Do the PSLF check before anything else

If you are a physician carrying six figures of medical-school debt, the single most expensive mistake you can make is refinancing your federal loans privately before you have ruled out Public Service Loan Forgiveness. Refinancing federal debt into a private loan is irreversible, and it permanently strips away PSLF eligibility, income-driven repayment, and federal forbearance. For a physician working at a nonprofit or 501(c)(3) academic hospital with a large balance relative to income, PSLF can forgive the remaining balance tax-free after 120 qualifying payments — frequently worth far more than any interest-rate reduction a refinance could deliver.

This is why Student Loan Planner estimates that refinancing medical-school loans is actually the right move for only roughly 20 to 30 percent of physicians. The headline-grabbing "lower your rate" pitch is genuinely valuable for the right physician and genuinely harmful for the wrong one. So the order of operations is non-negotiable: confirm whether PSLF or another federal program serves you better first, ideally with a fee-only fiduciary advisor, and only then evaluate refinancing. Our PSLF vs refinance decision framework walks through that fork in detail.

2026 update: the Repayment Assistance Plan (RAP) changes the refinancing calculus

Before you refinance a single federally-held loan, understand what you would be walking away from. A new income-driven repayment (IDR) option called the Repayment Assistance Plan, or RAP, was created through a reconciliation bill signed into law on July 4, 2025, and it is scheduled to become available to Direct Loan borrowers no later than July 1, 2026. RAP is now part of the federal menu that refinancing forfeits, and for residents, fellows, and anyone employed by a 501(c)(3) hospital, university, or government agency, it materially raises the stakes of the refinance decision.

RAP is not available to everyone. Parent PLUS Loan debt is not eligible — nor are Consolidation Loans that paid off Parent PLUS Loans, nor Consolidation Loans that paid off Consolidation Loans that paid off Parent PLUS Loans. If your debt includes Parent PLUS borrowing on your behalf, confirm eligibility on studentaid.gov before assuming RAP applies to you.

For borrowers who are eligible, RAP works differently from the income-driven plans physicians may already know. It carries a longer forgiveness timeline — 30 years, compared with 20 or 25 years under other IDR plans — but it also builds in two subsidies designed to keep balances from spiraling. First, an interest subsidy: if your required RAP payment is smaller than the interest accruing that month, the unpaid interest is not charged, so your balance cannot grow while you're in the plan. Second, a principal subsidy: if your monthly payment does not reduce principal by at least $50, the plan applies a subsidy to guarantee at least a $50 reduction in principal every month. RAP payments are calculated as a percentage of your adjusted gross income, with a $50-per-month deduction for each dependent and a $10 minimum monthly payment. We are deliberately not citing a specific percentage-of-AGI rate, a projected monthly payment, or a physician salary figure here — those depend on your own AGI, family size, and the final published plan rules, and none of those specifics were part of what we could verify. Run your own numbers at studentaid.gov before making any decision.

The detail that should stop you before you refinance: RAP has a one-way door. Payments made under RAP do not count toward forgiveness under the older income-driven plans — IBR, ICR, or PAYE. Every other IDR plan lets qualifying payments carry with you if you switch plans later; RAP does not extend that courtesy in reverse. If you are pursuing PSLF or another IDR forgiveness track and you move into RAP, you cannot switch back to IBR, ICR, or PAYE without losing the forgiveness progress you accumulated while in RAP. And as with any IDR plan, a RAP payment only counts toward RAP forgiveness or PSLF if it is made on time.

Why this matters for the refinance decision: refinancing federal loans with a private lender is irreversible. It permanently converts federal debt into private debt, and a private loan is never eligible for RAP, any other income-driven plan, or PSLF — regardless of what your employer or income does afterward. That was already true before RAP existed. What RAP changes is the size of what is on the table. Residents and fellows with low current income and an uncertain future employer now have another income-driven option, with meaningful interest and principal subsidies, sitting on the federal side of that line. Physicians at a 501(c)(3) hospital, academic medical center, or government employer pursuing PSLF have an additional plan to model against a refinance quote — and a new switching trap (RAP versus IBR/ICR/PAYE) to understand before choosing an IDR plan at all. None of this changes the calculus for a private-practice attending with no PSLF-qualifying employer and no plan to use IDR; for that physician, refinancing may still be the right call. But if you have any federal loans and any chance of qualifying for PSLF or benefiting from income-driven repayment, treat RAP as a mandatory line item in your PSLF-vs-refinance analysis, not a footnote. See our PSLF vs refinance decision framework for how to work through it, and confirm current plan details directly at studentaid.gov before you decide.

Who should — and shouldn't — refinance

Refinancing tends to make sense for physicians who: have private loans already (these have no federal benefits to lose), or are attendings in private practice with no PSLF-qualifying employer, a strong income, good credit, and a plan to aggressively pay the balance down. For these physicians, shaving even a percentage point off a large balance can save tens of thousands over the life of the loan.

Refinancing usually does not make sense for physicians who: work for a nonprofit or government employer and are pursuing PSLF, are early in training with uncertain future employment, have a balance large enough relative to income that forgiveness math wins, or might need the federal safety net of income-driven repayment (including the new RAP option) and forbearance if their income drops. When in doubt, keep federal loans federal until the picture is clear — you can always refinance later, but you can never un-refinance.

