Education Column
Learn more about the impact that MASA has on Alabama policy
How the Federal Government Shutdown Impacted Alabama Medical Students
Rhea Nichani, Editor-in-Chief
The recent federal government shutdown highlighted how political decisions can directly affect medical education and patient care. For medical students across Alabama, the shutdown was more than a headline; it underscored how dependent medical training is on stable federal funding, public health infrastructure, and safety-net programs that support both learners and patients.
Although medical schools and hospitals remained open, the uncertainty created by the shutdown was felt in meaningful ways. Many Alabama medical students train in clinical settings that rely heavily on federal funding streams such as Medicare, Medicaid, and public health grants. During the shutdown, concerns about delayed reimbursements and strained hospital resources drew attention to the vulnerability of safety-net systems, particularly in rural and underserved areas of the state. Students witnessed how financial instability can impact staffing, clinic operations, and patient access to care, realities that directly shape both learning environments and patient outcomes.
The shutdown also disrupted research and academic opportunities for students involved in federally funded projects. Delays in grant reviews, pauses in agency communication, and uncertainty surrounding future funding affected students pursuing research, academic medicine, or advocacy-focused careers. For many medical students, research is not only an academic requirement but also a way to address health disparities and contribute to evidence-based policy. Interruptions during the shutdown reinforced how federal instability can disproportionately affect trainees early in their professional development.
Beyond academics and clinical training, the shutdown amplified financial and personal stress for medical students. Medical education already carries significant financial burden, and uncertainty surrounding federal student aid operations, health insurance subsidies, and broader economic conditions added another layer of strain. For students caring for patients who rely on federally supported programs, the shutdown also raised concerns about delayed care, loss of coverage, and worsening health outcomes, further emphasizing the physician’s role as both caregiver and advocate.
Ultimately, the government shutdown served as a real-time lesson in health policy. Alabama medical students were reminded that public health agencies, insurance systems, research institutions, and clinical training sites are deeply interconnected. Decisions made at the federal level inevitably reach hospitals, clinics, and classrooms. As future physicians, understanding these connections is not separate from medical education. It is, in fact, an essential part of preparing to care for patients and advocate for the systems that make that care possible.
References
The State of Physician Well-Being in 2025: What Medical Students Need to Know
Rhea Nichani, Editor-in-Chief
The journey to becoming a physician has always been demanding, but the current landscape of clinician well-being is one of the most complex the profession has ever faced. The Physicians Foundation’s 2025 Well-Being Survey, a leading national assessment of physician mental health, reveals a workforce still carrying significant emotional strain. For medical students preparing to enter residency, these findings offer more than a snapshot of physician wellness-they outline the environment and culture they will soon enter, influence, and eventually help reshape.
This year’s survey presents a nuanced picture. Although reported burnout has decreased modestly to 54%, many physicians continue to experience deeper emotional distress. Nearly 57% reported inappropriate or intrusive feelings of anger, anxiety, or tearfulness in the past year. Almost 46% withdrew from family, friends, or colleagues, and 34% described feeling hopeless or purposeless-levels mirroring some of the most challenging periods of the pandemic. These statistics indicate that while burnout may be evolving, emotional exhaustion remains a defining challenge within the profession.
One of the most troubling findings is the persistent stigma surrounding mental-health care. A striking 73% of physicians believe stigma still prevents help-seeking, while 38% fear licensing, credentialing, or insurance repercussions. For medical students-who already navigate steep academic demands, financial pressures, and the emotional realities of patient care-this stigma can reinforce harmful norms suggesting that vulnerability is risky and that distress should be managed silently.
These insights are especially important for students who are preparing to transition into clinical training or residency, where work demands increase and support systems may shift. The survey underscores a critical truth: well-being is not solely an individual responsibility. It is shaped by culture, institutional policies, and the expectations we normalize. Students have an opportunity to influence those norms early-through the conversations they initiate, the support they offer peers, and the questions they ask when evaluating training programs.
Recognizing early signs of distress-withdrawal, irritability, declining motivation, persistent anxiety-is essential, as is making use of the mental-health resources provided through medical schools and training institutions. Seeking support early is an act of self-awareness and professionalism, not a sign of inadequacy. Students can also push back against stigma by checking in on classmates, speaking honestly in safe spaces, and advocating for learning environments that value psychological safety and transparency.
As students prepare for residency, the 2025 data should empower them to ask meaningful questions about wellness culture: How do residents access mental-health services? Is there protected time for appointments? What structures exist to support trainees during periods of personal or academic difficulty? These questions reflect maturity, insight, and an understanding of sustainable practice-qualities increasingly recognized as essential in modern medicine.
