ABSTRACT This exploratory project draws on semi-structured one-hour interviews with eight self-identified Women of Color on the East Coast of the United States. Deploying critical bi-focality as a conceptual framework, this paper uses counter-storytelling to explore the narratives of Women of Color who are first in their families to attend college and/or graduate school to understand the complex dynamics and intimacies of upward social mobility through educational attainment. Rather than position upward social mobility as inherently desirable or positive, this paper suggests that Women of Color re/de/construct social mobility in ways that challenge, reinterpret, and reconceptualize hegemonic narratives by: 1) locating the anti-blackness within/of social mobility; 2) acknowledging and navigating student loan debt and the myth of meritocracy within the racialized neoliberalism of higher education; 3) speaking to the being and process of becoming a woman of color through higher education; and 4) capturing and holding the tensions, dualities, and conflicts within emotions and between institutions.

Purpose First, we expand understanding of the causes of debt aversion, specifically, whether it is a preference in its own right. Second, we investigate the consequences of debt aversion for a range of debt products. Design/methodology/approach This exploratory, simultaneous, mixed-methods study uses financial, demographic, psychographic and interview data to investigate debt attitudes and usage among 70 Australians aged 18–40 years. Findings Debt aversion is primarily motivated by fear. Debt invokes psychological stress due to risks of exogenous events and the inability to control spending. Fears also centre on a lack of financial capability and loss of autonomy/freedom in life choices. Minimalist values are a separate, less common driver. Interviews confirm the importance of social learning for debt usage. Negative debt attitudes are associated with reduced usage of credit cards and home mortgages, but not student debt, informal debt or buy-now-pay-later products in the Australian context. Research limitations/implications Debt aversion is not a distinct preference, although attitudes are important for explaining debt usage. Practical implications Debt aversion is not a distinct preference, although attitudes are important for explaining debt usage. Originality/value We uncover a new connection between debt aversion and home mortgages in the Anglosphere. Anxiety about the ability to maintain autonomy and control spending is a crucial yet underappreciated source of debt aversion.

ABSTRACT While millions of Americans struggle with student loan debt, Black students are disproportionately reliant on loans to finance their education and bear the largest debt burdens as a result. Many political elites have framed their support for student debt relief explicitly in terms of ameliorating racial injustice and shrinking the Black-White wealth gap. Yet, we know relatively little about whether and how racial identity drives support or opposition for student debt relief policy. This study employs conjoint and framing experiments with a qualitative probe to examine how racial identity and race-based messages influence people’s support for student debt cancellation. While we find that people view individual Black borrowers as slightly more deserving of debt relief relative to other groups—a reversal of the typical pattern in social welfare policy—these attitudes do not translate into preferences for racially-targeted policies, nor do they make people more receptive to positive race-based messaging for student debt relief. Among Republicans, they weaken support. Our work sheds light on the complex ways in which racial identities affect people’s preferences for this key issue in American political economy.

Abstract Problem Accelerated pathway programs graduate students in three, rather than four, years. While these programs help address physician workforce shortage and student debt, they have not implemented rigorous assessment frameworks aligned with Competency-Based Medical Education (CBME) training to ensure students are ready to graduate one year early. This report describes an accelerated pathway program using a CBME framework to transition students into graduate medical education programs when they are deemed competent. Approach Starting in 2018, the Virginia Commonwealth University School of Medicine (VCU-SOM), developed an accelerated and competency-based graduation (CBG) program focusing on competency as the standard for graduation. Students apply to the CBG program in their second year, with selection based on academic performance, program commitment, and mutual interest with the affiliated residency. Except for reduced post-clerkship elective time, students complete the same curriculum as non-CBG peers. Progress during the clinical year is evaluated by the CBG Clinical Competency Committee (CCC) to ensure students meet required milestones for advancement and eligibility for accelerated graduation. Outcomes As of 2024, 20/33 (61%) CBG students graduated in 3 years, while the remainder (13/33; 39%) transitioned back to the standard program. CCC analysis showed increasing competency ratings, with nearly 100% achieving ‘competent’ or ‘on track’ in core domains. Some assessment areas showed lower competency, identifying targets for improvement. Program directors report that all CBG graduates are progressing appropriately through residency milestones, with no significant concerns about performance or burnout. Next Steps The CBG program offers a competency-based, time-variable pathway (CBTV) from medical school to residency, utilizing a CCC and designed to support both early and traditional progression based on achievement of competency. Future steps include adapting to the removal of Step 1 scores as a selection tool, ensuring adequate Entrustable Professional Activities (EPA) data for decision-making, and expanding participation across additional specialties.

