Student loans -- I'm f#*%@!

[Left]

saw the link about the whitecoatinvestor, I can't say I agree with him... Yes, he says how he can save money for retirement... but he isn't doing it for ER//FI. I don't know if it is the same whitecoatinvestor since it's a different site and just same name but http://forums.studentdoctor.net/threads/an-emergency-docs-budget.817037/. Even with all of his savings, while I have no problems how he spends his money, I don't think he should give advice while he himself is still "living in debt" as evident that he could have paid off the debt but chooses to spend money on something that isn't the debt so IMO he's living on debt the same as the walmart guy living on credit cards... If he had paid off the debt and not rely on having it forgiven than that would be "his" money to spend, but as long as he is "in debt" I feel like he shouldn't be able to live so spendy on tax payer money/private loan money but that isn't up to me.

The only reason I bring this up is that my sister just graduated med school and starts residency in a few weeks. She'll have $250k or so in debt and yes she will make close to estimated $200k/year after 3 years of residency, her plan is still to work 10 years and have it forgiven. I'll didn't go to med school and I make $50k/year and will continue to make that (adjusted for inflation of course in future). But I also don't work 80 hours/week like she does in residency, if I choose to work that hard I would be making $100k/year. But even without working extra hours, I'm on track to FIRE with $1m by the time I'm 40, 12 years. She is 26 now, will be in residency until 29-30. If she doesn't do a fellowship, she could start earning the $200k/year and have the debt paid off and be a millionaire by 40 as well. However, her plan is to work 10 years to let the loan be forgiven while slowly saving for retirement (IE: 10-20%/year) and "live like a doctor" in the meantime, meaning she still has to work until 60. Becoming a doctor is a "life" choice, while my job is one where I have no problem giving up. It's my way to becoming FI, and I'm not as invested in living my life as my career title. Being a doctor really is something that sticks with you for the rest of your life but that makes it harder to FI. Sure doctors save lives, but once I FI, I could also do as much good. Plus since I work as a medical technologist in hospitals, I kind of "save lives" as well, indirectly but still...

The only advice I can give and this might not be the best case for you is that it wouldn't be a bad idea to take out more federal loans to pay off the undergrad loans that are private. The loan forgiveness only works on federal loans if you weren't told that. As well as federal loans have a slightly lower interest rate. So if you take out $120k loan to pay off $100k debt, or you take out $20k loan for med school and leave $100k loan untouched, you'll still have same debt amount. This is just to consolidate all your loans into one place and with the goal of having it forgiven.

And then there's the entire loan forgiveness thing, do you really want to risk it not being forgiven or having it capped? I've read news articles about talks to cap the loan forgiveness. Regardless, 10 years is a long time for programs to change, so it may not even be around by the time it's your turn to have it forgiven.

Best advice I can give is not rely on it and live "like you are still in residency" once you are out for the first 5 or so years and just pay off the debt instead of waiting around for it to be forgiven. But since my sister isn't listening, it may be a moot point, all my doctor friends and her's are already 2 weeks out of med school starting to inflate their lifestyle. She will be given a work phone to use but she's already went and bought the galaxy s5 last week and doubled her cell phone bill (even if $50/month isn't "bad", it just isn't reasonable to me either). She's already talking about her next new car although she's smart enough to know she can't afford it YET. But I have no doubt that once she's "saved" enough, she'll think she can afford it and there goes her retirement money.

edit: fun fact, her graduating class of about 300 doctors as of today (so no interest yet) has a total debt of about $52 million. Imagine what happens when it is forgiven and think about why the politicians don't like the loan forgiveness talks. A reason why they talk about capping it.

[beltim]

I wonder what everyone advising the OP not to go to med school thinks their doctors did...

[dungoofed]

Ok, so the existing debt should be thought of as a "sunk cost" - you work towards minimising it one day at a time as best you can, and it shouldn't affect your future choices further than this.

