1) Well, have you considered a yearlong post-doc? It would be less money than an intern year, but still a great way to pay loans that come into repayment 6 months from graduation? And if you do it in your field, it can strengthen your application sometimes.
2) Have you considered post-poning graduation, and doing some more fourth year rotations? It would incur more loans, but then again, it would make you a fresh applicant for next year, and you could hand-pick placed to do externships.
3) Doing an international fellowship and postponing graduation - you would still be a fresh graduate, and helping set up an OR, and volunteering in third wordly country would look good, too.
4) Fresh out of ideas from there, but maybe you could even (I know I am on the anesthesia website), but try for a prelim year in gen surg as it is a five-year program, and may not count against the ACGME contract. I don't know if this is the case, but you could check with your graduate studies program of the dean.
Well, best of luck to you! I'll send positive thoughts to you
