I finished my medical training with roughly $500,000 in student loans from undergraduate and medical school. That's a lot of money. But perhaps the craziest part is that for most of the time I was accumulating that debt, I didn't really understand it.

I knew I was borrowing money. I knew that eventually I would have to pay it back. And I knew there was something called an interest rate attached to it. But I couldn't have told you exactly how much I owed, what my different interest rates were, how much interest was accumulating each year, or what my eventual strategy would be to get rid of the debt.

I just knew that I wanted to become a doctor. Medical school was expensive and I needed loans to pay for it. I didn't have the money to pay for it. So I borrowed it. And then I borrowed some more.

Looking back, this seems crazy. But I also know that my experience isn't particularly unique. Medical students spend an enormous amount of time learning incredibly complicated things. Yet many of us borrow hundreds of thousands of dollars without ever really learning how those loans work.

That was certainly me. By the time I finished training, my overall net worth was around negative $520,000. Most of that was student debt.

And yet, I don't regret taking out those medical school loans. They allowed me to become a doctor.

The important part was what happened next.

Medical school debt is enormous, but it can still be manageable

Medical school has never been cheap. But the numbers today are pretty staggering. According to the Association of American Medical Colleges, the median education debt among indebted medical school graduates in the class of 2025 was $215,000.

And debt doesn't tell the entire story.

For the class of 2026, the median four-year cost of attendance was nearly $298,000 at public medical schools and more than $408,000 at private medical schools. Those are median numbers. Plenty of medical students will spend considerably more.

So I don't think it is reasonable to simply tell future doctors, “Don't take out student loans.” For many people, that's basically the equivalent of saying, “Don't go to medical school.” That certainly was my situation.

Student loans gave me access to a career that otherwise would not have been available to me. For that reason, I don't view my medical school loans as some terrible financial mistake. But that doesn't mean they should be taken lightly either. There is a big difference between intentionally taking on debt as an investment in your future earning potential and blindly borrowing money because everyone around you is doing the same thing.

Unfortunately, I was much closer to the second category.

Medical students today face an entirely different loan landscape

This distinction has become even more important because the way medical students finance their education just changed significantly.

Beginning July 1, 2026, new graduate and professional students generally lost access to Grad PLUS loans. For medical students, new Direct Unsubsidized Loans are generally limited to $50,000 annually and $200,000 in aggregate for professional education. There is also a new $257,500 lifetime federal student loan limit.

There are important nuances and exceptions to these new rules, particularly for students already enrolled and borrowing before July 1, 2026. But for someone entering medical school today, the basic math is pretty striking.

The median cost of four years at a private medical school is now more than $400,000. The new federal professional-school borrowing limit is generally $200,000. That's potentially a very large gap.

The AAMC has raised concerns about these changes, including the possibility that students will increasingly need to turn to private financing to make up the difference. And that's a big deal.

Private student loans aren't inherently bad. I had private loans myself and eventually refinanced them to improve their terms. But private loans generally don't carry the same protections, repayment flexibility, and potential forgiveness options that come with federal loans. This means the cost of medical school matters more than ever.

I'm not saying that every student should automatically attend the cheapest medical school that accepts them. There are family considerations, geography, educational opportunities, personal preferences, and countless other factors that go into that decision. In fact, my decision to go to a more expensive medical school inadvertently became the best financial mistake I ever made because it exposed me to plastic surgery, a specialty that was not necessarily available at the public school I was also considering.

But I do think future doctors need to look at the actual numbers before choosing a school

• What will four years really cost?
• How much can you borrow federally?
• Where will the rest come from?
• What will the interest rates be?
• And what might your balance look like when you finally finish residency or fellowship?

Those questions deserve much more attention than I ever gave them.

The first step is knowing what you actually owe

My approach to student loans during medical school and much of residency was basically avoidance.

I knew they existed. I knew the balance was going up. But I didn't particularly want to look at it. Eventually, after experiencing financial burnout, I realized that ignoring the number wasn't making it any smaller. So the first step in dealing with medical school debt is incredibly simple: understand exactly what you have.

Know every loan balance. Know the interest rate. Definitely know whether it is federal or private. Know the repayment terms. Know what forgiveness programs it may qualify for.

This becomes especially important when interest rates are high. Federal Direct Unsubsidized Loans for graduate and professional students issued for the 2026-2027 academic year, for example, carry an 8.07% fixed interest rate.

Eight percent on a few hundred thousand dollars is real money.

Once you know what you owe, the next question becomes much easier. What are you actually going to do about it?

For most doctors, there are really two paths

The first is forgiveness.

For physicians working for qualifying nonprofit or government employers, Public Service Loan Forgiveness can be enormously valuable. PSLF generally allows the remaining balance on qualifying federal Direct Loans to be forgiven after 120 qualifying monthly payments while meeting the program's requirements.

If PSLF is your plan, then aggressively paying extra toward those loans usually doesn't make sense. You're trying to follow the rules, make the required payments, and ultimately maximize the amount forgiven.

This is why it is so important to understand how loan forgiveness actually works rather than just assuming that your loans will somehow disappear after ten years.

That was ultimately part of my own strategy. I made qualifying payments throughout training and into my attending career. After completing the required number of payments, my remaining eligible federal loans were forgiven through PSLF.

The second path is payoff.

If you aren't pursuing forgiveness, then I generally think you should make a deliberate plan to get rid of your student debt rather than allowing it to become a permanent monthly bill.

The worst strategy is often the accidental one in the middle.

