IDR Plans for Doctors Explained: SAVE vs PAYE vs IBR in 2026

Income-driven repayment (IDR) plans are the foundation of the PSLF strategy — you must be on an IDR plan to qualify for PSLF. But not all IDR plans are the same, and for physicians, the differences add up to real money.

This guide explains the four major IDR plans, which one typically wins for physician borrowers, and how to switch.

The Four IDR Plans: Quick Reference

For most physicians with loans originated after 2014: SAVE or PAYE will offer the lowest payments.

SAVE: The Newest Plan

SAVE (Saving on a Valuable Education) replaced REPAYE in 2023 and is generally the most favorable plan for borrowers with low income relative to their debt — which describes almost every physician in training.

How it calculates payments:

• Undergraduate loan debt: 5% of discretionary income
• Graduate loan debt: 10% of discretionary income
• Most medical school loans are graduate-level → 10% applies

Discretionary income definition:

• AGI minus 225% of the federal poverty line (compared to 150% for PAYE and IBR)
• This means a larger share of your income is protected, resulting in lower payments than PAYE for the same income

Key SAVE advantages for physicians:

1. Interest subsidy: If your monthly payment doesn't cover accruing interest, the government waives the difference. Your balance cannot grow while you're making qualifying payments. This is significant during residency, when IDR payments may be $50–$300/month while interest accrues at $1,500+/month.
2. Lowest payment floor during training due to the 225% poverty line threshold
3. Same 10% payment rate as PAYE during attending years (for graduate loans)

Forgiveness timeline:

• After 20 years for loans used for undergraduate education
• After 25 years for graduate/professional loans (most medical school debt)

One important caveat: SAVE's expanded forgiveness provisions are subject to ongoing litigation (as of April 2026). The 5% rate on undergraduate loans and some IDR provisions were challenged in court. Borrowers on SAVE should monitor updates. The core graduate-loan 10% payment structure has been more stable.

PAYE: The Gold Standard for PSLF

PAYE (Pay As You Earn) has been the preferred plan for PSLF-pursuing physicians for over a decade.

How it calculates payments:

• 10% of discretionary income
• Discretionary income = AGI minus 150% of the federal poverty line
• Payment is capped at the 10-year standard repayment amount (so if your income rises enough, you won't pay more than standard)

Why PAYE is often preferred for PSLF:

1. 20-year forgiveness (vs. 25 for some SAVE scenarios) if you don't reach PSLF at 120 payments
2. 10% payment rate — same as SAVE for graduate loans, but applies to a slightly higher income base (150% poverty line vs SAVE's 225%)
3. No interest subsidy — unlike SAVE, interest can capitalize on PAYE (though PSLF borrowers rarely care about this, since the balance will be forgiven)

Eligibility limitation: PAYE requires you to be a "new borrower" — you must have had no outstanding federal loan balance on October 1, 2007, and received a disbursement on or after October 1, 2011. Most physicians in training today qualify.

IBR: Two Versions, Different Rates

IBR (Income-Based Repayment) exists in two versions depending on when you first borrowed:

IBR for new borrowers (loans after July 1, 2014):

• 10% of discretionary income
• 150% poverty line threshold
• 20-year forgiveness
• Nearly identical to PAYE for most purposes

IBR for older borrowers (pre-2014 loans):

• 15% of discretionary income
• 150% poverty line threshold
• 25-year forgiveness

The pre-2014 IBR rate of 15% is significantly higher than SAVE/PAYE — if you have pre-2014 loans, consolidating into a Direct Consolidation Loan and switching to PAYE or SAVE is almost always worth doing.

