Oklahoma physician guide
Residency to attending in Oklahoma,
and the twelve months that matter most.
Oklahoma City was the highest-paying metro in the country for physicians in the 2026 Doximity report, which makes the jump from a $68,000 resident stipend the largest raise most of our clients will ever get. It also closes a window. Several of the best decisions a physician can make are only available while the income is still small, and this guide is about those: which employers count for loan forgiveness, what the state will pay toward your loans, and why your last resident year is the cheapest year you will ever have to move money into a Roth.
What should an Oklahoma resident do financially before becoming an attending?
Three things while the income is still low. First, confirm your employer counts for Public Service Loan Forgiveness: OU Health, OUHSC, INTEGRIS, Mercy, SSM Health St. Anthony, the VA and the tribal health systems all qualify, and payments made on a resident’s salary count exactly the same as payments made on an attending’s. Second, if you are headed to rural primary care, emergency medicine or general surgery, the Oklahoma Physician Loan Repayment Program pays up to $200,000 over four years. Third, convert pre-tax retirement money to Roth in the last year you are in the 22% or 24% federal bracket, because the same conversion as an attending costs 32% to 37%.
Source: 34 C.F.R. § 685.219 · Oklahoma HWTC, Physician Loan Repayment Program · Rev. Proc. 2025-32
Reviewed by Jeremy Baldwin, Founder & Private Wealth Advisor, Baldwin Financial, Oklahoma City. Last reviewed October 2026.
The rule
Five facts, each with its source.
Everything below comes from the federal regulations, the Oklahoma program’s own rules and contract, the IRS, and the employers’ nonprofit filings. Student loan rules changed substantially in 2025 and 2026 and may change again; the footer date is when we last checked. If a figure here ever disagrees with a source, the source wins and we fix the page.
PSLF counts payments, not dollars. A resident’s payment is worth as much as an attending’s.
Forgiveness comes after 120 qualifying monthly payments while working at least 30 hours a week for a government or 501(c)(3) employer. Nothing in the rule conditions credit on the size of the payment, so the three to seven years of income-driven payments made on a resident or fellow stipend count in full. For a physician who trains at OU, INTEGRIS or Mercy and stays at a qualifying employer, forgiveness can arrive within a few years of finishing training, with the balance never having been paid at an attending’s rate.
Most Oklahoma hospital employers qualify; the physician-owned ones do not.
OU Medicine, Inc., INTEGRIS Health, Mercy Hospital Oklahoma City and SSM Health Care of Oklahoma are all 501(c)(3) organizations on their IRS filings; the University of Oklahoma Health Sciences Center is a state employer; the Oklahoma City VA is federal; Norman Regional and Stillwater Medical are public trusts; and the regulation names tribal governments, which covers the Chickasaw and Cherokee health systems. Oklahoma Heart Hospital is physician-owned and for-profit, Hillcrest in Tulsa is owned by a for-profit operator, and private groups and surgery centers are for-profit, so none of those count. The entity that matters is the one in box b of your W-2, which the PSLF Help Tool checks by employer identification number.
The 2026 repayment landscape: SAVE is gone, RAP is here, and new loans have fewer choices.
The SAVE plan ended by court settlement in March 2026 and its borrowers had to move to other plans. The Repayment Assistance Plan launched July 1, 2026: payments run from 1% to 10% of adjusted gross income on a sliding scale, less $50 a month per dependent, with forgiveness after 30 years, and RAP payments count for PSLF. Loans made after July 1, 2026 can only use RAP or a standard plan, Grad PLUS loans ended for new borrowers on that date, and professional students are now capped at $50,000 a year and $200,000 in total. Older loans keep access to income-based repayment. Months spent in the SAVE forbearance do not count toward PSLF automatically; the buyback process converts them, under rules the Department revised in 2026; check studentaid.gov for the current terms.
Oklahoma pays up to $200,000 toward the loans of physicians who practice in rural communities.
The Physician Loan Repayment Program, run by the Health Care Workforce Training Commission (the former Physician Manpower Training Commission), pays $50,000 at the end of each of four years of full-time practice in an approved community outside a 35-mile radius of Oklahoma City and 30 miles of Tulsa, prorated to the loans you actually carry. It is open to family medicine, geriatrics, general internal medicine, general pediatrics, obstetrics and gynecology, emergency medicine and general surgery, carries an emphasis on Medicare and SoonerCare patients in its rules, depends on annual funding, and accepts applications year-round. Federal law excludes from income a state loan repayment made for service in underserved areas, which this program is designed to be; confirm the tax treatment with the Commission and your CPA before you count on it.
A Roth conversion is taxed at the bracket you are in when you convert, and residency is the low one.
Converting a pre-tax IRA to Roth, or a pre-tax 403(b) balance where the plan offers an in-plan Roth conversion, adds the amount to taxable income in the year of the conversion, with no 10% penalty and no income limit. A 403(b) that does not offer in-plan conversion can usually be moved only after you leave the program, which for a June graduate is still the same low-income calendar year. For 2026, a single filer’s 22% bracket runs to $105,700 of taxable income and the 24% bracket to $201,775; a PGY-3 at OU earning $67,773 has, after the $16,100 standard deduction, roughly $54,000 of room in the 22% bracket alone. An attending at Oklahoma City’s average compensation lands in the 32% bracket on a joint return and the 35% bracket on a single one. Oklahoma taxes a 2026 conversion at 4.5% either way, so the state is neutral; the federal difference is eight to thirteen points on every dollar converted.
