Yohance: And we are rolling. Ryan, thank you so much for joining us on becoming an Attending today. I'm so happy to have you, and I've been waiting to have this conversation with you for weeks. So for listeners that are just joining us again, this is my distinguished guest, Dr. Ryan Kelly. May I call you Ryan?

Ryan: Sure.

Yohance: Okay, good. So, Ryan, you know, I'm frustrated about this because I already shared it with you a little bit.

Ryan: The.

Yohance: The student loan changes are just. I mean, they're insane. I can't believe how they've gutted the graduate program, how they've capped both graduate loans and cap the loans for undergrad. And I'm really concerned on the impact this is going to have on your profession. And I already know how concerned that students are about the amount of money they have to borrow and just all the complexities there. This is really, as you can tell. Let me step back a second. Ryan, why don't you share with us a little bit about your journey on becoming an attending. So let's start with high school. Did you know you wanted to be a doctor in high school?

Ryan: I mean, you know, I knew I wanted to be in healthcare. You know, I was lucky enough to do, you know, nursing assistant program while I was in high school to get initial exposure, and then the journey kind of went through from there. I didn't know if I wanted to be a physician assistant versus a physician. I spent a year doing a government program in Germany, interning in hospitals, came back and went to undergrad, Was still kind of on the fence of things, and then decided, I really want to pursue medicine. Went to graduate school, subsequently medical school, and here we are today.

Yohance: Got it. So where did all this happen? What part of the country were you in?

Ryan: So, obviously I'm, you know, local in Orlando, Florida, but born and raised in central Florida. Um, I went to school down in Tampa and got my graduate degree, went to St. George's University for medical school and did residency in South Florida. And then now I practice as an attending in Central Florida.

Yohance: So had no desire to go experience snow or tornado. You're okay with hurricanes? You just thought, that's good enough for you?

Ryan: Yeah, I'm a real one. I can survive a little. A little rain. It's not. Not a problem. But I did spend the second two years of medical school in inner city New York City. So I got enough of that action for a while, knowing that Florida is a much better place to be.

Yohance: So, Ryan, what role did lending play in your journey through undergrad and then graduate school?

Ryan: Yeah, I Think that's a great question because I'm definitely somebody who benefited very well from these type of programs. You know, in a country that's already projected to have a significant amount of physician shortage over the next 10 to 15 years, now we're just kind of adding insult to injury with how we're making lower income people, at least most student borrowers, ineligible for pursuing higher medical education, unfortunately. So in my sense, I was first generation college student with my family. If it weren't for loans and borrowing opportunity with the federal government, I wouldn't have become a physician, I wouldn't have went to college or done any of those things. So as things have changed over time, it allowed me the opportunity and I went to a private medical school, so it was more expensive, but I wouldn't have had said opportunity if I didn't have obvious lending. And obviously that has changed over time with interest rates and lending has changed, but the US government has always been a preferred lender for people and the majority of medical school students rely on said federal funding. So to have that at threat at the moment is pretty unfortunate because this is going to stray even more people away from the profession. One, but two, it's going to completely oust people that you know, are really smart and that are high achievers and that could really benefit the country as being medical professionals. So the people that we need to represent these communities that need people are now more disenfranchised and not going to have that opportunity to chase that medical education that I was so fortunate to have.

Yohance: Let's talk about that shortage a bit. Ryan, you mentioned that there is a current shortage in physicians in the U.S. can you share a little bit more about that?

Ryan: Yeah. So I mean, even just projected by 2030, we're going to be basically short a minimum of 50,000 doctors just in primary care alone. The real figures are substantially larger. You know, in my profession in emergency medicine, they were projecting for a while there would be a surplus. And then Covid happened and we are. It is glaringly obvious that there is not a surplus of emergency physicians. And you know, with current trends, population changes, there's just nothing. The US government has taken no stances. Medical education in the United States has taken no stances to express this because medical spots for training continue to shrink in relative to the population growth, unfortunately.

Yohance: And AI is not going to help us with this at all, is it?