Which Plan to Choose: The Physician Decision

During Residency and Fellowship

SAVE is the strongest choice during training because:

• The 225% poverty line threshold (vs 150% for PAYE) results in slightly lower payments on a $65K resident salary
• The interest subsidy prevents your balance from ballooning while you make small IDR payments
• If your payment doesn't cover accruing interest, you pay nothing extra — the government absorbs the difference

Example — PGY-1 in Internal Medicine ($65K salary, $250K debt at 6.5%):

• Monthly interest accruing: ~$1,354
• SAVE payment: ~$114/month
• PAYE payment: ~$228/month
• Interest subsidy on SAVE: government covers $1,240/month of unpaid interest
• PAYE: no subsidy; balance grows by ~$1,126/month

During training, SAVE's interest subsidy prevents balance growth entirely. PAYE's lack of subsidy means the balance grows, even though both paths reach PSLF at year 10 regardless.

During Attending Phase (Pre-PSLF Year 10)

Once you're an attending earning $200K–$600K, the interest subsidy matters less (you're paying more than accruing interest on most plans). The difference between SAVE and PAYE narrows.

At high attending salaries, the standard repayment cap on PAYE (your payment can't exceed 10-year standard) becomes relevant — SAVE has no such cap. For very high earners, PAYE may result in slightly lower payments if the cap kicks in.

Practical advice: Most physicians start with SAVE in training (better subsidy), then reassess at attending hood. The difference in annual payments between SAVE and PAYE at attending salaries is typically $0–$2,000/year — not worth obsessing over.

If You're Not Pursuing PSLF

If you're on standard repayment or aggressive payoff, IDR plan choice matters less. You're likely paying above the IDR floor regardless. In this case:

• Any qualifying IDR plan keeps you eligible if you ever reconsider PSLF
• SAVE's interest subsidy is still valuable if you occasionally dip to minimum payments

How Payments Are Calculated: The Formula

For any IDR plan, the calculation follows this structure:

Monthly Payment = (Plan Percentage × Discretionary Income) / 12

Discretionary Income = Max(0, AGI − Poverty Line Multiplier × Federal Poverty Line)

Federal poverty line (2025, continental US):

• 1 person: ~$15,060
• 2 people: ~$20,440
• 4 people: ~$30,900

Plan-specific multipliers:

• SAVE: 225% → poverty threshold = $33,885 (single), $45,990 (couple)
• PAYE/IBR: 150% → poverty threshold = $22,590 (single), $30,660 (couple)

Example — Attending IM physician, $280K salary, single, family of 1:

For a married physician on MFS with family of 2 under PAYE: threshold rises to $30.7K, payment drops slightly.

Switching Plans: What You Need to Know

You can switch IDR plans at any time. The switch takes effect after recertification.

Important: When you switch plans, any unpaid interest may capitalize (be added to your principal balance). SAVE minimizes this risk with its interest subsidy. PAYE has no such protection.

For PSLF borrowers: Switching plans does not reset your qualifying payment count. Your 120-payment clock continues regardless of which qualifying IDR plan you're on.

How to switch:

1. Log in to StudentAid.gov
2. Go to "Manage Loans" → "Repayment Plan"
3. Select your plan and confirm
4. Your servicer will recalculate your payment

Allow 1–3 months for the new payment to take effect. Continue making existing payments during the transition.

The PSLF Interaction: Annual Recertification

Whichever IDR plan you choose, you must recertify your income annually to maintain IDR status and PSLF eligibility. Missing recertification can result in:

• Your payment reverting to the 10-year standard amount
• A gap in qualifying PSLF payments
• Interest capitalization

Set a reminder for 60 days before your anniversary date (when you first enrolled in IDR). Recertify even if your income hasn't changed.

Summary: The Physician Playbook

1. During training: Enroll in SAVE. The interest subsidy prevents balance growth. Verify your employer is PSLF-qualifying.

2. At attending start: Keep SAVE or switch to PAYE. Run a quick calculation — the difference is typically $1,000–$2,500/year. Recertify income with your attending salary.

3. If married: Evaluate MFJ vs MFS impact on your IDR payment before recertifying. The filing status change can be worth more than the plan choice.

4. Recertify annually — no exceptions. Missing this resets your payment to standard repayment.

5. Use the calculator to model your specific plan choice with your salary, debt load, and training timeline — the MedDebt Calculator lets you adjust the IDR percentage to compare 10% vs 15% scenarios.