I thought it would be nice to start an open conversation about medical student loans and our plans to pay them back. I am a PGY-1 in Family Medicine and have $457,000 of federal DIRECT loans, and I’m enrolled in the PAYE income driven repayment plan.

3 years of FM residency will count towards the 10 years of Public Service Loan Forgiveness (PSLF), then I plan to work for an FQHC, a 501c3, or government agency like the VA for 7 years. This plan leads to earning 100% tax free forgiveness 10 years after med school graduation.

And a reminder that the income driven repayment plans like PAYE and REPAYE are in and of themselves forgivness plans regardless of the pursuit of PSLF. PAYE is a 20 year plan while REPAYE is a 25 year plan, paying 10% of your discretionary income along the way.

If your debt to income ratio after residency is greater then 1.5 (for example a $200,000 salary w/ $450,000 in student loan debt is way over that), you are often times better off going for forgivness through PAYE/REPAYE for 20/25 years (Thank you @StudentLoanTrav)

For those of us in primary care medical specialties w/ higher debt to income ratios, paying off the entirety of the debt is not the most savy financial plan. Doctors have been making poor decisions with their money for a long time. Time we start having a more open convo about it.

We no longer need to listen to that angry uncle telling us we must pay all of our student loans back (like he did) when current tuition prices are 30 times higher than inflation since the 1970s. We have to play this game smarter, not harder.

It’s not our fault the higher education system is raising tuition at astronomical rates because they know they can get away with it. We need government regulation of higher ed tuition increases.

So in summary, I am going for #PSLF (or another income driven forgiveness program) because my debt to income ratio will be greater than 2:1, and I believe I will be happy working for an FQHC or the VA after residency. Plus I want a quality work-life balance with my family.

What’s your student loan plan #MedTwitter?