Policy Comparison · 2026
IBR vs RAP
for Physicians
SAVE is dead. PAYE and ICR are being phased out. Two plans remain for physicians: IBR for existing borrowers, and the new RAP for loans disbursed after July 1, 2026. Here is what both plans actually mean for your paycheck.
Bottom line
IBR is better for most physicians.It caps payments at standard repayment, qualifies for PSLF, and offers 20-year forgiveness vs RAP's 30 years. If you already have federal loans, you are on IBR — that is the right place to be. RAP only applies to loans first disbursed July 1, 2026 or later, meaning it primarily affects students entering medical school in fall 2026 and beyond.
Side-by-side: IBR vs RAP
| Factor | IBR | RAP (New July 2026) |
|---|---|---|
| Who it applies to | Any borrower with eligible federal Direct loans — available now, no cutoff date | Loans first disbursed on or after July 1, 2026 only. Existing borrowers are not eligible. |
| Monthly payment formula | 10% of discretionary income (borrowers after July 1, 2014) — capped at what standard 10-yr repayment would be | ~10% of prior-year AGI divided by 12 — no standard payment cap |
| Residency payment estimate ($60K salary, $250K debt) | ~$317/month — 10% of ($60K − $21.9K poverty line) | ~$500/month — 10% of $60K AGI ÷ 12 |
| Attending payment estimate ($300K salary, $250K debt) | Capped at standard repayment — typically $2,500–2,900/month. High earners pay no more than 10-yr standard. | ~$2,500/month — 10% of $300K ÷ 12. No cap. Higher-earning specialties pay full 10% of income indefinitely. |
| Forgiveness timeline | 20 years (new borrowers after July 1, 2014) or 25 years (older borrowers) | 30 years — 10 years longer than modern IBR |
| Forgiveness taxable? | Currently tax-free through 2025 law (American Rescue Plan). Status after 2025 unclear — historically taxable. | Tax treatment not yet finalized. Assume taxable until legislation clarifies. |
| PSLF eligible? | Yes — IBR qualifies for PSLF. Most physicians pursuing PSLF should be on IBR. | Unclear as of June 2026. Regulations still being written. Do not assume RAP qualifies until confirmed. |
| Protects against hardship? | Yes — if income drops, payment drops. Standard cap also limits payment for high earners. | Yes — if income drops, payment drops. But no cap means high earners pay more than they would under IBR. |
| Best for physicians | All current borrowers. Any physician on federal loans right now should be on IBR (not SAVE, not PAYE after July 2026). | Only applies to loans first disbursed July 1, 2026+. Starting medical school in fall 2026? Your loans will be on RAP by default. |
Sources: studentaid.gov, "One Big Beautiful Bill Act" (signed 2026), AAMC. Payment estimates assume $250K debt at 7% interest, 3-year residency at $60K salary.
PSLF compatibility with RAP is unconfirmed
As of June 2026, the Department of Education has not confirmed whether RAP payments count toward PSLF's 120-payment requirement. Students entering medical school in fall 2026 should monitor studentaid.gov for official guidance before assuming PSLF is an option with RAP loans.
Estimated total cost by specialty
Assumes $250K in federal loans at 7% interest. IBR figures reflect 20-year forgiveness for eligible specialties. RAP figures reflect 30-year repayment. Attending salaries from Marit Health 2026 medians.
| Specialty | Median salary | IBR total paid | RAP total paid | IBR forgiven |
|---|---|---|---|---|
| Family Medicine | $240K | $162K | $218K | $148K |
| Internal Medicine | $260K | $174K | $234K | $131K |
| Pediatrics | $230K | $153K | $207K | $157K |
| Psychiatry | $250K | $168K | $225K | $140K |
| Emergency Medicine | $340K | $215K | $285K | $84K |
| Neurology | $290K | $189K | $253K | $108K |
| OB/GYN | $315K | $204K | $272K | $94K |
| Anesthesiology | $388K | $247K | $330K | $51K |
| Radiology | $420K | $267K | $357K | $31K |
| Orthopedic Surgery | $533K | $302K | $422K | — |
| Neurosurgery | $620K | $302K | $422K | — |
| Dermatology | $395K | $251K | $335K | $47K |
Estimates only. Actual payments depend on family size, filing status, and future income. Use the calculator for personalized numbers.
You are on IBR if…
- ✓You took out federal loans before July 1, 2026
- ✓You are currently in medical school, residency, or fellowship
- ✓You are an attending physician on a federal IDR plan
- ✓You were on SAVE and were auto-moved to Standard (switch to IBR now)
- ✓You are pursuing PSLF — IBR is the correct qualifying plan
RAP applies to you if…
- →You are starting medical school in fall 2026 or later
- →Your federal loans are first disbursed on/after July 1, 2026
- →You are taking out Grad PLUS or unsubsidized loans for the first time after July 2026
- →You want to understand what your new loan terms will look like
- →You need to know whether RAP will qualify for PSLF (TBD — monitor studentaid.gov)
Were you on SAVE? Act now.
The 8th Circuit eliminated SAVE on March 10, 2026. Borrowers who were on SAVE were automatically moved to Standard Repayment — which may mean significantly higher payments. Switch to IBR immediately at studentaid.gov.
Frequently asked questions
Does RAP apply to my existing medical school loans?+−
No. RAP only applies to loans first disbursed on or after July 1, 2026. If you already have federal student loans — even if you are still in school — those loans remain eligible for IBR, PAYE, and ICR (until those plans phase out). RAP is only for borrowers taking out new federal loans starting July 1, 2026.
Is IBR still the best plan for physicians pursuing PSLF in 2026?+−
Yes. After SAVE was eliminated by the 8th Circuit on March 10, 2026 and PAYE/ICR are being phased out for new enrollees after July 1, 2026, IBR is the recommended plan for physicians pursuing PSLF. It caps payments at 10% of discretionary income and qualifies for the 120-payment PSLF count. If you are currently on SAVE, switch to IBR immediately via studentaid.gov.
Does RAP qualify for PSLF?+−
This has not been confirmed as of June 2026. The regulations implementing RAP under the "One Big Beautiful Bill Act" are still being finalized by the Department of Education. Do not assume RAP qualifies for PSLF until the Department officially confirms it. Medical students starting school in fall 2026 whose loans will be under RAP should monitor studentaid.gov closely.
What should I do if I am starting medical school in fall 2026?+−
Your federal loans disbursed after July 1, 2026 will be under RAP by default. This means 30-year forgiveness (vs 20 years on IBR) and payments based on 10% of your full AGI rather than discretionary income. You cannot switch to IBR for those loans. You should still pursue PSLF if you plan to work at a nonprofit — but monitor whether RAP qualifies for PSLF as regulations are finalized. Use the MedDebt Calculator to model what your RAP payments will look like relative to expected attending income.
Which plan results in lower total payments for physicians?+−
IBR results in lower total payments for most physicians, primarily because of two factors: (1) the standard payment cap protects high earners from paying more than 10-year standard repayment would require, and (2) 20-year forgiveness means less total interest accrues compared to RAP's 30-year timeline. For low-income specialties (family medicine, pediatrics, psychiatry), IBR combined with PSLF produces the lowest lifetime cost by far. For high-earning subspecialists (neurosurgery, orthopedics), neither plan results in forgiveness — aggressive payoff or refinancing may produce lower total cost.
See your actual numbers.
The MedDebt Calculator models IBR, PSLF, aggressive payoff, and refinancing with your exact loan balance and specialty. Free, no signup.
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