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Paying Off Medical School Debt: 5 Strategies for Doctors
The best strategy to pay off medical school loans will depend on your career, salary and financial priorities.
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Teddy is a former student loans writer with NerdWallet, where she covered topics around managing money before, during and after college. Her work has been featured by The Associated Press, USA Today, the Chicago Tribune and Reuters.
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Ryan Lane is an editor on NerdWallet’s small-business team. He joined NerdWallet in 2019 as a student loans writer, serving as an authority on that topic after spending more than a decade at student loan guarantor American Student Assistance. In that role, Ryan co-authored the Student Loan Ranger blog in partnership with U.S. News & World Report, as well as wrote and edited content about education financing and financial literacy for multiple online properties, e-courses and more. Ryan also previously oversaw the production of life science journals as a managing editor for publisher Cell Press. Ryan is located in Rochester, New York.
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Paying off medical school debt can be a bitter pill. As a resident, you’re probably not earning enough to make full monthly student loan payments. As an attending physician, you’re likely facing a balance that’s thousands of dollars more than it was when you graduated.
These five strategies can help make paying off medical school loans a bit easier.
1. Make payments during residency
Medical school loans accrue interest while you're in school and typically enter repayment six months after you graduate.
It’s possible to postpone student loan payments during your residency or fellowship, but it will cost you. Interest accrues during periods of deferment and forbearance, increasing your total balance.
For example, pausing payments for three years on $201,490 — the average medical school debt among the class of 2019 — would add about $37,779 to your balance, assuming that you had a 6.25% average interest rate, didn’t make any interest payments during that time and had no subsidized loans.
To save on interest, make at least partial payments during residency and use deferment and forbearance only as a last resort. If you can’t afford full payments during residency, sign up for an income-driven repayment plan.
NerdWallet ratingNerdWallet's ratings are determined by our editorial team. The scoring formula for student loan products takes into account more than 50 data points across multiple categories, including repayment options, customer service, lender transparency, loan eligibility and underwriting criteria.
Fixed APR
3.24-17.99%
College Ave Student Loans products are made available through Firstrust Bank, member FDIC, First Citizens Community Bank, member FDIC, or M.Y. Safra Bank, FSB, member FDIC. All loans are subject to individual approval and adherence to underwriting guidelines. Program restrictions, other terms, and conditions apply. (1)All rates include the auto-pay discount. The 0.25% auto-pay interest rate reduction applies as long as a valid bank account is designated for required monthly payments. If a payment is returned, you will lose this benefit. Variable rates may increase after consummation. (2)As certified by your school and less any other financial aid you might receive. Minimum $1,000. (3)This informational repayment example uses typical loan terms for a freshman borrower who selects the Flat Repayment Option with an 8-year repayment term, has a $10,000 loan that is disbursed in one disbursement and a 7.78% fixed Annual Percentage Rate (“APR”): 54 monthly payments of $25 while in school, followed by 96 monthly payments of $176.21 while in the repayment period, for a total amount of payments of $18,266.38. Loans will never have a full principal and interest monthly payment of less than $50. Your actual rates and repayment terms may vary. Information advertised valid as of 5/29/2025. Variable interest rates may increase after consummation. Approved interest rate will depend on creditworthiness of the applicant(s), lowest advertised rates only available to the most creditworthy applicants and require selection of the Flat Repayment Option with the shortest available loan term.
Variable APR
4.24-17.99%
College Ave Student Loans products are made available through Firstrust Bank, member FDIC, First Citizens Community Bank, member FDIC, or M.Y. Safra Bank, FSB, member FDIC. All loans are subject to individual approval and adherence to underwriting guidelines. Program restrictions, other terms, and conditions apply. (1)All rates include the auto-pay discount. The 0.25% auto-pay interest rate reduction applies as long as a valid bank account is designated for required monthly payments. If a payment is returned, you will lose this benefit. Variable rates may increase after consummation. (2)As certified by your school and less any other financial aid you might receive. Minimum $1,000. (3)This informational repayment example uses typical loan terms for a freshman borrower who selects the Flat Repayment Option with an 8-year repayment term, has a $10,000 loan that is disbursed in one disbursement and a 7.78% fixed Annual Percentage Rate (“APR”): 54 monthly payments of $25 while in school, followed by 96 monthly payments of $176.21 while in the repayment period, for a total amount of payments of $18,266.38. Loans will never have a full principal and interest monthly payment of less than $50. Your actual rates and repayment terms may vary. Information advertised valid as of 5/29/2025. Variable interest rates may increase after consummation. Approved interest rate will depend on creditworthiness of the applicant(s), lowest advertised rates only available to the most creditworthy applicants and require selection of the Flat Repayment Option with the shortest available loan term.
