Should I refinance my medical school loans during residency?

Usually not, for federal loans. The Repayment Assistance Plan ties the payment to your resident income, waives the interest that payment does not cover, and counts every month toward Public Service Loan Forgiveness at a nonprofit or public hospital. A refinanced loan gives up all three permanently. Private loans borrowed for medical school are a different matter and can be refinanced whenever a lender offers a lower rate.

What does a resident pay under the Repayment Assistance Plan?

The annual payment is 1 to 10 percent of adjusted gross income by bracket, divided by twelve, less $50 a month per dependent, with a $10 minimum. A resident earning $60,000 pays about $250 a month; at $65,000, about $325. Interest the payment does not cover is waived rather than added to the balance.

Do residency payments count toward PSLF?

Yes, when the employer qualifies and the payments are made under a qualifying plan such as RAP. Most teaching hospitals are nonprofit or government employers. A five-year residency can produce 60 of the 120 qualifying payments before attending income starts. Refinancing ends that credit on the refinanced loan.

When does refinancing medical school loans make sense?

After training, for a physician who is not pursuing PSLF, whose loans carry a 2022-23 or later rate, and who is offered a fixed rate at least a full point below the federal rate after the 1 point auto pay reduction, on a payment under about 15 percent of gross income. On a $200,000 balance, a 5.5 percent ten-year refinance costs about $60,000 in interest against about $133,000 under RAP at an attending income.

Can I refinance federal medical school loans back into federal loans later?

No. Refinancing moves the debt to a private lender permanently. Federal consolidation is only available for federal loans, and a refinanced loan is no longer federal.

Should I refinance my private medical school loans during residency?

You can, if a lender offers a lower rate than you have and a payment you can carry on a resident salary. Private loans have no federal protections to lose. Most residents qualify for better pricing once they have an attending contract, so prequalifying in the final year of training and refinancing then usually produces a lower rate.

Refinance Medical School Loans: Residency, PSLF and RAP

Medical school borrowers carry the largest federal balances in the system and the longest wait before a full salary arrives. Three to seven years of residency on a modest income, with six-figure loans accruing interest, is exactly the situation refinance lenders advertise to, and exactly the situation in which refinancing a federal loan is most often a mistake. The right answer changes at the end of training. This guide separates the two periods: what to do with your loans during residency, and when refinancing beats the federal options once you are an attending.

The one-sentence version

Keep federal loans federal through residency, because the Repayment Assistance Plan and Public Service Loan Forgiveness are worth more than any rate during training; refinance after training only if you are not pursuing PSLF and a lender offers a fixed rate well below your federal rate on a payment you can carry.

What you are starting with

Federal graduate loans first disbursed in 2026-27 carry 8.07 percent (Direct Unsubsidized) and 9.07 percent (Grad PLUS, for borrowers still eligible under the grandfathering rules). Earlier loans keep their own year's rate: graduate Direct Unsubsidized loans ran 7.94 percent in 2025-26, 8.08 percent in 2024-25, 7.05 percent in 2023-24, 6.54 percent in 2022-23, and 5.28 and 4.30 percent in the two years before that, according to Federal Student Aid's rate history. Grad PLUS loans from the same years ran one point higher. Grad PLUS ended for new borrowers on July 1, 2026, and professional students now borrow up to $50,000 a year and $200,000 in total in federal loans, so newer classes carry a mix of federal and private debt. Our guide to medical school loans covers the borrowing side; this guide covers what to do with the loans you already have.

Private refinance pricing depends on your credit, income and term. In the second week of November 2026, lenders' published fixed ranges started a little above 4 percent for the strongest applicants and ran past 11 percent for borrowers who barely qualified. An attending physician with strong credit usually sees the low end; a resident usually does not.

During residency: why the federal loan wins

Three federal features matter more in residency than at any other point in a physician's career.

The Repayment Assistance Plan keeps the payment small and stops the balance growing. RAP sets the annual payment at 1 to 10 percent of adjusted gross income by bracket, divided by twelve, less $50 a month per dependent. A resident earning $65,000 pays about $325 a month regardless of balance; at $60,000, about $250. Interest the payment does not cover is waived rather than added to the balance, and if a payment reduces principal by less than $50, the Department adds a match so principal falls by at least that much. A $200,000 balance at 8.07 percent accrues about $1,345 of interest a month; under RAP the roughly $1,000 the resident's payment does not cover is waived. Over three years of residency that is roughly $36,000 of interest that never lands on the balance. A refinanced loan with a reduced payment during training accrues every dollar.
Residency payments count toward PSLF. Most teaching hospitals are nonprofit or government employers, so payments made under RAP during residency count toward the 120 needed for Public Service Loan Forgiveness. A resident who completes a five-year program has made 60 qualifying payments before earning an attending salary; a physician who then stays at a nonprofit or public hospital reaches forgiveness after five more years. Federal Student Aid's report for August 2026 shows about 1.29 million borrowers with $96.4 billion discharged through PSLF and its related waivers. A refinanced loan can never qualify, and the payments already counted on it stop counting.
Deferment and forbearance exist for the years when income is thin. Residency, fellowship, a research year or a gap between programs are the situations in which a private lender is least flexible. Some lenders market a reduced payment during training, which helps cash flow; the balance still grows for every month of it.

