Physicians often enter the workplace with substantial debt. The relationship between debt and reported career plans among internal medicine residents is unknown. To determine distributions of educational debt among internal medicine residents and associations of debt with reported career plans. Cross-sectional survey using data from the annual Internal Medicine In-Training Examination Residents Questionnaire completed by U.S. categorical internal medicine residents. Categorical internal medicine residencies in the United States. 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. Distributions of educational debt were tabulated. Proportions of residents choosing career plans were calculated for various levels of debt. 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. The study addressed total educational debt, but not when it was incurred, and did not allow inferences related to causality. Educational debt is associated with differences in reported career plans among internal medicine residents.