The Ultimate Medical School Debt Repayment Guide for New Doctors

average medical school debt

$189,000: That’s about the average medical school debt for 2017 graduates, according to the Association of American Medical Colleges (AAMC).

What’s more, a third of graduates also have debt from their undergraduate studies, with a median balance of $25,000.

If you’re facing the six-figure average med school debt, find out if you can qualify for the following medical school repayment options and loan forgiveness programs for doctors.

How to pay the average medical school debt of $189,000 or more

It’s fairly common for medical graduates to put their student loans into forbearance while they complete their residency. But by doing so, you can quickly rack up interest and add even more to your medical school debt.

Putting the average medical school debt of more than $189,000 into forbearance over three years of residency, for example, adds $36,855 to the outstanding balance (assuming a 6.50% interest rate). That brings the total med school loan balance to $225,855.

If you can avoid forbearance or start repaying a portion of your medical school debt, it can help keep interest charges under control. Here are some medical school loan repayment options you can use to manage your debt.

Income-driven repayment programs

On a standard 10-year plan, monthly payments for the average medical school debt of $189,000 are more than $2,100 per month.

Meeting this financial obligation could be a stretch for doctors right out of medical school — especially when the average first-year resident earned just $53,580 annually in 2016, per the AAMC.

Physicians might want to consider switching to an income-driven repayment plan to keep up with their federal student loans on a smaller income. These programs set monthly payments to match your income and cost of living, keeping them affordable.

Under the Pay As You Earn (PAYE) plan, for instance, first-year residents would have approximate monthly payments of just $300 to $350, according to the AAMC.

Using an income-driven repayment plan for medical school loans won’t be the fastest or cheapest way to pay your debt. But unlike forbearance, PAYE will help fight the balance creep of added interest.

Med school graduates might be able to use these four federal income-driven repayment plans:

Keep in mind that eligibility requirements and repayment structures vary. So make sure you get to know each plan before deciding on one.

Refinance medical school loans

Student loan refinancing also might be an option for some medical school graduates.

Through refinancing, you can take out a new loan with a private lender and use those funds to pay off existing loans. Because you’re replacing your debt with a new loan, you’ll have the chance to adjust your repayment schedule and even get a lower interest rate.

This can be a huge benefit since, on average, medical school debt has a higher interest rate than undergraduate debt. The highest federal student loan rates are charged on the types of loans extended to med students:

  • The Direct Unsubsidized Loan rate for graduate and professional students was 6.00% in 2017-18.
  • The Grad PLUS Loan rate was 7.00% in 2017-18.

These rates combined with high average medical school debt balances can lead to huge interest charges. On the $189,000 average med school debt with a rate of 7.00%, for instance, the borrower pays about $74,000 in interest in addition to repaying the principal.

Refinancing medical school debt to a new loan with a 5.50% interest rate would lower monthly payments by $143 and save over $17,000 in interest.

The benefits can be even more compelling when you look at real-life examples:

However, this option has some potential drawbacks. Here are a few things to consider before refinancing your medical school debt:

  • Meeting credit requirements: You’ll have to meet certain eligibility requirements based on your current income and credit history. This might be tricky for physicians right out of medical school or in residency.
  • Losing federal student loan benefits: Switching med school debt from federal loans to private loans also means you’ll forgo access to federal student loan benefits, including repayment plans, the option to forbear or defer student debt, and loan forgiveness for doctors.

All things considered, refinancing is a medical school loan strategy worth considering. However, make sure it’s right for you before you decide to refinance your student loans.

You also can look into refinancing options specific to your profession. For example, SoFi has a refinancing product for physicians in their residency.

Negotiate a physician signing bonus

Signing bonuses are a common way employers attract the medical professionals they need. In fact, 90 percent of doctors recruited through the Medicus Firm in 2016 received employment offers that included a signing bonus, according to HealthLeaders Media.

The average signing bonus offered to physicians was just under $25,000. Assuming a 25 percent income tax rate, you’d take home $18,750 of that signing bonus.

If you applied that sum to make an extra payment, you’d save $15,650 in interest on the average medical school debt balance of $189,000 (assuming a 6.50% interest rate and a standard 10-year term), according to our lump sum extra payment calculator.

If you know you want to join a practice or hospital instead of setting up your own office, look for these opportunities to get extra cash to put toward student loans.

Carefully read your contract and verify the details and conditions of your signing bonus. A signing bonus often requires a commitment to remain at the employer for a certain tenure. And make sure your signing bonus is just that — a bonus, not an advance or a loan you’ll repay through future paychecks.

If you can negotiate a large signing bonus, it can be a great start to your medical school loan repayment. You could knock out a quarter of the average medical school debt in one payment, greatly reducing the amount of interest you’ll owe over time.

Student loan forgiveness for doctors

In addition to using clever repayment strategies, physicians might look into student loan forgiveness for doctors. It can be a lifeline for physicians who struggle with the average medical school debt or owe even more.

That’s probably why 3 in 5 physicians completing a residency in 2017 cited student loan forgiveness as a major concern, according to a survey from health care research firm Merritt Hawkins.

The trade-off, however, is fewer employment choices. You’ll likely have to work in an area of high need or for a nonprofit hospital to qualify for programs that offer loan forgiveness for doctors. Staying eligible for student loan forgiveness through these programs also might limit your choices when it comes to pay, specialty, location, and employer.

If you’re willing to make these sacrifices, student loan forgiveness programs can pay off in the long run.

