Good Luck

After a few hours of counting cents and trying to make sense of your options, it’s worth noting that real life can easily get in the way of almost every repayment strategy. You could get married and your spouse could have a ton of student loans, making REPAYE or even federal forgiveness programs make sense when they didn’t before. Or, you could get married and your high-earning spouse could have no student loans, completely changing the effectiveness of the REPAYE program. You could enter academia by accident. You could end up finding a private practice job that you can’t pass up. You may decide to work part-time to care for your family in one way or another and thus no longer qualify for PSLF even if you do work in academia. You might quit medicine altogether to pursue your dream of making bespoke soap.

Unless you only have a small amount of loans and paying them down as fast as possible is the obvious solution, anything else you do may require revision over time. This is particularly true if the calculus between options such as paying your loans off and trying to get them forgiven doesn’t differ by large amounts and depends on the relative details of monthly payments and shifting interest rates. The beauty of this situation is that as long as you’re proactive, you’ll be fine. While the initial return on your investment in medicine is terrible, it generally works out in your favor over a 30-year career.

You should run your current and possible numbers into one of the various free calculators online to help you make decisions, but you should be wary of accepting any long-term predictions. The problem is that it’s hard for any calculator to demonstrate your options accurately as a proactive young physician. The fact that you’ve read this book or want to use a calculator at all means that the simple assumptions these usually make don’t apply. But taking the time to input different scenarios into a calculator and plotting out your strategy does work.

As we’ve discussed, people trying to aggressively repay their loans who choose an income-driven repayment plan like REPAYE during residency may be best served by refinancing privately to a short-term loan and even making extra payments as much as possible after completing training. But even this simple common scenario is difficult to capture in any available calculator.

You can test the assumptions yourself. You don’t need to pay anyone anything, and if you did, the future could still invalidate your best-laid plans. Don’t be a passive participant in your financial life. You’ve probably lived for years at 5, 6, or 7%, but now it’s time to make change.



I’d love to receive your feedback. This book is a living document and will benefit from your thoughts and experiences—just email me at

I’d also be grateful if you took the time to share what you’ve learned with others. We’re all in this together.


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