Should I Refinance My Medical School Loans? A Doctor's Decision Guide (2026)

Refinancing medical school loans can save doctors $50,000–$150,000 in interest — but it permanently ends PSLF eligibility.

In summary, refinancing medical school loans can save as much as $50,000 to $150,000 in interest, but paying off the remaining $200,000 or more in loans would mean giving up the tax-free loan forgiveness that you were planning for in the first place.

This guide details when refinancing your loans makes sense and how to crunch the numbers for your own individual circumstances.

What Refinancing Actually Does

The essence of refinancing federal student loans is that a private lender pays off the borrower’s existing federal loans. Then, the borrower is issued a new private loan, typically with a lower interest rate than the rates on the existing federal loans.

The catch: your loans are no longer federal. That means you permanently lose access to:

PSLF — the program that forgives remaining debt after 120 payments in a qualifying public sector or nonprofit job
Income-driven repayment (IDR) plans — SAVE, PAYE, IBR, and ICR, which cap your monthly payment at 5–10% of discretionary income
Federal deferment and forbearance — including the option to pause payments during financial hardship. financial hardship
Future federal forgiveness programs — any new policy changes that might benefit borrowers This is not a reversible decision. Once you refinance your loans, you will give up federal protection of your loans once had.

The Core Question: Are You Pursuing PSLF?

The PSLF calculator before the numbers question.

Qualifying employers include:

Government organizations (federal, state, local, tribal)
501(c)(3) nonprofit hospitals and health systems
Academic medical centers
VA hospitals
Federally Qualified Health Centers (FQHCs)

If the answer is yes — or even possibly — do not refinance your federal loans. The math almost never works in your favor.

The lower your interest rate on your federal loan(s), the more will be forgiven when PSLF is granted, since the amount of remaining principal on your loan(s) when the 120 payment requirement is met will be reduced by the amount of interest paid on the loan(s) during the repayment period. For example, a physician with $250,000 in federal education loan debt, who earns $300,000 as an attending physician, can pay down as much as $100,000 to $180,000 in principal on his/her loan(s) during a 10-year repayment period (as long as he/she make payments on time) and have that principal amount and accrued interest forgiven tax-free when PSLF is granted. Thus, the interest rate on a federal education loan(s) will almost always be less than the interest rate offered by a private lender for refinancing a federal education loan(s). If you’re working at a nonprofit hospital, academic medical center, or government employer and plan to stay in that type of role, stop reading and run your PSLF numbers instead.

When Refinancing Makes Sense for Doctors

Refinancing your loans can make sense when the following criteria are met:

1. You’re going into private practice or a for-profit employer. · For those employed in private practice groups, for-profit hospital systems, and locums work refinancing of federal loans may be an option for you as you are not eligible for PSLF in the first place. You have nothing to lose by running the numbers on refinancing your federal loans.

2. Your debt-to-income ratio is manageable. The amount of debt that you have in relation to your income will also give you an idea of how well refinancing will work for you. For example, a cardiologist earning $450,000/year with $180,000 in debt would be a good candidate for refinancing. On the other hand, an Internal Medicine physician earning $220,000/year with $350,000 in debt would need to weigh the interest savings from refinancing against the interest savings and protections from aggressive federal repayment (such as PAY As You Earn) or an Income-Driven Repayment plan (such as Income-Based Repayment or Revised Pay As You Earn).

3. You can qualify for a meaningfully lower rate. Typically, Federal graduate PLUS loans have a fixed interest rate for the life of the loan. Currently for 2024-2025 loans, the fixed rate is 8.08%. If, however, you can refinance your loans to a fixed rate of 5-6%, that will translate into $3,000-5,000 in annual interest savings (based on a $200,000 loan balance). But, if you can only get a refinance loan with an interest rate reduction of 1-1.5%, then it is probably not worth giving up the federal loan protections of income-driven repayment and Public Service Loan Forgiveness.

4. Your income is stable and unlikely to drop. Refinancing to lower rate loans will fix you into a payment, with no margin for income fluctuation. Hence, those who are in mid-residency with fluctuating financial status (e.g. because of large varying amount of work or educational obligations) should not be considering refinancing until they are in attending status and have secure financial status.

5. You’re focused on paying down your loans aggressively and do not intend to extend the repayment period. The best refinancing scenario is one that combines the lowest possible interest rate with the shortest possible repayment term and highest possible monthly payment. If you refinance your PLUS loans to a lower interest rate but extend the repayment term to 20 years in order to lower monthly payments, then you are likely to be paying more in interest over the life of the loan than you would if you were repaying the loans under the federal repayment options.

The Math: Refinancing vs. Staying Federal

Let's run a real example.

Scenario: Dermatologist, private practice

Loan balance: $220,000
Current rate: 7.05% (weighted average federal)
Income: $380,000/year attending salary
Residency: 4 years completed, now attending

Option A: Standard federal repayment (10-year)

Monthly payment: ~$2,560
Total paid: ~$307,000
Total interest: ~$87,000 Option B: Refinance to 5.2% fixed, 10-year term
Monthly payment: ~$2,355
Total paid: ~$282,000
Total interest: ~$62,000
Savings: ~$25,000

Option C: 4.8% fixed 7 year refi (aggressive)

Monthly payment: ~$3,050
Total paid: ~$256,000
Total interest: ~$36,000
Savings: ~$51,000

A shorter term and a lower rate will save this dermatologist $25,000-$51,000 by refinancing his current loans. This dermatologist is in private practice, well paid, not a PSLF candidate and thus would not benefit from paying off his loans under the terms of the PSLF program with IDR payments.

