DO Student Loans: A Complete Repayment Guide for Osteopathic Medical Students

Students borrow similarly at osteopathic medical schools and often even more; yet most repayment guides focus on students who take USMLE and MD programs. If you are a student at DO school, you have access to federal loans and IDR plans along with eligibility for PSLF like MD students do. Yet there are some specific details for DOs that you should understand before you plan a repayment strategy.

How Much DO Students Borrow

Students graduating with a Doctor of Osteopathic Medicine (DO) degree have large debt and according to AACOM reports average debt exceeds $260, 000, comparable to average MD debt and often higher. Most DO schools are private and do not offer tuition subsidies that some public MD programs do. Loans available are Direct Unsubsidized Loans (up to $20, 500 annually) and Grad PLUS loans. These cover tuition fees and living costs and rates are set by federal government and are the same for both MD and DO borrowers. Tuition varies for new DO programs and for-profit institutions and this can push total debt to over $300, 000. Before choosing a program it is wise to estimate total debt expected based on specialty salary that you plan to practice. This ratio helps you decide whether Public Service Loan Forgiveness (PSLF) or aggressive repayment would be most sensible.

DO Students and PSLF Eligibility

Important: DOs qualify for PSLF under exactly the same rules as MDs; program does not care about the degree. If you work for nonprofit hospitals, government entities, VA facilities or FQHCs, your payments count toward the 120 needed for forgiveness; this applies whether your degree is DO or MD. This is important because DOs typically focus more on primary specialties such as family medicine, internal medicine and pediatrics and this sector of work also has a lot of jobs in the nonprofit sector and government. This alignment with PSLF tends to go unnoticed by DOs when choosing a repayment plan. Roughly 20 percent of active DOs work for employers eligible for PSLF; chances of finding such employers are very high if you seek a career in underserved or rural areas.

The COMLEX vs. USMLE Decision Has No Loan Implications

When you take COMLEX or USMLE some students take both and that means extra cost from the exams. Others do not take USMLE. Choice of which exam to take does not influence how much you will have to pay back with loans: federal loans do not mind whether you pass a licensing exam or not. Differences in exam choice do matter for matching residencies but financially don't let expense of fees drive you into borrowing too much. Fees for COMLEX levels are about $600 to $700; adding USMLE Steps adds another $1500 or more to fees. Costs need to be budgeted for but do not stress because you have at least $250, 000 in loans regardless.

Residency Training and Loan Strategy for DO Students

Since merger of systems for AOA and ACGME in 2020, changes have been significant for DO graduates entering residency. Today all DO graduates match into the same residency programs along with MD graduates and receive similar salary structures.

During residency both DO and MD students have three main options:

Income Driven Repayment (IDR): PAYE, IBR based on income. Most residents pay $300 to $600 per month. For those aiming for Public Service Loan Forgiveness (PSLF) those payments count towards 120 qualifying payments.

Residency forbearance: allows you to stop payments altogether but interest continues accruing. For a residency of three years at $260,000 at an interest rate of 7%, this results in an added balance about $55,000 before you start repayment as an attending.

Payments are usually not made at all. This is rarely a smart move.

For planning a career in nonprofit primary care it is smart to start using IDR during residency and submit annual PSLF employment certification. Each residency month counts towards qualifying PSLF meaning one less month to pay after becoming an attending and earning more.

DO Students at For-Profit Schools: What to Know

Loan access for osteopathic doctors who go to private for profit schools is the same as for others; tuition is usually higher. Some of these schools have had accreditation problems before and that is something to be careful about. From the perspective of loans: federal loans are yours as long as you have filed FAFSA and the school is Title IV eligible. Eligibility for Public Service Loan Forgiveness (PSLF) is unaffected by the fact that the school is for profit as long as the employer after graduation is qualified as a nonprofit or government. There is protection if accreditation of your school is lost or it closes while you are enrolled but you hope this will never happen.

Matching Into a Specialty: How It Changes Your Repayment Math

Choice of specialty greatly affects repayment strategy. For DO and MD students matched to primary care (family medicine, internal medicine and pediatrics), typical attending salaries range around $230,000 to $290,000:

• Debt load of $260,000 is roughly one salary and is manageable.
• The Paycheck Forgiveness Program (PSLF) is quite useful for those who work in nonprofits.
• Income Based Repayment (IDR) for physicians as attendings is high but manageable too.

For graduates who select specialties with higher salaries (emergency medicine, anesthesiology and radiology) typical salaries run $350,000 to $550,000.

• The debt ratio is much better and payoff is often stronger than PSLF because of longer training time.
• Payments qualifying during training alone can reach 60 to 84 months.

For DO graduates who match subspecialties like surgery, longer training (five to seven years residency plus fellowship) leads to longer repayment breaks.

• PSLF is very attractive because of long qualifying employers and payments made during that time can go as high as 60 to 84 months.

Caribbean and IMG Considerations for DO Borrowers

Graduates of accredited COCA schools who are DOs receive exactly the same federal loans and programs for repayment as all other US medical students. Prospective students also consider foreign schools. Graduates from schools abroad including the Caribbean face a different situation and that is discussed elsewhere.

Building Your Repayment Plan as a DO Student

For both DO and MD students the most important thing is to have a common framework:

1. Determine your own total balance of federal loans and interest rates yourself by checking studentaid.gov.
2. Estimate expected salaries for specialty based on data from MGMA or AAMC.
3. Decide the likely employer type: nonprofit academic center, community health center, private practice or corporation.
4. Compare PSLF with aggressive payoff using your actual numbers.
5. Choose an IDR plan during residency rather relying on default forbearance.
6. Submit annual certification forms for PSLF if you select that plan.

Both students make biggest blunder by putting off thinking about loans until residency ends. Important decisions made during training like signing up for IDR and starting to build qualifying payments will have huge impact on total cost of loans.

Want to see comparisons of PSLF and IDR versus aggressive payoff? Use MedDebt's calculator here. Designed specifically for doctors including those who will benefit from PSLF enter your loan balance and length of residency to get full results. Data sources: AACOM 2024 Graduation Debt Data and Federal Student Aid Program PSLF guidelines as well as ACGME merger match documentation.