Policymakers have a roadmap to ease medical student debt

March 13, 2026

By Mandi Neff, Megan Mortimer and Anna Waldman

Physicians are more likely to carry student loan debt than any other professional. Federal rules that should help ease that burden instead have been tilting the wrong way.

We're increasing pressure on policymakers to correct that shift. The Department of Education and two congressional committees recently heard from us on a couple of proposed rules, and our message was clear: Reducing medical student debt is crucial to a robust primary care system.

In 2025, H.R. 1 eliminated Grad PLUS loans while capping unsubsidized professional borrowing to $50,000 a year and $200,000 lifetime. That cap is too rigid and will not lower tuition costs. Instead, it will burden students, particularly those from lower-income backgrounds pursuing primary care careers.

And a rule finalized late last year unfavorably altered terms of the Public Service Loan Forgiveness (PSLF) program, which has helped thousands become family doctors.

Many of you participated in an AAFP Speak Out campaign amplifying the Academy’s objections to those changes. That advocacy continues ahead of the stated July 1 implementation for multiple regulations—and so does your opportunity to add your voice. We’re also closely monitoring further rulemaking that affects medical student debt.

To help current and future primary care physicians, the Department of Education and Congress need to:

• Reduce the cost of medical education.
• Ease the severity of medical student debt.
• Fix a recently proposed rule that would establish concerning new student loan policies (alongside a couple of favorable changes).

The Department of Education says its proposed rule, Reimagining and Improving Student Education (RISE), would simplify federal student loan programs and provide targeted debt relief.

That’s largely not the case for future family physicians.

Parts of the proposal could worsen the primary care workforce shortage, especially in rural and underserved communities. That workforce is crucial to combating and preventing chronic disease.

With your help, we’re telling policymakers that either PLUS loans must remain accessible to medical students or new loan programs need carve-outs for medical students that reflect primary care physicians' unique education costs, training length and public service value.

Specifically, the RISE proposals should include:

• Either no automatic proration for programs with part-time enrollment, or clear exceptions so no future primary care physician is forced into private lending or delayed completion of their education;
• Exemption from a proposed new forbearance limit; and
• Continuation of economic hardship and unemployment deferments that a proposal would eliminate for future borrowers.

There is some good news in the proposed rule—a provision that would let a borrower rehabilitate a defaulted federal student loan up to two times.

This doubling is a much-needed nod to what borrowers face early in their careers, and a good on-ramp to income-driven repayment and PSLF programs.

The letter we sent the Senate Special Committee on Aging, in response to a hearing on physician workforce challenges, urged action to combat student medical debt burden. Our letter to the House Subcommittee on Higher Education and Workforce Development was likewise to answer a hearing, this one dedicated to high education costs.

Medical student debt is a major barrier to growing the primary care workforce and a significant administrative burden. Our letters emphasized that the stress of such debt worsens physician shortages.

Family physicians need legislation that:

• Exempts medical degrees from the $200,000 cap on loans for professional degrees,
• Requires the Department of Education or the Small Business Administration to work with private lenders who adhere to certain lending rules, and to make that “safe lender” list public;
• Lets medical residents defer federal loan interest during residency (something that the REDI Act, which we support, would do); and
• Creates additional support for loan repayment programs that help primary care physicians during their training and early career.

We’re analyzing another rule proposed by the Department of Education, this one governing Pell grants and containing a couple of problematic elements.

Students with higher expenses who have non-federal grants and scholarships that fully cover attendance costs, calculated as an average, may lose Pell grant eligibility. This would disproportionately affect lower‑income students pursuing family medicine, further straining the primary care pathway.

Students who are earning or have already completed a graduate credential would, if the proposal succeeds, be barred from receiving a Pell grant to enroll in an eligible workforce program. That would lock out anyone on a medical school track, as well as medical school graduates.

We are formulating our response to this proposal and will keep you updated.

Use the Academy’s Speak Out tool to urge that your members of Congress pass legislation preserving the PSLF program.

Join the AAFP’s Advocacy Ambassadors program, which equips you with tools and training to start building relationships with elected officials.

Get involved with your state’s AAFP chapter to advocate for state-level medical loan-forgiveness programs.

— Mandi Neff, senior regulatory and policy strategist; Megan Mortimer, federal legislative and regulatory affairs manager; and Anna Waldman, federal legislative and regulatory affairs associate