How should I manage my student loans in residency?

Student loan management as an attending is very straightforward (refinance unless going for PSLF). As a resident, it can be far more complicated. In fact, this is one of the most complicated financial decisions a doctor ever faces and a great time to consider professional advice.

For most residents, enrolling in REPAYE even before graduating from medical school is the best choice because REPAYE effectively subsidizes your interest rate and all of those payments count toward the 120 required payments for PSLF.

However, if you are married to another high earner, you may wish to file your taxes Married Filing Separately and enroll in PAYE instead of REPAYE. If you are going for PSLF, you may also wish to switch from REPAYE to PAYE at the time of residency graduation in order to maximize the amount forgiven.

Finally, private loans (i.e. those not eligible for REPAYE or PSLF) can be refinanced even as a resident while still keeping payments low. Deferment of student loans during residency is usually a mistake.