The employers
Oklahoma physician employers and PSLF.
Built from IRS filings and the employers’ own governing documents. Employment status, not where you round, is what counts: a physician who practices at a nonprofit hospital but is paid by a for-profit group does not qualify, and a physician employed by a hospital’s nonprofit physician entity does. The PSLF Help Tool at studentaid.gov confirms any employer by EIN.
| Employer | Status | PSLF |
|---|---|---|
| OU Health (OU Medicine, Inc.; OU Health Partners for physicians) | 501(c)(3) nonprofit (OU Health Partners is reported as one) | Qualifies. Check which entity is in box b of your W-2; faculty may be paid by the university, which qualifies as a state employer |
| University of Oklahoma Health Sciences Center (residents and faculty) | State of Oklahoma | Qualifies |
| INTEGRIS Health | 501(c)(3) nonprofit | Qualifies |
| Mercy Hospital Oklahoma City; Mercy Health Oklahoma Communities (physicians) | 501(c)(3) nonprofit | Qualifies |
| SSM Health St. Anthony | 501(c)(3) nonprofit | Qualifies |
| Oklahoma City VA Health Care System | Federal government | Qualifies |
| OSU Center for Health Sciences and OSU Medical Center (Tulsa) | State of Oklahoma | Qualifies; confirm the paying entity’s EIN in the Help Tool |
| Norman Regional Health System; Stillwater Medical Center | Public trusts | Qualify as governmental employers |
| Saint Francis Health System (Tulsa) | 501(c)(3) nonprofit | Qualifies |
| Chickasaw Nation, Cherokee Nation and other tribal health systems | Tribal governments | Qualify; the regulation names tribal governments expressly |
| Variety Care and other federally qualified health centers | 501(c)(3) nonprofits | Qualify |
| Oklahoma Heart Hospital | Physician-owned, for-profit | Does not qualify |
| Hillcrest HealthCare System (Tulsa) | For-profit (Ardent) | Does not qualify |
| Private physician groups and surgery centers | For-profit | Do not qualify, however many Medicaid patients they see |
The Department of Education’s October 2025 rule that would have let the Secretary disqualify employers found to have a “substantial illegal purpose” was vacated by two federal courts on June 30, 2026, before it took effect; the Department appealed on August 27, 2026, and the vacatur stands while the appeal is pending. The qualifying-employer definition above is the one in force.
The trap
Four ways the first attending year undoes the plan.
None of these is about the money being spent badly. They are about timing, and each is cheaper to avoid in the spring of your last resident year than in the fall of your first attending one.
Taking the for-profit offer with 80 payments made pauses a clock that may be worth the balance.
A resident who finishes training with four to five years of qualifying payments and joins a physician-owned hospital or a private group pauses the PSLF count with three to four years left; the months only resume at a qualifying employer. As an illustration, a physician carrying $300,000 who stays at a nonprofit makes three or four more years of income-driven payments, perhaps $120,000 to $160,000 at an attending’s income, and has the rest forgiven; the same physician at a for-profit pays the whole balance with interest. Run both offers with the forgiveness included, not just the salary line.
A Roth conversion done in July of the attending year is taxed on the attending’s return.
The conversion is taxed in the calendar year it happens. A resident who starts in July at $400,000 has a half-year of attending income on that year’s return and has already left the 24% bracket by the time the 1099-R arrives. The last clean year is the calendar year before the start date; a July start leaves no clean half-year, and only a gap year or a fellowship year adds another. Pay the tax from savings, not from the account; converting $40,000 and withholding $10,000 of it is a withdrawal with a penalty.
Signing bonuses and moonlighting arrive without withholding.
A $50,000 signing bonus is typically withheld at the flat 22% supplemental rate when the household’s marginal rate is 35%, and moonlighting paid on a 1099 is withheld at nothing. The first attending year routinely produces a five-figure April balance plus an underpayment penalty. A single estimated payment in the quarter the money lands, federal and Oklahoma, solves it.
The student loan interest deduction phases out at $85,000; the employer benefit does not.
The $2,500 deduction for student loan interest phases out between $85,000 and $100,000 of income for a single filer in 2026, so it ends with residency. What survives is the employer-paid student loan benefit under § 127: up to $5,250 a year, now permanent and indexed after 2026, paid by an employer directly toward your loans without being taxed. It is worth asking about in the offer letter, because many Oklahoma health systems offer it and few residents know to ask.
The decision
The twelve-month checklist, in order.
Twelve months out, certify your employment for PSLF through the Help Tool if you have not, so the count is right before you negotiate; then read every offer with the forgiveness math included and the employer’s EIN checked. Ask each employer three things the salary line does not tell you: whether they pay the § 127 student loan benefit, whether the 403(b) or 401(k) has a Roth option and what the match is, and what the disability policy’s definition of disability says, because a specialty-specific own-occupation policy bought while you are a resident is cheaper and easier to qualify for than it will ever be again.
