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$540K debt after medical school normal?

goriku671

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Hello all,

I am beginning medical school in the fall and I am coming in with already a massive undergraduate student debt. Having grown up poor, I really had terrible financial literacy. I just wanted to get a college degree and I didn't care how much it would cost. Only after graduating college and working did I gain some sense of how to deal with finances (although, I am certainly still learning).

I created an excel sheet calculating how much debt I will be in after medical school. If my calculations are correct, factoring interest compounding daily, I would end up at around $540,000!! I make several assumptions. First that the low interest rate for 2020-2021 (4.3%/5.3% (direct unsub/grad plus) will remain for next school year as well, but will go back to 6%/7% the last two years. My second assumption, is that cost of attendance for my school will remain the same and I will need to pull the maximum amount of loan that I am offered.

Is this normal and are there others out there that will be or are currently in similar debt? Are there any books you recommend or resources I can read to better prepare myself how to handle this much debt?

Sorry for the long post.

Screen Shot 2020-06-02 at 5.46.45 PM.png
 
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chaim123

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Hello all,

I am beginning medical school in the fall and I am coming in with already a massive undergraduate student debt. Having grown up poor, I really had terrible financial literacy. I just wanted to get a college degree and I didn't care how much it would cost. Only after graduating college and working did I gain some sense of how to deal with finances (although, I am certainly still learning).

I created an excel sheet calculating how much debt I will be in after medical school. If my calculations are correct, factoring interest compounding daily, I would end up at around $540,000!! I make several assumptions. First that the low interest rate for 2020-2021 (4.3%/5.3% (direct unsub/grad plus) will remain for next school year as well, but will go back to 6%/7% the last two years. My second assumption, is that cost of attendance for my school will remain the same and I will need to pull the maximum amount of loan that I am offered.

Is this normal and are there others out there that will be or are currently in similar debt? Are there any books you recommend or resources I can read to better prepare myself how to handle this much debt?

Sorry for the long post.

View attachment 308738

Interest does accrue during school, but does not compound daily. Compounding is the process of adding interest to the principle and then earning interest to the interest, which does not happen. That being said, tuition will rise over the years, interest rates will change, etc.

Debt is scary, but the key to combatting it now is to take out less debt! Create a budget - you don't use the entire COA is you aren't eating out every day. Apply to external / internal scholarships. And then of course remember that many medical students have debt.

However, I will note your debt is quite a bit higher than most, but it seems you have considerable undergrad debt and 0 scholarship from your school.
 
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Flodaddy

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It’s not normal.

I have $350K, but I’m in a surgical subspecialty where my income: debt ratio will be at least 1:1. $540K is double the salary of some of the most popular specialties. You will deal with a lot of stress and make a lot of sacrifices on this path. It will be tough if on top of that all your expendable salary was going towards loans. Those loans will influence where you practice, what specialty you practice, and practice setting (ie academic v community).

It’s not even if you can pay it off. It’s about if it’s worth making all these sacrifices and being chained. $400K is the max I’d be willing to take. Make sure you kick butt in med school if you are taking on that kind of debt

I’m sorry that we have an education system that puts students in this kind of position. It’s unfair and nonsensical
 
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goriku671

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Interest does not accrues during school, but does not compound daily. Compounding is the process of adding interest to the principle and then earning interest to the interest, which does not happen. That being said, tuition will rise over the years, interest rates will change, etc.

Debt is scary, but the key to combatting it now is to take out less debt! Create a budget - you don't use the entire COA is you aren't eating out every day. Apply to external / internal scholarships. And then of course remember that many medical students have debt.

However, I will note your debt is quite a bit higher than most, but it seems you have considerable undergrad debt and 0 scholarship from your school.

Are you sure? I am pulling Federal Direct Unsubsidized Loans and Grad Plus Loans, which I am almost certain accrue interest while in school and compound...

But yes, I received 0 scholarships or grants.

Thanks for your input, though.
 
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Flodaddy

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Are you sure? I am pulling Federal Direct Unsubsidized Loans and Grad Plus Loans, which I am almost certain accrue interest while in school and compound...

But yes, I received 0 scholarships or grants.

Thanks for your input, though.
I think it was typo because they absolutely do accrue interest and that interest capitalizes when you enter repayment
 
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chaim123

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I think it was typo because they absolutely do accrue interest and that interest capitalizes when you enter repayment

Yes my apologies. DOES accrue, but DOES NOT compound daily. You will not be earning interest on your interest each day. As said it capitilizes after the grace period when entering repayment.
 
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solitarius

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It's up to you to figure out if this is right for you.

That's a pretty scary amount, imho. Educational debt is one of those few classes of loans that you can't get out of.

People like you are going to feel a lot of pressure to enter one of the high-paying specialities like the surgical specialties, regardless of whether you like something else. Servicing that thing in family medicine is gonna be near impossible.
 
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Doggeronie

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Hello all,

I am beginning medical school in the fall and I am coming in with already a massive undergraduate student debt. Having grown up poor, I really had terrible financial literacy. I just wanted to get a college degree and I didn't care how much it would cost. Only after graduating college and working did I gain some sense of how to deal with finances (although, I am certainly still learning).

I created an excel sheet calculating how much debt I will be in after medical school. If my calculations are correct, factoring interest compounding daily, I would end up at around $540,000!! I make several assumptions. First that the low interest rate for 2020-2021 (4.3%/5.3% (direct unsub/grad plus) will remain for next school year as well, but will go back to 6%/7% the last two years. My second assumption, is that cost of attendance for my school will remain the same and I will need to pull the maximum amount of loan that I am offered.

Is this normal and are there others out there that will be or are currently in similar debt? Are there any books you recommend or resources I can read to better prepare myself how to handle this much debt?

