The U.S. Department of Education has released the final rule on the national overhaul of the broken Public Service Loan Forgiveness Program (PSLF). Included in the rule is the specific fix sought by the California Medical Association (CMA), so that all eligible California and Texas physicians can participate in the program, despite our state prohibitions on physician employment. This is a major win for California and Texas physicians, hospitals and patients. It ensures California and Texas can compete equally with all other 48 states for a physician workforce, which will ultimately protect patient access to medical care in our states.

For years, CMA along with the California Hospital Association, the Texas Medical Association, and the Texas Hospital Association – representing more than 100,000 physicians and hundreds of hospitals – have been urging the Dept. of Education to fix the inadvertent exclusion of California and Texas physicians.

The PSLF program was intended to provide loan forgiveness to individuals who commit to community service for 10 years by working full time (30 hours/week) in non-profit organizations, such as non-profit hospitals/clinics. Unfortunately, the program’s implementing regulations were narrowed to require physicians to be “directly employed.” As a result, physicians in our nation’s two largest states were inadvertently excluded because, while they may be working full time in private nonprofit hospitals and able to meet all PSLF eligibility requirements, state laws in California and Texas prohibit these hospitals from employing physicians.

“With the average medical education loan debt at more than $200,000, far too many students simply cannot afford to become physicians without loan forgiveness. The rule will allow low-income, minority students to pursue careers in medicine and help our neediest, most marginalized patients in underserved communities,” said CMA President Donaldo Hernandez, M.D. “The situation is worse in California and Texas as we are projected to have the two largest physician shortages over the next decade. Because of the rule, access to care for our most vulnerable patients served by physicians and  non-profit community hospitals, children’s hospitals, and rural hospitals will be protected. As physicians and hospitals, we will be able to fully care for the patients who need us most.”

The final rule now ensures that physicians in all 50 states have equal access to loan forgiveness. Applications will open in July 2023 under the new rules, which are retroactive for the last 10 years of work in public and private non-profit hospitals and clinics.