Best routes for PSLF

[psych2028]

Hi everyone,

Throwaway acct here. Middle of 3rd year now and I am applying psych next cycle. Sadly I sold my soul to attend the local private med school fully self-financed with loans. This plus having hefty previous loans due to undergraduate and masters degree means I will be graduating with around $550k all federal loans. Because of this mountain, I have determined my best path is likely to aim for PSLF 10-year plan matching at a qualifying residency plus 4-5 years (depending on fellowship or not) attending. I have a few career interests that I want to hash out here to see if any of you have thoughts or recommendations.

1). Military. Financial assistance program. 4 years civilian residency, 5 years payback, then 1 year doing something else that qualifies PSLF. I do have a strong wish to serve, and I am a previous HPSP applicant but I decided to wait so I wasn't locked in so early with the dangling carrot of HPSP money. In hindsight this probably would've been a great option because now I'm drowning in tuition debt. I'm professionally interested in psych issues pertaining specifically to military members and veterans, so there are a lot of things that align with this route.

2). VA. It would help me "serve" I guess, and would count towards PSLF. But I have heard many concerns and frustrations about working in the VA.

3). Ride it out for 5-6 years in a qualifying nonprofit hospital as an attending then decide what practice setting I want after.

4). Suck it up, live frugally, give up on PSLF, and work crazy hours to knock the debt out. I recently perused that prison job thread where some people mentioned 600k-800k is attainable if you totally sell your soul. I could probably grind this out if necessary.

5). Any other good PSLF-oriented routes you have heard of or recommend?

Any of these options stand out to any of you? I guess the bottom line is that I'm still holding on to my dream to serve in the military, and this PSLF route via the financial assistance program plus active duty payback, seems to be a financially viable route if I manage to do my due diligence and get PSLF after 10 years. It would kill two birds with one stone--desire to serve, and PSLF. But there are really serious and scary tradeoffs--professional and personal inflexibility, bureaucracy, etc. Should I give up on this and be more practical, and just try to grind it out to pay off this debt?

Thanks in advance...this is partially a thread post asking for advice, and partially me just doing some self reflection by putting this all in writing. Haha.

P.S. I know the PSLF program is scary because politics change and a lot of people are getting denied. I have a family member who recently got her loan forgiven after 10 years, and other medical mentors who are in the process, so I have help I can rely on to at least give me a great chance to navigate through it successfully.

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[Ole_Toe]

I’m sure others can contribute far more than me, but I would not plan on #4 at all. Those prison jobs may very well not exist when you complete training, the market may change, or you may not have an appetite for it. I would just be careful about telling yourself that you’ll just make 800k for two years to pay it off because that may not be an option.

I do believe that the VA has its own loan forgiveness that is independent of the PSLF qualification. Definitely look into that. Also you didn’t mention NHSC loan forgiveness which is an option you should be familiar with.

I kind of agree that with 500k slowly paying it off with minimum payments over 6 years post residency is the way to go. Try to get as much forgiven as possible while investing and saving in case the rug gets pulled on PSLF? Seems like a decent gamble.

 

[WisNeuro]

I’m sure others can contribute far more than me, but I would not plan on #4 at all. Those prison jobs may very well not exist when you complete training, the market may change, or you may not have an appetite for it. I would just be careful about telling yourself that you’ll just make 800k for two years to pay it off because that may not be an option.

I do believe that the VA has its own loan forgiveness that is independent of the PSLF qualification. Definitely look into that. Also you didn’t mention NHSC loan forgiveness which is an option you should be familiar with.

I kind of agree that with 500k slowly paying it off with minimum payments over 6 years post residency is the way to go. Try to get as much forgiven as possible while investing and saving in case the rug gets pulled on PSLF? Seems like a decent gamble.

They have a few options, I think the EDRP is something like 40k/yr up to 200k or something. So, some loan repayment and a mix of frugal living is also a possibility.

 

[clozareal]

In my area, the public health medicaid clinics pay quite a bit, qualify for PSLF, and have loan forgiveness on top of that (which doesn't make sense if you're going to get them all forgiven anyways since your goal would be to minimize your post-tax monthly income as much as possible). They have inpatient and outpatient options.

Most academic centers also qualify because they're 501c3 and directly hire their faculty (as opposed to some bigger non-profit institutions that are staffed by doctor groups that aren't non-profits) so they would qualify for PSLF if you want to stay where you did residency/fellowship or work in an academic center.

Each VA is different so I would definitely get a feel for the ones you would be applying to. Some of the VAs are very nice to work at, are cush jobs, and have great colleagues to work with. They also have a loan forgiveness option but if you're going for PSLF, it would also not make sense to accept it.

 

[Bartelby]

VA would be way less restrictive than the military in terms of shaping what you want your practice to look like. If you are very interested in serving servicemembers or veterans, the VA Plus PSLF seems like a good way to go. VA salaries are really not too bad, and you will probably have enough energy left over to do some moonlighting or a side private practice if you want to earn more (though I don't know how that interacts with PSLF payments, I never pursued that program).

Overall though, your situation seems like one where doing whatever number of years you need to as a new attending in a non-profit setting seems very much worth it to get that amount of loan forgiveness.

 

[jbomba]

Refinance to the lowest rate possible, work a ton and put that money into the market. You're going to do better on that money in the long term than you will paying off your 3 something % student loan. I've run the numbers and this can be as much as half a million or more over your entire working life; i.e. paying the student loan off as fast as possible or putting all of that money into the market - minimum monthly payments.

 

[Old&InTheWay]

Refinance to the lowest rate possible, work a ton and put that money into the market. You're going to do better on that money in the long term than you will paying off your 3 something % student loan. I've run the numbers and this can be as much as half a million or more over your entire working life; i.e. paying the student loan off as fast as possible or putting all of that money into the market - minimum monthly payments.

If op makes $240000/yr and signs up for IBR, they will pay 1830/mo for 6 years post residency and then the balance will be forgiven. Total replayed will be about $130000. PSLF is definitely a better deal than refinancing.

