Quick answer: PSLF Buyback is no longer priced on the SAVE formula — since March 31, 2026 the Education Department calculates it on IBR, PAYE, or ICR, using your tax return for each calendar year the forbearance covered. Because a physician's income can quadruple between residency and attending inside that same window, doctors routinely owe far more than the SAVE-era figure they were expecting, and it comes due as an unscheduled lump sum a physician mortgage does nothing to cover.

Update — September 14, 2026: The pricing rules below still apply to pre-RAP pauses, including the 2024–2026 SAVE forbearance. But the Education Department has since narrowed who can buy back at all: deferment or forbearance months spent on the Repayment Assistance Plan (RAP) or the new Tiered Standard plan are no longer eligible. If you are on RAP or expect to be, read PSLF Buyback Is Closed to RAP Borrowers before you plan around a future buyback.

If you sat in the SAVE administrative forbearance while the litigation played out — and most public-service borrowers did — those months earned you no PSLF credit. PSLF Buyback is the mechanism for reclaiming them. You pay what you would have paid on a qualifying plan during those months, and the months count.

The catch is how the Education Department now calculates that number, and physicians are exposed to it in a way almost no other profession is.

The pricing change most coverage skipped

On March 31, 2026, the Department stopped using the SAVE formula to price buyback amounts. Because the courts held that SAVE is not a legal repayment plan, the calculation now runs on IBR, PAYE, or ICR instead. The Department reconfirmed this in updated buyback guidance reported on August 20, 2026, specifically for borrowers looking to buy back the 2024–2026 administrative forbearance.

The difference is not marginal. One widely cited example: a borrower who would have owed roughly $4,300 under the SAVE formula owes closer to $12,800 under IBR. Same months, same borrower, nearly triple the bill.

Why the calendar-year rule hits doctors hardest

The SAVE forbearance began around July 2024, which means it has run well past twelve months. That puts nearly everyone in it under the Department's long-gap rules, and those rules are the part that should get a physician's attention.

For a gap of twelve months or more, ED does not pick one payment and multiply. It asks for tax returns and family size for each calendar year the forbearance covered, then computes what you would have paid under the lowest available IDR plan in each of those years separately:

For a teacher or a public defender, those three lines look roughly the same. Income in 2024 resembles income in 2026, so the buyback is a fairly flat calculation.

For a physician, those lines can differ by a factor of four. If you matched into attending work partway through this window, your 2024 return shows resident income, your 2025 return shows a partial attending year, and 2026 shows the full number. The Department prices each slice at that slice's income. Your buyback cost is therefore driven not just by how long you sat in forbearance but by where your training-to-attending jump falls inside it.

Two doctors with identical loan balances and identical forbearance months can owe very different amounts, purely because one finished fellowship in 2024 and the other in 2026.

There is also a documentation trap worth knowing. If you do not supply the requested returns and family-size information within 30 days, ED defaults to the 10-year Standard payment — which for a large medical-school balance is usually the most expensive outcome on the menu.

Where this collides with buying a house

Here is the part nobody in the physician-mortgage space is connecting.

A physician mortgage solves the down payment. That is genuinely what it is for. What it does not solve is cash reserves — the seasoned funds a lender wants to see sitting in your account after closing — and it does not solve a five-figure lump sum arriving from the Department of Education in the same twelve-month window as your purchase.

Buyback is not a payment plan. It is a lump sum. And you do not control the timing. Roughly 88,000 buyback requests were pending as of April 30, 2026, down slightly from a peak near 89,700; ED has estimated 18,000–19,000 of those are duplicates, putting true unique volume closer to 70,000. April 2026 was the first month on record where the Department decided more requests than it received. The Department has since stopped publishing processing data altogether, which means the honest answer on timing is that nobody outside ED knows.

So the realistic scenario for a physician buyer is this: you submit a buyback request, wait an unknown number of months, and a bill for five figures arrives — possibly while you are under contract, possibly three weeks after you close and drained your reserves to get there.

Two more things worth being clear-eyed about:

Buyback does not improve your mortgage application. While your request sits in the queue, the loans are still on your credit report and still generating a monthly payment that feeds your debt-to-income ratio. Buyback buys you forgiveness eventually. It does nothing for your DTI today. If you are unsure how your servicer's reported payment flows into underwriting, see our guide to student loans and your mortgage.

Waiting does not make it cheaper. Staying in forbearance longer adds no PSLF credit and does not reduce the buyback price. It only lengthens the period you will eventually be asked to pay for.

What a physician planning a purchase should actually do

Pull your 2024 and 2025 returns and estimate the buyback for each calendar year separately at IBR — not at your old SAVE payment. That number, not the SAVE-era figure in your head, is what you should be planning around.

Then decide the sequencing question deliberately. If the estimate is large and a purchase is close, the answer may be to hold the buyback funds in a separate, clearly documented account so an underwriter is not looking at reserves you have already spoken for. Talk to a lender about how a pending buyback obligation should be disclosed rather than discovering it at underwriting.

And confirm the gate before you build plans on any of this: you generally cannot use buyback unless the months you are buying, added to your existing qualifying months, would get you to 120. Buyback is a way to finish, not a way to catch up.

Verify your own repayment and buyback details at StudentAid.gov and with your servicer before acting on any of this.

MedPharmaConnect is an educational resource, not a lender. Always verify program details, current rates, and eligibility with licensed mortgage professionals.