The math changed the day you became an attending.
Your salary just jumped. Your PSLF clock is still running. And you have financial decisions in front of you that will compound for decades — refinancing, physician mortgage, contract negotiations, retirement accounts. Get the numbers right now.
$150–400K
Typical PSLF savings for attendings
Specialty dependent
5–7yr
Time to payoff if you refinance aggressively
Surgical specialties
0%
Down payment on physician mortgage
At most major lenders
6.5–10yr
PSLF remaining as a new attending
After residency + fellowship
Your attending decisions
Four decisions every new attending faces
PSLF or refinance?
If you're working at a nonprofit hospital or academic medical center, PSLF is almost always worth more. If you're joining private practice, refinancing and paying aggressively often wins. The break-even depends on your specialty and payment count.
Run the PSLF vs refi comparisonPhysician mortgage
0% down, no PMI, future income qualifying — physician mortgages let you buy a home before your student loans are paid off. Most major lenders work with residents and new attendings.
Compare physician mortgage lendersNew attending financial checklist
20 items to complete in your first year as an attending: disability insurance, backdoor Roth IRA, 403(b)/401(k), contract review, and more.
Open the checklistRefinancing comparison
Not pursuing PSLF? Compare 6 refinancing lenders side by side — rates, terms, resident-specific programs, and forbearance options. Juno and ELFI offer affiliate rates.
Compare refinancing lendersReal numbers
Estimated PSLF savings by specialty
Assumes nonprofit employer throughout attending career. Surgical specialties often benefit more from aggressive payoff.
| Strategy | Debt | Savings vs standard |
|---|---|---|
| Internal Medicine (PSLF) | $250K | ~$210K |
| Family Medicine (PSLF) | $230K | ~$200K |
| Psychiatry (PSLF) | $240K | ~$205K |
| Emergency Medicine (PSLF) | $255K | ~$180K |
| Orthopedic Surgery (aggressive payoff) | $280K | N/A — paid in full ~6yr |
Illustrative estimates. Run your actual numbers in the calculator. Try it free →
Free tools
Everything built for attendings
Debt Calculator
Model your exact attending numbers: salary, specialty, current PSLF count, refinancing rates. See PSLF vs aggressive payoff vs IDR side by side with net worth projections.
Model my attending financesPhysician Mortgage Comparison
0% down, no PMI, student-loan-friendly DTI. Compare 6 major physician mortgage lenders — Fairway, BMO, First Horizon, Regions, TD Bank, and KeyBank.
Compare mortgage lendersNew Attending Checklist
20-item interactive checklist for Day 1 through Year 1 as an attending. Disability insurance, Roth IRA, 403(b), contract red flags, and physician mortgage.
Start the checklistRefinance Comparison
Not pursuing PSLF? Compare the top refinancing lenders with real rates, terms, and physician-specific programs. Juno group negotiation and ELFI currently active.
Compare refinancing optionsCommon questions
Attending physician financial questions
As a new attending, should I stay on IBR or refinance?
It depends on two things: (1) Is your employer a qualifying nonprofit for PSLF? If yes, stay on IBR and keep accumulating PSLF payments — refinancing ends PSLF eligibility permanently. (2) If PSLF isn't in play, refinancing to a lower rate (typically 5–7% vs federal 8.08%) and paying aggressively is often the better financial move. Run both scenarios in the calculator with your actual debt and salary to see the true dollar difference.
How many PSLF payments do I need left when I start as an attending?
Depends on your training length. A 3-year IM resident enters attending life with 36 payments done, needing 84 more (7 more years). A 5-year general surgery resident + 1-year fellowship enters with 72 done, needing 48 (4 more years). Your PSLF forgiveness date as an attending is roughly: (120 - payments already made) ÷ 12 = years remaining. If that number is under 10 and you're at a nonprofit employer, PSLF is almost certainly worth more than refinancing.
Is a physician mortgage worth it or should I wait and put 20% down?
If putting 20% down would deplete your emergency fund or delay homeownership by 3+ years in an appreciating market, a physician mortgage often wins. You avoid PMI without a down payment, and you keep liquid capital invested. The trade-off is a slightly higher interest rate (typically 0.25–0.5% more than a conventional 20%-down rate). Run the math on rate vs. investment returns for your market.
What should I do with my first attending paycheck?
In priority order: (1) Max your employer's 403(b) or 401(k) to capture any match. (2) Fund a backdoor Roth IRA ($7,000/year). (3) Get disability insurance — your greatest financial asset is your ability to practice. (4) Build a 3–6 month emergency fund if you don't have one. (5) Then decide between extra loan payments, taxable investing, and physician mortgage down payment. The full 20-item New Attending Checklist covers all of this.
When does refinancing make more financial sense than PSLF?
Refinancing beats PSLF when: (1) Your attending employer is not a 501(c)(3) nonprofit (private practice, for-profit hospital, industry). (2) Your loan balance is relatively small (under $150K) and your income is high — the math doesn't save enough on a small balance. (3) You have fewer than 50 qualifying PSLF payments and plan to switch to a non-qualifying employer — in that case starting the 120-payment clock over is unrealistic. Use the MedDebt Calculator to model both paths with your exact numbers.
Free · no signup
PSLF or refi? Run your attending numbers.
Enter your specialty, debt balance, and employer type to see PSLF savings vs. aggressive payoff vs. refinancing — with net worth projections through your career.
Model my attending finances — free