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With around 1.5 million open job openings listed each month and hundreds of thousands of projected shortages across specialties, health systems need to strengthen their talent pipelines and incentivize workers to step into more specialized roles — fast.
The healthcare professionals best positioned to step into hard-to-fill roles are already on staff, yet few will take the next step. For many, finances stand in the way.
Even with tuition assistance programs in place, many employers still rely on reimbursement models that place the financial burden on employees, asking them to pay for programs upfront and wait to be reimbursed. For a certified nursing assistant (CNA) or a licensed practical nurse (LPN) already managing student loan payments alongside rent and childcare, floating thousands of dollars while waiting for reimbursement isn’t a realistic option.
Filling the roles systems need most will take a new approach, one that reimagines how tuition assistance is both designed and delivered.
Financing advanced healthcare education is getting harder
In healthcare, specialization is particularly costly and demanding, with most roles requiring a professional degree, license or examination. Workers who want to move into these roles often take on significant debt to do so, often on top of the debt they carry from undergraduate schooling.
New federal policy changes make pursuing this additional education even harder.
- Most notably, beginning July 1, the One Big Beautiful Bill Act will eliminate the Grad PLUS loan program for new borrowers and phase it out for existing borrowers. This program previously covered costs up to full attendance. Now, students will have to find a way to fill the gap.
- For Unsubsidized Federal Direct loans, loan amounts are capped at $20,500 per year for graduate programs, often well short of program costs. This change limits borrowing options for many students and, for those without access to private student loans or extra funds, blocks them from pursuing a degree entirely.
- The administration’s new distinction between professional and graduate programs places many nursing, physician assistant (PA), and similar healthcare degrees under the lower federal borrowing tier, limiting students to $100,000 in aggregate federal loans rather than the $200,000 available to designated professional programs.
- For healthcare organizations that have relied on nurse practitioners (NPs) and PAs to fill workforce gaps and sustain billable services, these new limits will further thin the talent pipeline and make it harder to deliver quality care.
As federal loan access narrows, employer-sponsored tuition assistance is increasingly one of the only remaining levers for getting workers into specialized roles.
Without a path forward, employees leave
Without realistic paths to advancement, retention gets difficult. A recent report finds that nearly a quarter of healthcare workers have hit a career stall, without promotion or a raise for five years or more. And reportedly, over half are searching job boards and taking interviews in hopes of finding a new role within the year.
As workers leave, institutional knowledge walks out with them. The new staff doesn’t know the systems, patients or culture as well, making care less efficient, inconsistent and impersonal. Floors stay understaffed. Wait times grow.
Health systems have tried to address these issues by offering tuition assistance to help workers advance and fill gaps. But the way most of those programs are structured undermines the intention.
Why tuition assistance programs aren’t working for frontline workers
The standard model of tuition assistance, which asks employees to pay tuition upfront and then wait to be paid back, prevents most frontline workers from participating.
According to a recent study, nearly a third of employed bachelor’s and master’s degree holders already carry between $25,000 and $50,000 in student loan debt, and more than a third (33%) of employed PhD holders carry more than $100,000. That debt weighs heavily: Nearly half (45%) of surveyed full-time employees experience financial stress that inhibits their ability to focus at work. Burdened already, healthcare workers are unlikely to float thousands of dollars more for weeks or months to pursue a more specialized role.
Beyond the cost barrier, 42% of full-time employees across all ages and educational levels are unsure whether their employer offers tuition assistance or how the benefit works. And a benefit that workers don’t know about or can’t practically access isn’t functioning as a workforce strategy. It’s just another line item.
Filling gaps and retaining talent will require a new approach — one that removes upfront costs, reduces financial stress and makes education accessible.
How direct pay models transform education access
As many as 76% of employees say they’d be more likely to pursue additional education and use tuition assistance to do so if the costs are covered fully upfront. Direct pay models do exactly this.
Before the employee spends anything out of pocket, direct pay models cover approved education costs directly. No reimbursement lag, no credit card, no taking on more debt for a credential the employer is theoretically willing to cover. The financial risk stays with the organization rather than the worker, freeing many to pursue the license they’ve put off or the degree they believed was out of reach.
The model is especially useful for healthcare organizations with specific workforce gaps. A hospital system short on nurse practitioners, for example, can direct tuition assistance specifically toward RNs who want to make that move, while maintaining reimbursement models for less critical roles. The most effective direct pay models place no restrictions on education provider, format, or location — so workers can enroll in the accredited program that fits their schedule, with clinicals completed locally.
A benefit that was once underutilized can now function as a direct response to workforce needs — improving retention, recruitment and staff quality at the same time.
How employers can be the fix
Federal loan access is narrowing. Healthcare workforce gaps continue to widen. And the workers who want to advance are carrying more financial pressure than ever. In this environment, employer-sponsored education benefits may be the only realistic path forward for many healthcare workers who want to take the next step in their careers or stay with an organization they believe in.
Health systems that recognize this and restructure their benefits accordingly won’t only retain more employees. They’ll become employers that healthcare workers actively seek out.
About Jeni Burckart
Jeni Burckart, an expert in student loan debt, is the Vice President of Healthcare and Workforce Services at Tuition.io. With a background as a clinical pharmacist and nearly a decade of experience in education assistance benefits and student loan support, she brings a unique perspective to the intersection of healthcare, workforce strategy, and education financing.
