When you do insane things, you aren’t just automatically normal afterwards. And when you do insane things on repeat for 6 years, you are not automatically normal for some time afterwards.

One year out, I am not certain I am fully recovered. Especially as the year consisted of a busy work schedule, multiple grant and manuscript submissions, and the chaos that is life with a 5 and 6 year old. Not fully recovered, but getting there, perhaps.

The one year anniversary of my PhD coincides precisely with my semester break. The academic break brings rest, but more importantly brings time for reflection. I usually reflect within a career journal I have been keeping since I graduated with my DPT. It is useful, and insightful, and also hilarious. For example one time I was convinced I would open my own pilates/PT studio that also doubled as a coffee shop. Too many things, my dear. Too many things.

At the start of this break, I went back to my journal and something interesting happened. For so long, I have had a pretty long and somewhat consistent things on the horizon: graduate, promote, publish my dissertation. And when I looked ahead this time around, I had nothing obvious upcoming in terms of big goals. To be clear, I have plenty to do in work and life, but there is something about a lofty goal that will take years to achieve that has always given me a lot of meaning. And at the moment, I don’t have anything quite like that.

Now some people may find this to be perfectly ok. But I started this article by describing myself as positively insane. Or rather, I am someone who tends to do things that are insane (people first language). So not having any big projects is somewhat defeating. Ok, maybe not defeating per se, but not very motivating.

So what now?

In college, I worked at the Writers’ Center, and when I was about to graduate, the director of the center gave all seniors a hand-written note (which I still have) and a copy of Ann Patchett’s graduation speech, which was turned into a book: “What Now?” The speech does not exactly answer that question, but rather describes how to be open, present, and appreciate the journey. It does so in little anecdotes ranging from baking cookies in a dorm to spending time with a stranger in an airport.

I have read this little book cover to cover more times than I can count since it was gifted to me. It has, at times, given me clarity in decisions. At others, it has given me comfort that its ok even if I don’t know what’s coming. This time, I don’t have a precise “What Now” in terms of which things I will pursue, but I am starting to come up for air and look around. And as I do, I am trying to pay close attention to the things that bring me excitement. Not things that are easy, or make sense, or might be profitable, but things that genuinely give me excitement.

One of those things I am feeling excitement for is something that has been a piece of me since my Writers’ Center days, but has not always manifested: writing. And the thing about writing (just like one of my other favorite things running), is that to be a writer, one must simply—well—write!

So, write I will.

The final rule can be found here. In the coming weeks and months, we will see many articles and posts written about this final rule. Many will be written by AI, and many will be written by people that didn’t read the language in the decision themselves. I encourage everyone in academia to read these documents in full. To read the language that was used, and to understand the changes for themselves.

These loan changes will affect almost everyone that pursues higher education (that doesn’t come from a family with enough wealth to pay for education out of pocket). It will also impact all of us that work in higher education. I believe it will also impact those in clinical care that rely on clinical education programs to support their clinic volume.

Here are the major points from the decision I believe are most crucial to understand:

1. Graduate student loans are capped annually at $20,500, with an aggregate cap of $100,000

2. For the first time, Parent PLUS borrowers are capped annually at $20,000, with an aggregate cap of $65,000 per dependent

3. Rehabilitation degrees (PT, OT) will be considered graduate student loans rather than professional (which would up the cap to $200,000).

Now there are substantial changes to loan repayment options which will move into 2 (instead of the prior 16 or so) repayment options: Tiered Standard plan and the Repayment Assistance Plan (RAP). This is important, but the major upset with this news relates to the decision to consider only a narrow definition of a professional degree within the final rule.

I am going to dive into this part a bit more because the language (in my opinion) is more infuriating than the actual decision. The decision maintains that the original 11 core professional degrees will be counted (pharmacy (Pharm.D.), dentistry (D.D.S. or D.M.D.), veterinary medicine (D.V.M.), chiropractic (D.C. or D.C.M.), law (L.L.B. or J.D.), medicine (M.D.), optometry (O.D.), osteopathic medicine (D.O.), podiatry (D.P.M., D.P., or Pod.D.), theology (M.Div., or M.H.L.), and clinical psychology (Psy.D. or Ph.D.)), with the addition of a “multi-part test” to see if any other degrees count. This is the infuriating part.

The multi-part test has 4 components:

1. Signifies both completion of the academic requirements for beginning practice in a given profession, and a level of professional skill beyond that normally required for a bachelor's degree

2. Is generally at the doctoral level, 5 and that requires at least six academic years of postsecondary education coursework for completion, including at least two years of postbaccalaureate level coursework

3. Generally requires professional licensure to begin practice

4. Is within a four-digit Classification of Instructional Programs (CIP) code in the same intermediate group as the core list of 11 program fields.

A Doctor of Physical Therapy Degree (DPT) meets the first three specifications very clearly. The fourth specification is the one that requires some more investigation. A full list of CIP codes can be found here. “Within a four-digit CIP code” essentially means, the degree must start with the same four digits as one of the existing 11 professional programs. So, PharmD is 51.2001, so anything that begins with 51.20 and meets the other three specifications in the test above, would be considered professional. Physical Therapy and Occupational Therapy fall under Rehabilitation and Therapeutic Professions (51.23), and therefore, do not meet the criteria for a professional degree.