Public Student Loan Forgiveness (PSLF) for doctors

Physicians whose work qualifies as “public service” can qualify for the Public Student Loan Forgiveness Program.

This is largely determined by their employer. Public service includes full-time employment by a 501(c)(3) tax-exempt nonprofit or public institution (which many hospitals are). It also includes working in areas that are underserved or have a high need for medical professionals.

Borrowers must make 120 payments (monthly payments for 10 years) while carrying out PSLF-qualified work. Then, the federal government will forgive the remaining debt.

Use our Public Service Loan Forgiveness calculator to see how much you could save with PSLF.

Military programs for medical school loan repayment assistance

Branches of the military offer help with tuition for medical students who are service members. But even doctors who have already graduated and are practicing can enroll in military service and get student loan assistance.

Some of these benefits can be combined, while others are an either/or choice. Any of them can take a large chunk out of the average medical school debt.

Make sure you understand these programs and their service requirements so you know what you’re signing up for.

Army doctor student loan assistance

Several student loan repayment assistance options for Army physicians exist and can help you manage your medical school student loans.

  • The Financial Assistance Program awards grants of up to $45,000 per year as well as a monthly stipend of $2,000 or more to Army members enrolled in an accredited residency.
  • The Active Duty Health Professions Loan Repayment Program offers up to $120,000 toward repaying medical school loans. Physicians must be on active duty to qualify, and the benefit is paid out in $40,000 disbursements over three years.
  • Health Professionals Special Pay offers up to $75,000 to both active-duty physicians and doctors who are members of the Army Reserve who have completed a residency in a qualifying specialty. Payments of up to $25,000 are made over the three years.

Navy medical school loan repayment assistance

Members of the military serving as Navy physicians can take advantage of similar incentives. Here are some Navy medical loan repayment assistance options:

  • The Health Professions Loan Repayment Program (HPLRP) offers a yearly maximum payment of $40,000 directly to medical school loans minus federal income taxes, which are typically about 25 percent. It’s open to medical students or residents and Navy physicians.
  • The Navy Financial Assistance Program offers up to $275,000 in assistance to medical residents. It’s paid in grants of up to $45,000 per year for up to four years. It also includes a monthly living stipend of $2,200 for up to 48 months.
  • Practicing physician sign-on bonuses offered by the Navy are also impressive. They can be between $220,000 and $400,000, depending on the physician’s specialty and experience.

Air Force medical school loan assistance

The main way the Air Force helps its members pay for medical school is through its Health Professions Scholarship Program. However, it’s mostly for students who have yet to complete a degree.

The Air Force Financial Assistance Program (FAP), however, can help physicians in the Air Force pay their medical school debt.

Similar to the Navy’s program, it offers a $45,000 grant for each year of your residency and has a monthly stipend of $2,000.

Once you complete your residency, you’ll be obliged to complete a year of service for each year you receive FAP plus an additional year.

Indian Health Services Loan Repayment Program

The Indian Health Service (IHS) is a federal health program for American Indians and Alaska Natives that offers a loan repayment program for health professionals. Those who take advantage of this program will be based in IHS facilities with the greatest need.

In exchange for a two-year service commitment, the IHS Loan Repayment Program will repay up to $40,000 in medical school loans. Physicians can renew their contract for additional student loan benefits until their debt is repaid.

National Institutes of Health Loan Repayment Programs

While many programs offer medical school repayment assistance for practicing doctors, the National Institutes of Health (NIH) offers awards to health professionals in research careers.

To qualify for the NIH Loan Repayment Programs, participants must agree to a minimum two-year contract to perform research funded by a nonprofit organization in the U.S.

Participants can qualify for $35,000 per year in student loan repayment. It also can be applied to most undergraduate, graduate, and medical school debt.

Through these eight programs, health researchers can receive student loan assistance while employed with the NIH (intramural programs) and eligible organizations outside the NIH (extramural programs).

The NIH also has two loan repayment programs for clinicians. One assists clinicians from a disadvantaged background, and the other assists clinicians conducting health disparity research.

National Health Service Corps loan repayment assistance

The National Health Service Corps (NHSC) offers loan repayment assistance to doctors and medical professionals.

NHSC Loan Repayment Program

The first option is the NHSC Loan Repayment Program. Participants commit to working at least two years at an NHSC-approved site.

This program can earn licensed health care providers up to $50,000 toward student loans. Participants also can serve as primary care medical or mental/behavioral health clinicians.

The student loan payout is tax-free and disburses at the beginning of the service commitment to maximize interest savings. What’s more, program participants can apply to extend this benefit beyond the initial two years.

The length and level of assistance provided by the NCHS will depend on the area of service, with high-need areas qualifying for larger loan repayments.

Students to Service Program

For medical students in their last year of school, the NHSC offers a Students to Service Program that provides up to $120,000 toward educational costs and student loans.

In return, the med student commits to providing primary health care at an NHSC-approved site for three years post-graduation.

Medical school loan repayment assistance programs by state

There are many state-sponsored programs that help physicians and doctors repay medical school loans.

Many are offered through the NHSC’s State Loan Repayment Program (SLRP). It provides incentives for doctors to practice in federally designated “health professional shortage areas” (HPSA).

These areas are listed in the AAMC’s database of state-level loan forgiveness and repayment programs for medical school.

Some states also have their own student loan repayment assistance plans (LRAPs) for physicians. Most often, these plans offer student loan repayment or special pay for doctors who commit to practice in medically underserved areas.