Six months out, make the Roth conversion where the account allows it, sized to the top of the 22% or 24% bracket with the calculator below, and if you are not already contributing to the resident 403(b) as Roth, switch; there is no income limit on Roth deferrals and the 2026 limit is $24,500. Fund a health savings account if the plan is high-deductible: $4,400 for self-only coverage in 2026, $8,750 for a family, triple tax-free. If a rural post is on the table, submit the state loan repayment application; it is accepted year-round and the Commission tells you where the approved communities are.
In the first attending quarter, set the estimated payment for the bonus and any 1099 income, redirect the raise before it becomes the lifestyle (the usual rule is to live on the resident budget plus a third of the increase for the first year), and build the plan the raise deserves: the loans, the Roth, the insurance, the house, and the retirement accounts a new attending in Oklahoma City can now fill faster than almost anywhere in the country. That plan is the conversation we have with new attendings every June, and the earlier in the year it starts, the more of the above is still available.
Run your numbers
How much to convert in your last low-income year.
Enter how you file, your taxable income for this year before any conversion (wages after the standard deduction, roughly), the pre-tax balance you could convert, and the federal bracket you expect as an attending. The calculator applies the 2026 federal brackets and Oklahoma’s 4.5% rate. Nothing you enter leaves your browser.
- Room left in the 22% bracket
- Room left in the 24% bracket
- Tax on converting it all this year
- Tax on the same money as an attending
Questions we get
Asked often enough to answer here.
Does OU Health qualify for Public Service Loan Forgiveness?
Yes. OU Medicine, Inc., which operates the OU Health hospitals, is a 501(c)(3) organization on its IRS filings, and physicians employed through OU Health Partners or the University of Oklahoma Health Sciences Center are on nonprofit or state payrolls. Confirm the employer identification number in box b of your W-2 in the PSLF Help Tool, because the entity on the W-2 is what counts.
Do payments made during residency count toward PSLF?
Yes, in full. The rule counts qualifying monthly payments made under an income-driven plan (including the Repayment Assistance Plan) while employed full-time by a qualifying employer; the size of the payment is irrelevant. Months spent in the SAVE forbearance do not count automatically and must be bought back.
How much does Oklahoma’s Physician Loan Repayment Program pay?
Up to $200,000: $50,000 at the end of each of four years of full-time practice in an approved rural community, prorated if your loans are smaller. It is open to family medicine, geriatrics, general internal medicine, general pediatrics, obstetrics and gynecology, emergency medicine and general surgery; practices within 35 miles of Oklahoma City or 30 miles of Tulsa, and in Lawton, do not qualify. Applications are accepted year-round by the Health Care Workforce Training Commission.
Why convert to a Roth during residency instead of later?
Because the conversion is taxed in the year it happens, at that year’s bracket. A resident’s taxable income sits in the 22% bracket and often has tens of thousands of dollars of room before the 24% bracket ends; the same conversion made as an attending is taxed at 32% to 37%. Oklahoma’s 4.5% applies either way. The tax should be paid from savings so the entire balance moves.
Does Baldwin Financial work with residents?
Yes. The decisions in this guide have deadlines that do not come back. We work with residents and fellows on the transition itself: the loan strategy, the conversion, the disability coverage and the first attending year’s plan. Baldwin Financial is a fee-only fiduciary adviser in Oklahoma City and is paid only by the people it advises.
An invitation
The raise is coming either way.
The twelve months before it are the plan.
A complimentary conversation, by video, phone, or in person in downtown Oklahoma City, at a time that works for you. Nothing to prepare and nothing to bring. Come as you are; leave knowing more than you arrived with.
What the conversation looks like
- 01
You talk. What you own, what you owe, who depends on you, and whatever is coming up that you have not solved yet.
- 02
We tell you what we see. The two or three things we would look at first, and why those and not the rest.
- 03
You decide, on your own time. If we are not the right fit, we will say so and point you toward someone who is.
Or reach us directly
- Phone
- (405) 266-7856
- Meetings, by appointment
- 629 W. Main Street, Suite 10080, Oklahoma City, OK 73102
In person downtown, or by video - Serving
- Oklahoma City, Edmond, Nichols Hills, and clients who have moved away
This guide is educational and general. It describes federal and Oklahoma rules and program terms as published on the date shown in the footer, which change often in this area, and it is not personalized tax, legal or investment advice. Employer status is taken from IRS filings and public documents on their stated dates; confirm your own employer in the PSLF Help Tool. Baldwin Financial, LLC is not affiliated with any employer, loan program or government agency named here. Insurance, where it is part of a plan, runs through a separate, disclosed entity, The Baldwin Insurance Firm, LLC, which may receive commissions; you are free to use any insurer, and nothing here is a recommendation of any insurance product. The calculator is an illustration using 2026 federal brackets and the Oklahoma rate; it ignores credits, phase-outs, other income and the alternative minimum tax.