Whether you take on another stack of debt should be seen as a separate issue. The questions you should be asking are:

- Will you successfully complete your post grad and get your qualification?
- Assuming everything lines up, how long until you expect to have paid off this second lot of debt?
- What are the other options?

Looking back at my own life, being obligated (trapped?) to make monthly payments for an extended period of time doesn't work well for me. This applies whether it is paying off a loan or adding to an investment. But for some people, the discipline that a loan forces you to take on has pros that outweigh the cons.

So personally I'd be looking at other options but if you're ok with the increased obligation pretty much ruling your life for the next x years (not to mention the resulting stress, the fact that your wife doesn't "get" mustachianism, etc) and the figures add up (which my all accounts they appear to) then I'd say go for it and bet on yourself.

[dungoofed]

...and be really nice to that wife of yours, because she is what is making this whole plan possible!

Not picking on your comment specifically but there seem to be a lot of people who agree that the wife's role in all this is huge. I agree, but I also believe that 1) if you get through this together then you will be closer than before. You'll have something that you fought through to achieve together, the "hard times," and nothing will ever take this experience away from you, and 2) I think a lot of women are more than happy to encourage and support a husband if the final goal is him becoming a doctor (I'd be more concerned about OP upping and leaving once the degree was in hand! lol)

But seriously, these two things alone may be enough "glue" to make sure your marriage is able to survive anything, and it might be worth doing it for this reason alone.

[Rbuckyfuller]

For what it's worth, if you have a background in public health and a strong desire to get a medical degree - you might want to consider the MD/PhD route (https://www.aamc.org/students/research/mdphd/).  This way, your medical training would be $0 but would (understandably) entail a longer time commitment as you would be getting two degrees.  A PhD an Epidemiology might be an option for you since you already have the MPH, and there are a few programs that offer a joint MD and a PhD in Epi.  Just my $0.02, but I wish you all the best as I too am strategizing how best to pursue my academic desires without accumulating student loan debt.   

This is a good idea.

[PeteD01]

saw the link about the whitecoatinvestor, I can't say I agree with him... Yes, he says how he can save money for retirement... but he isn't doing it for ER//FI. I don't know if it is the same whitecoatinvestor since it's a different site and just same name but http://forums.studentdoctor.net/threads/an-emergency-docs-budget.817037/. Even with all of his savings, while I have no problems how he spends his money, I don't think he should give advice while he himself is still "living in debt" as evident that he could have paid off the debt but chooses to spend money on something that isn't the debt so IMO he's living on debt the same as the walmart guy living on credit cards... If he had paid off the debt and not rely on having it forgiven than that would be "his" money to spend, but as long as he is "in debt" I feel like he shouldn't be able to live so spendy on tax payer money/private loan money but that isn't up to me.

The only reason I bring this up is that my sister just graduated med school and starts residency in a few weeks. She'll have $250k or so in debt and yes she will make close to estimated $200k/year after 3 years of residency, her plan is still to work 10 years and have it forgiven. I'll didn't go to med school and I make $50k/year and will continue to make that (adjusted for inflation of course in future). But I also don't work 80 hours/week like she does in residency, if I choose to work that hard I would be making $100k/year. But even without working extra hours, I'm on track to FIRE with $1m by the time I'm 40, 12 years. She is 26 now, will be in residency until 29-30. If she doesn't do a fellowship, she could start earning the $200k/year and have the debt paid off and be a millionaire by 40 as well. However, her plan is to work 10 years to let the loan be forgiven while slowly saving for retirement (IE: 10-20%/year) and "live like a doctor" in the meantime, meaning she still has to work until 60. Becoming a doctor is a "life" choice, while my job is one where I have no problem giving up. It's my way to becoming FI, and I'm not as invested in living my life as my career title. Being a doctor really is something that sticks with you for the rest of your life but that makes it harder to FI. Sure doctors save lives, but once I FI, I could also do as much good. Plus since I work as a medical technologist in hospitals, I kind of "save lives" as well, indirectly but still...