Sorry for the long post.

View attachment 308738
Last I checked, the average debt after graduating from college was ~30k, and after graduating from med school it was ~230k. So the average med student has ~260k in debt.

I don't think that matters though, your debt is your debt and you still have to pay it off. You'll be able to do it but it's definitely tougher than it would be.
Look into income based repayment or PSLF because that's probably your best option.
 

goriku671

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It's up to you to figure out if this is right for you.

That's a pretty scary amount, imho. Educational debt is one of those few classes of loans that you can't get out of.

People like you are going to feel a lot of pressure to enter one of the high-paying specialities like the surgical specialties, regardless of whether you like something else. Servicing that thing in family medicine is gonna be near impossible.

The debt is SCARY. Unfortunately, I am one of those who had to do a post-bacc program, which is why my undergrad debt is higher than usual. I would have done things a little differently, but hindsight is 20/20.

I am definitely not interested in primary care (except EM). I am mostly interested in surgical specialties like ENT, Gen Surg, Ortho as well as IM subspecialties. Although, I admit I won't know for certain what I end up doing until I've matched. If I end up doing a surgical subspecialty, PSLF is definitely something I will be considering.
 
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dragoon

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Going to recommend what most people recommend and to read WCI for financial literacy. I also personally enjoyed physicianonfire's 4 physicians posts for more long-term goals.

Looking over your math at a glance, it seems right considering you're entering with 100k in loans + 4 years of ~90k each. Depending on where you live/your family situation, you could probably get away with 10-20k less each year.

edit: Just found this (are we allowed to post links?) from a google search, but it states "AAMC data shows that students graduate from medical school with a median debt of $200,000 and only 0.5% of students accumulate education debts over $500,000"
source: https://www.aamc.org/system/files/c...esmallbusinesscommitteeregardingmedicaled.pdf
 
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deleted957830

Hello all,

I am beginning medical school in the fall and I am coming in with already a massive undergraduate student debt. Having grown up poor, I really had terrible financial literacy. I just wanted to get a college degree and I didn't care how much it would cost. Only after graduating college and working did I gain some sense of how to deal with finances (although, I am certainly still learning).

I created an excel sheet calculating how much debt I will be in after medical school. If my calculations are correct, factoring interest compounding daily, I would end up at around $540,000!! I make several assumptions. First that the low interest rate for 2020-2021 (4.3%/5.3% (direct unsub/grad plus) will remain for next school year as well, but will go back to 6%/7% the last two years. My second assumption, is that cost of attendance for my school will remain the same and I will need to pull the maximum amount of loan that I am offered.

Is this normal and are there others out there that will be or are currently in similar debt? Are there any books you recommend or resources I can read to better prepare myself how to handle this much debt?

Sorry for the long post.

View attachment 308738
My advisor and his wife are both physicians on the lower end of the spectrum of high-paying specialties. Money was a huge concern as both my husband and I are also in medical school. He told me that they have over $1 million dollars in debt, 3 children, and were still approved for a $800K mortgage (he said they have about $18K left per month after paying loans). While he said they will be paying on their debt until they die, it was better than any alternative in their reality, and they love what they do (and can still live a better lifestyle than most Americans). He told me to look at it as a monthly "improving your life" tax.

I'm the first person in my family to not work in a factory or bakery. I would take on $5 million just to not be that miserable. If I decided not to go to medical school because of the cost...then the system won by not allowing someone from a poor background to advance. It's all about perspective. The debt level of the average medical student is severely skewed due to the average background of most medical students. You'll be fine, and you will still live a better life than the majority of Americans. It's all about perspective. Debt aimed at improving your life and funneled toward doing what you love is never a bad investment. People take out $500K to open restaurants that fold in 2 years. You have a lifelong career that connects you with your community. I plan on paying back the minimum each month until it's wiped away or I die. People spend money on more outrageous things per month..
 
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Doggeronie

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Hello all,

I am beginning medical school in the fall and I am coming in with already a massive undergraduate student debt. Having grown up poor, I really had terrible financial literacy. I just wanted to get a college degree and I didn't care how much it would cost. Only after graduating college and working did I gain some sense of how to deal with finances (although, I am certainly still learning).

I created an excel sheet calculating how much debt I will be in after medical school. If my calculations are correct, factoring interest compounding daily, I would end up at around $540,000!! I make several assumptions. First that the low interest rate for 2020-2021 (4.3%/5.3% (direct unsub/grad plus) will remain for next school year as well, but will go back to 6%/7% the last two years. My second assumption, is that cost of attendance for my school will remain the same and I will need to pull the maximum amount of loan that I am offered.

Is this normal and are there others out there that will be or are currently in similar debt? Are there any books you recommend or resources I can read to better prepare myself how to handle this much debt?

Sorry for the long post.

View attachment 308738
Maybe you should do military medicine. 540k is a LOT of debt. If you sign up before you start school, my understanding is that you get a 25k sign on bonus, and then you continue to receive 2k/month as a stipend throughout med school.
 
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BunnyMan17

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Maybe you should do military medicine. 540k is a LOT of debt. If you sign up before you start school, my understanding is that you get a 25k sign on bonus, and then you continue to receive 2k/month as a stipend throughout med school.
Unless they've changed it I believe the bonus is 20K, but it fluctuates based on demand/funding. You get that 2k/month stipend plus a few weeks of active duty pay every year. As of now they don't have a cap for cost. Then when you're in residency you make 80-100k depending on location, COL, etc. The attending pay is quite a bit less though. That being said, every spread sheet I've looked at comparing HPSP vs. civillian shows its a pretty good deal for at least those 4 years as long as you're not doing a long residency and super lucrative specialty. Note if you want FM or such, a lot of attendings have told me the pay is often more comparable military vs. civillian. That's just FM though.

