laserbeams

5+ Year Member
Sep 3, 2012
38
18
Status
Resident [Any Field]
I'm in the latter half of my training, which means that I'm probably going to start a job search within the next year. Dire job market warnings aside, I am more thoroughly considering my post-training career options and and the somewhat daunting task of paying back my medical school loans (which pretty far on the wrong side of the bell curve).

Previous threads (here and here) have discussed income based repayment (IBR) and public service loan forgiveness (PSLF), and how it doesn't make sense for most rad onc attending salaries. Two slightly newer options are Pay As You Earn (PAYE) and Revised PAYE (RePAYE). The rules attached to each program are slightly different and a good analysis can be found here.

The short version of PSLF with (Re)PAYE: if someone works full time a qualifying state/federal/tribal organization or non-profit organization (501c3), loan debts can be forgiven after 120 monthly payments. Residency counts for ~60 of these payments. Payments are capped at the 10 year standard repayment rate for PAYE (i.e. monthly payments won't keep rising even if salary does).

So, in other words, 60 additional monthly payments after residency and one can be free of med school debt. This leads to my 3 questions:

1) What does the job market look like (basically anywhere in the U.S.) for 501c3 jobs? Lots of attendings work at 501c3 hospitals, but my understanding is that they are paid by a contracted physician group, which aren't typically 501c3. Does that mean most qualifying jobs are academic?

2) Does anyone have experience to share regarding practicing radiation oncology at the VA or similar government positions? Any pros/cons I wouldn't otherwise be aware of having worked with others in different specialties who work within the VA system? I love working with vets, but I'm sure there are a number of "unique" challenges I'm not considering.

3) Finally, and potentially most financially important: is all of this moot given the opportunity cost of losing out on potential "partnership years" in private practice, assuming one is interested in such a thing?

Many thanks for any/all advice and input. I'm confident I'll be able to pay these off in a relatively reasonable amount of time, but it'd be nice to maximize my savings throughout the process.
 
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winstonfoot5

2+ Year Member
Jan 26, 2017
28
24
I'm in the latter half of my training, which means that I'm probably going to start a job search within the next year. Dire job market warnings aside, I am more thoroughly considering my post-training career options and and the somewhat daunting task of paying back my medical school loans (which pretty far on the wrong side of the bell curve).

Previous threads (here and here) have discussed income based repayment (IBR) and public service loan forgiveness (PSLF), and how it doesn't make sense for most rad onc attending salaries. Two slightly newer options are Pay As You Earn (PAYE) and Revised PAYE (RePAYE). The rules attached to each program are slightly different and a good analysis can be found here.

The short version of PSLF with (Re)PAYE: if someone works full time a qualifying state/federal/tribal organization or non-profit organization (501c3), loan debts can be forgiven after 120 monthly payments. Residency counts for ~60 of these payments. Payments are capped at the 10 year standard repayment rate for PAYE (i.e. monthly payments won't keep rising even if salary does).

So, in other words, 60 additional monthly payments after residency and one can be free of med school debt. This leads to my 3 questions:

1) What does the job market look like (basically anywhere in the U.S.) for 501c3 jobs? Lots of attendings work at 501c3 hospitals, but my understanding is that they are paid by a contracted physician group, which aren't typically 501c3. Does that mean most qualifying jobs are academic?

2) Does anyone have experience to share regarding practicing radiation oncology at the VA or similar government positions? Any pros/cons I wouldn't otherwise be aware of having worked with others in different specialties who work within the VA system? I love working with vets, but I'm sure there are a number of "unique" challenges I'm not considering.

3) Finally, and potentially most financially important: is all of this moot given the opportunity cost of losing out on potential "partnership years" in private practice, assuming one is interested in such a thing?

Many thanks for any/all advice and input. I'm confident I'll be able to pay these off in a relatively reasonable amount of time, but it'd be nice to maximize my savings throughout the process.
Take the job that makes the most sense for you. If it is academic and a 501c3, then great, pursue loan forgiveness. If its private practice, then refinance your loans to the lowest interest rate you can, "live like a resident" (i.e. live on a residents salary and put the attending surplus income towards your students loans) and pay back aggressively (2-4 years). If its private practice and happens to be a 501c3, which I'd think would be unusual, then great, pursue loan forgiveness. If you pursue loan forgiveness, I'd recommend "living like a resident" and saving aggressively in a side account until the amount is roughly equal to your student loan burden; if something happens and you are unable to forgive, for whatever reason, then you can refinance and pay it down with the side account
 
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shogun0660

New Member
10+ Year Member
Aug 11, 2006
206
52
Status
Attending Physician
Take the job that makes the most sense for you. If it is academic and a 501c3, then great, pursue loan forgiveness. If its private practice, then refinance your loans to the lowest interest rate you can, "live like a resident" (i.e. live on a residents salary and put the attending surplus income towards your students loans) and pay back aggressively (2-4 years). If its private practice and happens to be a 501c3, which I'd think would be unusual, then great, pursue loan forgiveness. If you pursue loan forgiveness, I'd recommend "living like a resident" and saving aggressively in a side account until the amount is roughly equal to your student loan burden; if something happens and you are unable to forgive, for whatever reason, then you can refinance and pay it down with the side account

See also white coat investor book and website for useful information regarding PSLF, as well as general personal finance for physicians.
 
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runnerdoc7

7+ Year Member
Jun 21, 2010
36
5
Status
Resident [Any Field]
I agree as well, and would add that with the rapid increase in the percentage of new grads taking "employed" positions with hospitals over the last few years, this is going to be an option for more and more people in "private practice." Anyone taking an employed position should look into whether their employer is a 501c3 because many community hospitals are.
 
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laserbeams

laserbeams

5+ Year Member
Sep 3, 2012
38
18
Status
Resident [Any Field]
Thanks for the replies. I admittedly did not do a great job of explaining the nature of my question. I appreciate and agree with the suggestion to take the job that makes sense for me (or the one I can find!) but I was trying to get a sense if staying in an income-based repayment program (i.e. PAYE or REPAYE) made sense when attending-hood was just around the corner.

For anyone else finds themselves in a similar situation (current resident, large loan burden, on PAYE, unsure about future job prospects, and worried about ever-growing interest), I'd recommend looking into REPAYE with an interest subsidy. There are downsides such as 10% discretionary payment not having the same 10-year repayment max as PAYE, but half of the accruing interest is subsidized. In other words you can have your cake (eligibility for PSLF, if you qualify) and eat it, too (avoid amassing enormous amounts of interest during residency).

Thanks again!
 
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