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Meet Altelisha Taylor, a family medicine physician, and get clear insights into student loan repayment options. We discuss the Public Service Loan Forgiveness (PSLF) Program and discuss options to address medical school debt as a new attending.

Altelisha Taylor is a family medicine resident and can be reached at Career Money Moves.

She discusses the KevinMD article, “What are the best student loan repayment plans for medical students and residents?”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Altelisha Taylor. She’s a family physician and a sports medicine specialist. Today’s KevinMD article is titled “What are the best student loan repayment plans for medical students and residents?” Altelisha, welcome back to the show.

Altelisha Taylor: Thank you for having me. It’s been a long time since we’ve spoken, so it is nice to be back.

Kevin Pho: I think the last time that we spoke was about two and a half years ago, and you have finished all your training. Now you’re out there in the wild. So tell me, how has your story been since we last spoke?

Altelisha Taylor: I guess first I’ll start with medical training. We spoke when I was a resident. I finished residency, thank God, and I matched into a fellowship in sports medicine, so I moved from Atlanta to LA, where I did my sports medicine fellowship. It was one of the best years of my life. I was an assistant team physician for the Lakers, for the Dodgers and for a lot of the UCLA sports, so that was amazing and fantastic. I finished fellowship and moved back to Atlanta to get ready to start my attending job. It’s been a long time coming. I’m so excited medical training is over for me, so that’s one part of my life where I’m just glad that it’s happened.

The other part is the financial wellness part. I love to help doctors with financial wellness, because I believe one of the best things that money can buy is control over your time, and that’s one of the things that I feel like a lot of doctors don’t have. So I usually spend a lot of my time teaching doctors about financial wellness, whether that is doing financial workshops or writing blogs and articles. I just joined this amazing company called Attend, which is a comprehensive financial platform for doctors. We help them with their student loans, we help them get disability insurance, we help them find out all of the things that they need to do to master this transition from training to attending. So I’ve been doing that, and then I’ve been co-hosting a podcast, Money Meets Medicine. So it’s been busy, but it’s been rewarding. I’m passionate about it all, if you couldn’t tell, so it’s been a lot.

Kevin Pho: Fantastic. So tell me about that transition from training to attending. How has that gone?

Altelisha Taylor: It’s been, well, let me be honest. I always tell people I like to be HOT: humble, open and transparent. So I finished training, but I haven’t yet started my new attending job. I start next month. This whole break has been very lovely, but I’m excited. One thing I’m excited about is obviously higher pay. The other thing is being able to finally set down roots in one city and not having to move from place to place because of the match. And then the other thing is to finally be able to practice on my own. I have been a trainee for quite some time, and that has its own joys and struggles, but it’s nice to finally be the person that’s in charge, to be able to take ownership for my patients, to not have to worry about telling my patients that I’m going to leave in a year or two years. So it’s been nice, and I’m excited about the future.

Kevin Pho: I want to talk about that other arm of your professional profile, which is the financial wellness part. How did you get the training and knowledge to be confident enough to guide other clinicians in their own financial wellness journeys?

Altelisha Taylor: That’s a question. I think it’s twofold. One is my own education, and two is experience. I am not a financial advisor; let me state that very clearly now. But I did work in finance before I went to medical school. I took a few econ courses in undergrad. I went to Duke for undergrad, and I was part of the Duke Financial Educational Partnership. That is a program that helped connect undergraduate students with mentors on Wall Street, so I did a Barclays analyst day, and I had mentors at a lot of the big banks. I had a mentor at Goldman Sachs and a mentor at Morgan Stanley, so those are some of the big Wall Street banks. So I had some introduction to finance from there. When I finished undergrad, I spent a year working at the Center on Budget and Policy Priorities, so I had some health policy finance experience, and then I worked in private capital in Washington, D.C., for a year before going to medical school. So I think part of this is my own personal experience working in finance and getting some of that education, and then, oh, it’s just passion and interest.

I’ll be really honest and say one of the things that really motivated me to want to help other doctors in this area was when I actually decided to do family medicine as a specialty. I knew that I wanted to do sports medicine; that was always the end goal. But because sports medicine is a subspecialty, you kind of have to choose a primary specialty first. When I was in medical school, it was really hard for me to decide: Am I going to go the primary care route to sports medicine, or am I going to go the surgical route to sports medicine and go through orthopedic surgery? I was really having a hard time deciding one versus the other.