Ultimately, the findings of the 2025 Well-Being Survey serve as both a warning and a call to action. If more than half of physicians continue to experience distress and one-third report hopelessness, then our systems-and the culture of our profession-must continue to evolve. Medical students entering the field today have a unique opportunity to lead that change by valuing their own well-being, advocating for supportive environments, and helping build a future in which physician health is treated as foundational to high-quality patient care.
MASA-MSS Section Representatives Driving Advocacy and Innovation
Rhea Nichani, Editor-in-Chief
The MASA-MSS Section Representatives play an integral role in shaping healthcare policy in Alabama. They work directly with physicians across the state to amplify medical student engagement and advocacy on a daily basis.
For instance, Lupita Contreras, our Medical Education Chair, is actively strengthening connections between medical students and statewide initiatives. She is collaborating with the Committee to organize a statewide Narcan training event for medical students, promoting awareness and preparedness in responding to opioid overdoses. At the upcoming Medical Education Section Meeting, she will also participate in an accreditation review process for a new local health system—an experience she describes as offering “valuable insight into how educational and institutional standards are evaluated.” She hopes to apply these lessons to future MASA-MSS initiatives.
Trey Vardaman, our Medical Service Chair, is investigating the prevalence of sham peer reviews in Alabama. Sham peer reviews occur when hospitals or medical staff misuse the peer review process to remove a physician for personal, political, or competitive reasons. Such actions can result in loss of privileges and mandatory reporting to the National Practitioner Data Bank, creating long-term consequences for a physician’s career. To raise awareness and protect future medical professionals, Trey is planning an educational event for fourth-year medical students and residents on recognizing and mitigating risks when entering new jobs or signing contracts.
Lastly, Sumedha Bobba, Minority Physicians Chair, and Julia Kaufmann, Women Physicians Chair, are both advancing initiatives centered on guidance and professional development. Sumedha is designing a mentorship program connecting medical students with physicians across the state to foster meaningful professional relationships. Meanwhile, Julia is organizing a Women in Medicine panel at the Alabama College of Osteopathic Medicine to highlight leadership, advocacy, and opportunities for female physicians in Alabama.
How Eliminating Graduate PLUS Loans Would Affect Alabama Medical Students
Rachel Cotter, Health Policy and Advocacy Chair
Medical education in the United States is incredibly expensive. Today, the median cost of attendance for United States medical schools over 4 years is $286,454 for public institutions, and $390,848 for private institutions.¹ To tackle the high cost of graduate education, some lawmakers have endorsed changes to government loan options, such as modifying the cap for federal direct unsubsidized loans and eliminating graduate PLUS loans. Supporters of these changes, including Alabama’s own United States senator Tommy Tuberville, propose that this will incentivize medical schools to reduce their tuition costs, and thus reduce the amount of loans students must take out. However, recent data from the Association of American Medical Colleges suggests that the increasing cost of medical education has little to do with rising costs of tuition and more to do with rising costs of attendance due to annual inflation.²
Medical students are allowed to borrow an amount annually that equates to the cost of attendance. The cost of attendance is calculated by adding together the total cost of tuition, living expenses, personal expenses, books and supplies, transportation, and loan fees. For medical schools in the state of Alabama, the tuition ranges from $36,198 to $60,576 and the annual cost of attendance ranges from $69,123 to $100,424. Currently, the maximum amount of unsubsidized loans that a medical student can take out annually is $40,500. However, the cost of medical education greatly surpasses this value. To bridge this gap, students take out graduate PLUS loans, which are on the chopping block. The Association of American Medical Colleges estimates that about half of all medical students in the United States take out graduate PLUS loans, which equates to more than $1 billion annually.
Student loans already accrue interest at an exuberant rate. As of 2025, federal direct unsubsidized loans have a 7.94% interest rate and graduate PLUS loans have an 8.94% interest rate.³ These are still often the best option for medical students, due to the flexibility of repayments and potential for forgiveness. Without graduate PLUS loans, students will be forced to rely on predatory private student loans. The interest rates for private student loans are highly variable and are only beneficial if the interest rate is known to remain low and the debt can be repaid quickly. If you are already in a tough spot financially, private student loans can accrue interest at a rate that far exceeds that of unsubsidized and graduate PLUS loans. Therefore, eliminating graduate PLUS loans will not only increase the amount of debt for medical students, it will also exacerbate socioeconomic barriers to becoming a physician. For fellow Alabamians that oppose this legislation, reach out to our state’s US senators, Tommy Tuberville and Katie Britt, as well as your congressional district’s representative.