So, where does that leave us? It leaves us in a place where most of the DPT programs in the US are not going to be able to be afforded without students taking out private loans. To be more demonstrative of how many programs would actually be able to support students without any private loans, see this Figure which I created from PTCAS data. All programs in red would exceed the graduate cap.

However, this decision additionally has tremendous downstream implications for the diversity of our profession (which already has its many issues) as well as implications for availability. If fewer people can afford the degree, we will have fewer providers to care for our communities.

I am happy to see the APTA strongly opposing this decision. If you read this far, please take a minute to reach out to congress via this quick link:

Email Your Member of Congress

I entered this profession with over $200,000 in student loans. I love this profession, and believe so much in what we can do for our patients and for our communities. I was able to pay off my loans in just 7 years because of the protections federal student loans provided. When I graduated, I felt so unsupported by those that entered before me. There was a strict divide between those that entered as a Bachelors or Masters and those that paid the higher rates for the DPT. Instead of feeling welcomed or mentored, I heard “well I wouldn’t have gone to school if I had to pay that much.” And now, we don’t just face a crisis for students, or a crisis of availability, but we face a new divide.

Those that entered before and after July 1, 2026.

But what good does it do to perpetuate that divide? I am seeing programs push up fall start dates just to get one more class in before this change. Don’t get me started on how useless that is in the long-run, but sure it’s nice for that one cohort of students you are trying to protect.

I believe the best thing we can do to protect our new graduates and incoming students is to agree we will continue to fight for them. This decision will not affect us—those that have been practicing and have paid off our loans years ago—in the same way it will affect our next generation. But it certainly will impact our profession and our patients. And for that, we must continue to oppose this. We must continue to think of creative ways to support our students and those that must borrow to enter this profession. And we must use language that doesn’t perpetuate this divide—especially as academics and mentors.

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Earlier, I had sent myself a file from my everyday computer (the one that, for reasons I no longer question, doesn’t connect to the printer) to my less regularly used computer, the one that does. Why was I printing? A fair question, because if you know me, you know I avoid printing unless it is absolutely necessary. It is as much a reminder that I am a true millennial, and not to be confused with an Xennial, as it is a genuine lack of need for a printer.

But today, I had to print.

The computer responded in something close to a normal amount of time, and with the help of a colleague, I chose the correct printer. I walked out of the faculty offices, across the hall, and into the admin office area to retrieve my form.

The Louisiana State Board of Medical Examiners only accepts requests for license files through written, mailed requests. And I need this data for my current project.

So I filled out the form in Word, printed it as requested, addressed the envelope, and tucked the form inside. I waited to seal it until I had the check ready.

Two hundred dollars, to be sent by check or money order.

I have made it 40 years without fully understanding what a money order is, so I went with the check.

Then I went home to find my checkbook, only to remember that I do not actually have one. My bank closed and was bought out, and the new bank never sent me checks. To be fair, I never requested them.

So: another administrative detour. Order checks.

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Once that was done, I found stamps for this letter and one other heading to Little Rock, Arkansas. In total, I requested six license files today from three states, for both occupational therapy and physical therapy. The work took three hours, and now I wait for responses from all six agencies.

In each of these three states—Mississippi, Arkansas, and Louisiana—physical therapy and occupational therapy data are handled by different entities.

At one point, I had three computers open, each doing a different part of the project. One was loading ArcGIS under a new license. One was printing. One was doing pretty much everything else.

In the middle of it all, I looked down at my to-do list for the day: post-its, envelopes, forms, stamps, state websites.

This is research, I thought to myself.

This is what workforce research really looks like. What it really feels like.

It is a far cry from the glamour of publications and podcasts and even the advocacy efforts. It is not sharing a pretty map, which, if I am honest, I had gotten used to doing over the past few months.

It is navigating state health department websites. It is sending requests for data files in the actual mail. It is unglamorous, tedious, and only the beginning of another project.

This is the process.

And this is as much research as the rest of it.

I wanted to share this anecdote from my morning because it felt like the real, official start of my next big project.

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The grant writing began this work months ago. The funding, the new computer, the ArcGIS license, the logistics, all of which mattered. But this was the first morning it truly felt underway: envelopes addressed, forms signed, checks ordered, stamps found, requests sent into the world.

And then comes the part no one really talks about.

The waiting.

The trusting.

Trusting that the forms will arrive. That the agencies will respond. That the data will eventually make its way back. That today’s most tedious three hours are actually the foundation of tomorrow’s map, manuscript, and policy recommendation.

This is the process and the part where progress feels least like progress, and where trust has to do the heaviest lifting.

What part of your own process asks the most trust from you?

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But knowing how to code and feeling comfortable using data science methods in my academic work were very different things. I did not feel confident describing myself as someone who was well-practiced in data science, and I certainly did not feel prepared to teach others about coding or reproducibility.

In many ways, that feeling persisted through the fall.

