The way I see it, I have 3 options:
1) sign up for IBR or PAYE (or would I only be eligible for REPAYE?) working in public hospital and make 10 years of payments with the rest forgiven by PSLF
I dislike this idea for three reasons: 1. Generally these jobs pay you less than the alternative. 2. You have 50K in high interest private loans that are your first priority. 3. PSLF for high income professionals is going to go up in a puff of smoke (my opinion). This program will not be maintained for physicians. Leaving you holding the bag after making decisions banking on it and then it goes away.
2) sign up for IBR or PAYE and go out into the community where I would potentially make more money and pay off the loans over 20ish years
Terrible idea. 20ish years? What is wrong with you? 20 years?
3) consolidate all my loans into one with a low interest rate and low payment over 20-30 years, and use my discretionary income to invest in more lucrative options
Dear lord. 20 - 30 years? Don't take this the wrong way, but what are you thinking?
Here's the right answer:
1. Take a well-paying job that you like. Don't rule out community gigs. Don't work at some academic place for peanuts either.
2. Pay off the 50K high interest loan in the first 6-9 months.
3. Refinance your 220K federal loan at a 5 year fixed rate, and pay that off. (Depending on your take home pay you may have to keep your 220K federal on IBR and pay off the private loan first, then refinance once you are done with the 50K private loan, but the punchline is do this quickly). Do not refinance your high interest 50K loan into the 220K as it is likely to screw up your interest rate which otherwise should be around 3-4%. Get rid of it as quick as possible.
4. Done in about 5 years.
Space this out to 20-30 years and it will bleed you dry. You can't "invest in more lucrative options" and let these things fester, particularly not at whatever "high rate" you have them at. I know, you're doing the math, and going, "WTF, you want me to put that much money into my loans every month?" And the answer is YES. And you are saying, "WTF, how am I going to buy an M5, and a big house with a pool when I get done," and I'm saying, "You're not going to buy that until you pay some of this s$%& off." I've got a partner who's almost 10 years out and STILL sitting on 200K of debt because she bought too much other crap and never made it a priority to pay it off and now she's working more than she wants to because she can't afford to live without it.
By no means am I a "never have any debt under any circumstances" kind of guy but your idea to approach these as 20-30 year payoffs is terrible. IMO. There is one right answer and I gave it to you. Good luck!