$359k in med school debt; advice for family member

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FrugalProfessor
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Re: $359k in med school debt; advice for family member

Post by FrugalProfessor »

smitcat wrote: Mon Jul 20, 2020 10:15 am
RocketShipTech wrote: Mon Jul 20, 2020 10:08 am
Dottie57 wrote: Mon Jul 20, 2020 8:31 am A podiatrist doesn’t go to normal medical school. The costs are significantly less. Is op sure the degree is podiatry?
I agree with Dottie, something is off here.

Podiatry school is four years at $40k per year.

Did OP really rack up $200k in living expense debt over those four years?
"Did OP really rack up $200k in living expense debt over those four years?"
8 years of school and 3 of residency accruing 4 kids and a spouse that does not work along the way.
School's website says that cost of attendance is about $45k/year (tuition + cost of living). Adjust upwards for family of 6. Add $20k of undergrad debt. Add 3 years of residency making below the poverty line. Add accumulated interest = $360k.
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Ferdinand2014
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Re: $359k in med school debt; advice for family member

Post by Ferdinand2014 »

khram wrote: Mon Jul 20, 2020 2:14 am Is $150-250k really normal starting for that kind of med school debt? Does it rise very quickly?

I wouldn't eat Ramen, but no fancy vacations for a while, and no house until debt is paid off. Maybe take a small vacation every $100k s/he pays off, I dunno. Sometimes you need to live a little to keep your sanity, especially after the med school grind. But make sure a little doesn't become every year.

Married with 4 kids, how old is s/he? How long of a career does s/he expect to have?

The spouse needs to work, or s/he needs a big raise if closer to the $150k side.

Look for a new job. Is 401k not normal for doctor jobs?

Also relevant: what is a realistic minimal budget for a family of 6? How soon is college coming up for the first kid?

Get this family member to make their own post. There are a lot of decisions to make here. The first step is getting involved him/herself in the outreach.
Podiatry. Not medical school.
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fredflinstone
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Re: $359k in med school debt; advice for family member

Post by fredflinstone »

FrugalProfessor wrote: Mon Jul 20, 2020 7:43 am
flyninjasquirrel wrote: Mon Jul 20, 2020 7:37 am Ugh why take on $359k in med school debt and do podiatry? :oops: DW and I had $450k of combined med school debt but at least I went into a high paying specialty and will have it paid off in <5 years. Also, $150k still seems on the low side for podiatry.

He needs to try to increase his income. Best way to do this for him would probably be to get into the OR and do as many procedures as possible.

Refinance to a lower interest rate ASAP.

Keep expenses low. Don't buy a house.

I wouldn't trust the government for anything. Best to not rely on any type of forgiveness.

Totally feasible to have it paid off in <10 years if he manages things right.
Great advice! He's fortunately going to be in the OR. $150k is definitely conservative. $200k is probably more realistic. But it's hard because he's brand new to this. He's trying really hard to make money; I trust he's doing his best here.

I agree with your recommendation to not buy house and keep expenses low. His spouse is the problem there; not sure she'll stick around if they continue to live cheap.

I agree with your assessment to not trust the gov't for forgiveness; particularly for something promised 25Y in the future.

Thanks again for the thoughts!
Let her go.
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sd323232
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Re: $359k in med school debt; advice for family member

Post by sd323232 »

FrugalProfessor wrote: Mon Jul 20, 2020 9:56 am
Maverick3320 wrote: Mon Jul 20, 2020 8:38 am I guess I'll be the jerk to say it straight: the biggest problem here is poor decision making. Four kids, an outmoded view on family roles, 360K debt for a podiatry degree. PLSF might be a possibility, but does the government have an overwhelming need for podiatrists right now?

OP, you can spend hours of your life trying to help someone with this issue but the true issue is their perspective on finances. I'm guessing your financial advice may not go over well.
I appreciate the straight talk and the advice to stay out. Probably the best advice yet, but I'm trying to do him a favor by helping him with this life altering decision!
I'm still not sure what a kind of favor are you doing him? If financial independace is not his goal, and its probably not by life decisions he took, your advice does not mean anything to him especially if he didnt ask for it. Let other people live life they want, our way is not for everyone.
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Re: $359k in med school debt; advice for family member

Post by Big Dog »

contact a lender such as SoFi or Republic to inquire about a refi of those loans at a much cheaper rate, and therefore lower payments. The downside of course is that one immediately loses any federal loan protections.
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Watty
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Re: $359k in med school debt; advice for family member

Post by Watty »

FrugalProfessor wrote: Mon Jul 20, 2020 12:36 am
* Expected near-term income in the neighborhood of $150k-$250k
....
* Currently renting modest home in LCOL area; would like to purchase home soon
.....
* The monthly payment for a 10Y repayment schedule would be about $4k/month.
It is not an ideal situation but it does not look like a dire situation to me.

You can look up the median household income in their city or zip code and it might surprise you how low it is. In the entire US the median household income is about $60K so in a low cost of living ares it is likely even less.

In a low cost of living area lots of large families live on modest incomes and they even buy modest homes.

They just need to keep their lifestyle as if they made something like $90K a year(before taxes and tithe) for a few more years and throw all the extra money towards the school loans. If they have some years when their income is closer to the higher end of their income range they should be able to have it paid off in a lot less than 10 years.
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Re: $359k in med school debt; advice for family member

Post by RocketShipTech »

Big Dog wrote: Mon Jul 20, 2020 10:39 am contact a lender such as SoFi or Republic to inquire about a refi of those loans at a much cheaper rate, and therefore lower payments. The downside of course is that one immediately loses any federal loan protections.
+1.

First Republic might be able to get that interest rate down to the 2s.

https://www.firstrepublic.com/personal- ... lsrc=aw.ds
MBB_Boy
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Re: $359k in med school debt; advice for family member

Post by MBB_Boy »

FrugalProfessor wrote: Mon Jul 20, 2020 7:45 am
anon_investor wrote: Mon Jul 20, 2020 7:39 am
FrugalProfessor wrote: Mon Jul 20, 2020 7:28 am
smitcat wrote: Mon Jul 20, 2020 7:13 am "Spouse is stay at home spouse so job prospects are limited. They are part of church which promotes 1950s stereotypes of men providing and women making lots of babies."
Interesting - How does the Church feel about minimum payments , manipulating AGI, and the 25 year forgiveness rule?
Not sure how the church feels about those things, but the church believes those unwilling to pay 10% of income to church will not go to heaven. For the believer, this creates a pretty strong incentive to pay tithing.

