September 18, 2025
What You Need to Know: CMA has urged the U.S. Dept. of Education to abandon a proposed rule that could disqualify nonprofit hospitals that provide gender-affirming care from participation in the Public Service Loan Forgiveness program. CMA warned that such a change would cut off loan forgiveness for many physicians, undermining efforts to recruit and retain physicians — especially in rural and medically underserved communities already facing severe physician shortages.
The California Medical Association (CMA) is calling on the U.S. Department of Education to preserve the current definition of qualifying employers under the Public Service Loan Forgiveness (PSLF) program, warning that proposed changes could disqualify physicians at nonprofit hospitals and threaten patients’ access to care.
In a letter to Linda McMahon, Secretary of the U.S. Department of Education, CMA stressed that PSLF is essential to recruiting and retaining the next generation of physicians — particularly in rural and medically underserved communities. The proposed rule could be interpreted to exclude employers that provide gender-affirming care, effectively penalizing physicians who work at nonprofit hospitals that offer medically necessary services to transgender patients.
“PSLF is vital to ensuring a future physician workforce,” said CMA President Shannon Udovic-Constant, M.D. “Restricting eligibility would threaten the availability of physicians in nonprofit settings and weaken patient access to care, especially in medically underserved areas.”
PSLF allows physicians to have their federal student loan debt forgiven after making 10 years of qualifying payments while working in nonprofit settings. According to the Association of American Medical Colleges (AAMC), the median medical student graduates with more than $200,000 in debt — making PSLF a critical incentive for pursuing careers in medicine.
With the AAMC projecting a shortage of up to 86,000 physicians by 2036, CMA stressed that any rollback of PSLF eligibility would further strain an already fragile health care workforce.
CMA is urging the U.S. Department of Education to preserve the current regulations governing the Public Service Loan Forgiveness program to help maintain access to care, particularly in rural and medically underserved communities.
Physicians supported by the PSLF program play a critical role in caring for the patients and communities who need them most. As medical students invest in their careers to serve all patients — including during their required residency training — it is essential to maintain access to medical education and preserve their eligibility for PSLF.