AttendingFi Research · 2026 Edition
The 2026 physician & dentist student-loan report
Medical and dental graduates leave training with a median education debt near $205,000 — but what that debt means depends entirely on the specialty it's paired with. We ranked 32 medical and dental specialties by debt-to-income, the single ratio that decides whether a physician should chase forgiveness or refinance and pay it off. Debt-to-income ranges from 36% to 111%.
By the AttendingFi research team · checked against current federal program rules and published compensation data, June 2026. Free to cite with attribution to AttendingFi.
Debt-to-income by specialty, 2026
Ratio = $205,000 median education debt ÷ representative early-career income. Click a column to sort.
| Specialty ↕ | Income ↕ | Debt-to-income ↕ | Tier |
|---|
Incomes are representative early-career figures by specialty, the same values powering the AttendingFi calculator; debt anchor is the AAMC-reported median education debt. Individual debt and income vary widely.
Five findings
1. The dentist's paradox.
General dentistry shows the highest debt-to-income in the dataset at 111% — not because dentists borrow recklessly, but because dental-school debt rivals medical-school debt while early-career income (~$185,000) sits well below most physician specialties. The lowest-income field carries the heaviest relative load.
2. Surgical specialties have the most slack.
Orthopedic surgery (36%), plastic surgery (37%), and cardiology (39%) clear their education debt against income several times over. For these specialties, aggressive private refinancing often beats forgiveness — the math rewards paying the loan off fast.
3. Primary care lives on the PSLF side of the line.
Family medicine (80%), pediatrics (85%), and internal medicine (76%) carry debt-to-income ratios where income-driven repayment plus Public Service Loan Forgiveness usually wins. The higher the ratio, the more forgiveness is worth relative to refinancing.
4. The 50% line is the strategic fault line.
Below roughly 50% debt-to-income, refinancing tends to win; above it, forgiveness strategies pull ahead. Eighteen of the 32 specialties here sit above 50% — meaning for most physicians and dentists, PSLF or long-term income-driven forgiveness is the center of the plan, not an afterthought.
5. Residency is where the leverage is.
Every one of these specialties passes through 3–7 years of residency or training at roughly $60–75k, when income-driven payments are low or $0. Months of training under a qualifying employer are the cheapest qualifying payments a physician will ever make toward forgiveness — and deferment or forbearance months from that period can often be recovered through PSLF buyback.
What to do with your ratio
If your debt-to-income is below ~50%, modeling usually favors refinancing to the lowest rate and paying aggressively. Above ~50%, income-driven repayment paired with PSLF (if you work for a nonprofit or government employer) tends to forgive more than you'd save by refinancing — and refinancing federal loans permanently forfeits PSLF eligibility. The only way to know your number is to run your actual loans:
Tools: Loans by specialty · PSLF Buyback Calculator · Missing Months Checker
Methodology & sources
Debt anchor: the Association of American Medical Colleges (AAMC) reported median education debt for medical-school graduates, approximately $205,000. Income figures are representative early-career attending/practitioner compensation by specialty, consistent with the values AttendingFi's calculator uses to model repayment. Debt-to-income is computed as a single median-debt anchor divided by specialty income to make specialties directly comparable; it is a planning lens, not a forecast of any individual's situation. Dental specialties are included because dental graduates face comparable debt against generally lower early-career income. Reviewed against current federal program rules, June 2026.
Educational analysis, not individualized financial advice. Figures are representative and rounded. Verify your own loan details at studentaid.gov.