References
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From Classroom to Clinic: How Grad PLUS Loans Support the Physician Workforce Patients Rely On
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Proposed Changes to Federal Student Loans Could Worsen the Doctor Shortage
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Interest Rates for Direct Loans First Disbursed Between July 1st, 2025 and June 30th, 2026
Alabama
Legislative Session from the Eyes of a Medical Student
Rachel Cotter, Alabama Legislative Session Attendee and MASA-MSS Member
On April 15th, a group of medical students had the exciting opportunity to visit the Alabama State Capitol in Montgomery and witness firsthand how the state government operates. Their day began with a meeting with Evans Brown, the Manager of Government Relations and Public Affairs for the Medical Association of the State of Alabama (MASA). Brown spoke with the students about some of MASA’s current legislative priorities, including efforts to reform prior authorization processes and address scope creep. Prior authorization, which requires physicians to obtain approval from insurance companies before proceeding with certain treatments, is a major source of frustration and can lead to significant delays in patient care. Additionally, Brown discussed scope creep, a term used when non-physician providers seek to expand their scope of practice beyond their training, potentially lowering the overall standard of medical care.
Following the discussion, the students made their way to the Alabama State House to observe legislative sessions in both the House of Representatives and the Senate. A legislative session is a formal period during which elected officials meet to propose, debate, and vote on new laws and amendments. Watching these sessions gave the students valuable insight into how healthcare policy is shaped and highlighted the intricate process of turning ideas into actionable laws. It also showed how critical it is for future physicians to understand and engage with legislative processes that directly impact the practice of medicine and the wellbeing of their patients.
This experience emphasized the vital role of grassroots advocacy in protecting and improving patient care. By participating in events like these, medical students not only learn how to navigate the political landscape but also become empowered to advocate for policies that enhance healthcare delivery. Speaking out on important issues ensures that the voice of the medical community remains strong and that future changes in healthcare policy prioritize the needs of patients.
Authorizing Abortion from Rape and Incest Pregnancy
Rhea Nichani, Editor in Chief
On June 24th, 2022, Alabama began enforcing its total abortion ban, which prohibits abortion at all stages of pregnancy, following the U.S. Supreme Court’s decision to overturn Roe v. Wade in the case Dobbs v. Jackson Women’s Health Organization.
Hence under existing Alabama law, abortion exceptions are limited, based on the Human Life Protection Act. These exceptions include 1) to save the pregnant person’s life, 2) to prevent serious risk to the pregnant person’s physical health, and 3) if the fetus is not expected to survive the pregnancy. Given this, representative Juandalynn Givan is sponsoring a bill in the house that is attempting to expand abortion exceptions to include cases of rape and incest. It also mandates that the father convicted of rape or incest resulting in pregnancy must pay for the abortion and all related medical expenses. The father must also undergo court-ordered sterilization.
Given that Alabama's abortion ban is considered to be one of the strictest in the country, this bill is predicted to be a controversial topic in the current legislative session.
Alabama Lawmakers Have a Plan to Help Fix the Rural Health Crisis
Rhea Nichani, Editor in Chief
Alabama lawmakers are actively working to solve one of the state’s largest health crisis by filing legislation that enhances the existing tax credit of 5,000 to 10,000 so as to support rural hospitals by incentivizing physicians to work in underserved communities. This is increasingly important, as since 2011, according to the Center for Healthcare Quality and Payment Reform, seven rural hospitals have closed and reports predict that more than half of the state’s 52 rural hospitals are at risk of closing, with 19 at immediate risk. In fact, pediatricians, dentists, and maternity care have disappeared in over a third of the state’s counties. These healthcare facilities closing will only further impact the community by eliminating the ability to recruit industry in the area. In turn, education groups will not have children to educate in the areas.
This expansion in legislation will extend tax credit benefits to physicians residing in populations of 50,000 or fewer, as well as, municipalities with populations of 20,000 or less, in a county with 50,000 or less. The Medical Association supports this initiative, as it directly addresses longstanding healthcare disparities and bolsters access to medical care for Alabama’s rural residents.
State Funded Medical Residencies Expanded
Frances Case, Student Representative
Committee on Medical Education
To tackle the physician shortage in Alabama, the state legislature has committed to increasing support for primary care and psychiatric residency programs. An $800,000 investment has been allocated to the Cahaba Medical Care Center Family Residency program to add five new slots in Centreville, targeting rural healthcare needs. Additionally, opioid settlement funds are being used to create two new psychiatric residency programs in Montgomery and Birmingham, with a focus on substance abuse treatment. Auburn and Huntsville will also gain new psychiatric residency programs funded through other sources, addressing the critical shortage of mental health professionals in the state.
The Medical Association supports these initiatives as they directly address the urgent need for more healthcare providers in underserved areas. By expanding residency slots and focusing on substance abuse, these programs aim to improve access to essential medical and psychiatric care, particularly in regions severely affected by the opioid crisis. This proactive approach is essential for meeting the growing demand for healthcare services across Alabama, especially in counties lacking adequate mental health resources.