 

[nexus73]

If you are set on the military or VA, I think that's great as they will both qualify, and VA has loan payment matching program, which may or may not be advantageous if you're pursuing PSLF.

If you don't go the military/VA route, IMO the best options are community mental health center or employed at nonprofit hospital (which could be clinic or inpatient). The community mental health clinic may also get you NHSC money sort of as a hedge to pay down loans just in case PSLF gets modified and you end up having to pay back some or all of your loans (everything I've read on this indicates any changes would not apply to current borrowers, but nothing is set in stone I don't think). The hospital employed jobs can be fairly lucrative if you are busy on an inpatient unit and on an RVU payment model; this setup could also be a hedge where you could make very good money and save/invest it on the off chance you end up having to pay the loans back yourself. I assume the prison jobs would also qualify for PSLF being a state employee, and the pay can be extremely high, if you can tolerate that type of work.

I'm sure you're already aware of this, but make absolutely sure you will be employed by a qualifying employer. Nothing would be worse than getting into residency and finding out the hospital is non-profit, but everyone is employed through a separate physician group that is for profit. Kaiser Permanente is the classic example of this, the health plan is non profit, but the physicians are employed by a separate for profit entity.

 

[jbomba]

If op makes $240000/yr and signs up for IBR, they will pay 1830/mo for 6 years post residency and then the balance will be forgiven. Total replayed will be about $130000. PSLF is definitely a better deal than refinancing.

Yeah at his loan amount and income you're right. I think when income gets into the 400s it begins to shift.

 

[Animal Mother]

Outpatient community mental health is an option as well. High no show rate, pretty good pay at some spots, additional "loan forgiveness" that you can sometimes pocket.

 

[Celexa]

In terms of next steps, I recommend seeking out a residency which will qualify you for pslf and has rotations at a VA.

VA is an interesting thing. I've been at two (medical school and my residency both had time there). It's not my particular cup of tea but at both places I wouldn't say the dysfunction was wildly different in amount from what you might find in other places, although it sometimes manifested in ways particular to the VA. I have coresidents who hated every minute they spent there and multiple coresidents who are taking VA jobs at graduation. The pay is decent, benefits are good, hours are chill and there's no noncompete.

Best way to figure out if that'll be a good place for you is to go to a residency where you'll be able to experience it first hand.

 

[Mass Effect]

Yeah at his loan amount and income you're right. I think when income gets into the 400s it begins to shift.

Even in the 300's, PSLF is the more lucrative way to go. The only times I would recommend paying it all off is if someone's debt is below 300, if their residency was at a for-profit, or if they are set on a private practice set up right out of residency and can guarantee a salary of 300K+. If someone wants academics, VA, CMHC or has more than 300K in debt, I'd go PSLF all the way.

 

[jbomba]

Even in the 300's, PSLF is the more lucrative way to go. The only times I would recommend paying it all off is if someone's debt is below 300, if their residency was at a for-profit, or if they are set on a private practice set up right out of residency and can guarantee a salary of 300K+. If someone wants academics, VA, CMHC or has more than 300K in debt, I'd go PSLF all the way.

My debt is in the mid 200s and planning on cobbling together a couple jobs plus starting a pp when I start. Guessing my first year pay will be 600s. I could clear the entire debt in a year or refinance and pay it off slowly. By investing that 300k rather than paying the debt lll come out roughly 600k ahead assuming average returns over 25 years. But yah his debt is far larger and pay anticipated to be much less.

 

[Candidate2017]

HPSP tution/stipend + $275k sign on bonus + military salary ends up being less than what you can make as a psychiatrist in the community. Inpatient or outpatient work for a nonprofit hospital system qualifies for PSLF and can gross you $300k-400k, plus performance and retention bonuses, and loan repayment.

However, the only thing that will make a big difference in the long term is gaining financial literacy.

 

[sloop]

Yeah at his loan amount and income you're right. I think when income gets into the 400s it begins to shift.

Realistically, income level doesn’t really modify whether PSLF makes sense unless you either can’t make close to the same income in a PSLF job or you have a lifestyle where you need such a high cash flow that you can’t really control your taxable income. If you’re happy in a job that qualifies for PSLF and you have significant debt, it generally makes sense to do PSLF whether you’re making $200K or $400K+.

Even if you’re somehow making like 400K in a PSLF qualifying job, just contribute to a 403(b) to the point that your income is enough to sustain your lifestyle, but not in excess of that. Your IBR payment will reduce accordingly. That way, you’re not throwing money away towards loans that are just going to be forgiven. You get to invest your money and maximize the amount you’re forgiven.

 

[FlowRate]

I hadn't really ever run the PSLF numbers because my personal situation wasn't relevant (over half in private institutional loans). Just did the calcs and most situations where med school loans are >$100k and 100% federal benefit from PSLF. Assuming you don't defer/forebear in residency. 10% of discretionary barely even touches interest for someone like OP.

 

[Ole_Toe]

I hadn't really ever run the PSLF numbers because my personal situation wasn't relevant (over half in private institutional loans). Just did the calcs and most situations where med school loans are >$100k and 100% federal benefit from PSLF. Assuming you don't defer/forebear in residency. 10% of discretionary barely even touches interest for someone like OP.

It’s tough because you feel the pressure to refinance early on during residency. At 400-500k the 6.5% federal interest rate would be like 30k a year on a 50-60k pretax intern salary. An impossible situation. Sacrifice all quality of life spending and the total still grows. At 3% you can control it a bit more easily. But you lose the opportunity for large scale PSLF forgiveness down the line.

 

[Old&InTheWay]

Even if OP were to make 900k/year, IBR payments over 6 years would cover the entire principal ($550k), and then any accrued interest would be forgiven (so in essence an interest free loan).

 

[sloop]

I hadn't really ever run the PSLF numbers because my personal situation wasn't relevant (over half in private institutional loans). Just did the calcs and most situations where med school loans are >$100k and 100% federal benefit from PSLF. Assuming you don't defer/forebear in residency. 10% of discretionary barely even touches interest for someone like OP.