Although student loans have made health professional education accessible for a greater proportion of the US population, rising student indebtedness has incited considerable discourse. This study aimed to characterize US chiropractors' self-reported student loan debt, student loan relief opportunities, and perceived value of chiropractic training. A 38-item cross-sectional, anonymous, electronic survey was developed. Chiropractors who graduated from a US-based, Council on Chiropractic Education-accredited Doctor of Chiropractic program (DCP) were recruited. The survey was conducted between February 2025 to March 2025. Survey domains included (1) demographics, (2) financial characteristics, (3) loan relief, and (4) educational and career value. Descriptive statistics and visualizations were used for analysis. A total of 1,455 responses were collected. The mean (SD) and median (Q1-Q3) student loan debt at graduation was $176,297 ($89,460) and $185,000 ($120,000-$240,000). At survey completion, 85% retained student loan debt, averaging $232,062 ($102,691) with a median of $240,000 ($177,500-$290,000). Mean (SD) gross income in 2023 was $99,068 ($100,349); median (Q1-Q3) was $76,000 ($50,000-$115,000). Approximately 87% of respondents reported being ineligible or unsure about eligibility for loan relief programs. Over half (53.3%) disagreed or strongly disagreed that their DCP provided a positive return on investment (ROI), and approximately 70% rated the financial ROI of DCP training as low or very low. Perceptions of non-financial ROI were more favorable. Overall, 65% would not choose a chiropractic career again; among them, 67.3% would pursue a career in another healthcare field. US chiropractors are burdened with considerable student loan debt that outpaces gross income. The findings of this study are commensurate with prior studies investigating chiropractic educational debt, yet likely are not unique to the profession and represent larger challenges faced by many modern US health professions. Innovation is likely needed to support the sustainability of the chiropractic profession given tension between educational debt and income.

ABSTRACT This paper examines the role of income inequality in amplifying the macroeconomic effects of student debt. I argue that inequality captures structural differences in households' access to non‐student credit, with higher inequality reflecting a greater concentration of credit‐constrained households and thereby amplifying the adverse effects of student debt repayment on consumption. Using state‐level data, I show that the negative association between student debt and subsequent aggregate consumption growth is significantly stronger in states with higher inequality. Consistent with this mechanism, several stylized facts indicate that higher inequality is associated with lower levels of non‐student debt. Finally, I develop a simple model illustrating how income inequality increases the prevalence of borrowing constraints, thereby amplifying the sensitivity of consumption to debt repayment.

Objectives. To characterize the national landscape of student loan debt for state and local public health staff and consider the potential roles of loan forgiveness and repayment in workforce development. Methods. This study analyzed data from the nationally representative 2024 Public Health Workforce Interests and Needs Survey, which had 57 000 respondents in the United States. We calculated descriptive statistics and performed an interval regression to assess correlates of student loan balance. Results. More than 40% of the workforce has a student loan balance: $48 000 on average, among those with any debt. Differences are observed by age, race/ethnicity, and level of academic degree. Conclusions. As in other fields, governmental public health is experiencing high rates of turnover while having difficulty with recruitment. Lack of competitive pay and benefits makes it difficult to find and retain staff who may have a public service inclination but also have bills to pay. High on that list of bills, for many, are student loans. Public Health Implications. Loan forgiveness and repayment represent important policy tools to address the ongoing workforce shortage and may be adversely affected by recent federal legislation. (Am J Public Health. 2026;116(4):485-491. https://doi.org/10.2105/AJPH.2025.308290).

How do income-driven repayment plans benefit student debt borrowers?