Here are the student loan assistance programs available in each state (excluding state loan repayment programs that are currently unfunded or otherwise inactive). Some states also might have State Loan Repayment Programs that are unlisted and administered through the NHSC.


SHARP offers awards, such as repayment of qualifying education loans and payment of direct incentive, to attract primary care physicians to medically underserved Alaska communities.


The Arizona State Loan Repayment Program includes the Primary Care Provider Loan Repayment Program and the Rural Private Primary Care Provider Loan Repayment Program.

Both programs require physicians to commit to a minimum two-year contract. Ultimately, $65,000 is awarded for that time. A third year of service will get $35,000, and the fourth year will get $25,000.


Physicians practicing in an HPSA in Arkansas can qualify for up to $50,000 in loan repayment assistance for a two-year contract. This program is administered through the NHSC SLRP.

The Community Match Rural Physician Recruitment Program offers an incentive of up to $80,000 for a four-year commitment to practice in a rural community in Arkansas.


The California State Loan Repayment Program requires a commitment of two years for full-time work or four years of half-time work in an HPSA.

The Health Professions Education Foundation highlights “golden opportunities” for medical school loan repayment assistance in California.


The Colorado Health Service Corps offers awards up to $90,000 for physicians who commit to a three-year contract practicing in an HPSA in the state.


The Delaware State Loan Repayment Program grants awards to doctors practicing at approved sites in HPSAs in the state. Based on experience and specialty, practitioners can receive up to $100,000 toward student loan assistance with a two-year contract.


The Rural Areas Assistance Program in Georgia offers up to $25,000 per year in student loan repayment for each 12-month commitment to practice medicine in a rural community. Doctors could receive $100,000 total for up to four years.


The Hawaii State Loan Repayment Program offers repayment of educational loan debt to health care professionals who make a two-year commitment to provide service at an approved site.


The Idaho State Loan Repayment Program awards $5,000 to $25,000 per year for a two-year commitment to work for a nonprofit or public employer in a health professional shortage area.

Additionally, the Rural Physician Incentive Program in Idaho provides repayment of up to $100,000 over four years for primary care, family, internal and pediatric physicians serving in shortage areas in Idaho.


The Illinois State Loan Repayment Program requires a two-year commitment to provide health care services in a health professional shortage area. In exchange, program participants receive up to $25,000 per year in loan repayment ($50,000 total).


Iowa’s Primary Care Recruitment and Retention Endeavor (PRIMECARRE) offers full-time physicians up to $50,000 per year in return for a two-year commitment to working at a nonprofit or public employer in an HPSA.

The Rural Iowa Primary Care Loan Repayment Program is limited to medical students of the Des Moines University College of Osteopathic Medicine or the University of Iowa Carver College of Medicine. It offers up to $40,000 per year toward student loans.

Additionally, this program requires a minimum five-year commitment to working in an eligible commitment service area.


The Kansas State Loan Repayment Program offers $25,000 per year to physicians making a two-year commitment to working in an ambulatory outpatient setting.

Additionally, the Kansas Bridging Plan offers up to $26,000 in loan forgiveness to physicians in Kansas residency programs. Participants must commit to practicing medicine full time in a rural community for 36 continuous months after completing their residency.


The Kentucky State Loan Repayment Program offers loan repayment assistance for primary care doctors committed to working in an HPSA for at least two years.


The Louisiana State Loan Repayment Program incentivizes physicians to practice in an HPSA with up to $30,000 per year in loan repayments. A three-year commitment is required.


Maryland’s State Loan Repayment Program awards physicians up to $50,000 per year in medical school loan repayment for a two-year commitment to practice in an HPSA.


With the Massachusetts Loan Repayment Program for Health Professionals, doctors can receive up to $50,000 for a two-year contract serving in an HPSA in the state.


The Michigan State Loan Repayment Program requires a commitment to practice in an HPSA for at least two years. Participants can get up to $200,000 in student loan repayment over eight years.


Participants in the Minnesota State Loan Repayment Program receive up to $20,000 per year toward educational loan repayment. There’s a two-year obligation to serve in a Minnesota HPSA.

There’s also the Minnesota Rural Physician Loan Forgiveness Program. It requires a minimum of three years working in a designated rural area in Minnesota. Participants are awarded up to $25,000 per year toward educational loans, with a maximum of $100,000 for four years of service.

Participants of the Minnesota Urban Physician Loan Forgiveness Program can get up to $25,000 per year toward medical school loan repayment (maximum $100,000 for four years). It requires a three-year minimum commitment to practicing in an underserved urban community.


The Missouri Health Professional State Loan Repayment Program offers up to $50,000 toward student loans for two years of service in an HPSA.


The Montana NHSC Student Loan Repayment Program offers physicians up to $15,000 per year for two years of practicing in an HPSA.

Montana Rural Physician Incentive Program (MRPIP) participants can qualify for up to $100,000 (over five years) in student loan repayment assistance by practicing in a rural or underserved community.


The Nebraska Loan Repayment Program offers up to $60,000 per year in loan repayment assistance to physicians who practice in state-designated shortage areas. A three-year obligation is required, and the physician must accept Medicaid.


The Nevada Health Service Corps offers loan repayment assistance with a commitment, typically of two years, to practice in a state-designated underserved area. Awards are based on available funding and vary by applicant.

