The physician's student-loan glossary
Every term you'll meet deciding what to do with your loans — defined in plain English, written for doctors and dentists, and grounded in the federal rules. 39 terms, no jargon for jargon's sake.
New to all this? Start with the complete physician's guide to student loans, then run your real numbers to see which of these terms actually drive your answer.
Adjusted Gross Income (AGI)
Your total income minus specific deductions, taken from your tax return. IDR payments are calculated from AGI, so pre-tax retirement contributions (401k/403b) that lower AGI can also lower your IDR payment.
Autopay discount
A small interest-rate reduction (commonly 0.25%) for enrolling in automatic payments — offered on both federal loans and most refinance loans. Small but free.
Capitalization (capitalized interest)
When accrued unpaid interest is added to your principal balance, so you then pay interest on interest. Capitalization events (leaving a plan, consolidation, end of grace) can quietly enlarge a physician's balance. RAP prevents balance growth by waiving unpaid interest each month.
Consolidation (Direct Consolidation Loan)
Combining multiple federal loans into one Direct Loan. It can make FFEL loans PSLF-eligible and simplify servicing, but it can also reset progress and capitalize interest — timing matters. Not the same as private refinancing.
Cosigner / cosigner release
Someone who shares legal responsibility for a private/refinanced loan, often used by residents to qualify or get a better rate. Many lenders allow cosigner release after a set number of on-time payments.
Cost of attendance (COA)
The school-certified total cost (tuition, fees, living expenses) that caps how much you can borrow, especially via Grad PLUS. Borrowing the full COA is a major driver of six-figure physician debt.
Deferment
A temporary postponement of payments; on some loan types the government covers interest, on others it accrues. Like forbearance, deferment months generally don't count toward forgiveness.
Direct Loan
A federal student loan made directly by the U.S. Department of Education. Only Direct Loans are eligible for PSLF and the current IDR plans — older FFEL loans must be consolidated into a Direct Loan to qualify.
Discretionary income
For most legacy IDR plans, your AGI minus 150% of the federal poverty guideline for your family size. IDR payments are a percentage of this figure — not your gross income — which is why family size and filing status change your payment. (RAP uses total income, not discretionary income.)
Employment Certification Form (ECF / PSLF form)
The form that certifies your employer qualifies for PSLF and logs your qualifying payments. Physicians should submit it annually (and when changing jobs) so qualifying residency/fellowship payments are counted and not lost.
FFEL (Federal Family Education Loan)
An older, now-discontinued federal loan program. FFEL loans are not directly eligible for PSLF or current IDR plans; borrowers usually must consolidate them into a Direct Consolidation Loan to qualify.
Fixed vs. variable rate
A fixed rate stays constant for the life of a refinanced loan; a variable rate can rise or fall with market indexes. Physicians planning a short, aggressive payoff sometimes choose variable for a lower starting rate; those wanting certainty choose fixed.
Forbearance
A temporary pause on payments during which interest usually still accrues. Most forbearance months do not count toward PSLF or IDR forgiveness — a common, costly trap for residents parked in forbearance instead of a qualifying IDR plan.
Forgiveness (taxable vs. tax-free)
Cancellation of remaining loan balance. PSLF forgiveness is tax-free; long-term IDR forgiveness (after 20–30 years) is generally taxed as income at the federal level. Which one you're aiming for changes the entire strategy.
Grace period
The months after leaving school before payments are due (typically six months for student loans). Interest may accrue, and the clock on forgiveness hasn't started — many physicians benefit from entering a qualifying IDR plan promptly rather than coasting through grace.
Grad PLUS Loan
A federal loan that covers graduate/professional school costs up to the full cost of attendance. Most physician and dental debt is a mix of unsubsidized Direct and Grad PLUS loans, which carry higher interest rates and origination fees.
Income-Based Repayment (IBR)
A legacy IDR plan that caps payments at 10% (or 15% for older borrowers) of discretionary income and — critically for physicians — never exceeds the 10-year Standard payment. That cap is why high-earning attendings who first borrowed before July 1, 2026 often pay far less on legacy IBR than on RAP.
Income-Contingent Repayment (ICR)
The oldest IDR plan (20% of discretionary income or a fixed 12-year schedule). Generally the most expensive IDR option for physicians; being phased out under the 2025 law.
Income-Driven Repayment (IDR)
Any federal repayment plan that sets your monthly payment based on income and family size rather than your balance. Includes RAP and the legacy plans (IBR, PAYE, ICR, SAVE) being phased out. IDR plans are what make PSLF affordable during low-earning training years.
Loan Simulator (studentaid.gov)
The Department of Education's official federal tool for estimating payments. AttendingFi complements it with physician-specific modeling — your training-to-attending income jump, specialty income, and the refinance comparison the federal simulator doesn't run.