The only advice I can give and this might not be the best case for you is that it wouldn't be a bad idea to take out more federal loans to pay off the undergrad loans that are private. The loan forgiveness only works on federal loans if you weren't told that. As well as federal loans have a slightly lower interest rate. So if you take out $120k loan to pay off $100k debt, or you take out $20k loan for med school and leave $100k loan untouched, you'll still have same debt amount. This is just to consolidate all your loans into one place and with the goal of having it forgiven.

And then there's the entire loan forgiveness thing, do you really want to risk it not being forgiven or having it capped? I've read news articles about talks to cap the loan forgiveness. Regardless, 10 years is a long time for programs to change, so it may not even be around by the time it's your turn to have it forgiven.

Best advice I can give is not rely on it and live "like you are still in residency" once you are out for the first 5 or so years and just pay off the debt instead of waiting around for it to be forgiven. But since my sister isn't listening, it may be a moot point, all my doctor friends and her's are already 2 weeks out of med school starting to inflate their lifestyle. She will be given a work phone to use but she's already went and bought the galaxy s5 last week and doubled her cell phone bill (even if $50/month isn't "bad", it just isn't reasonable to me either). She's already talking about her next new car although she's smart enough to know she can't afford it YET. But I have no doubt that once she's "saved" enough, she'll think she can afford it and there goes her retirement money.

edit: fun fact, her graduating class of about 300 doctors as of today (so no interest yet) has a total debt of about $52 million. Imagine what happens when it is forgiven and think about why the politicians don't like the loan forgiveness talks. A reason why they talk about capping it.

James M. Dahle, MD (whitecoatinvestor) has his own website, just published a book, and frequently posts on the Boglehead forum.
I have not read his book, but heard that it is basically a well organized and abbreviated version of what you can find on his website and there he is spot on.
It is not only interesting for doctors but for anyone with much higher than average income and little time to spend on things outside the profession.

http://www.amazon.com/The-White-Coat-Investor-Investing/dp/0991433106

[dude]

Someone already mentioned the military, but here are a couple other options -- look into the United States Public Health Service (PHS).  You can pick up your student loan forgiveness again working for them, and I believe they also have a separate student loan repayment system.  Also, you will be eligible for a pension -- it's very much like the military, with the same rank structure and similar pay (officer level).  In addition, PHS officers enjoy absolute immunity from lawsuits, i.e., you'll never pay a dime in malpractice insurance.

Here's another -- if you can't get into PHS consider going to work for the Federal Bureau of Prisons (many PHS doctors, nurses and administrators are assigned to BOP).  They are always hiring doctors.  Also keeps you eligible for loan forgiveness, but has the advantage of being a full-time law enforcement position, and thus a 20-year retirement schedule, with a LEO pension (and 401k with generous match).  You aren't absolutely immune from suit, because you can be sued for civil rights violations (btu there's a high bar there), but are immune from med mal claims against you (only Uncle Sam can be sued for the negligence of its employees), so again no need to carry med mal insurance.

Or just work really fucking hard and be a superstar doc pulling down $3mil/year like my orthopedic friend from high school (part of his income is from his position as the team doc for an NBA franchise).

Good luck!

[HopetoFIRE]

Not sure if any other physician has replied, but this is my POV.  If it has been your lifelong dream to become a physician and you have been accepted, go for it!  I am a big proponent for weighing the pros and cons of the cost of obtaining a degree with future income.  I have to say that a medical degree is worth it most of the time.  With that said, you really need to be sure you really want it.  When someone else said that becoming a doctor is a "life" choice, it is a true statement.  Partially due to having to pay back a tremendous amount of money and partially due to the fact that most doctors' identities are greatly tied to their profession and peers.  Medical school is hard and residency is even harder.  Even when you finish, if you are expecting easy money, you are in for a huge surprise.

