Student Loans During Residency: IBR, RAP, PSLF, or Forbearance?

You don’t have to make federal loan payments during residency if you request the residency forbearance, which pauses them one year at a time through training. But interest keeps accruing, and the paused months don’t count toward Public Service Loan Forgiveness (PSLF). The alternative is an income-driven payment on IBR or RAP, which on a first-year stipend runs roughly $250 to $400 a month for a single resident.

• Your loan dates decide your plans. Loans all disbursed before July 1, 2026 can use IBR or RAP. Any newer Direct Loan, including a consolidation, limits you to RAP or Tiered Standard.

• IBR and RAP land close together on a stipend. The bigger differences are what happens to unpaid interest and what you’d pay as an attending.

• The residency forbearance survives the 2027 changes. The new nine-month cap applies to general forbearance on future loans.

• Residency months can count for PSLF. Your employer and your plan both have to qualify.

Payments start when your grace period ends, about six months after you leave medical or dental school, and the plans open to you depend on when your loans were disbursed, not on your graduation year. The first bill usually lands partway through intern year. Payments don’t pause on their own when residency starts. If you haven’t picked a repayment plan or asked for the forbearance by the end of grace, the bill comes anyway.

If every federal loan you hold was disbursed before July 1, 2026, you can choose Income-Based Repayment (IBR) or the Repayment Assistance Plan (RAP) and move between them. IBR months carry into RAP’s forgiveness count, but RAP months generally don’t count toward IBR’s 20- or 25-year forgiveness period. Tiered Standard isn’t open to you.

If you have any Direct Loan disbursed on or after July 1, 2026, IBR is gone for your whole portfolio, including the older loans. Your options are RAP or Tiered Standard, and you can switch between them at any time. A fourth-year student who borrowed for 2026–27 lands here before residency even starts.

A Direct Consolidation Loan made today is a new Direct Loan, so consolidating during residency ends IBR for everything you owe.

SAVE is gone, and PAYE and ICR are scheduled to end June 30, 2028.

On a first-year stipend, RAP and the 10% version of IBR land within about $50 a month of each other, roughly $250 to $400 for a single resident. The Association of American Medical Colleges (AAMC) put the average first-year resident stipend at roughly $68,000 as of July 2025. The figures below use adjusted gross income (AGI) for a single resident with no dependents.

RAP takes a flat percentage of your entire AGI, set by $10,000 income band: 5% between $50,001 and $60,000, 6% to $70,000, 7% to $80,000, and so on up to 10% above $100,000. It subtracts $50 a month for each dependent and never drops below $10. IBR takes 10% of AGI above 150% of the poverty guideline, which is $23,940 for a single person in 2026, if you owed nothing on federal loans on July 1, 2014, or when you took out a loan after that date. Otherwise, you’re on the older version, which takes 15%.

• At $60,000 AGI: about $250 a month on RAP, $301 on IBR, and $451 on the older 15% IBR.

• At $65,000: about $325 on RAP, $342 on IBR, and $513 on the older IBR.

• At $70,000: about $350 on RAP, $384 on IBR, and $576 on the older IBR.

• At $75,000: about $438 on RAP, $426 on IBR, and $638 on the older IBR.

The two trade places just above $70,000, where RAP steps up to 7%. For a resident, the bigger difference is what happens to unpaid interest.

On an illustrative $300,000 at 7%, interest accrues at about $1,750 a month. On RAP, if you pay on time, the Department of Education waives that month’s unpaid interest and matches up to $50 toward principal, so your balance doesn’t grow. Paying ahead can suspend the waiver unless you tell your servicer not to advance your due date.

On IBR, unpaid interest accrues, about $17,000 a year in that example, and it capitalizes if you leave IBR, miss your annual recertification, or later earn enough that your payment reaches IBR’s cap.

Marriage changes the math. If you file separately, each plan looks only at your own AGI. If you file jointly, both use combined income, and RAP has no poverty-line offset, only the $50 per dependent, so a working spouse can push you into a higher band. IBR’s poverty-line deduction grows with family size: 150% of the guideline is $49,500 for a family of four. If you both have federal loans and file jointly, RAP calculates one household payment and splits it between you by each spouse’s share of the combined balance. Filing status can move the payment more than the choice between IBR and RAP does, so a full comparison before your first recertification covers your payment under both filing statuses, with the tax cost of each alongside it.

