PA School Student Loans in 2026: SAVE Plan Ending, RAP Plan, PSLF, and Debt-to-Income Strategy

If you’re applying to PA school right now, I know what’s taking up 90% of your brain:

Getting in.

And that makes sense. But I want to say something most people don’t hear until after they’ve borrowed a life-changing amount of money:

Student loan strategy has to be part of your PA school decision before you take out the loans.

Because once you graduate, you don’t get to “undo” your debt-to-income ratio. You just have to live with it.

In this conversation, I’m joined by my colleague Kaitlin Hile (a clinical pharmacy specialist with training in federal student loan strategy) and Savanna Perry (a Dermatology PA and the founder of The PA Platform) to walk you through what’s changing in student loans, what repayment paths actually look like, and what I want you thinking about now, while you still have leverage.

Why I’m So Passionate About This: I Borrowed Without a Plan

I didn’t do this the smart way.

I blindly signed up for loans. I didn’t know anything about anything. And it wasn’t until I was completely done — when I already had all the student loan debt — that I went, “Oh… I’m going to have to figure out something to do with this.”

So please be smarter than I was.

If you’re in the pre-PA phase, you’re in the best position possible: you can still make decisions that protect your future self.

The 4 Student Loan Paths After Graduation (Know These Before You Borrow)

When you finish school, there are really only a few directions you can go:

1) Standard Repayment (10 years)

This is the default: pay your loans off over 10 years.

2) Accelerated Repayment (Less than 10 years)

Pay it off faster — 7 years, 5 years, whatever — which usually means a higher monthly payment.

3) PSLF: Public Service Loan Forgiveness (10 years, tax-free)

This is the most common forgiveness path. If you work full-time for a qualifying employer (nonprofit or government) and make 120 qualifying payments, your remaining federal student loan balance is forgiven tax-free.

4) Taxable Loan Forgiveness (long-term repayment + tax bill)

This is when you use an income-driven repayment plan but you don’t have a qualifying employer. You make payments for a long time, and whatever is forgiven at the end gets taxed like ordinary income.

Those are the paths. And here’s why I’m starting with them:

Your PA program choice can trap you into a path you never wanted.

The Debt-to-Income Ratio Rule That Will Protect Your Freedom

If you’ve never heard the phrase “debt-to-income ratio,” I want you to remember this.

Your debt-to-income ratio is:

Your total student loan debt ÷ your expected first-year salary

That includes undergrad + grad school and includes federal + private student loans.

The goal is to keep your debt-to-income ratio as close to 1:1 as possible — meaning your total debt should not exceed what you expect to earn in your first year.

Is it hard as a PA? Yes.

But it’s still something you can influence — and you should.

Because once that ratio gets to 2:1 or 3:1, you often cannot afford standard repayment on your take-home pay. And that’s when people end up feeling “stuck” taking jobs they don’t actually want because they need the forgiveness structure.

Specialty Reality Check: Why Dermatology Is the Example I Always Use

Let’s say you’re sitting there as a pre-PA thinking:

“I’ve been an MA in derm for years. I love derm. That’s my plan.”

Okay — then you need to be careful.

Because derm is dominated by private practice and private equity, and there aren’t a ton of PSLF-qualifying employers in that space.

So if you borrow a huge amount and PSLF isn’t realistically available for the career you actually want, you’re left with:

• standard repayment (often unaffordable)
  
• accelerated repayment (even more unaffordable)
  
• taxable forgiveness (often one of the most expensive approaches)
  
  

This is why I keep saying: borrow with your real life in mind, not just your dream scenario.

And yes, you might change your mind in school — most people do — which is another reason keeping your debt-to-income ratio close to one protects your options.

“Top Program” vs “Half the Price” Program: My Real Answer

Kaitlin said something I agree with completely:

You have to ask, how much better is that program really? Is it genuinely going to change your job prospects, or does it just have a stronger reputation?

Here’s my spill-the-tea answer:

Eight times out of ten, it’s not worth it.

If you’re going to PA school, graduating, and getting a clinical job… no one cares where you went to school. They care if you’re a good clinician.

And you don’t learn how to be a good clinician in school (no offense). You learn it on rotations and in real practice.

Now — if you’re going for a small, competitive residency or fellowship program, then yes, school reputation can matter a little bit more.

But for most people? Borrowing double for a name doesn’t make your future life easier.

PSLF Isn’t About Specialty — It’s About Employer Status

A question that came up was whether PSLF is restricted to primary care.

It’s not.

PSLF is based on your employer’s tax status — nonprofit or government — not your specialty.

You can work in a wide range of specialties and still qualify as long as the employer qualifies.

Kaitlin also mentioned the Federal Student Aid employer search tool where you can confirm if an employer qualifies (you’ll usually need the EIN, which is public record and easy to find).

SAVE Plan Is Ending: Here’s What Replaces It

Let’s talk about the thing you’ve probably heard the most about: the SAVE plan.

Kaitlin’s point was very clear:

SAVE is going to cease to exist moving forward.

Income-driven repayment (IDR) is an umbrella category (there are multiple plans), but for most people taking out federal loans after July 1, the key plan to know about is the RAP plan.

Here’s the high-level overview Kaitlin shared:

• RAP is calculated based on AGI (Adjusted Gross Income)
• it uses a sliding scale, but for most healthcare professionals (AGI over $100K), it’s typically 10% of AGI
• strategy matters because there are ways to reduce AGI and lower payments (especially relevant for PSLF)
  
  

Important nuance:

These strategies tend to be most powerful for PSLF because anything you don’t pay is potentially forgiven tax-free.

How I Want You to Compare PA Programs (Do This Before You Commit)

If you’re applying right now, I want you to do something super practical:

Add up the total cost of every program you’re applying to.

That means:

1. tuition
2. cost of living (rent matters a lot)
3. total expected borrowing
   
   

A program in rural Kentucky vs a program in New York City? Your rent alone can change your loan burden dramatically.

Once you know total cost, you can estimate your debt-to-income ratio and compare schools objectively.

I’m old (I used Excel)  but whatever system you use, this needs to be a column somewhere.

Use Salary Data, Not Hope

When you’re estimating your first-year income, don’t guess.

I mentioned MaritHealth because they have helpful salary data you can filter by location and years of experience.

And here’s the reality check I gave on the call:

If a program costs $300,000, ask yourself:

Am I going to earn $300,000 when I graduate to compensate for this?

The answer is no.

That’s why this decision matters so much — it can shape your job options for a decade or more.

Federal Loan Limits and PA Program Classification (Why This Could Change Borrowing)

Kaitlin explained that a bill signed into law in July 2025 created limits for future borrowing — with different caps for graduate vs professional programs.

The issue for PAs is classification.

If PA programs are treated as non-professional graduate degrees, federal borrowing limits could push many future PAs into private student loans once they hit federal caps.

And private loans are less flexible:

• higher interest rates historically
  
• harder to qualify without strong credit or a co-signer
  
• no income-driven repayment options
  
• fewer hardship protections
  
• discharge rules can vary by lender
  

This is why professional organizations matter.

What I Want You to Do Now (So You Don’t Feel Trapped Later)

If you’re in the pre-PA stage, here are the simplest action steps:

1) Know the 4 repayment paths

Standard, accelerated, PSLF, taxable forgiveness.

2) Protect your debt-to-income ratio

Get as close to 1:1 as possible.

3) Compare programs by total cost

Include cost of living.

4) Don’t assume PSLF is specialty-based

It’s employer-based.

5) Pay attention to changing IDR rules

SAVE ending and RAP becoming the main plan matters for future borrowers.

Watch the Full Conversation

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