I am also surprised that many posters would discourage you from going to med school due to loans.  Almost everyone I knew had over $100k in loans.  Average debt of a med student is now closer to $200k.  As far as average pay, it varies so widely by specialty.  When they say average of $250k, you have to remember that that is combining all specialty and different lengths of time in practice.  I would say average primary care starting salary is in the low 100k.  You would have to be VERY lucky to get a job that will pay >$200k plus 10% loan payback (or be willing to live in the middle of nowhere).  TBH, I would not focus so much on finding a job that has loan repayment unless it gives a you a very attractive package like that.  I have a friend who took a loan repayment job... well, let's just say her salary is one of a starting physician.  If you are able to find a busy practice, you will come out way ahead in terms of salary even after paying your own loans. 

The big issue I find with most new grads is that they want to cushy job with no weekend calls and seeing only 15 patients a day.  Well, guess what?  That's not going to pay the bills.  To cover all expenses plus average physician salary ($150000), you need to see about 18 patients a day.  If you are willing to work hard, you can make more.  You can also make more in a private practice than being employed in a hospital.  I am a PCP and see average of 30-35 patients a day (sometimes not by choice) and do pretty well. 

What the previous posters stated about keeping your COL low and avoiding a lifestyle creep is a good advice.  I would be happy living the way we lived when I was a resident, but it's not just me.  I got to throw my DH a bone once in a while for sticking through everything with me.  I am sure his idea of being married to a doctor and the lifestyle he had envisioned does not match how we are living now.  Don't get me wrong, we have way more than enough but probably less than most physicians. 

So I guess my whole point is it is worth it financially if you really want and are willing to stick it through.  It is hard to fail out of med school but going to med school does not guarantee residency of choice.  There are lots of compromises to be made through med school and residency, especially for a married couple.  It can definitely affect your timeline in regards to children, especially if you rely on your wife's income for living expenses (ever looked at how much daycare costs?).  Make sure you let your wife know of your financial goals for when you are done with school (i.e. paying off debt, retiring early, etc) or you may be shocked of her expectations of when she is done "supporting" you. 

[Rbuckyfuller]

For what it's worth, if you have a background in public health and a strong desire to get a medical degree - you might want to consider the MD/PhD route (https://www.aamc.org/students/research/mdphd/).  This way, your medical training would be $0 but would (understandably) entail a longer time commitment as you would be getting two degrees.  A PhD an Epidemiology might be an option for you since you already have the MPH, and there are a few programs that offer a joint MD and a PhD in Epi.  Just my $0.02, but I wish you all the best as I too am strategizing how best to pursue my academic desires without accumulating student loan debt.   

This is a good idea.  It is what my sister-in-law did.

[former player]

For what it's worth, if you have a background in public health and a strong desire to get a medical degree - you might want to consider the MD/PhD route (https://www.aamc.org/students/research/mdphd/).  This way, your medical training would be $0 but would (understandably) entail a longer time commitment as you would be getting two degrees.  A PhD an Epidemiology might be an option for you since you already have the MPH, and there are a few programs that offer a joint MD and a PhD in Epi.  Just my $0.02, but I wish you all the best as I too am strategizing how best to pursue my academic desires without accumulating student loan debt.   

This is a good idea.  It is what my sister-in-law did.

I'm not so sure it's a good idea.  MD/PhD is great for those who have no existing debt and don't want to accumulate debt from an expensive med school while studying.  OP's issue is exactly the opposite: he already has debt and is going to a relatively very cheap med school.  Also, the longer he takes to pay off his existing debts the bigger the problem will be, and MD/PhD takes at least 6 years whereas MD takes only(!) 4.  So for his particular situation, his best bet if he is going to med school (and I hope he doesn't turn down the opportunity just because of his existing, manageable, debt, as it seems highly likely he wants to be a doctor enough that he would regret not doing it) is to get done in 4 years on as little extra debt as possible so that he can start paying down his existing debt immediately after.