Not surprisingly, the church has amassed a $100B investment portfolio, dwarfing the endowment of Harvard's $40B endowment and the Gates foundation's $46B endowment.
I always wondered if the 10% was of gross or take home.
I was taught that those who pay gross are more honorable than those who pay out of net. "Do you want gross blessings or net blessings?" But there is very little official guidance; more like do what your heart tells you is right.
Off topic, but I learned gross. Assuming you accept the premise in the first place, it makes sense. Why should a government increasing taxes result in less money being donated? Not like the financial needs of the poor/missionary work/church bills go away. And of course, if it's a moral/ethical imperative for you, makes even more sense.
muddgirl
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Re: $359k in med school debt; advice for family member

Post by muddgirl »

If health care is so crummy why isn't an HSA an option? Employers don't have to offer and HSA, if the plan qualifies then he can open one independently.

A lot of Mormon wives work from home. I see a lot of excuses and not solution-oriented mindset.

You can lead a horse to water but you can't make them drink.
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Re: $359k in med school debt; advice for family member

Post by Living Free »

FrugalProfessor wrote: Mon Jul 20, 2020 10:00 am
I'm 100000% sure that he went to podiatry school in a VCOL area. I get that non-podiatrists be offended that I called it "med school" in the subject line. My apologies for the poor word choice.

I don't really understand the huge negativity in the thread. Podiatrists can make good incomes to the point that repaying $360k of debt is trivial in a few years. I'm not convinced he's made a poor financial decision to go to school. None of us, including him, have any idea on what his alternative career path would have been; he almost certainly would have chosen one that pays around 50% less. On a net-present-value basis over a 30 year working career, it's surely positive NPV relative to many (but not all) career options he could have chosen.
I agree. Surprising amount of negativity for a bogleheads thread. Anyway, if he's able to make $250k per year then the debt load is manageable at just under 1.5x gross. Not ideal, but he should be able to get out of that relatively quickly (?maybe 5-10 years, hopefully closer to 5. really shouldn't be too hard to throw ~$60k per year at it while still doing retirement account investing...) IF he lives frugally and works hard at it.
If he is only making 150k per year then that is going to be a lot tougher and he should try to find out how to increase his income.
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Re: $359k in med school debt; advice for family member

Post by FrugalProfessor »

muddgirl wrote: Mon Jul 20, 2020 11:20 am If health care is so crummy why isn't an HSA an option? Employers don't have to offer and HSA, if the plan qualifies then he can open one independently.

A lot of Mormon wives work from home. I see a lot of excuses and not solution-oriented mindset.

You can lead a horse to water but you can't make them drink.
I appreciate the thoughts; particularly the HSA suggestion. I'll have him double check the plan documentation.

I've personally had high deductible plans in the past that were non-HSA compliant because they paid out insurance benefits on prescriptions prior to hitting the deductible. Such a silly rule to negate $7.1k/year in tax deductions (FICA + Federal + State).
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Re: $359k in med school debt; advice for family member

Post by ohboy! »

Good news is if he can and once he did wrangle himself out of debt he could be in a great position. With my GF in significant student loan debt I constantly remind her how much less spending now translates to more opportunity later. She has about 1:1 debt to gross income. Her plan is to pay it off in 3 years if no speed bumps. Age is a big factor.
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Re: $359k in med school debt; advice for family member

Post by FrugalProfessor »

MBB_Boy wrote: Mon Jul 20, 2020 11:09 am Off topic, but I learned gross. Assuming you accept the premise in the first place, it makes sense. Why should a government increasing taxes result in less money being donated? Not like the financial needs of the poor/missionary work/church bills go away. And of course, if it's a moral/ethical imperative for you, makes even more sense.

I've had a friend who argued that since federal marginal tax rates capped out at 91% in 1950, this would imply 101% tithe on income paid if based on gross. Therefore, net is the only logical conclusion.

I've had other friends who argue that they receive benefits from gov't spending (roads, military, schools, etc), so it's logical to spend on gross.

I've had a CFA friend who based it on gross - trad 401k - social security, with the implication that they'll pay downstream tithing on 401k distributions (plus interest) and social security payments. Unless you deduct social security (or not tithe the social security distribution), you'd end up double tithing.

There's no clear guidance either way on the topic. The more you think about it, it's an accounting nightmare, though I tend to like the sympathize with the CFA on this one.
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NotWhoYouThink
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Re: $359k in med school debt; advice for family member

Post by NotWhoYouThink »

I've had a friend who argued that since federal marginal tax rates capped out at 91% in 1950, this would imply 101% tithe on income paid if based on gross. Therefore, net is the only logical conclusion.
Clever sounding shallow argument. the 91% was a marginal rate on very high incomes.

People with low incomes never saw anything like a 91% marginal tax rate anyway, so tithing 10% would not put them in the 101% or even 51% range.

People with high incomes can deduct large contributions, it's only the income after the deductions that gets taxed.

What you tithe 10% of is a topic for another board, though.
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Re: $359k in med school debt; advice for family member

Post by rich126 »

Interesting choices.

While I've gone to podiatrists I have also been told by several doctors that if I require surgery I'd be much better off going to a surgeon that specializes in the foot/ankle and not having a podiatrist doing it.

Like others here, lots of questionable decisions. And having more and more children will make it tougher. And what happens to the doctor if he gets sick and is unable to work for an extended period of time? Hopefully he has very good disability and life insurance.
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Re: $359k in med school debt; advice for family member

Post by new2bogle »

FrugalProfessor wrote: Mon Jul 20, 2020 7:43 am

I agree with your recommendation to not buy house and keep expenses low. His spouse is the problem there; not sure she'll stick around if they continue to live cheap.
Does not compute with church teachings. If she will break this, might as well forgo the 10% tax as well and save that for the loan.
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Re: $359k in med school debt; advice for family member

Post by Aku09 »

I don’t have a lot of advice other than he needs to tackle it asap. I graduated from CRNA school 4 years ago with 150k in debt and was making 160k. I have refinanced my student loans a total of 4 times. Most recently refinanced to a 5 year variable last fall and currently have 0.18% interest rate.

My wife went back to work 2 years ago as a school teacher making 35k and I have gotten a raise last fall with most of that extra money going to student loans. I didn’t get really serious about paying them off and my financial future until 1.5 years ago. I’ve started maxing my 401k since then and now pay $3500 a month towards student loans.