How to compare physician refinancers (the 6 levers)

Once you have decided refinancing is right for you, the lenders look more alike than their marketing suggests. Compare them on six things:

• The rate you are actually offered. Advertised "rates from" numbers are best-case. Get a soft-pull quote from several lenders — it is free and does not affect your credit — and compare the real offers.
• Resident/fellow in-training terms. If you are still training, this can dominate every other factor. Look for low in-training payments and, critically, whether interest capitalizes during training.
• Fixed vs variable options and terms. Confirm the available repayment terms (5–20 years) and whether both fixed and variable are offered.
• Hardship and forbearance protections. Private loans vary widely in what happens if your income drops. Read the deferment/forbearance policy before signing.
• Fees and prepayment penalties. The major reputable refinancers charge no origination or prepayment fees; verify this for any lender you consider.
• Perks and ecosystem. Some lenders bundle career support, member benefits, or cashback bonuses. Treat these as tie-breakers, not primary reasons.

The major lenders for medical-school loans

The lenders most consistently named for physician and medical-school loan refinancing in 2026 are Laurel Road, SoFi, Earnest, Splash Financial, and ELFI. Here is how they tend to be positioned — verify the current specifics and, above all, the rate you are personally quoted.

Laurel Road. A healthcare-focused lender (operating under KeyBank) repeatedly highlighted for residents and fellows, thanks to an in-training program that allows a token monthly payment while interest accrues simply rather than capitalizing during training. For physicians still in residency or fellowship, this is often the standout feature in the category.

Earnest. Frequently rated at or near the top of the medical-school refinance category on comparison platforms, noted for flexible repayment terms (including the ability to fine-tune your term and payment), competitive rates, and relatively accommodating qualification. A strong all-around option for attendings.

SoFi. More than a lender — a broader financial platform. Beyond competitive rates, SoFi bundles member perks like career coaching, networking events, and unemployment protection, which some physicians value. If you want a one-stop financial ecosystem, SoFi is worth a quote.

Splash Financial and ELFI. Both are well-regarded marketplaces/lenders that routinely appear in physician refinance shortlists and sometimes carry sign-up bonuses. Because Splash works across a network of lending partners, it can be a useful way to surface a competitive offer. Always compare its final quote against the direct lenders above.

A note on our links: MD Passive Income does not currently have affiliate relationships with these lenders, so the names above are editorial mentions, not paid placements. If that changes, we will disclose it clearly per our standards. For now, go directly to each lender to request a quote.

Residents and fellows: the in-training advantage

If you are still in training, your decision is different from an attending's. Many physicians in residency should not refinance federal loans at all — staying federal preserves PSLF eligibility and access to income-driven repayment, which can be ideal during low-income training years. But if you have already determined PSLF is not your path, the in-training refinance programs become relevant.

The key variable is interest capitalization. Standard federal forbearance lets unpaid interest capitalize (get added to principal, so you pay interest on interest). A lender that lets you make a reduced in-training payment while interest accrues simply can save a meaningful sum over a multi-year training period compared to letting it capitalize. Run that comparison specifically for your balance — it is often the difference-maker for trainees who have ruled out forgiveness.

What rates physicians can expect in 2026

Refinance rates move with the broader rate environment and with your personal credit, income, and chosen term, so no one — including us — can promise you a number, and any rate we might quote here would be stale by the time you read it. Fixed rates offer certainty over the life of the loan; variable rates typically start lower but carry the risk of rising over time. Check each lender's currently published rate ranges directly on their site, since these change with market conditions.

The only rate that matters is the one you are actually offered. Because every major refinancer provides a free soft-pull estimate that does not affect your credit, the correct move is to collect quotes from three or four lenders in a single sitting and compare the real offers side by side. Shorter terms carry lower rates but higher monthly payments; longer terms do the reverse. Choose the shortest term whose payment you can comfortably sustain.

The step-by-step refinance process

• 1. Rule out PSLF and federal programs. Confirm your employer's status and run the forgiveness math first.
• 2. Check your credit and pay down revolving balances. A clean credit profile earns a better rate.
• 3. Gather documents. Loan statements, proof of income (or signed contract for incoming attendings), and ID.
• 4. Get soft-pull quotes from 3–4 lenders. Same day, same balance and term, so the comparison is apples-to-apples.
• 5. Compare total cost, not just rate. Factor term length, fixed vs variable, and hardship protections.
• 6. Apply with your chosen lender (one hard pull). Then confirm your old loans are paid off and keep records.
• 7. Revisit in a few years. No prepayment penalty means you can refinance again if rates or your income improve.

Five expensive mistakes to avoid

1. Refinancing federal loans before ruling out PSLF. The irreversible error. Always check forgiveness first.

2. Quoting only one lender. Rates vary by lender for the same borrower. Skipping comparison leaves money on the table.

3. Chasing a cashback bonus over the rate. A $500 bonus is trivial against a percentage point on a large balance held for years.

4. Picking the longest term for a low payment. It minimizes the monthly bill but maximizes lifetime interest. Choose the shortest term you can sustain.

5. Ignoring hardship protections. Private loans lack the federal safety net. If your income is variable, weigh the forbearance terms heavily.

Frequently asked questions

Related reading

• PSLF vs Refinance: A Physician's Decision Framework — the fork to resolve before you refinance.
• Physician Disability Insurance: Own-Occupation Explained — protect the income that repays the loan.
• Best Physician Mortgage Loans Compared 2026 — the other big physician borrowing decision.
• Physician Tax Reduction Strategies 2026 — free up cash flow to attack the balance.
• 1099 Moonlighting Taxes for Physicians 2026 — how extra 1099 income changes your AGI, and with it your RAP or IDR payment math.
• The MD Passive Income Start-Here Guide — the whole physician-finance roadmap.