IF YOU TOOK OUT LOANS TO fund your medical training, you’re in good company. Sixty-seven percent of 2023 medical school graduates accrued debt from their medical training, reports the Association of American Medical Colleges’ latest annual Graduation Questionnaire. The median total? A whopping $200,000. Despite the prevalence and enormity of student debt, your loan figures may feel nebulous—what’s another 0?—until it’s time to start paying them back.

“I kind of equate student loans [with] Monopoly money,” says Scott Geiger, M.D., a urologist practicing in State College, Pennsylvania. “[It] doesn’t really become real until you start thinking about your first job.”

It’s true: Whether you start paying back your loans during residency or after, it may not be until you’re getting a paycheck that you get a handle on what your debt truly means. This is due in part to the lack of financial education available to medical trainees and is compounded by the presupposition that a high earning potential makes debt no big deal.

“There’s a notion that doctors are going to be rich, and even though they have a lot of student loans, who really cares about that?” says Nii Darko, D.O., a New Jersey-based locum tenens trauma surgeon who hosts the Docs Outside the Box podcast with his wife, Renée Darko, D.O., a locum tenens OB/Gyn. But “most people who go into medicine are going in for very altruistic reasons. …[They] aren’t prepared for the economic repercussions of what it does to them, the student loan that they have to pay.”

As you’ll soon learn, both Geiger and the Darkos tackled their own multi-six figure debts in remarkably short order. They serve as proof that you, too, can make a plan to pay back your loans.

Slash your debt by sticking to a residency budget

step 1: Face the numbers.

The first step in tackling your debt is to look the figures in the face. The longer you put it off, the larger they’ll grow. Geiger finished medical school in 2016 more than a quarter of a million dollars in debt.

“I’m quite debt-averse, so it did not leave me feeling good,” he says of his loan figures. And though he made income-driven loan repayments in residency to keep his debt from ballooning, not every physician shares this experience.

The Darkos finished medical school in 2006 with $240,000 in debt each — a combination of loans from undergrad and their dual-degree medical school and business school programs. But they had received little guidance on how to tackle their debt, so after the six-month grace period for loan repayments elapsed, their debts began to snowball.

“I didn’t really understand how to seek help from Sallie Mae and the student loan servicers [to set up] payments that [were] more consistent with how much I [was] actually bringing in as a resident,” says Nii Darko.

As a result, he got stuck in a cycle of forbearance. “I just stopped answering phone calls from Sallie Mae,” he says. “I would only speak to them when it was…time to either default or forbear. And in order to get them off my back, I would just forbear. And this cycle happened for literally five to six years. …Maybe I’d make like a $100 payment here and there, but I just was really struggling.”

Renée Darko’s story was the same: “Superimpose it,” she says.

By the time they married in 2013, their debts had grown nearly 40%. “We were starting to put our finances together, and I think I’m in the $240,000 range, and she was thinking the same thing,” says Nii Darko. “And you go back online and [realize], no, actually during those six years of forbearance, we added on an additional $90,000 of interest. So it actually became $330,000 each.”

This type of realization can feel like a gut punch, but it’s also the catalyst for fostering your own financial education and developing your game plan.

step 2: take your financial education into your own hands.

Nervous about his debt accumulation, Geiger had begun reading about personal finance during his fourth year of medical school. “You probably need to take your financial education in your own hands, and the sooner you do it, the better,” he says.

But, as the Darkos demonstrate, it’s never too late. They began their personal finance education when they were newly married — and newly sharing that $660,000 of debt. They turned to podcasts to get the information that they hadn’t received elsewhere.

“We got our MBAs, and we [still] didn’t understand much about budgeting, at least from a personal finance standpoint,” says Nii Darko. “I started really consuming podcasts … We started to realize that from a what-was-coming-in, what-was- coming-out on a monthly basis [standpoint]…we weren’t very disciplined.”

It wasn’t that they were overly spendy. They just hadn’t learned to be intentional with their money. “We actually never had lifestyle creep,” he says. “It was really just the cost of entry to becoming physicians.”

step 3: Find your payoff motivation

With your debt figures clear and some financial education under your belt, you also need to identify your why. What is the debt costing you, beyond just the money?

The Darkos wanted to be closer to family but couldn’t afford it. For others, including Geiger, the mental weight of the debt may serve as motivation enough. “The debt really bothered me,” he says. “So I knew my goal was to pay it down as quickly as possible.”

step 4: Develop a plan and a timeline

Geiger developed a plan: Find an attending job that offered loan forgiveness, maintain a modest lifestyle and become debt-free quickly.

“You’re much less likely to follow through with anything if you haven’t formulated a plan,” says Geiger. “My recommendation is, [as] the White Coat Investor says, to live like a resident for a few years,” citing the famed motto of James Dahle, M.D.

He ended up taking a job that offered $150,000 of loan forgiveness over three years. “After taxes [that’s] about $99,000,” he says. “So that cut out about a third of my loan.” This also helped him establish a timeline to pay off the loans: two to three years.

