Specialty salaries
The 16 built-in specialty presets use attending-compensation figures triangulated from the MGMA Provider Compensation Survey, the Medscape Physician Compensation Report, and AAMC academic-salary benchmarks. We use the median (not the mean) to avoid tails from a small number of very high earners.
Residency stipend defaults to the national PGY-1 median (~$65K) with a 2% annual growth rate across training years — roughly in line with CPI. Fellowship salary defaults can be overridden per scenario.
Debt and interest
Default debt of $250,000 reflects the 2025 AAMC graduation survey for MD students with debt (DO graduates typically carry slightly more). Default federal interest rate of 6.5% matches the 2025 Direct Unsubsidized rate for graduate students; private refinance rates are modeled separately and do not carry federal protections.
Interest capitalization follows federal rules: unpaid accrued interest is added to principal only at defined events (end of grace, end of forbearance, leaving an IDR plan, loss of PSLF eligibility). The default scenario assumes capitalization only at the end of training — toggle available in the advanced panel.
PSLF
Public Service Loan Forgiveness requires 120 qualifying monthly payments while working full-time for a 501(c)(3) non-profit or government employer. We count residency payments when PSLF-eligible, which substantially changes the math for primary-care and academic specialties. The forgiven balance is modeled as tax-free at the federal level, per current IRS guidance.
Net-worth projection
Net worth is computed as cumulative after-tax income minus living expenses minus loan payments, plus investment growth on any remaining discretionary income. Defaults:
- Effective tax rate: 32% (federal + state blended for attendings)
- Investment return: 7% annualized (long-run S&P 500 real return is closer to 6–7%)
- Inflation (CPI): 2.5%
- Living expenses: $3,000/month residency, $5,500/month attending
The “net-worth crossover” is the first year in which projected net worth first reaches zero — i.e. debt-minus-assets flips positive. This is the single most useful framing of payoff progress for most borrowers.
Private refinancing
When the refinancing option is enabled, the calculator models a private refinance that takes effect at the start of the attending phase — after residency and fellowship. The training-phase balance (already accounting for interest capitalization rules) becomes the refi principal. Key assumptions:
- Standard amortization formula at the user-entered rate over the chosen term
- Origination fee (if any) is rolled into the principal
- No income-based payment flexibility — fixed monthly payment throughout
- Refinancing converts federal loans to private, permanently forfeiting PSLF, IDR plans, federal forbearance, and death/disability discharge protections
- Actual rates vary by credit score, debt-to-income ratio, and lender; the user is responsible for verifying current market rates
The breakeven analysis compares true total cost (payments only — no federal forgiveness) between PSLF and refinancing for the user's scenario. It is a directional indicator, not a guarantee.
Spouse and household income
The calculator’s Expert Mode includes full dual-income modeling: spouse income, spouse debt, Married Filing Jointly vs. Married Filing Separately filing status, and household-size-aware IDR calculations. When filing jointly, spouse income raises the borrower’s AGI for IDR purposes; when filing separately, it is excluded but the borrower incurs an MFS tax-drag penalty (adjustable in advanced settings).
Spouse debt is modeled at a simplified level (minimum, standard, or aggressive repayment) for household net-worth projections but does not receive its own month-by-month interest + forgiveness simulation. For married couples where both spouses carry complex federal debt, consult a fiduciary advisor.
Job-change modeling
Expert Mode also supports mid-attending job changes. Users can specify a year (1-indexed from the start of the attending phase) at which their salary steps to a new value and — critically — whether the new employer qualifies for PSLF. When the new employer does not qualify, the 120-qualifying-payment counter freezes from that year onward while IDR payments continue, modeling the real-world cost of losing PSLF eligibility mid-career.
What the calculator does not model
To keep the tool fast and predictable, we intentionally omit:
- State income-tax variation beyond the blended default
- Variable-rate private loans or refinance rate ladders
- Employer loan repayment benefits, signing bonuses, moonlighting
- Specific tax treatment of IDR forgiveness (non-PSLF) — the Tax Bomb Card provides a directional estimate using IRS brackets, but state-level treatment is intentionally omitted
- Partial-year disruption scenarios (PSLF stress test uses whole years)
- Spouse-specific forgiveness simulation — spouse debt uses a simplified fixed-repayment model rather than a full month-by-month IDR + PSLF engine
Disclaimer
This is an educational projection, not personalized advice. Your real numbers will differ. If you're making a six-figure decision (PSLF vs refinance, public vs private employer), consult a fiduciary advisor who specializes in physician finance.