Which Professions Are Hit the Hardest

When people talk about student loans, the conversation almost always starts with the total balance.“I owe $300,000.” “I borrowed $400,000.” That number feels overwhelming, and emotionally, it makes sense to fixate on it.But loan balance alone doesn’t determine whether student debt is manageable.How much debt you have relative to your income is what actually drives your repayment options and determines your long-term financial flexibility.

A $300,000 loan can be devastating at one income level and surprisingly manageable at another.The difference isn’t budgeting tricks or “living like a resident.” It’s math.To understand how this plays out in real life, we analyzed survey data from more than 8,000 readers of Student Loan Planner.The results reveal which professions are under the most strain from student loans and which ones have more room to breathe.

The toughest professions for debt-to-income ratios A quick note on the data: These figures come from a large survey of borrowers who tend to carry above-average student debt.That means the dollar amounts skew high — but the skew is consistent across professions.That makes the relative differences meaningful, even if the exact dollar amounts aren’t universal.Naturopathic physicians top the list The profession with the highest average debt-to-income (DTI) ratio in the entire survey was naturopathic physicians (NDs).

Average income: ~$93,000 Average student debt: ~$301,000 DTI ratio: just over 3:1 At that ratio, traditional repayment is rarely realistic.Nearly everyone in this category ends up relying on income-driven repayment (IDR), not because they want to, but because the numbers don’t offer any other choice.Acupuncturists Interestingly, acupuncturists ranked second, even though their average debt is lower than that of NDs.The reason is income.

When your payment is tied to a percentage of income, lower earnings can be more constraining than higher balances.A borrower paying 10% of income toward loans is better off earning $93,000 than $65,000, even if the debt is slightly higher.Chiropractors Chiropractors ranked third, with a noticeably lower student loan debt-to-income ratio than the top two.Still, this group faces real pressure, just not at the extreme levels seen among NDs and acupuncturists.

The “middle zone” where financial planning decisions get complicated A large cluster of professions landed in the 1.6 to 1.8 DTI ratio range, including: Occupational therapists Veterinarians Therapists and psychologists Dentists Physical therapists This is where student loan strategy becomes highly individualized.Take dentists as the clearest example.The average salary is high relative to many healthcare professions, but the range of debt is enormous.In-state dental school graduates might borrow $250,000.

Private school graduates can easily leave with $600,000 to $700,000.This means that two dentists with the same degree can face radically different dental school repayment options.This group often splits into two camps: Borrowers who aggressively repay, refinance, or buy into private practice Borrowers who still pursue forgiveness, often through nonprofit employment or extended IDR plans There’s no universal “right” answer here.Small differences in debt, location or employer benefits can swing the math.

Professions where PSLF often shapes the outcome There’s a noticeable group of professions in the survey that cluster around a 1.2 to 1.3 debt-to-income ratio, and the common thread isn’t income alone — it’s employer type.These are typically professionals working for nonprofit or government employers, where Public Service Loan Forgiveness (PSLF) is available.In the survey data, this shows up most often among healthcare and professional roles that can practice inside large institutional systems rather than private practice.In these cases, borrowers aren’t necessarily choosing forgiveness because they can’t repay their loans.

They’re choosing it because, at this DTI level, PSLF often produces a better financial result than aggressive payoff.That distinction matters.A DTI ratio in this range still leaves room for flexibility.Borrowers could refinance and pay their loans off over time.

But when PSLF is on the table, many opt for forgiveness instead, especially when payments are capped as a percentage of income and the remaining balance can be eliminated after 10 years.This helps explain why some professions with similar earnings and debt loads end up following very different paths.The availability of PSLF doesn’t just reduce payments, it changes the optimal strategy altogether.Low DTI professions There’s a group of professions in the survey that cluster around a roughly 1:1 debt-to-income ratio.

These are typically people with widely recognized professional credentials — fields often associated with financial stability.This group includes: Physicians Lawyers Dental specialists It’s tempting to lump these professions together, but that hides enormous variation.When pediatricians earn $150,000 and brain surgeons earn $900,000, you can’t draw conclusions about what any individual borrower’s outcome will be.One of the more surprising findings in the survey was that dental specialists (such as orthodontists and endodontists) reported higher average incomes than physicians overall.

That doesn’t mean dental specialization is “better” than medicine.It simply highlights how misleading averages can be when income ranges are wide.The lowest debt-to-income outcomes overall: Engineers At the very bottom of the DTI spectrum in the survey are engineers.Unlike the professions discussed earlier, engineering does not require a professional degree to practice.

Many engineers enter the workforce with only an undergraduate credential or with a relatively short graduate program tacked on.As a result, student loan balances tend to be modest.At the same time, incomes are often comparable to roles like physician assistants, but without the cost or length of professional school.That combination places engineers at the most favorable end of the DTI range observed in the data.

In the context of this spectrum, engineers help explain why time in school and cost of education matter just as much as income when evaluating the long-term impact of student debt.The 2026 policy shift that could change everything One of the most consequential developments affecting future borrowers is the introduction of the 2026 federal borrowing caps.Under the new law: Professional degree programs are capped at $200,000 total borrowing Graduate programs are capped at $100,000 Many professions in this survey currently exceed those limits.That means something has to give.

Over time, I expect: This won’t affect existing borrowers directly, but it will reshape who can afford professional degrees going forward.Is professional school still worth it? Despite everything, the answer is still yes — generally.Student loans don’t ruin financial lives on their own.Poor alignment between debt, income and strategy does.

If you understand where your profession falls on the debt-to-income spectrum, you can make better financial decisions.That means understanding what’s right for your situation, whether it’s student loan forgiveness, aggressive repayment or something in between.