The Darkos initially planned to pay off their debt over 15 years, but with their sights set on moving near family, they landed on a much shorter timeline.

“I started thinking, well, does that mean that we will [spend] 15 years away from our family?” says Renée Darko, who decided to call Sallie Mae and ask for iterations of three-, five- and 10-year payment plans. “I determined that, you know what, a three-year payment is doable.”

The shorter timeline lit a fire under them. “I kind of ambushed [Nii] at the door when he came home from work that day,” says Renée Darko. “I was like, ‘We’re going home in three years. We’re going to be able to pay this off in three years.’”

step 5: Get aggressive with the debt

In order to achieve their goals of rapid payoff, both Geiger and the Darkos had to pay down their debt aggressively.

“The minute I started getting paychecks, I was paying anywhere from $5- to $10,000 a month on top of the $33,000 lump sum I would dump into them every year when I got the [loan forgiveness] installment,” says Geiger.

The Darkos began tackling their debt by making a no-new-debt pact. Their next step was to cut unnecessary expenses and earn extra money while living on less. “We decided to rearrange our budget, get rid of certain things,” says Renée Darko. “We [became] very deliberate and intentional about where our money was going.”

They switched from whole life insurance to term life insurance, restricted dining expenses and even limited themselves to a $200 monthly grocery budget. They also did locums work on the side whenever they weren’t on call.

step 6: try not to put your life on hold

Paying off debt rapidly doesn’t have to mean putting your life on hold, but it does mean not every expense can be a priority.

Geiger and his wife still bought a house while paying off their loans, but they bought below their means. They also married while paying off debt, but they waited until they could fund the wedding themselves, without their families’ savings.

For the Darkos, a new house was not a priority, but growing their family was.

“We did want to start our family and realized that we were having trouble doing that,” says Renée Darko. “We decided to go the route of IVF, which, as you can imagine, is extremely expensive, but we said we were not going to create any more debt.”

They decided that she would forgo travel locums jobs so that she could complete her IVF treatments and that he would, as he puts it, “Pack my bags and go yonder and go work,” i.e., take on locums jobs. (And though the IVF itself was unsuccessful, they did manage to grow their family thanks to two spontaneous pregnancies!)

An aggressive debt repayment plan is only sustainable if it does not require you to sacrifice the priorities that are truly important to you and your family. The ones that aren’t, however, can wait.

“We didn’t buy any new vehicles until after our loans were paid off,” says Geiger. “I was driving a 2008 Toyota — that wasn’t a goal physician car, but I never felt like I was sacrificing a good quality of life.”

step 7: Don’t skimp on savings

Despite being aggressive with their debt repayments and selective about their expenses, Geiger and the Darkos did not allow themselves to slack on their savings.

“I was aware of compounding interest with investments, so I was maxing out all the other tax [advantaged] savings accounts,” says Geiger. He maxed out a Roth IRA as a resident, then switched it to a backdoor Roth as an attending. He also maxed out the employer- offered 403(b), 457(b) and Health Savings Accounts. To further protect himself financially, he also got disability insurance.

The Darkos also saved as they tackled their debt, specifically focusing on savings that received an employer match.

They also funded their traditional IRAs and had a six- month emergency fund, but, like Geiger, they waited to build a brokerage account until after they paid off their debt.

step 8: Find freedom from the experience

In the end, living like a resident after residency did allow Geiger to pay down all his debt in just two years. His wife, who is an OB/Gyn, also managed to pay off her loans in two and a half years.

The Darkos, too, achieved their three-year payoff goal by deliberately sticking to a budget. But, as Nii Darko points out, it felt different than residency because this time around, they got to experience the freedom that budgeting brings.

The Darkos also found the flexibility of locums work to be freeing, and they eventually switched entirely to locums. In that way, the work they put in to pay off theirdebt helped them find more freedom in their finances, in their career choices and in their lives.

Choose which gratification to delay

If you pinched pennies through med school or barely got by in residency, you may experience the understandable temptation to live large once you get your attending salary. But you’ll ease your transition to practice and set yourself up for financial success if you live like a resident just a little longer.

“I think a lot of people want to rush to get a house and a car and start their life,” says Geiger. “[But] if you get rid of this debt, then you’re going to have a lot of extra income to do whatever you want. …Delaying it for another few years was not the end of the world.”

The truth, as Renée Darko points out, is that you’re delaying gratification either way.

“The question in terms of student loan debt…is which gratification are you willing to delay?” she says. “Because if you decide, I want to get the biggest house…the cars…everything, then you’re essentially still delaying the gratification of being out of debt.”

In the end, paying off your debt—or getting on the right plan to pay it off—will afford you the freedom to make the best career and life choices for you and yourfamily. And as Geiger and the Darkos demonstrate, that freedom may be closer than you think, perhaps just two or three years away. •