If you are in a medical or dental residency, federal rules give you the right to put your federal student loans into forbearance during medical residency, and your servicer must grant the request once you submit proof of enrollment. That is the short answer. The longer answer is that just because you can pause payments does not mean you should. For residents working at nonprofit hospitals or academic medical centers, choosing forbearance over an income-driven repayment plan can cost tens of thousands of dollars in lost forgiveness credit and capitalized interest.
Here is what to weigh before you sign the form.
Who Qualifies and Why the Servicer Cannot Say No
You qualify if you are serving in a medical or dental internship or residency program that either leads to a degree or certificate from a qualifying institution, or that you must complete before you can begin professional practice in your field. The governing regulations are 34 CFR § 682.211 for older FFEL loans and 34 CFR § 685.205 for Direct Loans.1eCFR. 34 CFR 682.211 – Forbearance2eCFR. 34 CFR 685.205 – Forbearance
The word “mandatory” is doing real work here. Discretionary forbearance is up to the servicer; mandatory forbearance is not. The regulation uses “shall,” so once you send in a complete request with the required certification, the servicer must approve it.
One quirk in the rule: mandatory residency forbearance is available only if you are not eligible for a medical or dental internship deferment, or if your promissory note does not provide for that deferment.1eCFR. 34 CFR 682.211 – Forbearance The internship deferment was a feature of older FFEL-era notes, and most current Direct Loan borrowers go straight to mandatory forbearance. Your servicer can confirm which applies to your specific loans.
Fellowships and Private Loans
The federal request form names internship and residency programs. It does not name fellowships.3Federal Student Aid. Mandatory Forbearance Request – Medical or Dental Internship/Residency, National Guard Duty, or Department of Defense Student Loan Repayment Program Forbearance If your fellowship is supervised training that leads to a degree or certificate, or that you must complete before practicing, you may still qualify. Ask your servicer with your program details in hand rather than assuming you are shut out.
Also, this right applies only to federal loans. Private student loan forbearance depends entirely on your loan contract, and private lenders set their own rules, which are usually less generous than federal ones.4Consumer Financial Protection Bureau. Is Forbearance or Deferment Available for Private Student Loans? Keep paying your private loans until the lender confirms any postponement in writing.
How to Request the Forbearance
Submit the federal form titled “Mandatory Forbearance Request: Medical or Dental Internship/Residency, National Guard Duty, or Department of Defense Student Loan Repayment Program Forbearance.” You can download it from your servicer’s website or from the Federal Student Aid site.3Federal Student Aid. Mandatory Forbearance Request – Medical or Dental Internship/Residency, National Guard Duty, or Department of Defense Student Loan Repayment Program Forbearance You will need your Social Security number, loan account numbers from your billing statements, and the start and end dates of your current training period.
The form has a certification section that an authorized official at your program must complete. Usually that is your program director or a designee. They verify full-time participation and give their title and contact information. Instead of filling out that section, they can attach a signed letter with the same information.3Federal Student Aid. Mandatory Forbearance Request – Medical or Dental Internship/Residency, National Guard Duty, or Department of Defense Student Loan Repayment Program Forbearance Make sure the dates on the form match what your program has on file. Mismatched dates are the most common reason for delays.
Upload the completed form through your servicer’s secure portal for the fastest turnaround, or send it certified mail if you have to use paper. While the request is being reviewed, your servicer may grant up to 60 days of processing forbearance, but that is discretionary, not mandatory.5eCFR. href=”https://www.ecfr.gov/current/title-34/subtitle-B/chapter-VI/part-682/subpart-B/section-682.211″ target=”_blank” rel=”noopener”>34 CFR 682.211 – Forbearance Keep making payments, or at least stay in contact with your servicer, until you see written confirmation that the forbearance has been applied.
Duration and Renewal
Mandatory residency forbearance is approved in 12-month increments.1eCFR. 34 CFR 682.211 – Forbearance At the end of each 12-month period, you have to submit a new request with fresh certification. Nothing renews automatically. A four- or five-year residency means four or five separate applications.
The renewal deadline is where residents get burned. Once your current forbearance expires, your account goes back to active repayment, and any missed payments show up as delinquent. Set a reminder for at least 60 days before each expiration so you have time to get the new certification signed. If your remaining training is less than a full year, the regulation allows a shorter forbearance period, so the last renewal before you graduate typically covers only the months left.1eCFR. 34 CFR 682.211 – Forbearance
What Forbearance Costs You in Interest
Forbearance stops your monthly payments. It does not stop interest. Interest accrues every day on your full principal balance during forbearance, on both subsidized and unsubsidized loans. When the forbearance ends, the accrued interest capitalizes, meaning it is added to your principal. From that point on, you pay interest on the larger balance.
