, and Idaho each chip in to pay for their own residents’ medical training, and in exchange those students agree to come home and practice, or pay the money back. Depending on the state it is three or four years of service, and it is not locked to any one specialty. Come back as whatever kind of doctor you want, just come back. The logic is almost embarrassingly simple. Every one of these students is a doctor the state is going to need, and if you treat them decently, most do not just return, they stay. The state gets the physicians, the jobs, the taxes, the care. The student gets a way into medicine that does not bury them.
And the one state that never built this? Washington. The state that hosts the school the whole region leans on never set up the deal for its own students. That is the whole problem in a sentence. Nobody is asking too little of Washington’s graduates. Washington just never built the road that turns public money into doctors where the doctors are needed.
We are not starting from zero, to be fair. Washington runs a Health Professional Loan Repayment Program that pays off part of a doctor’s debt for working in a designated shortage area, plus a small state loan program for people willing to go rural. But both are thin. The awards are capped, you have to be in a shortage area to qualify, and the loan program runs mostly on private money instead of state dollars. That is not a state deciding every student is worth investing in. It is a patch. Washington should take what it already has and put real money into it, on its own dime.
And the numbers are on our side. The AMA’s own research puts the average physician at more than a million dollars a year in economic activity, which dwarfs what it costs to train one. Bring these students back as doctors and you do not just fill gaps in care, you fill them with people who grew up in these communities and understand them. If we want a physician workforce that can survive the next decade and looks like the people it serves, the time to build that road is now.
Patrick is a KCMS student member. A Physician’s Perspective features voices from across our community.