Casey Wiley, M.Ed — The $50,000 Cliff: How the New Loan Rules Are Quietly Rewriting Who Gets to Become a Doctor

Casey Wiley joins Dr. Michael Jerkins to unpack the biggest shift in medical school financing in decades: the July 2026 elimination of Grad PLUS loans under the One Big Beautiful Bill Act. For roughly twenty years, students could borrow up to the full cost of attendance. Now federal borrowing is capped at $50,000 a year—and for many trainees, that opens a funding gap of $25,000, $70,000, or more.

Casey, the mind behind the Med School Money Guy channel, walks through what actually changed and who it hits first. He explains the confusing line between “legacy” and “new” borrowers, the aggregate and lifetime caps that can quietly run out mid-degree, and the rise of private loans as the new gap-filler—along with everything students give up when they leave the federal system, from income-driven repayment to PSLF. He makes the case that credit score has become a gatekeeper to a medical career, with 10–15% of first-years unable to qualify for the loans they now depend on.

The conversation also takes on the harder questions. Who gets squeezed out when funding depends on creditworthiness and co-signers—and what does that mean for a physician pipeline already trying to reach rural, lower-income, and first-generation students? Is tuition-free medical school a real fix or a fundraising fantasy? And amid the caution, where’s the good news? Casey points to the new RAP repayment plan as the bill’s genuine silver lining: congressionally durable, interest-subsidized, and structured to keep balances from ballooning during residency.

Throughout, one theme anchors the discussion: the rules are changing faster than the advice can keep up. Understanding them now—before June application deadlines and August panic—is the difference between a manageable plan and a career-altering scramble.

Here are 7 main takeaways from our conversation with Casey:

1. Changing Borrowing Limits Reshape Medical Education Financing

Medical students can no longer borrow up to the full cost of attendance the way they used to, so many will need to turn to private loans to cover tuition, rent, and other living expenses.

2. Federal Loan Caps Drive Credit Building and Private-Lender Shopping

Because federal borrowing is now capped, students need stronger credit and often a co-signer to qualify for private loans with competitive rates and workable repayment terms.

3. Loan Restrictions May Narrow Who Can Afford Medical School

The new rules may hit lower-income, rural, and first-generation students hardest, since they’re less likely to have family help or a financial cushion to absorb the gap.

4. Borrowing Rules and “New Borrower” Status Change Federal Eligibility

Students with prior graduate debt, or those who take longer to finish school, could run out of federal borrowing room earlier than expected and be forced into private financing sooner.

5. Public Service Loan Forgiveness Will Matter Differently Now

PSLF is still an option, but it becomes more complicated when students are also carrying private debt that does not qualify for forgiveness, making repayment strategy more important.

6. Living Costs, Not Just Tuition, Are Driving Debt Higher

The episode makes the case that tuition has not exploded in the same way people assume, while housing, food, and other everyday costs have risen sharply and are driving much of the debt growth.

7. The New RAP Plan Is the Biggest Silver Lining

The new repayment assistance plan may help graduates keep debt from growing during residency by subsidizing interest and reducing principal, giving them a more stable path into repayment.

Transcript:

Casey Wiley, M.Ed:
Prior to now, every student going to medical school could borrow up to the cost of attendance. Cost of attendance includes tuition, living expenses—absolutely everything. Last year, when the One Big Beautiful Bill Act passed, we knew they were going to eliminate the Grad PLUS Loan. So we went from being able to borrow whatever our cost of attendance was down to only being able to borrow federally up to $50,000 per year for medical students.

Dr. Michael Jerkins:
Welcome back to another episode of The Podcast for Doctors (By Doctors). I’m Dr. Michael Jerkins. We have a very special guest today to discuss an extremely timely topic.

Today on The Podcast for Doctors (By Doctors), we’re joined by Casey Wiley, a financial aid manager who has worked in financial aid for more than 20 years, helping medical students fund their education and pay off debt. He also creates financial literacy content on YouTube, where he’s known as The Med School Money Guy.

Casey, welcome to the podcast.

CW:
Hey, thanks so much for having me. It’s an interesting time.

MJ:
Here we are at the beginning of July 2026. I’d love for you to summarize what’s changed about paying for medical school just this month.

CW:
Okay, this might take our full hour.

MJ:
Yeah.

CW:
To set the stage, for about the last 20 years, every student going to medical school—provided they met the federal eligibility requirements—could borrow up to the full cost of attendance. That included tuition, living expenses, and everything else.

Last year, when the One Big Beautiful Bill Act passed, we knew this was coming. We’ve had about a year to prepare, but we knew they were going to eliminate the Grad PLUS Loan. For medical students, that’s really been the lifeline. At many schools, the Direct Unsubsidized Loan would cover tuition, while the Grad PLUS Loan covered any remaining tuition along with living expenses.

Now we’ve gone from being able to borrow up to the full cost of attendance to only being able to borrow federally up to $50,000 per year for medical students and other professional programs. Medical students are the group I work with most.

For resident students at my school, we’re seeing about a $25,000 reduction per year in available federal borrowing. For non-resident students—who at our school only have non-resident status for one year—that first year comes with about a $70,000 reduction in what they can borrow federally. They have to find another way to fill that gap.

MJ:
Where are students finding the money to fill that Grad PLUS gap?