[MsSindy]

...and be really nice to that wife of yours, because she is what is making this whole plan possible!

Not picking on your comment specifically but there seem to be a lot of people who agree that the wife's role in all this is huge. I agree, but I also believe that 1) if you get through this together then you will be closer than before. You'll have something that you fought through to achieve together, the "hard times," and nothing will ever take this experience away from you, and 2) I think a lot of women are more than happy to encourage and support a husband if the final goal is him becoming a doctor (I'd be more concerned about OP upping and leaving once the degree was in hand! lol)

But seriously, these two things alone may be enough "glue" to make sure your marriage is able to survive anything, and it might be worth doing it for this reason alone.

Since I'm not familiar with the path to being a doc, I was really enjoying reading this thread and don't really have anything to add to the OP.  However, I have to strongly disagree that a lot of women would be happy to encourage and support a husband being a doctor - I couldn't think of a worse lifestyle!  Late nights, on-call, all that stress and pressure ---- no thanks!

[LibrarIan]

Based on what others have said, it's pretty clear that there are pros and cons. Becoming a physician will net you tons of dough and you can pay all that stuff down. However, not going that route and doing the loan forgiveness thing will work wonders on your debt as well (although I cringe at the irresponsible way in which people can rack up a ton of debt and then make it magically disappear by these means - but hey, take what you can get).

I am an extremely debt-averse person. Under no circumstances would I do what you're about to do. I was able to make it through undergrad and grad school totally debt free and now my wife is about to start grad school without taking out loans. I hear the debt issues of others and nearly faint! If I were you, I would do the debt forgiveness option and after all that's gone I'd live totally MMM-style and retire early, avoiding the extra work of more school.

[studentdoc2]

For what it's worth, if you have a background in public health and a strong desire to get a medical degree - you might want to consider the MD/PhD route (https://www.aamc.org/students/research/mdphd/).  This way, your medical training would be $0 but would (understandably) entail a longer time commitment as you would be getting two degrees.  A PhD an Epidemiology might be an option for you since you already have the MPH, and there are a few programs that offer a joint MD and a PhD in Epi.  Just my $0.02, but I wish you all the best as I too am strategizing how best to pursue my academic desires without accumulating student loan debt.   

This is a good idea.  It is what my sister-in-law did.

I'm not so sure it's a good idea.  MD/PhD is great for those who have no existing debt and don't want to accumulate debt from an expensive med school while studying.  OP's issue is exactly the opposite: he already has debt and is going to a relatively very cheap med school.  Also, the longer he takes to pay off his existing debts the bigger the problem will be, and MD/PhD takes at least 6 years whereas MD takes only(!) 4.  So for his particular situation, his best bet if he is going to med school (and I hope he doesn't turn down the opportunity just because of his existing, manageable, debt, as it seems highly likely he wants to be a doctor enough that he would regret not doing it) is to get done in 4 years on as little extra debt as possible so that he can start paying down his existing debt immediately after.

I'm an MD/PhD student, and I would STRONGLY caution against going into an MD/PhD program for purely financial reasons. At my school, MD/PhD takes 8 years on average (I've never heard of anyone graduating in 6, and if they did, I would seriously question the credibility of their PhD). I'm in an excellent program, but I would say that there's at least a 12% dropout rate. The amount of time and work it takes to pursue the PhD requires serious dedication, and I've known no one going into such a program for purely financial reasons who actually graduated with both degrees. With that said, an MD/PhD program can be a great fit for the academically inclined (i.e.. usually physicians who intend to work at academic medical centers), and the financial aid is a great cherry on top -- my program is full tuition, free health insurance, and ~$30,000 (taxable) living stipend (all in all, around $85,000 per year in aid).

But it sounds like you have a dream of becoming a physician. Go to school, work during your first summer, live as inexpensively as possible, and definitely look into working in an underserved areas for loan forgiveness/aid when you graduate. But don't do MD/PhD just to escape the debt.