It was interesting. I was actually sitting on my couch, I think it was the beginning of my fourth year of medical school, and my dad called me, and he could tell that something was bothering me. He said, “Altelisha, what’s wrong? What’s wrong?” I finally got the courage to tell him, and I said, “You know what, Dad? I’m having a hard time figuring out which specialty I’m going to go into. I’ve got to be honest and say I really love family medicine. I love all that it’s about. I love talking to my patients. I like the relationships that I get to have with them. I like that I get to see patients from the time they’re babies to the time that they’re elderly adults. I love that family medicine has this emphasis on public health and public policy. I really do feel like it’s right up my alley. But, Dad, I can’t ignore the money that I could be making in orthopedic surgery. I can’t ignore the fact that I would go to school for maybe an extra year or two of training and make substantially more money.” I said, “Dad, it just doesn’t make financial sense for me.”

And he said, “You know what, Lisha? I hear what you’re saying, but at some point you’re going to have to define success for yourself. At some point you’re going to have to stop living your life for other people and do the things that make you happy. If money is your primary concern, if money is the reason why you’re having trouble making this decision, then why don’t you just start learning more about investing? Why don’t you start learning more about ways to pay down this debt? Why don’t you start learning more about other avenues where you can still have the wealth that you desire and have the life that you desire, but also have the career that you want?” And so that was the motivation for me.

Kevin Pho: So on today’s podcast we’re going to focus on one financial aspect that is on the minds of a lot of medical trainees, which is how to repay their student loans. I was on one of those Facebook financial groups, and there was a primary care physician who posted her student loans. It was in excess of $400,000, and she was wondering how she was going to pay that all off on a primary care salary. So I think today’s topic certainly is very relevant. Your KevinMD article is titled “What are the best student loan repayment plans for medical students and residents?” So tell us, how did your article come about?

Altelisha Taylor: I actually wrote this article a little while ago, when I was looking into the different student loan repayment plans. Similar to the person that you spoke about, I also have student loans, not quite that high of a burden, but around the average. Statistics today show that the average medical student has around $250,000 in student loan debt, and I am certainly in that middle. So when I came out of medical school and I realized I had this large student loan burden, similar to the person you spoke about, I was wondering, what are my options? Am I just supposed to live with really frugal means until I’m able to pay this thing back, or are there other options available to me? So I started looking into this. Are there student loan forgiveness programs? Are there repayment programs that would make it more affordable? That’s really how this article came about, because I wondered, and it wasn’t just me that had this question. A lot of my friends were wondering as well.

I wrote this article during a time when not a lot of people knew about Public Service Loan Forgiveness. They hadn’t revamped the income-driven repayment plans at that time, so things were quite confusing. You would call your loan servicer and they would tell you one thing, and then you would call back and speak to a different person and they would tell you something else. So it was really hard to get good information about the different repayment plans, and I thought, “Man, if I wondered this, I should probably write this down and share it with other people so they’re knowledgeable as well.”

Kevin Pho: So let’s get everyone on the same page, for some context. If you have a medical trainee who just finished residency and now they’re obviously an attending, just list out the repayment options that they’re confronted with.

Altelisha Taylor: I always tell people, you know what, there are two big buckets, if you will. There are the people that know they’re going to end up repaying their loans themselves, so these are the “I’m paying it back myself, and I already know that” people. And then there are people that are like, “I’m trying to get my loans forgiven. Look, I’ve got a big loan burden. It’s not realistic for me to pay these back. I’ve got kids, I’ve got a spouse, I’ve got other uses for my money right now, and there’s just no way I could pay down this burden.” So I’ve got the “I’m going to pay it back myself” crowd and the “I’m going to try to get it forgiven” crowd, and once we figure out which crowd you’re in, or what makes the most sense for you, then we can really make a plan of action for you.

Kevin Pho: All right, so what kind of questions should one ask themselves in order to place themselves in one of those two buckets?

Altelisha Taylor: I always tell people, let’s figure out the basics. Let’s figure out where you are starting from. That is usually my step one. What do I mean by that? I mean, let’s log into StudentAid.gov, let’s get the courage to look and see what that number is, and let’s figure out, number one, how much do you owe? How much do you owe? I have some people that have really large student loan balances, and I’m like, “You know what? It probably isn’t realistic for you to pay this back, so we need to figure out a way for you to get it forgiven.” And then I have other people that have really small loan balances, and I’m like, “OK, maybe this is more feasible for us.”

