“Our Economy Is Being Plundered By Wall Street Elites” is fantastic discussion of private equity in America on the Wealthion Podcast. It’s an interview with Gretchen Morgenson, Pulitzer-prize winning author of the new bestselling These Are the Plunderers: How Private Equity Runs―and Wrecks―America. If you’ve been wanting to learn more about the industry but haven’t had the time, this is a great introduction.
$39 billion of student loans were forgiven tax-free this month.
If you have any FFEL, Perkins, or Health Education Assistance Loan (HEAL) Program loans, please check out the IDR Waiver FAQ. You have until the end of 2023 to do a Direct Consolidation to make those loans eligible for loan forgiveness programs and count previous payments without resetting the clock.
The Biden student loan forgiveness plan was blocked by the Supreme Court, but the new repayment changes are currently (and will likely stay) alive and well. The “New REPAYE” plan has been rebranded: SAVE (“Saving on a Valuable Education,” in case you were wondering).
Here are the take-home points, mostly courtesy of this brand new White House briefing:
Lower Payments for Undergrads
For undergraduate loans, cut in half the amount that borrowers have to pay each month from 10% to 5% of discretionary income.
SAVE—like PAYE and REPAYE—uses 10% of discretionary income for graduate borrowers as well as a weighted average of those numbers if you have debt from both undergrad and grad school.
Lower Payments for Everyone
Raise the amount of income that is considered non-discretionary income and therefore is protected from repayment, guaranteeing that no borrower earning under 225% of the federal poverty level—about the annual equivalent of a $15 minimum wage for a single borrower—will have to make a monthly payment under this plan.
Discretionary income is currently defined as 150% of the poverty line. This change will decrease payments for all borrowers except those with very high incomes.
For example, in the continental US, the poverty line for an individual in 2023 is $14,580. This means the income excluded for a single person for PAYE/REPAYE is $21,870 and for SAVE will be $32,805.
In practice, this means that not only will PGY1 residents have $0 payments, a lot of PGY2 residents probably will too. A later years resident certifying an income of $60k for example would have their payment decreased from $318/mo to $227/mo under the new plan.
10-year Forgiveness for Low-volume Borrowers
Forgive loan balances after 10 years of payments, instead of 20 years, for borrowers with original loan balances of $12,000 or less. The Department estimates that this reform will allow nearly all community college borrowers to be debt-free within 10 years.
This long-term non-PSLF forgiveness takes place after 20 years for undergrad borrowers and 25 years for graduate borrowers, which is unchanged from REPAYE. This income-driven repayment (IDR) loan forgiveness is currently set to become taxable again in 2025 and is irrelevant for the majority of doctors.
A Full Unpaid Interest Subsidy
Not charge borrowers with unpaid monthly interest, so that unlike other existing income-driven repayment plans, no borrower’s loan balance will grow as long as they make their monthly payments—even when that monthly payment is $0 because their income is low.
This will be huge for residents, who often find themselves in the situation of “negative amortization” when their calculated monthly payments do not cover accruing interest.
The REPAYE unpaid interest subsidy waived half the unpaid amount; SAVE waves it all.
It also means those $0 payments interns typically enjoy yield an effective 0% interest rate. Amazing!
But furthermore, no matter what you owe, you’ll probably feel like you have a 0% interest rate loan outside of the mandatory monthly payment. Technically, our example resident with that $227 monthly payment would have an effective rate of 1.36% on a $200k loan balance (less than inflation = free money)
Truly, one of the great pains for residents—especially those with big loans—was to watch the amount they owed balloon while they slogged through training. No more! You might not make any progress, but your loans won’t grow.
The generousness of this combination—lower payments, waived interest, and more built-in forgiveness—has raised the possibility that some private companies will sue the government to shut this down. I don’t think they have a real chance of winning that case.
The unpaid interest subsidy also means that waiving the in-school deferment for undergraduate loans while in graduate school (or the deferment for any PLUS loans) would be also an easy way to save a lot of interest, as those loans would effectively become 0% interest rate while in school with a typical student’s income.
The Married Filing Separately Loophole
Not mentioned but still important: The Married Filing Separately Loophole, which was closed in REPAYE, has been reopened. This means that married borrowers can choose to file taxes separately in order to exclude their spouse’s income from the payment calculation.
This has historically been especially important for residents with high-earning spouses and has been a key reason to pick PAYE (and occasionally IBR) instead of REPAYE (discussed at length in the Maximizing PSLF chapter).