During those early months of the fellowship, I was engaging with the material and applying reproducibility principles in fairly practical ways. I worked on organizing code for ongoing projects, and I incorporated more structured workflows into the supplementary materials for two grants and two manuscripts that I submitted during that time. All of those submissions were accepted, which was encouraging. It felt like forward progress, but not what I would describe as transformational.

It felt more like I was going through the motions of what I thought I should be working on in the program.

Once spring arrived, I began to see a shift. I started to see clearer opportunities to use data science approaches within other areas of my work. I was collaborating with teams of faculty to answer questions about student outcomes and the curriculum while simultaneously building out student and faculty research teams to begin work on our 2026 grants. As our projects expanded, I realized that if we wanted to grow our research capacity, we needed shared skills and shared workflows.

I did not have formal experience training others in these methods, so I relied on my other teaching experience, which usually begins with content creation. So I started by building a guide.

Initially, I built that guide in Google Docs because it felt familiar and manageable. But then I saw one of the Quarto documents my teaching assistants were using, and I remember thinking very clearly, I wish I knew how to do that.

So I decided to learn.

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My first attempt at building and publishing a Quarto document as an HTML file on GitHub took hours. I moved between R, Visual Studio, and GitHub, trying to understand what each step of the process was actually doing. At the time, it felt far more complicated than it should have been.

Eventually I realized that the complexity was not necessarily inherent to the workflow. I simply did not what I was doing.

So I approached the problem the way we often do when learning new methods: through repetition.

I began intentionally building document after document and pushing each one through the full process. Through this repetition, my confidence grew in very concrete ways. I started to recognize common errors more quickly. I understood how repositories were structured and how version control supported collaboration. I became more comfortable navigating GitHub and sharing code with colleagues.

In the fall, I had actively avoided opening GitHub whenever possible. By the spring, I had nearly twenty repositories and was regularly using them as part of collaborative research efforts. To organize these guides, I built out a Rehab Maps Analytics Lab.

I did not come into this work from a computer science background. I came into it as a clinician, educator, and academic leader because to answer the questions I wanted to ask, I needed to use these methods.

That perspective shapes how I now teach these skills. When I create tutorials or training materials, I try to write for people who are deeply knowledgeable in their disciplines but who may not see themselves as “data people.” I aim to bridge the gap between academic expertise and technical workflows, using language and examples that feel relevant rather than intimidating.

Perhaps the most enjoyable part of the fellowship has been watching others begin to understand the value of reproducibility. At first, code often looks overwhelming or inaccessible. But over time, colleagues and students start to see its potential. They begin to recognize that structured, reproducible approaches can make their work more transparent, more collaborative, and ultimately more impactful.

I have also discovered that I genuinely enjoy the teaching component of this work. Supporting others as they develop confidence with data science tools has become one of the most meaningful aspects of my professional growth, and it is something I hope to continue through future roles within the fellowship and beyond.

More broadly, the fellowship helped me clarify which aspects of academic work truly energize me. Academic careers often involve balancing teaching, research, service, leadership, and new initiatives. While many of these responsibilities are valuable, they do not all create the same level of engagement.

Through this experience, I noticed that certain projects draw me in very deeply. When I open an R document, I know that time will somehow evaporate. I will enter a state of flow and usually have to brought back to reality by an external stimulus—usually by the ping of a Team’s meeting starting if I’m being honest. That sustained focus is a signal that I am working on something that fuels me.

What I am taking forward from the ReproRehab fellowship is not only a stronger technical skill set. It is a greater confidence in my ability to build systems, support teams, and contribute to a culture of reproducibility within rehabilitation research and education.

For clinicians and academics who are curious about data science, my experience has reinforced a simple but important lesson: confidence rarely arrives before practice. It develops through doing the work repeatedly, often imperfectly, until unfamiliar processes begin to feel routine.

Reproducibility is not just a methodological choice. It is a way of thinking about collaboration, sustainability, and shared learning. And gratefully, it is something that can be learned.

I am grateful for the opportunity this fellowship provided. I am glad I decided on a whim just before graduating with my PhD that I wasn’t ready to stop learning. Mostly, I am excited to return to the community next year as a Teaching Assistant.

2025 began with the chaos of the final three months of my six-year dissertation. There were a lot of tears—mostly from finally completing analyses that took years to build. Seeing the maps unfold in the early hours of the morning, usually alone, was surreal. Oddly enough, I cherish those moments. Just me, the work, and the result. No commentary. No explanation. Just the rawness of research and the expression of learning.

Then came the celebration. I defended in March—on St. Patrick’s Day, no less—then pushed through edits, graduation prep, and finally, the big day.

We spent a few days in The Woodlands with no computers, no email, just family. After pictures, I took my gown, hat, and diploma cover back to the room with my daughter. We’d coordinated our outfits (which I was very proud of). Standing in the mirrored elevator, feeling years of working–student–parent weight lift, is a memory from 2025 I’ll hold onto tightly.

And then came the “after.”

I knew it was coming, but knowing and experiencing are different things. When you work so long and so hard toward something and then it ends… there’s a hollowing, a recalibration. Summer was full of this strangeness. I wanted to publish. I wanted to rest. I wanted to reflect. Meanwhile, regular life did not pause—work deadlines, parenting needs, and big changes around me continued. Several close colleagues moved on, and I found myself in unfamiliar territory.

