Since implementation, PSLF has faced increasing pressure to curtail its scope and availability to future borrowers.
7,8 A more concrete threat to PSLF surfaced recently with the Promoting Real Opportunity, Success, and Prosperity Through Education Reform (PROSPER) Act, which would rewrite the Higher Education Act.
9 Congress is periodically charged with reauthorizing the Higher Education Act to allow for review, revision, and improvement of existing education legislation.
5 Described by some as more reform than reauthorization, the PROSPER Act proposes changes to federal loan limits, loan type, loan repayment, and loan forgiveness program options.
9
Although the PROSPER Act does not directly reference PSLF, the legislation would eliminate future PSLF enrollment and restrict income-driven loan repayment programs for future borrowers.
9 A variety of loan options currently exist for borrowers. These options are to be supplanted by the new Federal ONE loan program starting in 2019, and this new program is not eligible for PSLF. Current borrowers with the existing basket of eligible loans would continue to be PSLF eligible. However, in addition to already outlined cuts to education grants and $235,500 caps on federal lending for professional program trainees (an amount prohibitive for the average student to cover costs for medical school), repayment programs would be reduced from the current 9 to 2: standard and income-based.
In the wake of rising medical graduate indebtedness, a body of literature has emerged that links debt with higher risk of physician burnout, depression, and skepticism regarding policy change.
10,11 In a recent study (in press), we found that if loan forgiveness programs were excluded, osteopathic graduates with higher levels of debt were less likely to choose primary care specialties.
12 Previous studies have investigated the economic utility of medical education
13 and the performance of different repayment plans over time.
14