Thread by @tjwebbmd

"Live like a resident for a few years so you can pay off your debt" appears to be a bit of a controversy right now.

I finished college with $0 in debt and about $1,000 in savings. By the end of residency in 2016, my med school loans had grown to $470,000.

2/ My living like a resident included a lot of awesome factors. I was married; we had 2 children and an awesome dog we had adopted in med school. We had a reliable baby sitter and went on dates semi-regularly. We had a little rent house that was fairly priced. We had two cars.

3/ If we had continued on my resident salary- or given ourselves a 50% raise- and used the rest of my new income to pay loans, we would have been able to pay off my med school debt in about 5-6 years.

That does sound really nice, but I don't think it would have been sustainable.

4/ First of all, it would have been terrible financial advice. When we graduated from residency we had about $5,000 in savings. We were quite proud of that, and it would have paid our rent for several months...

5/ But I don't know any financial advisor who would tell us to use 80% of our income to pay on non-transferrable federal student loans with so little to fall back on. But the moment you divert 25% or 50% of those payments to savings, that 5-6 years stretches substantially.

6/ If we had lived on a resident salary and put 75% of the rest towards loans and 25% towards savings, we could pay off our loans in 7.5 years. If we did 50/50, it would be 13 years; longer than the service period for Public Service Loan Forgiveness.

7/ In residency our grocery budget was $200 per month. My spouse was amazing at stretching that for our family of 4, but I took a lot of my meals at the hospital and we still had fights over me eating a piece of fruit meant for one of the kids. The grocery budget had to increase.

8/ One of our two cars was a 6 year old Hyundai we had bought in med school; the other was a 16 year old Honda my spouse got when she started college. Both had issues. The Honda had a window held up with a rubber spatula wedged in the door frame...

9/ I replaced 3/4 of the window lift mechanisms, the starter, lots of other parts... But we knew we would need to replace the car soon, and I had already run to work out of necessity more often than I could count. We also wanted more kids and neither car would hold a family of 5.

10/ We lived in a city where housing prices were rising steadily; we had already seen huge price increases while we were in residency. Continuing to rent for an additional 5-13 years would have been a very bad move if we ever wanted to own a home.

11/ We also gave/give away a significant portion of our income, and we couldn't morally justify keeping our charitable giving at our residency amount when we were suddenly making more money, just to divert that money to paying off loans. It just didn't feel right for us.

12/ Lots of other small things; my spouse and I hadn't really bought new clothes in about 6-7 years, there were home projects we really needed to complete but couldn't afford, I didn't have adequate life or disability insurance; things like that.

13/ To summarize, if we had continue to rent for 5 more years, kept no money in savings, kept a $200/mo grocery budget, decided not to have more children, used unreliable transportation, and had no unexpected expenses, we could probably pay off our student loans in 5-6 years.

14/ Let me just pause to say that for many people the life I've described would be a dream; $200 a month for food, a safe home, and cars that pretty much work would all be godsends. I absolutely recognize that, even with crushing student loan debt, I'm incredibly privileged.

15/ But committing to those sacrifices, even those financial errors, didn't feel like wisdom just to pay off student loans, when there were other possibilities; like Public Service Loan Forgiveness, state repayment programs, or the possibility of student loan cancellation.

16/ We did pay fairly aggressively on our loans. We also bought a reasonably priced house and a used minivan, and put some money in savings. Today I still owe about $225,000; about what I had originally borrowed to attend medical school. Our grocery budget is $800/month.

17/ This is the year we would have paid off my student loans if we had gone with the "live like a resident" plan in earnest. On reflecting over the past 6 years and the financial stressors we've had and choices we've made, I can say is that the advice seems good on the surface...

18/ But ultimately it's based in a tremendous amount of privilege and assumptions about privilege. Lots of factors have to be in place already for it to be sound advice; things like housing, savings, and other financial and non-financial resources.

19/ I know many residents who live on the edge of poverty as is; one financial set-back or unexpected expense will tip them over. Those financial stressors are a huge psychological burden, especially for folks working 80+ hours/week.

20/ Telling them to start taking the first 70% of their paycheck and sending it to the federal government for the next 5 years is a little tone deaf... Many need to spend some time and money first just becoming financial secure and experiencing the peace that comes with that.

21/ Moreover, when they graduate residency many physicians are now the highest earners in their families and financially support family needs like education expenses, weddings or funerals; this is a deeper moral obligation than paying off their loans as quickly as possible.

22/ "Live like a resident" is good advice if it means "don't buy a speedboat" and "you don't need a mansion." But I've never actually know any residents from poor backgrounds doing that when they start making 'doctor money'.

23/ Instead, they are just making commonsense financial choices to catch up to something like where others are in life who didn't choose to become physicians; owning a home, upgrading their 'starter furniture', putting away some money in savings.

24/ It really just feels like "live like a resident for a few years (if you weren't rich enough to afford med school)" is just another moral attack on poverty. You started behind, so you should stay behind; you can start to live like me when you've payed your (moral) debts first.