This leaves me with some excess money every month which I have just been stockpiling with all of the covid stuff going on. I ended up taking a pay cut when everything started which I have been paid back in full for. Plan is to pay my remaining balance by the end of the year.

Long story, but the point is if he is serious about it he will build momentum/traction as time goes on. When I first graduated I was on a 9 year plan, then it was a 7, then by the end of 2021 and now by the end of 2020. We have still taken several vacations, but all that money this year has gone back into the student loan fund as travel just hasn’t happened. I have 3 kids so I can understand the plight your family member is going through.
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Re: $359k in med school debt; advice for family member

Post by reln »

FrugalProfessor wrote: Mon Jul 20, 2020 12:36 am A family member just graduated podiatry school and residency with $359k in student loans. Here are the relevant parameters:

* All loans are Federal Direct
* Mix of Unsub Stafford + Student Plus
* Weighted avg interest rate is 6.1%
* Married with 4 kids (relevant for disposable income calcs)
* Expected near-term income in the neighborhood of $150k-$250k
* No access to 401k/HSA (relevant for disposable income calcs)
* Does not qualify for PSLF; employed by a normal non-public practice
* Currently renting modest home in LCOL area; would like to purchase home soon

It seems to me that the family member has three potential (and completely divergent) paths:
1.) Suck it up. Eat Ramen, Beans, and Rice for a decade. Throw every penny of free cash flow at paying down the debt. Look to refinance debt at private firm (Sofi, etc), though this option seems to limit future forbearance flexibility in case of financial hardship.

2.) Make minimum payments, defined as 10% of discretionary income (=(AGI-150% FPL)/12). Manipulate AGI to the extent possible (401k if ever becomes an option, HSA if ever becomes an option, etc). Let balance balloon because minimum payments will be insufficient to cover interest expense. Exploit 25Y loan forgiveness in the year 2045, which is considered to be a taxable event, meaning that the effective forgiveness is something like a 60-70% of the loan balance. Or wait for a Bernie-style politician to bail them out sooner. Admittedly this path has a lot of legislative risk; there is no guarantee that this policy will be in place in 25Y.

If they go down this path, my research seems to indicate that the REPAYE payment plan would be optimal because of reduced interest accrual vs other payment plans. If I'm wrong here, please let me know.

3.) Quit their new job and find a job at a non-profit, enjoying tax-free loan forgiveness in 10Y.

The family member has no interest in Option #3 above, so let's scratch that off the list.

A lot of forum members would make the case that #1 is the only ethical route. I don't disagree, but I'm also interested in understanding which path maximizes their expected lifetime wealth.

Since this is a non-trivial financial decision, I thought I'd bounce it off of the smartest group of people I've found on the internet. Thanks in advance for your input!!!!!!!!!!!

Detailed loan info below (sorted descending by balance):
5/13/2014 DIRECT UNSUB STAFFORD LOAN $59,201.49 5.41%
5/11/2015 DIRECT UNSUB STAFFORD LOAN $57,919.56 6.21%
5/2/2016 DIRECT UNSUB STAFFORD LOAN $54,366.89 5.84%
8/26/2013 DIRECT UNSUB STAFFORD LOAN $52,810.34 5.41%
5/2/2016 DIRECT STUDENT PLUS LOAN $41,586.43 6.84%
5/13/2014 DIRECT STUDENT PLUS LOAN $31,671.56 6.41%
5/11/2015 DIRECT STUDENT PLUS LOAN $30,917.29 7.21%
8/26/2013 DIRECT STUDENT PLUS LOAN $24,474.37 6.41%
2/16/2011 DIRECT SUB STAFFORD LOAN $5,712.30 4.50%

If they go Option #2, here's how I calculated their minimum payment amount:
* Healthcare Premiums: $16k
* Standard Deduction: $24.8k
* FPL with 4 kids: $35.16k
* 150% FPL: $52.74k

Discretionary Income = AGI - 150% FPL
Discretionary Income = (Gross - Standard Deduction - Healthcare Premiums) - 150% FPL

Minimum Payments (let me know if this looks wrong):
* $150k gross income => $471 monthly; $5,646 annual
* $200k gross income => $887 monthly; $10,646 annual
* $250k gross income => $1,304 monthly; $15,646 annual
* $500k gross income => $3,387 monthly; $40,646 annual (outside of expected income, but included for illustration purposes)

For reference:
* The monthly interest burden on $359k of debt at 6.1% is $1,825. Any payment less than this will lead to ballooning of balances.
* The monthly payment for a 10Y repayment schedule would be about $4k/month.
#2 min payments
JPM
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Re: $359k in med school debt; advice for family member

Post by JPM »

OP, your friend is in a pickle and his family situation is an outlier, but $300,000+ debt is not unusual for someone funding medical education as an individual. Some MD couples graduate with upwards of $600,000 combined debt. This is a sad situation IMO but professional education has become very expensive in the USA.

Supporting a large family while paying off a burdensome student loan is an enormous challenge as other posters have mentioned and the financial planning considerations have been outlined in other posts.

Maximizing income from his professional situation should be the top priority for the doctor and the following thoughts look at that.

Generally speaking, salaried positions are most lucrative to start with. With the large existing debt, purchasing an existing private practice is probably impossible and working for someone else in a small private clinic is unlikely to be lucrative for some years. Some government jobs permit moonlighting opportunities for the energetic. A fraternity brother of mine had a long career as a dentist for an urban county and had a private practice on Saturdays and 2 evenings per week. In his fifties, political conditions brought about a very favorable early retirement pension opportunity and he worked the private practice for another 12 years then retired very comfortably. Podiatry jobs for a county health department, the VA system, or the state prison system may afford similar opportunities.

Among large integrated medical groups, the best payers are probably not in HCOL urban areas where competition for those jobs drives down salaries. Some integrated groups are a lot more doctor-friendly than others. An integrated group in the exurban midwest, intermountain region, or south would probably pay better than an urban or suburban practice, but there are no doubt exceptions. Ask to work six days. Staffing six days may be a problem that needs working thru, but the extra production can go to paying off the loan quicker. Sometimes getting the employer to staff longer hours and extra days is the biggest stumbling block.

