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First off, I recommend you read Medical Student Loans by Ben White, it will answer all your questions. Like a 4-5 hour read I think all 4th year med students should read, along with White Coat Investor as you'll never have as much free time as you do now to lean a little about finances.

The thing to know about your loans in terms of the $0 payment is that your loans have a 6 month grace period after graduation, meaning no payment is due for 6 months. (If you took time off between undergrad and medical school you may have already used this up on your undergrad loans and something you should look into.) Most residents take advantage of this and then enter IDR ~6 months into residency when the grace period ends. This doesn't give you the $0 payment for a full year though, as when you enter IDR, on the form it asks if your income has substantially changed since your most recent tax return. In this case, you are legally supposed to answer yes and submit pay stubs that would then dictate your monthly payment amount. Making $55k/year means about $300/month in payments. Some residents lie and use their 4th year tax returns with $0 income and extend the $0 payment for another year. This is not legal and something I do not recommend.

The legal way to do this is actually to consolidate all your loans the day after graduation, waive the 6 month grace period on the consolidation form, and use your M4 tax return of $0 income on the IDR form before July 1st as that way you're telling the truth. This will start your payments 6 months earlier than your fellow residents, but you'll both be paying $0. Of note, for this to work, you need to file taxes this year and you should also be aware consolidating has two down sides. 1) your new interest rate becomes a weighted average of all your loans and is then rounded up to the nearest 1/8th of a percent. 2) you can not longer attack your loans with the avalanche method as you no longer have several loans with differing interest rates, but one large loan with one interest rate. In your case there would actually be a 3rd down side which is that because you have some subsidized loans where under REPAYE the feds will cover 100% of the unmet interest by the minimum payment for the first 3 years, drops the 50% as the new loan is considered unsubsidized. This strategy is typically recommended for residents pursing PSLF and not necessarily something I would recommend you pursue. I would likely recommend the typical 6-month grace period option because of these downsides and the fact that it doesn't sound like you want to do PSLF.

There are no consequences for switching out of REPAYE in terms of the interest subsidy which I think you are alluding to, but just for completeness sake, should be aware that switching from REPAYE to another IDR plan does capitalize the unpaid interest. This is essentially true when refinancing with a private company too as they are going to pay off the loans in full, including interest, and give you a new loan for that total amount, meaning all that unpaid interest accrued during residency becomes part of the principal for the new loan.

Whether you should ride out REPAYE or refinance as an attending is really going to depend on what rate you can get in 5 years from now, how much your making, and how stable your job is. Something I would revisit then and not worry about too much now.

Hope that was helpful!

Hey, we graduated at the same time! As long as you keep paying extra towards your high-interest loans first, you will pay them off quickly. One thing that will allow you to pay off your loans even faster is to change your repayment plan to 25 years instead of the standard 10.

This sounds counterproductive, but what this will do is dramatically reduce your minimum monthly payment. I did this and my monthly payment went from $500 to $260. However, I still pay the full $500 (plus some). Now, I am able to force $240 of the original $500
minimum payment to my loans with the highest interest rates.

This only works on federal loans because the interest rate will not change. Call your loan servicer and ask about a 25 year FIXED repayment plan. They will try to get you on an income-driven repayment plan, but don't do this as your payments will change as your income does. You want the 25-year fixed payment. I had a friend that tried this, but for some reason, his loan servicer would not let him do it. I think that your income and debt balance have some influence on whether or not you can get on the 25-year plan.


Another thing that you can do to retain more of your income is to rework your car insurance. You are on the right track by not paying it monthly. This saves you some premium as you pay for it all at once. To get the cheapest rates, you should buy a policy that lasts a full year (not 6 months because your rates can increase 2 times per year as opposed to 1). You should also get a $1,000 deductible. Most people have $500 deductibles. If you get a $1,000 deductible, you get put in a lower risk pool and will have a lower premium to pay. Just be sure that your emergency fund could take a $1,000 hit instead of a $500 one if you get in a wreck. Make sure that you also have good coverage like 100/300. Don't ever get the state minimums as this is not enough coverage and you will get sued to cover everything your insurance fails to pay if you are in an accident.

Another thing that you should do is read these 3 books. It sounds like your debt is under control and you are already familiar with Dave Ramsey (you are ignoring his snowball method for the much much much much much better avalanche method). So your debt is under control and will be paid off in a few years. What happens then? You should read these three books now, so you can set up your future today:

"The index card" by Harold Pollack.

This book tells you everything you need to know about personal finance. It is very simple and you will be ahead of the curve if you read this.

https://www.amazon.com/Index-Card-Personal-Finance-Complicated/dp/0143130528/ref=sr_1_2?ie=UTF8&qid=1536937178&sr=8-2&keywords=the+index+card

The second book you should read is "Unshakeable" by Tony Robbins. This book covers some of the same stuff in "the index card", but it goes into more depth about how to invest in index funds for taxable accounts, 401k, Roths, and other IRAs. This book can show you how to minimize your fees and help keep your risks manageable. It is a great book for learning how to invest for the long haul (it's not a get rich quick scheme).

