Cardiology vs Internal Medicine

Cardiology

With 6 years of training counting toward PSLF, cardiologists need only 4 more attending years to reach forgiveness — making PSLF worth running the numbers for, especially at academic centers. However, the $580K median salary means IDR payments are high, limiting the forgiven amount. PSLF is most compelling for academic cardiologists earning $350–450K.

For cardiologists in private practice or cardiology groups earning at or above the $580K median, aggressive payoff after fellowship is typically the dominant strategy. At this salary, $235K of debt can be eliminated in 3–4 years with focused payments.

Internal Medicine

Most internal medicine physicians work at academic medical centers, VA hospitals, or nonprofit health systems — all PSLF-qualifying employers. With a 3-year residency counting toward the 120-payment requirement, IM physicians can reach forgiveness just 7 years into attending practice.

Refinancing makes more sense if you're heading into private practice or a for-profit setting where PSLF doesn't apply. With an attending salary around $310K, aggressive payoff over 7–9 years is very achievable.