New federal borrowing caps and the elimination of Graduate PLUS loans set for July 2026 raise concerns about access to care in rural communities.
The American Association of Orthodontists (AAO) is warning that upcoming federal student loan policy changes could exacerbate workforce shortages and limit patient access to specialty care, particularly in rural and medically underserved areas.
Set to take effect July 1, 2026, the new policies include federal loan caps and the elimination of Graduate PLUS loans. The AAO notes that orthodontic residents graduate with an average of approximately $567,000 in student loan debt, one of the highest amounts in healthcare education. Unlike many medical residents, orthodontic and dental residents typically pay tuition during their residency without receiving a stipend or salary.
Without long-term policy solutions, the organization warns that rising financial pressures may push new specialists toward higher-income metropolitan markets to manage repayment obligations, rather than rural communities where access to care is already limited. This shift also threatens to limit workforce opportunities; because orthodontists often open small businesses and employ staff in communities across the country, limiting access to specialty training could reduce these broader economic and healthcare benefits.
“As one of less than 20 orthodontists practicing in North Dakota during my career, I saw and experienced firsthand how difficult it can be for rural communities to attract specialty care,” says retired orthodontist Dr Dennis Sommers. “Significant new federal borrowing restrictions could make that challenge even greater. If young orthodontists face greater financial pressure and fewer opportunities to finance and purchase their own practices, more may choose larger metropolitan markets over smaller and rural communities where access to specialty care is already limited.”
Advocacy Efforts and Federal Legislation
With student debt increasingly shaping workforce decisions across healthcare and other advanced professions, the AAO is taking its concerns directly to lawmakers. Nathan Mick, vice president of advocacy for the AAO, says the organization is “actively engaging with policymakers at both the federal and state levels to pursue meaningful solutions that protect access to education, strengthen the orthodontic workforce, and support patient access to high quality care.”
At the 2026 AAO Professional Advocacy Conference in Washington, DC, members and residents met with more than 60 congressional offices to discuss the policy changes. David Barker, assistant secretary for postsecondary education at the US Department of Education (DOE), also addressed attendees regarding the implementation plans. The AAO has submitted comments to the DOE advocating for a delayed implementation of the new loan caps to avoid disruption for students and educational institutions.
The organization is also promoting the Resident Education Deferred Interest (REDI) Act. Reintroduced in March 2025, the bipartisan legislation would allow medical and dental residents to defer student loan payments without accruing interest during their training.
State-Level Loan Repayment Programs
At the state level, the AAO is highlighting programs designed to address workforce shortages. In Florida, advocacy efforts helped secure $6 million for the FRAME dental student loan repayment program, offering up to $250,000 in assistance for orthodontists practicing in underserved areas. Applications for the Florida program close May 31, 2026.
Additionally, the Maryland Dent-Care Loan Assistance Repayment Program is accepting applications through July 31, 2026, to support dentists and orthodontists serving Medicaid populations.
Photo: ID 112833871 © Tero Vesalainen | Dreamstime.com