Expanding the midwifery workforce is an important strategy for improving perinatal outcomes and addressing the current perinatal workforce shortage. However, the cost of education is a primary barrier to accessing midwifery programs and can affect students' educational experience. State initiatives to fund midwifery education, including through direct scholarships, offer a promising approach to support students and expand the midwifery workforce. The purpose of this program evaluation was to explore the impact of scholarship funding on students' midwifery educational experiences. Data were obtained through the responses to a short survey that was distributed to the 25 students who had received a scholarship for their midwifery education. Quantitative responses were analyzed using frequencies or means, while qualitative responses were coded using the principles of content analysis. Of the 25 eligible participants, 19 completed the survey, yielding a response rate of 76%. The survey responses revealed that cost is a consideration in selecting a midwifery program, although not the principal factor. Scholarship funding contributed to students' academic success, supported their mental health, and alleviated the financial burden of day-to-day expenses. Despite receiving this financial support, most students continued to work during their time in the midwifery program and will still graduate with student debt. Scholarships for midwifery students can help to mitigate a primary barrier to accessing education and can support the growth of the midwifery workforce with its associated improved perinatal outcomes. Additionally, targeted state funding can drive workforce diversification, contributing to health equity.

The Quarter-Life Crisis (QLC), a period of intense self-doubt, anxiety, and identity confusion during early adulthood has become a widespread phenomenon affecting mental health and well-being globally. In the Indian context, this phase is further shaped by cultural expectations, economic uncertainty, and social transitions that shape young adults’ sense of purpose and stability. Although often discussed in psychological and sociological terms, the QLC remains under-addressed in public health discourse. This perspective paper argues for the recognition of QLC as a legitimate public health issue with cross-sector implications. Economic precarity, including unstable employment, student debt, and housing insecurity, plays a critical role in exacerbating this crisis, making it not only a psychological experience but also a condition influenced by broader socioeconomic and cultural forces. Drawing on developmental psychology, sociocultural theory, and the framework of the Sustainable Development Goals (SDGs), this paper situates the Quarter-Life Crisis within India’s evolving social landscape and examines it as a social determinant of mental health. It further highlights community-based and digital interventions, such as resilience and self-compassion apps, that can support young adults. Integrating QLC into public health frameworks particularly those focused on Good Health and Well-Being (SDG 3) can offer timely, systemic solutions to a rising mental health concern among India’s youth and the global young adult population.

The increased use of Buy Now Pay Later (BNPL) among Malaysian university students has sparked interest in the aspect of financial literacy and the ability to sustain debt. This paper explores the relationship between BNPL usage and level of debt management among Malaysian university students. Our research designed a quantitative approach was used through an online survey conducted among the active BNPL user of Malaysian university students. Census results from 150 participants were analyzed to test the purposed hypotheses. The results indicate that students perceived financial management capability, attitude and perceived behavioral control have significant effects on their behavior toward BNPL services. Low levels of financial literacy, combined with poor debt repayment behavior, also contribute to higher levels of student debt and higher levels of financial stress. In summary, this study demonstrates that BNPL services offer access to credit for Malaysian university students but at the same time create financial risk due to their failure in financial literacy. Hence universities and loan institutions should encourage financial literacy to prevent financial stress among students

Given that structural and systemic racism in the United States has led to significant wealth gaps for some global majority populations, student debt may have even more costly impacts on the career outcomes for Black arts graduates in comparison to their White peers. Therefore, we investigated the research question, what effects do race and student loan debt have on the career choices of U.S. Black college arts graduates? To answer this research question, we tested our hypothesis using data from the National Survey for College Graduates (NSCG). Relative to White arts graduates, Black arts graduates are more likely to have borrowed to pay for school, still owe on their debt, and conditional on having borrowed and owing; they borrowed and owe more. They are also 12.5% less likely to work in the arts relative to White arts graduates, and to pay for college with funding sources that do not require repayment such as assistance from family and personal savings. As a result of these findings, we pose implications for cultural policy, as well as pose further research for future inquiries.

Following a career in medicine requires significant devotion, determination, and monetary investment. Medical Doctor (M.D.) students often face intense academic necessities while contending with the financial strain of tuition, living expenses, and student debt. This article scrutinizes the perilous role of scholarship opportunities in the simplification of these financial challenges and in encouraging academic excellence,professional growth, diversity, and positive societal outcomes. By emphasizing the multidimensional benefits of scholarships, the study highlights their importance in supporting and advancing equity within the medical profession.