Thankfully, summer also brought some ease. My kids needed less. They swam. They played. There was space to think. I met with my PhD advisors, made a loose plan: turn chapters into manuscripts; find small pools of funding.

Then fall arrived like a storm.

Everyone needed more—my kids, my work, my calendar. From September through December, it felt like I could barely breathe. I struggled to say no and slowly lost many of the things that ground me: reading, writing, even using a paper planner. Everything became survival mode.

And yet, somehow, I stuck to the plan. Manuscripts went out. Grants went out. By December, I had two accepted papers (one published) and two grants awarded. I am deeply proud of what I accomplished. I am less proud of how I accomplished it.

Looking to 2026, I feel something I haven’t felt in years: space. There is no enormous dissertation cloud hanging overhead. I do have a Fellowship to complete by April and one more dissertation paper to submit, along with two funded projects to lead, but nothing feels as all-consuming.

I don’t yet know how to manage a national research team, but I’m humbled that I get to learn. I hope to read more, write more, publish more, present more, and build work that matters.

At a neighborhood New Year’s gathering, I pulled a little pop-up fortune that read: “Pay close attention to your own Yes—to the things that restore you, and the things that you love.” That feels like my guiding phrase this year.

This first year post-dissertation has been harder than I expected, and it isn’t over yet. I want to use this space to share more—what the research process really looks like while it’s happening, how I’m organizing, what I’m learning, what we’re finding.

I’m excited.

I’m deeply grateful for breaks. And yet, they carry their own tension. You’ll be told to rest. You’ll hear it’s a good time to catch up. I always feel the pull to do both while really just wanting to return rejuvenated.

For me, this often shows up as a break bucket list. It blends restful activities (reading, sleep, walks), catch-up tasks (haircuts, appointments), and rejuvenating things like catching up with friends. And yes, it also includes what others might call “work.”

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This break, my husband thought I only had a week off when I actually had two. Why you might ask? Because the second week included writing blocks and a few meetings. To me, they were the kind that energize me, but to the outsider, it certainly looks like work. His comment made me pause: Did I need to do these things during break? Did they cost me something? Would more activities that look like traditional rest make me feel better?

The more I reflected, the more I realized: my break life and my work life don’t actually look that different. My schedule is somewhat flexible, I spend time (whether I’m on break or not) meeting about things I care about, writing, and working towards my research projects. And maybe that’s special. To be doing work that I end up doing anyway—even when my time is my own.

💬 I’d love to know: What does a real break look like for you?

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The problem is not that humans draw lines in the land, but rather that the ways in which humans live (how they settle in neighborhoods and communities) and how geography works, often leads to discrepancy. When you add in concepts like democracy and representative structures, the way you decide to draw these lines, have massive and long-term consequences.

Let's talk about Texas.

Texas is in the midst of a special legislative session, which should be focused on reconstruction and future prevention after the July 4th floods that swept over 100 people away. Instead, it's focused on redrawing congressional districts.

Why do districts need to be drawn in the first place? Texas has 38 seats in the United States House of Representatives. And these 38 representatives should serve roughly equal populations (determined by the census). The problem is, of all the ways land is divided in Texas, there is no designation that equals 38. There are 254 counties, 2,655 zip codes, and 6,896 census tracts. So to make congressional districts, lines are drawn. Based on population. You could do this by splitting the counties that are two large and combining counties that are too small. But that is not how it's done. Instead, lines are drawn purposefully. This is done by different processes in different states. In Texas, it’s supposed to be done every 10 years based on the census, and historically, lines have been drawn to systematically dilute the voice of marginalized communities. Its as if you had a cake that had a flower in the middle. If you didn’t want a few people to have too much of the flower, you would cut the cake in a way, so that everyone only had a little bit of the flower. When this happens with people, the people do not get to elect someone from their community because their community is divided. Not by geography, not physically, but by an imaginary line that outlines a district. This is the really layman's explanation of gerrymandering.

Texas is already gerrymandered. You can tell based on how absurd the current maps look. There is no reason for maps to have this much squiggle and swirl to them apart from deliberate drawing decisions.

So let's see how already gerrymandered Texas will look with the proposed new districting that's on the docket this special session.

From the large Texas map, it's hard to see what's changed. Especially when we color code all land the same color:

But we can do some "fun" things with maps. We can color code sections of land based on percentages of data. In this case, let's look at percent Hispanic and percent Black:

Again, hard to tell what's happening at this vantage point. Let's zoom in:

These maps show an incredibly disturbing reality. The new districts, particularly when you zoom into the Houston metropolitan, so a how the new lines have diluted the Hispanic and Black communities. The color goes from dark blue, to medium blue and the number of districts with higher prevalence are reduced. Perhaps this is a good time to remind you that Texas is more than 40% Hispanic.

The wildest thing is that this is so blatant. It is not the time to do this. They are doing this at the bequest of the president. And it is so obviously about demographics.

