All of the ophtho residents I know are in forbearance. The advice that I have gotten from a financial planner is that the $300-400/month in residency it will take to pay IBR will make a bigger difference to you now than payments later will. EVERYONE should use

THE AAMC MEDLOANS ORGANIZER AND CALCULATOR to figure out what their loan repayment will look like. It is a GREAT TOOL!

I'm about $180,000 deep in student debt right now. For me, if I do IBR then my loan balance after residency will be $219,000. If I go into forbearance then my loan balance after residency will be $238,000. A difference of $19,000 - but how much will I have paid during residency? The calculator estimates my IBR payment would be between $330 and $445 per month. If I split the difference at $388/mo then I will have paid $18,600 in the four years of residency to lower my loan balance by $19,000. A difference of $400.

Even if I extend the calculation to 5 years (fellowship, baby) then I end up with a sum total difference of $7,000 at the end of fellowship.

So to sum it up:

IBR payments in a 4 year residency for my level of debt end up saving me no money over the long term. Over 4+1 fellowship they save me $7,000 at the end of the 5 years. This is not a fancy discounted cash flow calculation and I'm not assuming that I will be making interest on the money I keep during residency. I have also not calculated the difference in interest growth after the 5 years of residency on the loan balance difference.

For my personal situation, that almost $25,000 is more valuable now than $7,000 after residency/fellowship. My family and I can easily continue the resident standard of living and pay down extra on loans to eliminate the balance difference in a year out of residency/fellowship.