Learn the Current Procedural Terminology (CPT) coding system well and code accurately for the specialty. Even small procedures like nail or callus trimming can add to the payment for a visit. The larger groups police coding accuracy and that helps. The integrated groups are each on a computer system that can aid efficiency in the clinic when used correctly with practice efficiency and accurate coding as the object of its use. Use of templates for commonly done procedures and common office visit routines are very helpful in specialty practices where 90% of the work is part of a repertoire of 8-12 procedures and office visit routines.
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Re: $359k in med school debt; advice for family member

Post by delamer »

new2bogle wrote: Mon Jul 20, 2020 12:01 pm
FrugalProfessor wrote: Mon Jul 20, 2020 7:43 am

I agree with your recommendation to not buy house and keep expenses low. His spouse is the problem there; not sure she'll stick around if they continue to live cheap.
Does not compute with church teachings. If she will break this, might as well forgo the 10% tax as well and save that for the loan.
This reminds me of the true crime shows where a woman kills her husband because she doesn’t “believe” in divorce...

So a 10% tithe is insisted upon, but divorce is justified if disposable income is too low?
khram
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Re: $359k in med school debt; advice for family member

Post by khram »

FrugalProfessor wrote: Mon Jul 20, 2020 7:08 am
khram wrote: Mon Jul 20, 2020 2:14 am Is $150-250k really normal starting for that kind of med school debt? Does it rise very quickly?

I wouldn't eat Ramen, but no fancy vacations for a while, and no house until debt is paid off. Maybe take a small vacation every $100k s/he pays off, I dunno. Sometimes you need to live a little to keep your sanity, especially after the med school grind. But make sure a little doesn't become every year.

Married with 4 kids, how old is s/he? How long of a career does s/he expect to have?

The spouse needs to work, or s/he needs a big raise if closer to the $150k side.

Look for a new job. Is 401k not normal for doctor jobs?

Also relevant: what is a realistic minimal budget for a family of 6? How soon is college coming up for the first kid?

Get this family member to make their own post. There are a lot of decisions to make here. The first step is getting involved him/herself in the outreach.
Not sure about income trajectory. He's still trying to figure it out.

Ramen was more metaphorical. Early 30's. Hopefully a long career (30+ years).

Spouse is stay at home spouse so job prospects are limited. They are part of church which promotes 1950s stereotypes of men providing and women making lots of babies.

My family of 7 spends around $55-$60k/year. I'm more frugal than them.

Agreed he should take ownership of the situation and do his own research; I was just trying to crowdsource a little advice to someone who clearly needs it.
Then this is going to be a big problem. 4 kids before the job, spouse doesn't want to work, surrounded by church folks who push this agenda. If it's a matter of income vs. cost of daycare and they're young, I understand. Otherwise, they will never come out ahead.
They go to church requiring 10% tithe, so that hurts.
I am not religious, so I don't understand this, and I will never understand this. The family member not making own thread, refusing to have spouse work, having tons of kids early, and giving a ton of money to church. Do you share your income with the church? I assume lying is cause not to go to heaven or something like this?
Maverick3320 wrote: Mon Jul 20, 2020 8:38 am I guess I'll be the jerk to say it straight: the biggest problem here is poor decision making. Four kids, an outmoded view on family roles, 360K debt for a podiatry degree. PLSF might be a possibility, but does the government have an overwhelming need for podiatrists right now?

OP, you can spend hours of your life trying to help someone with this issue but the true issue is their perspective on finances. I'm guessing your financial advice may not go over well.
100% agree.
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Re: $359k in med school debt; advice for family member

Post by Young Boglehead »

muddgirl wrote: Mon Jul 20, 2020 11:20 am If health care is so crummy why isn't an HSA an option? Employers don't have to offer and HSA, if the plan qualifies then he can open one independently.

A lot of Mormon wives work from home. I see a lot of excuses and not solution-oriented mindset.

You can lead a horse to water but you can't make them drink.
If “work from home” means “work” for an MLM, then he should thank his lucky stars she hasn’t gone down that rabbit hole. If working from home means having a normal job or starting a business with low investment costs, that would obviously be a great idea.
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Re: $359k in med school debt; advice for family member

Post by FrugalProfessor »

new2bogle wrote: Mon Jul 20, 2020 12:01 pm
FrugalProfessor wrote: Mon Jul 20, 2020 7:43 am

I agree with your recommendation to not buy house and keep expenses low. His spouse is the problem there; not sure she'll stick around if they continue to live cheap.
Does not compute with church teachings. If she will break this, might as well forgo the 10% tax as well and save that for the loan.
Touché!
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Re: $359k in med school debt; advice for family member

Post by FrugalProfessor »

reln wrote: Mon Jul 20, 2020 12:16 pm #2 min payments
Another contrarian!
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Re: $359k in med school debt; advice for family member

Post by muddgirl »

FrugalProfessor wrote: Mon Jul 20, 2020 11:39 am
muddgirl wrote: Mon Jul 20, 2020 11:20 am If health care is so crummy why isn't an HSA an option? Employers don't have to offer and HSA, if the plan qualifies then he can open one independently.

A lot of Mormon wives work from home. I see a lot of excuses and not solution-oriented mindset.

You can lead a horse to water but you can't make them drink.
I appreciate the thoughts; particularly the HSA suggestion. I'll have him double check the plan documentation.

I've personally had high deductible plans in the past that were non-HSA compliant because they paid out insurance benefits on prescriptions prior to hitting the deductible. Such a silly rule to negate $7.1k/year in tax deductions (FICA + Federal + State).
Yes not all crummy plans qualify but I missed out on 3 years of HSA contributions because I didn't realize my plan qualified because my employer did not offer a sponsored HSA.
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Re: $359k in med school debt; advice for family member

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Reminder, religion discussion and spousal relationship are off-topic for this forum.
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Re: $359k in med school debt; advice for family member

Post by SpaghettiMonster »

FrugalProfessor wrote: Mon Jul 20, 2020 10:16 am
smitcat wrote: Mon Jul 20, 2020 10:15 am
RocketShipTech wrote: Mon Jul 20, 2020 10:08 am
Dottie57 wrote: Mon Jul 20, 2020 8:31 am A podiatrist doesn’t go to normal medical school. The costs are significantly less. Is op sure the degree is podiatry?
I agree with Dottie, something is off here.

Podiatry school is four years at $40k per year.