Ryan: You know, as much as AI is integrated in medical care, it's still cannot do the physical services that need to happen.

Yohance: I can, I. I Went and got some blood tests this morning, annual physical, that sort of thing. And I was very thankful to have a human there.

Ryan: Sure.

Yohance: I, I don't think I want a machine drawing my blood, not for the amount of blood it took. I mean, I mean, it could prick my finger and take a little drop. But when I'm sitting there and you're taking vial after vial. Yeah, I need a human there. I need her to talk through it, coax me through it, then need my doctor to come by and say, hey, everything's going well. Yes, it's going well. That's all she said. That's, that's the only words we exchanged. But that felt good because I knew that she saw me and that I was real and she was too. So let's, let's get into a little bit about the, how funding for education works because a lot of our, our listeners that tune into the show are more in the undergraduate, so they're thinking about, okay, do I want to go to medical school, do I, what type of profession do I want to choose if I go that route? And some of them are aware that of the funding for their undergraduate, but they're not quite aware of the funding for medical school. So can we take your medical school for example? How much did it cost per year for one year each year of medical school when you went?

Ryan: I know a little bit, but yeah, it changes. So I would say that on average, minus, you know, you have your living expenses and everything. On top of that, my school was anywhere from 60 to $75,000 per year. And then obviously there are the, and that's just like your baseline tuition with all of your initial fees, but there is a significant portion of other fees and things that happen on top of that. So probably averaged, you know, a minimum of $75,000 per year with the baseline. And you know, this was basically all covered essentially by initial, you know, federal loans and so graduate plus loans that were, you know, optioned based off of the changing interest rates for that time being. So I went to a private school, so it was more expensive. But even at the baseline, if you look at the most recent average value for four year medical education at the United States medical school is about $380,000, you know, out the door for four years.

Yohance: So with that, I want to bring in the sombering news about the changes to the graduate school lending. And this is true not just for medical school, this will be true for law school, true for architecture, engineering, any sort of graduate program. So beginning July of 2026, and yes, I'm going to read this because I don't want to mess it up. But Beginning July of 2026, the federal borrowing for new professional students is capped at 4,50,000 per year with a 200,000 aggregate limit. So Ryan just shared with us that for his education, which was how many

Ryan: years ago Ryan was now. Four years ago.

Yohance: Four years ago. All right, so I haven't heard any news, and it would make headline news of any medical schools or colleges that have reduced tuition.

Ryan: I don't think that's ever going to happen, unfortunately.

Yohance: I don't think so either. Now, there have been a few schools out there that have said they've received massive gifts. There's actually one in New York, I can't think of the name of it, but received this massive gift of billion dollars or something. And they're saying now medical school is going to be free for anybody that attends that school. But imagine how many people are trying to go there, and they probably only accept like 80 students a year or something like that. So good luck there. It's probably less than that. I'm probably way overestimating it, but. So four years ago, Ryan said his average was $75,000 per year. And all of that was covered through the Graduate plus lending program, through the federal government. Now interest rates change each year, et cetera. But all he had to do was fill out the form and they said, where are you going to school? And they sent the money to the school and that was it, starting July 1st of this year. So for those of you that are hearing this before July 1st, coming soon, for those of you hearing it after July 1st, it happened already. That lending amount will be capped at $50,000. Ryan, if you were in a time machine and went back four years ago, or I guess eight years ago now to your first year, what would you have done? If you, the government said, yeah, we understand that the cost is 75,000, but we're only going to give you 50. How would that have affected your trajectory to now? I mean,