NerdWallet ratingNerdWallet's ratings are determined by our editorial team. The scoring formula for student loan products takes into account more than 50 data points across multiple categories, including repayment options, customer service, lender transparency, loan eligibility and underwriting criteria.
Fixed APR
3.19-16.99%
Lowest rates shown include the auto debit discount. Advertised APRs for undergraduate students assume a $10,000 loan to a student who attends school for 4 years and has no prior Sallie Mae-serviced loans. Interest rates for variable rate loans may increase or decrease over the life of the loan based on changes to the 30-day Average Secured Overnight Financing Rate (SOFR) rounded up to the nearest one-eighth of one percent. Advertised variable rates are the starting range of rates and may vary outside of that range over the life of the loan. Interest is charged starting when funds are sent to the school. With the Fixed and Deferred Repayment Options, the interest rate is higher than with the Interest Repayment Option and Unpaid Interest is added to the loan’s Current Principal at the end of the grace/separation period. To receive a 0.25 percentage point interest rate discount, the borrower or cosigner must enroll in auto debit through Sallie Mae. The discount applies only during active repayment for as long as the Current Amount Due or Designated Amount is successfully withdrawn from the authorized bank account each month. It may be suspended during forbearance or deferment. Advertised APRs are valid as of 6/23/2025. Loan amounts: For applications submitted directly to Sallie Mae, loan amount cannot exceed the cost of attendance less financial aid received, as certified by the school. Applications submitted to Sallie Mae through a partner website will be subject to a lower maximum loan request amount. Miscellaneous personal expenses (such as a laptop) may be included in the cost of attendance for students enrolled at least half-time. Examples of typical costs for a $10,000 Smart Option Student Loan with the most common fixed rate, fixed repayment option, 6-month separation period, and two disbursements: For a borrower with no prior loans and a 4-year in-school period, it works out to a 10.28% fixed APR, 51 payments of $25.00, 119 payments of $182.67 and one payment of $121.71, for a Total Loan Cost of $23,134.44. For a borrower with $20,000 in prior loans and a 2-year in-school period, it works out to a 10.78% fixed APR, 27 payments of $25.00, 179 payments of $132.53 and one payment of $40.35 for a total loan cost of $24,438.22. Loans that are subject to a $50 minimum principal and interest payment amount may receive a loan term that is less than 10 years. A variable APR may increase over the life of the loan. A fixed APR will not.
Variable APR
4.37-16.49%
Lowest rates shown include the auto debit discount. Advertised APRs for undergraduate students assume a $10,000 loan to a student who attends school for 4 years and has no prior Sallie Mae-serviced loans. Interest rates for variable rate loans may increase or decrease over the life of the loan based on changes to the 30-day Average Secured Overnight Financing Rate (SOFR) rounded up to the nearest one-eighth of one percent. Advertised variable rates are the starting range of rates and may vary outside of that range over the life of the loan. Interest is charged starting when funds are sent to the school. With the Fixed and Deferred Repayment Options, the interest rate is higher than with the Interest Repayment Option and Unpaid Interest is added to the loan’s Current Principal at the end of the grace/separation period. To receive a 0.25 percentage point interest rate discount, the borrower or cosigner must enroll in auto debit through Sallie Mae. The discount applies only during active repayment for as long as the Current Amount Due or Designated Amount is successfully withdrawn from the authorized bank account each month. It may be suspended during forbearance or deferment. Advertised APRs are valid as of 6/23/2025. Loan amounts: For applications submitted directly to Sallie Mae, loan amount cannot exceed the cost of attendance less financial aid received, as certified by the school. Applications submitted to Sallie Mae through a partner website will be subject to a lower maximum loan request amount. Miscellaneous personal expenses (such as a laptop) may be included in the cost of attendance for students enrolled at least half-time. Examples of typical costs for a $10,000 Smart Option Student Loan with the most common fixed rate, fixed repayment option, 6-month separation period, and two disbursements: For a borrower with no prior loans and a 4-year in-school period, it works out to a 10.28% fixed APR, 51 payments of $25.00, 119 payments of $182.67 and one payment of $121.71, for a Total Loan Cost of $23,134.44. For a borrower with $20,000 in prior loans and a 2-year in-school period, it works out to a 10.78% fixed APR, 27 payments of $25.00, 179 payments of $132.53 and one payment of $40.35 for a total loan cost of $24,438.22. Loans that are subject to a $50 minimum principal and interest payment amount may receive a loan term that is less than 10 years. A variable APR may increase over the life of the loan. A fixed APR will not.