Did OP really rack up $200k in living expense debt over those four years?
"Did OP really rack up $200k in living expense debt over those four years?"
8 years of school and 3 of residency accruing 4 kids and a spouse that does not work along the way.
School's website says that cost of attendance is about $45k/year (tuition + cost of living). Adjust upwards for family of 6. Add $20k of undergrad debt. Add 3 years of residency making below the poverty line. Add accumulated interest = $360k.
I agree. There’s something off with the numbers. As a resident, the salary is anywhere from 55-65k/yr and increases yearly. Even in a HCOL area, I wouldn’t necessarily say that it’s below the poverty line. It would be difficult for a family of 6 though. I’m leaning more toward a financial behavior issue at the heart of things as well. As unpalatable as it sounds to him, he may just have to suck it up for a number of years for the loan forgiveness.
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FrugalProfessor
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Re: $359k in med school debt; advice for family member

Post by FrugalProfessor »

Aku09 wrote: Mon Jul 20, 2020 12:11 pm I don’t have a lot of advice other than he needs to tackle it asap. I graduated from CRNA school 4 years ago with 150k in debt and was making 160k. I have refinanced my student loans a total of 4 times. Most recently refinanced to a 5 year variable last fall and currently have 0.18% interest rate.

My wife went back to work 2 years ago as a school teacher making 35k and I have gotten a raise last fall with most of that extra money going to student loans. I didn’t get really serious about paying them off and my financial future until 1.5 years ago. I’ve started maxing my 401k since then and now pay $3500 a month towards student loans.

This leaves me with some excess money every month which I have just been stockpiling with all of the covid stuff going on. I ended up taking a pay cut when everything started which I have been paid back in full for. Plan is to pay my remaining balance by the end of the year.

Long story, but the point is if he is serious about it he will build momentum/traction as time goes on. When I first graduated I was on a 9 year plan, then it was a 7, then by the end of 2021 and now by the end of 2020. We have still taken several vacations, but all that money this year has gone back into the student loan fund as travel just hasn’t happened. I have 3 kids so I can understand the plight your family member is going through.
Thanks for sharing your success story! It's a great example of what he could do if he wanted to.
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PQ12$
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Re: $359k in med school debt; advice for family member

Post by PQ12$ »

Op - Disregard the posters that say stay out of this. You clearly get the limitations and frustrations of trying to help someone in this situation -- as you say you can give advice and if they don't take it so be it.

They are in a hole, so they should definitely stop digging -- if you could just get one of them to see the wisdom of monthly budgeting and revenue/expense analysis to insure the live below the means while paying this debt off, it might be the best gift you could give. Lots of apps, etc. (we use Mint) that make this easy to do. We have a monthly budget now and both get a text if we exceed our restaurant, or alcohol, or whatever budget and lemme tell you it helps us stay on track. FYI I'm an option 1 guy - just start paying it off as aggressively as he can (while keeping the family happy and not incurring more debt) and do what he can to make more.

4 kids, a strong marriage, an MD degree at 30 -- sounds like this guy has been busy doing some significant things in his short life. Pretty impressive. My bet is he figures it out.
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Re: $359k in med school debt; advice for family member

Post by tashnewbie »

FrugalProfessor wrote: Mon Jul 20, 2020 12:29 pm Thanks for sharing your success story! It's a great example of what he could do if he wanted to.
I think the bolded language above is the key, *plus* whether he and his spouse are on the same page. If he and his spouse aren't on the same financial page, then I don't see how the path ahead will be feasible or simple.

If he and his spouse can get on the same page and both want to tackle aggressively this ball and chain, then I would look to refinance the loans, then attack them with gazelle-like intensity (to take a phrase from Dave Ramsey...maybe they would be receptive to his getting out of debt philosophy, given the religious similarities?). Depending on the refinanced rate, how frugally they live, and his earnings trajectory, they could have the loans paid off in less than 10 years, which would make the prospect of PSLF irrelevant. The huge caveat with pursuing this strategy though is what I said above - both spouses have to be on the same page about treating this debt like a scourge on their lives.

ETA: Mathematically, it might be better to go for PSLF, although he will take a tax hit on the amount forgiven, which will be a substantial amount for him. If he's truly opposed to working for a qualifying employer, then the best option imo is to refinance the loans and pay off aggressively. Regardless of which path he takes, he and his wife need to be on the same page.
Last edited by tashnewbie on Mon Jul 20, 2020 2:20 pm, edited 1 time in total.
Dottie57
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Re: $359k in med school debt; advice for family member

Post by Dottie57 »

smitcat wrote: Mon Jul 20, 2020 9:29 am
Dottie57 wrote: Mon Jul 20, 2020 8:31 am A podiatrist doesn’t go to normal medical school. The costs are significantly less. Is op sure the degree is podiatry?
"A podiatrist doesn’t go to normal medical school"
Huh? Looks like 4 / 4 / and then 2-4 residency all while having a family of 6.

https://learn.org/articles/Podiatrist_E ... tions.html
Take a look at this. No medical school but a podiatry college.
https://learn.org/articles/Podiatrist_E ... tions.html
physician_finance
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Re: $359k in med school debt; advice for family member

Post by physician_finance »

Nothing gets physicians going like conflating medical school and podiatry school. ;)

That debt loan is completely reasonable for the situation. The cost of attendance for these schools can approach or exceed 70K per year. Add in undergraduate debt and interest accrual and 360K is easily reached without living extravagantly.

Option #2 is not good. Even if the terms of 25 year forgiveness don't change, there is a huge tax bomb at the end of the road.

PSLF is a more reasonable options. The media stories about people being denied for loan forgiveness are somewhat alarmist; if you truly work for a qualifying employer, are under the correct plan, document carefully, and are persistent about getting the money, PSLF is a feasible option for current borrowers. Many 501c/non-profit hospitals employ podiatrists and often have good retirement benefits allowing lowering of adjusted gross income used for repayment calculators. At an AGI of 130K and family size of 6, the monthly payment under the PAYE/REPAYE plan will be < $700 a month.

The VA employs podiatrists and has robust loan repayment options.

Finally, if no plan for PSLF then first priority should be private loan refinancing, which in the current economic climate should cut the rate almost in half.
khram
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Re: $359k in med school debt; advice for family member

Post by khram »

physician_finance wrote: Mon Jul 20, 2020 1:35 pm That debt loan is completely reasonable for the situation. The cost of attendance for these schools can approach or exceed 70K per year. Add in undergraduate debt and interest accrual and 360K is easily reached without living extravagantly.
That may be reasonable in the sense of not having lived it up too much (but maybe there were scholarships, we don't know), but it's not reasonable (IMO) to take on that kind of debt for $150k income. Even $250k. Of course it's far too late to say "don't take on this debt, choose a different path."

