The Workflow

A lot of this book has been detailed background coupled with an in-depth discussion of your options and considerations for evaluating student loan debt and picking a repayment strategy. Admittedly, some of the details and scenarios we’ve discussed do not pertain to many borrowers, but the goal here isn’t to tell you what to do so much as give you the tools you need to make your own strong informed decision.

Here’s the brief version to summarize the simple approach, both as a conclusion and for those of you who stopped caring a few pages in:

Step 1:

Try not to borrow so much money.

Step 2:

Consolidate your federal loans into a Direct Consolidation after graduation and before starting internship.

Step 3:

Pick your (first) repayment plan, probably REPAYE, maybe PAYE, hopefully not IBR.

For most folks:

Single: REPAYE

Married with non-working spouse: REPAYE

Married with working spouse: Compare REPAYE and PAYE.

  • If you get a subsidy with REPAYE, then REPAYE. If you don’t, then PAYE.
  • If attempting PSLF, then compare PAYE payments with filing taxes jointly and separately. If MFS saves you more money than you lose in extra taxes, then probably PAYE with consideration of filing taxes separately.
  • If definitely not doing PSLF, consider private refinance, but probably still end up waiting until after training. Always compare private rates with the REPAYE effective

If you are 100% confident in pursuing PSLF: PAYE (income cap limit without needing to switch plans in the future)


Step 3.1:

Don’t spend too much money.

Step 3.2:


Step 3.3:

If relevant, maximize REPAYE and PSLF benefits by minimizing your adjusted gross income through retirement accounts and other “income-reducing” measures.

Step 3.4:

If you’re not sure about PSLF, consider putting extra money toward retirement or in something safe like an interest-bearing online savings account as a “loan payoff slush fund” that can be deployed if your plans change.

Step 4:

Stay on top of annual IDR income certifications. If considering PSLF, file employment certification forms annually as well.

Step 5:

Keep abreast of coming changes to your finances, career, and family to adjust your plan accordingly.

  • If you originally choose REPAYE and are on the cusp of personal or spousal income increases, weigh the possibility of switching to PAYE if you’ll be losing your PAYE eligibility (partial financial hardship) or breaking past the standard payment-cap.
  • Likewise, consider filing taxes separately in PAYE/IBR.

Step 6:

Eventually get rid of those student loans, either via PSLF or paying it off as fast as you can.

If you’re an attending not bound for PSLF and you’re able to make progress paying down your loans, then you likely make too much money to have any benefit from federal loans and should consider refinancing.

When it comes to actually paying off a loan, a lower rate is a lower rate, and a shorter term always reduces interest costs.



I’ve put this brief section at the end because I believe it’s important to understand how the loans and repayment options work before plugging and chugging. It’s very easy to use a calculator to get an incorrect answer if you ask it the wrong question.

Most calculators will give you a “first month” payment based on your actual inputs and an estimated “final month” payment and total repayment/forgiveness numbers based on multiple assumptions. The first month payment is gold. The final one is only good for illustrative purposes at best (and usually useless).

You’ll generally be better off calculating a new “first month” payment for each year of your repayment and iterating over years (which you can do all at once with the Doctored Money and Student Loan Planner calculators below) than to use any calculator’s predictions if any of your choices seem close.


The Federal Student Aid Repayment Estimator

The original. You can put in your loans, your spouse’s loans, family size and residence, your income, and your spouse’s income and it will spit out your monthly payments and estimated repayment for every federal repayment plan in a single comparison table. Very handy. It can pull in your loans if you log in to your FSA account. Otherwise it will take you a minute to put all the info (you’ll be faster if you just input a single “virtual consolidation” if you haven’t consolidated), but you can then quickly see how income changes monthly payment as well as the difference in tax filing status.



Doctored money

A detailed online embedded spreadsheet. Sometimes runs a bit slowly, but it allows you to plot out and compare all of your federal repayment plan options over a 10-year span. Well-designed with a bunch of nice tables and graphical depictions, including your annual REPAYE subsidy and effective REPAYE interest rate. It’s perfect for figuring out if PSLF is for you. If needed, you’ll have to compare any potential private refinance separately.



Student Loan Hero

Multiple single purpose calculators. Useful to quickly determine first month payments, as well as the costs of deferment/forbearance, your weighted loan interest rate, comparing refinancing term lengths.



Student Loan Planner

Detailed Excel spreadsheet. Like the Doctored Loans calculator with the addition and heavy branding of private financing. A little intimidating to use at first, but if you put a few minutes in, it’ll also give you detailed results in one place.

Link: (requires submitting your email)



Like the federal loan estimator but also includes PSLF estimates. It can also import your loans from NSLDS, which is neat.

Link: (requires AAMC login)


Helpful Further Reading

Income-Driven Repayment Plans

The basics, with helpful tables and links



AAMC Education Debt Manager

The newly updated 2017 version is a pretty slick and nicely-presented comprehensive review of the basics if you didn’t like the way they were described here. Free and worth a read but missing some of the nuances.



Doctored Money

Nice, new, and growing non-profit site with excellent discussions of federal repayment options. I particularly like their new loan scenarios page.

Link: (


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