CW:
For our students, we’re almost sending them out into the ether. We’re not what’s called a preferred lender school. There are a lot of regulations around when a school can recommend lenders, and our main campus doesn’t qualify.

So we provide students with good guidance, but they’re going out and researching private education lenders on their own. The private lending market has really grown again over the last few years. About ten years ago, there were maybe two or three lenders. Now, students are often coming in with two or three different loan offers that they can compare.

MJ:
When I was in medical school, I was under the Grad PLUS system. I borrowed what I needed—and hopefully not a dollar more.

CW:
Smart.

MJ:
I tried to be. Didn’t always make the best choices, but I tried.

This really applies to first-year students, right? If you’re already in your second, third, or fourth year of medical school, you still have access to Grad PLUS through the rest of medical school?

CW:
For most students, yes—but not everyone.

I’ve actually been working with a few students today to come up with plans. Some students qualify for what’s called legacy exemption status. That lasts until they either graduate or reach the end of what’s called the minimum expected enrollment period.

For a typical medical school, that’s four years or eight semesters. If a student repeats a year or takes an extra semester for any reason, they may lose their legacy status before they actually graduate.

Will that affect most students? No. But for those who do lose that status, the impact is significant.

As you mentioned, every incoming student now falls under these regulations as a “new borrower,” although the Department of Education uses that term a little differently than most people would expect.

MJ:
What’s different about their definition of a new borrower?

CW:
Most people would assume a new borrower is someone who’s never borrowed before. Historically, that was true—or someone borrowing for the first time at a new educational level.

Now, a new borrower includes:

Someone who’s never borrowed before.

Someone borrowing for the first time in medical school.

Anyone who loses their legacy status for any reason.

So even students who have already borrowed substantial federal loans can suddenly be classified as new borrowers under these regulations.

MJ:
One important point you mentioned is the $50,000 annual cap for professional schools—medical, dental, veterinary, and a few others.

In the future, though, some people are going to run into the aggregate borrowing limit. If someone attended an expensive undergraduate institution, my understanding is they could potentially begin medical school having already reached the lifetime borrowing limit. Is that correct?

CW:
It’s unlikely for someone coming straight from undergraduate education, but we absolutely could see it with students who already have graduate-level loans.

There are actually two limits at play.

The first is the aggregate borrowing limit:

$200,000 for professional programs like medicine, dentistry, and veterinary medicine.

$100,000 for other graduate programs.

$57,500 for undergraduate programs.

Fortunately, undergraduate borrowing is tracked separately. So undergraduate loans don’t count against the $200,000 professional school limit.

However, imagine a student who completes a two-year special master’s program before medical school. Those programs are excellent preparation academically, but if they borrowed around $40,500 for that program, they’d only have about $160,000 of remaining eligibility for medical school. That would cover three years at $50,000 per year, but in the fourth year they’d only have about $10,000 of remaining federal eligibility.

The second limit concerns me even more: the lifetime borrowing limit.

That includes every federal student loan you’ve ever borrowed—undergraduate, graduate, Grad PLUS, even loan programs that no longer exist.

Once you reach $257,500, that’s it. Your federal borrowing eligibility is exhausted permanently. Even if you repay those loans later, you don’t regain that lifetime eligibility.

MJ:
That’s what’s so interesting. Most people won’t reach that limit during undergrad, but if you attended an expensive university without scholarships and relied heavily on federal loans, you could eat into that lifetime limit significantly before medical school.

Another important point is that many future physicians don’t have much credit history before medical school. It’s not uncommon for students to have a very limited credit history—or no credit score at all.

When you move into the private lending market, it’s not as simple as applying and automatically getting approved.

In our analysis, we estimate that roughly 10 to 15 percent of first-year medical students either have a credit score below 660 or no credit score at all. That’s a major concern because they may not qualify for the additional $25,000 to $50,000 they need.

How is your school—and how are schools across the country—helping those students?

CW:
That’s probably the group we’re most concerned about.

At this point, there’s only so much we can do, especially for the incoming class. Orientation starts this week as we’re recording this, and I don’t even have access yet to see which students have been approved for private loans.

Fortunately, I meet individually with every applicant during their interview day for about 30 minutes. We’ve done that since our medical school opened. Over the past year, I’ve been encouraging students to start building their credit as early as possible.

Future classes will have even more time to prepare.

We recently met in New Orleans with the National Association of Advisors for the Health Professions, and one of the major topics was encouraging advisors to start talking with students about credit as early as college—bringing in experts to teach responsible credit management well before students apply to medical school.

For this incoming class, though, our advice is fairly limited:

Do everything you can now to strengthen your credit.

Look for a creditworthy cosigner who is willing to help secure the loan.

Of course, that means having an honest conversation because the cosigner is legally responsible if the borrower doesn’t repay the loan.

The good news is that I’ve actually been impressed with private loan interest rates this year. Many are coming in below current federal loan interest rates. Even though federal loans often remain the better long-term option because of their repayment protections, the private loan rates themselves have been surprisingly competitive.

MJ:
And you’ve seen those competitive rates on both fixed-rate and variable-rate loans?

CW:
As a general rule of thumb, I encourage students to focus on fixed interest rates. Among the offers I’ve reviewed, I’ve seen fixed rates as low as about 3%, and the highest has been around 7.5%. Every one of those has been below this year’s federal loan interest rate.

