Student loans in residency: the moves that matter
Residency feels like the wrong time to think about loans — your income is low and your hours are brutal. It's actually the most important time. The plan you pick now compounds for a decade, and decisions made (or avoided) in training are the difference between tax-free forgiveness and a six-figure mistake.
Your five high-leverage moves
- Get on an income-driven plan now. As a resident, your payment will be small — and if your hospital is nonprofit, every one of those small payments counts toward PSLF. Sitting in forbearance wastes that.
- Certify employment for PSLF every year. Submit the PSLF form annually so your qualifying payments are logged and not lost to servicer errors.
- Don't refinance federal loans yet unless you're certain you won't pursue PSLF. Resident refinancing usually trades away forgiveness for a rate cut that isn't worth it. (Refinancing private loans to a lower rate can make sense.)
- Decide your filing status deliberately if you're married — it changes your IDR payment.
- Run your numbers once a year as your situation changes (specialty, attending offers, marriage, kids).
Why it pays now: a resident on PSLF banks 36–84 qualifying payments at a tiny income before their attending salary ever arrives. Those low-income months are the most valuable payments you'll ever make toward forgiveness — and you can't get them back later.
The biggest resident mistake
Parking loans in forbearance "until I'm an attending." Forbearance months generally don't count toward PSLF or forgiveness, so you lose the cheapest qualifying payments of your career. If cash flow is tight, an income-driven plan — not forbearance — is almost always the right answer.
Don't guess — get your personalized plan
AttendingFi runs the real federal-rules math on your exact numbers — PSLF, RAP, capped IBR, refinancing, and your year-by-year income — and shows its work. Free, no login to see your answer, and yours to keep as your career changes.
Run my numbers →FAQ
What should a resident do with student loans?
Get on an income-driven plan, certify PSLF employment annually if your hospital qualifies, avoid refinancing federal loans, and run your numbers yearly. The goal is to bank cheap qualifying payments while your income is low.
Should residents refinance their student loans?
Usually not for federal loans — it forfeits PSLF, and residency is when PSLF is most valuable. Refinancing private loans to a lower rate can still make sense. Confirm your PSLF path first.
Do residency payments count toward PSLF?
Yes, if your training employer is a nonprofit or government hospital and you're on a qualifying income-driven plan. Certify employment each year so they're counted.
Educational estimates, not financial, tax, or legal advice. Verify program rules at studentaid.gov and confirm major decisions with a qualified advisor. See our methodology and disclosures.