Houston alone looks bad, but here are the rest of the metro regions:

So, if this goes through, remember: voting is not the only thing that matters, representation is determined by human choices, and these choices have consequences.

The belief that cutting benefits will reduce misuse assumes that health care operates like a transactional business — a one-to-one exchange between provider and consumer. And while parts of healthcare are absolutely a business, healthcare as a system is not a business. It is a system. And weakening part of that system doesn’t reduce cost or abuse — it destabilizes the whole.

The only thing I like better than a system is a metaphor, so let’s look at this metaphorically—perhaps with a summer activities slant because why not? Imagine you’re at a fair. There’s a long line for the rollercoaster. If someone sneaks in without a ticket, yeah — that’s unfair. They’re making the line longer for paying customers. That’s how some folks are describing public benefits — as handouts to people who didn’t “earn” their spot in line. But healthcare doesn’t work like a ride.

It’s not a point-of-service with optional rides. It’s a system — more like a public pool. Now think about a pool. One kid has an accident, and everyone is affected. The water has to be cleaned. The pool shuts down. Everyone’s day changes. That’s a system. The context — who’s in the pool, how prepared the lifeguards are, what policies are in place — all of it matters.

Health care is the same way. When someone can’t afford care, they still get sick. They still show up at the ER. They still need treatment. And if they don’t get preventative care, or if they have untreated chronic illness, we all end up paying. In dollars. In system strain. In public health outcomes.

Cutting Medicaid doesn’t make the problem go away — it just shifts the burden.

This bill doesn’t prevent fraud and waste. It multiplies both by weakening the system that keeps us all afloat. Understanding the difference between a point of service and a system isn’t just semantics — it’s survival.

Denying coverage also creates public health risks. Communicable diseases don’t check insurance status. When the uninsured can’t access timely care, we all become more vulnerable — to outbreaks, strain on emergency systems, and the indirect costs of deferred care.

If we really want to address inefficiencies in our health system, we need to invest in prevention, access, and upstream solutions. Cuts disguised as accountability don’t reduce waste — they deepen inequity and damage the very systems we all rely on.

In the book, Yeager highlights the work and impact of Keivan Stassun, now a professor of Physics, Astronomy, and Computer Science at Vanderbilt University. Stassun has made profound contributions in supporting young people from diverse backgrounds, including individuals with autism and other forms of neurodiversity. After earning his PhD, Stassun’s mother asked him, “Y ahora qué?”—“And now what?”

He started to answer the way I have lately: Get these papers out, publish, keep the momentum going. But his mother interrupted. That wasn’t what she meant. What she really asked was: You’ve been given so much—so now, what will you do with it?

That moment pierced me—especially reading it over Mother’s Day weekend, just one week after I walked across the stage to receive my PhD, in front of my 4- and 5-year-old children. I was able to complete this degree because I was given so much: support to work full-time and go to school, financial education that helped me manage loans, time from my husband, parents, and friends who stepped in when I needed it most.

Walking down the aisle toward the stage, I scanned the crowd of over 400 graduates. My children waved from the audience, holding handmade signs while each sat perched in the arms of my 6’4” husband. I will hold onto that image forever—not just because they’re my everything, but because it was so stark. They weren’t the only children in the room, but there weren’t many. Along the way, I met a few others parenting during doctoral work—but not many. The structures that prevent women, especially mothers, from pursuing higher education are real and persistent.

And now that the dissertation is done, I’m realizing something else: even without that extra layer, balancing work and parenting is still incredibly hard. I’ve seen so many fellow DPTs leave clinical work—and sometimes leave external work altogether—because the systems just weren’t built for us.

So even before reading that passage, I’d already felt the weight of “Y ahora qué?”

It’s part of what has pulled me toward this next chapter: writing more and launching a podcast. My goal is to support others—those pursuing career goals while navigating the complexity of healthcare, parenting, and life itself. The podcast will focus on sharing stories, and I’m also building a dedicated resource section on my website.

In the works:

1. A guide to navigating paid and unpaid leave in the rehab professions

2. Resources for parenting through PT/OT/SLP school

3. Tools and support for parents working in academia

I’d love your input.

As I build these resources and prepare podcast interviews, I want to hear from you.

Whether you're a parent in PT school, balancing weekend shifts with sick kids, or grading papers while your toddler builds a fort at your feet—I want this space to reflect your reality.

• What are your biggest challenges navigating parenting while working in healthcare?

• What were the biggest surprises?

• What do you wish had existed when you were juggling it all?

Comment below or send me a message.

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My presentations on the topic have varied over the years based on the political and legislative season. It would be naive to think that federal student loans (the type of loans the majority of students take out) would not be impacted by changes to our administration and makeup of the house, senate, and courts.

When I speak on the topic, I do so with a basic, two-prong philosophy:

1. Knowledge is power. Learn as much as you can about the system you have borrowed from, about how money works (and doesn’t), and about how to make more money when possible/desired.

2. Tune out the noise, and focus on you. Your goals specifically. What do you want your days to look like? What drives you? What discourages you? There will be a lot of people throughout your career that tell you, “You must do ____.” Block it out. Educate yourself, and make your decisions based on your goals and what you know. Everything else is just someone selling something to you.