MJ:
Right. And to your point, there are important repayment differences. Private loans don’t offer income-driven repayment plans or Public Service Loan Forgiveness.

I’m curious about what schools are doing to prepare for the future. You mentioned counseling students about building credit, but what are schools across the country doing more broadly to help students navigate these changes and continue paying for medical school?

CW:
We’re seeing more and more schools explore preferred lender arrangements, where they partner with a select group of lenders to provide students with better loan options—similar to some of the partnerships already in place through the AAMC.

I think we’ll continue seeing more schools move in that direction. Even schools saying, “It’s too late for us to implement this year,” are already researching the process and making sure they meet all the regulatory requirements so they’re ready for next year.

We’re also building much stronger financial literacy education for incoming students. The AAMC has done an excellent job with its FIRST financial wellness program, creating resources specifically about building credit and helping students avoid common credit mistakes before they even start medical school.

At the school level, we’re doing the same thing. Unfortunately, a lot of this is simply going to come down to education—but it’s education students need anyway.

For example, my school traditionally did a major financial literacy program in May. We’ve completely flipped that. Now, one of the very first things we teach incoming students is credit:

How credit works.

How to build a strong credit history.

How to use credit cards responsibly.

How to maintain good credit.

Under the Grad PLUS system, having little or no credit wasn’t a disadvantage—you could still qualify for federal loans. Now, students need good credit to qualify for private loans. So our goal is to help students build it early and help those who already have good credit protect it.

MJ:
Walk me through the ideal timeline.

Let’s say someone has just been accepted to medical school and needs a private loan, or they’re already enrolled and preparing for their next academic year. When should they begin shopping for loans, and when should they ideally have everything finalized?

CW:
Using our school as an example, classes begin in mid-July.

I recommend that students spend May building a detailed budget—and, if possible, actually trying to live on that budget. By the end of May, they should know exactly how much they’ll need to borrow through private loans.

Then, starting around June 1, they should begin submitting applications.

Most lenders will honor an approved credit check from June through mid-July, so that timeline works well. We generally don’t see lenders requiring a shorter approval window than that.

So far, it’s worked fairly well. I have had a few students email me over the past week who still haven’t started the process. They’ll probably still be okay because our tuition bills aren’t due until August, but waiting does create more anxiety since everything happens much closer to the payment deadline.

The private loan certification process is also more complicated than the federal loan process.

Federal loans are highly automated because the systems were designed around them. Private loans require much more manual processing. That’s actually how I got started in financial aid more than 20 years ago—we manually processed private loans by logging into individual lender systems.

Today there are really only two major processing systems, which makes things easier, but it’s still much more hands-on than the federal process.

MJ:
Let’s say it’s July, and a student can’t get approved for a private loan. Maybe they’re an incoming student, or maybe they’re returning next year without access to Grad PLUS.

How are schools handling students who simply can’t secure private financing?

CW:
That’s honestly the biggest question because we really haven’t had to face it yet.

For continuing students—especially those who lose legacy status during their final year—I think schools are going to do everything they possibly can to help them finish. They’ll bend over backwards to get those students across the graduation stage.

For students entering under these new borrowing rules, though, I don’t know that schools have the financial resources to provide enough grant aid to close those funding gaps.

There’s been a lot of discussion about whether the One Big Beautiful Bill Act will reduce tuition. Personally, I don’t think that’s likely.

I’ve looked at the financials at our medical school. We’re certainly not generating large profits. If anything, we’re probably operating at a slight loss each year.

There simply isn’t extra money sitting around that we can turn into scholarships for students who can’t qualify for private loans.

I think we’re going to see attrition rates increase. Some students may have to withdraw, while others may take a leave of absence to improve their credit before returning.

As a result, I think we’ll eventually see changes in both four-year and five-year graduation rates. Schools’ hands are going to be tied in many of these situations.

MJ:
How do you think that ultimately affects the physician workforce if only certain groups of students are financially able to attend medical school?

CW:
I do think that’s going to happen.

Students whose families can afford to help them—or who don’t need to rely heavily on private loans—will continue attending medical school.

Over the past several years, we’ve made meaningful progress toward building a physician workforce that better reflects the populations we serve. Unfortunately, I worry that progress could slow or even reverse.

Take South Carolina, for example. We have a large rural population, and we’ve done a great job increasing the number of physicians coming from rural communities.

But many rural communities don’t have significant financial resources. South Carolina is a wonderful place to live, but once you get farther into many rural areas, there’s simply not a lot of wealth.

Those are exactly the students we may start losing.

We may also lose first-generation students, people who decide later in life that they want to become physicians, and students whose families simply can’t afford to help finance medical school.

I think we’ll see a real demographic shift. It probably won’t become obvious immediately, but if you look at graduation data five years from now, I think those changes will be apparent.

MJ:
I agree—that’s one of the biggest concerns.

If I remember correctly, about 25% of medical students nationally don’t need to borrow money to pay for school. Is that about right?

CW:
Yes, that’s roughly the national average.

At my school, though, we’re much higher need. Around 90% to 93% of our students receive some form of financial aid. There are several medical schools across the country with similar student populations.

MJ:
What do you say to people who argue that the solution is simply making more medical schools tuition-free?