Let’s look at this for an internist at a non-profit teaching hospital. Here he would qualify for PSLF provided he makes 120 payments on an eligible repayment plan while working full time for his employer. Assuming an income-driven repayment plan his total payments would equal $150,000 and he would have $120,000 + of tax-free forgiveness. In contrast, refinancing his loans would likely cost him far more.

This calculator will do all the comparison work for you, based on your specific information: specialty, salary, loan balance and repayment terms.

Resident and Fellow Timing: Usually Wait

Most residents and fellows should not refinance.

During the time when your income is low (as a resident, for example $55,000-$75,000) your payments on an Income-Driven Repayment plan will be very low (as low as $200-$500 per month). It would cost you more to refinance your loans into a private education loan where your payments would be based on a lender’s calculation of the repayment amount for the total loan amount, rather than your actual income.

As residents and fellows you do not know where you will end up practicing. And as a result, you would commit to paying back a private loan based on your income as a resident/fellow when you have no idea whether you will be practicing at a for-profit or non-profit institution.

One possible exception to this rule would be for a resident who knows with certainty that upon completion of their training they will be entering into private practice, and who can see from their numbers that they can service additional principal payments on their loans even on a resident stipend. In such cases, it might actually make sense to begin paying down principal on their loans during their time in training. However, this would be the exception rather than the rule.

Wait until you are an attending physician with a signed contract and clear picture of your practice setting!

Variable vs. Fixed Rate: Which to Choose

Private lenders offer two types of fixed rate loans as well as variable rate loans that initially offer a lower rate but then can increase over time.

For doctors with large loan balances and multi-year repayment timelines, fixed rates are almost always the better choice. Here's why:

Variable rates are tied to benchmark rates (SOFR) that can increase significantly
The rate environment can be unpredictable over a 5–10 year time frame.
The interest cost will quickly start to eat away at any interest savings that you had at the beginning of the loan.
Fixed rate predictability makes financial planning easier

Variable rate loans are generally best for borrowers who will repay the full amount of the loan in 2-3 years and can absorb the risk of market rates.

Lenders Worth Comparing

Once you have made the decision to refinance, it is in your best interest to compare rates from 3-4+ different lenders. In order to compare rates, most lenders perform a soft credit inquiry when checking your rate, which does not affect your credit score.

Lenders with physician-specific programs worth comparing:

Laurel Road — This is one of the few physician specific loans. They allow docs to refinance even while they are in residency/fellowship. They also offer a have a very physician friendly product that allows them to make $100/month payments while they are in training.
Earnest: Earnest is known for having competitive rates and terms with excellent customer service reviews.
SoFi — large lender with physician mortgage and career coaching bundled.
Splash Financial: They have a good track record of being able to get good rates for their customers by shopping around to multiple lenders.

When comparing various lenders you must always look at their APR as well as the interest rate they are advertising. You must also see what kind of origination fees the lender charges (most private lenders who refinance medical student loans charge $ zero) as well as whether they have any prepayment penalties as well as whether they offer any type of economic hardship deferment in case you lose your job.

The Decision Framework

Use this checklist before refinancing:

Do not refinance if:

You work or plan to work at a nonprofit, government, or academic employer
You're a resident and unsure of your practice setting
Your debt-to-income ratio is above 2:1 (e.g., $300K debt on $150K salary)
You'd need IDR payments to make the monthly payment affordable
You're counting on future federal forgiveness programs

Refinancing may make sense if:

You're in or heading to private practice at a for-profit employer
Your attending income comfortably covers aggressive loan payments
You can qualify for a rate that's at least 1.5% below your current rate
You're committed to paying off the loan in 7–10 years
You have stable employment and an emergency fund

Run Your Own Numbers

The decision isn't theoretical — it comes down to your specific loan balance, income, interest rate, and career path.

The MedDebt Calculator models both scenarios side by side: what you'd pay under federal repayment or PSLF vs. what you'd pay after refinancing. It shows the total cost, monthly payments, and breakeven point so you can see exactly which path saves you more money.

Run your numbers now →

Enter your loan balance, specialty, and residency length and the calculator will show you — in under 60 seconds — whether refinancing or staying federal puts more money in your pocket over the long run.

The Bottom Line

Refinancing is the right move for a meaningful subset of doctors — those in private practice with stable high incomes and no path to PSLF. For them, it can save $30,000–$100,000 in interest over the life of the loan.

For everyone else — residents, fellows, doctors at nonprofit hospitals, academic physicians, and anyone with any chance of qualifying for PSLF — the math rarely works in favor of refinancing. The loss of federal protections and forgiveness potential outweighs the interest rate savings.

The question isn't whether refinancing rates are good. It's whether refinancing is right for you, given your specific career path and loan situation. Run the numbers before you decide.

Data sources: Federal student loan interest rates from studentaid.gov (2024–2025 academic year). Physician salary ranges from MGMA Physician Compensation Report 2024 and Medscape Physician Compensation Report 2024. PSLF statistics from studentaid.gov. Private lender rates representative of market as of 2026 — individual rates vary based on creditworthiness.