Financial fitness for physicians

A THIRD-YEAR RESIDENT RECENTLY FOUND HERSELF IN A COMMON BUT STRESSFUL POSITION: multiple job offers, a mountain of student debt ($366,000 to be exact), and one offer from her own mother’s private practice tugging at her heartstrings. She admitted she was nearly in tears: “I’m so confused by all these swirling job details, I can’t think straight.”

For physicians transitioning from residency into practice, a physician job interview isn’t just about securing a position— they’re  about  gathering  the  right information to make a confident, financially sound decision. That includes understanding how each role might impact long-term student loan repayment.

Signing bonuses vs. student loan repayment assistance 

According to the AMA, fewer employers are offering dedicated student loan repayment programs. Instead, many have shifted to offering larger signing bonuses, often as a way to keep things equitable—since not all physicians carry student loan debt. A lump-sum bonus gives the new hire flexibility. But here’s the catch: bonuses are taxable.

For example, a $25,000 signing bonus, taxed at roughly 30%, nets closer to $17,500. That’s significantly less than many physicians expect—especially if they were hoping to put that money toward student loans.

A student loan strategy checklist 

To accurately compare offers, physicians should ask the same questions at every interview. These key topics can help assess how student loans might be affected by each opportunity:

• Does this position qualify for Public Service Loan Forgiveness (PSLF)? Follow-up: Is the position at least 30 hours per week?
• Is it eligible for the National Health Service Corps Loan Repayment Program or any state/local loan repayment programs?
• Does the employer offer loan repayment assistance? Follow-ups: How is it structured—one-time, annually, monthly? Is it paid to the physician or directly to the financial institution?

By asking these questions consistently, you can line up all the details and make comparisons with clarity and confidence.

Real-life example: Weighing the options

Here’s how that third-year resident’s three categories of offers stacked up:

For-profit group practice:

• $125,000 student loan incentive (as a signing bonus)
• Starting salary: $340,000
• Not PSLF eligible
• Flexible schedule and high future earning potential
• This was her favorite in terms of culture and fit

Three nonprofit hospitals:

• Starting salaries: $286,000-$303,000
• Smaller or no student loan incentives
• PSLF eligible
• One offered greater opportunity for leadership growth

Her mom’s practice:

• Salary: $150,000
• Not PSLF eligible
• No loan assistance
• Strong emotional appeal, but financially least viable

After analyzing the long-term impact of student loan repayment, she discovered that the nonprofit offers with PSLF would save her $90,000 on her loans. However, when she compared the potential earnings and growth at the for-profit job, the numbers tipped back in favor of her top-choice practice.

Her final decision? She accepted the for-profit offer—and negotiated a flexible schedule that allows her to spend one week a month working in her mother’s clinic. Financially sound, emotionally satisfying— a solution that worked on all levels.

Final thoughts 

Use your interviews not just to impress—but to investigate. The right questions now can lead to less debt, more clarity, and ultimately, a career path that checks every box. •