The numbers add up quickly. A resident with $200,000 in unsubsidized Direct Loans at 7% accrues about $14,000 in interest each year of forbearance. Over a four-year residency, that is roughly $56,000 in new interest capitalizing onto the balance, and compounding pushes the real cost higher. A $200,000 debt can easily grow past $260,000 by the end of training without a missed payment, because no payments were made at all.
You can head this off with voluntary interest payments during forbearance. Even a small monthly amount aimed at the interest reduces what capitalizes at the end. Your servicer can tell you the current monthly interest accrual so you know the target.
Forbearance vs. Income-Driven Repayment
This is the decision that matters, and it is the one residents most often get wrong. Mandatory forbearance sets your payment at zero, but it also gives you zero credit toward income-driven repayment forgiveness or Public Service Loan Forgiveness. An IDR plan bases your payment on your income and family size, and for many residents that payment is low.
Under most IDR formulas, a single PGY-1 earning around $65,000 would have a monthly payment somewhere in the range of $300 to $450. That is real money on a resident’s stipend, but each of those payments counts toward the 120 needed for PSLF and toward the 20- or 25-year forgiveness clocks on IDR plans. Every year in forbearance is a year of qualifying payments you cannot get back through ordinary means.
The IDR menu is in flux. As of early 2026, the SAVE Plan is blocked by a federal court order, and borrowers who were enrolled in or had applied for SAVE have been directed to pick a different repayment plan.6Federal Student Aid. IDR Court Actions IBR and PAYE remain available, and a new Repayment Assistance Program is scheduled to begin in mid-2026. Check the Federal Student Aid site before you choose, because the list of plans may have shifted again.
Some IDR plans also provide an interest subsidy on subsidized loans during the first three years of repayment. Forbearance never does. For residents with a mix of subsidized and unsubsidized loans who plan to pursue any forgiveness track, that subsidy tilts the comparison further toward IDR.
One practical note tied to timing: federal Direct Loans enter a six-month grace period automatically after graduation, and no PSLF credit accrues during that grace period. If you have already matched at a PSLF-eligible employer, you can ask your servicer to waive the grace period, enroll in an IDR plan, and start earning qualifying payments from your first month of residency.
PSLF and the Buyback Option
Most residency programs run through nonprofit hospitals or academic medical centers that qualify as PSLF employers. If yours does, every month on an IDR plan during residency counts as one of the 120 qualifying payments needed for full forgiveness. Even months where your IDR payment calculates to $0 count, as long as you are enrolled in the plan and working full-time for a qualifying employer.
Months in forbearance do not count. Voluntary payments made during forbearance do not count either, because you are not enrolled in a qualifying repayment plan while forbearance is active. A four-year residency spent in forbearance is 48 qualifying payments left on the table.
If you have already used forbearance during residency and want that time back, there is a recovery path. The PSLF Buyback program lets you retroactively purchase forbearance or deferment months to count toward the 120.7Federal Student Aid. Public Service Loan Forgiveness Buyback The important limit: buyback is available only when the purchased months would complete your 120 total. You cannot buy back months in advance to bank them.
Other conditions apply. You must have an outstanding loan balance at the time of purchase and confirmed qualifying employment during the months you want to buy back. The amount owed per month is based on what your IDR payment would have been then. If you were on an IDR plan immediately before or after the forbearance, your servicer uses the lower of those two payment amounts. Otherwise the Department of Education requests tax information to calculate what your IDR payment would have been.7Federal Student Aid. Public Service Loan Forgiveness Buyback
Once the servicer sends you a buyback agreement, you have 90 days to pay the full amount. Miss that window and the agreement is voided; you would have to restart. The agreement is also voided if you submit a new PSLF form, consolidate your loans, or have your loans forgiven or discharged for any other reason after it is issued.7Federal Student Aid. Public Service Loan Forgiveness Buyback
When Forbearance Is Still the Right Call
Forbearance is not always the wrong choice. If your residency program does not qualify for PSLF and you do not plan to pursue long-term IDR forgiveness, the forgiveness math simply does not apply. If your plan is to pay off your loans aggressively once you are earning attending-level income, the gap between forbearance and IDR during training comes down mostly to interest cost, and that gap narrows if you make voluntary interest payments while in forbearance.
Forbearance also works as a short-term bridge. If you are between programs, changing employers, or waiting on paperwork for an IDR application, mandatory residency forbearance keeps you out of delinquency with no payment required. You can move into or out of forbearance during residency, so you are not locked in for the full 12 months if your situation changes.
The residents who lose the most are the ones who slide into forbearance without doing the comparison. If your program qualifies for PSLF and you plan to stay in academic medicine or nonprofit healthcare, skipping IDR enrollment during training is one of the most expensive quiet decisions you can make with your student loans.