How Doctors Pay Off Med School Debt: 4 Repayment Paths

Doctors can pay off student loans by choosing repayment strategies that match their career paths, financial goals, and personal circumstances.

In a 2024 report by the Education Data Initiative, about 75% of medical graduates have student loans, owing an average of nearly $235,000 just from medical school.

There isn’t a single “one-size-fits-all” approach to repaying your medical student loans. You can mix and match strategies to build the repayment plan that makes sense for you and your goals. Here are four paths to consider.

One way to pay your medical school loans is to apply for an Income-Driven Repayment (IDR) Plan. Essentially, IDR plans adjust your monthly payments based on your income and family size. This path is ideal if you have a lower-paying specialty (below $300,000) as it keeps monthly payments manageable by tailoring to your situation.

On top of that, if you are already working (or plan to work) in a nonprofit, academic, or government organization, payments made through an IDR plan make you eligible for the Public Service Loan Forgiveness (PSLF) program and count as qualifying payments. After making 120 qualifying payments, your remaining loan balance should be forgiven, tax-free.

How long does repayment through this path take?

IDR forgiveness comes after 20 to 30 years, depending on the plan: 30 years under the Repayment Assistance Plan, which is your only income-driven option if any of your loans were disbursed on or after July 1, 2026. PSLF shortens that timeline further, forgiving loans after 10 years.

Steps to start paying off your medical loans with IDR:

1. Apply for an IDR plan online at https://studentaid.gov/idr as soon as possible, ideally at the start of residency.

2. You can also download and print a paper copy of the IDR form and submit it to your loan servicer for processing.

The sooner you repay your loans under an IDR plan, the earlier your monthly repayments will count towards PSLF.

Steps to apply for PSLF:

1. Check your eligibility for PSLF by logging into studentaid.gov again and clicking the PSLF Help Tool. The tool will ask you to enter the Employer Identification Number (EIN) on your Wage and Tax Statement and tell you if your employer qualifies for PSLF.

2. If your employer is marked as “Not Eligible” or “Likely Ineligible/Undetermined” when you select them but you believe they qualify for PSLF, you can still select the option to use that employer and upload supporting documentation on the next slide.

3. If you do qualify for PSLF, you have two ways to submit your application:

   • Using the PSLF Tool, complete the rest of the required fields and provide your employer’s email address so they can receive your form and electronically sign the document. After your employer has certified your form, it also will be electronically submitted.

   • Download, print, and fill out a paper copy of the PSLF form. Have the Employer Section on your PSLF form signed by your employer and manually send it to the provided mail address or fax number.

You will need to resubmit the PSLF Form annually and keep records that can verify your income and family size details to ensure your payment calculations are accurate.

An alternative way to pay off your student loans is to take an aggressive repayment approach. By refinancing your student loans into a private loan at lower rates, you can lower the amount you’ll pay in total and shorten your repayment timeline.

This approach is ideal if you have a high-income specialty, typically earning $300,000 or more. A higher income can be more appealing to private lenders, and a higher credit score likely gives you access to lower interest rates.

Just know that refinancing federal student loans means losing your eligibility for federal loan forgiveness programs like PSLF or IDR. Timing now matters as much as the rate you’re quoted: the disbursement date of your most recent federal loan decides which federal plans you can still reach, which is where refinancing medical school loans starts.

How long does it take?

Typically, doctors who follow this path eliminate their debt in 5 to 10 years after residency, sometimes even faster. To get to shorter timelines, there are additional decisions or changes you can make.

Optional actions to boost this approach:

• Research refinancing options and get the lowest fixed interest rate possible.

• Temporarily “live like a resident” again. Adopt a lifestyle and spending habits similar to those of your residency days.

• Take on additional income sources by securing locum tenens assignments (temporarily stepping in for clinicians while they’re unavailable or where there’s a shortage), extra shifts, or negotiating for bonuses.

Another method doctors can use for their student loans is to look for and take on financial incentives from employers or external loan repayment programs to speed up their debt repayment.

This includes loan repayment contributions from hospitals, recruitment bonuses, tax-free repayment benefits from employers, or loan repayment programs like the National Health Service Corps (NHSC).

For employer-sponsored loan repayment programs, you will also be required to remain in that position for a set number of years as a condition for that incentive.

This path is available if you are working in underserved or rural communities that often have a shortage of physicians, military or governmental roles, or are willing to negotiate employment contracts that explicitly include loan repayment benefits.

How long does it take?

This approach is more situational than the first two paths and depends greatly on the annual contribution amount your employer can offer for your student loans.

In a 2023 report by AMN Healthcare’s Physicians Solutions division, loan repayment incentives can range from $10,000 to offers as high as $400,000.

This approach doesn’t necessarily shave off entire years from your repayment timeline unless you have a smaller debt to begin with, but it can help as an additional fund that’s dedicated solely to repaying your loans.

Actions you can take:

• Actively seek and ask about employer loan repayment incentives when interviewing for positions.

• Explore loan assistance opportunities through the NHSC or similar state-based programs.

• Carefully go over any service requirements or contractual obligations tied to the repayment incentives.

This last loan repayment approach involves considering consolidation, or combining multiple loans into a single loan. This way, you will only need to manage and pay one loan lender, but aside from that convenience, consolidation can have several downsides.

You might get a lower interest rate with the new terms of that combined loan, but then have an extended repayment period, potentially paying more overall across the loan’s duration. With the way consolidation works, it merges the weighted average interest of all your loans and leaves you with a new interest rate that isn’t always better than your original one.

Only consider this path if lowering monthly payments and having manageable loan servicing is your priority. This is often considered by doctors looking to balance loan repayment with other financial goals (homeownership, family planning, retirement saving) as it lets you set aside a portion of your income for alternative plans rather than having to contribute most of it to loan repayment alone.

How long does it take?

Repayment timelines with this path vary widely, around 10 to 30 years, and are affected by your consolidation terms and personal financial decisions.

Consolidation advice:

• Take advantage of grace periods. Direct Loans (both Subsidized and Unsubsidized) and Federal Family Education Loans don’t require you to start regular payments until 6 months after leaving school.

• Consolidating your loans at least 30 days before the grace period ends might help you secure a lower interest rate, but be sure to check details with your lender, since consolidating can shorten or end your grace period early.

Related: Do FFEL Loans Qualify for PSLF?