New Hampshire

The New Hampshire State Loan Repayment Program requires a minimum commitment of three years practicing in an underserved area. The medical school loan repayment award is up to $75,000 for three years, with an option to receive another $40,00 for a 24-month extension of service.

New Jersey

The Primary Care Practitioner Loan Redemption Program of New Jersey requires a two-to-four-year commitment working in an HPSA or state-designated underserved area. It provides up to $120,000 over four years toward repaying qualified educational loans.

New Mexico

The New Mexico Health Professional Loan Repayment Program will pay off up to $25,000 per year in medical school loans if a physician commits to practicing for two years in a designated medical shortage area in New Mexico.

New York

Doctors Across New York provides an additional payment of up to $150,000 over a five-year commitment to doctors practicing in underserved areas.

Additionally, the Regents Physician Loan Forgiveness Award Program grants up to $10,000 per year to physicians practicing in shortage areas for two years. What’s more, those who have more than $20,000 in eligible expenses can apply for an additional two-year award.

North Carolina

North Carolina has loan repayment assistance up to $100,000 for a four-year commitment to practicing in underserved rural communities.

The NCMS Foundation Community Practitioner Program also offers grants totaling up to $70,000 (capped at half the total loan amount) to a physician willing to commit to five years serving in HPSA.

North Dakota

The North Dakota Federal State Loan Repayment Program offers participants up to $50,000 per year for a two-year commitment practicing at public or nonprofit sites in areas of need.

Participants in North Dakota’s Health Care Professional Student Loan Repayment Program can get up to $150,000 toward student loans for a five-year commitment to serving in a defined area of need in the state.


The Ohio Physician Loan Repayment Program places physicians in high-need areas. Up to $25,000 per year toward medical school debt will be granted for a two-year commitment. For an additional two-year commitment, the award is bumped up to $35,000 per year.


The Oklahoma Medical Loan Repayment Program awards a $160,000 maximum toward student loans over four years: $25,000 for the first year, $35,000 for the second, $45,000 for the third, and $55,000 for the final year.

A two-year minimum commitment to working in a rural or underserved area is required for this program. The commitment can be extended to a maximum of four years.


The Oregon Partnership State Loan Repayment is a two-year service commitment to an HPSA in Oregon. In exchange, participants will receive payments of up to 20 percent of total qualified educational debt each year.

There’s also a Medicaid Primary Care Loan Repayment Program for physicians in underserved Oregon areas who serve Medicaid patients. A minimum three-year commitment can get a physician an award of up to $105,000 toward educational debt.


The Pennsylvania Primary Health Care Loan Repayment Program offers physicians up to $100,000 toward student loans in exchange for a two-year contract to practice at an approved site.

Rhode Island

The Rhode Island Health Professionals Loan Repayment Program grants student loan assistance to approved physicians who make a two-year commitment to practice in an HPSA in the state.

South Carolina

The South Carolina Rural Physician Incentive Grant is for primary care providers who practice in rural or underserved areas of South Carolina. It awards $60,000 to $100,000 for a four-year contract.

South Dakota

South Dakota’s Recruitment Assistance Program offers primary care physicians an incentive of more than $196,000 for a three-year commitment to practice in an eligible rural community.


The Tennessee State Loan Repayment Program provides up to $50,000 in student loan assistance for a two-year commitment. There’s also an option to renew the contract for an additional $20,000 per year. It’s open to primary care practitioners working at eligible practice sites.


Texas’ Physician Education Loan Repayment Program (PELRP) offers up to $160,000 over four years of practice in a Texas HPSA.

There’s also the St. David’s Foundation Public Health Corps Loan Repayment Program, which requires four years of service at eligible sites. Awards of up to $30,000 are granted to physicians each year (up to four years.

And the Rural Communities Health Care Investment Program (RCHIP) offers partial student loan reimbursement up to $10,000 for physicians practicing in medically underserved Texas communities.


Utah’s Rural Physician Loan Repayment Program matches loan assistance awards provided by qualifying rural hospitals in rural areas. The total matched amount physicians can receive is up to $15,000 per year.


The Vermont Educational Loan Repayment Program for Health Care Professionals offers annual awards of up to $20,000 for health care primary care practitioners. They must work at a medically underserved site, typically for 12 or 24 months.


The Virginia Student Loan Repayment Program (VA-SLRP) requires physicians to make a minimum two-year commitment. Participants can be awarded a total of $140,000 toward educational loans for a maximum of four years of practicing in a Virginia HPSA.


Washington’s Federal-State Loan Repayment Program (FSLRP) awards up to $70,000 for physicians who contract to work for two years at a qualifying site in an HPSA.

The Health Professional Loan Repayment Program (HPLRP) is a state-funded program that commits health service providers to a minimum of three years practicing in an eligible site as determined by the state. Participants can be awarded up to $75,000 in return.


The Health Professions Loan Assistance Program offers up to $100,000 in student loan assistance. That’s $50,000 per year for a two-year commitment practicing in a Wyoming HPSA.

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Published in Refinancing and Consolidation, Student Loan Repayment

  • White Coat Investor

    Rather than $176K, potential medical students should know that many of them will owe $400K+ upon finishing residency. Telling them anything less is just sugarcoating. Sure, some of them will get out with less, but there is huge variation in this.

    • Thanks for your comment. I have no doubt there’s truth to what’s you’re saying, and we’re surely not trying to sugarcoat. We’re merely reporting from a source (Association of American Medical Colleges) that listed these figures.