I’ve been thinking about how to educate students on financial literacy given the climate, the uncertainty, and the current context. After much thought, my philosophy is the exact same: Educate yourself and tune out the noise.

However, the knowledge may be slightly harder to keep up with. Let’s back up here and consider the “historical” context about what I am talking about. Yes “historical” is in quotes, because I am really talking about the last 15-20 years, which is hardly history, but as far as student loans go, there are three major eras in the past 15 or so years that should be understood if we are to have a real conversation about student loan context.

For transparency, I am making up the names of the “Eras,” but the facts are not made up, and I will do my best to link to the resources throughout.

Era 1: Pre-COVID

The student loan era before COVID was in a lot of ways a simpler time, but not without changes that were (surprise!) enacted politically or as a result of contextual changes in our financial environment.

Public Service Loan Forgiveness began in 2007 under President George W. Bush as part of the College Cost Reduction and Access Act of 2007. The direct language of this act states that, “Cancels the [Direct Loan] balance owed by borrowers who, after October 1, 2007, have made 120 payments under income-based or standard repayment plans while employed in certain public service jobs.” This was the first major loan repayment option that offered forgiveness after a period of payment.

Because 120 payments take 10 years to complete, the first individuals to seek forgiveness did not do so until 2017. In the early years of PSLF forgiveness, it became apparent that there may be some issues with actually receiving forgiveness on this plan. These issues were multifaceted related to individuals thinking they worked for an eligible employer when they didn’t, miscalculating payments, or having payments that were not being counted by servicers. Understanding the relative newness of PSLF is important as we consider the other changes and events that occurred following it’s implementation.

Quite quickly after the implementation of PSLF came the 2008 financial crisis. Readers of my generation will remember this period more distinctly than some perhaps. The profound uncertainty and unexpectedness of this experience as a new college graduate is something I could write about for days, but let me focus myself to the point of this article. In any financial crisis, the body experiencing that crisis is going to act to save money somehow.

One of the ways the United States Federal Government sought to save money was through the Budget Control Act of 2011. (If we’re keeping track, we are in the Obama Era now). This is a 28 page act, but the relevant component of this act was to eliminate subsidized loans for all graduate loans. I am always surprise this doesn’t get more attention because if you think about reducing the cost of education for graduate borrowers, a more reasonable target would not be cancellation, but rather giving back the ability to have subsides on graduate loans.

Let’s explain this with a simple visual. This chart shows three situations. A subsidized loan that accrue no interest during the time a student is in school, an unsubsidized loan at 7% and an unsubsidized loan at 11%. You can see that for a 3 year program with only 60k in loans, the Budget Control Act increased the amount of interest accrued from $0 to as much as 14k. Now, this is simplified because it was likely that graduate borrowers received a portion of subsidized and unsubsidized loans in actuality.

With these events and before COVID-19, there were three main ways borrowers repaid their loans:

1. As fast as possible — often via a standard repayment plan or through refinancing through a private bank.

2. With Public Service Loan Forgiveness — Working 10 years and having the balance of the loan forgiven without a tax bump at the time of forgiveness.

3. With extended (20-25 year) repayment plans — that usually came with some amount of the loan forgiven with that amount forgiven being taxable.

Now, this is a simplified version of the options because there were even pre-COVID a number of options within each of these main strategies, but these were the basic choices.

Era 2: COVID and Emerging COVID

On the afternoon of Friday March 27th, 2020, I was listening to NPR in my car on the way to see a patient in home health. They announced that Trump was about to sign the Cares Act. This act did many things, but the thing most relevant to me was that is suspended involuntary collections of student loans. It also paused all interest accrural. This was a huge deal to me as I had about 50k remaining on my 200k loan and I was uncertain as to how I was going to maintain my patient caseload without childcare for my 10 month old. This interest pause remained until September 2023, and by that time, I was able to save and pay off the remainder of my loan.

From my perspective, this move set up an era of student loans that was incredibly uncertain. The end-date for this forbearance continued to be extended, and extended, and extended. And as it was extended, talks on the possibility of Student Loan Cancellation began to percolate. Student loan cancellation is very different than forgiveness. It would mean that loan balances would be wiped out without the need for borrowers to pay taxes on the amount forgiven and without the requirement of public service.

During the Biden administration, President Biden attempted sweeping loan cancellation by invoking the Heroes Act. This attempt was ultimately struck down in a 2023 supreme court case Biden vs. Nebraska and the Department of Education vs. Brown.

In response to these court decisions, Biden then moved to unveil his “Plan B,” The Save on a Valuable Education Plan (SAVE). Essentially what the SAVE plan did was offer a new pathway to loan payoff that took an extended payment plan, but took away the tax bomb at the end, eliminated the need to work in public service, and significantly lowered monthly payments. It was (financially speaking) a no brainer to sign up for this plan if you ran the numbers. Except for the fact that it was put into place without going through negotiated rule making.