The attending years are where the plans split. At $300,000 of AGI, RAP takes 10%, or $2,500 a month, with no cap. IBR stops at the 10-year standard payment on the balance you had when you entered IBR. On a PSLF track, the attending years before forgiveness are when that cap limits what you pay on IBR, while RAP keeps rising with income.

The RAP calculator and the IBR calculator each run a payment on your own AGI, filing status, and family size, and the IBR vs. RAP comparison covers the two plans in full.

The residency forbearance pauses your federal payments up to a year at a time, renewable for as long as you’re in training, and the pause costs you interest and PSLF credit. Federal rules require your servicer to grant it while you’re in a medical or dental internship or residency you must complete before you can practice. You request it from your servicer on the form currently titled Mandatory Forbearance Request: Medical or Dental Internship/Residency, National Guard Duty, or Department of Defense Student Loan Repayment Program.

The interest runs roughly $21,000 a year on that $300,000 example, accruing on your full balance every paused month. On Direct Loans, it generally doesn’t capitalize when the forbearance ends. It stays on the account as accrued interest, and you can pay some or all of it during the pause.

The PSLF cost is time. Forbearance months don’t count toward PSLF’s 120 payments, even if you send a payment during them.

PSLF buyback is the exception, but it comes at the end of the track. Once you have 120 months of certified qualifying employment, you can pay to recover forbearance months that fell during that employment, only as many as you need to reach forgiveness.

Under the department’s current guidance, the price is based on the lowest income-driven payment you were eligible for at the time, and you have 30 days to send your tax and family-size information and 90 days to pay. The backlog has run over a year. Months enrolled in RAP or Tiered Standard can’t be bought back, so if those were your only options, buyback is effectively out of reach. The PSLF buyback timeline covers the process.

The residency forbearance sits outside the nine-month cap in the July 1, 2027 changes. That cap applies to general forbearance, at nine months in any 24, for loans disbursed on or after that date. Loans already disbursed keep today’s rules. The forbearance limits page covers the general caps.

Not for Direct Loans in medicine. In-school deferment and graduate fellowship deferment both exclude medical internships and residencies, so a physician resident’s federal tool is the forbearance above.

Dentistry is the exception. A dental residency may qualify for in-school deferment if you’re enrolled at least half-time at an eligible school that certifies it. Interest on unsubsidized and Grad PLUS loans still accrues during that deferment and is added to your principal when it ends.

Economic hardship deferment doesn’t fit most residents either. It keys to means-tested benefits or full-time earnings at or below 150% of the poverty guideline, and a stipend is well above that line for a single resident or small household. Economic hardship and unemployment deferments aren’t available at all for loans disbursed on or after July 1, 2027. The forbearance vs. deferment page covers the broader differences.

“Residency deferment” is mostly a private-lender term. Sallie Mae describes deferring its medical school loans during internship and residency in 12-month increments, up to 48 months total. Private terms come from your promissory note.

Residency months count toward the 120 qualifying payments when your employer and your plan both qualify. The specialty doesn’t matter. In 2025, the House bill and a Senate draft would have excluded residency from PSLF, but the final law didn’t.

The employer is whoever issues your W-2. For a resident, that usually means a 501(c)(3) nonprofit or a government employer, such as a VA, county, or state university hospital, and you have to average at least 30 hours a week. A for-profit hospital doesn’t qualify. The one exception to the W-2 rule covers physicians in states like California and Texas, where state law bars nonprofit hospitals from employing physicians directly, so a physician contracted to a qualifying hospital there can still count, as the PSLF for physician contractors page explains. The common miss is a resident paid by a for-profit management company, staffing entity, or physician group while working inside a nonprofit hospital. The hospital’s name on the badge doesn’t decide it; the employer on the W-2 does, and its employer identification number (EIN) can be checked against the PSLF eligible hospital list. A W-2 from a payroll company contracted to run a qualifying employer’s payroll still counts as that employer’s. A PSLF form submitted in intern year confirms the answer before years accumulate.