You aren't optimizing for forgiveness. But you aren't aggressively paying the loans off either. You just keep making payments.

For years. And years. And years.

Don't let student loans become another utility bill

This is where I think physicians can get themselves into trouble.

You finish training. Your income jumps dramatically. Suddenly the $2,000 or $3,000 student loan payment that once seemed enormous doesn't feel quite so painful.

So you pay it. Then you pay it again next month. And eventually student loans start feeling like the mortgage, electricity, cable bill, or cell phone. They're just there.

I've even written about the fact that some physicians end up carrying student debt into retirement or even until death. To me, that is a perfect example of how normalized this debt can become.

If you aren't pursuing forgiveness, I don't think that should be the goal. The goal should be to make the debt disappear. That doesn't necessarily mean throwing every available dollar at your loans tomorrow. Your interest rate matters. Your retirement savings matter. And your other financial goals matter.

But there should be a plan.

Your attending income is your greatest weapon

The transition from trainee to attending is probably the greatest financial opportunity that most physicians will ever have.

Your income may increase three-, four-, or even five-fold almost overnight. Unfortunately, your lifestyle can expand just as quickly.

After delaying gratification for a decade or more, it's incredibly tempting to immediately buy the big house, finance the expensive car, take the luxury vacations, and generally start spending like a doctor.

Some lifestyle expansion is completely reasonable. You worked hard to get there. But the gap between your new attending income and your old resident lifestyle is incredibly powerful. Don't waste it.

When I became an attending, my wife and I tried to use that gap intentionally. We didn't put every available dollar toward my student loans. Instead, we developed a broader strategy that allowed us to attack the debt while simultaneously building assets.

We invested in index funds.

We bought cash-flowing real estate.

And we paid down debt.

Plus we continued making qualifying PSLF payments on the federal loans that eventually qualified for forgiveness.

There are certainly arguments that we could have optimized things differently. Maybe we could have paid the loans faster. Maybe we could have invested more.

But I'm not particularly interested in finding the mathematically perfect strategy in retrospect. We had a plan. We followed it. And it worked.

Should you pay off student loans or invest?

This is one of the most common questions doctors ask, and unfortunately there isn't a universal answer.

If you're pursuing PSLF, paying extra on eligible loans generally makes little sense. If your student loans carry a 3% interest rate, aggressively paying them off instead of investing may not be the obvious choice. But if you owe $300,000 at 8%, that's a very different situation.

This is why personal finance is personal.

I generally advocate that physicians work toward saving and investing about 20% of their gross income for retirement and long-term financial goals. I don't love the idea of putting off investing for a decade while waiting to become completely debt free.

Beyond that, you can direct additional money according to your own written financial plan. Maybe you invest and pay off loans simultaneously. Maybe you attack high-interest loans first. Or maybe PSLF makes the most sense.

And if you have private loans, refinancing can sometimes help, although you should be extremely careful before refinancing federal loans into private loans. Once you give up federal protections and forgiveness eligibility, you generally can't get them back.

There are a lot of reasonable strategies.

Doing nothing intentionally isn't one of them.

Paying off student loans is about more than the interest rate

We tend to frame debt decisions mathematically.

What's the interest rate? What's the expected investment return? Which option produces the highest theoretical net worth?

Those things matter. But there is another side to debt that is harder to put into a spreadsheet. Debt creates an obligation on your future income. Every month that you owe money, some portion of the work you do today is already spoken for. And this is especially important for physicians.

Financial freedom isn't about retiring as early as possible for me. It's about having enough financial independence that I can practice medicine on my own terms.

That could mean reducing clinical time. Saying no to an extra call shift. Leaving a toxic job. Starting a business. Taking a lower-paying position that you enjoy more. Or simply knowing that you don't need every dollar of your next paycheck.

Student loans work in the opposite direction.

Imagine sending $3,000, $4,000, or $5,000 every month toward student debt. Then imagine that balance finally reaching zero.

That cash flow doesn't disappear.

It becomes yours. You can invest it. Save it. Spend it. Give it away. Use it to create passive income. Or use it to buy back some of your time.

Debt creates obligations. Financial freedom creates options. And options are incredibly valuable for doctors.

From negative $520,000 to the other side of student debt

When I finished training with roughly $500,000 in student loans and an overall net worth around negative $520,000, the numbers felt pretty overwhelming.

But what I eventually learned is that the size of the starting hole matters less than having a plan to climb out of it.

My student loans weren't the problem. They allowed me to become a plastic surgeon and build a career that I love. The problem was that for years I barely understood them.

Once I started learning about personal finance, everything changed. My wife and I created a written financial plan. We controlled our lifestyle inflation. We invested. Eventually we bought real estate. We paid down debt. And we intentionally pursued PSLF for the loans that qualified.

Eventually, the student loans were gone.

Today's medical students are going to have to navigate a somewhat different road. Medical education remains extraordinarily expensive while the federal borrowing system has become more restrictive. That makes understanding the cost of medical school, the types of loans available, and the eventual repayment strategy even more important before signing on the dotted line.

If you need student loans to become a doctor, take the loans

I did.

But know what you're borrowing. Understand what it costs. Have a plan for how you're going to handle it. And when that attending paycheck finally arrives, use the enormous financial opportunity it creates rather than immediately giving all of it away to lifestyle creep.

Medical school loans can be a tool that helps you become a doctor. Just don't let it become something that controls what you can do once you get there.

What do you think? How much were your medical school loans? How did you handle them? What is the best way for current or future medical students to handle them? Let me know in the comments below!