PA School Cost & Loan Repayment Guide 2026

According to a report from the Association of Physician Assistants Education from 2023, graduates of PA programs average a debt load of $112, 500. However, many report much higher totals ranging from $150, 000 to $180, 000. Costs rise quickly during a program lasting two and a half years. Starting salaries for PAs are close to $120, 000 but a careful repayment strategy is important. What PA School Actually Costs in 2026 At graduation, actual debt often exceeds the advertised price for PA programs. Public programs cost between $80,000 and $95,000 including living costs while private programs cost between $100,000 and $140,000 including living. Average breakdown of debt for students: In-state public programs: $70,000 to $100,000 in unsubsidized loans Public programs out of state or private: $110,000 to $160,000 Programs in high cost cities: $150,000 to over $180,000 Students generally borrow from unsubsidized Direct Loans from the federal government up to $20,500 per year for graduate students and PLUS loans cover the rest. For the 2024–25 academic year, Grad PLUS loans carry an interest rate of 8.08 percent and unsubsidized loans have rate at 7.05 percent. A balance of $130,000 implies roughly $875 in monthly interest from the first day. PA Salary vs. Debt Load: The Starting Position AAPA reports that new PAs earned a median salary of $120,000 to $125,000 in 2023 this varies greatly by specialty and location. Median salaries for specialty areas are as follows: Specialty | Median Salary ($130k debt) | Debt to Income Ratio Surgery Subspecialties | $135,000 to $155,000 | 0.84 to 0.96 Emergency Medicine | $130,000 to $145,000 | 0.90 to 1.00 Primary Care | $105,000 to $120,000 | 1.08 to 1.24 Dermatology | $120,000 to $140,000 | 0.93 to 1.08 Psychiatry | $110,000 to $130,000 | 1.00 to 1.18 Ratio under 1.5 is generally considered manageable. Most practicing PAs fall within reasonable range compared to most physicians who borrow $250,000 to $350,000 for medical school and earn salaries similar to their own in early years. Federal Repayment Options for PA Students in 2026 Graduate students with federal loans now have access to all repayment programs. Choosing between IBR, Standard Repayment and PSLF has become critical right now especially because SAVE no longer exists and RAP will be available only after July 1, 2026 for loans disbursed thereafter. Income-Based Repayment (IBR) Under IBR payments are limited to 10 percent of discretionary income for borrowers from after July 1, 2014. Forgiveness occurs after twenty years. For someone with $125,000 annual income: Discretionary Income: ~$91,700 after deduction of 150% poverty level for single filers Monthly IBR payment is close to $764 per year After 10 years Standard Repayment on $130,000: about $1,434 per month IBR reduces cash flow but you pay more overall interest unless you get forgiveness. You can take the IDR quiz to find the right plan for you. IMPORTANT: SAVE program ended March 2026. Standard Repayment is now the principal income sensitive option for current borrowers. If you were enrolled in SAVE you were automatically switched to Standard Repayment. Switch to IBR now. PSLF for PAs: A Genuine Opportunity Primary Care Physician Assistants (PCPAs) can get Public Service Loan Forgiveness (PSLF) just like doctors. Working at nonprofits and clinics that have 501(c)(3) status including VA hospitals and Federally Qualified Health Centers (FQHCs) is where PCPAs usually work. Many PCPAs do not realize PSLF eligibility for PCPAs. They think PSLF is reserved for physicians. PSLF does apply to all. Example: Debt: $130,000 Salary at qualifying hospital: $125,000 10 years of Income Based Repayment (IBR): $110,000 to $120,000 Tax free forgiveness about $60,000 to $80,000 depending on interest accrual. PSLF is the right choice at academic hospitals or VA or FQHCs, a detailed guide for both doctors and APCs is available here: Guide for Doctors and APCs. t for PCPAs too. Primary care PCPAs are very well situated for this because they commonly work at qualifying nonprofit or government places and thus their debt is forgiven faster after 10 years given generally lower salaries compared to subspecialists. Repayment Assistance Plan (RAP) — New for 2026 Payments under RAP are 10 percent of discretionary income and you get forgiveness after 30 years and receive full subsidy for interest which means that your balance won't grow if your payment is lower than interest. This is new from One Big Beautiful Bill Act; however, this is not as good for practicing PAs compared to IBR mainly because forgiveness happens in 30 years rather than 20 years. The subsidy for interest is very useful especially during low income years. Students and graduates currently are not eligible for RAP because loans were incurred before the cutoff. Standard Repayment: When It's the Best Choice For PAs who do not qualify for PSLF and plan to pay off loans quickly: Standard repayment plan for 10 years (or a longer 15 year version) works if: Income over $150, 000 (think of high demand specialties like surgery) Employer is for profit (no PSLF option available) Debt is relatively low ($70, 000 to $90, 000) Imagine a PA with a salary of $140, 000 and $70, 000 of debt. Monthly payments under Standard at 10 years would be about $740. That is manageable at this income level and you will be debt free in ten years without worries about forgiveness. Should PAs Refinance? Refinancing is giving up eligibility for protections from Public Service Loan Forgiveness (PSLF), Income Based Repayment (IBR), and Income Driven Repayment (IDR) forbearance. In exchange you get a lower rate. Decisions for PAs are usually clearer than for physicians. Refinance only if all these are true: You work for for profit employer and PSLF path is not available. Your income is high enough to repay in 5–10 years. You have a stable emergency fund and steady job (so you lose flexibility of IDR plans). Current rates offer very significant reduction (check rates at /refinance). Do not refinance if: You are PSLF pursued and refinancing cuts you off permanently. You work for nonprofits, VA or Federally Qualified Health Centers (FQHC) and so have PSLF eligibility. Your income is not steady and you need flexibility for IDR plan use. Most new PAs should wait a year or two to be sure of employer status and financial stability before giving up those federal benefits. State Loan Repayment Programs for PAs These programs are often overlooked but can be very valuable. Many states provide grants to primary care physicians (PAs) who work in Health Professional Short Service Areas (HPSA) or rural and underserved areas. These grants are distinct from the federal PSLF. Notable state programs: NHSC Loan Repayment Program: You can get up to $50,000 tax free for two years of work at an approved site by NHSC. PAs are eligible and it is highly competitive but worth applying. State-specific programs: Several states including Pennsylvania and New Mexico offer loan repayment between $20, 000 and $50, 000 for primary care shortage areas and PAs work there. Indian Health Service: PAs working at IHS sites receive up to $40, 000 annually. Very few people know about this; competition is low. If you are willing to work for a few years in underserved areas, these programs can substantially reduce your PA school debt. A Quick Look: Two PA Grads, Same Debt, Different Results Graduate A: Surgeon PA at for profit hospital, salary $145,000 Debt: $130,000 at average rate 7%, strategy: pay aggressively $2,000 a month; paid off in around 6 years; total paid about $144,000; no PSLF nor IDR subsidy, paid off independently. Graduate B: Primary Care PA at FQHC (non profit) salary $115,000 Debt: $130,000; strategy: use IBR ($700/month) plus PSLF track; after 10 years paid about $84,000, remaining $90,000 forgivable tax free. Total paid $84,000—roughly $60,000 less than Graduate A. PSLF saved Graduate B about $60,000 despite lower salary; best financial strategy is not always most responsible feeling. FAQs Can Physician Assistants use Public Service Loan Forgivenss (PSLF)? Yes. Eligibility for PSLF depends on your employer and loan type, not on your profession. Any PA who works full time for a qualifying 501(c)(3), government or nonprofit employer gets to apply for PSLF. After starting a qualifying job submit Employment Certification Form (ECF) on studentaid.gov. Are PA School Loans Eligible for Income-Based Repayment (IBR)? Yes. Most PAs borrow Direct Loans and these qualify for all federal repayment plans including IBR and new RAP for new loans from July 2026 onward. How does PA school debt compare to medical school debt? Much lower. Average debt from PA school is around $100,000 to $125,000 (AAMC 2024 data) compared to about double that for average medical school debt. Doctors also start with higher salaries and can pursue higher income specialties. See comparison of medical debt by specialty at this link. Should I do residency after graduation and does that affect loan repayment? PA residencies are optional. Usually they pay $55,000 to $70,000 for a year. That lower income year helps with PSLF if you work for a qualifying employer, as your payments will be low and more forgiven. If not pursuing PSLF this year of lower income slows down debt repayment. When should I enroll into IBR? You should enroll into IBR as soon as you start repayment, usually 6 months after PA graduation. Don't wait for due payments. Log into studentaid.gov and apply right after graduation so that lower based on income payment is set before standard repayment kicks in. Run Your Own Numbers Each physician has a unique situation regarding debt. Use the Med Debt Calculator to model repayment strategies: Pay for Life First (PSLF), aggressive repayment or refinancing – based on actual loan balance, specialty and income. Free and quick – only takes two minutes. Also showing year by year projections for net worth.

This article is for informational purposes only and does not constitute financial, legal, or tax advice. Every borrower's situation is unique — consult a certified student loan advisor or fee-only financial planner before making repayment decisions.

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