Yeah. If you have significant qualifying debt, pursuing PSLF winds up being so easy to justify.

In med school, the school’s financial advisor basically walked me through consolidating all of my student loans into qualifying loans as I was graduating. He then advised me to submit a tax return with my zero income as a medical student. Instead of taking the six month no-payment grace period, I got to make qualifying $0 payments for the first year. Then, the second year payments were extremely low because they were based on my first tax return in residency, which was effectively half of my intern salary (only the first half of intern year).

My residency employment qualified, and so does my fellowship. I’m going to be entering my first attending job with 5 years of certified payments. Spending another five years with a PSLF employer to get forgiveness is an absolute no-brainer. This is especially true because it happens to coincide with several good places to work as an early career forensic psychiatrist (state jobs and such).

 

[NickNaylor]

I think the discussion of pursuing PSLF vs. not is fairly complicated and situation- and individual-specific, so I'm going to stay away from that specific topic.

My only advice, which I tell medical students and residents, is that if you plan to try and take advantage of PSLF, make sure you understand the details of your employment. Especially in private settings, it's not uncommon for a hospital or clinic system to be a non-profit but the physician group or whatever organization you're working for is a for-profit organization. These arrangements may not be immediately transparent, thus the importance of specifically understanding your employment arrangement. If you don't, you mind find yourself in a situation where you've been working for an organization thinking you're accruing PSLF time, but you aren't.

 

[jbomba]

Even if OP were to make 900k/year, IBR payments over 6 years would cover the entire principal ($550k), and then any accrued interest would be forgiven (so in essence an interest free loan).

Can you help me understand if I'm thinking about this correctly?

I ran these numbers just now - assuming 600k salary and 300k debt, making minimum payments for pslf, one would pay the loan off in 6.2 years with roughly 5k monthly payments. Essentially getting no pslf benefit assuming 4 years of minimal qualifying residency payments.

If one refinanced to 3% over 15 years minimum payments would be roughly 2k a month with total interest paid of roughly 80k. However that extra 3k a month saved over the first 6 years would grow to over a million in interest earned over 25 years (even if no further investment was made to the account after those 6 years).

So if ones salary is such that the minimum payments would eliminate any benefit of pslf, the goal should be to pay as slowly as possible. Does that sound right to you?

 

[mistafab]

Can you help me understand if I'm thinking about this correctly?

I ran these numbers just now - assuming 600k salary and 300k debt, making minimum payments for pslf, one would pay the loan off in 6.2 years with roughly 5k monthly payments. Essentially getting no pslf benefit assuming 4 years of minimal qualifying residency payments.

If one refinanced to 3% over 15 years minimum payments would be roughly 2k a month with total interest paid of roughly 80k. However that extra 3k a month saved over the first 6 years would grow to over a million in interest earned over 25 years (even if no further investment was made to the account after those 6 years).

So if ones salary is such that the minimum payments would eliminate any benefit of pslf, the goal should be to pay as slowly as possible. Does that sound right to you?

This is somewhat correct, however you have not quantified or placed risk anywhere in your calculation. Risk is valuable; or the lack of, rather.

 

[Ole_Toe]

This is somewhat correct, however you have not quantified or placed risk anywhere in your calculation. Risk is valuable; or the lack of, rather.

I'm also curious, OP, on what you are basing the 600k salary in psych for 15 years. That would be more than double average salary and starting right out of residency with no down years. Obviously if you had a couple years making 250k or even 350k the PSLF would be looking much better in a head-to-head. You've done your homework, so I'm just curious what your plan is for getting to 600k consistently.

 

[jbomba]

I'm also curious, OP, on what you are basing the 600k salary in psych for 15 years. That would be more than double average salary and starting right out of residency with no down years. Obviously if you had a couple years making 250k or even 350k the PSLF would be looking much better in a head-to-head. You've done your homework, so I'm just curious what your plan is for getting to 600k consistently.

I was the one who was posting about the prison jobs a couple weeks ago. The plan would be to take one of those which on its own pays 660k for four days a week, 40 hours (330/hr).

I plan to start a private practice on my Fridays and over time maybe cut back on the prison job and swap it for a general inpatient job. Regardless, based on insurance reimbursement in the area I should easily be able to net 260-330/hr and fill quickly. Call it 300 less expenses or 250/hr x 8 hours a week to start. I realize I won't have this day one but should have it within a few months. So that's another 100k.

Throw in the random locums weekend maybe once a month, which I've seen pay anywhere between 4-10k a weekend. Call it 6k. So that's another 72k for 12 weekends a year.

So adding it all up that comes out to 660+100+72 or 830k a year. Now you'll argue I'll probably want more than two weeks off, which I'll try to negotiate with the prison job, so assuming 4 weeks off, total income would look more like 800k annually.

Take away the prison job and replace it with a standard inpatient job for 300k that allows me to leave after rounding and I can just increase pp hours in the afternoons and take Fridays entirely off and still come close to 800k. The 600k figure in the original post was a conservative estimate. With the number of work from home job and high paying locums jobs which don't require daily or even weekly commitments, it doesn't really seem that hard to make much more than the average in psychiatry.

 

[nexus73]

I was the one who was posting about the prison jobs a couple weeks ago. The plan would be to take one of those which on its own pays 660k for four days a week, 40 hours (330/hr).

I plan to start a private practice on my Fridays and over time maybe cut back on the prison job and swap it for a general inpatient job. Regardless, based on insurance reimbursement in the area I should easily be able to net 260-330/hr and fill quickly. Call it 300 less expenses or 250/hr x 8 hours a week to start. I realize I won't have this day one but should have it within a few months. So that's another 100k.

Throw in the random locums weekend maybe once a month, which I've seen pay anywhere between 4-10k a weekend. Call it 6k. So that's another 72k for 12 weekends a year.

So adding it all up that comes out to 660+100+72 or 830k a year. Now you'll argue I'll probably want more than two weeks off, which I'll try to negotiate with the prison job, so assuming 4 weeks off, total income would look more like 800k annually.

