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ATTENTION: Debt-Laden Young Physicians Who Want To Grow Their Family


A young physician couple find themselves at the dawn of their careers, and now they want to start a family. Turns out starting a family could have implications for how and how fast they repay their medical school loans.

Tick… tick… tick…. The biological clock may be ticking.

I was meeting with a wonderful couple the other day, two neurologists. They are just transitioning into practice and they are so excited!

Their income is going to be awesome and they’ll have so much cash flow they won’t know what to do with it. Okay, okay, I’m sure they’ll figure out some ways to spend that dough. =-)

In reviewing their financial situation, we came to the tough question of debt.

He has more than $300,000 in medical school debt and she has more than $200,000 in medical school debt.

Here they are

having gone through undergrad, gone through medical school, gone through residency, and now gone through fellowship

in their mid 30s and left with a mountain of debt.

Time is running out! Tick… tick… tick… Her biological clock is ticking and they want to start a family.

They both have enrolled in Income-Based Repayment (IBR) plans and have been minimizing their payments, while checking off the days towards the Public Service Loan Forgiveness (PSLF) program, which will allow them to become debt free.

(Make sure to check out this article and this article for more information on these programs.)

However, when we talked about their future plans and their family. I wondered whether or not this was the right move.

You see, after having their first kiddo, she is mulling over cutting back down on work to half-time, a 0.5.

I thought that was great and wonderful, but it doesn’t work for IBR & PSLF!

PSLF requires that you work FULL-TIME to get your credit for the year. According to, “You are generally considered to work full-time if you meet your employer’s definition of full-time or work at least 30 hours per week, whichever is greater.

"If you are employed in more than one qualifying part-time job at the same time, you may meet the full-time employment requirement if you work a combined average of at least 30 hours per week with your employers.

This is very interesting: You have to meet your employer’s definition of full-time OR work at least 30 hours per week, whichever is GREATER.

In this case, half-time at 20 hours or 25 hours per week isn’t going to cut it. Those years that she takes to still work BUT not work full-time and raise her family will NOT count toward the 10 years needed to qualify for the program!

Thus, I was pushing them towards having the neurologist husband's loans work towards IBR/PSLF as planned. After all, we are talking about more than $300,000 in potential forgiveness!

However, we need to change it up for the wife neurologist’s loans. I emphasized that we should refinance her loans through SoFi, DRB, or another loan consolidator.

I ended up listing off five different reasons why I thought this was important:

1)That she was considering going half-time.

2)This ensures no matter what happens with the government & PSLF, that about half of their loans are in their power and thus can be erased on their terms.

3)It immediately lowers the interest rate on her loans.

4)Once they have their debts paid off, it allows her to have the freedom to quit altogether and stay home with the kids if she wishes.

5)This makes an unknown variable a known variable that will make it easier to plan.

You should have seen the look they gave me.

Their noses crinkled, eyes blank, and heads dipped downward. The room was very quiet.

They struggled with the idea and to be honest, have yet to implement it.

I worry about them and can audibly hear the biological clock going going tick…. tick… tick…

Dave Denniston, Chartered Financial Analyst (CFA), is an author and authority for physicians providing a voice and an advocate for all of the financial issues that doctors deal with. He is the author of 5 Steps to Get out of Debt for Physicians, The Insurance Guide for Doctors, The Tax Reduction Prescription, and his new book, The Freedom Formula for Physicians.

He’s glad to answer any questions about insurance policies or other financial matters. You can contact him at (800) 548-1820, at, or visit his website at to get a copy of The Freedom Formula for Physicians.

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