I'm not taking out a loan for living expenses, only tuition. And I you can make payments during residency. And you probably don't have to do a fellowship right after residency. All these things add up.
I bet I could pay 280K in the 3 years following med school+residency as an attending. And probably less even since I could pay 12k minimum per year during residency. That's 36K off just by living frugally as a resident assuming a 3 year residency.
That's fine. And all that is certainly possible, but a lot of it is unlikely.
First off, paying $1,000 a month in residency is going to be no small task. I'll be taking home $3,150 a month next year after taxes. You're talking about living off of $2,150 a month for health insurance, housing, utilities, food, car, gas, insurance, cell, entertainment, incidentals, etc. that's a really tall order. God forbid you live in an expensive city. Further, that $1k a month wouldn't even cover your interest - it would be a break even proposition at best.
Second, the same goes for paying 100k a year towards student loans as a new attending.
Your interest alone will be in the tens of thousands a year. You will be in an extremely high tax bracket, have other significant expenses (insurance/malpractice/etc) and you will surely be tired of living as a pauper. It's possible, but life happens. You'll eventually need to buy a new car/have a kid/get married/whatever.
Lastly, that was kinda my point about fellowship. It would be highly uncommon for someone to go back to fellowship after being an attending for 3 years. First, it's a $200k/y pay cut. You also would be having a huge jump in work hours. By that point, you may have a wife and kids who don't love the idea of you working an extra 20-30h a week and an enormous pay cut, not the mention the possibility of having to move. You may have a house that you may not be able to sell easily, you have a group of friends, etc. Again, it if possible. I know 1 attending who did fellowship after a few years, but I know 4 IM MDs who took a "temporary job" until they paid off their loans/finished their military commitment and, yada yada yada, they're in the 40s-50s.
I'm just saying you need to think about your future, especially if youve been bit by the "prestige bug.". How would you like to have a shot of doing residency at MGH but turn it town because it would cost $2k/mo for rent? Have a shot at doing fellowship at Hopkins, but you have to give it up to work as a hospitality? Want to do a 5 year residency but actually give up your chosen career because you have insurmountable debt? Fall in love with academics and research but have to go PP because the pay.
Or even worse, go to med school for a couple years, realize you hate medicine but have 2-300k in debt. Good luck finding a non-medical job to pay that off.
If you're young, you'll be best served in the long run by fiscal responsibility and delayed gratification. Period.