BACKGROUND:Physicians often enter the workplace with substantial debt. The relationship between debt and reported career plans among internal medicine residents is unknown. OBJECTIVE:To determine distributions of educational debt among internal medicine residents and associations of debt with reported career plans. DESIGN:Cross-sectional survey using data from the annual Internal Medicine In-Training Examination Residents Questionnaire completed by U.S. categorical internal medicine residents. SETTING:Categorical internal medicine residencies in the United States. PARTICIPANTS:22,563 residents in their third (final) year of residency, representing 74.1% of all eligible U.S. categorical internal medicine residents from 2003 through 2007. MEASUREMENTS:Distributions of educational debt were tabulated. Proportions of residents choosing career plans were calculated for various levels of debt. RESULTS:International medical graduates represented 48.7% of the cross section and had considerably less debt than U.S. medical graduates: 53.8% of U.S. medical graduates had debt of 100,000 dollars or greater and 60.2% of international medical graduates had none. U.S. medical graduates with debt of 100,000 dollars to 150,000 dollars were less likely than those with no debt to choose a subspecialty career (57.5% vs. 63.5%). U.S. medical graduates with debt of 50,000 dollars to 99,999 dollars were more likely than those with no debt to choose a hospitalist career (8.5% vs. 6.2%), and this preference increased with increasing debt level (10.0% for those with >150,000 dollars debt). These associations are more pronounced for U.S. medical graduates than for international medical graduates. LIMITATION:The study addressed total educational debt, but not when it was incurred, and did not allow inferences related to causality. CONCLUSION:Educational debt is associated with differences in reported career plans among internal medicine residents.