Doctor Residency vs Attending Debt Payoff Calculator

Average US medical school debt is $230K in 2026 (AAMC), with many specialists graduating with $300K+. Four mainstream payoff paths exist: PSLF (10 years at a nonprofit hospital, tax-free forgiveness), REPAYE/SAVE (25 years, taxable forgiveness), private refinance (5-7 year aggressive payoff at lower rate), and standard 10-year federal. The optimal path depends on specialty income, residency length, and willingness to commit to qualifying employers.

PSLF Math for Most Residents

Public Service Loan Forgiveness is the highest-EV path for residents in primary care, hospitalist, EM, and any specialty entering academic medicine. The math: 4-7 years of residency at income-driven payments ($200-600/mo) followed by 3-6 years of attending payments capped at 10% of discretionary income. After 120 qualifying payments (10 years total), remaining balance is forgiven tax-free. For a $300K debt with a 4-year residency followed by 6 years as a $250K attending, total payments are typically $180-220K and forgiven balance is $150-250K — saving $100-200K vs standard repayment.

When Private Refinance Beats PSLF

High-income specialists (surgery, anesthesia, sub-specialists) earning $400K+ can usually pay off debt in 5-7 years at refinanced rates around 5%, beating PSLF on total cost. The trade: zero forgiveness, no income protection if you change careers, no death/disability discharge (federal loans have it; private don’t). Critical sequence: never refinance federal loans before certifying PSLF eligibility — once refinanced to private, the loans permanently lose federal forgiveness, income-driven repayment, and discharge protections. Certify employer annually with FedLoan/MOHELA. Job changes mid-PSLF to private practice break the eligibility track.

Last updated May 2026. Sources: Federal PSLF, AAMC Tuition and Student Fees Report.