Take away the prison job and replace it with a standard inpatient job for 300k that allows me to leave after rounding and I can just increase pp hours in the afternoons and take Fridays entirely off and still come close to 800k. The 600k figure in the original post was a conservative estimate. With the number of work from home job and high paying locums jobs which don't require daily or even weekly commitments, it doesn't really seem that hard to make much more than the average in psychiatry.

i don't know if this is sustainable...for most people

 

[jbomba]

i don't know if this is sustainable...for most people

48 hours a week doesn't seem so bad particularly when you consider the prison or inpatient job isn't seeing patients non-stop like you might in a private practice.

True I don't think I'd do this when I'm 55, but it doesn't seem so much worse than a lot of other specialties. In fact this seems world's better than a lot of surgical jobs.

 

[nexus73]

48 hours a week doesn't seem so bad particularly when you consider the prison or inpatient job isn't seeing patients non-stop like you might in a private practice.

True I don't think I'd do this when I'm 55, but it doesn't seem so much worse than a lot of other specialties. In fact this seems world's better than a lot of surgical jobs.

I'll be the first to say not everyone is equal, and some people can really work a lot and do fine. We had a locums like this who saw a ton of patients, and was somehow able to be completely disengaged with patients. And the patients all hated him because he seemed to be just going through the motions, and wasn't present with them. He didn't give the wrong medicines or anything, but nobody liked him and were constantly asking to switch doctors.

IMO psychiatry is more emotionally draining. Surgeons can put in new knees and hips, or cut out gallbladders and fix hernias all day long and it's just mechanical repetition. It's a lot more draining to interact with patients, conversing about their mental health needs, discussing possibilities of treatments, being ok with the uncertainty of mental health treatments, saying no to the drug seekeers, or dealing with the borderlines. Whereas a surgeon is scrubbing in and doing yet another bread and butter cholecystectomy...and the patient is asleep.

 

[jbomba]

I'll be the first to say not everyone is equal, and some people can really work a lot and do fine. We had a locums like this who saw a ton of patients, and was somehow able to be completely disengaged with patients. And the patients all hated him because he seemed to be just going through the motions, and wasn't present with them. He didn't give the wrong medicines or anything, but nobody liked him and were constantly asking to switch doctors.

IMO psychiatry is more emotionally draining. Surgeons can put in new knees and hips, or cut out gallbladders and fix hernias all day long and it's just mechanical repetition. It's a lot more draining to interact with patients, conversing about their mental health needs, discussing possibilities of treatments, being ok with the uncertainty of mental health treatments, saying no to the drug seekeers, or dealing with the borderlines. Whereas a surgeon is scrubbing in and doing yet another bread and butter cholecystectomy...and the patient is asleep.

I hear that. Personally I feel like I can deliver good care and not get emotionally invested in my patients. Granted I'm still in residency but even seeing 14 outpatients in a day doesn't feel particularly draining.

In an ideal world I'd work on building a private cash practice where I could see 32 patients a week and spend an hour with each. So, something to work towards as I grind it out I suppose.

 

[psych2028]

Interesting and helpful discussion so far, thank you to everyone who has contributed. I appreciate it. I found a PSLF calculation table on WCI to help determine whether PSLF is typically worth it based on accumulated federal debt and expected post-residency income. It looks like with my estimated $550k it is worth it even at the upper end of incomes (especially if I want to do a fellowship). I guess the main issue moving forward (assuming I match into a qualifying residency, which would be a top priority for sure) would be to decide whether active duty military medicine would be an acceptable path, or if I should: just go for VA, or pursue a potentially more lucrative path at a nonprofit hospital system. Not interested in pure academia. It sounds intriguing to work the jobs @jbomba is talking about, but it also seems pretty risky for me to give up PSLF for jobs I'm not sure will be there in 4-5 years.

Should You Go For PSLF as an Attending Physician? | White Coat Investor

VA would be way less restrictive than the military in terms of shaping what you want your practice to look like. If you are very interested in serving servicemembers or veterans, the VA Plus PSLF seems like a good way to go. VA salaries are really not too bad, and you will probably have enough energy left over to do some moonlighting or a side private practice if you want to earn more (though I don't know how that interacts with PSLF payments, I never pursued that program).

Overall though, your situation seems like one where doing whatever number of years you need to as a new attending in a non-profit setting seems very much worth it to get that amount of loan forgiveness.

I am concerned about the restrictions of active duty military, there is no getting around it. There are upsides including interesting professional experience, service locations (could be bad I admit, but often good for my branch of interest), personal satisfaction of serving, veteran status for life, and more. But at what cost, financially, personally, and professionally? Tough to answer. Also, this sounds silly, but a lot of my family lives near a huge Navy base (my branch of preference) and I have thought about settling back down there someday. I feel like it would give me a ton of credibility down the road with the local patient population if I were a veteran.

In terms of next steps, I recommend seeking out a residency which will qualify you for pslf and has rotations at a VA.

VA is an interesting thing. I've been at two (medical school and my residency both had time there). It's not my particular cup of tea but at both places I wouldn't say the dysfunction was wildly different in amount from what you might find in other places, although it sometimes manifested in ways particular to the VA. I have coresidents who hated every minute they spent there and multiple coresidents who are taking VA jobs at graduation. The pay is decent, benefits are good, hours are chill and there's no noncompete.

Best way to figure out if that'll be a good place for you is to go to a residency where you'll be able to experience it first hand.

I help with research and basic operations within a psych clinic at my local VA. It seems like an impressive facility and the doctors I've met are happy, but I certainly don't have a clear idea of what reality of practicing there is like. I can imagine how much things vary from one location to the next.

Realistically, income level doesn’t really modify whether PSLF makes sense unless you either can’t make close to the same income in a PSLF job or you have a lifestyle where you need such a high cash flow that you can’t really control your taxable income. If you’re happy in a job that qualifies for PSLF and you have significant debt, it generally makes sense to do PSLF whether you’re making $200K or $400K+.

