Med School Opens New Worlds, But Pile of Debt May Tag Along

Medicine was always on James Cross’s path. During undergrad, he dabbled in a few other fields, but after a stint as an emergency medical technician, he knew he wanted to be a doctor. But he also knew that accepting a large amount of debt would be part of the bargain.

Today, as a fourth-year medical student at Drexel University in Philadelphia, he’s accrued about $200,000 in loans, which puts him right in line with the average medical student, excluding premedical and other educational debt.

While facing that kind of debt isn’t desirable, it’s a burden most future doctors willingly take on — 73% of medical school graduates have education debt. Like Cross, they are mission-driven and have a genuine passion for their career choice. But the debt can discourage some from entering the field, and at the very least, impact earnings for years to come.

The upside, for now, is that “physicians still earn among the highest salaries of working professionals in the United States,” according to LaMont Jones, the managing editor for education at US News & World Report. “Pay is significantly higher among doctors in certain specialties, like orthopedics, brain, and plastic surgery, so it’s not surprising that many medical students who are concerned about debt and income after school lean toward fields of practice that pay more.”

This holds true for Cross, who is planning to focus on anesthesia, which ranked as the eighth highest-paid specialty in the 2024 Medscape Physician Compensation Report in 2024, with an average salary of $472,000 per year. Cross also counts himself as lucky, having had some parental support in financing his cost of living.

“I know classmates without that support who have had to incur much higher amounts of debt,” he said.

Cross took on traditional federal student loans, has saved some money along the way, and intends to reconsolidate and use income repayment plans during residency. “That’s the least painful option to manage the loans,” said Cross. “But now that the federal government has removed the guardrails to the plans, things feel much more uncertain.”

Cross is referring to the Public Service Loan Forgiveness Plan (PSLF), enacted by Congress in 2022. While the current presidential administration has kept that open, an executive order excluded certain employers from the plan, and by extension, certain student loan borrowers.

No matter where a student may fall on the debt spectrum, most must figure out a path forward to eventually tackle debt.

Getting There From Here

Getting a handle on debt is something that ideally begins before even entering medical school, according to Jones.

“Investigate all your options before the med school application cycle even begins,” he said. “It’s essential to do comparisons, identifying schools where you can still get good training at a significantly lower cost. If accepted to multiple schools, compare and negotiate financial aid packages.”

There is growing awareness of how high a burden medical school can be, according to Daniel Bonnici, MD, JD, clinical assistant professor of clinical science at the Kaiser Permanente Bernard J Tyson School of Medicine (KPSOM), Pasadena, California. And because of it, there’s a small but growing push to make medical school free.

“Like many problems in the United States, there are the haves and have nots when it comes to medical school debt,” he said, “so some schools are looking to become tuition free.”

That’s currently the case at KPSOM, which has waived all tuition and fees for classes entering in the fall of 2020 through the fall of 2025.

“The cost of medical school is high, and that debt can impact students’ future career choices as well as the type or location of their clinical practice, so our hope is to help minimize those concerns for our students,” said Bonnici.

Other schools that have joined the tuition free ranks include Cleveland Clinic in Cleveland, Columbia University in New York City, Emory University in Atlanta, and the Albert Einstein College of Medicine in New York City. Johns Hopkins University in Baltimore offers tuition free opportunities for families earning under $300,000. Each school has different versions of the offers, but all are funded by donations and are available typically at elite medical schools, which lead critics say this may create an increased disparity between who does and doesn’t get into medical school.

For students already in medical school, the issue is how to pay off the debt already accruing. 

“The best approach is to create a customized plan, which means considering more than just the regular income-driven repayment options,” said Dennis Shirshikov, educational leader at Full Mind Learning. “While plenty of med students do benefit from income-based repayment programs or Public Service Loan Forgiveness, some alternatives are even more creative — like negotiating directly with loan servicers for lower interest rates, or potentially even negotiating employer-sponsored repayment assistance.”

While looking at private loads is an option — and may become more necessary in light of the federal government cuts — it’s not always an attractive one.

“I’m on the hook for my loans at the 6-month mark following graduation,” said Cross. “If PSLF doesn’t come through, I’ll be looking at applying for forbearance and then accumulating interest. Or I can consider a private lender with much higher rates than a federal loan, with no flexibility. This is a big weight on me.”

Should federal loans remain an option, they are by far the best option, according to Jones.

“Although they’re in a state of flux right now, they have benefits that help ease the burden of repayment, including grace periods and income-based plans, as well as loan forgiveness after making qualifying monthly payments for 10 years while working in a qualifying position at a qualifying employer.”

While in medical school, you can also pay interest on your loans, said Jones. “That will keep the interest from capitalizing at the end of school and being added to the loan principal, which causes you to pay interest on interest,” he said. “Paying student loan interest as you go along can help you graduate from med school with less debt and lower monthly payments.”

The task of paying down debt post-graduation can be made harder for some students because it’s often a time when they’re also getting married and starting a family.

“I had my first child while in medical school,” said Bonnici. “My expenses built up over time and dollars weren’t coming in until several years later.” 

That’s an important consideration when looking to pay down debt. Add into your equation geography — the cost of living varies greatly from one place to the next — family plans and expected salary from your specialty. Family medicine and pediatrics, for instance, will provide you with a much lower income than something highly specialized. The flip side is that you may be practicing and earning income much sooner.

“Consider a job that will qualify you for student loan forgiveness, even if it’s not in your dream location,” Jones said. “Since there will be a major doctor shortage in the US in the coming years, it will probably be easy to relocate once your debt is more manageable or paid off.”

No two students will have the same story, but debt and uncertainty are a common thread. Despite it all, few doctors regret their choice of career.

“Becoming a physician is an honor and a privilege, and the best decision I ever made,” said Bonnici. “The cost was ultimately very worthwhile for me and my career.”