      Do you have another source that shows higher amounts? We’d love to include those in this post if you do.


      Student Loan Hero

      • Mike A

        I just finished residency and a one yr fellowship & have well over $400,000 in student loan debt while trying to care for a family with 3 small children. I tried to refinance to a lower interest rate but was denied. It is very stressful & depressing trying to figure out how Im going to repay this enormous debt.

        • Hi Mike,

          Sorry to hear you were turned down. I can imagine it’s very stressful.

          Were you able to find out why you were turned down for refinancing? If so, this can often help you improve and hopefully you can apply and get approval later on.

          If there’s anything else we can do to help, let us know.


          Student Loan Hero

        • Aa

          I finished residency and fellowship with 300k+, the worse is that once you start working as a doc and making more than 150k, we can not use the interest pay on student loans instead we pay back Uncle Sam more at the end of the yr. crazy. I’ll agree pay as much as one can, I didn’t do and after 5 yrs of paying the minimum I realize the big mistake and now I’m back on tract paying as much as a can to get ride of them.

      • KM

        If you look at most schools’ cost of attendance you can see the higher amounts. Even my state medical school costs $280K. Most medical students come from wealthier backgrounds and receive parental support, which brings down the average significantly.

        I’ve been accepted to a few medical schools this year, which would all put me at $500K in debt by the time I finish residency. I’m currently trying to decide if I should go or jump ship now.

        • Yikes — definitely some scary numbers there! Best of luck with your decision.

          Student Loan Hero

        • Allie

          I think “most” in regards to a wealthy background is unfair. My husband and I are both residents will 400k total each after completion. Both of us are from very poor backgrounds. If say in my Med school class maybe 20% has some family financial support in regards to tuition. None the less, I am happy I went and love what I do. I make a good living and although the dept is very high, we plan to pay our 800k total down in the first 5years out devoting 20k/month to our combined loans. Even in doing that, we could live well if we choose to, but it’s best to wait until the debt is gone to live “like a doctor”.

  • Agree with all the statements made in regard to the growth of loans, and will re-emphasize that this issue will get worse before it gets better as medical classes increase in size and out-state tuition continues to climb. Some are now borrowing in the range of 70-80k per year when all is said and done, quickly accelerating those figures north of 400k when they come out at the other end of the tunnel. The best approach to helping students has to be multi-faceted and start by edifying on these financial topics at an earlier point in the journey.

  • epilobium

    Hey, so I have a question. I’m an older student and had a prior career. So I’m fortunate enough that when I sell my house to move to residency, i’ll have a chunk of money that I could use to pay off most of my student loans. Part of what is stopping me from doing that right away is, why pay them off if I can get someone else to (i.e., loan repayment programs, signing bonuses)? I will be an Emergency Med physician and will most likely go back to Alaska where I believe there will be IHS and/or rural incentives (loan repayment). Although I don’t know for sure, and they are not listed on that link you have. But that said, why take the chance and why not free myself up from having to do something in the future, and just pay them off. No one knows what the future will bring. And paying interest is really annoying. Anyway, what are your thoughts?

  • Allie

    What many students don’t realize is that if your loans are “forgiven” under any federal plan (after 10 years in underserved areas/20-25 yes otherwise) the forgiven portion is taxed as income in the year it is forgiven. For a physician, likely already in a high tax bracket, you should expect to pay 40% tax on any income over around 220k/yes as in individual or around 400k as a couple. This means if you have 200k forgiven in addition to a base salary of 200k, you will have taxes of about 90k on the forgiven amount alone due on the tax year it is forgiven. Plus of course, taxes on your actual earned income as well.

    • Nill

      Not true with the forgiven for working in a non profit plan (PSLF). PSLF is tax free but at this point its looking to possibly be capped around 50-100k before current medical students would be able to use it

  • Joe

    The 176,000 average is misleading. Look at the AAMC graduation questionare data from 2015. About 20% of graduates have no educational debt, and another 10% have less than 50,000. The average debt is skewed from these wealthier family individuals, it would be better to report the median, which is probably over 200,000. It’s impossible for resident to cover all the interest payment on these higher numbers, so yes the debt will grow throughout residencyas well. Link to the questionare is below.

  • Hi,

    Thanks for your question. You’re right that it’s a fairly complicated decision. We typically advise borrowers who are planning to get some sort of forgiveness or repayment assistance to factor that in to the total cost and repayment decisions. So if you think you may get this yourself, you’re right that you might not want to repay a big chunk right now.

    I’m not sure that I have a better answer that as they future really is uncertain and you aren’t sure what will and won’t be available. If you really want to get mathy and check different scenarios, I’d recommend meeting with a Certified Financial Planner to evaluate your options.

    Hope this helps. Let me know if you have other questions.



  • Hi Joe,

    Thanks for pointing this out. I just located the October 2015 fact card, and it lists the median debt for all graduates at $183,000. You can see this here:



  • A. Michael

    As you point out at the start of the article, there is this misleading attitude that medicine is so lucrative you shouldn’t worry about debt. Fortunately, a lot of financial aid departments are trying hard to dispel this myth. Students need to think hard about how to minimize their debt even if it seems like you’re barely making a dent in the full cost. Choose the a lower cost school, consider any kind of help you can get from your family and don’t live large (drinking and going on vacation are not good uses of student loans; unfortunately I know a lot of peers who do this).

