PSLF or HPSP route for entering medical student [Help]

[CatDad26]

Well the cycle is almost over and it looks like I'll be attending a private medical school (only have 1 A) which will require loans of about 95k a year. I already have 200k of private debt from undergrad, so that would make my total debt before residency about 600k (with interest, maybe even 700k+). Terrifying I know. I will be paying the interest monthly on my private debt so luckily that will not increase during school.

Primary care route for forgiveness isn't really an option for me. No shame on primary care physicians, it's just definitely not for me and I'd rather pursue either the federal loan forgiveness program (PSLF) or have the military pay for it and owe my time afterwards (HPSP).

I'd like to do either ENT, plastics, anesthesiology, maybe EM. Most likely something surgical.

Is it better for me to take the federal loans, pursue a residency program that qualifies towards PSLF, then get an attending job afterwards at a PSLF qualifying hospital. Doing the math, I should be debt free by 38 as long as the PSLF program stays intact.
OR
Sign up and give a bit of my life and autonomy (in picking my specialty) to the military, in return for no debt.

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[RangerBob]

I'm not sure you can find a job in any of those fields very easily that's PSLF-eligible. Lots of hospital are "PSLF-eligible," but what matters is who actually employs you/pays your paycheck. So you need to be an employee of the non-profit hospital or a non-profit physicians group to qualify, and from my understanding those aren't common in the specialties you mention. Though, ENT and plastics get paid so well it's probably irrelevant anyway. And EM/anesthesia pay great too...

If you work at the VA in any of those specialties, that would count. But surgical specialties in particular have a bigger pay cut percentage-wise when they work for the VA vs private practice/etc.

Regarding the military: Only pursue this option is you actually want to be in the military. This is the advice see every single current military doc give.

$600k is A LOT of money. No way around that. The 400k from med school alone will collect a lot of interest over med school/residency. It helps you can pay off the private loan interest each month, though if you're paying it off with your federal loans it's just moving water from one bucket to another (possibly higher interest rate) bucket.

If you aren't familiar with WhiteCoatInvestor already, read his blog. Lots of great student loan advice.

ENT and Plastics should be able to make $400k+. If you live like a resident (and I really mean live like a resident) for a few years, you'll pay your loans off very quickly.

One trick is refinancing if you're not going to be eligible for PSLF. I refinanced a bunch of my loans and they're under 2% fixed now.

On the other hand, no one seems to be willing to restart student loan payments, so who knows what'll happen there...

 

[CatDad26]

I'm not sure you can find a job in any of those fields very easily that's PSLF-eligible. Lots of hospital are "PSLF-eligible," but what matters is who actually employs you/pays your paycheck. So you need to be an employee of the non-profit hospital or a non-profit physicians group to qualify, and from my understanding those aren't common in the specialties you mention. Though, ENT and plastics get paid so well it's probably irrelevant anyway. And EM/anesthesia pay great too...

If you work at the VA in any of those specialties, that would count. But surgical specialties in particular have a bigger pay cut percentage-wise when they work for the VA vs private practice/etc.

Regarding the military: Only pursue this option is you actually want to be in the military. This is the advice see every single current military doc give.

$600k is A LOT of money. No way around that. The 400k from med school alone will collect a lot of interest over med school/residency. It helps you can pay off the private loan interest each month, though if you're paying it off with your federal loans it's just moving water from one bucket to another (possibly higher interest rate) bucket.

If you aren't familiar with WhiteCoatInvestor already, read his blog. Lots of great student loan advice.

ENT and Plastics should be able to make $400k+. If you live like a resident (and I really mean live like a resident) for a few years, you'll pay your loans off very quickly.

One trick is refinancing if you're not going to be eligible for PSLF. I refinanced a bunch of my loans and they're under 2% fixed now.

On the other hand, no one seems to be willing to restart student loan payments, so who knows what'll happen there...

Thanks for the response, super helpful. I guess I never thought about whether there are even PSLF-eligible positions for those specialties.

As long as it's PSLF-eligible hospital, I should be all set for residency, right? I would assume residents are just employed by the hospital on paper. The tricky part seems to be getting an attending job in those specialties that's eligible. But would you say most jobs at academic institutions would qualify, or is this not the case?

 

[RangerBob]

Thanks for the response, super helpful. I guess I never thought about whether there are even PSLF-eligible positions for those specialties.

As long as it's PSLF-eligible hospital, I should be all set for residency, right? I would assume residents are just employed by the hospital on paper. The tricky part seems to be getting an attending job in those specialties that's eligible. But would you say most jobs at academic institutions would qualify, or is this not the case?

Most residency positions qualify since you're employed by the academic center/hospital, which are typically non-profit. But there are some residency programs that don't qualify as they're a for-profit institution.

Unfortunately the same isn't true of being an attending. It's not uncommon for the residents to qualify for PSLF as they're employed by the academic center/hospital, but for the attendings to not qualify because they're actually employed by a for-profit physician's foundation. There are lots of docs working at non-profits (like me) that don't qualify because they're employed by a for-profit foundation or private practice group, or they're solo practitioners like I am. You have to figure out who's actually signing your paycheck, and then find out if they're non-profit (or a governmental agency).