The fact that some students (dental, medical, even law) are coming out of school with $300-500k in debt is a massive problem. There is no guarantee you graduate, or that you find a good job. IMO more than $50k of debt for a $150k job is a bit high. I am not sure how much lower doctor salaries are in other countries where education costs are more reasonable.

[My comment is a bit more general, not making a distinction between podiatry and medicine, I know.]
muddgirl
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Re: $359k in med school debt; advice for family member

Post by muddgirl »

Another budgeting/get out of debt expert that might appeal to them is Jesse Mecham. https://www.amazon.com/gp/aw/d/0062567586/
ArchiteuthisDux
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Re: $359k in med school debt; advice for family member

Post by ArchiteuthisDux »

I would suggest looking at refinancing part of the debt to shorter term lower interest private loans, repaying them, then repeat.

I know this is contrary to accepted teaching to pay higher interest loans first, but private lenders like SoFi are currently offering interest rates in the high 2%/low 3% on shorter term loans (like 5-10 years). He probably won't qualify to refinance the entire amount (and shouldn't, because he'll lose the other protections that come with federal loans) but it would probably save quite a bit of money over the long term.

He also needs to make sure he's working somewhere his long term income trajectory is upwards. 200K seems to be about average for employed podiatry; if he can start his own practice or buy into a private practice his income may go up a lot depending on how well it's managed and whether there are other income streams like owning part of a surgery center. If he likes to operate and can get a reputation for being good at the more complicated cases (hindfoot etc) that may also increase income.

Depending on where they live they may well be able to afford a reasonably nice house but it certainly won't be a mansion
SpaghettiMonster
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Re: $359k in med school debt; advice for family member

Post by SpaghettiMonster »

He could try joining an orthopedics group. The busier and more success podiatrists I know are part of a larger orthopedic group and they have a larger referral base. He could get a solid patient base and payor mix. The solo podiatrists are the ones I see most often whittling away with amputations or doing debridements on unfunded hospital inpatients.
smitcat
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Re: $359k in med school debt; advice for family member

Post by smitcat »

Dottie57 wrote: Mon Jul 20, 2020 12:59 pm
smitcat wrote: Mon Jul 20, 2020 9:29 am
Dottie57 wrote: Mon Jul 20, 2020 8:31 am A podiatrist doesn’t go to normal medical school. The costs are significantly less. Is op sure the degree is podiatry?
"A podiatrist doesn’t go to normal medical school"
Huh? Looks like 4 / 4 / and then 2-4 residency all while having a family of 6.

https://learn.org/articles/Podiatrist_E ... tions.html
Take a look at this. No medical school but a podiatry college.
https://learn.org/articles/Podiatrist_E ... tions.html
Yes - looks like 4 years undergrad, 4 years DPM school , then 2-4 years in residency all while having 4 kids and a spouse that does not work.
At 10+ years of school and residency with a family of 6 I am surprised his loans are not larger.
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Re: $359k in med school debt; advice for family member

Post by JonnyDVM »

ModifiedDuration wrote: Mon Jul 20, 2020 7:53 am
JAZZISCOOL wrote: Mon Jul 20, 2020 7:49 am You might suggest your family member check out the White Coat Investor site. The founder, an MD, is also a BH member and posts here often. He has a lot of great advice and articles for medical professionals on paying off school loans, etc.

https://www.whitecoatinvestor.com/new-t ... tart-here/
+1
Yes I’m sorry to say I see some red flags here. 400k in the hole. Required 10% tithe for church. Wife doesn’t want to live frugally. These are ingredients for a lifetime of bad finances. The 25 year forgiveness plan when you make hundreds of thousands a year is absurd IMO. Your relative really needs to take control of his financial lives now before it spirals out of control. If he immediately buys the doctor house and the doctor car and selects the lowest monthly loan payoff option, he’s going to be in for a lifetime of playing catchup.

Take it from me. The best way to do this is to live like he has been living on a modest income. Pay that debt down. THEN buy the doctor house. It’s much less stressful.

WCI is the perfect place for him to research.
I’d trade it all for a little more | -C Montgomery Burns
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Re: $359k in med school debt; advice for family member

Post by deltaneutral83 »

FrugalProfessor wrote: Mon Jul 20, 2020 10:03 am
I agree with your second paragraph; it's all about mentality and the implications of a lax mentality.

You usually can't discharge SL in bankruptcy.
You have now seen that a lot of BH are unable to grasp any problem involving money without attacking it with a calculator and a spreadsheet. It's what we do, and we are good at the numbers side of things because we've either been through this (probably on a much smaller shovel/hole scale) in our much younger days or never had issues with debt in the first place and can't relate. This problem ends with a calculator and spreadsheet, but it begins with a different attitude than currently being displayed. Traction on this with 4 children and a non earning spouse, a 10% haircut, etc. etc. will take more than a fleeting effort to overcome IMO. It will be 24/7 indefinitely. Making anywhere less than $175k for the situation described in OP will mean either living like a pauper or straight up gambling on the future. In fact, I think there's some gamble involved that can't even be mitigated with scorched earth budget for 2-3 years. Tough situation, there are about 100 ways it could go wrong and about 2 or 3 it could go right, have to be intentional and focused.
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Re: $359k in med school debt; advice for family member

Post by JonnyDVM »

khram wrote: Mon Jul 20, 2020 1:44 pm
physician_finance wrote: Mon Jul 20, 2020 1:35 pm That debt loan is completely reasonable for the situation. The cost of attendance for these schools can approach or exceed 70K per year. Add in undergraduate debt and interest accrual and 360K is easily reached without living extravagantly.
That may be reasonable in the sense of not having lived it up too much (but maybe there were scholarships, we don't know), but it's not reasonable (IMO) to take on that kind of debt for $150k income. Even $250k. Of course it's far too late to say "don't take on this debt, choose a different path."

The fact that some students (dental, medical, even law) are coming out of school with $300-500k in debt is a massive problem. There is no guarantee you graduate, or that you find a good job. IMO more than $50k of debt for a $150k job is a bit high. I am not sure how much lower doctor salaries are in other countries where education costs are more reasonable.

[My comment is a bit more general, not making a distinction between podiatry and medicine, I know.]
Anyone that goes to professional school and comes out with less than 3X that amount of debt is fortunate. This is the norm and it is indeed a problem. The elephant in the room if you will. With a high salary such debt is not insurmountable. Spending those high salaries like water though.....
I’d trade it all for a little more | -C Montgomery Burns
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Re: $359k in med school debt; advice for family member

Post by inbox788 »

physician_finance wrote: Mon Jul 20, 2020 1:35 pm Nothing gets physicians going like conflating medical school and podiatry school. ;)

That debt loan is completely reasonable for the situation. The cost of attendance for these schools can approach or exceed 70K per year. Add in undergraduate debt and interest accrual and 360K is easily reached without living extravagantly.