Based on the schools that have already moved in that direction, have we seen evidence that free tuition leads to a physician workforce that’s more representative of the communities it serves?

CW:
I think it’s still too early to know.

Outside of the Uniformed Services medical programs, which have always been tuition-free, the schools that have recently adopted free tuition are still relatively early in the process. Most are only now graduating their first or second class, so we simply don’t have enough long-term data yet.

Would I love for my school to become tuition-free? Absolutely.

Every year we do a holiday tradition where faculty and staff write wishes that are displayed around campus. One year, our dean wrote, “I want us to become a tuition-free medical school.”

I couldn’t agree more.

But when you look at the numbers, it’s an enormous challenge.

With approximately 110 students per class and our current tuition, we’d need to raise nearly $400 million to make tuition permanently free.

If someone wants to donate $400 million, I’d love to meet them—and we’d happily name the school after them.

The reality is that donors capable of making gifts like that are incredibly rare, and there are more than 150 medical schools competing for the same philanthropic support.

MJ:
I’ve spoken with some states that are raising money for scholarship programs, but that just doesn’t scale to the billions of dollars that would be needed each year.

And, by the way, we haven’t even talked about dental students or dental residents. Dental specialists are already graduating with $500,000 to $600,000 of debt in some cases—orthodontists, pediatric dentists, and others. This is going to have a tremendous impact on several specialties over time.

CW:
I think you’re absolutely right.

My institution only has a medical school, so naturally my focus is a little narrower. But dental students are graduating with significantly higher debt burdens.

Using the numbers you mentioned, a best-case scenario might be someone graduating with $200,000 in federal loans and another $300,000 in private education loans.

What does repayment look like in that situation? Especially in dentistry, where many graduates are buying into a practice or opening one of their own, how do you realistically take on that additional business debt while also repaying hundreds of thousands of dollars in student loans?

MJ:
Exactly. And as you pointed out, over time we’re likely to see more private debt and less federal debt.

How are you advising medical students—and residents, if you’re working with them—to think about Public Service Loan Forgiveness (PSLF)? It isn’t affecting today’s graduates yet, but eventually students graduating with a larger share of private loans will need to factor that into their career decisions.

CW:
One positive development that came out of this legislation is the new Repayment Assistance Plan (RAP).

It provides some meaningful benefits, and I actually have graduates this year choosing RAP even though they aren’t required to.

Take someone starting residency who isn’t sure whether they’ll pursue PSLF or what type of job they’ll ultimately have. Maybe they’re entering anesthesiology, where private practice remains common.

With RAP, they can make their required monthly payments while the government subsidizes the remaining unpaid interest. On top of that, the program applies $50 per month toward principal.

That means we won’t continue seeing situations where physicians finish residency owing more than they borrowed because unpaid interest kept accumulating. Instead, we know their balance should at least be moving in the right direction.

That also keeps PSLF as an option longer into someone’s career. Students won’t feel pressured to make an immediate decision simply to avoid accumulating another $60,000 to $70,000 in interest during residency.

Overall, I think PSLF will remain available and continue being a valuable option for many physicians.

I just don’t think it’ll be as financially dramatic as it has been in the past.

Instead of seeing someone receive $300,000 in loan forgiveness, I think we’ll more commonly see much smaller amounts forgiven while borrowers are also paying down their private loans separately.

MJ:
Where does that estimate of around $150,000 come from? If the lifetime federal borrowing limit is $257,500, couldn’t someone theoretically have nearly all of that forgiven under the current PSLF rules?

CW:
They absolutely could. I just don’t think that will be typical.

Most medical students enter with relatively little educational debt. Among borrowers at my school, the average incoming debt is about $20,000, and that’s fairly consistent nationally.

Remember, that’s only among students who already have debt. Many incoming medical students have none because they earned substantial scholarships during college.

At the extremes, though, yes—you absolutely could see someone approach the full lifetime limit.

Imagine a student who enters medical school with the undergraduate borrowing limit of $57,500, then borrows the full $200,000 available during medical school, enters something like neurosurgery, and remains in training long enough that they never make attending-level payments before reaching PSLF eligibility.

They might only repay $25,000 to $40,000 during residency, leaving roughly $240,000 eligible for forgiveness.

I just don’t think that’s going to be the norm.

Most physicians complete three- to five-year residencies. Then they spend five years making attending-level payments before reaching ten years of qualifying PSLF payments.

By that point, they’ve already repaid a much larger portion of their federal loans.

MJ:
What’s your general advice for physicians starting residency now who have RAP available?

CW:
This is one of those situations where individualized counseling really matters. At my school, every borrower meets with me one-on-one before graduation because everyone’s circumstances are different.

But if I had to generalize:

If you’re absolutely certain you’re pursuing PSLF and entering a specialty where private practice is uncommon—for example, obstetrics and gynecology, where nonprofit employment is much more common—I would probably recommend staying with the traditional Income-Based Repayment (IBR) plan.

IBR is the only repayment plan established directly by federal statute rather than administrative action, so it’s likely to remain available long term.

If there’s any uncertainty—either about pursuing PSLF or about eventually working in private practice—I’d lean toward RAP.

IBR payments are generally a little lower, but RAP provides valuable interest benefits.

Once your income exceeds roughly $70,000, RAP payments typically become somewhat higher than IBR, but we’re usually talking about only $30 to $50 more per month.

