U.S. Dept. of Education reopens rule-making on public service loan forgiveness benefits

July 13, 2021
Area(s) of Interest: Advocacy Physician Workforce 

The U.S. Department of Education has reopened its “negotiated rule-making process” to make changes to the Higher Education Act, which includes the Public Service Loan Forgiveness Program (PSLF).  The California Medical Association (CMA) and the Texas Medical Association (TMA) have for years been urging the U.S. Department of Education to correct an unjust denial of the PSLF benefits to physicians in California and Texas because of conflicting state laws. CMA is aggressively pursuing both a legislative and regulatory fix to the issue so that California and Texas physicians are not precluded from participating in the loan forgiveness program.

Congress enacted the Public Service Loan Forgiveness program in 2007 in an effort to improve access to care by encouraging physicians to pursue careers working in nonprofit settings. Under the program, individuals can have their education loans forgiven after making 120 qualifying monthly payments under a qualifying repayment plan while providing care in a non-profit hospital. 

Unfortunately, when the U.S. Department of Education wrote the implementing regulations, they narrowed the regulations to require physicians to be directly employed. Because state laws in California and Texas prohibit most hospital employment of physicians, our physicians were unintentionally excluded from the program. Physicians in all other 48 states participate in the program.

CMA, TMA, along with the California Hospital Association (CHA) and the Texas Hospital Association (THA) sent a joint letter to the Department of Education in response to the request for comments, urging the department to reopen the regulations and  fix the PSLF program to allow all eligible California and Texas physicians to participate. CMA Vice President of Federal Government Relations Elizabeth McNeil also testified on behalf of CMA, CHA, TMA and THA before the Department of Education during their recent hearings on this issue.

The inadvertent exclusion of California and Texas physicians puts our states at a severe disadvantage in recruiting young physicians who are choosing to practice in other states where their $250,000 in average medical student loan debt can be forgiven.

CMA is urging the Department of Education to ensure there is equal treatment of physicians, hospitals, and patients in all 50 states under the PSLF Program. We must be able to operate on a level-playing field with other states to attract young physicians who can keep pace with the increasing demand for patient care.


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