If you're a physician drowning in student loan debt, you're not alone. The average doctor now graduates with approximately $200,000 in medical school loans, a crushing burden that can derail your financial future without the right repayment strategy. This physician student loan guide will show you exactly how to eliminate your medical school debt years faster than you thought possible, whether through Public Service Loan Forgiveness (PSLF), strategic refinancing, or aggressive repayment strategies designed specifically for doctors.
Medical school debt isn't like other student loans. Here's what makes doctor student loans unique:
Understanding how medical school debt compounds during your training is crucial for choosing the right repayment strategy.
| Medical Training Stage | Years | Physician Income | Loan Payment Ability | What Happens to $200,000 Medical School Debt |
|---|---|---|---|---|
| Medical School Year 1-2 | 2 | $0 | Cannot pay | Grows to $214,000 |
| Medical School Year 3-4 | 2 | $0 | Cannot pay | Grows to $229,000 |
| Residency Training | 3-7 | $60,000-70,000 | Minimal payments | Can grow to $250,000-300,000 |
| Fellowship (if applicable) | 1-3 | $70,000-85,000 | Small payments | Continues growing |
| First Year as Attending Physician | 1 | $250,000+ | Finally can attack! | Now you can make progress |
Most physicians graduate with a mix of federal loans:
Before diving into specific tactics, physicians must choose between two fundamental approaches to medical school debt elimination.
| Factor | Fast Payoff Strategy for Doctors | PSLF for Physicians |
|---|---|---|
| Time to debt freedom | 2-5 years | 10 years |
| Monthly payment | Very high ($5,000-$15,000) | Lower ($500-$3,000) |
| Total amount paid | Less (save on interest) | Potentially much less |
| Best for which doctors | Private practice, high-earning specialties | Hospital-employed, academic physicians |
| Career flexibility | Complete freedom | Must stay with qualifying employer |
| Risk level | Low (you control everything) | Medium (program requirements) |
| Tax implications | None | Tax-free forgiveness |
| Ideal if you owe | Any amount | $150,000+ |
Income-Driven Repayment (IDR) plans are essential for physicians, especially during residency when your income is low relative to your medical school debt.
| Plan Name | Payment Calculation | Forgiveness Timeline | Best for Which Physicians | Key Advantages for Doctors | Disadvantages |
|---|---|---|---|---|---|
| IBR (Income-Based Repayment) | 10-15% of discretionary income | 20-25 years | Most doctors seeking PSLF or lower payments | • Most flexible • Wide eligibility • Payment cap protection |
• Higher percentage for older borrowers • Interest capitalization |
| PAYE (Pay As You Earn) | 10% of discretionary income | 20 years | PSLF-seeking physicians who qualify | • 20-year forgiveness • Payment never exceeds 10-year standard |
• Strict eligibility • New enrollments into the Pay As You Earn (PAYE) plan will not be accepted on or after July 1, 2027. |
| SAVE Plan | 10% of discretionary income | 20-25 years | Currently unavailable for new enrollment | • Would offer interest subsidy • Lower payment calculation |
• Court challenges • Currently unavailable |
| ICR (Income-Contingent) | 20% of discretionary income | 25 years | Only if no other options | • Can include Parent PLUS | • Highest payments • Longest forgiveness timeline |
Example for a medical resident:
This low payment during residency allows you to qualify for PSLF while managing your budget.
PSLF offers complete tax-free forgiveness for physicians working at qualifying hospitals and healthcare organizations.
| PSLF Requirement | What Physicians Need to Know | How to Verify | Common Doctor Mistakes |
|---|---|---|---|
| Qualifying Employer | • Non-profit hospitals • University medical centers • VA hospitals • FQHCs |
Use PSLF Help Tool | Assuming all hospitals qualify |
| Full-Time Status | • 30+ hours/week • Most attending positions qualify • Residency counts! |
Verify with HR | Not counting residency |
| Eligible Loans | • Direct Federal Loans only • Consolidate FFEL if needed |
Check StudentAid.gov | Having wrong loan type |
| Payment Plan | • Must be on IDR plan • IBR or PAYE recommended |
Select on StudentAid.gov | Using wrong repayment plan |
| 120 Payments | • 10 years of qualifying payments • Don't need to be consecutive |
Track via PSLF forms | Not certifying annually |
| Career Stage | What Physicians Should Do | Payment Strategy | PSLF Payment Count |
|---|---|---|---|
| Medical School | Learn about PSLF options | No payments required | 0 |
| PGY-1 (Intern Year) | • Start IBR/PAYE immediately • Submit first PSLF form • Waive grace period |
Low income-based payments (~$300) | 12 |
| Residency (PGY 2-3) | • Annual PSLF certification • Continue IDR payments |
Slightly higher (~$400-500) | 36 |
| Fellowship | • Don't refinance! • Keep certifying |
Moderate payments (~$600-800) | 60 |
| Attending Years 1-5 | • Higher salary = higher payments • Stay the course |
Capped payments (~$2,000-3,000) | 120 - Forgiveness! |
For doctors not pursuing PSLF, refinancing can save tens of thousands in interest.
| Loan Details | Federal Medical School Loans | After Physician Refinancing | Doctor's Savings |
|---|---|---|---|
| Balance | $250,000 | $250,000 | - |
| Interest rate | 8.08% | 3.5% | 3.3% reduction |
| Term | 10 years | 10 years | Same |
| Monthly payment | $2,878 | $2,471 | $407 less |
| Total interest | $95,360 | $46,520 | **$48,840 saved!** |
| Physician Career Stage | Should You Refinance? | Why | Exceptions |
|---|---|---|---|
| Medical School | Never | No income for approval | None |
| Residency | Usually No | Low income = worse rates | 100% certain about private practice |
| Fellowship | Maybe | Better income and rates | Still considering PSLF |
| New Attending | Yes (if no PSLF) | High physician salary = best rates | Any PSLF possibility |
| Established Attending | Definitely (if no PSLF) | Excellent credit and income | Already pursuing PSLF |