Kaley Parchinski , 2025-05-21 08:30:00
This month I became the first physician in my family.
Well, actually, I might have a third cousin somewhere in Michigan who is a psychiatrist. Regardless, I am the first physician in my family that we keep regular contact with. An accomplishment, if I may be so bold. My mother prepared a big barbeque spread for a post-ceremony feast. My godmother brought premixed Old Fashioneds. My partner had to frantically look up pressure washer rentals for our pollen-blanketed back patio, lest my mother skewer us and slap us down on the grill next to the pork.
Instead of preparing for celebrations, however, I found myself knee-deep in the federal student aid website. My plans for repaying back my federal student loans are on the operating table, about to be amputated by new legislation.
The House of Representatives Education and Workforce Committee’s reconciliation bill proposed major changes to the Public Service Loan Forgiveness (PSLF) program that would affect medical residents and future students.
Currently, participants in the PSLF program must make monthly qualifying payments for 10 years. Graduates must also work for a qualifying employer, which includes nonprofit and public sector positions. Depending on specialty, residency lasts from three to seven years. Additional specialization during a fellowship can add even more years of training. Physicians begin repaying loans immediately after graduation. If residency years no longer count toward PSLF, to qualify, doctors would need to spend an additional three to seven years at a qualifying employer to make up for lost residency payment time.
The bill would prevent medical students taking out federal loans in 2025 or later from counting their residency years toward PSLF. It also eliminates Grad PLUS loans — an essential resource for covering the cost of medical school.
I, along with many others, worry that these changes will make medical school unaffordable, turn loan repayment into a pipe dream for residents, and worsen physician shortages — especially in primary care and underserved areas.
PSLF, while imperfect, remains a vital loan forgiveness program for medical students, who graduate with an average of $202,453 in debt. This new legislation would be the first to specifically exclude a group of borrowers since President George W. Bush signed PSLF into law in 2007.
After a minimum of eight years of studying and thousands of dollars in debt, it is hard to fathom why lawmakers are targeting my classmates and me. I further cannot understand how my time in residency is anything other than public service worthy of a little debt relief.
When I begin my internal medicine residency in July at Duke University, I will make $67,284 per year. This will roughly be my salary for the next three years. This is on par with other residents’ salaries across the country, adjusted for cost of living. I will learn the finer details of medicine, beyond the book knowledge I have now. I will learn to manage someone’s insulin, provide countless primary care checkups, and maybe even save a few lives. Some weeks, I’ll work up to 80 hours, all while interest accumulates on my $130,265 in student loans.
I hope to be an infectious disease doctor, which requires another two to three years of training after three years of residency. If you ask most doctors, this is not a popular specialty, and some well-intentioned mentors have questioned my choice.
In Georgia, where I live, the average salary for an infectious disease doctor is $185,905 — after a minimum of 13 years of education post–high school. It might well be less than that. Salary can vary widely by state and if one works for an academic versus community hospital. (Academic hospitals typically pay less.) But I didn’t go into medicine for the money.
PSLF is how many students like me interested in lower-paying specialties justify their choice. Without viable repayment options or the ability to start PSLF during residency, I worry fewer students may pursue fields like infectious disease, pediatrics, or primary care — and even fewer may return to rural or underserved communities, where salaries can be lower. The discourse on our student-run forums says as much.
Beyond PSLF, another key way medical students afford school is under threat with Congress’ new bill. I consider myself lucky. With a college scholarship, the Pell Grant, and some generous family members, I was able to keep my loans below the national average and avoid taking out Grad PLUS loans for medical school. These loans have higher interest rates than other federal loans. For many of my classmates however, Grad PLUS loans were necessary to cover the cost of attendance at the Medical College of Georgia, the cheapest school in Georgia. If the cost of attendance of medical school does not change and legislation eliminates Grad PLUS loans, many future medical students will not be able to afford medical education.
Barring changes to the proposed legislation, I will be grandfathered in for PSLF qualifying payments during residency. However, future changes — like nonprofit hospitals losing their 501(c)(3) status — could jeopardize PSLF eligibility even for me, unless I leave residency to work for a qualifying employer (which isn’t possible during training). I won’t get into the thicket of whether hospitals that make billions in revenue should qualify as 501c3 organizations. But if the tax code changes, health care workers — from nurses to respiratory therapists to phlebotomists — could lose PSLF eligibility, too.
Lawmakers must not single out medical residents and students by excluding them from PSLF. Eliminating this support for future health care workers is short-sighted and damaging.
I want to serve my patients. Hell, I even want to pay back my loans. But right now, my ability to do either is on life support.
Kaley Parchinski is a recent medical school graduate and will begin internal medicine residency in July. Her views are her own and do not represent any of the institutions she is affiliated with.