OP, my 4th year in undergrad we had an accountant teach a personal finance class and there was a break out session for the future medical students. I don't have the numbers or sheet anymore but holding your debt for a lifetime is definitely not a good idea. It can control you in ways you're not even aware of. Not to mention student debt can't be discharged and passess on. It's tempting to look at it as a tax but taxes don't own you like that. What if you get hurt and can't work? What if the economy tanks and your holdings/investings plummet? Do you really want that hanging over your head for the rest of your life? Debt is a necessary evil for most medical students but don't stay in bed longer than you have to.
 
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Doggeronie

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Unless they've changed it I believe the bonus is 20K, but it fluctuates based on demand/funding. You get that 2k/month stipend plus a few weeks of active duty pay every year. As of now they don't have a cap for cost. Then when you're in residency you make 80-100k depending on location, COL, etc. The attending pay is quite a bit less though. That being said, every spread sheet I've looked at comparing HPSP vs. civillian shows its a pretty good deal for at least those 4 years as long as you're not doing a long residency and super lucrative specialty. Note if you want FM or such, a lot of attendings have told me the pay is often more comparable military vs. civillian. That's just FM though.

OP, my 4th year in undergrad we had an accountant teach a personal finance class and there was a break out session for the future medical students. I don't have the numbers or sheet anymore but holding your debt for a lifetime is definitely not a good idea. It can control you in ways you're not even aware of. Not to mention student debt can't be discharged and passess on. It's tempting to look at it as a tax but taxes don't own you like that. What if you get hurt and can't work? What if the economy tanks and your holdings/investings plummet? Do you really want that hanging over your head for the rest of your life? Debt is a necessary evil for most medical students but don't stay in bed longer than you have to.
Yeah I think HPSP would probably be a saving grace for OP.
Otherwise this debt is going to hold him prisoner for decades
 
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deleted957830

It's tempting to look at it as a tax but taxes don't own you like that. What if you get hurt and can't work? What if the economy tanks and your holdings/investings plummet? Do you really want that hanging over your head for the rest of your life? Debt is a necessary evil for most medical students but don't stay in bed longer than you have to.
Everything owns you and hangs over your head. Your mortgage, car lease/payment, children, mistakes at work, etc. No one gets out alive. Moreover, you're only on the hook for private loans after death/injury. Federal loans grant you protection, which is why I think it's best to NEVER take out private loans. Federal loans are based on your income. I owed over 100K from undergrad and due to my income, my monthly payment was $0 during my gap year and I lived like a queen. Doctors can still live a very nice life (compared to the average American; see above post) with the debt OP is talking about.

Yeah I think HPSP would probably be a saving grace for OP.
Otherwise this debt is going to hold him prisoner for decades

This talk of debt holding you "prisoner" is overblown. I know guys who spend more on trophy wives than my husband and I will spend on loans per year. It's all relative and it's all about perspective. The majority of Americans are in significant amounts of debt and don't make $200K/year. When I start seeing physicians applying for food stamps or qualifying for other government programs, then I think we can start with the "debt holding you prisoner" talk. Otherwise, it's a monthly payment, just like anything else in life.

If you want to listen to the money gurus who think all debt is bad and you shouldn't take on anything you can't pay back in 10 years, then by all means. It's a personal choice. Nevertheless, for many Americans, that pursuit is unrealistic. Most Americans live paycheck to paycheck with essentially 0 savings. Nobody becoming a physician is getting a raw deal or will live anywhere near the poverty line. You will live quite a fine life regardless, unless you live like an idiot (and we all know that saying about idiots and money).
 
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Dr. Anonymouss

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How much is your yearly tuition and how much are you planning on spending for living expenses? That sounds absurdly high.

For reference, my schools tuition is around 36,000 and I am hoping to live off 15,000. I will adjust this cost based on my spending and will be living quite frugally. Based on this I am hoping to have <250,000 in loans by the time I am an attending physician.
 
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DrOngoGablogian

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Debt is not that scary. It is an investment, even a number that big. If you were looking at a different grad path with a lower prospective earning potential/job security and tossing out numbers like that it would be a different story.

Quick numbers from one of the simple online calculators gives you just under a 3000$ monthly payment on 500k @6% over 35 years. 36k a year—like others have said think about it like you’re paying 36k in order to receive your doc salary. Even on the low end you can comfortably plan on 250k a year. After taxes, you’re looking at something like +15,000 -3000 = +12,000/month. That’s a very comfortable living, and a secure one which is a big deal.

The military prospect is more appealing at 500k than at 200k (obviously, since the opportunity cost stays the same in either case). But thats important to recognize—the opportunity cost is still the same. Only do it if you’re ok with that trade. You’re going to be fine either way.

Finally if you end up in a specialty even in the middle of the earning pack, this is a moot point. 450k/year is more than 300k after taxes. That’s 25k/month take home pay—22k after your loan payment. If you are struggling to make ends meet in this scenario, you need different advice that I cannot provide.
 
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deleted957830

Debt is not that scary. It is an investment, even a number that big. If you were looking at a different grad path with a lower prospective earning potential/job security and tossing out numbers like that it would be a different story.

Quick numbers from one of the simple online calculators gives you just under a 3000$ monthly payment on 500k @6% over 35 years. 36k a year—like others have said think about it like you’re paying 36k in order to receive your doc salary. Even on the low end you can comfortably plan on 250k a year. After taxes, you’re looking at something like +15,000 -3000 = +12,000/month. That’s a very comfortable living, and a secure one which is a big deal.