Credible lets you check with multiple student loan lenders to get rates with no impact to your credit score. Visit their website to take the next steps.
2. Switch to income-driven repayment
An income-driven repayment plan is the best option for residents who can’t afford to make full payments.
There are four federal income-driven plans that cap monthly payments at a percentage of your income, extend the repayment period to 20 or 25 years and forgive any balance that’s remaining after the repayment period. Many doctors choose Pay As You Earn (PAYE) or Revised Pay As You Earn (REPAYE) when paying off medical school debt.
Monthly payments can be substantially lower on an income-driven plan: With a $$57,191 annual income — the average stipend for first-year residents in 2019, according to the Association of American Medical Colleges — you’d owe $320 a month if you had no dependents.
The downside of income-driven repayment is that your monthly payment may not cover all of the interest as it accrues, meaning your total loan balance may increase. REPAYE offsets this with its unique, partial interest subsidy that waives half of the unpaid interest.
Payments will increase as your income increases, meaning you may outgrow income-driven repayment as your career advances. On REPAYE, for instance, your monthly payment could end up being higher than it would be on the standard, federal 10-year repayment plan.
3. Seek loan forgiveness
There are several medical school loan forgiveness programs, including Public Service Loan Forgiveness, available to doctors who are willing to work in the public sector or in underserved areas for a certain period of time. Loan forgiveness may be a good option if your career goals align with one of these program’s requirements.
Depending on whether you have federal or private student loans, you may be able to combine loan forgiveness for doctors with another repayment strategy to maximize the amount you get forgiven.
4. Refinance to save on interest
Student loan refinancing is likely the best option for doctors paying off medical school debt aggressively. If you can get a lower rate, you could save thousands of dollars in interest over the life of your loan.
Physicians are typically ideal candidates in the eyes of student loan refinance lenders. Qualifying for the lowest rates requires excellent credit and a high income relative to your debt. You may want to refinance medical school loans during or after your residency, or both.
If you refinance during your residency, you may be able to pay as little as $100 a month. However, those low monthly payments won’t be enough to cover the interest as it accrues, meaning your balance will increase.
Before refinancing — either as a resident or as an attending — make sure you’re comfortable giving up access to Public Service Loan Forgiveness and income-driven repayment. Refinanced loans aren’t eligible for those federal programs.
How much could refinancing save you?
Note: This calculator assumes that after you refinance, you’ll make minimum monthly payments.
After years of education and training, you’ll finally reap the income benefits of your career once you become an attending physician. But if you can live like a resident for a few more years, you’ll have more money to devote to saving, investing and paying off medical school debt.
You may want to make extra payments to get rid of medical school loans faster. But before you do, focus on other financial priorities including:
Establishing an emergency fund of at least $500, but ideally enough to cover three to six months of living expenses.
Investing in a retirement fund, at least enough to get your employer’s 401(k) match.
Paying down high-interest debt like credit cards.
How long does it take to pay off medical school debt?
Your repayment strategy will determine how long it takes to pay off medical school debt. For example, pursuing Public Service Loan Forgiveness will mean 10 years in repayment, while income-driven plans can last as long as 25 years.
There's never any penalty for paying off student loans early, and many doctors choose to aggressively repay their medical school debt.
According to a 2019 survey from staffing agency Weatherby Healthcare, 35% of doctors paid off their loans in fewer than five years. They did this via strategies like making extra payments and refinancing student loans. Of the doctors who still had loans, the majority expected it to take at least 10 years to finish repayment.