During residency, that’s a manageable difference if it preserves flexibility while reducing interest growth.

MJ:
Let’s get into another detail.

Some graduates choose to waive the standard six-month grace period after graduation and consolidate their loans immediately so repayment starts sooner.

How are you advising students about that six-month grace period?

CW:
It depends on which repayment plan they’re choosing.

If they’re planning to use IBR, I generally recommend keeping the six-month grace period.

That’s because consolidation creates a brand-new loan, and new loans only qualify for RAP—not IBR. Consolidating immediately could prevent someone from accessing IBR altogether.

That actually goes against advice I’ve given for years.

Historically, I’d tell students to consolidate as soon as possible after graduation so they could start qualifying payments during residency and receive six additional PSLF-eligible payments.

Now, for students pursuing IBR, I usually recommend waiting through the grace period before entering repayment.

If they’re choosing RAP, though, I still generally recommend consolidating immediately and eliminating the grace period.

Many people don’t realize this, but while you’re in your standard grace period you can’t begin repayment.

A consolidation loan, however, doesn’t carry that mandatory grace period the way Direct Unsubsidized or former Grad PLUS Loans did.

MJ:
As someone who’s been through this process, I really appreciate that your school offers one-on-one counseling.

Not every medical school does.

Graduates are moving across the country, completing hospital onboarding, handling licensing paperwork, and adjusting to residency. Student loans often don’t become a priority until the grace period is almost over.

For students who’ve already graduated and left campus, where do you send them for reliable information?

CW:
Before they leave, I give what has become one of my most popular sessions every year: “Public Service Loan Forgiveness for Idiots.”

The title is intentional.

My point is always, if I can figure out PSLF, you certainly can. You’re the ones who got into medical school.

One thing I have everyone do during that session is pull out their phones and create reminders.

We actually pause the presentation while everyone schedules them.

For example, if you’re choosing RAP and consolidating your loans, I tell everyone to set a reminder for July 1 that says:

Consolidate your loans.

Download your Master Promissory Note.

Complete any remaining required paperwork.

Then I have them create a second reminder that repeats every year for ten years to submit their Employer Certification Form for PSLF.

The goal is to make the process as automatic as possible.

I’ve also posted this year’s “Idiot’s Guide to Public Service Loan Forgiveness” presentation on my YouTube channel.

Eventually I’ll take it down because this graduating class is unique. They have repayment options that no previous or future class will have, so I don’t want outdated guidance circulating later.

Just today I received an email from one of my graduates saying everything worked exactly as planned because the reminders on their phone told them what to do.

You’re going to get busy.

Anything you can do to simplify the process and take memory out of the equation is worth doing.

MJ:
I’ve talked with some states that are raising money for scholarship programs, but those efforts just don’t scale to the billions of dollars that would be needed every year.

And we haven’t even touched on dental students or dental residents. Dental specialists are already graduating with $500,000 to $600,000 of debt in some cases—or more for orthodontists, pediatric dentists, and others. This is going to have a significant impact on several specialties over time.

CW:
I think you’re absolutely right.

My institution only has a medical school, so naturally my focus is more on medical students. But dental students are already carrying much higher debt loads.

Using the numbers you mentioned, a best-case scenario might be someone graduating with $200,000 in federal loans and another $300,000 in private education loans.

What does repayment look like in that situation? Especially in dentistry, where many graduates are buying into a practice or opening one of their own, how do you take on business debt while also repaying that level of student debt?

MJ:
Exactly. As we move toward more private borrowing and less federal borrowing, how should medical students—and residents, if you advise them—think about Public Service Loan Forgiveness (PSLF)?

It won’t affect today’s graduates much yet, but eventually physicians will be graduating with more private loans. How should that influence their thinking?

CW:
One of the positives that came out of this legislation, at least from a financial aid perspective, is the new Repayment Assistance Plan (RAP).

I already have graduates this year choosing RAP because of the benefits it offers.

For someone entering residency who isn’t certain they’ll pursue PSLF—or isn’t sure whether they’ll ultimately work in private practice—RAP creates a lot of flexibility.

For example, someone entering anesthesiology may eventually choose private practice. Under RAP, they can make their required payments while the government subsidizes the remaining unpaid interest. On top of that, $50 each month goes directly toward principal.

That means we shouldn’t continue seeing physicians finish residency owing substantially more than they borrowed because of accumulating interest. Instead, their balance should actually be decreasing.

RAP also allows physicians to postpone the decision about PSLF. They won’t feel pressured to commit immediately just to avoid another $60,000 to $70,000 of accumulated interest during residency.

Overall, I think PSLF will remain an excellent option for many physicians.

I just don’t think it’ll produce the same level of loan forgiveness we’ve seen in the past. Instead of someone having $300,000 forgiven, I think much smaller amounts will be more common while borrowers are simultaneously paying down private loans.

MJ:
Where does that estimate come from? If someone can borrow up to the lifetime federal limit of $257,500, couldn’t nearly all of that still be forgiven under PSLF as it’s currently written?

CW:
Absolutely—it could happen. I just don’t think it’ll be typical.

Among borrowers at my school, the average incoming educational debt is around $20,000, and that’s fairly consistent nationally.

Remember, that’s only among students who already have debt. Many incoming medical students have little or no undergraduate debt because they earned scholarships.