Married Filing Jointly (MFJ)
A tax filing status that combines spousal income. On legacy IDR this generally raises your payment versus MFS, but often lowers total taxes. RAP counts spousal income regardless of filing status in most cases.
Married Filing Separately (MFS)
A tax filing status that, on most legacy IDR plans, lets a married borrower base payments on their income alone rather than household income. It can sharply cut IDR payments but usually raises your tax bill — a tradeoff worth modeling with a CPA.
Negative amortization
When your monthly payment is smaller than the interest accruing, so your balance grows even though you're paying. Common for residents on IDR with large balances. RAP's interest waiver is designed to stop this.
Negative vs. positive amortization
Amortization is how a loan balance is paid down over time. Under positive amortization each payment reduces principal; under negative amortization the balance grows. Knowing which you're in tells you whether 'just paying' is actually making progress.
NHSC Loan Repayment
The National Health Service Corps program, which offers loan repayment (often up to tens of thousands of dollars) to clinicians who work in designated underserved areas. A separate path from PSLF that some primary-care physicians and dentists stack strategically.
OBBBA (2025 reconciliation law)
The 2025 federal budget-reconciliation law that created the RAP plan, began sunsetting SAVE/PAYE/ICR, and changed which borrowers keep access to legacy plans based on when they first borrowed. It reshaped physician loan strategy from mid-2026 onward.
Origination fee
An upfront percentage subtracted from a federal loan at disbursement (notably on Grad PLUS loans), effectively raising your real borrowing cost. Private refinance loans generally have no origination fee.
Partial financial hardship
An eligibility test on some legacy IDR plans: you qualify if your calculated IDR payment would be lower than the Standard 10-year payment. Many residents meet it easily; many attendings no longer do.
Pay As You Earn (PAYE)
A legacy IDR plan (10% of discretionary income, capped at the Standard payment, forgiveness after 20 years) that is being sunset under the 2025 law. New enrollment is closing; existing physicians should model whether to stay or move.
PSLF buyback
A process that lets borrowers pay for certain past months that would have counted toward PSLF but didn't (for example, months spent in certain forbearances), once you've otherwise reached 120 months of employment. Useful for physicians whose payment count lagged their employment.
Public Service Loan Forgiveness (PSLF)
A federal program that forgives the remaining balance on Direct Loans tax-free after 120 qualifying monthly payments made while working full-time for a U.S. government or 501(c)(3) nonprofit employer. For physicians, residency and fellowship years at a nonprofit hospital can count — which is why certifying employment early matters.
Qualifying payment
A monthly payment that counts toward PSLF's 120-payment requirement: made under a qualifying IDR (or Standard) plan, for the full amount, while working full-time for a qualifying employer. Training-year payments often qualify if your hospital is nonprofit.
Refinancing
Replacing federal (and/or private) loans with a new private loan, ideally at a lower interest rate. Refinancing federal loans permanently forfeits PSLF, IDR, and federal protections — so it usually makes sense only once you've ruled out forgiveness. Our engine recommends it strictly when your numbers favor it.
Repayment Assistance Plan (RAP)
The new income-driven repayment plan created by the 2025 federal law (OBBBA). Payments scale from 1% to 10% of total (not discretionary) income, drop $50/month per dependent child, never let interest capitalize, and lead to forgiveness after 30 years. RAP has no payment cap, so high-earning attendings can pay more under RAP than under capped legacy IBR.
SAVE Plan
The Saving on a Valuable Education plan, a short-lived IDR plan that was enjoined by courts and is being eliminated under the 2025 law. Physicians who were parked in SAVE forbearance need a new plan; our engine models the current options.
Servicer
The company that manages your federal loan billing, payment counts, and paperwork on behalf of the Department of Education. Servicer errors on PSLF counts are common, which is why keeping your own records and certifying annually matters.
Standard Repayment Plan
The default 10-year fixed federal plan. Its payment amount also serves as the cap for legacy IBR payments — the reason capped IBR protects high-earning attendings.
The tax bomb
The lump-sum income tax owed on the balance forgiven at the end of a 20–30 year IDR plan (non-PSLF forgiveness is generally taxable). PSLF forgiveness, by contrast, is tax-free. For large balances this tax can be substantial, so it should be saved for in advance — our engine estimates it.
Weighted-average interest rate
The blended rate across your loans, weighted by balance. It's the number to compare against a refinance offer — refinancing helps only if the new rate (for the path you'll actually take) beats your weighted average.
Know the terms — now get your answer
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Run my numbers →Educational definitions, not financial advice. Program rules change — verify specifics at studentaid.gov. See our methodology and disclosures.