The proposed PSLF rule threatens our workforce. We’re ready to fight for it

The Department of Education listened to the AAFP about the Public Service Loan Forgiveness (PSLF) program, yet it failed to truly hear us.

The department’s recently proposed PSLF rule demonstrates as much by jeopardizing a pillar of the primary care workforce pathway. The Academy is preparing a detailed objection to the proposed rule, advocating in coalition with other medical societies and readying Speak Out and chapter campaigns to amplify your voices. You’ll hear more about this work in the weeks ahead. For now, I want to remind you what we’ve already done together. 

New limits to Public Service Loan Forgiveness eligibility

In March, an executive order directed the Department of Education to revise PSLF eligibility requirements. The Academy understood the potential impacts: a 2025 survey of AAFP members indicated that, of members enrolled in a student loan repayment program, 86% were in PSLF. (An estimated 40% of all physicians are enrolled in PSLF.) We urged the department to include a family physician in the discussion and nominated two members, but no family physicians were selected, leaving the medical community with far too little representation in the process.

Still, I was able to testify at a May department hearing about the importance of the PSLF program to family physicians. I told policymakers that, without this vital program, many in our specialty “would have been forced to leave public service for the private sector, leaving critical health needs unmet.”

Congress, meanwhile, did hear some of what we were saying. 

In June, the AAFP pressed lawmakers to remove a problematic provision from the sweeping H.R. 1 that would have excluded medical and dental residents from participating in PSLF. That campaign was successful, thanks in large part to the pushback of our members. However, the law eliminates Grad PLUS loans and institutes a lifetime $200,000 cap on unsubsidized professional borrowing, moves we strongly cautioned against. The AAFP will push for solutions in future legislation, and we’ve already begun offering recommendations to the Department of Education on how best to mitigate the harm to medical students that will come from the elimination of Grad PLUS loans. 

Advocating to preserve the PSLF lifeline 

If finalized, the William D. Ford Federal Direct Loan Program proposed rule would severely limit PSLF options for family physicians as well as for the health care organizations—and communities—that need doctors.

That’s why the Academy is gearing up to push back hard against this proposal.

Many of us know firsthand that loan forgiveness programs such as PSLF are a professional lifeline that also improves lives in our communities. We know that physicians who have the freedom to practice where they choose are very likely to stay where they’re already doing good. 

A Department of Education statement accompanying the proposed rule said it would “restore the Public Service Loan Forgiveness program to its original purpose—supporting public servants who strengthen their communities and serve the public good.” Thousands of family physicians practicing today thanks to PSLF and similar programs can tell you that the program already delivers on this promise. If you’re one of that number, building strong relationships with patients in underserved areas, you are indeed a public servant, strengthening your community and serving the public good, and you deserve a better rule than this one. 

As I wrote this past winter, family medicine will always stand up—for our patients, for our communities and for the future of our specialty. Today’s fight over PSLF is another moment to live that promise. And together, we will.