DYNAMIC STUDENT LOAN PLANNING
Most physicians don’t make a bad student loan decision.
They make a good one… and keep it too long.
Income-driven plans are incredibly helpful early on. They protect cash flow when margins are thin and options are limited.
The problem is that income doesn’t rise gently after training.
It skyrockets.
When that happens, student loans stop being a background consideration and start interacting with everything else: taxes, savings, housing, career flexibility, family planning… all of it.
What I see again and again is physicians assuming that staying put is the conservative choice here. This idea that changing course is risky. That it’s better to “wait one more year” before revisiting the decision.
But student loans don’t reward patience.
They reward timing.
Every year a misaligned loan strategy stays in place, it limits options and quietly raises the stakes on future decisions.
So what’s a doc to do?
The goal isn’t to rush into refinancing or abandon forgiveness prematurely.
It’s to make sure your loan strategy still fits the life you’re actually living now… and not the one you were in during training.
Instead of asking, “Should I stay in PSLF or refinance?”
Start with a simpler question:
Does my loan plan still match my income and my life?
Here’s the framework I use to answer that.
Step 1: Anchor to today’s tax reality
Before you touch a calculator (most available online aren’t even that good), you need to lock in the inputs that actually drive federal student loan math.
Most calculators assume static income, ignore tax strategy, and can’t model filing-status tradeoffs or future income ramps, which is where real money is won or lost.
Start by writing down today’s facts -- not what your loans were originally set up for.
Current household AGI:
(Not salary. AGI reflects retirement contributions, HSA, and other pre-tax benefits.)
Filing status:
This one choice can swing payments by $1,000–$3,000+ per month in some households and affect SAVE payments, PSLF efficiency, and access to tax credits.
You’re allowed to choose the filing status that optimizes your entire financial picture… not just loans, but this decision should never be made in isolation.
Just so you have an idea: when it comes to income-based plans…
PAYE does NOT consider your spouses income, while REPAYE (SAVE) absolutely does.
State residency:
Community property vs non-community property state
High-tax vs low-tax state
State taxes do not affect IDR calculations directly, but they significantly affect after-tax cash flow, which determines how painful your payment actually feels. Community property rules become especially relevant if considering MFS.
Community property states include CA, TX, AZ, WA, NV, NM, ID, LA, and WI.
They can radically change how income is “assigned” between spouses for loan purposes.
Income trajectory over the next 24–36 months:
Guaranteed salary vs RVU / bonus-heavy compensation
Partnership track or private practice transition
PSLF-eligible employer stability
The 24–36 month window matters because IDR recertifications, tax filings, and refinancing decisions lag your income changes. Today’s choice often affects payments years from now. If you’re unsure, that uncertainty itself is a planning input.
Near-term life changes that affect cash flow:
Home purchase (down payment + DTI pressure)
Childcare (often a second mortgage)
Spouse stepping back from work
If any of these inputs have changed since your last loan decision, your strategy is likely optimized for a prior version of your life.
Step 2: Identify what your loans are competing with
At this stage, student loans are no longer an isolated problem.
They’re competing with:
A true cash buffer (not “whatever’s left in checking”)
A home down payment that won’t destroy liquidity
Childcare costs that arrive on schedule, not when convenient
Retirement contributions that reduce both taxes and loan payments
Career optionality (PSLF vs private practice vs locums)
If your loan strategy forces you to:
Underfund cash
Delay employer matches
Avoid career moves
Live paycheck-to-paycheck on a high income
Then the math may be “optimal,” but the strategy is not functional.
Step 3: Redefine what the loans are for in this chapter
For the most part, there are three routes you can take when it comes to student loan planning.
Which of these is your biggest priority?
Minimizing lifetime interest
(Aggressive payoff, refinancing, certainty)Maximizing liquidity
(SAVE, lower required payments, flexibility)Preserving career flexibility
(PSLF optionality, employer changes, part-time transitions)
You cannot optimize all three at once.
Once the priority is clear, the strategy usually is too.
Remember, this isn’t a permanent choice. It’s a working definition for this chapter of your career.
Early on, liquidity and flexibility often matter more than minimizing interest. Later, certainty may take over.
The mistake isn’t choosing the “wrong” priority… it’s failing to revisit the question as income, family, and career evolve.
Before you go:
Sometimes the most helpful next step is simply having someone pressure-test one narrow question with you.
If student loans have started to feel heavier as your income has grown, that’s usually a sign the strategy needs a second look.
Book some time to go over your personal situation here.
I’m happy to help you think it through.
That’s all for today.
See you next week!
— Carlos
FINANCIAL PEARL
The most expensive loan strategy is the one that no longer fits, but hasn’t been questioned.