Cost of living is one of the key factors in residency selection among U.S. medical graduates, given rising student loan debt. No studies have investigated anesthesiology stipends relative to regional cost of living. This study aimed to compare anesthesiology resident stipends nationwide using the Cost-of-Living Index (COLI) to assess purchasing power. The AAMC directory was queried to obtain accredited anesthesiology residency programs for the 2024-2025 academic year. CA1 (post graduate year 2) stipends were collected via internet search and residency programs were assigned to metro areas using region specific COLI metrics. City, state, geographic region, and reputation ranking were recorded and absolute and relative discrepancies were calculated. Of 174 anesthesiology residency programs, 118 (67.8%) were analyzed. The national average CA-1 stipend was $70,757 ± $9,718, with medians of $66,137 in low COLI areas and $74,046 in high COLI areas (median difference $7,909, [95% CI $5,969-$12,728, p < 0.001]. California showed the largest adjusted deficit (-$26,969, -30.98%), whereas Oklahoma had a $13,096 surplus (+ 21.00%). In the 10 major cities, average stipends decreased from $76,052 ± $10,860 to $59,499 ± $11,252 after COLI adjustment (-21.8%, p < 0.001). The absolute discrepancy between small and medium programs was not significant (-$3,498, p = 0.19), while large programs faced a 12.82% shortfall ($9,742) despite higher unadjusted salaries. Among the top 12 programs based on reputation ranking, stipends were higher in high COLI regions with half showing > 30% loss after COLI adjustment. Anesthesiology residency stipends showed substantial variation after adjusting for regional cost of living, with many high COLI areas experiencing marked reductions in real purchasing power.Given rising educational debt, applicants should consider COLI adjusted stipends when evaluating programs to better assess regional affordability and financial impact. N/A.

Background and Purpose. Concerns about student debt, wages, and reimbursement pressures are increasingly shaping the discourse within physical therapy. These challenges are real, but much of the discourse around physical therapy education is being shaped by a deficit-based narrative. If we let pessimism dominate, we risk preparing students to enter a shrinking field, rather than empowering them to shape an expanding one. This position paper urges a reframe, viewing this moment not as a crisis to manage but as a platform for bold leadership, using education as our most powerful lever. Position and Rationale. We propose a Physical Therapist Education Agenda grounded in workforce needs and organized around 4 strategic themes: 1) Primary Care: preparing students for first-contact roles; 2) Nonclinical Roles: preparing students for policy, administration, research, innovation, and entrepreneurship; 3) Technology-Enabled Practice: leveraging artificial intelligence and emerging technologies; and 4) Educational Models: committing to culturally responsive practices dismantling barriers to entry and lower costs. These strategies demonstrate what becomes possible when education is used to redefine the profession's contributions and its beneficiaries. Discussion and Conclusion. The profession's future depends on thinking beyond traditional roles and leading at the systems level. Educators are essential to this transformation, not in silos but as partners in shaping the next generation. Together, we are not just preparing clinicians; we are building a more innovative, equitable, and adaptable workforce. Those who shape the profession's educational pathways are in the best position to help define what comes next.

The increased pressures associated with the cost-of-living crisis (CoLC) have been demonstrated to impact population health. Research has shown that women are particularly vulnerable to negative life and health experiences associated with cost-of-living pressures, which are exacerbated by a range of gendered structural inequities. To date, very few studies have qualitatively explored the impact of the CoLC on the lives of women. A qualitative online survey was conducted with n = 570 younger Australian women (18–40 years old). The study explored the health and social impacts of the CoLC on younger women’s lives and their suggestions about the range of policy responses that could help women during times of economic crisis. Three themes were constructed from the data using a reflexive approach to thematic analysis. First, participants described the CoLC as a source of stress that shaped their everyday lives, particularly in relation to food insecurity, unaffordable housing, student debt, and insecure or underpaid employment. Second, the CoLC was perceived to have a direct negative impact on participants’ health and social outcomes, with participants reporting that they were sacrificing basic needs, avoiding necessary medical and dental care, and experiencing impacts on their mental health. Third, participants called for consideration of equity in policy reform, housing and pricing reform, and expanded healthcare access. The findings highlight the urgent need for gender-responsive economic and social policies in order to reduce health inequities exacerbated by financial crises.