So, figuring out how much you owe. Figuring out how many different loans you have; usually you get a loan for each semester that you were in medical school or each semester that you were in undergrad. How many different loans do you have? What is the interest rate on those loans? What’s the fee that you’re being charged to have the loan in the first place? What’s your loan servicer? Usually when people have federal loans, they are given a loan servicer, which is the company that you actually use to repay the loans. Who’s your loan servicer? So these are some of the basics where I’m like, “OK, let’s figure out where your starting point is.”

And then let’s understand all of the different options that may be available to you, and that really depends on where you are in your training. Are you a resident? Are you an attending? Are you someone that’s open to switching jobs? Let’s see, does your employer qualify for Public Service Loan Forgiveness? Are there other loan forgiveness programs that you may be eligible for? I find that a lot of physicians tend to focus solely on Public Service Loan Forgiveness, because it is a great program, but that program may not be good for one person, or it may not be applicable to everybody. So there are other loan forgiveness programs that people sometimes forget about. There’s that default income-driven repayment forgiveness that will forgive your student loan burden after you’ve made 20 to 25 years of payments. There is a faculty repayment program where, if you are faculty at a medical institution, they’ll give you $40,000 towards your student loans every two years. There are these other loan forgiveness programs if you work in rural areas, if you serve underserved people. So there are all of these different loan forgiveness programs that I think people sometimes aren’t aware of or forget about. So let’s really figure out what options are available to us. So number one is figuring out where you are, and number two is knowing your options.

And then number three is, if you’re in this transition period, if you’re not sure what you’re going to do for the rest of your career, if you’re not sure what your attending job is going to look like, then I usually tell people, “All right, let’s just pick a plan that’s affordable for you now.” So let’s pick out the most optimal income-driven repayment plan, especially if you’re someone who’s got federal student loans. These plans have changed so much over time. There’s the Biden repayment plan, which is now called SAVE; it stands for Saving on a Valuable Education. He’s come up with that plan, and that plan just hit the market in July, so maybe you might want to look into that plan. There are some other income-driven repayment plans that may be more suitable for some attendings that have a higher income. So let’s really run the numbers and figure out which plan you should enroll in that will give you the lowest monthly payment, or which plan you should enroll in that will have you paying the least amount on your loans over a period of time. So it’s really selecting the most optimal income-driven repayment plan.

And then lastly, if your employer qualifies, then why don’t we just enroll in the Public Service Loan Forgiveness program? This is a program that is free. It is not binding, meaning if you decide to sign up for it and then you change your mind later, it’s not like you owe any money. It’s not like there’s any penalty. So there’s really no harm in signing up for it. So let’s just get you signed up for this program, let’s get you in the most optimal income-driven repayment plan and let’s continue to check in with you every six months or a year and make sure that that’s still the right plan for you.

Kevin Pho: So let’s talk more about the Public Service Loan Forgiveness program, because that’s the option that I see come up most frequently on the loan forgiveness pathway. You mentioned a little bit about that program, but tell us a little bit more. What kind of commitment does a physician need in order to continue qualifying for that program? How much of that loan is forgiven? Just give us a little bit of the nuts and bolts of that program.

Altelisha Taylor: Absolutely. There are four eligibility criteria for this program. Number one is that you have to work for an eligible employer. What is that? That is usually an employer that is a nonprofit institution, a governmental institution or an academic institution. And because those three things are so broad, a lot of physicians do actually qualify. So if you’re not sure, what you can do is take a look at your pay stub. There’s something on your pay stub called an EIN number. It stands for employer identification number, and you can plug that into the federal PSLF Help Tool, and they’ll let you know if your employer qualifies. So number one, you’ve got to work for an eligible employer.

Number two, you have to work at least 30 hours per week. That is what, in the eyes of the Department of Education, is considered full time. So as long as you work at least 30 hours per week, then that’s good.

Number three is you have to be enrolled in an income-driven repayment plan, so you have to select a payment plan where you’re making monthly payments based on the amount of income that you bring in. And there are four different income-driven repayment plans that you can select from. There is Pay As You Earn; there is Revised Pay As You Earn, which is now called SAVE; there is Income-Based Repayment; and then there is Income-Contingent Repayment. So you’ve got to choose one of those income-driven repayment plans.

And then the last thing is that you have to make at least 120 payments, or 10 years’ worth of payments. Those payments do not have to be consecutive. So you can get your payments in during residency, take a few months off before starting your attending job and then resume those payments. You can get a job in private practice for a couple of years, make a lot of money and then go back to an academic job, and it’ll continue to count. But you need to make at least 10 years’ worth of payments.

So I’ll repeat those one more time. Number one, you’ve got to work for an eligible employer. Number two, you need to work at least 30 hours per week. Number three, you need to be signed up for an income-driven repayment plan. And number four, you have to make at least 120 payments, or 10 years’ worth of payments.