With everything else + the reopening of this loophole, SAVE is a great plan for borrowers and overall greatly simplifies student loan management.
The Payment Cap
The one important “loophole” of PAYE and IBR that remains closed from REPAYE appears to be the removal of The Payment Cap. With the older plans, your monthly payments were capped at the amount of the standard 10-year repayment even if 10% of your discretionary income would be a larger number. This created a PSLF boon for doctors with long training because even with their subsequent high income they would never “pay their fair share.” Even so, for the vast majority of people nationwide, SAVE will be better than PAYE.
The government’s plan is that SAVE replaces REPAYE, and they close PAYE and ICR to new borrowers. The intention is also to close PAYE to even current borrowers who simply want to switch starting summer 2024, but doing so would actually go against precedent, so we’ll see how that plays out when some of these operational details are finalized. If your income is set to rise high enough in the future for the payment cap situation to be relevant—and PAYE is closed—IBR (which is in the actual 2007 law passed by Congress) will probably always be available. We’ll know more when the plan is fully in effect.
For those currently in PAYE or considering choosing it now while still available, the only practical consideration that is relevant is this payment cap situation with regard to loan forgiveness. For doctors set on PSLF, one would need to compare the savings from lower payments during residency with the potential savings from capped payments as an attending.
As an example, the maximum monthly payment on the older plans for our hypothetical $200k borrower was $2,220. In SAVE, you only hit that amount with an annual income of around $330k. So the “optimal” choice depends on how much you borrow, how much you earn, and how many years of attending income you have before achieving PSLF.
This would mostly affect people with relatively high attending incomes relative to their debt. The most future-proof plan given the uncertainty of a medical career would be to choose SAVE, and that is what I suspect the vast majority of residents would choose even if they had the option. If nothing else, the lower payments during residency will probably impact your life more than lower payments as an attending.
For those with massive loan balances and plans for work that wouldn’t qualify for PSLF, then the payment cap consideration is also potentially relevant to the 25-year IDR loan forgiveness, but this is a very uncommon scenario for physicians (further discussed in this chapter).
Conclusion
Because the plan only improves upon REPAYE without downsides, all borrowers on REPAYE will automatically be switched over to the new plan:
Borrowers who sign up or are already signed up for the current Revised Pay as You Earn (REPAYE) plan will be automatically enrolled in SAVE once the new plan is implemented.
Easy peasy.
For recent graduates, the COVID payment freeze has been and the new SAVE plan will be a huge boon, even if the $10k student loan forgiveness that some residents would have received didn’t pan out.
Graduating medical students: if you haven’t already begun, it’s around time to consolidate your federal student loans. The benefits are discussed in this chapter from my (free) book. While you’re at it, you should also probably read the whole thing.
From Verdad’s “Private Equity Fundamentals” (a good albeit somewhat technical read):
The sample of companies we looked at is nearly unprofitable on an EBITDA basis, mostly cash flow negative, and extraordinarily leveraged (mostly with floating-rate debt that is now costing nearly 12%). These companies trade at a dramatic premium to public markets on a GAAP basis, only reaching comparability after massive amounts of pro-forma adjustments. And these are the companies that most likely reflect the better outcomes in private equity. The market and SPAC boom of 2021 presented a window for private equity and venture capital firms to take companies public, and private investors took public what they thought they could. Presumably, what remains in the portfolios was what could not be taken public.
Resolving these challenges will be difficult. Growth seems more challenging in a wobbly economy, and the tailwind of rising multiples has disappeared. Private equity sponsors will likely need to have difficult conversations with their lenders and focus on operational execution to manage costs as they navigate a less friendly macro environment. From a quantitative perspective, the fundamentals of sponsor-backed companies look frightening.
GAAP stands for “Generally Accepted Accounting Principles.” EBITDA stands for “earnings before interest, taxes, depreciation and amortization.” These companies often report adjusted “pro-forma” measures to make themselves look better:

It’s a nice summary of the house of cards.
The online course version of WCICON23, “Continuing Financial Education 2023: The Latest in Physician Wellness and Financial Literacy” is now available. It includes 55 hours of content and qualifies for 22 hours of CME. It also includes a talk from yours truly on the surprisingly interesting topic of thinking about thinking.
Enrollment is $100 off through midnight on April 17th and would be—in my opinion—a great way to use your CME funds.
(Signing up from this post also supports my writing, thank you.)
Registering through the link here is also one of those effortless ways you can support this site while doing what you were going to do anyway.