    What is interesting is how student debt is impacting the life decision of physicians. Surveys from the AAMC claim that the majority of students don’t consider student debt relevant in specialty choice, but what about the choice of practice type (private vs community vs academic), where to live, or when to start a family? While it is true that physicians have low repayment rates, I think there is real “hidden” cost to student loans we are only starting to understand.

  • Patricia Sammarco Caravaglio

    Well, $ 176,000 would be great for my son. He’s looking at $ 275,000 to $ 300,000 when he’s done. Feel really bad that financially we can’t help him. Did as much as we could for college along with his sister and brother.

  • Dan M.

    If I do the income driven plan can I make two payments a month ( 20% instead of 10%) and get the 120 payments done in 5 years instead of ten?

  • Darlene

    My friend was unable to land a residency. He makes well under 50k, owes 500k in student loans and is struggling to make income based payments. Completely overwhelmed and feeling hopeless. What should he do???

  • Joseph Pruner

    I have $450,000 in medical school debt. My starting salary will be $200,000. My wifes is $85,000. Is it best to pay off these loans as quick as possible or do IBR, which I am eligible for. ???

  • Hi Dan,

    Assuming you’re referring to Public Service Loan Forgiveness, unfortunately no, you cannot do this. The reason is that the rules related to this stipulate you can only make one qualifying payment per month. So there’s no possible way you can do this faster than 120 months.

    You can read more about what counts as a qualifying monthly payment here:

    Hope this helps. If there’s anything else I can do, let me know.



  • Hi Joseph,

    That’s hard to answer. Are you judging this based on if you can get forgiveness or not?

    To figure it out, you really need to do the math and find out what works out best. You can use this tool to compare repayment plans and forgiveness:

    In general, we do recommend borrowers pay off loans as fast as possible as this often saves the most money. But it really depends.

    If there’s anything else i can do to help, let me know.



  • Caroline M

    It is sadly making me feel better about my situation here. I am not a physician, but a PA. Just graduated in September, started working in October. Pre-taxes, my salary is $122k (though I also work as an IC so have to put taxes away and pay for all my “benefits”). Anyway, so my take-home is $80k that isn’t taxed and not going towards my benefits that I would normally receive. I did not have any assistance in PA school (went to Midwestern U.) nor did I have much help in undergrad, so I have loans from both. I have all gov loans and am currently paying $2500 per month per the Standard Repayment plan. I currently have $215k in student loans. My 2 top loan amounts are $67k (at 7.65%) and $66k (at 6.16%). Those are my top 2 interest rates. Is it better to keep paying off $2500 in student loans for the next 120 months, or switch to the a different payment plan where my monthly payment would be closer to $1500 and put the extra $1000 to the one with the highest interest. Would that make that much of a difference? Meanwhile the other loans continue to gain interest… Edit: **I should also mention I applied for the NHSC loan repayment program, so I’m hoping for that.

  • Annmarie

    I am going to graduate from medical school in 2017 with $230,000 in debt. Fortunately my husband has saved enough money for us to buy a house in the location where I land my residency almost entirely with cash. Both of us would like my student loan debt to disappear as fast as possible after starting residency. I plan on using a huge chunk of my residency pay towards med school debt since we have my husband’s income to pay for our other expenses. My question is, if my monthly repayment amount is $2000 based on Income Based Repayment for standard 10 year plan, can I make pay off more than that amount? My goal is to make a huge dent in my med school debt in residency, so after I graduate from residency I can pay off the loan in 2 to 3 years.

  • Hi Annmarie,

    Thanks for your question. Are you simply asking if you can make extra payments on Income-Based Repayment? If so, the answer is that yes, you can. If you plan to pay off your loans in 2-3 years, you monthly payments will likely need to be much larger than the required amount.

    You can use our Prepayment Calc to figure this out:

    Just throwing in an estimate on your interest rates of 6%, you’ll need to pay about $7,179 per month to pay off your loans in 3 years. By paying them off early, it’s estimated you’ll save about $55,131.

    Hope this helps. If there’s anything else I can do, let me know!



  • Hi Caroline,

    Thanks for your question. It’s typically beneficial to direct payments to the loans with the highest interest rates to save the most money and pay off loans faster. To find the answer to how much you’d save by doing this, there’s definitely some math involved. It’s a bit complicated given other loans are involved.

    You can find our calculators here, which may be able to help:

    Here’s a Debt Snowball Calculator that may be able to help too:

    If there’s anything else we can do, let us know!



  • Ryan

    if you are fortunate enough to find a hospital to help pay off your student loans. Is there away for the hospital to pay of the loans directly in your behalf so you don’t have to pay taxes on the loan repayment?

  • Michael

    I currently have about 150,000$ in student loan debt (Most of which is from graduate school). I am currently enrolled in the Repaye program and my monthly payment is not nearly enough to cover the monthly accrued interest. It is my understanding that under this program the government pay 100% of subsidized loan interest not covered by the payment for the first 3 years, and then 50% of the interest not covered for the remaining years. They also cover 50% of unsubsidized loan interest not covered by the payment for all years. Is it possible to be in Repaye with no intention of wanting the forgiveness, pay more on the loans, but still receive the interest benefit from the government?
    My loans accrue 800$ in interest a month
    My standard payment is 400$
    The governemnt pays half the difference (200$)
    *And then I make an additional payment a few days later (1,000$)

    If this is possible? and if it is why dont most people choose this route? Essentially you still pay something similar to your standard 10 year repayment but save yourself alot of interest in the beginning (because the government covers 50%)? Let me know if this seems crazy or am I missing something?