The military prospect is more appealing at 500k than at 200k (obviously, since the opportunity cost stays the same in either case). But thats important to recognize—the opportunity cost is still the same. Only do it if you’re ok with that trade. You’re going to be fine either way.

Finally if you end up in a specialty even in the middle of the earning pack, this is a moot point. 450k/year is more than 300k after taxes. That’s 25k/month take home pay—22k after your loan payment. If you are struggling to make ends meet in this scenario, you need different advice that I cannot provide.
Well said! My dad raised a family of 3 on 25K/year...not a month. But like I said, it's all about perspective. I have classmates who drive Cayennes and go to Greece during a week off. The thought of my husband and I having 12-20K a month left over after our loan payment is nothing short of a dream.
 
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BunnyMan17

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Everything owns you and hangs over your head. Your mortgage, car lease/payment, children, mistakes at work, etc. No one gets out alive. Moreover, you're only on the hook for private loans after death/injury. Federal loans grant you protection, which is why I think it's best to NEVER take out private loans. Federal loans are based on your income. I owed over 100K from undergrad and due to my income, my monthly payment was $0 during my gap year and I lived like a queen. Doctors can still live a very nice life (compared to the average American) with the debt OP is talking about.



This talk of debt holding you "prisoner" is overblown. I know guys who spend more on trophy wives than my husband and I will spend on loans per year. It's all relative and it's all about perspective. The majority of Americans are in significant amounts of debt and don't make $200K/year. When I start seeing physicians applying for food stamps or qualifying for other government programs, then I think we can start with the "debt holding you prisoner" talk. Otherwise, it's a monthly payment, just like anything else in life.

No, everything does not own you and hang over your head the same way 500k of debt does...that's a bit of a red herring in this case either way. Just because other things have weight doesn't influence whether or not you should add another significant factor. Furthermore, if you steward your money well then many of those will be a nonissue.
Mortgages and car payments are a fair point but just like any other debt, it should be paid off as soon as you are able. Also fair point on the federal loan protection, I learned something there.
If you were "living like a queen" with over 100k in debt, regardless of mininum payment, that doesn't sound like the wisest financial decision.

Other people having poor financial sense, dropping a fortune on trophy wives, or having large amounts of debt is a non-sequitar if that's to justify holding on to debt for a lifetime.
I'm not saying debt is this big scary monster that should be avoided at all costs, it is a means to an ends. Once you've got what you need, get out and move on. That being said if you want to keep the debt lifelong and are okay with that risk, then power to you. There are worse career fields to be in and owe so much.
 
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bananafish94

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To answer your question having that much debt isn't overtly abnormal but it's certainly well above the average amount. For reference I also have debt from undergrad but I went to a state school and have about 300K total in loans. Like others have said I highly recommend the White Coat Investor book, website, and forums. The federal student aid website also has a lot of good resources for understanding the various payment strategies.

You are the only person that can decide what amount of debt you're comfortable with. I will tell you though that even if you do have that much debt it's not like you will be expected to pay $5000/month as a resident. The federal income-based repayment plans are great programs that make life a lot easier. In my first year of residency, for example, I'm literally going to be paying $0/month because that's what my "income" was last year and the payment plans are capped at 10% of your discretionary income. Depending on where you ultimately do your training and work as an attending, you could also consider PSLF which would forgive all the debt after 10 years. If that doesn't appeal to you, you can refinance with a private company. Some people are more comfortable aggressively paying off their loans fast in a few years, others are more comfortable paying it down with small chunks of their income over a long period of time. It all depends on what's best for you!
 
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Domepiece

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Second @bananafish94 above.

I have redone your calculations and split out your loan balances so you can see the interest accrued and fees (which are not on top of the loan, but taken out of your loan disbursement before it hits your bank account).

Interest does accrue on federal loans while in school, but does not capitalize until the end of the grace period (6 mos or federal consolidation loan) following medical school. I am not sure as to the specifics of undergraduate federal/private loans with regards to capitalization, but presume interest is not capitalizing while in school if granted deferment. In the end, you are correct that your total indebtedness is ~$540K which is significant. Your COA for medical school is very high at ~$370K in costs which likely contributes to this significant indebtedness. I would suggest looking into PSLF and reading the AAMC Debt Management booklet. Budgeting will be paramount.

I would also suggest keeping in mind that you can take out the full cost of attendance at the beginning of the semester and are able to return unused federal loans within 120 days of disbursement to have both that loan amount and accrued interest on that loan amount erased. This can save considerable debt if consistent in doing this over your time in medical school.

1591209391962.png
 
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BunnyMan17

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Out of curiosity do y'all if the PSLF approval rate is doing any better since 2017? I seem to recall hearing on NPR about very few applications getting approved. When I'm looking at the April 2020 report it looks like most of the PSLF applications were rejecting... but the most common reason listed was (lack of) "qualifying payments".
My school's tuition situation is kinda unique so I get a handful of questions about us vs. PSLF everyone time I volunteer at an info session.
 

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bananafish94

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Out of curiosity do y'all if the PSLF approval rate is doing any better since 2017? I seem to recall hearing on NPR about very few applications getting approved. When I'm looking at the April 2020 report it looks like most of the PSLF applications were rejecting... but the most common reason listed was (lack of) "qualifying payments".
My school's tuition situation is kinda unique so I get a handful of questions about us vs. PSLF everyone time I volunteer at an info session.
I’m not sure what the current approval rate is but in 2017 PSLF was exactly 10 years old which means there was literally 0 room for error at all. If you did one payment incorrectly it would be rejected. It’s very important to make sure you’re on top of the yearly paperwork because obviously the government is going to look for any reason not to forgive hundreds of thousands of dollars if they can. But if you do everything right on your end, they have to.
 