I’m very much looking forward to speaking again this coming year at the Physician Wellness & Financial Literacy Conference (aka WCICON23), which will take place March 1-4 at the very nice JW Marriott Desert Ridge in Phoenix. If you have a CME fund to burn, I can’t think of anything else I’d rather spend it on.
Code CON23BW will net you $200 off an in-person registration through January 25.
The official application for the Biden student loan forgiveness is now live. Impossible to say if any legal action will block it in the end, but for now the safest thing to do if you qualify is to apply as soon as possible. It’ll take about 2 minutes.
Apply here.
From Bloomberg, some crazy machinations involving the restructuring of Envision, the massive medical staffing company, in order to pay off debts.
This is because Envision had $7 billion debt from its 2018 leveraged buyout by KKR, and KKR needed to find ways to exploit the paper details in order to restructure the company without getting taken to court and blocked.
“Loose documents have become the norm rather than the exception,” says Damian Schaible, co-head of restructuring at Davis Polk & Wardwell. “If we go into a real recession, we are going to see more and more borrowers and sponsors seeking to exploit document loopholes to create leverage against and among their creditors.”
Here’s the quick summary, which invokes the playbook of spinning off the valuable assets in order to essentially dump the crappy ones:
Envision, which also explored a consensual debt exchange that would have raised less funding, ultimately opted for what is considered one of the most controversial and coercive out-of-court restructurings to date. The [initial] deal…would prove to be just the beginning of a series of maneuvers that eventually allowed the company to restructure the vast majority of its debt but forced creditors to turn against one another.
The strategy rested on two pillars. The first was a drop-down transaction, in which a company’s most valuable assets are moved away from existing creditors and used as collateral for new debt. The second was a series of debt repurchases and exchanges that gave certain creditors priority over others and pushed anyone who declined to participate to the end of the line for repayment.
We always talk about stocks being risky and bonds being relatively safe, but corporate debt is its own beast in this world where overleveraged companies can successfully exploit loopholes to screw over current creditors in order to obtain new financing.
Envision first designated [their profitable ambulatory surgery business] Amsurg as a so-called unrestricted subsidiary, effectively moving it out of reach of existing creditors without violating provisions in the credit agreement that prohibited moving or transferring the asset. The Amsurg assets would then be used as collateral to borrow $1.3 billion from Angelo Gordon and Centerbridge, who’d effectively be stepping ahead of everyone else in the repayment waterfall. Envision could then use the cash raised from the hedge funds to boost liquidity and to repurchase some of its existing debt at steep discounts.
Ultimately, only $153 million of the original loan was left outstanding, as owners of 96% of the debt had exchanged their holdings and waived their rights to litigate the transaction in the future.
Likely a harbinger of things to come. The “bad guys” largely win. And for creditors, better to get pennies on the dollar than nothing.
The years of low-interest easy money did a lot of emboldening and overleveraging, and everyone was eager to deploy capital on dubious deals:
There was a bitter irony in the way most of the company’s creditors ended up competing for crumbs. Four years earlier, when Credit Suisse Group AG sold the debt that financed KKR’s purchase of Envision, demand was so high that a salesperson teased investors with a picture of cake crumbs on a plate. The message then: Hurry up and grab it before it’s all gone.
Some interesting passages and food for thought from Just Keep Buying: Proven Ways to Save Money and Build Your Wealth by Nick Maggiulli (a personal finance book with much more data behind its analysis than average for the genre).
On saving:
And one of the most common financial stressors is whether someone is saving enough. As Northwestern Mutual noted in their 2018 Planning & Progress Study, 48% of U.S. adults experienced “high” or “moderate” levels of anxiety around their level of savings. The data is clear that people are worried about how much they save. Unfortunately, the stress around not saving enough seems to be more harmful than the act itself. As researchers at the Brookings Institute confirmed after analyzing Gallup data, “The negative effects of stress outweigh the positive effects of income or health in general.” This implies that saving more is only beneficial if you can do it in a stress-free way. Otherwise, you will likely do yourself more harm than good.
That’s a counterintuitive claim: stressing about not saving enough does more harm than not saving enough.
On spending:
Researchers at the University of Cambridge found that individuals who made purchases that better fit their psychological profile reported higher levels of life satisfaction than those who didn’t. Additionally, this effect was stronger than the effect of an individual’s total income on their reported happiness.
