Usually you can defer your loans for a maximum of four years after medical school. So fellows often have to start paying back their loans. They do it by: not having taken the max out to begin with so they can afford to pay on a fellow's salary or by being married to someone who brings in an income. Moonlighting, if permitted by the program, is yet another option.
It is a pretty complicated subject it depends on the amount of money that was borrowed. If like me you borrowed a crap load of money you can defer for three years. But, the trick is then you refinance under a consolidation loan and then you can defer another three years. So this should give you enough time to finish your residency and fellowship if so inclined.
But, some people in my class that did not take much money say around 35k had to start paying.
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