[Rpesek6904]

"You would have to be VERY lucky to get a job that will pay >$200k plus 10% loan payback (or be willing to live in the middle of nowhere). "

The physician that responded (with a good reply) stated the above about getting the $250,000 job plus loan repayment. I can say that both of my friends who landed those jobs do live "in the middle of nowhere." They live in rural Nebraska and Iowa. I think I said that, but I think it is worth emphasizing since some people are not willing to move to a rural area. If you are, you can reap rewards.

Another side note, the rural counties want doctors so bad they actually get in bidding wars (sometimes) over doctors. Apparently my brother-in-law doctor doesn't get 10% of his loans repaid per year but 25%. Which, considering the debt, was shocking. Again, he lives "in the middle of nowhere." Do your own research about these options to inform yourself. I only have ancedotal evidence.

By the way, the people that live in "nowhere" don't think it's all that bad :)

Good luck

[iwanttobelive]

Looks like you're going ahead with it. But I'd say its a bad idea taking on all this debt.

[greaper007]

Want to get evil?    Figure out a way to get non-federal loans and use those to pay off your student loans.    Credit cards, home equity etc.    Once you get all the student loans paid off, file for bankruptcy.

(Only slightly sarcastic)   I'm not sure what I would do in your situation, but I'd be looking really hard for a way to just get rid of those loans.    I don't think you'll really ever be able to pay them off in a reasonable time frame.

[Left]

Or do medical in california and get their scholarship for a full ride, but you need to do primary practice but if it is your thing,
http://www.cbsnews.com/news/faced-with-too-few-physicians-california-offers-free-medical-school/
there's worse ways to spend a career than living in california and debt free though

it's an old article but one of my favorites on it. Wish more places would encourage primary doctor students like this.

[brandino29]

Holy smokes, guys!  I was unable to check in for a week and I came back to 60+ replies.  Rather than trying to respond to specific comments I'll just do my best to respond to them together.

In general, most of the comments were supportive and calming.  Obviously I'm on MMM for a reason, I believe in living a low-cost, high quality life.  While I disagree with the commenter that suggested I was trolling by asking the MMM community about taking on debt (almost all of us already have or will still in the future for some reason or another), the additional student loans in and of themselves are the only thing that make me hesitant about doing it, which is why I laid it bare on here. 

Yes, I have been accepted into medical school already and I start in 2 months.  I had previously considered the MD/PhD route when I first started really thinking about going back but the PhD part is of limited interest to me.  I want to go into medicine for the clinical aspect, not the research.  As one commenter mentioned, I would forever regret not going because this is truly a dream of mine.  I want to go into medicine not for the earning potential but because I want to be a physician.  I've worked in public health, largely in a health policy realm but with some clinical type experience as well, for about 5 years now so it's not a delusion to escape what I'm in now. 

I've considered the military route but did not apply this year because I didn't qualify (I surpassed the minimum combined MCAT score required but I had one section that fell below the minimum).  I could apply after my first year if I'm in good standing at my school and in the top 50% of students in my class.  There are plenty of other considerations of a military route though beyond financial.  It's generally a minimum of a 7 year commitment to repay your service after residency, maybe more depending on your training, and you have limited say in where you live during that time.

Fortunately I have a very supportive and amazing wife (and we already have a daughter and a house) and she was the one that really saw how much I desired to do it and helped push me into making my dream a reality. 

I posted for a reason though and it's helped me see that I should avoid going for the scholarship with tons of strings attached because that could put me in the same position I find myself in now. I want to go in with an open mind and to pursue the field of medicine that really interests me the most, whatever that may be.  Those same programs offer plenty of loan repayment options too if you're willing to work in certain areas and I'm seeing now that it is probably better to approach it like that, if I decide that's what I want to do after I'm through rather than force myself into it now. 

