Orthopedic Surgery vs Dermatology

Orthopedic Surgery

PSLF is almost never the right choice for orthopedic surgeons. At $730K, IDR payments approach or exceed standard repayment amounts, leaving little to forgive. The specialty also skews heavily toward private practice, ambulatory surgery centers, and orthopedic groups that don't qualify as PSLF employers.

Refinancing is frequently the right move for orthopedic surgeons once they have an attending contract. At $730K, an aggressive $15K/month toward loans eliminates $245K in under 2 years. The interest savings from refinancing are real but secondary — the main advantage is faster payoff and simplified loan management.

Dermatology

Dermatology is predominantly practiced in private offices, dermatology groups, and private equity-backed practices — very few of which qualify for PSLF. Even for the minority of dermatologists at academic or nonprofit medical centers, the $512K salary means IDR payments are high and the forgiven amount is small. PSLF rarely produces a meaningful advantage in this specialty.

Refinancing is the dominant strategy for dermatologists. At $512K, directing $8–12K/month toward loans eliminates $235K in 2–3 years. The combination of high income and predominantly private employment makes dermatology one of the clearest cases in medicine for refinancing over PSLF.