BunnyMan17

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I’m not sure what the current approval rate is but in 2017 PSLF was exactly 10 years old which means there was literally 0 room for error at all. If you did one payment incorrectly it would be rejected. It’s very important to make sure you’re on top of the yearly paperwork because obviously the government is going to look for any reason not to forgive hundreds of thousands of dollars if they can. But if you do everything right on your end, they have to.
Sounds about par for the course. Thanks!
 

DrOngoGablogian

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No, everything does not own you and hang over your head the same way 500k of debt does...that's a bit of a red herring in this case either way. Just because other things have weight doesn't influence whether or not you should add another significant factor. Furthermore, if you steward your money well then many of those will be a nonissue.
Mortgages and car payments are a fair point but just like any other debt, it should be paid off as soon as you are able. Also fair point on the federal loan protection, I learned something there.
If you were "living like a queen" with over 100k in debt, regardless of mininum payment, that doesn't sound like the wisest financial decision.

Other people having poor financial sense, dropping a fortune on trophy wives, or having large amounts of debt is a non-sequitar if that's to justify holding on to debt for a lifetime.
I'm not saying debt is this big scary monster that should be avoided at all costs, it is a means to an ends. Once you've got what you need, get out and move on. That being said if you want to keep the debt lifelong and are okay with that risk, then power to you. There are worse career fields to be in and owe so much.

I understand what you are saying, and that is a sound, responsible way of looking at things. But consider this:

Z=total debt
x=amount of income during gap year/residency/etc (which is tiny relative to XX)
XX=amount of income post residency (huge relative to x)
y=tiny realistic loan payment on x income
YY=huge realistic loan payment on XX income

Scenario 1
During gap year/residency you make the minimum possible loan payments you can, trying to bring y as close to 0 as possible. You spend all of your x to afford yourself a decent quality of life during this period. Z only grows during this period. Once you are done residency, you start paying YYs--which on XX salary, still affords you a great quality of life. Eventually you pay off Z.

Scenario 2
During gap year/residency you make the biggest possible loan payments you can, trying to bring y as high as possible. You greatly sacrifice quality of life during this period, in order to afford your higher z payments on x salary. Z still grows during this period; the y payments you sacrificed QOL to make were minuscule compared to Z. Once you are done residency, you start paying YYs--which on XX salary, still affords you a great quality of life. Eventually you pay off Z, at some point slightly sooner than scenario 1.


The only real difference, is you made life suck worse in scenario 2 than it needed to for ~9 years. Both scenarios will turn out the same.

If I task you to chop a tree down in 2 days, and on the first day I give you a knife, while on the second I will give you an ax--are you going to beat yourself up on day 1 trying to get a head start with the knife? Or chill day 1, and easily chop it down day 2 with the ax?
 
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BunnyMan17

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I understand what you are saying, and that is a sound, responsible way of looking at things. But consider this:

Z=total debt
x=amount of income during gap year/residency/etc (which is tiny relative to XX)
XX=amount of income post residency (huge relative to x)
y=tiny realistic loan payment on x income
YY=huge realistic loan payment on XX income

Scenario 1
During gap year/residency you make the minimum possible loan payments you can, trying to bring y as close to 0 as possible. You spend all of your x to afford yourself a decent quality of life during this period. Z only grows during this period. Once you are done residency, you start paying YYs--which on XX salary, still affords you a great quality of life. Eventually you pay off Z.

Scenario 2
During gap year/residency you make the biggest possible loan payments you can, trying to bring y as high as possible. You greatly sacrifice quality of life during this period, in order to afford your higher z payments on x salary. Z still grows during this period; the y payments you sacrificed QOL to make were minuscule compared to Z. Once you are done residency, you start paying YYs--which on XX salary, still affords you a great quality of life. Eventually you pay off Z, at some point slightly sooner than scenario 1.


The only real difference, is you made life suck worse in scenario 2 than it needed to for ~9 years. Both scenarios will turn out the same.

If I task you to chop a tree down in 2 days, and on the first day I give you a knife, while on the second I will give you an ax--are you going to beat yourself up on day 1 trying to get a head start with the knife? Or chill day 1, and easily chop it down day 2 with the ax?

Fair points and scenarios, don't necessarily disagree with any of it. The key point is the goal in both situations is to pay off the debt. My qualms only come in with that is not the goal.

That's a good analogy at the end there. But don't forget the time between day 1 and 2 can be several years (or more) in which the tree may or may not find some miracle grow and turn into a redwood sized beast. Every day it will grow a little more than the day before, I would personally prefer to finish chopping it down when it is easiest/smallest. That being said if there is minimal interest accrued for a time and little danger of having to find Tom Bombadil to bail me out after the tree swallows me, I can see what you're getting at and how that applies to/negates some of my earlier points.

I understand a lot of it is a money now or money later choice and there is certainly a lot to be said for both sides. Heck, I chose my school with a healthy dose of both factoring in. I just can't count the number of civillian attendings that I've talked to who took the debt for life approach and lived to regret it... If it's for you then power to you. As long as OP understands that kinda debt is not just another Verizon bill.
 

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You better get into a specialty where you can make 350k+ without doing a fellowship... 540k sounds like an unsurmountable amount to pay back but assuming you can take home 200k/yr, you can pay that back in 5-6 years.
 
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Dr. Anonymouss

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You better get into a specialty where you can make 350k+ without doing a fellowship... 540k sounds like an unsurmountable amount to pay back but assuming you can take home 200k/yr, you can pay that back in 5-6 years.

