If you are a physician with substantial student loan debt and pursuing Public Service Loan Forgiveness (PSLF), it is critical to stay on top of the ever-changing landscape of rules, payment plans, and program requirements. There have been significant shifts over the past several years, and additional updates are expected to take effect in the coming years.
Below are several key updates and planning considerations for physicians pursuing PSLF in 2026.
PSLF Basics Remain the Same
The core structure of PSLF has not changed. I’m asked constantly whether the program as a whole is at risk. While legislation can always change, I remain optimistic about the future of PSLF for current borrowers.
Physicians can still receive tax-free forgiveness of their remaining federal student loan balance after making 120 qualifying monthly payments while working full-time for a qualifying nonprofit or government employer.
Repayment Plans Are Changing
One of the biggest areas of change surrounding PSLF is the income-driven repayment (IDR) system.
There are many borrowers still in the SAVE plan, but this is going away. If you haven’t already, you should very likely be taking proactive steps to move into a repayment plan that qualifies. Time spent in SAVE is currently not counting toward the 120 payments required for forgiveness.
One of the biggest updates in the past several months is that the financial hardship requirement for high-income borrowers has finally been removed from the system.
For example, if you are a cardiologist earning $650,000 and were previously stuck in SAVE and unable to switch into IBR (new or old) or PAYE, you are now able to do so because the hardship requirement has been removed. This is beneficial for several reasons.
- Your payments begin counting again toward forgiveness, which is the most important factor.
- These plans also include a payment cap, meaning your required payment will never exceed the 10-year standard repayment amount. For example, if you owe $300,000 at 6%, your payment would not exceed roughly $3,300 per month. That is often far lower than what the payment would be based on 10% or 15% of discretionary income, which could be $5,000–$7,000 per month.
Residents and Fellows Should Still Be Making Payments
This is not a new rule, but I frequently come across physicians in training who are not paying close attention to their student loans or who are reluctant to switch out of SAVE and begin making qualifying payments.
I understand that income is much tighter during residency and fellowship, and it can feel like this will all be easier once you have attending income. However, it is important to understand the difference in payment amounts.
During training, qualifying payments may cost roughly $300–$500 per month. Once you reach attending income, the minimum payment could easily be $1,500 per month or more, even for lower-paying specialties. In many cases these payments can be several thousand dollars per month.
The more qualifying payments you complete during training, the fewer payments you will need to make later when they are significantly more expensive.
Married Borrowers Should Consider Filing Separately
This is another consideration that has not changed but remains important. If you are married and both spouses have earned income, you should consider filing taxes separately so that your spouse’s income is not included in the calculation for your loan payments under an income-driven repayment plan.
Example: a resident making $70,000 with $300,000 of student loans is married to an engineer making $100,000.
Monthly payment on IBR/PAYE:
Filing Joint: $1,000–$1,200 per month
Filing Separate: $300–$400 per month
You should consult with your CPA to determine the difference in tax liability between filing jointly and separately and decide whether the loan payment savings outweigh the potential increase in taxes. In many cases, the reduction in loan payments more than offsets the additional tax cost.