Even if you’re somehow making like 400K in a PSLF qualifying job, just contribute to a 403(b) to the point that your income is enough to sustain your lifestyle, but not in excess of that. Your IBR payment will reduce accordingly. That way, you’re not throwing money away towards loans that are just going to be forgiven. You get to invest your money and maximize the amount you’re forgiven.

Good idea to max 403b. One reason I figured active duty military was a good route during my PSLF window was that although the pay is quite a bit lower than what I would expect even compared to a nonprofit job, it would be less bad than normal since I'd be riding out the 10 years for PSLF. Higher pay = higher 10% IBR payments for those 5-6 years. But I guess even if the pay is substantially higher at a nonprofit, and I could contribute max amounts to a 403b, that would offset any sort of "savings" I'd get by having a crap pay job. Haha.

 

[psych2028]

I think the discussion of pursuing PSLF vs. not is fairly complicated and situation- and individual-specific, so I'm going to stay away from that specific topic.

My only advice, which I tell medical students and residents, is that if you plan to try and take advantage of PSLF, make sure you understand the details of your employment. Especially in private settings, it's not uncommon for a hospital or clinic system to be a non-profit but the physician group or whatever organization you're working for is a for-profit organization. These arrangements may not be immediately transparent, thus the importance of specifically understanding your employment arrangement. If you don't, you mind find yourself in a situation where you've been working for an organization thinking you're accruing PSLF time, but you aren't.

That is definitely important advice. I have been having my dad help with some of the preliminary research since he is a retired attorney. But I might even consider hiring an attorney with student loan experience to help cover my bases at each step--the cost would be worth it for peace of mind to ensure I am qualifying.

I'm also curious, OP, on what you are basing the 600k salary in psych for 15 years. That would be more than double average salary and starting right out of residency with no down years. Obviously if you had a couple years making 250k or even 350k the PSLF would be looking much better in a head-to-head. You've done your homework, so I'm just curious what your plan is for getting to 600k consistently.

I was just referencing that other thread about @jbomba who was interested in pursuing a high paying prison job. I wouldn't expect to make anything close to that amount. I was just curious about whether those balls-to-the-wall jobs are out there and even remotely feasible for someone wanting to dig out of massive debt. I guess I'd be open to it if it means knocking out these loans and getting some financial stability into my life, but for that type of income there has to be some serious sacrifice with hours, quality of life, location, practice preferences, etc.

 

[jbomba]

That is definitely important advice. I have been having my dad help with some of the preliminary research since he is a retired attorney. But I might even consider hiring an attorney with student loan experience to help cover my bases at each step--the cost would be worth it for peace of mind to ensure I am qualifying.


I was just referencing that other thread about @jbomba who was interested in pursuing a high paying prison job. I wouldn't expect to make anything close to that amount. I was just curious about whether those balls-to-the-wall jobs are out there and even remotely feasible for someone wanting to dig out of massive debt. I guess I'd be open to it if it means knocking out these loans and getting some financial stability into my life, but for that type of income there has to be some serious sacrifice with hours, quality of life, location, practice preferences, etc.

I can tell you the sacrifice isn't hours or location. The other two I can't speak to yet.

 

[Ellomate]

Just wondering what the salary range is for VA, CMHC, academic, or other non profit job opportunities are out there - especially in the east coast, mainly from Virginia to NY.

THANK YOU!

 

[comp1]

VA jobs are generally found on usajobs.gov, take a look. They seem to say salary starts at $235k. It's going to be closer to $250k almost anywhere before board certification (+$10k) and that doesn't include the performance pay bonus or hiring bonus. Of course, the VA does not compete on salary, pretty much anywhere. It aims to be average for pay in a given market, literally. The VA instead competes on chill working conditions and benefits including leave time and the best 401k type vehicle and pension. If you don't find a position in the exact site you want, there almost certainly still is a psychiatrist opening still there. You just need to find the physician recruiter. Contact the recruiter from a nearby advertisement and tell them what you are looking for. I also need to mention that EDRP (the $200k in physician loan repayment) and PSLF are not mutually exclusive. You get both at the VA and, my goodness if you have as much debt as the OP, you should...

 

[sloop]

Just wondering what the salary range is for VA, CMHC, academic, or other non profit job opportunities are out there - especially in the east coast, mainly from Virginia to NY.

THANK YOU!

This is a very wide geographic range and includes a lot of practice environments. As such, the salary range is very wide, like between $200K and $350K. As a general rule, academic positions will be on the low-mid end of the range. Certain academic institutions are notorious for paying poorly and account for the lowest numbers in the range. VA will probably be in the middle, most likely around $250K in most areas. State jobs span the gamut but there is often high demand at state hospitals so this will involve the mid-high range and the highest number I have seen is in one particular state hospital in the mid-Atlantic region (though the job does involve in-house call).

As usual, the largest cities tend to pay less and rural areas that have difficulty recruiting offer more. As has been mentioned, when considering the true public sector jobs (state, federal government, etc.), you should think about the value of the benefits/work environment and how those fit into your long-term plans. For a lot of people, the stability of a pension plan is very attractive. Some of these jobs are also relatively low intensity and lack some of the stresses associated with traditional hospitals (less pressure from utilization reviewers, etc.) but come with their own unique frustrations and challenges.

 

[annoyedpsychiatrist]

VA jobs are generally found on usajobs.gov, take a look. They seem to say salary starts at $235k. It's going to be closer to $250k almost anywhere before board certification (+$10k) and that doesn't include the performance pay bonus or hiring bonus. Of course, the VA does not compete on salary, pretty much anywhere. It aims to be average for pay in a given market, literally. The VA instead competes on chill working conditions and benefits including leave time and the best 401k type vehicle and pension. If you don't find a position in the exact site you want, there almost certainly still is a psychiatrist opening still there. You just need to find the physician recruiter. Contact the recruiter from a nearby advertisement and tell them what you are looking for. I also need to mention that EDRP (the $200k in physician loan repayment) and PSLF are not mutually exclusive. You get both at the VA and, my goodness if you have as much debt as the OP, you should...

