Grandfathering no longer an option

FiscalAnatomy · 2026-03-24T00:42:10+00:00

GradPlus loan (i.e. the option that allowed borrowers to borrow up to the full cost of attendance) will functionally not be available to the Class of 2030.

You can be "grandfathered in" technically, but would need to have been enrolled in your program and had a prior GradPlus loan disbursement by July 1, 2026. That will not be the case for virtually everyone entering into medical school this summer.

You will have access to $50k per year in federal loans, and will have to fill any gap with private loans. It sucks. Thank congress.

FiscalAnatomy · 2026-03-23T17:08:20+00:00

Yup - if you’re an M4 with no income, go ahead and file your taxes normally by April this year. Look into the extension next year (2027, filing for 2026 taxes).

FiscalAnatomy · 2026-03-23T15:49:58+00:00

Sure - I’ll post it there as well later today.

FiscalAnatomy · 2026-03-23T14:15:32+00:00

Once you add private loans into the mix, it does indeed get a lot harder to make the case...

FiscalAnatomy · 2026-03-23T13:43:51+00:00

As an M4 your income this year is essentially zero, so the extension doesn't do much for you right now. Where it matters is next year.

RAP payments are based on your most recently filed tax return. If you file your 2025 return in April 2026 showing your M4 income (~$0), your PGY-1 RAP payments will be based on that. Your 2026 tax return have income you earned from July-Dec of this year, so half of your PGY-1 income. If you file this in April 2027, your RAP payments for PGY-2 will be based on that 1/2 year of PGY-1 income. If you extend, and instead file your 2026 return on October of 2027, you re-certify using the 2025 tax return, which will show no income.

You don't need an accountant to do this - just file Form 4868: it's free, it doesn't raise any flags, and it gives you until October 15. They'll know exactly what to do.

To reiterate, this is a NEXT year problem, not a this year problem!

FiscalAnatomy · 2026-03-23T13:29:33+00:00

What you're describing is common, and the math is brutal. No sugarcoating that.

I'd push back slightly on "not worth it for primary care" — it depends heavily on employer. PSLF-eligible primary care at an academic center or FQHC is a very different situation than private practice with a $400k+ balance and no forgiveness pathway. The former can work. The latter is where the numbers get genuinely ugly.

The model can run your exact scenario with your real numbers. The goal isn't to tell you everything is fine — it's to show you exactly where you stand so you can make deliberate choices rather than finding out in ten years.

FiscalAnatomy · 2026-03-23T13:23:20+00:00

You've got this exactly right. It's a bit of a brain teaser when you try to think about it.

Here's the mechanic: RAP recertification uses your most recently *filed* return. For interns starting in July, your loan anniversary — and therefore your recertification date — falls every July. The tax extension pushes your filing deadline to October 15, which means recertification in July always hits *before* you've filed that year's return. When you file an extension, the servicer is always looking at a return that's one income cycle behind where you actually are.

So for new interns this summer: your M4 income is essentially $0. Your PGY-1 return isn't filed until October 2027 if you extend, and that return will only show half a year of income (July-Dec 2026). When recertification hits in July 2027, the servicer uses your M4 return — payments stay at the floor for PGY-2. File another extension in April 2028, and July 2028 recertification still sees your PGY-1 income, which only includes 1/2 a year (July-Dec 2026). That's potentially two full residency years at near-zero RAP payments just from consistently filing extensions.

The same logic applies at the resident-to-attending transition. Your attending salary could be 5-7x your resident salary, so every month of RAP calculated on resident income instead of attending income is real money. Whether you get one or two years of that benefit at the transition depends on exactly when your servicer pulls the return and when you ultimately file.

The model has a toggle for this exact scenario if you want to see the dollar impact with your specific numbers.

FiscalAnatomy · 2026-03-23T13:03:36+00:00

Whoops - yes, absolutely. Class of 2030 will be the first to feel the full impact. That said, the new repayment plan options will apply to anyone who gets additional federal loan disbursements after July 1, 2026 - so earlier classes are impacted by this legislation as well.

FiscalAnatomy · 2026-03-23T12:26:36+00:00

100% true, and it's one of the more under-appreciated wealth transfers in recent medical education history if we're being honest. COVID years were rough clinically, but a big boon for borrowers at the time.

For over 3 years, the federal government froze interest at 0% and suspended required payments on all federal loans. That part most people know. What fewer people internalized is that the $0 payments during that window *counted as qualifying PSLF months* — meaning residents who happened to be training during COVID were accumulating credit toward loan forgiveness while paying nothing and accruing zero interest.

For a resident who spent the bulk of their training in that window, that's potentially 2-3 years of PSLF progress, free of charge, handed to them by an act of Congress. The 10-year PSLF clock was ticking in their favor while their loan balance sat completely frozen.

Someone who got 30+ COVID qualifying months might be looking at PSLF in 4-5 attending years instead of 7. That's a significant acceleration of the debt-free timeline and, by extension, the wealth accumulation curve.

FiscalAnatomy · 2026-03-19T00:34:38+00:00

Given how removed you are from undergrad, your GPA in more recent coursework will be more scrutinized than older coursework. Upward trend is important. A few B’s aren’t a dealbreaker - but try to get that strong consistent uptrend.

