I asked a handful of people in my med school cohort this when they went to residency. Many of them could not afford the payments during residency.
Well, there is actually currently an income-based repayment program that lowers the payments you'd make on your public loans. It isn't enough to actually cover the interest, so the amount continues to grow, but at least you make a little progress on it. Private loans are not eligible for this. The other advantage of making payments on your public loans during residency (if you go the income-based repayment route) is that there's also currently a public service loan forgiveness program. So basically, if you make on-time payments for 10 years and work for a non-profit entity (your time during residency/fellowship counts and something like 80-90% of hospitals are "non-profit"), the balance of your public loans is forgiven. Because of these two things, my husband (and many of his coresidents) are paying off at least a portion of their loans during residency. Of course, you never know when these programs may disappear... Given the state of things in Washington currently, I wouldn't be surprised if these end up getting cut sometime soon.
That said, as debateg mentioned, the amount you make as a resident is fairly modest... But we've found (living off of his resident salary and my MD/PhD stipend as a family of 3 currently, soon to be a family of 4) that we're able to live very frugally, pay the amount we owe (through IBR) on the public loans and also money towards his private loans (total is ~$1000/month) and even save a tiny bit each month. For us, that's meant living a little bit outside of the city in a blue-collar town where we could get cheaper rent, shopping sales at the grocery store, and eating out pretty rarely (and when we eat out, we're talking Chipotle, not fancy $100 dinners). My son gets 95% of his clothes second-hand from consignment sales (the other 5% are gifts) and most of his toys & books from there as well. He doesn't know the difference
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As for the original poster, I think those that have mentioned that it doesn't just come down to a money issue are right (although in your post, you've already mentioned several non-money related factors). A couple other things to think about:
- Don't discount the burden you may feel from having that much debt... even if you plan to go into a high-paying speciality. Even if logically I know that once my husband starts as an attending that he'll be making much more than he is now and that we'll be able to pay off the debt relatively quickly if we want, it's a terrible thing to look at that number in the meantime... Before we got married and I was living on my MD/PhD stipend, although it's not a ton of money, I was able to save a few thousand a year to invest in mutual funds even while living in a high cost-of-living city (although I was in student housing). I could leave at any time if I wanted from the program and not be in debt (although I would've wasted years of my life). However, for people like my husband, he really didn't have that choice after racking up that much debt. How else could he pay it off?
- Another consideration is that if you do an MD/PhD, you're essentially signing up to be a student for an extra (in all statistical likeliness) 3-4 years. At 21 or 22, that may not sound like a huge deal, but you may feel differently at 29 or 30 especially when you have more years of training (as a resident and potentially as a fellow ahead of you).
- If you think there's a possibility that you might want to start a family in the next 8, 10, 12 years... look at the other "women & tenure clock thread"
I could go on... but I won't