Is VA chill working conditions though? When I was a resident, we did a lot of VA and working conditions kinda sucked. Attending would have at least like 15 patients on the schedule. Most would demand controlleds. On top of that, they had this weird way of doing intakes they implemented that took >40 minutes just to document an intake..it was a stupid idea to increase "collaborative care"...then my understanding is you have to accept walk ins? i remember people walking in at like 4:30 or later lol

 

[comp1]

So if you've seen one VA, particularly as a resident, you've seen one VA. There is a good amount of paperwork in the VA. It's the largest healthcare system in the world, after all. However, there should be an extensive array of clerical and nursing staff to help with that. If there's not, there might be some issues at that particular VA. In terms of controlleds, yes, there will be pressure from the patients. There will be that anywhere. However, at the VA there is a system that specifically backs up and supports reduction in controlled prescribing and even at some VAs makes reduction in dangerous things like combined benzo and opiate prescribing a part of performance pay. You won't be just throwing patients to the wind either. There is the availability of pain management specialists and addiction specialists to refer to as well. As far as walk-in's, that's going to be the most specific thing in the world. It's not even specific to the VA system you're interested in, it's literally specific to the site within that system. It's a good thing to ask about. Every VA site should have a plan in place for near closing time emergency evaluations. At most clinics attached to a hospital I've seen, such patients would go to the ED for assessment if they arrive after 3:30. Most VA providers take their tour of duty seriously and if it's repeatedly disrupted for patient emergencies, that's something for a supervisor to address.

 

[Sushirolls]

I'm not offering up a solution, just my story.
Got into PSLF as resident, knocked out about 3 years there maybe a bit more. It ballooned during this time with minimal payments ~6.8% rate.

Worked at a "non profit" Big Box shop for ~3-4 years, and got it attested to. Was paying max monthly rate per PSLF. Limited headway.

Couldn't go back to Big Box shops. Just couldn't do it. Opened PP even with loan burden. Continued to pay full monthly rate. Covid hit, things paused, no payments.

Fled Blue State like a refugee to Red State. Used home equity to pay off remainder of loans in past few months, conveniently just before re-payments resumed.

In summary, I had paid more in interest than the original balance. ~3.4 years to ride out doing PSLF at another non-profit was considered multiple times, but the house equity plan worked for me.

 

[annoyedpsychiatrist]

I have roughly 4 years and 3 months left until im done with PSLF. With that time frame in mind, and being so close, i really want to go all the way and finish it. With the loan pause especially, just making no payment and instead investing that money, will save me an insane amount of cash in the long run. I have roughly 320k in loans left (was originally 360). Applied for bidens 10k program (just barely made it since this iis my 2nd attending year), and my state has a 20k a year scholarship i applied for so well see if i get it (as it depends on a few factors). But factoring in the returns/interest ill get off investing, and having around 300k or so (little less with mininum payments resume) after 4 more years..thats hard to pass up. Ill bet the net savings will be like 400-450k easy. Thats a house right there. But i work for a not for profit hospital system and i like my job so that really does help.

 

[alina_s]

As someone who went the NHSC scholarship route, I would not recommend this. I’d like to think that if PSLF had been available when I was a student, I would have gone that route. Even with NHSC loan repayment, unless you’re already at a job and know you like it, the triple penalty plus interest for breaking your contract is very high risk for the reward, especially with big loans.

 

[heartsink]

As someone who went the NHSC scholarship route, I would not recommend this. I’d like to think that if PSLF had been available when I was a student, I would have gone that route. Even with NHSC loan repayment, unless you’re already at a job and know you like it, the triple penalty plus interest for breaking your contract is very high risk for the reward, especially with big loans.

Can you expand on why you would not recommend NHSC / what is different about PSLF that is much better? Is NHSC very restrictive in what jobs qualify?

 

[alina_s]

Can you expand on why you would not recommend NHSC / what is different about PSLF that is much better? Is NHSC very restrictive in what jobs qualify?

Super-restrictive for the NHSC scholarship. It's awarded while you're in school and you are committing to serve at a site, however they may choose to define sites years down the road whenever you're done with training. The terms of the deal can and do change and if you don't like it, you had best accept the change, else be prepared to go into deep debt. There is a small stipend, although I didn't get by on just that, even single in Cleveland. When I signed up, there had been more scholarships years before, so they were allowing psychiatrists to go to sites from the NHSC list with lower HPSA scores. Regions are assigned HPSA scores but sites have to apply to be NHSC sites. While I was in training, the NHSC shrank and for several years, nearly the only psychiatry sites were BOP. When I signed up, they were allowing an extra year of training for child psychiatry, but that was canceled before I started residency. I got away with child training because they still allowed an extra year of training for chief residency positions, the training director was willing to make me chief resident before I ever started the program, and the NHSC didn't know that in psychiatry, a chief residency isn't an add-on year the way it is in medicine. NHSC loan repayment sites are still from the HPSA list and I think you have to apply for loan repayment after you have a job and your odds of "winning" are better if the HPSA score is higher. Once you sign for the loan repayment, the terms are the same- if you don't complete your contract with them, the NHSC will calculate how much time you owed and bill triple that proportion of your loan repayment, plus interest.
PSLF is just a matter of getting 10 years of service at any non-profit spread out however you like, and your training years can count. No penalty for changing jobs or breaking a contract.

