July 22, 2025

PSLF Under the Big Beautiful Bill: What Every Primary Care Clinician Needs to Know

If you work in primary care and rely on Public Service Loan Forgiveness (PSLF), major changes are coming—and your career and finances could be affected. Here's what you need to know about how the “One Big Beautiful Bill” (OBBB) may impact your student loans, repayment plans, and long-term forgiveness options.

Why This Matters for Primary Care

Primary care clinicians—especially those working in community health centers, public hospitals, nonprofit systems, or academic settings—often rely on PSLF to make their careers financially viable. You give your time, training, and energy to public service. In return, PSLF helps forgive your loans after 10 years of service and qualifying payments.

But that path is about to shift... because what’s a little more chaos between you and forgiveness?

What’s Staying the Same

PSLF Is NOT GOING AWAY
You can still get your loans forgiven after 120 qualifying payments while working full-time for an eligible nonprofit or government employer (Tate, 2024).

Your Progress So Far Is SAFE
If you’ve already made qualifying payments under existing income-driven repayment (IDR) plans like SAVE or PAYE, those still count—even after the new law takes effect (CBS News, 2024).

RESIDENCY remains eligible for PSLF.

⚠️ What’s Changing—and How It Affects You

1. SAVE, PAYE, and Other IDR Plans Are Ending

  • Starting in mid 2026, current income-driven repayment plans will be phased out.
  • You’ll be moved or mandated to switch into one of two remaining options between July 1, 2026 and July 1 2008:
    • IBR (Income-Based Repayment)
    • RAP (Repayment Assistance Plan)—a new plan created by the bill (NASFAA, 2025).

Why It Matters:If you're on SAVE now, your monthly payment may go up under RAP or IBR, affecting your monthly cash flow and budget (Investopedia, 2024).

2. PSLF Eligibility Depends on Your Repayment Plan

  • After the transition, only IBR, RAP, or a 10-year standard plan will qualify for PSLF.
  • New borrowers (after July 1, 2026) will have standard plans of 10–25 years, but only the 10-year option will count for PSLF (Student Borrower Assistance, 2024).

Translation for busy clinicians:If you start borrowing after 2026, you’ll need to opt into RAP or IBR to stay PSLF-eligible. Choosing an extended or graduated plan could disqualify you.

3. Employer Eligibility May Shrink

  • The Dept. of Education may narrow which employers qualify for PSLF.
  • Some nonprofits that do not directly provide public services (e.g. advocacy or research organizations) may become ineligible (Tate, 2024).

Implication for you:If you work in an academic, nonprofit, or hybrid setting, double-check that your employer still qualifies—and submit employment certification forms annually to protect your PSLF status.

💰 What Is RAP and How Will It Work?

Repayment Assistance Plan (RAP) is the new IDR option replacing SAVE. Key features:

  • Monthly payments: 1–10% of your adjusted gross income (AGI)
  • $10 minimum payment
  • $50 deduction per dependent
  • Forgiveness after 30 years of repayment (for non-PSLF borrowers) (Student Borrower Assistance, 2024)

Note: The 30-year timeline doesn't apply if you're pursuing PSLF—you still only need 10 years (120 payments) if employed in a qualifying job and on a qualifying plan like RAP or IBR.

What You Should Do Now

For Current PSLF Track Borrowers:

  1. Keep submitting your employment certification yearly to FSA.
  2. Watch for announcements about your current IDR plan's phase-out date.
  3. Be ready to transition into IBR or RAP before 2028 to stay PSLF-eligible.
  4. Confirm your employer’s eligibility every year

For New or Future Borrowers:

  1. Be strategic about your repayment plan—avoid extended or graduated plans.
  2. Confirm your employer’s eligibility every year.

Your Career, Your Calling – Student Loans Shouldn’t Get in The Way

Primary care is the backbone of public health—and PSLF is a critical part of making this work sustainable for physicians, NPs, and PAs. The Big Beautiful Bill won’t erase PSLF, but it will change how you get there.

If you're counting on forgiveness, stay informed, choose the right repayment plan, and certify your employment annually to protect your future.

References

  1. Tate, C. (2024). How the “Big Beautiful Bill” Affects Public Service Loan Forgiveness (PSLF)
  2. Student Borrower Protection Center (2024). Big Bill Means Big Changes for Student Loan Borrowers
  3. CBS News (2024). Big Beautiful Bill Changes Student Loan Repayment
  4. Investopedia (2024). How the Big Beautiful Bill Affects Student Loan Payments for Existing Borrowers
  5. Reddit PSLF Community
  6. National Association of Student Financial Aid Administrators (NASFAA, 2025). Federal Student Aid Change Summary – OB3
  7. Next Mission Financial Planning (2024). College Planning and the Big Beautiful Bill
  8. Student Loan Planner (2024). Student Loan Changes in the One Big Beautiful Bill

ChatGPT (OpenAI, 2025).Summarization, synthesis, and clarification of PSLF policy details and legislative updates related to the One Big Beautiful Bill. Model: GPT-4o. Accessed July 2025.