  • Erin

    I have a question that seems to frequently garner different answers. If you make payments during residency and/or fellowship under an approved plan (IBR, etc), do these count towards the 120 payments for the public service loan forgiveness program?

    • Christopher Lai

      Yes, IBR payment plan is under the qualified payment plan for PSLF.

  • Hi, thanks for the post. I have a question hoping the board can help. My wife is a physician and has close to $300,000 in debt. She was doing income based repayment, and wasnt even making the interest payments while doing fellowship, and now makes $160,000 pre-tax and her payment is $3300/month. Even this is barely bringing down the principal on the loan. I am not a physician and earn $150,000 pre-tax.

    We are debating whether to file jointly or separately to pay back our loans. Couple questions:

    if we file jointly, will her income based monthly payment jump up a lot, or is there some sort of cap to how much this can be?

    if we file separately, would it make sense to keep paying the minimum income based amount, or should we pay it down as fast as possible.? She currently qualifies for the non-profit debt forgiveness, but this is after 10 years (she is 1.5 years into it, so has 8.5 to go), but she said this doesnt apply if she decides to go part time after we have our second child, and it seems like the amount she would be forgiven either way would be minimal and seemingly outweighed by all the extra interest paid??

    I tried using the calculator you posted here, but its a bit confusing. any advice/help is appreciated.

    • Hi,

      Glad we can help!

      I’m not exactly sure how much her payment will jump, but you can get an estimate using this calculator:

      For IBR, payments are capped at the 10-year Standard Repayment amount.

      In terms of what you should do, that’s pretty hard to say. It sounds like she may be eligible for Public Service Loan Forgiveness from what you’re telling me. This calculator can help with that:

      Just keep in mind that this calculator can’t account for the 1.5 years of payments she’s already made.

      I hope this helps a bit! If there’s anything else I can do, let me know.



      • thanks! it seems like shes already capped so us filing jointly wont have much of an impact, and she unlikely to get much in the way of forgiveness. We are going to try and pay it down as fast as possible. unfortunately, with so much in student loans, its hard for her to refinance to better rates

    • Christopher Lai

      With IBR, only your wife’s income is considered if you chose to file your taxes separately from her spouse. However, the payments are capped at the 10-year Standard Repayment amount, as Jeffrey stated.

      With 8.5 years more to go and the possibility of going part-time, it seems like PSLF is out as an option for your wife. So you essentially have two choices:

      (1) file separately and continue to make the monthly IBR payment, even if she goes part-time, as any remaining loan balance will be forgiven in 25 years

      (2) what is the interest rate your wife is paying on her loan? If it is high, considering refinancing it with a private lender (SoFi, Earnest), and try to pay it off as fast as you can.

      $300k in debt is high, but between both of you, you make a combine salary of $310k, so things could definitely be much worse.

  • Matthew Felten

    Hello, I am in the first year of residency now with 60,000 federal loan (6.6 interest rate) which it is on income based plan pay and 107,000 private loan (8.8 interest rate) on deferment because I can’t afford payments with my income. I would like to refinance the privet loan but I don’t know if I will be approved for a lower rate and if have to make payments right a way if I get accepted. I have ruled out a cosigner as an option. Can you tell me if refinancing right now in my first year of residency is a good idea or not?
    Thank you.

    • Christopher Lai

      8.8% on your private loan is high. You CAN try to refinance your private loan, but I’m not sure you can get a much better rate considering that you are just in your first year of residency and with no co-signer. Additionally, I highly doubt you can get the same deferment benefit that you are getting with your current private loan, as the new private lender might require you to start making repayments immediately. I will definitely recommend refinancing once you become an attending, though.

      I will recommend you NOT refinancing your federal loan, as this will make it ineligible for PSLF if you are planning to go that route.

  • Hi Matthew,

    Typically you must make payments right away if you’re approved for refinancing. However, if you’re in a “grace period,” some lenders will honor this.

    That said, it may be difficult to get approval for student loan refinancing while you’re in residency due to debt to income eligibility requirements.

    If you’re curious, nearly all of the lenders (all but Citizens Bank and College Ave) we work with offer a soft credit pull rate check with no obligation that takes less than 5 minutes. You can see them here:

    If you have other questions, let us know!



  • C’havala J

    Hi, Student Loan Heroes!
    I have a slightly unusual situation. I went to medical school in Australia, and have chosen to train in Australia, too. I graduated with about $360k in medical school debt at depressingly standard high interest rates. My income is around USD $80k per year, but anaesthesia training here will take me about 9 years total. I have observed that most refinancing inquiries require an employer from a pre-populated list of US institutions. Any recommendations for begging leniency for the impoverished expat? I would love for my interest to be more manageable so I can pay everything off as quickly as possible, but so far can’t figure out how to apply!

    • Hi C’havala,

      Thanks for your question. Are you a U.S. Citizen? That’s the first requirement.

      Our refinancing lending partners that explicitly state U.S. residency is not required are DRB, LendKey, and CommonBond. LendKey does state that you must at least apply with a U.S. address. Have you tried any of these lenders?

      SoFi, Earnest, and Citizens all say that U.S. residency is technically required.

      You can find these lenders here:

      If there’s anything else I can do to help, let me know.



  • J Curtis

    I’m trying to decide between the different Income based repayment options. What is the downside of just choosing the one with the lowest payments? Because the income based repayments are not even enough to cover the interest on my loans, when is that interest capitalized if I am under an income based plan?