 

[annoyedpsychiatrist]

Super-restrictive for the NHSC scholarship. It's awarded while you're in school and you are committing to serve at a site, however they may choose to define sites years down the road whenever you're done with training. The terms of the deal can and do change and if you don't like it, you had best accept the change, else be prepared to go into deep debt. There is a small stipend, although I didn't get by on just that, even single in Cleveland. When I signed up, there had been more scholarships years before, so they were allowing psychiatrists to go to sites from the NHSC list with lower HPSA scores. Regions are assigned HPSA scores but sites have to apply to be NHSC sites. While I was in training, the NHSC shrank and for several years, nearly the only psychiatry sites were BOP. When I signed up, they were allowing an extra year of training for child psychiatry, but that was canceled before I started residency. I got away with child training because they still allowed an extra year of training for chief residency positions, the training director was willing to make me chief resident before I ever started the program, and the NHSC didn't know that in psychiatry, a chief residency isn't an add-on year the way it is in medicine. NHSC loan repayment sites are still from the HPSA list and I think you have to apply for loan repayment after you have a job and your odds of "winning" are better if the HPSA score is higher. Once you sign for the loan repayment, the terms are the same- if you don't complete your contract with them, the NHSC will calculate how much time you owed and bill triple that proportion of your loan repayment, plus interest.
PSLF is just a matter of getting 10 years of service at any non-profit spread out however you like, and your training years can count. No penalty for changing jobs or breaking a contract.

Wow, it sounds like a scam to me. The penalty part is absurd. Thats why i chose not to do it, too much risk not enough reward for me. Whereas like you said, pslf im free to essentially choose my job and there are a lot of psych jobs that meet criteria. Just 4 more years to go...

 

[Ellomate]

I think my worry is not unusual that if going the PSLF route, we are limited in the jobs we can get. My biggest fear is completing 6-8 years but just absolutely burned out and want to just go to a higher paying route to pay off the loan. But by then, the interest on my loans would eat me alive… 320k at the moment.

Also, do many people have side gigs or other psych part time to aid your income while holding a job that qualifies for PSLF? (I.e when holding a job at the VA, can you have telehealth patient on the weekends?). Is it worth it? As higher gross income lead to increased payment to the loans.

Lastly, I’m starting residency in July and getting married before I start. She works in corporate and has a decent income. Thinking of doing PAYE to avoid paying 10% of JOINT income. Is this smart or does MFJ + REPAYE reap more benefit in the long run?

 

[annoyedpsychiatrist]

There are a lot of jobs that qualify. Heck you usually get 4 years just doing residency, most residencies qualify. The majority of hospitals are not for profit, and hospital based outpatient practices by extension qualify (that are not for profit)

 

[sloop]

I think my worry is not unusual that if going the PSLF route, we are limited in the jobs we can get. My biggest fear is completing 6-8 years but just absolutely burned out and want to just go to a higher paying route to pay off the loan. But by then, the interest on my loans would eat me alive… 320k at the moment.

Also, do many people have side gigs or other psych part time to aid your income while holding a job that qualifies for PSLF? (I.e when holding a job at the VA, can you have telehealth patient on the weekends?). Is it worth it? As higher gross income lead to increased payment to the loans.

Lastly, I’m starting residency in July and getting married before I start. She works in corporate and has a decent income. Thinking of doing PAYE to avoid paying 10% of JOINT income. Is this smart or does MFJ + REPAYE reap more benefit in the long run?

There are a lot of qualifying jobs. Many nonprofit hospitals qualify. State, local, and federal government jobs also qualify. If you don’t like one job, you can always go to another qualifying job.

All of the other questions depend entirely on your individual situation. How are you spending the money from the additional job? Can you put it into retirement accounts to minimize impact on your monthly payment? Do you have expenses that require extra cashflow even if at the end of the day it increases your payment?

With regard to what plan to do, this is probably the simplest calculation. Plug your numbers into a calculator to figure out how much different the two plans are in terms of savings. Then figure out which filing status works out better for you and by how much, on average. Then figure out the net benefit of each plan/filing status combination. Then consider the other differences in the plan and how valuable those are (like the length of time to non-pslf forgiveness, etc.). Without having all of your financials, nobody here can answer this. You have to run the numbers yourself.

 

[comp1]

The VA has no restrictions on outside employment outside of your tour of duty time.

 

[ObsequiousAplomb]

As someone who got completely hosed by the military, I would recommend that everyone avoid them like the plague. They medically discharged me and demanded I pay the full balance immediately. When I couldn't they put it in collections. Took years of court battles and an extra $30k and a bankruptcy to even get them to settle to just letting me pay the original amount off over 30 years.

I also would like to expound a little on the correctional jobs. There is a great deal of diversity in the offerings that I feel might be being overlooked in the OP's consideration.

Yes, there are these high-paying locums roles that Jbomba is talking about (though I thought their post was about jails, not prisons). Some pay $300 or even $330 per hour. It would mean bouncing around various prison jobs chasing the contracts that are open for those rates. I know a doctor who does roughly 6 months in CA and then 3 months in PA and 3 months in OH each year as he rotates around the most lucrative roles he can. I think he probably makes 7 figures, but that means he's not around for his family at all. He's pretty old though, so I imagine his kids are all grown and out of the house. I imagine he's also divorced.

There are also slightly lower paying but also very reasonable prison jobs paying around $200 per hour. These are in much less austere roles than the aforementioned ones. Regardless, these locums roles are almost universally working for a for-profit staffing agency contracted through the correctional system and would not qualify for PSLF.

There are also employed state or federal jobs in the correctional systems. These can pay $220k-400k depending on the area per year. Those can qualify for PSLF as long as they're actually through the state department of corrections and not through a staffing agency. They also frequently qualify for state or federal pensions. My dad, a semi-retired psychiatrist, worked in one of those roles for 20 years (after working for 10 years as a contractor at first). He made his paltry salary, but now he gets a pension of ~$120k per year for the rest of his life. Now he contracts as a 1099 at $200/hour at the exact same prison doing the exact same role but remotely from his FL retirement farm.

IMO, I think that's a very reasonable way to work in corrections. While he would have definitely made more working as a contractor the entire time, the peace of mind of knowing he has that pension is the best thing for him. Of course, this really all predicates on the fact that he has extremely poor financial literacy and never had a networth above $100k until he retired. He also sank a rather ridiculous sum of money suing the state to try and have his contractor years qualify for his pension, including getting all the way to the supreme court of that state...he lost. So I don't recommend doing that.

