One Big, But Not So Beautiful, Designation

I recently celebrated a birthday, very quietly, which is uncommon for me.  Born on St. Patrick’s Day and with Irish roots, it has long been a day of considerable celebration.  Over the past few years, Patrice and I have enjoyed the day in Savannah, whose parade and festivities are superior to the nation’s bigger cities. 

Surprised?  Make a roadie and come find out.  You’ll not be disappointed.  Maybe I’ll see you next year.

This year’s calendar of events included a visit to an orthopedic surgeon, for a consult on progress related to injuries sustained in an accident in late January.  I was glad to make this visit.  If you believe that baseball is a metaphor for life, an inch of two either way…involving body and breakage, would have meant no birthday to celebrate for me. 

Yes, this near-fatal experience happened very quickly, resulting in contusions to my head, one of which took a divot out of my scalp (and may have me patched forever), nicks and bruises in places I didn’t see for several days thereafter, four broken ribs, and a punctured right lung.  My right ulnar knob was orphaned from the rest of this bone, looking like a what a major league hitter might be holding after breaking his bat on an inside fastball.  My elbow completely dislocated, and my triceps detached.

Have one of these injuries and you will incessantly utter unspeakables to help soothe the pain.  Make a personal salad with all of them, at once, and you can end up in the hospital for three days.

Like I did.

Exiting the ambulance and entering the trauma unit, I met Renee, a nurse practitioner, unit team captain, and navigator of everything that would happen to me over the next three days.  Except for the 5:00 AM blood draws performed by a phlebotomist, Renee was the first person Patrice and I saw each morning, mid-afternoon, and late-evening.  Highly skilled and an expert communicator, we had the chance to ask every question, each of which was answered fully.

Having destroyed a recently sutured surgical wound on my right shoulder (removed hours before on the same day), work was needed to examine, cleanse, and close a blown-up, widely opened area whose edges were mostly scar tissue. 

Who repaired this?  Amanda, another nurse practitioner, who took great care in closing this wound and keep me from looking like a vulture had feasted on my shoulder once healed. 

Following numerous x-rays and scans - near faint-inducing when asked to fully straighten an arm with a softball-sized hematoma and no intact skeletal architecture – I met another nurse practitioner who splinted this piece of shoulder-to-fingertip roadkill until surgery.

To educate me on the risks of tension pneumothorax and surgery scheduled the next day (scary, look this up), and the value, technique, and timing of enduring the pain associated with hourly spirometer treatments, another nurse practitioner served as coach (and parent) before and after surgery.  Respiratory therapist…not.  I was far too broken to have anyone focus on me within a silo.

After an overnight where Patrice and I were checked on (and allowed to sleep for long stretches), Justin, a physician assistant met me before sunrise to measure my grip strength and assess for nerve damage prior to scheduling the reassembly of my broken, splintered, and yet unclaimed parts.

Following surgery, while in recovery, another nurse practitioner, a woman with a southern accent who I called “Brooklyn” (because I couldn’t remember her name) guarded me one-to-one until it was time for me to safely return to my patient room.  The next afternoon, Renee green-lighted me for discharge, as those responsible for my care were scheduled off for the weekend, winter weather was coming to the South, and staffing unpredictability could make it rougher for me there than at home.

Seven weeks later, I’m continuing to bounce back.  For the past month, two people have been central to my recovery.  My surgeon, who is one of the five ballsiest people I’ve met in my life’s history, and my physical therapist, Caroline, who has relied on every bit of her seven years of academic preparation and multiple years of work experience to build, drive, and adjust my treatment plan to help me restore the functions lost and regain the strength needed to participate in my own recovery and live a productive, yet different, life.

The skills, knowledge, technique, and critical thinking displayed by those playing a part in evaluating, determining, and delivering what was, and continues to be, the approaches to care helping me get from where I am (or was) to where I’ll be, are overwhelming.  Inside this health system, I’m just a guy, north of sixty, with a retail, high-deductible insurance plan, and zero local connections.  Yet I’ve received VIP-level care from a group of incredibly gifted…professionals.

Yes, professionals.  People who went to school, did the work, passed the tests, took the beatings, and bet – emotionally, physically, and financially – on themselves. 

Without them, I’d have been totally screwed.

Now, the reverse may be on the horizon.  No, not for incumbent nurse practitioners, physician assistants, and physical therapists, but for future colleagues and successors.  As part of the One Big Beautiful Bill, the student loan programs specific to higher education will establish caps for graduate-level degrees ($20,500 annually) and professional degrees ($50,000 annually).  In the U.S. Department of Education’s value engineering approach to this program, nurse practitioners, physician assistants, and physical therapists (among others) have been designated as graduate-level, rather than professional level.

The reason for the relegation?  As shared in a statement by the Under Secretary of Education, to ensure that borrowers will not face “insurmountable debt to finance degrees that do not pay off.”

One doesn’t need to be a labor economist to figure out where this is going.  Student loan caps, at this level and for these fields, will stifle interest as prospective candidates will likely lack the financial wherewithal to bridge the recurring, multi-year gap between tuition costs and loan limits.  Supersize this over a few years, and the existing supply deficits for these practitioners, regionally and nationally, will widen.

As they do, the supply of nursing educators will additionally burden schools presently operating at sub-optimal levels for their current class sizes, or restricting program expansion for those with excess demand.

When this experience catches up to the patient, they will be screwed, too. 

It wasn’t difficult to see this coming.  In September 2025, a California court ruled that nurses with a doctorate, or Doctor of Nursing Practice degree, could not refer or display their professional title with “Dr.” included.  In a master stroke, the presiding judge referenced this talking point from an AMA survey in his decision…39% of patients mistakenly believed that DNPs are physicians.

Wow.  Rather than educate a patient for their own benefit, punish a professional instead. 

It can be argued that the Administration, or its appointed negotiated rulemaking bureaucrats, “didn’t read the room”  From their press release, the Department of Education (DoE) went into damage control, as evidenced by this distinction:

Myth: The Trump Administration does not view nurses as professionals because they are not classified as a “professional degree.”

Fact: The definition of a “professional degree” is an internal definition used by the Department to distinguish among programs that qualify for higher loan limits, not a value judgement about the importance of programs. It has no bearing on whether a program is professional in nature or not. 

OK, then.  Let’s add one final fact that didn’t appear in the DoE presser.  If there was great concern about these professional job categories being able to repay student loan balances, these roles would be in the supernaturally low-risk category.  In some markets health systems are “picking up the tuition tab” for nurse practitioners, physician assistants, and/or physical therapists, in exchange for a multi-year employment commitment.  This is smart business.

Where these market dynamics don’t exist, today’s compensation levels provide these professionals the financial leverage to pay their bills, and their student loans, too.  This can’t be said across the full spectrum of new and recent graduates produced by the nation’s institutions of higher education.

Could there be a reversal on the OBBB and DoE’s relegation?  Surely.  This change is scheduled to go live on July 1, 2026, and plenty of people are on fire about it.  Is it likely?  I’d not bet a mortgage payment on it.

Should there be no directional change, however, I believe that things will be very different.  May take a few years to get there, but not too many.

At the risk of barking in the wilderness to decision makers, I’ll share this.  Given my recent “near miss” with total personal destruction, my DNPs, PAs, and DPTs were, and are, as important as the JDs, CPAs, CFPs, and MBAs could ever be.