$200,000 from a professional degree. The usual advice is wrong for you.
Medicine, dentistry and law produce balances of this size attached to incomes that start low and end high. That shape breaks most standard repayment guidance, which assumes your current income resembles your future one. The decisions taken during training years determine the total cost more than anything done afterward.
On a $60,000 income, $200,000 in student loans runs $250 a month on RAP, the cheapest payment, or $300 on IBR (new), which costs the least overall. Change the numbers to see your own.
Borrowers at $200,000 are typically medical, dental, veterinary or law graduates entering residency, articling or a first associate position. The defining feature is a large balance combined with a training period on a modest salary followed by a substantial income increase.
$200,000 on the 7 plans open to you
On $40,000 a year
| Plan | Monthly | Total | Years | Forgiven |
|---|---|---|---|---|
| IBR (loans from July 2014 onward) | $134 | $59,601 | 20.0 | $625,560 |
| Repayment Assistance Plan | $100 | $119,490 | 30.0 | $182,000 |
| Income-Contingent Repayment Ends 2028-07-01 |
$401 | $211,874 | 25.0 | $553,759 |
| Standard 10-year | $2,273 | $272,759 | 10.0 | - |
| Graduated | $1,392 | $290,612 | 10.0 | - |
| Tiered Standard Plan | $1,353 | $405,874 | 25.0 | - |
| Extended | $1,353 | $405,874 | 25.0 | - |
On $60,000 a year
| Plan | Monthly | Total | Years | Forgiven |
|---|---|---|---|---|
| IBR (loans from July 2014 onward) | $300 | $113,342 | 20.0 | $522,201 |
| Repayment Assistance Plan | $250 | $249,793 | 30.0 | $177,665 |
| Standard 10-year | $2,273 | $272,759 | 10.0 | - |
| Graduated | $1,392 | $290,612 | 10.0 | - |
| Income-Contingent Repayment Ends 2028-07-01 |
$734 | $357,711 | 25.0 | $222,592 |
| Tiered Standard Plan | $1,353 | $405,874 | 25.0 | - |
| Extended | $1,353 | $405,874 | 25.0 | - |
On $85,000 a year
| Plan | Monthly | Total | Years | Forgiven |
|---|---|---|---|---|
| IBR (loans from July 2014 onward) | $509 | $180,518 | 20.0 | $393,001 |
| Standard 10-year | $2,273 | $272,759 | 10.0 | - |
| Graduated | $1,392 | $290,612 | 10.0 | - |
| Income-Contingent Repayment Ends 2028-07-01 |
$1,151 | $379,832 | 19.7 | - |
| Repayment Assistance Plan | $567 | $397,167 | 30.0 | $105,029 |
| Tiered Standard Plan | $1,353 | $405,874 | 25.0 | - |
| Extended | $1,353 | $405,874 | 25.0 | - |
How much of this you actually pay
On IBR (loans from July 2014 onward), the plan that costs you least at $60,000 a year.
What the balance does over time
A line that stays flat or climbs is a plan where the payment isn't covering the interest.
Why the training years decide everything
During residency or an equivalent training period your income is low and the balance is at its largest, which is exactly when an income-driven plan produces its greatest benefit. Payments calculated on a trainee salary against a $200,000 balance are a small fraction of what a standard schedule would demand.
Those years also count. Every month on a qualifying plan while employed by a qualifying institution accrues toward Public Service Loan Forgiveness, and many teaching hospitals are nonprofit employers that qualify. A residency spent on the correct plan can deliver a third or more of the required payments at the lowest payment amounts you'll ever have.
The alternative that many trainees choose is forbearance, on the reasoning that the salary is too low to pay anything. It produces no forgiveness credit and accrues interest on a very large balance throughout. The difference between those two choices across three to seven years of training is the largest single decision in this entire page.
The specialty and sector question
Where you end up determines which path is correct, and you often have to choose the repayment approach before that's settled. The reasonable strategy is to keep both options open during training, which means an income-driven plan with employment certification filed annually, because that preserves the forgiveness route without committing to it.
If you finish training and move into a high-earning private role, you can abandon the forgiveness path and repay aggressively on a large salary. The years spent on an income-driven plan cost you very little in that scenario, because the payments were low and the alternative was forbearance at a higher cost.
If you stay at a nonprofit hospital, university or public defender's office, the forgiveness path completes and cancels a very large balance tax free. Having certified employment throughout is what makes that available.
The asymmetry is the point. Keeping both options open is cheap; closing the forgiveness option early is expensive and irreversible. That argues strongly for the income-driven plan during training regardless of what you expect to do afterward.
Refinancing, and when it becomes reasonable
Refinance lenders market heavily to this group, because a physician with a confirmed post-training salary is an excellent credit risk and the balances are large. The rates offered can be genuinely attractive relative to the graduate and PLUS rates these balances usually carry.
Refinancing during training is almost always the wrong call. It ends income-driven eligibility at the exact point in your career when it's worth the most, and it forecloses forgiveness before you know which sector you'll work in.
After training, in a private role, with forgiveness definitively off the table and a high stable income, refinancing $200,000 from 8.07% or higher to a materially lower rate saves a very large amount. That's the moment the case becomes strong.
Sequence matters more than the decision itself. The same refinance that's damaging in year one of residency is sound in year one of practice. Don't let a good offer arrive early and be accepted early.
The mistake: forbearance through residency
It's the default recommendation trainees give each other, and it's the most expensive advice circulating in professional education. Forbearance during training accrues interest on a very large balance for the entire period, adds it to the principal at the end, and generates zero qualifying payments toward forgiveness. An income-driven plan over the same years produces small payments you can afford, keeps the balance from compounding as fast, and banks a substantial share of the one hundred and twenty payments at the lowest amounts your career will ever produce. Across a multi-year residency the gap between these two choices routinely runs into six figures. Choose the plan before training starts, not after.
$200k questions
Should residents use forbearance or an income-driven plan?
An income-driven plan in nearly all cases. Payments are low on a trainee salary, interest treatment is better, and the months count toward Public Service Loan Forgiveness if the hospital qualifies. Forbearance achieves none of that.
Do residency years count toward forgiveness?
Yes, if the employer qualifies and you're on a qualifying plan. Many teaching hospitals are nonprofits that do. Certify employment annually to confirm it while the records are current.
When should a doctor refinance?
After training, in a private role, once forgiveness is definitively not the path. Refinancing during residency surrenders the protections at the point they're worth the most.