PSLF protections preserved in a win for family medicine

The Trump administration has dropped all three of its appeals challenging the court decisions that vacated the Department of Education’s Public Service Loan Forgiveness (PSLF) rule. This is a major win for physicians working in public service and for nonprofit employers, as the final rule would have put their ability to access loan forgiveness at risk.

The AAFP opposed potential restrictions throughout the rulemaking process, emphasizing how the PSLF program helps physicians afford to practice in communities that rely on their services. Protecting that opportunity is central to our work of reducing the burden of medical student debt and our mission of supporting the next generation of family physicians.

What the vacated PSLF rule would have changed

Finalized in late 2025, the rule would have allowed the Department of Education to disqualify nonprofit and public service employers from the PSLF program if it determined they had a “substantial illegal purpose.” That label could have prevented employees from earning qualifying payments toward loan forgiveness even if they played no part in the activities under scrutiny.

The consequences of such a rule could have extended across large organizations, impacting physicians’ eligibility by actions elsewhere in the health system. While borrowers would have retained credit for payments earned before any disqualification, the final rule offered no avenue for individual borrowers to appeal.

Why PSLF matters to family medicine

For family physicians pursuing careers in public service, the PSLF program offers a way to manage student debt while working. Created by Congress in 2007, the program forgives remaining federal Direct Loan balances after 120 qualifying payments made while borrowers work full time for a qualifying employer.

Our members’ experiences show why that matters. More than 68 percent of AAFP survey respondents participated in a loan repayment program, and 75 percent of that group used the PSLF program. Respondents described how the program helps make work in rural and underserved areas possible, with many saying they would have to practice elsewhere without it.

How the AAFP brought its concerns to policymakers

The AAFP urged the Department of Education to withdraw the employer eligibility rule or substantially modify it to protect family medicine. We warned that restricting access to the PSLF program would not only make it harder to retain current physicians, but could hurt efforts to recruit new ones as well.

We also challenged proposals in Congress that would have made medical school harder to finance and delayed residents’ progress toward loan forgiveness. Our message was consistent throughout—that student debt policies should make it easier for family physicians to serve the communities that need them, not more costly.

Testimony and coalition advocacy

Then-AAFP President Jen Brull, MD, FAAFP, brought members’ perspectives directly to the Department of Education in May 2025, describing how the PSLF program allowed physicians to deliver care to their rural hometowns. That June, we joined other medical and dental organizations in urging Congress to preserve PSLF access during residency years, as residents serve patients but often earn modest salaries.

Comments on the employer eligibility rule

Our comments from September 2025 called for due process, clear standards when disqualifying employers and protections for physicians whose work was unrelated to their organization’s alleged violations. We also urged the Department to establish corrective action procedures and a fair path for employers to appeal decisions.

What the court decisions and appeal dismissals mean now

With the government’s appeals dismissed, the court decisions that vacated the rule remain in place. Family physicians working for qualifying employers can continue pursuing loan forgiveness without the additional employer restrictions the rule would have imposed on the program.

This outcome does not resolve individual payment count disputes. If you have lost qualifying payments and believe this is incorrect, you can submit a PSLF reconsideration request​ to the Department of Education. The AAFP’s resources for managing student loan debt provides information to help you navigate program changes.

Help the AAFP show policymakers what borrowers are experiencing

The Academy will continue to work with policymakers on reducing the cost of medical education and breaking down barriers to entering family medicine. Whether you’re just exploring the PSLF program, pursuing forgiveness or have already received it, your perspective can help shape our advocacy efforts.