There is also the 1 percentage point auto pay reduction. Direct Loan borrowers on auto pay get a full point off from July 1, 2026 through June 30, 2028, and the Department of Education extended enrollment to December 31, 2026. That makes an 8.07 percent loan a 7.07 percent loan, which is the number any refinance offer has to beat. Our residency salary planning guide covers the budgeting side of training.

What a residency refinance product actually offers

A few lenders sell a refinance aimed at residents, with a small payment during training. Citizens, for example, publishes a medical residency refinancing product with fixed rates from 6.39 to 10.55 percent in its October 2026 disclosure; our Citizens review has the detail. The structure can lower the monthly outlay below what a standard private loan would demand, but it does not lower it below RAP for most residents, it accrues interest that RAP would waive, and it ends PSLF credit permanently. The case for it is narrow: a resident with private loans only, or with federal loans at a 2023 or later rate, strong credit, a working spouse or savings, and no public service plans.

After training: when refinancing beats RAP

The math flips once attending income arrives, for a physician who is not pursuing PSLF. RAP's payment rises with income: at $240,000 of adjusted gross income the bracket is 10 percent, or about $2,000 a month. On a $200,000 balance at 8.07 percent that payment takes about fourteen years to clear the loan and costs about $133,000 in interest. The same balance refinanced at 5.5 percent over ten years costs about $2,171 a month and $60,000 in interest. At 6 percent, about $2,220 and $66,000. Against the federal rate after the auto pay reduction, 7.07 percent on a ten-year schedule ($2,329 a month and $79,500 in interest), a 5.5 percent refinance still saves about $19,000.

Refinancing after training can make sense when all of these are true:

You are not pursuing PSLF, and you are sure of it. A physician at a nonprofit or public hospital with five or more years of qualifying payments is usually better off finishing the 120 than refinancing, whatever the rate.
Your loans carry a 2022-23 or later rate (6.54 to 9.08 percent for graduate loans). A 2020-21 or 2021-22 loan at 4.30 or 5.28 percent is almost never worth refinancing.
A lender offers you a fixed rate at least a full point below your federal rate after the auto pay reduction.
The new payment fits your income. On the CollegeLens affordability scale, under 10 percent of gross income is Comfortable and 10 to 15 percent is Manageable; a $2,200 payment is about 11 percent of a $240,000 salary.
You have savings or a second income to cover payments if your income stopped, because the private loan has no income-driven option.

Our refinance calculator runs the comparison for your own balance, rate and term, and asks you to confirm the federal trade-offs before it shows a result.

The middle path

Refinance private loans first. Loans borrowed privately for medical school carry no federal protections, so refinancing them to a lower rate once your income is settled gives up nothing but the old rate. Our guide to when to refinance a private student loan covers the timing.
Refinance only the highest-rate federal loans. A physician holding a 5.28 percent 2021-22 loan and a 9.08 percent 2024-25 Grad PLUS loan can refinance the second and keep the first federal. Lenders will usually refinance a subset of your loans.
Enroll in auto pay now. It costs nothing, lasts through June 30, 2028, and narrows the gap a refinance has to beat.
Prequalify, do not apply, during residency. Most lenders show a rate estimate with a soft credit check that does not affect your score. Knowing the number you would get as an attending is useful; locking it in as a resident usually is not.

Timing checklist

Before residency: enroll federal loans in RAP (or confirm the plan you are on), set up auto pay, and certify your employer for PSLF as soon as you start, even if you are unsure you will stay in public service.
Each year of residency: recertify income for RAP and submit the PSLF employment certification. Keep the confirmations.
Final year of training: prequalify with two or three lenders using your signed attending contract, and compare fixed rates for a ten-year term against your federal rate after the auto pay reduction.
First year as an attending: decide on PSLF. If your employer qualifies and you have five or more years of payments, finish the 120. If not, refinance the federal loans whose rate the private offer beats by at least a full point, and keep any 2020-21 or 2021-22 loan federal.
Keep the payoff letters. Once the private lender pays the federal loan, the decision cannot be reversed.

The bottom line

For a resident, the federal loan is the better product: RAP keeps the payment near $300 a month and waives the interest the payment does not cover, and every month counts toward PSLF at most teaching hospitals. For an attending outside public service with a 2022-23 or later rate and strong credit, a fixed refinance at a full point or more below the federal rate after auto pay saves tens of thousands of dollars and clears the loan in ten years. Refinance private loans freely, refinance federal loans only after training and only selectively, and never refinance a loan with PSLF credit on it. The federal refinancing guide covers the same decision for every borrower, and the refinance hub gathers the calculator and every guide in one place.

Sravani at CollegeLens

Refinancing Medical School Loans: What to Do in Residency and When Refinancing Beats RAP