5-6 years on a 200k salary seems like a significant stretch even with the most frugal person. That would essentially be 75% of his taxable income going to debt repayment. No person should due this to themselves. If he happened to get a job that payed on the lower end, it would make the most sense to stretch those payments over 20-25 years so his quality of life doesn't suffer dramatically.

On a serious note, I could see this amount of debt pushing OP into a higher paying specialty solely for financial reasons.
 
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Splenda88

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5-6 years on a 200k salary seems like a significant stretch even with the most frugal person. That would essentially be 75% of his taxable income going to debt repayment. No person should due this to themselves. If he happened to get a job that payed on the lower end, it would make the most sense to stretch those payments over 20-25 years so his quality of life doesn't suffer dramatically.

On a serious note, I could see this amount of debt pushing OP into a higher paying specialty solely for financial reasons.
I said 'take home' (aka after deductions).
 

DrOngoGablogian

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Fair points and scenarios, don't necessarily disagree with any of it. The key point is the goal in both situations is to pay off the debt. My qualms only come in with that is not the goal.

That's a good analogy at the end there. But don't forget the time between day 1 and 2 can be several years (or more) in which the tree may or may not find some miracle grow and turn into a redwood sized beast. Every day it will grow a little more than the day before, I would personally prefer to finish chopping it down when it is easiest/smallest. That being said if there is minimal interest accrued for a time and little danger of having to find Tom Bombadil to bail me out after the tree swallows me, I can see what you're getting at and how that applies to/negates some of my earlier points.

I understand a lot of it is a money now or money later choice and there is certainly a lot to be said for both sides. Heck, I chose my school with a healthy dose of both factoring in. I just can't count the number of civillian attendings that I've talked to who took the debt for life approach and lived to regret it... If it's for you then power to you. As long as OP understands that kinda debt is not just another Verizon bill.

If TB shows up, all bets are off. I mean, the ring does nothing when he puts it on...
 

NITRAS

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Everything owns you and hangs over your head. Your mortgage, car lease/payment, children, mistakes at work, etc. No one gets out alive. Moreover, you're only on the hook for private loans after death/injury. Federal loans grant you protection, which is why I think it's best to NEVER take out private loans. Federal loans are based on your income. I owed over 100K from undergrad and due to my income, my monthly payment was $0 during my gap year and I lived like a queen. Doctors can still live a very nice life (compared to the average American; see above post) with the debt OP is talking about.

This talk of debt holding you "prisoner" is overblown. I know guys who spend more on trophy wives than my husband and I will spend on loans per year. It's all relative and it's all about perspective. The majority of Americans are in significant amounts of debt and don't make $200K/year. When I start seeing physicians applying for food stamps or qualifying for other government programs, then I think we can start with the "debt holding you prisoner" talk. Otherwise, it's a monthly payment, just like anything else in life.

If you want to listen to the money gurus who think all debt is bad and you shouldn't take on anything you can't pay back in 10 years, then by all means. It's a personal choice. Nevertheless, for many Americans, that pursuit is unrealistic. Most Americans live paycheck to paycheck with essentially 0 savings. Nobody becoming a physician is getting a raw deal or will live anywhere near the poverty line. You will live quite a fine life regardless, unless you live like an idiot (and we all know that saying about idiots and money).

I agree that most of America is in debt up to their eyeballs and has the idea that they can "afford" something if they can pay for the monthly payment. I personally think that is a bad way to live life.

For the most part, people become wealthy in America by investing their income. Regular steady investment. Payments steal from your income, and your most predictable way to become wealthy. The debt also adds large amounts of risk to your life. Just cause you can "afford the payment" now doesn't mean you will in the future.

I lost/am losing a fairly significant amount of income because of COVID19. I should be fine because I had huge margin in my life because I have no payments other than a house payment (for now). This slowed down my investing. That's it.

You better get into a specialty where you can make 350k+ without doing a fellowship... 540k sounds like an unsurmountable amount to pay back but assuming you can take home 200k/yr, you can pay that back in 5-6 years.

Most medical students have very little clue how much physicians really make. There are ways for an IM doc to make $400k and $500k. But really there is a way for the OP to pay it off in 3-4 years. As in internist, they won't be fun years. . . . . but they will go by fast.

Again, this assumes that physician salaries stay stable. Who really knows.
 
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camtheram1815

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Honestly OP this is well above average and would give me serious hesitations. A military scholarship is usually not financially worth it in the long run, hence a strong desire to serve is needed. But this might be a circumstance where it would be justified and even recommended.
 
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Doggeronie

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I understand what you are saying, and that is a sound, responsible way of looking at things. But consider this:

Z=total debt
x=amount of income during gap year/residency/etc (which is tiny relative to XX)
XX=amount of income post residency (huge relative to x)
y=tiny realistic loan payment on x income
YY=huge realistic loan payment on XX income

Scenario 1
During gap year/residency you make the minimum possible loan payments you can, trying to bring y as close to 0 as possible. You spend all of your x to afford yourself a decent quality of life during this period. Z only grows during this period. Once you are done residency, you start paying YYs--which on XX salary, still affords you a great quality of life. Eventually you pay off Z.

Scenario 2
During gap year/residency you make the biggest possible loan payments you can, trying to bring y as high as possible. You greatly sacrifice quality of life during this period, in order to afford your higher z payments on x salary. Z still grows during this period; the y payments you sacrificed QOL to make were minuscule compared to Z. Once you are done residency, you start paying YYs--which on XX salary, still affords you a great quality of life. Eventually you pay off Z, at some point slightly sooner than scenario 1.


The only real difference, is you made life suck worse in scenario 2 than it needed to for ~9 years. Both scenarios will turn out the same.