At the extreme end, though, yes—you could absolutely see someone approach the full lifetime borrowing limit.

Imagine someone entering with the undergraduate limit of $57,500, borrowing the full $200,000 during medical school, then completing a long residency like neurosurgery. If they never have to make attending-level payments before reaching PSLF eligibility, they might only repay $25,000 to $40,000 before forgiveness.

In that scenario, they could potentially have around $240,000 forgiven.

I just don’t think that’s going to be the typical experience.

Most physicians complete three- to five-year residencies, then spend five years making attending-level payments before reaching ten years of qualifying PSLF payments. By then, they’ve already repaid a much larger portion of their federal debt.

MJ:
What’s your general advice for physicians starting residency now who have RAP available?

CW:
This is one of those situations where individualized counseling really matters. Every borrower at my school meets with me one-on-one before graduation because everyone’s circumstances are different.

But generally speaking:

If you’re absolutely certain you’re pursuing PSLF and entering a specialty where private practice is uncommon—for example, OB/GYN, where nonprofit employment is much more common—I would probably recommend remaining on the traditional Income-Based Repayment (IBR) plan.

IBR is the only repayment plan created directly by federal statute rather than administrative action, so it’s likely to remain available.

If there’s any uncertainty—whether about PSLF or eventually working in private practice—I would lean toward RAP.

IBR payments are generally a little lower, but RAP provides significant interest savings.

Once your income reaches roughly $70,000, RAP payments typically become slightly higher than IBR, but we’re usually talking about only $30 to $50 per month.

During residency, that’s a relatively small difference if it gives you flexibility while reducing interest growth.

MJ:
Let’s get into another detail.

Some graduates choose to waive the standard six-month grace period after graduation by consolidating their federal loans immediately so repayment starts sooner.

How are you advising students about that six-month grace period?

CW:
It depends on which repayment plan they’re choosing.

If they’re planning to use IBR, I generally recommend keeping the six-month grace period.

That’s because consolidation creates a brand-new loan, and new loans only qualify for RAP—not IBR. Consolidating immediately could make someone ineligible for IBR.

That actually goes against advice I’ve given for years.

Historically, I’d encourage students to consolidate as soon as possible so they could begin making qualifying payments during residency and gain six additional PSLF-eligible payments.

Now, if someone plans to use IBR, I usually recommend waiting until the grace period ends before entering repayment.

If they’re choosing RAP, however, I still generally recommend consolidating immediately and eliminating the grace period.

Many people don’t realize that while you’re in the standard grace period, you can’t enter repayment.

A consolidation loan, though, doesn’t carry the same mandatory grace period that Direct Unsubsidized Loans and the former Grad PLUS Loans did.

MJ:
As someone who’s gone through this process, I really appreciate that your school offers one-on-one counseling.

Not every medical school does.

Graduates are moving across the country, getting licensed, completing hospital onboarding, and starting residency. Student loans often become an afterthought until the grace period is nearly over.

Once students have left campus, where do you send them for reliable information?

CW:
Before they graduate, I give one of my most popular presentations every year: “Public Service Loan Forgiveness for Idiots.”

The title is intentional.

My point is always, if I can figure out PSLF, you certainly can. You’re the ones who got into medical school.

During that session, I have everyone pull out their phones and create reminders.

We actually stop the presentation while they do it.

For example, if they’re planning to consolidate and enroll in RAP, I have them create a reminder for July 1 to:

Consolidate their loans.

Download their Master Promissory Note.

Complete any remaining required paperwork.

Then they create another reminder that repeats every year for ten years to submit their Employer Certification Form for PSLF.

The goal is to make the process as automatic as possible.

I’ve also posted this year’s “Idiot’s Guide to Public Service Loan Forgiveness” presentation on my YouTube channel.

Eventually I’ll take it down because this year’s graduating class is unique. They have repayment options that no previous or future class will have, so I don’t want outdated guidance circulating later.

In fact, I received an email earlier today from one of my graduates saying everything worked exactly as planned because the reminders on their phone told them what to do.

You’re going to get busy. Anything you can do to simplify the process and take memory out of the equation is worth it.

MJ:
Absolutely.

I love that approach.

It’s interesting because so much of the content being created for this year’s graduating class has a very short shelf life. If you’re reading advice from 2025, it’s already outdated. Even guidance published earlier in 2026 may no longer apply because this space is evolving so quickly.

With all the changes brought by the One Big Beautiful Bill Act, I’m curious:

If you could rewrite the portions of the bill dealing with medical student loans, what would you have done differently?

CW:
If I were king for a day and could write the bill however I wanted, I probably still would have eliminated the Grad PLUS Loan.

But I would have replaced it with full cost-of-attendance Direct Unsubsidized Loans.

That may not be a popular opinion, but I do think students should have some skin in the game. Knowing you’ll have to repay your loans encourages people to pay closer attention to their finances.

Would I still love medical school to be tuition-free? Absolutely. I’m still looking for that donor, and anyone is welcome to talk with our development office.

Even our largest scholarships still expect students to cover their living expenses.

So my ideal system would allow students to borrow up to the full cost of attendance, if needed, but entirely through the Direct Unsubsidized Loan program.

I’ll admit there’s a selfish reason too—it would simplify financial aid administration because we’d only have to manage one federal loan program instead of multiple programs.