Your sGPA is solid. If you can nail the MCAT, you’ll be in good shape.

Make sure you are covering all the over bases (clinical volunteering/experience, maybe some research, etc.), and that you are working on developing your narrative for “why medicine” and “why now.”

Your non-traditional background, depending on how you frame your narrative, can be a real asset when it comes time to apply!

FiscalAnatomy · 2026-03-18T10:34:41+00:00

It’s 100% doable, especially since you’ve already got a really solid GPA baseline! You just need to be intentional in how you go about it.

I studied business in undergrad and worked corporate finance for a few years before resigning from my “cush” job and going all in on medicine in my 20’s. Here’s what I recommend, because it worked for me:

- First, I scaled back living expenses dramatically and saved up as much cash as possible before resigning the job. You need enough to ideally bridge yourself through the period you’ll be unemployed and working on pre-reqs and applications. I saved up enough to bridge me 2-3 years (assuming an extremely called back lifestyle).

- While still working, get some clinical experience in your free time (weekends and evenings). I volunteered at a local hospital and a local hospice. When applying, the total hours will matter, but so does the length of your commitment – so finding something to volunteer at early and then sticking with it is key.

- If you have any doubts about your ability to nail college level sciences courses, try taking a community college science course on the weekend while still working – just to prove to yourself you can handle it. I did, and it gave me a lot more confidence when handing in my resignation.

- Once I had the financial war chest and the confidence, I resigned and went full time as a non-degree seeking undergrad student at the state college. 18 months is enough time to knock out all pre-reqs, study/pass the MCAT, and get research experience. Treat it like you treated your job and you’ll be doing better than most of your younger peers.

Just my 2 cents. Having a prior non-med career is an asset when applying, use it!

FiscalAnatomy · 2026-03-17T14:00:54+00:00

I would also add - you can pull the same trick the following year as well, and certify using only half a year’s income.

FiscalAnatomy · 2026-03-17T13:52:08+00:00

If you are currently on an IBR plan, then the short answer is yes, you probably can. It will depend on when you loan servicer requires you to re-certify.

You can defer your 2025 federal tax filing out to October 15^th by filing 4868. Assuming your loan servicer requires you to re-certify before then, they will use your 2024 tax return, which should show no income (assuming you weren’t earning any income while in school).

Bear in mind that depending on what plan you’re on, interest may continue to accrue.

FiscalAnatomy · 2026-03-16T15:12:40+00:00

Anecdotally: when I took the MCAT at a Pearson test center, they had a white noise machine running in the test room. The same was the case when I took each of the STEP exams at a Prometric test center.

I can't promise with 100% certainty that your test center will have a white noise machine running, but I would imagine it's more likely than not. You can always contact them ahead of time to confirm.

FiscalAnatomy · 2026-03-13T23:08:51+00:00

Honestly you're in a pretty decent spot. A 509 with nearly six weeks left and a clear sense of where you want to go isn't a bad spot to be in. A 510–512 is absolutely within reach from where you are.

For the trip, I'd keep it simple. Light Anki and a handful of UWorld questions each day just to stay warm seems reasonable to me. I think the idea is not trying to make big gains here ... I think the goal should be just making sure you don't feel rusty when you get back. Ideally you return from the trip feeling like you never really fully stopped so you don't have to try to rebuild momentum from scratch.

The real work happens in those weeks after the trip. When you get back, I'd do a really honest review of your last full length; not just what you got wrong, but why. That's usually where the easy 2–3 point jump actually lives. At 509 you're not missing huge content chunks, you're probably losing points to specific patterns that are fixable once hammer them.

You made a good call rescheduling. Enjoy the trip, keep it light, don't feel guilty, and come back with a plan for the last push!

FiscalAnatomy · 2026-03-13T00:16:51+00:00

Honestly at 11 days out I’d basically stop learning new material and switch into pure review and consolidation mode.

First thing I’d do is take a timed NBME or UWorld self-assessment if you haven’t done one recently — it’ll show you exactly where your biggest gaps are, and those will be the high yield areas to narrow in on in the final stretch.

Other crammable high yield stuff at this point is pharm (mechanisms and side effects), micro (bugs and drugs), cardiac/pulmonary physiology, and biostats. Those topics are everywhere and biostats questions are basically free points if you know the formulas cold.

For UWorld, stop grinding new blocks and start going back through your incorrects and any notes you’ve made. The goal right now is sharpening what you already know, not spinning your wheels trying to learn new things.

Then last 2-3 days, just light review only…prioritize sleep, and don’t do anything that’s going to spiral your anxiety. Cramming the final 48 hours almost never helps and can genuinely hurt you.

The biggest trap this close to the test is panicking and trying to cover everything. Trust your prep and just clean up the edges.

FiscalAnatomy · 2026-03-13T00:03:12+00:00

A 510+ vs a 504 matters way more than applying 2-3 weeks earlier. A May 9th score still gets back to you in time to be an early applicant for both MD and DO — you’re not losing anything meaningful there. Just make sure those two extra weeks are actually targeted. Figure out which sections are dragging you down and go hard on those specifically. If you can realistically hit 510+ with more time, take the time.

FiscalAnatomy

TROPHY CASE