    • Christopher Lai

      Among the various income-based repayment options, PAYE and IBR are essentially the same, and are the lowest payment option. During your residency/fellowship years, it is most likely that your monthly payments will not come close to covering the interest on your loans. The interest will accumulate and capitalize monthly. Your monthly payments will then adjust higher when you finally become an attending, but will be capped at the 10-year standard payment rate of the original size of your loan.

      Because you are hardly making any payment during your residency/fellowship years, and are only making a capped payment during your attending years, PAYE and IBR are the least effective way to pay down your student loan debt. UNLESS you are planning to utilize PSLF, then it makes a lot of sense to pay as little as possible on the expectation that the entire student loan will be forgiven in 10 years time.

      If you are not planning to utilize PSLF, and still want an income-based repayment option, then I would recommend RePAYE. With REPAYE, you start off with the same payment during your residency/fellowship years, but your monthly payment will NOT be capped at the standard 10-year repayment once you start making real wages. The most important distinction is that if the payment under REPAYE does not cover the accruing interest on your student debt, your total loan balance will grow despite payments made (“negative amortization”), you will only be responsible for 50% of the interest accrued.

  • EvaSwitchBox20

    Glad to see the comments section here is still somewhat active…. I have a crazy student loan debt situation, that I feel fairly versed in, but am getting desperate. I have just of $300K in federal loan debt from medical school, and just over $200K private student loan debt from undergrad…..yea, I know, I have yet to meet anyone that can beat that unfortunately. I’ve got a good grasp of my federal debt loan repayment strategy thus far while in residency (will finish June 30th, 2018), but the bigger challenge now is that I have a few of the private lenders banging down my door trying to demand repayment now, and there’s no way I could afford them. I’m supporting myself and my wife, who has been unable find a job unfortunately. Are there any lenders who would consolidate my Private loans, and either allow me to defer while in residency thereafter, or either allow me to pay a fairly reduced payment? I’m just trying to stay afloat while finishing residency, then I’ll make more comfortable payments when I start getting a full salary.

    Any help would be fantastic!!! I feel like I know the answer, but I’m always hoping some nice new policy will come out and surprise me…. thanks!!!

  • EvaSwitchBox20

    Glad to see the comments section here is still somewhat active…. I have a crazy student loan debt situation, that I feel fairly versed in, but am getting desperate. I have just of $300K in federal loan debt from medical school, and just over $200K private student loan debt from undergrad…..yea, I know, I have yet to meet anyone that can beat that unfortunately. I’ve got a good grasp of my federal debt loan repayment strategy thus far while in residency (will finish June 30th, 2018), but the bigger challenge now is that I have a few of the private lenders banging down my door trying to demand repayment now, and there’s no way I could afford them. I’m supporting myself and my wife, who has been unable find a job unfortunately. Are there any lenders who would consolidate my Private loans, and either allow me to defer while in residency thereafter, or either allow me to pay a fairly reduced payment? I’m just trying to stay afloat while finishing residency, then I’ll make more comfortable payments when I start getting a full salary.

    Any help would be fantastic!!! I feel like I know the answer, but I’m always hoping some nice new policy will come out and surprise me…. thanks!!!

  • Judy Hsu

    Hi, my son is grading in may of this year with $197k in principal and $21k in interest.
    He is planing to use the PAYE plan during residency.
    would it be better if we can pay off the $21000 in interest first before the loan capitalizes ?
    How much would we save over all if we did this ? thanks

    • Christopher Lai

      It depends on whether your son is planning to utilize PSLF. It is always “better” to pay off as much of the debt (be it principal or interest) to reduce the amount of interest accumulating over the life of the loan, but if your son is planning to utilize PSLF, then the benefit in paying off the $21,000 in interest before the loan capitalizes greatly diminishes.

      Since he is using the PAYE plan, the monthly payment is dependent on his income, and capped at the 10-year standard payment rate when he becomes an attending. The balance of his student loan debt does not play a part in determining his monthly payment. And with PSLF, everything goes away in 10 years, assuming he works for a non-for-profit organization and makes 120 qualified monthly payments. Of course, this is with the assumption that the rules around PSLF does not change from today.

      However, if he is NOT planning to use PSLF, then yes, it makes plenty of financial sense to pay off the $21,000 in interest. How much you will save is really dependent on the interest rate you are paying amortized through the life of the loan. I would recommend considering refinancing with a private lender (SoFi, Earnest) as soon as he becomes an attending so as to get a better rate.

  • Judy Hsu

    Hi, my son is grading in may of this year with $197k in principal and $21k in interest.
    He is planing to use the PAYE plan during residency.
    would it be better if we can pay off the $21000 in interest first before the loan capitalizes ?
    How much would we save over all if we did this ? thanks

  • Hi,

    Sorry to hear about this! Unfortunately, I don’t know of any lenders that will allow you to refinance and then defer payments or get on some sort of reduced payment plan. To my knowledge, they all require borrowers to immediately begin repayment on the refinanced loans.

    Are your private lenders unwilling to defer your student loan payments? I know many do not offer much relief here, but it may be your best shot.

    Sorry I can’t be of more help. If there’s anything else I can do, let me know.



  • tsk tsk

    ur math is so off. Do you realize how much a 50k bonus is taxed? If the average person owes 150k even, theyll only pay off 28-30k!