Just a note regarding some of the more negative comments---I'm extremely proud of my parents who very unintentionally got pregnant when they were still in high school.  They ended up with two children, my brother who has a Ph.D. and is a university professor, and myself with a masters and, assuming all goes according to plan, an M.D. in a few years.  Finance was not their strong suit (still isn't, in fact), but they were great parents who valued our education.  In fact I went to undergrad on a full academic scholarship, but as a naive 20 year old college student was lured by the financial aid office to fund a summer abroad and a couple of new bikes (we've got a very f'ed up financial aid system with some perverse incentives).  The vast majority of my debt comes from grad school when I decided that going to a top 10 grad school would matter more than the cost of tuition, that's pretty much what the marketing and Princeton rankings are always telling us anyway, and I fell prey.  I also didn't just find out that I would be eligible for loan forgiveness, I've got my statement showing I have 48 months of qualifying service, going back to when I first consolidated all of my outstanding student loans into the Federal Direct program so I could qualify.  What I did newly find out though was that I could potentially qualify for loan forgiveness even as a physician earning good money as long as I work for a non-profit organization and continued on the Income Based Repayment plan.  On IBR and earning say $150,000, my monthly payments would increase substantially and be calculated based on a 10 year full repayment plan, but the remaining debt I had accrued in my grad school years could be forgiven after ~5 years of working in that capacity.

Anyway, thank you all for the feedback!

[totoro]

Good for you!

[former player]

If you are already four years into IBR, and then go to a residency which qualifies (many do), then depending on your choice of specialty and whether you do a fellowship, you will have a maximum of 3 years repayment as an attending, and possibly none at all.

[brandino29]

If you are already four years into IBR, and then go to a residency which qualifies (many do), then depending on your choice of specialty and whether you do a fellowship, you will have a maximum of 3 years repayment as an attending, and possibly none at all.

And that was news to me when I learned it, but it has ended up throwing a bit of a wrench into my thought process about the whole thing.  I started feeling it was a better decision to try to pay off accruing interest on a monthly basis because all of that interest will capitalize at the end of my in-school deferment but then when I realized that I could still qualify for the forgiveness, it wouldn't make any sense to worry about it.  But then if I don't worry about it and for some reason or another the forgiveness doesn't work out, I'm in a bigger hole than I would have been. 

[clarkfan1979]

Its seems normal to me to have around 200K of debt for an MD. It seems like you took out way more loans than necessary for undergrad but are getting a deal for medical school. In the end, the final number looks to be about the same as everyone else that goes to medical school.

[former player]

And that was news to me when I learned it, but it has ended up throwing a bit of a wrench into my thought process about the whole thing.  I started feeling it was a better decision to try to pay off accruing interest on a monthly basis because all of that interest will capitalize at the end of my in-school deferment but then when I realized that I could still qualify for the forgiveness, it wouldn't make any sense to worry about it.  But then if I don't worry about it and for some reason or another the forgiveness doesn't work out, I'm in a bigger hole than I would have been.

Your debt when you qualify will not be that much different from that of many (most?) other newly minted doctors, so you should be able to pay it off whatever you decide.  But, the important thing for you is that you are going to med school to follow your passion.  It would be silly to do that and then end up in a residency/specialty which you have chosen just because of IBR.   So my suggestion would be for you to pay off accrued interest while in med school, to the extent you can without making your and your wife's lives miserable and/or impacting on your relationship (eg because she feels resentful or you feel guilty at what feels like ridiculously reduced circumstances).  Choose your specialty because it's what you want to do, and your residency/fellowship because you will get the best training/fit in best there, regardless of whether or not you get IBR.  Then in your first attending job either take a job with IBR or live like a mustachian and throw the rest of your income at what remains of your debts, but either way you've got years before you have to make that decision.  And if you do end up going the IBR route, don't regret having made interest payments in the meantime: you were doing it to give yourself the freedom to choose the career path which was right for you and in any case were only paying for a debt you chose to run up and which gave you a great educational opportunity.  Win/win, in my book.

Good luck with med school.