So if you aren't willing / able to invest the excess income, a job with a pension is probably a great idea. Even better if you have a job with a pension like the VA or correctional work AND you're maxing out retirement investments. It makes sense to do the contracting for a few years to make sure you can actually tolerate correctional work, since there's nothing worse than grinding away for another decade to get the pension in a job you hate. You'd end up just like all the other employees there. But once you know you actually like it, it might be worth it (from a peace of mind standpoint) to convert to a pension-track position.

As an aside, I'm currently in negotiations with a state department of corrections to see if I can provide coverage for them. There's two roles I'm considering, and I wanted to explain them a little so that you might have an idea of what it entails.

The first is on their long-term "inpatient" unit. It's at a long-term prison, so people are going to be there for a minimum of one year. It's 44 cells, all single occupancy, so a census of 44. They want monthly notes (and monthly patient contact with me). 3/4 of the patients will have severe schizophrenia that couldn't be managed in the gen pop despite adequate medications. The rest will have a mixed bag of other SMI that also couldn't be managed in the gen pop. Swallowers, catatonics, etc. Less than 50% of the census will turn over year-to-year (discharging to gen pop or in rare circumstances to the community). While it seems rather straightforward to be < 20 hours per month at that size, there are a ton of meetings. Interdisciplinary meetings, meetings with various therapists to discuss progress, etc. They ideally want 40 hours a week but I'm trying to negotiate down to 25 (two 10s and a 5) to make room for private practice. They are offering either a salaried state position with all those government bennies at a W-2 of ~220k or between 175-220/hour as a 1099.

The second is at a processing prison, so people who are coming either straight from the community or from jail. They sit in a processing holding pattern for 30 days before being shipped off to their long-term prison. So this would be all the people with SMI who are going to prison for the first 30 days before they're placed to their next level of containment: gen pop, residential, etc. Instead of 30-day notes it would be weekly. Full turnover every 30 days of the 30 cell block. Pay's the same.

There's also the more typical prison jobs: managing a census of 400-1200 inmates in the general population. They are seen monthly, quarterly, or semi-annually for med management, just as if they were outpatients who all happened to live in the same apartment complex across the street from a CMHC. Pay's the same.

Universally, correctional jobs want med management only from their psychiatrists. They spend far too much per hour on us to let us spend more than 10-20 minutes per inmate. They employ vast numbers of psychologists and social workers for the therapy.

IME, prisons are non-inferior to state hospitals and CMHCs when it comes to levels of care available. All the ones I'm willing to affiliate myself with have 4-6 hours per day of groups for the inpatient-level inmates. They see psychiatrists on roughly the same schedule as state hospital systems, and they have interdisciplinary team meetings at roughly the same schedule. The main differences (in my experience of having worked with nice correctional facilities and tolerable state hospitals) relate to things like the colors of the walls and that prisons have no qualms about being prisons. So the doors may be iron bars or plexiglass, but the beds are just as uncomfortable, the privacy is just as poor, the food is just as ****, and the risk of violence from peers and staff is about the same. The vocational programs in prisons are more robust, and inmates might actually leave incarceration with a career and a job lined up in the community. The prisons I've experienced have required fewer PRN medications and have better de-escalation policies, go figure.

Prisons tend to be just as good if not better than CMHCs at ensuring that ASPD patients don't get mixed up in the mental health caseload. IME, if a patient leaves a prison and says "they wouldn't give me my [whatever drug] in prison, I didn't get any meds at all!" what they're really saying is the prison learned how to behaviorally manage them, not that the prison was providing such substandard care that they let a schizophrenic person fester in **** for years.

There are, of course, some drawbacks to the prison models. Tasing and pepper spray are still in their protocols (at the end, not the beginning). So you might have a catatonic patient that was tased, sprayed, or even shot with a rubber bullet when they wouldn't comply. This is more common in the gen pop than on the inpatient units. This is less likely to happen in state hospitals, though at the state hospital I most recently was involved in, a violent catatonic patient was shot and killed by security several years ago.

 

[Desired Member]

I'm not offering up a solution, just my story.
Got into PSLF as resident, knocked out about 3 years there maybe a bit more. It ballooned during this time with minimal payments ~6.8% rate.

Worked at a "non profit" Big Box shop for ~3-4 years, and got it attested to. Was paying max monthly rate per PSLF. Limited headway.

Couldn't go back to Big Box shops. Just couldn't do it. Opened PP even with loan burden. Continued to pay full monthly rate. Covid hit, things paused, no payments.

Fled Blue State like a refugee to Red State. Used home equity to pay off remainder of loans in past few months, conveniently just before re-payments resumed.

In summary, I had paid more in interest than the original balance. ~3.4 years to ride out doing PSLF at another non-profit was considered multiple times, but the house equity plan worked for me.

Thanks for sharing your experience. I decided not to pursue PSLF because I want to work part time. The prospect of being chained to working full time at a "non-profit" for 6 more years making minimum loan payments while massive amounts of interest capitalize on my loans makes me feel ill.

 

[Techmed07]

How the OP was allowed to get half a million in debt is wild. I have 128k and I am freaking out.

Paying the minimum payment for PSLF which subject to political whims is a gamble. If an administration can make forgiveness easier another could make it harder. It’s a gamble.

NHSC can be a trap. Indentured servitude, no leverage with the organization. I rather just get loan forgiveness directly from the group.

 

[Merovinge]

Thanks for sharing your experience. I decided not to pursue PSLF because I want to work part time. The prospect of being chained to working full time at a "non-profit" for 6 more years making minimum loan payments while massive amounts of interest capitalize on my loans makes me feel ill.

The interest capitalizing makes absolutely no difference in PSLF because you aren't paying any of it back. This was a much bigger concern before we started seeing droves of MDs getting the actual debt wiped out. Now that we know it's here there is very little risk if you follow the instructions with the certification letters.

Now if you want to work part-time and pay back your debt, awesome for you. That doesn't make the interest capitalizing a concern for anyone actually pursuing PSLF. There are so many solid jobs that qualify for PSLF in the MD space that it's a very modest chain or no chain at all for people inclined to take these types of jobs.