Another year, another round of changes to student loans.

If you're trying to figure out what the One Big Beautiful Bill Act actually means for your student debt, here’s the breakdown.

Starting July 2026, the federal government will no longer offer Grad PLUS loans if you're a medical student.

The one big Beautiful Bill Act capped federal borrowing for professional students at $50,000 per year, with a lifetime cap of $200,000. The median cost of med school at a public university is about $298k, and at a private school it's closer to $400,000. That gap, which is potentially $100,000 or more, now has to come from private lenders.

Private loans don't qualify for income driven repayment or for Public Service loan forgiveness either. They don't pause during residency when you're making $65,000 a year.

The good news is that PSLF still works during residency for federal loans. Earlier drafts of the Bill tried to exclude residency years from counting towards PSLF, but that provision got stripped from the final law. If you're training at a non profit hospital, those payments still count towards your 120 payments.

So your federal debt is capped at $200k and the rest is private. PSLF only forgives the federal portion. You're still on the hook for every dollar of private debt.

Take a current MS4 walking into residency with $200k in federal loans at 7% and $100k in private loans at 9%.

Under the old system, both portions could ride along on IDR-equivalent payments for the full 10-year PSLF clock. Forgive the federal balance, deal with the private balance as an attending. It was manageable.

Under the new system, the $100k private portion compounds at 9% for 4-7 years of training, and by the time you're an attending, that $100k is closer to $140k–$180k depending on your specialty length and rate. There's no income-driven repayment for it or forgiveness, just the clock running.

This is why the decision about how to structure your debt needs to happen earlier.

Every path to paying off loans is unique, in the same way that getting to medical school and training is. We can’t apply a blanket-wide strategy to all of you, but we can discuss some common paths that physicians typically take. None of this is financial advice.

One decision point is deciding if loan forgiveness is a path you want to follow. One of the unique aspects of being a physician is that there are federal programs like PSLF that forgive your loans after 10 years of qualifying employment. Some private employers also offer loan repayment as part of compensation, but that's separate from PSLF.

If you didn’t know yet public service loan forgiveness (PSLF) means if you work for a qualifying nonprofit, which is typical of most academic hospital institutions, then after 10 years of qualifying payments (120 qualifying monthly payments, they don't need to be consecutive), you can get all of your loans forgiven.

There are caveats to this, including:

The thing to remember is that you need to decide on loan forgiveness earlier in your training because it determines how you approach your loans altogether.

If you decide to do private practice rather than work for a qualifying employer non-profit, this would determine your minimum monthly payments that you make during your training.

You might want to either delay your loans because you know that you'll make a lot more money to pay them off later, or you might want to make higher payments today to decrease your interest in the future.

If you're on the PSLF path, you can start your qualifying payments during training.

Again, this all is determined by the type of loans you have (federal or private), the interest rates you're accruing, and what program you've been grandfathered into.