Option #2 is not good. Even if the terms of 25 year forgiveness don't change, there is a huge tax bomb at the end of the road.

PSLF is a more reasonable options. The media stories about people being denied for loan forgiveness are somewhat alarmist; if you truly work for a qualifying employer, are under the correct plan, document carefully, and are persistent about getting the money, PSLF is a feasible option for current borrowers. Many 501c/non-profit hospitals employ podiatrists and often have good retirement benefits allowing lowering of adjusted gross income used for repayment calculators. At an AGI of 130K and family size of 6, the monthly payment under the PAYE/REPAYE plan will be < $700 a month.

The VA employs podiatrists and has robust loan repayment options.

Finally, if no plan for PSLF then first priority should be private loan refinancing, which in the current economic climate should cut the rate almost in half.
OP said the borrower wasn't excited about PSLF and for good reason. Low pay in public jobs, risks of program changes, strategy optimization requires minimum payment that racks up high interest liabilities if the forgiveness isn't completed.

https://www.indeed.com/cmp/Department-o ... Podiatrist

With the high income, especially in a LCOL area, the large loan is manageable, and the best strategy is budgeting to cut much as possible as long as possible and pay off the 6% loan ASAP. If opportunity to refinance at lower rates (2-4% range) are available (Sofi?), then keeping a loan makes more sense, and taking on a mortgage becomes an option.

Once job situation is steady, because borrower lives in LCOL, there are opportunities where purchasing home makes sense over renting, despite the high educational debt. How much is rent and what the median price of similar homes in the same neighborhood. What's the price to rent ratio? https://smartasset.com/mortgage/price-t ... -us-cities

Apply to REPAYE to minimize payments, but keep making additional payments on highest interest loans and pay off as quickly as possible. Goal should be to extinguish the debt in less than a decade, and it should be an achievable goal. Or at least significantly tame the beast.
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Re: $359k in med school debt; advice for family member

Post by jayk238 »

FrugalProfessor wrote: Mon Jul 20, 2020 12:36 am A family member just graduated podiatry school and residency with $359k in student loans. Here are the relevant parameters:

* All loans are Federal Direct
* Mix of Unsub Stafford + Student Plus
* Weighted avg interest rate is 6.1%
* Married with 4 kids (relevant for disposable income calcs)
* Expected near-term income in the neighborhood of $150k-$250k
* No access to 401k/HSA (relevant for disposable income calcs)
* Does not qualify for PSLF; employed by a normal non-public practice
* Currently renting modest home in LCOL area; would like to purchase home soon

It seems to me that the family member has three potential (and completely divergent) paths:
1.) Suck it up. Eat Ramen, Beans, and Rice for a decade. Throw every penny of free cash flow at paying down the debt. Look to refinance debt at private firm (Sofi, etc), though this option seems to limit future forbearance flexibility in case of financial hardship.

2.) Make minimum payments, defined as 10% of discretionary income (=(AGI-150% FPL)/12). Manipulate AGI to the extent possible (401k if ever becomes an option, HSA if ever becomes an option, etc). Let balance balloon because minimum payments will be insufficient to cover interest expense. Exploit 25Y loan forgiveness in the year 2045, which is considered to be a taxable event, meaning that the effective forgiveness is something like a 60-70% of the loan balance. Or wait for a Bernie-style politician to bail them out sooner. Admittedly this path has a lot of legislative risk; there is no guarantee that this policy will be in place in 25Y.

If they go down this path, my research seems to indicate that the REPAYE payment plan would be optimal because of reduced interest accrual vs other payment plans. If I'm wrong here, please let me know.

3.) Quit their new job and find a job at a non-profit, enjoying tax-free loan forgiveness in 10Y.

The family member has no interest in Option #3 above, so let's scratch that off the list.

A lot of forum members would make the case that #1 is the only ethical route. I don't disagree, but I'm also interested in understanding which path maximizes their expected lifetime wealth.

Since this is a non-trivial financial decision, I thought I'd bounce it off of the smartest group of people I've found on the internet. Thanks in advance for your input!!!!!!!!!!!

Detailed loan info below (sorted descending by balance):
5/13/2014 DIRECT UNSUB STAFFORD LOAN $59,201.49 5.41%
5/11/2015 DIRECT UNSUB STAFFORD LOAN $57,919.56 6.21%
5/2/2016 DIRECT UNSUB STAFFORD LOAN $54,366.89 5.84%
8/26/2013 DIRECT UNSUB STAFFORD LOAN $52,810.34 5.41%
5/2/2016 DIRECT STUDENT PLUS LOAN $41,586.43 6.84%
5/13/2014 DIRECT STUDENT PLUS LOAN $31,671.56 6.41%
5/11/2015 DIRECT STUDENT PLUS LOAN $30,917.29 7.21%
8/26/2013 DIRECT STUDENT PLUS LOAN $24,474.37 6.41%
2/16/2011 DIRECT SUB STAFFORD LOAN $5,712.30 4.50%

If they go Option #2, here's how I calculated their minimum payment amount:
* Healthcare Premiums: $16k
* Standard Deduction: $24.8k
* FPL with 4 kids: $35.16k
* 150% FPL: $52.74k

Discretionary Income = AGI - 150% FPL
Discretionary Income = (Gross - Standard Deduction - Healthcare Premiums) - 150% FPL

Minimum Payments (let me know if this looks wrong):
* $150k gross income => $471 monthly; $5,646 annual
* $200k gross income => $887 monthly; $10,646 annual
* $250k gross income => $1,304 monthly; $15,646 annual
* $500k gross income => $3,387 monthly; $40,646 annual (outside of expected income, but included for illustration purposes)

For reference:
* The monthly interest burden on $359k of debt at 6.1% is $1,825. Any payment less than this will lead to ballooning of balances.
* The monthly payment for a 10Y repayment schedule would be about $4k/month.
I wouldnt classify this as med school as podiatry training is a limited specialty.

Its important because revenue generation is also limited.

250 is on the high end.

300k is probably for an established private practice.
Anything more is likely from ancillary income-ownership etc.

Id wager 150-200 is a reasonable income expectation.