MJ:
How do you respond when someone says these borrowing caps were necessary because medical school became too expensive, schools had unlimited access to federal loan money, and tuition increased faster than inflation?

CW:
When you look specifically at the past ten years, that argument really doesn’t hold up.

If you go all the way back to the creation of the GI Bill in the 1940s and 1950s, then yes, historically tuition rose dramatically.

But over the last decade, my school hasn’t increased tuition once.

At the same time, we’ve still had to absorb state-mandated salary increases and rising operating costs. I’m certainly not complaining about raises—everyone’s cost of living has increased—but tuition hasn’t been the primary driver.

For our school, and for many others I’ve spoken with, the biggest factor increasing borrowing has been living expenses, not tuition.

Our goal is to graduate students with as little debt as possible.

We don’t want to raise tuition. Every spending decision is evaluated by asking, “How much additional tuition would students have to pay because of this?”

We’re constantly trying to keep costs as low as possible while still providing the best education we can.

The biggest pressure has been inflation.

When I started at our medical school 14 years ago, tuition wasn’t dramatically different from what it is today.

But our estimated student living expenses have increased by more than $10,000—about a 30% increase.

Tuition hasn’t increased anywhere close to 30% over that same period.

MJ:
Do you think this legislation will ultimately cause medical schools to lower tuition?

CW:
Honestly, I don’t.

I don’t think most medical schools are operating with significant profits. I think many are simply trying to break even.

Think about what medical schools have to fund.

I’m professional staff, so I’m actually on the less expensive side of university employees.

But medical schools are paying practicing physicians to teach future physicians. Every hour a physician spends teaching is an hour they aren’t seeing patients.

Then you need exceptional PhD faculty to teach the biomedical sciences during the preclinical years.

None of that is inexpensive.

Medical school classes also can’t become enormous.

There’s a limit to how much you can increase class size before you need additional faculty, which raises costs again.

As I mentioned earlier, our school has gone nine years without increasing tuition, but that has required tradeoffs.

We’ve automated some processes and simplified others.

For example, I can’t offer as much financial literacy programming as I’d like because there simply isn’t enough funding.

Those are the kinds of difficult decisions schools have to make.

MJ:
It’s a difficult balance.

I’ve known physicians who created outstanding financial literacy programs at medical schools, but eventually many of those programs disappeared because they don’t generate revenue.

An attending physician teaching personal finance isn’t seeing patients or performing procedures during that time.

That’s unfortunate because I think we’d both agree physicians need more financial education—not less. Better financial literacy ultimately benefits everyone, including patients.

We’ve spent a lot of time discussing the potential downsides of these changes.

Is there any silver lining you see in this legislation?

CW:
From a financial aid perspective, absolutely.

The biggest silver lining is the new Repayment Assistance Plan (RAP).

The best repayment plan we previously had was the SAVE Plan. SAVE did an excellent job of preventing balances from growing during residency.

The problem was that it wasn’t created through legislation, which made it vulnerable to legal challenges.

RAP was created through an act of Congress.

That means it won’t disappear unless Congress changes the law.

In addition to many of SAVE’s benefits, RAP also includes monthly principal reduction.

I think students who can fully utilize their federal loans and enter repayment under RAP are going to be in one of the strongest repayment positions we’ve ever seen.

MJ:
I completely agree.

When SAVE was introduced, one criticism was that the government was subsidizing too much interest.

Then this legislation created another repayment plan that also heavily subsidizes interest, but it received far less attention because everyone was focused on the borrowing caps and the rest of this enormous bill.

For physicians in training, I think RAP is extremely beneficial.

I’ll admit I’m a little jealous.

I started residency with about $250,000 in student loans and finished with just over $300,000 because of accumulated interest.

RAP would have saved me a significant amount of money.

CW:
And you should be jealous.

It really is that good of a repayment plan.

MJ:
I agree.

I could probably talk about this all day, but let’s move into our final segment: Rapid Fire.

I always call it rapid fire, even though it usually isn’t.

I’ll make a statement, and you tell me whether you think it’s true or false. Then we can discuss it if needed.

True or false: Most medical students will now need private loans to finish medical school, and that trend will become even more common over time.

CW:
True.

I absolutely think so.

The encouraging part is that the lending market will respond to demand, and we’re already seeing that happen.

I think private loan products will continue improving.

For example, some lenders originally limited residency deferment to only three years.

Those same lenders have already begun offering year-by-year deferment extensions for borrowers who remain in residency, making repayment much more manageable during training.

MJ:
More common sense.

True or false: The One Big Beautiful Bill Act will lead to a physician shortage.

CW:
False.

I think medical schools will continue filling their classes.

The physician shortage already existed before the One Big Beautiful Bill Act, and I don’t think this legislation alone will significantly worsen it.

What I do think will change is who becomes a physician.

I also think we’ll see more students choosing higher-paying specialties.

Historically, research has shown that debt isn’t one of the primary factors influencing specialty choice. It usually ranks near the bottom of the list.

Going forward, though, finances are likely to become much more important because students will be balancing both federal and private loan repayment.

PSLF also won’t provide the same level of financial benefit for future borrowers who carry substantial private student loan debt alongside their federal loans.

MJ:
Exactly. What’s really interesting is what this could mean for international medical graduates.

