$700K in Student Debt as a Doctor (Full Repayment Breakdown)

I have $700,000 in student loan debt. Here's exactly how I'm handling it. I went from CRNA to medical school to anesthesiology residency and accumulated nearly $700K in federal student loans along the way. In this video,I break down my actual repayment strategy: which plan I'm on, why the 2026 policy changes flipped everything, and how I'm thinking about PSLF vs. aggressive payoff vs. refinancing as a resident physician. What I cover: → Why the SAVE plan being eliminated changes everything for resident physicians → How residency years no longer counting toward PSLF affects your timeline → The new RAP plan (July 2026) — and why locking into IBR/PAYE now matters → Married Filing Separately: when it saves you money and when it doesn't → How I'm reducing AGI through 403(b) contributions, HSA, and timing decisions → The 4-phase framework I'm actually using (residency → fellowship → attending → freedom) → PSLF vs. private refinancing — how I ran the math on my specific numbers Timestamps 0:00 – $700,000 in Debt 0:10 – Resident Salary + Family Pressure 0:20 – CRNA → MD: My Financial Pivot 0:32 – The $3 Million Decision Cost 0:48 – This Video: The Actual Repayment Plan The Numbers 1:02 – Breaking Down My Loan Numbers 1:18 – $125/day Interest Explained 1:34 – Income-Driven Repayment (IBR) During Residency 1:50 – Negative Amortization (Why Debt Still Grows) 2026 Policy Changes (Critical) 2:11 – Student Loan System Changed in 2026 2:26 – SAVE Plan is Dead 2:45 – Residency STILL Counts for PSLF (Huge) 3:12 – Loan Caps for Future Med Students 3:26 – Legacy Plans Ending (2028 Deadline) 3:52 – New RAP Plan (Worse for High Earners) 4:27 – IBR Expansion 4:48 – PSLF Employer Rules Tightened 5:03 – Forgiveness is Now Taxable (Except PSLF) 5:17 – What You Should Do RIGHT NOW (IBR Urgency) 4 Repayment Paths Explained Option 1: PSLF 6:00 – How PSLF Works 6:27 – Residency Payments Count 6:49 – Why You’re Not Starting at Zero 7:15 – The Tradeoff (Employer Restrictions) 7:39 – Can You Do Locums with PSLF? Option 2: Aggressive Payoff 9:02 – Refinance + Attack the Debt 9:32 – The Real Cost ($10K/month payments) 9:41 – Losing Federal Protections ⏳ Option 3: IDR Forgiveness 9:55 – 20–25 Year Forgiveness Strategy 10:09 – The Tax Bomb Problem What NOT to Do 10:46 – Why Forbearance is a Trap 11:26 – You’re Losing PSLF Progress 11:50 – The Best “Cheap” Payments You’ll Ever Make My Actual Strategy (Hybrid Plan) 12:46 – Why I’m Not Committing Yet 13:10 – Banking PSLF During Residency 13:23 – PSLF vs Ownership Decision 13:44 – My Current Moves (IBR + Tax Strategy) The Real ROI of Medicine 14:06 – Debt vs Investment Mindset 14:30 – Why W2 Thinking is a Trap 14:53 – Stacking Income Streams as a Physician 15:25 – MD = Optionality (Multiple Paths) 16:34 – 10-Year vs 3-Year Payoff Difference Advanced Optimization Strategies 17:58 – Married Filing Separately Strategy 18:50 – Lower Payments via Retirement Contributions 19:16 – Using the System Correctly Mindset Shift 19:24 – What $700K Debt Actually Feels Like 19:47 – Plan vs No Plan (The Difference) 7 Steps to Take THIS WEEK 20:14 – #1 Check Your Repayment Plan 20:25 – #2 Enroll in IBR 20:38 – #3 Get Out of Forbearance 20:51 – #4 Submit PSLF Employer Certification 21:23 – #5 Tax Filing Strategy 21:40 – #6 Max Retirement Contributions 21:48 – #7 Think About Ownership Early Closing 22:05 – My Plan Moving Forward 22:21 – Who Needs to See This 22:35 – Watch Next: $3M Cost Breakdown Free resources mentioned: 📊 Student Loan Planner — studentloanplanner.com 📊 AAMC FIRST Repayment Platform — aamc.org 📊 Official IDR/PSLF applications — studentaid.gov FAQ Q: Are you actually on PSLF? A: I'm currently enrolled in IDR and working at an academic/nonprofit institution, so yes I'm pursuing PSLF eligibility. Whether I stay on that path through attending years depends on my job offer situation. I run the numbers every year. Q: Should I refinance my loans during residency? A: Generally no and I explain why in the video. Refinancing federal loans to private forfeits all IDR and PSLF eligibility. During residency, that's almost always the wrong move. Q: What plan should I be on right now? A: If you're a resident physician with federal loans, the most urgent thing is getting off SAVE (if you're still on it) and into IBR or PAYE before the July 2026 RAP transition. This is time sensitive. Talk to Student Loan Planner if you have $200K+. Q: Does your spouse's income affect your IDR payments? A: Yes unless you file taxes Married Filing Separately. I cover the MFS tradeoff in the video. It's not a blanket recommendation, but for residents with a higher-earning spouse, it can meaningfully lower payments. I'm not a financial advisor. This is my personal decision-making process always consult a professional for your specific situation. 🔔 Subscribe for weekly content on anesthesiology, career transitions, and the real financial cost of becoming a physician. Instagram: @Chosen1james