Ryan: yeah, so I think that would have made it significantly more difficult knowing that going in, you know, then you, you know, you sit and you think about, is this really going to be worth it? Is this something that I really want? Because at the end of the day, you know, for physicians, very smart people, they could have made money in any profession, so to speak, but the sacrifice that time cost benefit that you put together to become a physician is very expensive. But if that happened to me at that time, my only option would have been to get some type of private loan. And the problem with that was I didn't have any collateral to offer them. What are they going to take my brain away from me? There was nothing else to be there. But in that sense that would have led the way for unfortunately almost predatory loan style offers. Because at the end of the day, these are kids fresh out of undergraduate, can be anywhere from 21 to 25 years old, no history of careers, not a very large credit history. They don't really know much better either. So a lot of them are just going to take what's available and what's offered. And that would have drastically changed the trajectory of my career. And the problem with that as well is that if something like this continues to happen, these new private lenders will emerge and there will be a whole secondary market for that, for kids to basically supplement what they can't borrow from the government because schools are not getting cheaper. Let's put that out there. Schools are not going to get any cheaper. So the reality is now these students are going to have to borrow more privately to get into or to finish school. And that's going to cause another larger problem, this elephant in the room. There's already a huge, huge basic deficit of primary care physicians in the country. And if students are paying more to go to school, their loan repayments are going to be much higher. That's going to dictate what type of specialty they go into. Now we see this.

Yohance: Think about that. Okay, so now everyone wants to be a neurosurgeon or everybody wants to be a, you know, an acute care cardiologist or I just made that phrase up, that's probably a real one. But yeah, they're going to choose these obscure professions that have a, A, a greater propensity to pay them a higher salary sooner because they're, now, they're not just being driven by their, their, their, their desire to care for society. It's still a part. But now the money factor drives it even more and makes them say I'm not going to choose that lower paying per pay if I'm going to go to school, if I'm going to borrow $300,000 to go to school, then I'm going to make sure that day one, I come out, I'm making four or five hundred thousand or more versus in primary care where you could come out only getting 150, $200,000 a year, especially if you go into a public space. But those are the spaces that have the most need right now for yeah, that none of those things equal anything good, of course.

Ryan: And on top of that, you know, these new private loans that people will use to sell subsidize what's left over for tuition, they will not be eligible for public service loan forgiveness. So now this creates another problem because you only have the $200,000 cap, which most people are already going to hit with starting education, even if they chose to work in inner city communities that were underrepresented to get credit to have public service loan forgiveness, you know, that's not going to cover any of this extra private loans that they had. So, so then that's gonna just turn people off more and more and more to that. And we've seen this in medical education since the 80s. As school costs have gone up, the proportion of people going towards more higher paying specialties has increased and the proportion of people going towards primary care has decreased. And so it just begets this terrible vicious cycle where people don't want to do that. And I fear that the new program with lending money to students going to medical school may exacerbate, will definitely exacerbate that problem.

Yohance: Well, now there is one small piece of good news that I want to make sure that we share. So especially if you're listening to this prior to July 1st and again, I'm going to read this straight from the Department of Education's website. And the sentence reads, students who are already enrolled in the Same program by June 30, 2026, and who have already received a direct loan for, for that program before July 1, 2026, May. I put emphasis on the May because I, I know we're in the month of May, but they could just say will, but they said may. May be able to keep their prior borrowing treatment. So break that down really quickly. What the way I interpret that is, they're saying is that if you're already in the program, you're a first year, second year, third year, fourth year medical student and you follow some rules that they set out. And I went and looked at the rules, guys. The rules are things like you have to have gone to, you have to have been in your program consecutively for fall and spring semesters. No semesters off. Ryan, did you know any medical students that took a semester off just because they were stressed out, whatever, and just couldn't do happens. So if that was you, that boots you out of the program. Of course your school has to be eligible, which most of them are. But it does play a role on some of our US citizens that are going to school. Abroad. So it's going to have an impact on you all. Even if your school was, you know, one of the schools that fit before, they may not fit in the future. Like I said, there's a lot of fine print. But the bottom line is that what they're trying to say is that if you're in the program, there are ways to stay in the program and be able to continue to borrow your 75, your 80 or 90,000 to finish out the rest of your medical school. But if you're not in the program, meaning you are a undergraduate, that's crossing the stage here in the next couple of weeks. If you don't already have your lending secured in the Grad plus program for your first year of medical school, you don't. If you decide you want to take a little bit of a gap or those sort of things, sorry, you're only going to be able to borrow up to $50,000 with a cap of $200,000 going forward. And Ryan's right. And I've been in financial services for 25 years and I've seen this happen in, not just in student loan lending, it happens in many different sectors where you have the government that's playing a role in helping to subsidize, to make lending more accessible for more people. And let's just keep it real. They're trying to make it more accessible for people of lower incomes, which tend to be majority people of color. It's just what it is. When they take that away, private money steps in to fill that void. And those private lenders, just like Ryan said, they don't follow public student loan forgiveness, which we're going to talk about, because that's changing too. They don't have programs or they don't have extensive programs for forbearance, extensive programs for deferment. They usually have something, but it's not going to be as generous as what the federal government's going to give. And the interest is usually higher and sometimes, and this one is a real catch for some people. I've, I've already talked to some individuals that are in this situation. They require a co signer, to Ryan's point, that has assets that can secure the loan. What if you don't have a co signer? What if your parents aren't in a position to do that? What if they are they, what if they don't own a home and they don't have assets? And you are to Ryan. And my point as well, from my mother's side, anyways, first generation college Graduates. My parents were in no situation to, or no position at all to be able to co sign for me to go to college. Okay. And I know I'm not alone out there. So this is putting a lot more stress, just as Ryan said, on the entire system. Like we're going to feel the effects of this years to come. However, one other piece of possibly good news is that Congress can change this.