For example, it has been well documented that people get more happiness buying experiences over material goods. However, what if this is only true for a subset of the population (e.g., extroverts)? If so, then we may be generating spending advice based on the 60%–75% of people who are extroverts to the dismay of introverts around the world.
I suspect Maggiulli is right to point this out. Just like scientists get annoyed when news media take a small experiment or a mild trend in the data and throw up a big bold headline, the idea that all humans benefit from the same things in the same sorts of ways doesn’t pass intuitive muster. For many people, I suspect there are probably plenty of high-impact ways to spend on some things and dumb ways to buy experiences.
On valuing an educational/career investment:
The proper way to find the current value of these future earnings is to discount this payment stream by 4% per year. However, there is a simpler way to approximate this—divide the increase in lifetime earnings by two. This will be roughly equivalent to a 40-year payment stream discount by 4% per year. I prefer this shortcut because you can now do the math in your head. Therefore, a $800,000 increase in lifetime earnings over 40 years is worth about $400,000 today.
Value of Degree Today = (Increased Lifetime Earnings/2) – Lost Earnings While things like taxes and other variables can affect this calculation, it’s still a simple way to check whether a degree is worth the cost.
Food for calculus when considering not just expensive degrees but also lengthy medical training or an additional fellowship.
On the health impact of debt:
For example, research published in the Journal of Economic Psychology found that British households with higher levels of outstanding credit card debt were “significantly less likely to report complete psychological well-being.” However, no such association was found when examining households with mortgage debt. Researchers at Ohio State echoed these findings when they reported that payday loans, credit cards, and loans from family and friends caused the most stress, while mortgage debt caused the least. On the physical health front, a study in Social Science & Medicine found that high financial debt relative to assets among American households was associated with “higher perceived stress and depression, worse self-reported general health, and higher diastolic blood pressure.” This was true even after controlling for socioeconomic status, common health indicators, and other demographic factors.
What makes buying a home even easier is if you can afford it. This means being able to provide 20% as a down payment and keeping your debt-to-income ratio below 43%. I chose 43% because that is the maximum debt-to-income ratio you can have for your mortgage to be considered qualified (i.e., lower risk). As a reminder, the debt-to-income ratio is defined as: Debt-to-Income Ratio = Monthly Debt / Monthly Income
Part of what makes mortgage debt less impactful to mental health is presumably the fact that mortgages feel universal and almost no one you are likely to know (at least early in your professional career) has the money to buy a house with cash.
Nonetheless, I suspect I will have a measurable well-being boost when mine is gone.
On why to invest:
In essence, by investing your money you are rebuilding yourself as a financial asset equivalent that can provide you with income once you are no longer employed. So, after you stop working your 9 to 5, your money can keep working for you. Of all the reasons why someone should invest, this might be the most compelling and also the most ignored. This concept helps explain why some professional athletes can make millions of dollars a year and still end up bankrupt. They didn’t convert their human capital to financial capital quickly enough to sustain their lifestyle once they left professional sports. When you make the bulk of your lifetime earnings in four to six years, saving and investing is even more important than it is for the typical worker.
Fund the life you need before you risk it for the life you want.
The conversion of human capital to financial capital is an excellent way of looking at/arguing for investing.
On being realistic about wealth:
For example, research in The Review of Economics and Statistics illustrates that most households in the upper half of the income spectrum don’t realize how good they have it…households above the 50th percentile in income tend to underestimate how well they are doing relative to others…even households at the 90th percentile and above in actual income believe that they are in the 60th–80th percentile range.
For example, you would need a net worth of $11.1 million to be in the top 1% of U.S. households in 2019. However, after controlling for age and educational attainment, the top 1% varies from as little as $341,000 to as much as $30.5 million. For example, to be in the top 1% of households under 35 that are also high school dropouts you would only need $341,000. However, to be in the top 1% of college educated households aged 65–74 years, you would need $30.5 million.
It’s incredibly easy to find some Joneses to keep up with.
On green grass:
But why does happiness start to decline in the late 20s? Because, as people age, their lives usually fail to meet their high expectations. As Rauch states in The Happiness Curve: “Young people consistently overestimate their future life satisfaction. They make a whopping forecasting error, as nonrandom as it could be—as if you lived in Seattle and expected sunshine every day…Young adults in their twenties overestimate their future life satisfaction by about 10 percent on average. Over time, however, excessive optimism diminishes…People are not becoming depressed. They are becoming, well, realistic.”
Part of the curse of medical training is to coincide with this natural stage of disillusionment.

