Should I pay my student loans during ophthalmology residency or wait?
By Ryan Inman
Published · Updated
The short answer
Pay the required payments, on time, under an income driven plan, and not a dollar more while forgiveness is live. A resident dollar has four better jobs than an extra loan payment, and the loan is the one obligation on the list that a federal program may cancel outright.
The median total education debt is $215,000 among indebted graduates (Association of American Medical Colleges, class of 2025). At a qualifying training employer, the income driven payments made across the internship year and three residency years count toward the 120 payments Public Service Loan Forgiveness requires, and the remaining balance is cancelled at the end of the count. Extra payments made along the way reduce a balance that cancellation would have erased, so they buy nothing. Waiting, in the sense of paying nothing at all, is not the alternative on offer: payments skipped outside a qualifying plan do not count, interest grows, and the count stalls. The resident answer is the disciplined middle: minimums, recertified, every month, and the rest of the paycheck sent to work elsewhere.
Part of the ophthalmology hub.
Where the resident dollar goes instead
The waterfall orders the resident paycheck, and the loan's extra payment is not on it. First, any employer match in the program's retirement plan, a guaranteed return no loan rate matches. Second, one month of reserves, because a resident with no cushion borrows the first emergency at card rates. Third, the credit cards themselves to zero, since card interest runs far above the 7 percent line this site uses to rank debt. Fourth, coverage, and in this specialty that means the individual own occupation disability policy bought in training, while the health record is clean. The loan plan runs in parallel with all of it, at minimums. Only after those steps does the backdoor Roth question and the Roth question for trainees even open, and both outrank extra loan principal at resident tax rates, because each year's Roth space closes at the April tax filing deadline and loan principal on a forgiveness track is worth nothing.
The arithmetic behind the ranking is worth seeing once. An extra $300 a month sent to loans across four training years is $14,400, because $300 times 48 is $14,400. On a live forgiveness track, the cancelled balance falls by exactly the extra paid and the household is $14,400 poorer in liquid assets for zero change in outcome. Off the track, the same $14,400 against a balance above 7 percent saves real interest and the ranking changes, which is why the answer is a track answer, not a loan answer. Know which track the household is on before deciding what a payment is worth.
When paying more is right in residency
Three situations move real money to the loans during training. The first is a decided private practice future with no qualifying employer anywhere in it: no fellowship at a qualifying center, no academic first job, and a household that has run the crossover and chosen payoff. Even then, the waterfall order holds, and extra principal waits behind the match, the first reserve month, the cards, and coverage. The second is a small balance. A borrower carrying far less than the median, whose balance a few attending years retire on any plan, gains simplicity from clearing it and loses little forgiveness value, because there was little to forgive. The third is a rate problem created by the loans themselves: a private loan, or a federal loan refinanced early by mistake, sits outside forgiveness entirely and is priced like any other debt above or below the 7 percent line.
What never justifies extra payments is discomfort. A $200,000 balance feels like an emergency at a trainee salary, and the feeling is understandable and expensive. The balance is a known quantity with a known program attached to it, and the resident years are the cheapest payments of the whole count. Treat the loan as a plan being executed, not a fire being fought, and let the paycheck do the four jobs that only resident dollars can do.
The main points
- On a live forgiveness track: required income driven minimums, recertified on schedule, and never a dollar extra.
- The resident dollar outranks loan principal four times over: the match, one month of reserves, the cards to zero, and the disability policy.
- Extra payments make sense only off the track, on a small balance, or on debt that sits outside the federal programs entirely.
- Refinancing in residency trades away forgiveness and income driven protection for a rate cut at the moment it is worth least.
Related questions
Should I refinance during residency to lower the rate?
Almost never. Refinancing federal loans into a private loan removes them from forgiveness and from income driven plans permanently, in exchange for a rate cut whose value is smallest exactly when the balance is youngest. The refinance question belongs to attending life, after the track decision is final, and it is worked on this hub for the first attending year.
What about interest accruing while I pay minimums?
It accrues, and on the forgiveness track it is cancelled with the rest of the balance, which is why the track answer holds. Off the track, accruing interest is the price of the four better jobs, and it is a fair price: the match, the reserve, the cleared cards, and the disability policy are worth more than the interest on minimum payments across four years. Watch capitalization events, recertify income on time, and the interest stays a known line item instead of a surprise.
My spouse has no loans. Does that change the answer?
It changes the household math, not the loan rule. A spouse's income raises the income driven payment when filing jointly and raises the household's capacity to fund the waterfall steps faster. Run the filing status comparison yearly, file the certification as usual, and put the household's extra capacity into the waterfall order rather than into principal on a track that cancels the balance anyway.
Sources
- Association of American Medical Colleges. Median total education debt of $215,000 among indebted graduates, class of 2025. Accessed October 2026.
- Federal Student Aid, Public Service Loan Forgiveness. The 120 payment structure that makes extra payments on a live track worth nothing. Accessed October 2026.
- Financial Fellowship, the tax efficiency ladder. The career wide funding order the resident waterfall follows. Accessed October 2026.