Internal Medicine vs General Surgery

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.

General Surgery

With a $477K attending salary, general surgeons have the income to pay off debt aggressively in 4–6 years after training — often beating PSLF in total cost. PSLF only makes sense if your practice setting is nonprofit and your income-driven payments are significantly lower than a standard 10-year plan.

Refinancing is often the best move for general surgeons heading into private practice. At $477K, you can direct $4–6K/month toward loans and be debt-free within 5 years. Rates from physician-focused lenders like Laurel Road and Earnest can drop your rate below 5%.