RALEIGH, N.C. (NCN News) – State Attorney General Jeff Jackson sued the U.S. Department of Education over a new rule he says would have devastating consequences for North Carolina’s healthcare workforce and leave many rural residents without primary care.
The new rule, created by the Department of Education, unlawfully narrows the definition of “professional” degree beyond Congress’ definition. As a result, nurses, physician assistants, physical therapists, occupational therapists, and audiologists are excluded from being able to borrow what they need to get their degrees – leaving North Carolina with even fewer healthcare providers. The lawsuit argues Congress established the definition, and the Department of Education is illegally trying to rewrite it.
“This isn’t just about a worker shortage – it’s a respect shortage,” Jackson said at a press conference. “Singling out nursing students and physician assistants for less financial aid is telling them the work they do isn’t important. That’s untrue and unfair. They are professionals under the law, and we’re going to court to make sure the Department of Education treats them that way.”
Congress created a cap last year for how much students pursuing “professional” degrees can borrow from the federal government. That law defined what counts as a “professional” degree, which includes advanced-practice nurses and other healthcare providers.
The new rule takes effect July 1 and would worsen the shortage of healthcare workers in North Carolina, where 93 of 100 counties already have a primary care shortage. Students pursuing these healthcare professions will be excluded from full participation in the main federal program that lets them affordably borrow what they need for tuition. That further constricts the pipeline of qualified healthcare professionals that North Carolina needs. Students who want to become nurse practitioners, physician assistants, or physical therapists would be limited to $20,500 a year in federal loans. Many of those programs cost more than that. For instance, graduate nursing programs routinely cost more than $30,000 a year, and that’s before living expenses. Students would have to take out more expensive private loans or skip the program altogether.
The cut hits nursing hard. Even certified registered nurse anesthetists, who must have a four-year college degree and must complete a three-year doctoral program are now deemed not “professional.” These are the nurses who deliver anesthesia in 80 percent of rural communities.
“Nurses who hold professional graduate degrees are educated with the highest level of rigor, science, and clinical expertise – skills that are deeply needed in every corner of the country, particularly in my home state of North Carolina and other states with large rural populations,” said American Academy of Nursing President Debra J. Barksdale, PhD, FNP-BC, FAANP, ANEF, FAAN who also teaches at UNC-Greensboro. “This rule will have far-reaching consequences for both patient care and the nursing workforce. It threatens access to care, particularly in areas that are underserved, and creates additional financial barriers for nurses seeking advanced education. Policies that discourage educational advancement, reduce support for graduate nursing students, or weaken investment in the future nursing workforce ultimately harm the health of the public we serve.”
“North Carolina is the birthplace of the PA profession – one of the fastest growing healthcare professions in the country,” said North Carolina Academy of Physician Associates President-Elect Chileatha Wynn. “Since 1967, when the first three PAs graduated from Duke University, the profession has grown to more than 200,000 PAs nationwide. Protecting the pipeline of this group of highly trained clinicians is critical to meeting the needs of patients – especially in states like North Carolina where the vast majority of individuals live in a healthcare provider shortage area. By taking a stand for aspiring PAs and other healthcare professionals, Attorney General Jeff Jackson and his fellow state attorneys general are taking a stand for the future of healthcare in our country.”
“Like every other state, North Carolina is grappling with severe shortages of healthcare providers of all kinds,” said Sen. Gale Adcock, a family nurse practitioner of 39 years who practiced in primary care for 29 years. “Primary care providers like NPs, PAs, and family physicians, particularly in rural communities, are essential to the health of North Carolinians of all ages. The DoE rule removing post-graduate nursing programs from the professional degree category will worsen an already critical situation. The effects of the rule change will be long term and devastating, hamstringing our workforce recruitment and development efforts.”
“Restricting federal student loan access for future physical therapists creates unnecessary barriers for students entering a profession already facing growing workforce demands,” said Dr. Tyler Shultz, President, American Physical Therapy Association North Carolina. “While APTA North Carolina supports efforts to improve affordability in higher education, these changes could reduce the number of qualified physical therapists entering the workforce and ultimately limit access to healthcare for patients and communities across our state.”
“With provider shortages at every level, we should be maximizing the capabilities of our entire profession,” said Bonnie Davis Meadows, President, North Carolina Nurses Association. “Simply put: making it harder to become a nursing professor or an Advanced Practice Registered Nurse will make it harder for the entire healthcare system to fill gaps in care.”
In 2025, Congress reduced the availability of federal loans for graduate and professional students. Starting in July, federal loans for graduate students will be capped at $20,500 each year and $100,000 total, and federal loans for professional students will be capped at $50,000 each year and $200,000 total.
What Congress didn’t do was change the pre-existing definition of professional degrees.
Attorney General Jackson’s lawsuit argues that the rule’s definition of a professional degree violates federal law because it changes the definition Congress adopted when it passed the bill.
Attorney General Jackson previously pushed back against the new rule before it was finalized. Projections estimate that by 2036, there will be a national shortage of 20,200 to 40,400 primary care physicians. Meanwhile, the Bureau of Labor Statistics estimates that demand for healthcare services will continue to rise from 2024 to 2034. Non-physician healthcare workers are crucial for filling this critical care gap.
The shortage of physicians is most felt in rural areas. With almost three million people living in a rural area, North Carolina has the second-biggest rural population in the country. Nurse practitioners are more likely than physicians to focus on primary care and work in rural areas, and physician assistants make up a rapidly growing share of the rural healthcare workforce. If nurses and PAs can’t get their degrees, people in rural communities often can’t get care.
Joining Jackson in filing the lawsuit are the attorneys general of Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Massachusetts, Maryland, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin, and the governors of Kentucky and Pennsylvania.