If I task you to chop a tree down in 2 days, and on the first day I give you a knife, while on the second I will give you an ax--are you going to beat yourself up on day 1 trying to get a head start with the knife? Or chill day 1, and easily chop it down day 2 with the ax?
It's easier to cut the tree down when it's still a seedling, even if all you've got is a knife. If you wait until you get an ax, by that time it's already a redwood, as another commenter said.

OP's student loans will balloon to over a million dollars over the course of their lifetime.

I say go military and forget about it. I personally would not be ok with a financial cloud of this enormity hanging over me for decades.
 
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Dr. Anonymouss

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It's easier to cut the tree down when it's still a seedling, even if all you've got is a knife. If you wait until you get an ax, by that time it's already a redwood, as another commenter said.

OP's student loans will balloon to over a million dollars over the course of their lifetime.

I say go military and forget about it. I personally would not be ok with a financial cloud of this enormity hanging over me for decades.

But what also hurts him is his 100,000 debt before medical school which will not be paid off by the military. If he chooses the military route he would be making military physician pay (****) while having >100,000 debt. There is no great option for them, the best would be a high paying specialty.
 

AnonymousDoctorGuyPerson

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But what also hurts him is his 100,000 debt before medical school which will not be paid off by the military. If he chooses the military route he would be making military physician pay (****) while having >100,000 debt. There is no great option for them, the best would be a high paying specialty.

I was actually going to follow up with this. I actually have more debt from before med school than I will probably acquire during. I'm currently sitting on ~250k (big oof I know, a culmination of undergrad, post-bacc, grad, and then unavoidable circumstances). I was very fortunate to receive a rather substantial scholarship for med school, but my debt burden, because of interest, will still be about 450-500k by the time I graduate.

Are there any resources I should be looking into? Personally I would've considered military if it would actually help substantially with my debt but in my case, it wouldn't make a huge impact.

Edit: I think the solution is marry rich
 
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BunnyMan17

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But what also hurts him is his 100,000 debt before medical school which will not be paid off by the military. If he chooses the military route he would be making military physician pay (****) while having >100,000 debt. There is no great option for them, the best would be a high paying specialty.
Depending on how frugally you want to live and where you do residency, it would not be unreasonable to pay that off or at least a very large chunk of it during residency, should you do military. I know plenty of residents who pay of their undergrad loans during a military residency. I agree 100k is a little on the higher side for that but if you take home ~75k (this is for portsmouth so somewhere with a higher BAH could net you more) and live off 50k, you can have the debt payed off by the end of a 4 year residency. Note the 1.2k intern bonus and 8k/year resident bonus too.

 

BunnyMan17

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I was actually going to follow up with this. I actually have more debt from before med school than I will probably acquire during. I'm currently sitting on ~250k (big oof I know, a culmination of undergrad, post-bacc, grad, and then unavoidable circumstances). I was very fortunate to receive a rather substantial scholarship for med school, but my debt burden, because of interest, will still be about 450-500k by the time I graduate.

Are there any resources I should be looking into? Personally I would've considered military if it would actually help substantially with my debt but in my case, it wouldn't make a huge impact.

Edit: I think the solution is marry rich

I agree finding yourself a sugar mamma/daddy would be the best option but there are also these guys here: Defense Finance and Accounting Service > MilitaryMembers > payentitlements > Pay Tables > HPO2 if you want to take out a large chunk of the debt immediately post residency. Although depending on your specialty, the pay differential in 4 years might make it a wash.
 
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qwerty89

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My advisor and his wife are both physicians on the lower end of the spectrum of high-paying specialties. Money was a huge concern as both my husband and I are also in medical school. He told me that they have over $1 million dollars in debt, 3 children, and were still approved for a $800K mortgage (he said they have about $18K left per month after paying loans). While he said they will be paying on their debt until they die, it was better than any alternative in their reality, and they love what they do (and can still live a better lifestyle than most Americans). He told me to look at it as a monthly "improving your life" tax.

I'm the first person in my family to not work in a factory or bakery. I would take on $5 million just to not be that miserable. If I decided not to go to medical school because of the cost...then the system won by not allowing someone from a poor background to advance. It's all about perspective. The debt level of the average medical student is severely skewed due to the average background of most medical students. You'll be fine, and you will still live a better life than the majority of Americans. It's all about perspective. Debt aimed at improving your life and funneled toward doing what you love is never a bad investment. People take out $500K to open restaurants that fold in 2 years. You have a lifelong career that connects you with your community. I plan on paying back the minimum each month until it's wiped away or I die. People spend money on more outrageous things per month..

I understand the point you are trying to make but there is so much bad financial advice in this post I don't know where to begin.

800K mortgate with 1 million combined debt is a good place to start. Sure its a "improving your life tax", but since student loans are not discharged in bankruptcy you REALLY better love practicing medicine for a long time. Private equity takes over your practice and now you hate it? Too bad you have to pay your "improving your life tax" every month despite having graduated med school 15 years ago. Living on less for a few years as an attending will give you the financial freedom to better choose if, where, when, and how you practice.

Keep in mind the people who take 500K to open a restaurant can still declare bankruptcy and have it wiped away. You can't do that with student loans.

The only way the bolded statement makes any sense is if you refinance to a very low 2% or less interest rate. Otherwise its foolish.
 
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goriku671

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Thanks, everyone for all your input. It seems, as I thought, over 540K debt after medical school is certainly not normal. Unfortunately, this debt will likely grow well into 600K while in residency. It's a scary thought as I just turned 30, so I won't be making physician's pay until I'm 37, if I do a 3 year residency, or 40 if I do a 5 year residency.