If you look at internal medicine, for example, my understanding is that roughly one-third of primary care internists are international medical graduates. If future physicians are carrying more private loans that aren’t eligible for forgiveness, there’s less financial incentive to choose primary care or internal medicine.

CW:
Right. Or they’re going to pursue a fellowship instead.

MJ:
Exactly. Then you have to fill that primary care gap somehow.

We need a strong pipeline of primary care physicians, and right now a significant portion of that workforce comes from international medical graduates. Some states are already proactively recruiting international physicians and making it easier for foreign-trained doctors to practice. I think we’ll continue to see states evolve in that direction.

It’ll be interesting to watch.

CW:
It definitely will be. I’ll admit I don’t spend much time studying physician workforce trends, so that’s fascinating information.

MJ:
All right.

True or false: Medical students today are more financially literate than they were ten years ago.

CW:
False.

There’s certainly more information available today, but not all of it is accurate.

Like we talked about earlier, information published even at the beginning of 2026 may already be outdated because the rules have changed so quickly.

The problem is that outdated information never disappears.

Students are getting advice from places like Reddit, where many contributors aren’t financial aid professionals or financial literacy experts. They’re also receiving advice from parents and grandparents whose own experiences paying for medical school are no longer relevant.

Even the guidance I’ve given students has changed over the past week because of these legislative changes.

So there’s more information than ever—but not necessarily more good information.

MJ:
That’s a great point. It’s hard enough to keep up with these changes when this is your job, let alone when you’re busy becoming a physician.

This next one is pretty straightforward because we’ve already talked about it.

True or false: The $200,000 federal borrowing cap is enough to cover medical school for most students.

CW:
False.

I think it’s enough to cover tuition at many schools.

But students also have to eat and have somewhere to live.

MJ:
Those are definitely important expenses.

Casey, I really appreciate everything you’ve done to educate medical trainees—not only through one-on-one counseling but also through your educational content online. We’ll talk about your YouTube channel in just a moment.

Before we wrap up, though, we ask every guest the same final question:

What’s one thing you’ve changed your mind about recently?

CW:
That’s a tough one.

Mine is very specific to a trip I just got back from.

I’ve changed my mind about adding a little dry sherry to turtle soup if you’re eating at the Court of Two Sisters in New Orleans.

MJ:
That may be the most niche answer we’ve ever had on the podcast. Congratulations.

CW:
At the end of the day, I’m a foodie.

One of my roles at the medical school is helping teach a culinary medicine course, so food has always been important to me.

We all have to eat, and food is where culture happens. It’s where life happens—around the dinner table.

That was a huge part of how I grew up.

I grew up in the Upstate of South Carolina in a family that was Slovak and Italian on one side and classic Southern on the other, so I had a very diverse culinary experience growing up.

MJ:
Where did you grow up?

CW:
In the Upstate of South Carolina.

MJ:
Since you brought up New Orleans—and you’re from South Carolina—I have to ask:

Which is the better food city: Charleston or New Orleans?

CW:
I’m going to surprise you and say… neither.

Greenville, South Carolina.

MJ:
Really? You think Greenville is better than New Orleans?

CW:
Yes.

Now, New Orleans absolutely has the best Cajun and Creole food. No question.

But in Greenville, I can find outstanding food from almost every cuisine.

We have my favorite falafel restaurant, Pita House, just down the road. We have incredible Thai restaurants, excellent New American restaurants like Lazy Goat, and Greenville recently earned its first Michelin star.

One thing I also love is that Greenville has its own culinary institute.

Anyone—not just professional chefs—can take individual cooking classes or even earn a culinary degree there.

Greenville has quietly become an incredible food destination.

MJ:
Wow. You’ve given me a lot to think about.

I definitely wasn’t expecting that answer.

I’m from Memphis, so I love our food. It’s not the healthiest food, but New Orleans has always been my favorite food city.

CW:
Memphis does outstanding dry-rub barbecue. You have to appreciate that.

MJ:
We definitely do.

None of it’s particularly healthy, though, and I’d imagine Memphis would be a challenging place to be vegan.

But I digress.

Casey, thank you again for joining us today. Before we wrap up, let our listeners know where they can find more of your content online.

CW:
If you want a little more of me—although I’m not entirely sure why you would—you can find me on YouTube as The Med School Money Guy.

Just search for “Med School Money Guy,” and you’ll find recordings of many of the educational sessions I teach for my students.

You’ll also find some older cooking videos.

One of my favorite money-saving tips is buying a whole turkey when they’re on sale for about 25 cents a pound.

I have a short video showing how to break down an entire turkey into multiple meals, along with a few recipes and other budget-friendly cooking ideas we’ve used over the years.

MJ:
Maybe you need a second channel: The Med School Food Guy.

CW:
It just doesn’t roll off the tongue quite as well as The Med School Money Guy.

MJ:
No, it doesn’t.

Casey Wiley, thank you so much for joining us. I really appreciate your time.

CW:
It’s been my absolute pleasure.

Thank you so much for having me, Dr. Jerkins.

MJ:

You can catch The Podcast for Doctors (By Doctors) on Apple, Spotify, YouTube, and all major platforms. If you enjoyed this episode, please rate and subscribe. Next time you see a doctor, maybe prescribe this podcast. See you next time.

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