Doctors and Dentists Get Good Student Loan News, But Uncertainty Remains

Doctors and dentists got some potentially good student loan news this week, as efforts by Republican lawmakers in Congress to reshape the federal student loan system and cut off access to key programs hit a major roadblock. But the legislative process is far from over, and much uncertainty remains. Here’s the latest.

GOP efforts to repeal IDR plans and restrict student loan forgiveness hits roadblock

The latest drama surrounds the budget reconciliation process, which would allow Republicans in the House and Senate to enact sweeping legislative changes through simple majority votes, bypassing the Senate filibuster. It takes 60 votes in the Senate to overcome a filibuster, and Republicans hold only 53 seats, so avoiding the filibuster is a priority for GOP lawmakers who want to enact massive tax cuts and slash government spending. President Trump has said he wants the legislation passed by July 4th.

House Republicans narrowly passed their reconciliation bill in May. The Senate released its own version of the legislation earlier this month. While the two bills differ in some ways, both would fundamentally remake the federal student loan system by repealing many existing income-driven repayment (IDR) plans — including for current borrowers — and limiting student loan forgiveness. 

Doctors and dentists would be particularly hard hit by the changes, as they could lose access to the most affordable IDR plans and be prevented from receiving credit toward Public Service Loan Forgiveness (PSLF) during the key early stages of their career.

But this week, the Senate Parliamentarian (a nonpartisan officer whose job it is to review legislation and interpret senate rules) made an unexpected ruling, determining that the provisions of the Senate reconciliation bill that repeal student loan relief programs for current borrowers do not comply with the Byrd Rule. The Byrd Rule is a senate rule that limits the type of legislation that can be passed through the budget reconciliation process. Provisions that expand the deficit too much, include unrelated policy riders, or aren’t strictly budgetary, would not comply with the rule.. 

The Senate Parliamentarian’s ruling doesn’t directly strip out the legislative provisions, but it means the provisions cannot pass the Senate through reconciliation. That means it would effectively require 60 votes for the Senate to enact those provisions. It is highly unlikely that enough (or any) Democratic senators would join Republicans to make that happen.

Doctor and dentist student loan borrowers could get reprieve

If the determination by the Senate Parliamentarian remains intact, key provisions of the reconciliation legislation that would have harmed doctor and dentist student loan borrowers would not be able to pass through the reconciliation process, and ultimately would be unlikely to become law in light of the filibuster. This would include a provision that would prevent medical and dental residency periods from counting toward student loan forgiveness under PSLF — one of the more controversial elements of the proposed legislation. 

“The term ‘public service job’ does not include time served in a medical or dental internship or residency program (as such program is described in section 428(c)(3)(A)(i)(I)) by an individual who, as of June 30, 2026, has not borrowed a Federal Direct PLUS Loan or a Federal Direct Unsubsidized Stafford Loan for a program of study that awards a graduate credential upon completion of such program,” reads the legislative text.

In addition, the Parliamentarian also ruled that the repeal of existing IDR plans for current federal student loan borrowers would also not comply with the Byrd Rule. Under the Senate proposal, current borrowers enrolled in the Saving on a Valuable Education (SAVE) and Pay As You Earn (PAYE) plans would be kicked out of those plans and switched to a modified version of the Income-Based Repayment (IBR) plan, which could be much more expensive, particularly for higher-income earners like doctors and dentists. 

If the Parliamentarian’s determination stands, that means borrowers currently in repayment may get to keep their repayment plan (of course, the SAVE plan is separately being challenged in court, and could get struck down anyway).

“The Byrd Rule must be enforced, and Republicans shouldn’t get away with circumventing the rules of reconciliation,” said Senate Budget Committee Ranking Member Jeff Merkley (D-OR) in a statement on Thursday. “Democrats will continue to make the case against every provision in this Big, Beautiful Betrayal of a bill that violates Senate rules and hurts families, students, and workers.”

New student loan borrowers, including new doctors and dentists, could still be impacted

While the Senate Parliamentarian’s ruling is good news for many borrowers already in repayment on their student loans, the situation remains less rosy for current students and prospective borrowers. The Parliamentarian’s determination only applies to borrowers currently in repayment. It does not impact elements of the reconciliation bill that would repeal existing IDR plans for new borrowers after July 1, 2026. These borrowers would only be able to enroll in either a Standard plan or a new IDR option called the Repayment Assistance Plan (RAP), which would have a 30-year term before a borrower could qualify for student loan forgiveness.

The ruling also would not change provisions of the reconciliation legislation that would eliminate Graduate PLUS loans and cap Stafford loans. Medical schools and medical associations have warned that these borrowing limits would force many students to either rely on costly and riskier private student loans, or they may simply decide not to pursue an advanced degree altogether. This could exacerbate an existing shortage of medical professionals, particularly in rural and other high-need areas. 

“We appreciate the importance of working to create an affordable and sustainable higher education system,” said the American Medical Association in a formal comment regarding the reconciliation legislation. “However, we worry that the bill, as currently drafted, would make medical school unaffordable for most students, even if they are the most qualified candidates applying. As such, we urge you to maintain subsidized and GRAD Plus loans, allow parents to have better borrowing terms to help fund their children’s higher education, and not cap the amount that an individual can borrow to pay for medical school.”

Future of key student loan programs to be decided soon

Republican leaders in the Senate have three broad choices about how to proceed in light of the Parliamentarian’s ruling:

• They could vote to override the Parliamentarian. However, this would be a politically explosive action, and GOP Senate leaders have said that they would not resort to this.
• They could consider these provisions effectively dead as they cannot be passed through reconciliation and would be unlikely to garner the 60 votes needed to overcome an expected filibuster. 
• They could rewrite the legislation to try to comply with Senate rules.

It appears that Republican leaders will try the third route and go back to the drawing board to rewrite key pieces of the legislation. Time will tell whether these student loan provisions will ultimately survive. Whether they do or not will make a tremendous difference for many borrowers, including doctors and dentists.