Borrowers with considerable student debt may experience pronounced financial constraints that can potentially impact their ability to achieve desired personal and professional goals following transition to practice. The objective of this study was to identify and examine the personal and professional impacts, if any, that student debt may have on certified athletic trainers. A validated, online web-based survey was disseminated to a convenience sample of 18,689 athletic trainers who were members of the National Athletic Trainers' Association (NATA). Likert scale and yes/no questions were used to determine whether student debt impacted the career choices, financial health, attainment of life milestones, career satisfaction, perceived quality of life, and self-reported stress/anxiety levels of certified athletic trainers. The response rate for the survey was 12.2%. Student debt impacts the practice setting athletic trainers choose to enter, where they choose to live and work, and which job they eventually accept. Also, the financial strain that comes from having significant monthly repayment obligations is a source of stress/anxiety for a majority of athletic trainers who completed the study and associated with self-reported decreased quality of life. Additionally, the financial uncertainty that accompanies student debt burden has personal repercussions, as a significant number of athletic trainers indicated that their debt load had resulted in the deferment or abandonment of at least one of life's important milestones. Student debt can affect an individual's ability to thrive both personally and professionally following transition to practice. More research is needed to enhance our understanding of the interactions between student debt and the personal and professional lives of athletic trainers so that proactive steps can be taken to mitigate the effects of student debt.

Recent federal student loan reforms proposed under the One Big Beautiful Bill Act (OBBBA) would redefine “professional degree programs” for purposes of federal borrowing limits, excluding Master of Social Work (MSW) and Doctor of Social Work (DSW) degrees from eligibility for higher loan caps. This policy analysis examines the potential consequences of reclassifying social work degrees as non-professional, with particular attention to educational access, workforce sustainability, and equity. Guided by a normative, advocacy-oriented evaluative framework and an ecological lens, the analysis draws on federal rulemaking documents, workforce projections, accreditation standards, and existing research on student debt and enrollment behavior. Findings suggest that reduced federal loan access may suppress MSW and DSW enrollment, disproportionately affect first-generation, low-income, and BIPOC students, and exacerbate behavioral health workforce shortages. The analysis concludes that the proposed reclassification risks undermining both social work education infrastructure and community well-being, and it offers policy-relevant considerations to better align loan reform with workforce and equity priorities.

This national survey aimed to describe the work settings, characteristics, employment activities, scope, functions, and challenges of the pharmacist workforce responsible for infectious diseases (ID) and antimicrobial stewardship (AMS)-related tasks in the U.S. An internet-based Qualtrics XM survey was distributed to 22,749 unique individuals with potential ID or AMS job responsibilities via email listservs for three national pharmacy organizations, and was open from 9/25/2024 to 10/24/2024. A respondent was considered engaged in ID/AMS activities if they reported involvement in at least one of 14 activities directly related to ID/AMS. A total of 796 pharmacists with ID or AMS job responsibilities responded (3.5% response rate), with 607 working clinically or administratively in ID or AMS further categorized in four mutually exclusive groups based on formal and informal ID/AMS responsibilities. Respondents were predominantly female (66%), less than 40 years of age (59%) and white (82%). ID-specific training was completed by 41.8%, and 74% reported having student loan debt at graduation. Work-related activities were diverse and most frequently included: staffing or taking calls on weekends related to ID/AMS, AMS, educating learners or healthcare providers about ID-related topics, precepting learners, and conducting ID-related research and/or quality improvement projects. Respondents frequently indicated they lacked adequate job resources. The results highlight the extensive responsibilities placed on ID/AMS pharmacists to fulfill multiple roles. Pharmacists frequently lack ID-specific training or dedicated time for AMS responsibilities. The workforce is young, suggesting a need for both increased capacity for training programs and strategies for workforce retention.

Sources of rising student debt in the U.S.: College costs, wage inequality, and delinquency