How the System Breaks Doctors Before They Even Start with Andrew Paulson
How Student Loan Debt Fuels Physician Burnout—and What You Can Do About It
Hello and welcome back to The Interesting MD blog, where we dig deep into the real challenges and joys of medical life beyond the exam room. I’m Dr. Rob Beck, and today, I’m tackling a subject that’s not only close to my heart, but also crucial for the well-being and career longevity of doctors everywhere: student loan debt and its massive role in physician burnout.
Recently on the Interesting MD Podcast, I had the privilege of sitting down with Andrew Paulson—the co-founder and lead consultant at StudentLoanAdvice.com, and a partner of the White Coat Investor Network. Andrew has counseled over 2,800 medical professionals about student loans. The stories I’ve heard in this conversation are all too real, and many of them mirror my own journey.
Let’s pull back the curtain on the realities, the emotional toll, and the evolving strategies for dealing with the student loan crisis in medicine.
The Heavy Reality: $667,000 in Debt—and We Are Not Alone
Let’s start with a story of two internists—me and my wife (who’s also an internist, and Canadian, meaning federal loans weren’t even an option for her). When we finished training in 2011, all our loans came out of forbearance and the number staring us down was $667,000. That’s right. Two young doctors, three kids (all born during med school and residency!), and over half a million dollars just to buy our professional futures.
Worse? In our first two years as attendings, over 24.5% of our after-tax income went to just the interest on those loans. Not even the principal. And we were earning at the 90th and 97th percentile for internists those years—proof that the financial stress isn’t just for those struggling to find work or in low-paying fields.
So often in medicine, we’re told, “You’re a doctor, you have nothing to worry about financially!” But here’s the truth: the emotional and psychological burden of this debt is real, it’s heavy, and it’s one of the leading contributors to burnout.
Why Student Loan Debt Drives Physician Burnout
When your financial situation feels inescapable—when bankruptcy isn’t even an option for student loans—the pressure becomes constant. As Andrew Paulson reminded us, the average doctor he works with owes $320,000 in student loan debt. Even ENT surgeons with high salaries and years out from school still carry around hundreds of thousands in loans. And it affects so much more than your monthly budget:
It crowds your mental space, making it hard to relax or fully enjoy your family.
It can eat away at your sense of accomplishment, no matter how hard you work or how many patients you help.
It forces you to say “yes” to extra shifts, consults, and work you should set boundaries with—fueling exhaustion and burnout.
It can even impact family planning, home ownership, and retirement.
You are NOT alone if you’re overwhelmed by your student loans, feel embarrassed talking about it, or worry there’s no way out.
There Is a Path Forward: What the Experts Say
Andrew’s approach isn’t magical, but it’s powerful: make a plan. Whether you’re a hands-on DIY numbers whiz or someone who doesn’t even know where to log in to check your loan balance, there’s hope.
Key strategies that Andrew has used to help thousands of doctors:
Get an Accurate Picture Early
Start by facing the numbers. It might hurt, but making a plan gets easier once you know where you stand.Understand Federal Repayment Options
Programs like Income-Driven Repayment (IDR) and the new SAVE and RAP plans can help. If you’re in training or work at a nonprofit, these can limit your payments—sometimes capping interest growth and even qualifying for forgiveness after 10 years.Pursue Public Service Loan Forgiveness (PSLF) if Eligible
If you’re at a nonprofit, government, or academic institution, PSLF is still alive and well. Andrew has seen over 400 clients receive forgiveness, with discharges up to $440,000—tax-free!Refinance Strategically
For those in private practice or with private loans, refinancing at better interest rates can slash your total repayment by tens of thousands. But be cautious if you might later qualify for forgiveness—don’t give up that federal flexibility lightly.Don’t Wait Until It’s a Crisis
Too often, doctors reach out when they’re desperate. Prevention matters: talk to an expert early, not just when your loans have ballooned out of control.
Huge Changes Are Coming: New Federal Limits and What They Mean
A major takeaway from our conversation: upcoming federal legislation is capping medical school loans at $200,000 (or $50,000/year) starting July 1, 2026. Many medical schools’ annual costs far exceed that, so future doctors will be forced to seek private loans—often at higher rates with fewer protections.
If you’re a parent planning ahead, or a current pre-med, this may reshape your financial planning. Private loans lack income-based repayment, forgiveness programs, and federal hardship protections. Now, more than ever, careful planning is non-negotiable.
Takeaways: Hope, Help, and a Healthy Financial Future
It is possible to build a great life as a doctor, even with a mountain of debt. But it requires planning, humility, and support.
If you’re facing these challenges:
Don’t hide in shame or suffer in isolation.
Know that others—myself, Andrew, and all our guests—have been through it.
You can pay off your loans or get them forgiven, but you need a plan, and sometimes you need professional advice.
You’re not alone, and there is a path forward.
Resources to Get Started
If this resonates with you, reach out to:
StudentLoanAdvice.com for expert, one-on-one advice (worth every penny if you’re overwhelmed).
The Interesting MD Podcast for more discussions on physician life, wellness, and navigating the journey.
The White Coat Investor for tried-and-true financial strategies for doctors.
Final Thoughts
Medicine is already a demanding path. Financial stress shouldn’t be the reason you lose your spark or your calling. Take control, get educated, and be proactive about your financial resilience. And remember: There’s no shame in asking for help.
Thank you for reading and being part of the Interesting MD community. If you have any questions, want to share your story, or need help getting started, reach out! We’re all in this together.
Stay interesting, stay balanced, and remember to take care of yourself—on the inside and the outside.
—
Dr. Rob Beck
Host, The Interesting MD
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