As someone that has obsessed (a bit) over these legislative changes, I was very worried that this would either be quickly struck down or worse struck down by an incoming administration following the precedent that was set in establishing it in the way it was established. I didn’t have much of a space to voice this, so I called up a friend and guest hosted a podcast on the political and legislative risks of student loans. I don’t know if anyone listened to it, but I can now (unfortunately) say, “I told you so.”

In February, 2025, a federal court blocked the SAVE plan.

Era 3: The Pendulum Swing

We are now entering the next era. And if you follow financial influencers on social media, you have likely seen some scary headlines. I tend to be a person prone to panic that is gratefully married to a person not prone to panic. My husband is an econ major, and whenever I start to panic about anything financial in the world, he makes some nonchalant but calming statement about the pendulum. I think what we are seeing in the student loan history of the last 20 years is a series of pendulum swings.

The unfortunate part is that these swings impact borrowers, parent borrowers, but ultimately the state of our nation. We need education. We need education for diverse populations, and we need a system that is built to support education. But that is not how everyone sees it quite yet, so swing back and forth we will.

The most recent house GOP bill that was introduced to committee this week calls for a number of changes that should be concerning to borrowers and future borrowers, but should also get the attention of Universities and faculty. I’ll include the bulleted points below, but note that this bill will likely be amended substantially before going to house vote and (eventually perhaps) to Senate vote.

1. Eliminate subsidized loans for borrowers (ok we talked about this ^)

2. End Grad-Plus and Parent-Plus programs—These are really high interest loans that borrowers generally have to take out if they don’t have savings or a means to pay for living expenses. I had a TON of grad-plus loans to get me through my DPT program.

3. Put a cap on student loan totals to $100,000 for graduate students and $150,000 for professional students. Ok, this would (if carried into law) would basically shutter most professional programs in the US if we’re being honest.

4. Reduce Pell grant access for students enrolled in less than 6 credits.

There’s a lot more to the bill, but let’s not get in a tizzy shall we? As someone who has “done my time” and paid off my loans, why should I care? I care about the future of education and specifically physical therapy and allied health education that will be substantially changed by this type of legislation. The biggest impact will be felt by underserved communities and underrepresented student populations. These are the individuals we need most to retain in our profession to meet the needs of our diverse communities.

Additionally, as an educator, I believe we need to educate our students for the realities of the profession, which for the vast majority of our students includes student loan repayment. So how then do we even begin to educate students on what to do with so much uncertainty. If loan plans take between 10-25 years to repay and we have seen three major eras in the last 20 years, how do we support our students and new graduates?

This is a question I am still struggling with. I think the answer goes back to my original advice: educate yourself and tune out the noise. I will do my best to keep writing on the topic and sharing updates as they come forth. We need a lot more of us educated on loans—not just complaining about them—but understanding them and working to improve the systems that impact borrowers, students, and graduates.

It’s possible that the pendulum is far from settling, so let’s work on guiding it a little, shall we? If you’re an educator, mentor, or student, share this article and start the conversation.

So, I thought I would share the gist of the speech in a format where tears don’t get in the way quite as much.

In order to write a dissertation, you must first have the methods approved by your committee and approved by the graduate school. I completed that process about two years ago. And this was great—except for the fact that the methods I had approved were ones that I did not know how to actually do. And not in an imposter syndrome sense—I literally didn’t know how to carry out the steps.

I had asked a question that required that the answer be one that used Geographic Information Systems (GIS), which is a software that I hadn’t previously used. If you are thinking, hmm, that is an interesting choice for a dissertation, you are correct.

But I was hell-bent on answering that question—so off I went.

And just like any project, when you are working on a dissertation, you will come up against road blocks at almost every step. Oh—this is harder with a sample this size unless I modify the methods. Oh—this dataset isn’t as clean as I thought. Oh—that data? Not actually available.

During my dissertation, in particular, I came up to these road blocks all the time. And at each phase, I dug in and figured it out. In some cases, I dove deeply into the corners of the internet to find old YouTube videos. In others, I re-read method sections 20 times until they finally made sense. And sometimes, I would call up friends, friends, acquaintances—even a friend’s husband, if that’s what it took.

At each road block, I figured it out.

And that brings me to the worst piece of dissertation advice that exists. Now if you have given this advice before, I don’t blame you. It is a pervasive thought and an easy one liner. It is:

The best dissertation is a done dissertation.

Let’s start with the fact that it doesn’t even make grammatical sense. 'The best dissertation is a done dissertation'? What does that even mean? The best is the best—most of us won’t write that one. But the bigger issue is the mindset it promotes. It puts the focus on the doneness of the dissertation.

If I finish, it will be good. The happiness will come when it is over. It will be good when it is over.

At each road block, I figured it out not because I was obsessed with being done, or because I was obsessed with winning awards, or because I was obsessed with having more letters after my name. I figured it out simply because I became obsessed with figuring it out.

So, if I had my druthers, I would flip this very common—very bad—advice. I would suggest instead:

Your dissertation will become done when you become obsessed with figuring it out.