With regards to the military, I did apply for the Navy HPSP. Unfortunately, due to a medical condition I may not be qualified. I may be qualified for the 3 year scholarship, if I manage to get a waiver. Believe me, it is something I am actively considering. I am just preparing for the worst case scenario and trying to understand what others may have done with similar debt.
 

goriku671

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Second @bananafish94 above.

I have redone your calculations and split out your loan balances so you can see the interest accrued and fees (which are not on top of the loan, but taken out of your loan disbursement before it hits your bank account).

Interest does accrue on federal loans while in school, but does not capitalize until the end of the grace period (6 mos or federal consolidation loan) following medical school. I am not sure as to the specifics of undergraduate federal/private loans with regards to capitalization, but presume interest is not capitalizing while in school if granted deferment. In the end, you are correct that your total indebtedness is ~$540K which is significant. Your COA for medical school is very high at ~$370K in costs which likely contributes to this significant indebtedness. I would suggest looking into PSLF and reading the AAMC Debt Management booklet. Budgeting will be paramount.

I would also suggest keeping in mind that you can take out the full cost of attendance at the beginning of the semester and are able to return unused federal loans within 120 days of disbursement to have both that loan amount and accrued interest on that loan amount erased. This can save considerable debt if consistent in doing this over your time in medical school.

View attachment 308817

Thank you so much for doing this and I appreciate the input. I like the way you did this.

I definitely understand that I can live way under the full COA if I budget wisely. I just wanted to paint a picture of what my debt would look like if I didn't. I am currently working on a personal budget that will work. My first year might be slightly higher because of moving cost and all the extra furniture that I have to purchase, but I'm hoping to be as frugal as can be.
 
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OraclePL

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1) Redo your calculations. As said before, interest does not compound annually which makes a large difference.

2) You can play defense (minimize loans) or offense (increase income) when it comes to your financial picture. For you, increasing your income as an attending is going to be extremely important. The field you choose matters to some degree, but what’s more than interspecialty pay differences is intraspecialty pay differences. If you’re willing to go rural and work extra shifts and moonlight, you can dramatically increase your income. I have hospitalist friends making more than subspecialists by picking up extra shifts.

3) Strongly consider PSLF

4) Educate yourself on personal finance in residency. Use The White Coat Investor, The Physician Philosopher, and The Financial Residency podcast. There's some bad financial advice in this thread, and you're going to get plenty over your career, so you might as well train yourself to identify it.

$540k isn't insurmountable, even if your numbers were accurate. But you'd be better off in certain jobs and situations than others. Be conscious of that when you find your first job.
 

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Hello all,

I am beginning medical school in the fall and I am coming in with already a massive undergraduate student debt. Having grown up poor, I really had terrible financial literacy. I just wanted to get a college degree and I didn't care how much it would cost. Only after graduating college and working did I gain some sense of how to deal with finances (although, I am certainly still learning).

I created an excel sheet calculating how much debt I will be in after medical school. If my calculations are correct, factoring interest compounding daily, I would end up at around $540,000!! I make several assumptions. First that the low interest rate for 2020-2021 (4.3%/5.3% (direct unsub/grad plus) will remain for next school year as well, but will go back to 6%/7% the last two years. My second assumption, is that cost of attendance for my school will remain the same and I will need to pull the maximum amount of loan that I am offered.

Is this normal and are there others out there that will be or are currently in similar debt? Are there any books you recommend or resources I can read to better prepare myself how to handle this much debt?

Sorry for the long post.

View attachment 308738
Interest doesn't compound while you are in school. It compounds once at the end of school when you enter repayment. If you enter an income-based repayment plan, it also accumulates but does not compound unless you change your payment plan, at which time a compounding event will occur
 

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If you feel patriotic and like the idea of military service... and also would be okay with common specialties - then I would consider military med. It is a great option for those who want to serve and are not interested in very specialized medicine/surgery.
 

ACSurgeon

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Few points
- try to minimize loans without ruining your quality of life

- to everyone advocating making the minimum payment over 35 years: this is a recipe for being a disgruntled 60+ year old physician who is still working out of necessity even though you hate your job and what the new admin/system is doing. For some reason, older doctors with financial freedom tolerate the BS a lot better because they know they have an out.

-often times those who have the mindset of paying off loans with minimum payments over a long time do it for the purpose of having more spending money and tend to be more wasteful or indulge in luxuries. Be cautious. Obviously some people are super smart with money and pay off certain debts over many years in order to free up money for higher return investments. I don’t think the average physician has that level of knowledge or discipline, I know I don’t! Be careful.

- there are no guarantees in life. You don’t know that you’ll be able to earn X amount for Y duration. People get sick. People develop life circumstances requiring them to not work or not work as much. People get divorced and lose half their income. Try to save/invest early and pay off debts early. Try to avoid massive loans for cars and homes, especially while you have massive student loans.

- for all the analysis of how far a certain amount of money goes: you’ll have much more expenses and you’d be surprised how quickly 10-15k post tax disappears. 2.5-5k will be your mortgage. 500-1000 per car. If you have kids, add 1500-2000 per child for daycare/school. And we haven’t talked about your regular shopping, spending, eating out etc. also, as a rich doctor you should be saving 1-3k a month, right? And you forgot about the 40k a year in retire

- for those comparing physicians to the average american worker: most physicians won’t be content living like the average american. We sacrifice too much. Work too hard. Think too highly of ourselves. Compare ourselves to other physicians and high earners. The list of reasons go on.

Try to have a balance. Learn to enjoy life without spending the maximum allowed for luxuries. Keep retirement in mind. If you require 20k a month to “survive” you’ll never have enough to retire.

for the OP- borrow as little as possible. Once all said and done, try to find the quickest way to pay back. This could be an employer or a high paying job or forgiveness program. I’d say ten years should be the max, faster would be better.
 
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