Honestly, depending on what your interest rates are on your student loans, you should probably start investing some of your money rather than just paying off loans. Sure it will take you longer to pay off loans, but why pay off a loan today that has a 2-3% interest rate when you could buy into an index fund that will pay you 10% on average? I would aggressively pay down the high-interest stuff (anything above 4%) as fast as possible. Once that is paid off, I would shift some of the money to invest. I would still pay more than the minimum on the remaining loans. Doing this will allow you to take advantage of compounding interest and your net worth will be higher when your loans are paid off. This is where you should stop listening to Dave Ramsey. Ramsey's goal is to get you out of debt as quick as possible. His goal is not to increase your net worth as much as possible. Once you get all your student loans above 4% paid off, your student debt is manageable and will be close to the traditional inflation rate. As long as you keep paying the current minimums, it will be gone by 2025 (sooner if you pay a little extra). But your net worth could be significantly higher if you take a few hundred dollars a month and invest it.

https://www.amazon.com/Unshakeable-Your-Financial-Freedom-Playbook/dp/1501164589/ref=sr_1_2?s=books&ie=UTF8&qid=1536937326&sr=1-2&keywords=unshakeable+tony+robbins

The third book you should read is "Your money or your life" by Vicki robbin. This book is crazy and has a cult-like following on places like the financial independence subreddit. This book shows you how to become financially independent. It has a foundation based on the mindset that "if you always want more, you will never have enough." This book shows you how to make a plan to retire as soon as humanly possible based upon your age, income, and fixed expenses. I have read it and adopted many of the concepts. I don't necessarily plan on retiring early, but I will be secure and able to retire if shit hits the fan, the option will be up to me and not my employer.

https://www.amazon.com/Your-Money-Life-Transforming-Relationship/dp/0143115766/ref=sr_1_1?s=books&ie=UTF8&qid=1536937840&sr=1-1&keywords=your+money+or+your+life+2018+edition

I hope this helps. Good luck!

What works in the real world is specialization. Learn one thing really well that people are willing to pay for.

Focus on one skill that is useful in new economy. Web development is one of those skills. There are others but web development is the one I'm most familiar with because that's what I do and I've researched the industry.

Why does this strategy work? Because of the 10,000 hour rule.

Here are great books on this subject:
http://www.amazon.com/Good-They-Cant-Ignore-You/dp/1455509124
http://www.amazon.com/Talent-Overrated-Separates-World-Class-Performers-ebook/dp/B001HD8NZ8/

Also spend 1% of your time planning and 99% of your time doing. Why? Because planning is guessing.
https://signalvnoise.com/posts/1805-lets-just-call-plans-what-they-are-guesses
http://s3.amazonaws.com/37assets/svn/Rework-by-Jason-Fried-and-David-Heinemeier-Hansson-Excerpts.pdf
http://ecorner.stanford.edu/authorMaterialInfo.html?mid=2353

Why Does College Cost So Much? is a great book

As a follow up on the my and SilentKnightOfOld's comments, I have to admit that there is an emotional aspect to owing almost 300K of student loan debt. I have 135k and am going for PSLF (3.5 years in), and it still bothers me sometimes when I see my balance changing very little. However, I have gone through the decision process many times and keep coming back to PSLF.

Here's an article about dealing with the emotions of student loan debt.

Ramit Sethi talks about psychology and the "invisible scripts" we have in our lives in his book. Basically, they are lies that we taught from childhood, and we should really analyze them to see if they are true. One of the most common: "debt is bad".

Dave Ramsey extols the "debt is bad" line in his book. He also realizes some simple elements about the psychology of money, in that paying off the smaller debt (snowball), regardless of interest, is a better path for most people since they get a bigger emotional win from seeing that one line item of debt eliminated rather than just seeing the interest calculations proving they are saving money from paying the higher interest debt (avalanche).

While I like the PSLF program, I realize that it is not for everyone. Some people just want to slash every expense, pay off the debt, and be done. Kudos to them. But their tool is hammer, and not everyone's money problems are a nail.

Have a frank conversation with yourself, then choose the best repayment option.

Lots of other good advice, i don't have anything to add regarding the loans but look into the Wahls Protocol for treating the MS. Dr. Terry Wahls reversed her MS with diet, see https://terrywahls.com and https://www.amazon.com/Wahls-Protocol-Radical-Autoimmune-Conditions-ebook/dp/B00DMCJOW8/

Check out this book: Boundaries Updated and Expanded Edition: When to Say Yes, How to Say No To Take Control of Your Life https://www.amazon.com/dp/0310351804/ref=cm_sw_r_cp_api_i_uK7WCbZRWSTAN