The plan has to qualify. IBR, RAP, and the 10-year standard plan all do. Tiered Standard doesn’t, as Tiered Standard and PSLF explains. A $0 payment counts if it’s billed under a qualifying plan during qualifying employment. Since July 1, 2026, late or partial payments don’t count.

Some months don’t earn credit. In-school, grace, and default months don’t count, and neither do most forbearance and deferment months, including the residency forbearance and the old SAVE forbearance.

Grace creates a trade. Consolidating can end it early so qualifying payments start sooner, but it also ends IBR for your whole portfolio, leaves RAP as your PSLF-qualifying plan, and ends buyback for earlier months. The credit gained is at most the six grace months; the loss of IBR and its attending-year cap lasts for the rest of repayment. If you hold FFEL or Perkins loans, consolidating is how they get into PSLF at all, and the same trade applies.

PSLF forgiveness isn’t federally taxable, while forgiveness at the end of IBR or RAP is federally taxable after 2025. The PSLF overview covers the program itself.

Refinancing federal loans with a private lender ends your access to IBR, RAP, PSLF, the RAP interest waiver, federal forbearance and deferment including the residency forbearance, and death and disability discharge. Refinancing private loans doesn’t give up anything federal.

Several lenders, including SoFi, Citizens, Earnest, and Laurel Road, advertise resident refinancing with a reduced payment during training, commonly $100 a month. Terms, eligibility, and how long the reduced payment lasts vary by lender.

Residency and relocation loans are private loans for costs like interviews and moving. Sallie Mae offers one, with a limit its page puts at up to $30,000. It isn’t a Direct Loan, so it doesn’t change which federal plans you can use.

The full comparison is on the medical school loan refinance page.

The same three options price differently depending on whether you’re aiming for PSLF, planning to pay the loans off, or not sure yet.

On a PSLF track, residency is a large share of the 120 payments. A three-year residency at a qualifying employer on IBR or RAP is up to 36 qualifying payments, less any grace months at the start of intern year; seven years of residency and fellowship at qualifying employers is up to 84. Those are usually the cheapest payments you’ll make toward the 120, because they’re based on a stipend. A residency spent in forbearance at the same employer produces none of them. The cash isn’t saved, only postponed: buyback is the only way to recover those months, with the limits described above, and it prices them at what you would have paid at the time. A few months of forbearance in a hard stretch postpones a few of those payments; forbearance for the whole residency postpones all of them. Inside the track, IBR and RAP both count, so the plan choice turns on the attending-year cap described above: IBR stops at the 10-year standard amount, and RAP keeps rising with income.

On a payoff track, the question is the balance you carry out of training. On RAP, an on-time payment keeps the balance from growing through the interest waiver. On IBR, unpaid interest accrues and can capitalize on any of the triggers above, including reaching the payment cap as an attending. In the forbearance, the full month’s interest accrues with no payment going out, though on Direct Loans it generally doesn’t capitalize when the pause ends. Refinancing federal loans during training trades them for a private loan and closes the federal options listed above.

If you haven’t decided, paying on a qualifying plan at a qualifying employer keeps both doors open: the months count toward PSLF if you end up there, and the balance behaves as described above if you don’t. The forbearance keeps the payoff door open and narrows the PSLF one. The physician forgiveness programs page covers the service-based programs, such as the National Health Service Corps, that sit alongside PSLF.

1. Check your disbursement dates. Your federal aid account lists each loan’s disbursement date, which tells you whether IBR is still on your menu.

2. Confirm your employer’s PSLF status. Look up the EIN on your W-2 or offer paperwork.

3. Run both payments on your own numbers, including filing status. Current pay stubs can document a new income that last year’s tax return doesn’t reflect. If you’re married, compare filing statuses with whoever prepares your taxes.

4. Tell your servicer what you chose. Enroll in a plan, or submit the residency forbearance form. If you pause, you can still pay interest.

5. Set a yearly reminder. Certify PSLF employment at least once a year and whenever you change employers, including the move from residency to fellowship, and recertify your income on time.