Kevin Pho: I just want to be clear in terms of the settings of these eligible programs. They’re not necessarily solely focused on rural areas? Is it feasible to have eligible employers in cities and in non-rural areas?

Altelisha Taylor: Yeah, absolutely. I did my residency at Emory, which is in the thriving city of Atlanta, and it qualifies. I did my fellowship at UCLA in Los Angeles, sunny California, and it qualified. So it’s really about who signs your checks. If the person that signs your checks, or that employer, is a nonprofit institution, an academic institution or a governmental institution, then you qualify. So this is not based on whether or not you work in a rural area or an urban area. This is all based on the classification of your employer.

And another good thing about this program is that, as it stands right now, there is no cap or limit to how much student loan debt they will forgive. I have seen doctors get $400,000 of student loans forgiven, $500,000 of student loans forgiven, $200,000 of student loans forgiven. So there is no cap. If you meet those four qualifications and you’ve made your 120 payments, they will forgive your debt.

There is actually a Facebook group, I think it’s called PSLF, which stands for Public Service Loan Forgiveness, Eligible Physicians. If you type that in, you can join that group. There are tens of thousands of people in that Facebook group, and you’ll see the stories of people saying, “Oh, man, today was my forgiveness day. I got my loans forgiven,” or “Oh, man, I’ve got one month left. I can’t wait.” People say, “You know what? I got my loans forgiven last year. I didn’t even think it was possible, but it happened for me.” So I really want to give people some assurance that this program does work.

I know a few years ago there were all these headlines in the news saying that people were applying for this program and getting denied. They have revamped the program since then. They have put in so much more information about how people can get forgiven. And remember, this is something that President Biden really wants to do. He really wanted to do a sweeping forgiveness program for everybody, but that wasn’t approved by the Supreme Court. So one of his ways of still giving people this forgiveness was relaxing some of the rules for the Public Service Loan Forgiveness program. So this is a program that is real. This is a program that physicians are using to get their student loans forgiven, and it may be a good avenue for you to get your student loans forgiven.

Kevin Pho: We’re talking to Altelisha Taylor. She’s a family physician and a sports medicine specialist. Today’s KevinMD article is titled “What are the best student loan repayment plans for medical students and residents?” Altelisha, earlier on in our conversation you mentioned so many options that new physicians are confronted with when it comes to addressing their student loans. Is there a central place where someone can go to evaluate these options rather than going to them individually? What resources do you recommend for that?

Altelisha Taylor: Yeah, I’m so glad that you asked. I just joined a company with my podcast co-host, Dr. Jimmy Turner, and that company is called Attend for Doctors. We’ve got a free app. If you go to the App Store, if you’ve got an iPhone, and you type in Attend for Doctors, there is an app there. You can make a profile, you can sync your loans, and we’re going to help you out. We’ve created a Public Service Loan Forgiveness quiz. We’ve got a Public Service Loan Forgiveness tracker that can keep track of your payments for you. We’ve got reminders to remind you to certify your income. We’ve got a financial checklist to remind you of different things that you may need to do. So I would recommend that first; again, that app is completely free.

Number two is my blog website, CareerMoneyMoves.com. You can go on there and click, and I’ve got a bunch of blogs and articles that will give you a lot of information. Number three is my personal website, DrLishaTaylor.com. You can go on that one and also get some information. And I mentioned that Facebook group, PSLF Eligible Physicians. If you’ve got a question, you can ask it in that group, and not only myself but a lot of other doctors chime in and answer questions that people have regarding the program. So I would start with those four resources as a good place. And of course, you can always go to the federal student loan website, that’s StudentAid.gov, and they have a frequently asked questions tab about Public Service Loan Forgiveness if you want to look there as well.

Kevin Pho: And my final question, Altelisha: Tell us some of the take-home messages that you want to leave with the KevinMD audience.

Altelisha Taylor: Yeah. With student loans, the payments are getting ready to restart, and I want to make sure that you’re not caught by surprise. So my take-home message is really to get a plan for your student loans. That means figuring out the basics: How much do you owe? Who is your loan servicer? How much is your payment? It means knowing your options, whether you’re getting it forgiven or you’re going to pay it back yourself. It means selecting the most optimal income-driven repayment plan for you and enrolling in Public Service Loan Forgiveness if you’re eligible.

Kevin Pho: Altelisha, thank you so much for sharing your time and insight, and thanks for coming back on the show.