Taking 400k debt for podiatry school let alone actual med school is insane. I would suggest aggressive repayment plan structure. The most aggressive possible.
MSO4PRN
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Re: $359k in med school debt; advice for family member

Post by MSO4PRN »

like others said, he needs to get in the OR and make some RVUs
he also should be reaching out to hospitalists groups/ PCPs in the area (go for more wealthy areas ie PPOs) and be available as possible. (also Infectious disease docs and infusion centers)

podiatry and ortho - foot always are in battle for consults, the nicest, most available one gets called over the (fill in the blank) other one.

also getting in to SNFs, LTACs, Nursing homes and trimming all their nails one saturday a month is how i knew one DPM bought a Tesla
Trader Joe
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Re: $359k in med school debt; advice for family member

Post by Trader Joe »

Your "family member" should look into Dave Ramsey on how to get out of debt.
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StormShadow
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Re: $359k in med school debt; advice for family member

Post by StormShadow »

FrugalProfessor wrote: Mon Jul 20, 2020 12:36 am A family member just graduated podiatry school and residency with $359k in student loans. Here are the relevant parameters:

* Currently renting modest home in LCOL area; would like to purchase home soon

It seems to me that the family member has three potential (and completely divergent) paths:
1.) Suck it up. Eat Ramen, Beans, and Rice for a decade. Throw every penny of free cash flow at paying down the debt. Look to refinance debt at private firm (Sofi, etc), though this option seems to limit future forbearance flexibility in case of financial hardship.

2.) Make minimum payments, defined as 10% of discretionary income (=(AGI-150% FPL)/12). Manipulate AGI to the extent possible (401k if ever becomes an option, HSA if ever becomes an option, etc). Let balance balloon because minimum payments will be insufficient to cover interest expense. Exploit 25Y loan forgiveness in the year 2045, which is considered to be a taxable event, meaning that the effective forgiveness is something like a 60-70% of the loan balance. Or wait for a Bernie-style politician to bail them out sooner. Admittedly this path has a lot of legislative risk; there is no guarantee that this policy will be in place in 25Y.

If they go down this path, my research seems to indicate that the REPAYE payment plan would be optimal because of reduced interest accrual vs other payment plans. If I'm wrong here, please let me know.

3.) Quit their new job and find a job at a non-profit, enjoying tax-free loan forgiveness in 10Y.
I think it's crazy to try to buy a house with that kind of debt.

Option 3 makes the most sense if they can find a place that makes this offer.
Otherwise, I'd go Option 1 and attack those student loans as hard as possible.

IMO, Option 2 is too much of a gamble. A "Bernie-style politician" (i.e. pro-socialized medicine) isn't going to bail out a podiatrist with a six-figure salary.
DarthSage
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Re: $359k in med school debt; advice for family member

Post by DarthSage »

I'd like to point out a rather contrarian position:

Have you even been asked to help/intervene?

You seem to have disdain for the family's lifestyle choices. Really--you're living in the 1950's if you have a SAHP? I'm a SAHM, and my degree is in electrical engineering. We, DH and I, decided this was the best choice for our family. Obviously, many people choose differently--fine with me, it's their choice.

Similarly, their religion, their choice. You don't have to agree, or like it, but it's not up for debate with them.

Your dislike of the wife comes shining through in your posts.

Personally, I'd choose to live frugally, and pay off the debt as quickly as possible. Debt makes me anxious. I don't find it unreasonable for a family to splurge a bit once the big paychecks are coming in. Some people are comfortable with high levels of debt. So long as they're not asking you for a bailout, who cares?

I think you need to check yourself and your own biases before offering any sort of advice. And if your advice in unsolicited, expect it to be rejected.
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calvin+hobbes
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Re: $359k in med school debt; advice for family member

Post by calvin+hobbes »

DarthSage wrote: Tue Jul 21, 2020 5:35 am I'd like to point out a rather contrarian position:

Have you even been asked to help/intervene?

You seem to have disdain for the family's lifestyle choices. Really--you're living in the 1950's if you have a SAHP? I'm a SAHM, and my degree is in electrical engineering. We, DH and I, decided this was the best choice for our family. Obviously, many people choose differently--fine with me, it's their choice.

Similarly, their religion, their choice. You don't have to agree, or like it, but it's not up for debate with them.

Your dislike of the wife comes shining through in your posts.

Personally, I'd choose to live frugally, and pay off the debt as quickly as possible. Debt makes me anxious. I don't find it unreasonable for a family to splurge a bit once the big paychecks are coming in. Some people are comfortable with high levels of debt. So long as they're not asking you for a bailout, who cares?

I think you need to check yourself and your own biases before offering any sort of advice. And if your advice in unsolicited, expect it to be rejected.
I completely agree. OP is wondering why the tone of posts is negative, it’s because the facts that have been provided include your own personal and unnecessary commentary which paints the relative, spouse and some of their views in a bad light.

Back to the original question: I vote for minimizing expenses, refinancing and slamming those loans over 5-10 years. It can be done, families of 6 can live off of 72k of take home pay. It’s not going to be fancy vacations and million dollar homes for awhile and that is the price to pay for this level of debt and salary.

The other option would be to relocate or find a job in an underserved area or with the government which offers loan repayment assistance. These offers, sometimes in more rural areas, are typically options for MDs/DOs. Not sure about podiatrists but well worth looking in to.
Deighve
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Re: $359k in med school debt; advice for family member

Post by Deighve »

I would just mention the Whitecoat investor website and book. I think that would be the best place to start.
EddyB
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Re: $359k in med school debt; advice for family member

Post by EddyB »

PQ12$ wrote: Mon Jul 20, 2020 12:50 pm
4 kids, a strong marriage, an MD degree at 30 -- sounds like this guy has been busy doing some significant things in his short life. Pretty impressive. My bet is he figures it out.
Except that he’s not an MD and there was concern about the wife leaving because of the debt. 4 kids, though.
FishTaco
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Re: $359k in med school debt; advice for family member

Post by FishTaco »

Is your family member W2 or 1099 for his new position?

If 1099, a whole world of retirement options become available to the motivated. If it was me, I would try to withhold as much as possible in order to drop my AGI. That is also a lifestyle decision that they may not be interested in.

It would be prudent to do some realistic calculations regarding how much will be paid on the loans as is, with 25 yr forgiveness, and PSLF. I did similar calculations when I got out of school and realized that the payments through PSLF would be about equal to quickly paying off the loans.
Locked