Question 1

What is the average medical school debt in 2026?

Accepted Answer

According to the AAMC 2024 Graduation Questionnaire, the average medical school debt at graduation is $202,450, with 73% of MD graduates carrying federal student debt. Debt varies by specialty: primary care physicians average $198,000–$213,000 while surgical subspecialists average $237,000–$258,000. By the end of residency, balances are typically 15–25% higher due to interest accrual at 8.08% on unsubsidized loans.

Question 2

Should I pursue PSLF or pay off my medical school loans aggressively?

Accepted Answer

PSLF is generally better for primary care physicians (family medicine, pediatrics, internal medicine, psychiatry) working at nonprofit hospitals or academic medical centers, where PSLF can save $80,000–$150,000 compared to aggressive payoff. Aggressive payoff is better for high-earning surgical subspecialists (neurosurgery, orthopedics) at for-profit employers, where a low debt-to-income ratio makes rapid paydown practical. The MedDebt Calculator compares both side-by-side with your exact numbers.

Question 3

How much do medical school loans cost during residency?

Accepted Answer

At the current unsubsidized graduate loan rate of 8.08%, a $202,450 balance accrues roughly $16,358 in interest per year. Over a 3-year residency (family medicine, emergency medicine) that is approximately $50,900 in unpaid interest. Over a 5-year residency (general surgery, radiology) that is approximately $101,800. This accrued interest capitalizes when repayment begins, permanently increasing the principal balance.

Question 4

What is the best IDR plan for physicians in 2026?

Accepted Answer

As of 2026, IBR (Income-Based Repayment) is the recommended IDR plan for most physicians pursuing PSLF. The SAVE plan was eliminated by the 8th Circuit on March 10, 2026, and PAYE/ICR are phased out for new enrollees after July 1, 2026. For loans disbursed on or after July 1, 2026, RAP (Repayment Assistance Plan) is required. IBR caps payments at 10% of discretionary income for post-July 2014 borrowers and provides PSLF-qualifying payments.

Question 5

Should I refinance my medical school loans during residency?

Accepted Answer

No — refinancing during residency is almost never the right move. Refinancing converts federal loans to private, permanently eliminating access to PSLF, IBR, and federal forbearance. Most residents should make income-driven payments (IBR) during training to keep monthly costs low and preserve PSLF eligibility. Refinancing only makes sense after residency, after confirming you will work at a for-profit employer with no interest in PSLF.

Question 6

Which medical specialties have the best debt-to-income ratio?

Accepted Answer

Neurosurgery has the best debt-to-income ratio at 0.32× ($250,000 average debt vs $788,000 salary), followed by orthopedic surgery (0.38×) and dermatology (0.49×). Primary care specialties have the highest ratios: pediatrics (0.90×), family medicine (0.84×), and internal medicine (0.86×). Physicians in specialties with ratios above 1.0× generally benefit most from PSLF. Data from Marit Health 2026 and AAMC Graduation Questionnaire 2024.

Question 7

Is PSLF forgiveness taxable for physicians?

Accepted Answer

No — PSLF forgiveness is completely tax-free at the federal level under current law. This is the key advantage over 20- or 25-year IDR forgiveness, which creates a taxable "tax bomb" in the forgiveness year. State tax treatment of PSLF forgiveness varies by state. The MedDebt Calculator models PSLF as tax-free; IDR forgiveness tax estimates are also modeled.

Question 8

How does the MedDebt Calculator work?

Accepted Answer

The MedDebt Calculator is a free, browser-based tool specifically built for the physician financial journey. Enter your loan balance, specialty, and income, and it models PSLF, aggressive payoff, IBR, and refinancing simultaneously. Features include 21 specialty salary presets (Marit Health 2026 data), resident year-by-year income modeling, net worth crossover visualization, PSLF progress tracking, and an AI Co-Pilot that accepts natural language inputs. No account required — all calculations run in your browser.

Strategy	Total paid	True total cost	Time to done	Monthly	Outcome
PSLF (forgiveness)	$264K	$264K	10 yrs	$3K/mo	Forgiven (~$143K tax-free)
Standard repaymentRecommended	$424K	$439K	14 yrs	$3K/mo	Fully paid off
Aggressive payoff	$377K	$547K	10 yrs	$5K/mo	Fully paid off

Year	Income	Paid	Balance	Net worth	Phase
Start	—	—	$250,000	-$250,000	residency
Year 1	$65,000	$3,111	$263,139	-$258,050	residency
Year 2	$67,958	$3,407	$275,981	-$264,989	residency
Year 3	$71,050	$3,716	$288,515	-$270,748	residency
Year 4	$74,282	$4,040	$300,725	-$275,254	residency
Year 5	$391,000	$40,976	$278,646	-$101,122	attending
Year 6	$412,798	$40,976	$255,088	$87,489	attending
Year 7	$435,812	$40,976	$229,953	$291,461	attending
Year 8	$460,108	$40,976	$203,134	$511,724	attending
Year 9	$485,759	$40,976	$174,519	$749,264	attending
Year 10	$512,840	$40,976	$143,988	$1,005,126	attending
Year 11	$541,431	$40,976	$111,412	$1,280,413	attending

Run your numbers.

Med School Debt Simulator

Standard repayment.

All three paths, side by side.

PSLF (forgiveness)

Standard repayment

Aggressive payoff

PSLF Progress Tracker

What you owe, year by year

When you turn the corner

Year-by-year snapshot