Not all of us will be crazy enough to start a dissertation, but if you are on that path, I hope you will consider this suggestion. And if you are on other paths, I hope you too will consider this reframing for whatever projects you are working on. Doneness will never bring lasting happiness. Even on the day I finished paying off >200k in student loans, I remember expecting to be elated. Instead, I cried, went on a walk, texted my husband, and moved on with my life. Being done with a dissertation is similar. There is contentment and pride in both cases with the doneness, but it doesn’t bring wholeness.

When I accepted the award, I didn’t feel like I’d conquered something—I felt like I’d followed my curiosity to the end of a maze. The tears weren’t about being done. They were about what it took to figure it out.

Figure it out, and the done will come.

How many conversations have you had that started this way? Too many to count probably. When I was a home health therapist, almost daily my coworker would call me (or I would call her) and ask, “Do you have a minute?” It was never just a minute, of course, but that wasn’t the point. The point was we were out there on our own navigating the healthcare system in the height of the COVID-19 pandemic, in the heat of a Texas summer, and both very pregnant with our second children.

The “minute” we were asking for was sometimes to brainstorm treatment ideas for our tiny patients or to work through how to best get important news or education points through to a parent: “Did you notice how they kept dropping toys?”

The “minute” was often about supporting each other through financial and career decisions: “Are you paying into short-term disability?” “Did you take the company car?” “When should I tell them about my pregnancy?”

The “minute” might also be about how to navigate a daycare fiasco: “Did you know he came home with someone else’s diaper and outfit on today?!” And sometimes the “minute” was just to be on the phone.

It was these conversations that initially sparked the idea to start a podcast.

Somewhere between raising two kids, finishing a PhD, and trying to map the rehab workforce—I realized I wanted to hear more voices. Not just data points, but real, layered stories about working in and around health systems.

If my goal is to wholeheartedly support the rehab workforce, I thought: why not amplify these conversations? What if we talked to rehab professionals, not about patient care, but about caring for ourselves? What if we talked to rehab professionals about how they mapped their path, navigated difficulty, and worked through systems?

I dream that this space will be a place to say the quiet parts. I hope to talk to rehab professionals from a variety of backgrounds and ask them, “Do you have a minute?”

The first episode drops next month. I hope you will tune in—and maybe even come on! If you’ve ever wanted to talk about burnout, billing, barriers, or baby wipes—you might be my kind of guest.

So, in short, I’m starting a podcast. It’s called Rehab Maps, and it’s built on those one-minute calls that were never really a minute.

If you are interested in sharing your map, fill out this interest form and lets chat! I’d love to hear your story.

I was chatting with a patient and food came up. I had been taught to address food from a nutrition/wellness lens in PT school. “Have you considered cooking?” I asked naively when she mentioned she would stop at the drive through on the way home. She paused, looked directly at me, and laughed in my face.

I often think about that moment and how grateful I am that she was comfortable enough with me to laugh in my face. She didn’t have air conditioning. It was over 100 degrees that summer in Central Texas, and there was no safe place in her home to cook. My suggestion was absurd.

The education I received was top tier, and yet I was completely unprepared this scenario. Shortly after, I started working in home health and realized more clearly how positively absurd so many of my physical therapy recommendations were after spending time in diverse home and community environments. I saw first-hand the impact of our complex medical system on the people we are meant to serve.

In PT school (at least 10 years ago), we were taught how to evaluate and treat the patient physically with some questions about psychosocial aspects and a nod to the environment by way of a small box in the lower left corner of the ICF model. 10 years later, I am convinced (and so is the literature) that environment may be the most important factor.

Is the rehab profession prepared for that possibility?

I would argue we are far from it. Not only are we not prepared for the possibility (and likelihood) that context may be the most important driver of health and outcomes, but we are woefully unprepared to understand the context in which we provide care. “Woefully unprepared” is a line paraphrased from a quick note I jotted down while listening to Terry Nordstrom at the 2025 Mary McMillan Lecture.

What would it mean to truly prepare our profession for context? That’s the map I’m drawing now...

That’s why I created Rehab Maps—a space to explore the intersections of healthcare, workforce trends, education, and policy that shape our profession.

What You Can Expect from Rehab Maps

Each week, I'll be sharing insights on topics like:

• Workforce trends - Where are rehab professionals needed the most?

• Finances and career mobility - How can we make rehab careers more sustainable?

• Alternative career paths - What does rehab look like beyond traditional clinical roles?

• Big picture policy and education shifts - What changes are coming, and how can we prepare?

• Parenting in Rehab - How do we navigate a profession that is not always setup for caregiving?

And eventually, I’ll be launching a podcast, bringing on guests to share their own "career maps"—their journeys in rehabilitation, the pivots they've made, and the lessons they've learned along the way.

Why Me? Why Now?

I’ve been in the rehab world for over a decade as a clinician, educator, researcher, and advocate. My research has focused on mapping rehab workforce shortages, improving financial literacy for PTs, and integrating social determinants of health into education. Now, I want to take these conversations into a space where we can collectively explore where rehabilitation careers are headed.

Join the Conversation

If you’re a rehab professional, student, or educator looking for a fresh perspective on where our field is going, Rehab Maps is for you. Subscribe to stay updated, and drop a comment—what career questions or challenges are on your mind?

Let’s navigate this landscape together.