Ryan: These are, I think.

Yohance: Yeah, these are. Go ahead, Ryan. I'm sorry, go ahead.

Ryan: Yeah. So this is, is going to be, I think, one of the most, especially going into midterm election year, going to be just a highly, you know, and we're not even talking about the medical community alone. Like law is a very large thing, as you recommended. And no graduate program is cheap. Think about all of the engineers. You know, most baseline engineers all have master's degrees nowadays, especially if they want to do anything significantly. And that is not cheap. So it's not just a problem in the medical community. This is going to be a problem in the academic community as a whole. And we're going to feel a little bit of it at first. But the, you know, seven years from now, when you go from the people that already went through this and now they're in medical training, those numbers are going to even drop more. So it's like the initial pain will be nothing compared to what will happen. You know, projecting. We can't really, you know, that will be, you know, past different administrations and you know, won't be as much of a political problem for these people now that are making those decisions for when the ramifications actually hit. And so that's a big, big, big thing. And I think that if Congress doesn't make that, we're just jeopardizing the future of, you know, every successful person and in turn the free market system in the United States for years to come.

Yohance: Hey dude, ditto 100, man. Like I said, I'm very passionate about this because I work with a lot of physicians who have four or five hundred thousand dollar loans. I have one that has $697,000 of student loans. Now there's two careers baked into there. It was one, you know, started one route nursing and then went another route physician and just kept borrowing to make it happen. And the federal government was right there, like take what you need. Unfortunately, that individual has controlled interest rates because they were set by the government. They're not variable, has deferment options, forbearance options. Payments are done with a, a federal system that says you can't charge this person more than this amount per month and we'll probably have some amount of forgiveness. I don't see how they're ever going to make enough money to pay. I mean, maybe they will, but I probably won't. I'm hoping that there's some sort of forgiveness in their future. So before we talk about residents moving to residency and for those that have already gotten past this point and how the, those changes are going to, the other changes coming to them, let's talk a little bit about some of the solutions. So Ryan and I have already spoken over, over and over again about the fact that we believe that the private market is going to step in. I don't even say, I don't even have to say believe anymore. I've talked to owners of banks and bless them, they're in a business of making money. But if you've ever seen the cartoon where their eyes turn to dollar signs and shoot out of their heads, that is what happened when I was having the casual conversation. They're grinning ear to ear because they're thinking and it's. And this is, they're doing this unconsciously. So it's not like they were salivating in front of me. But as I'm talking, they're like, yeah, people are going to need to get some loans. And I mean, we're going to have to step in. Oh, darn it, we'll make some money off them. But that's, that's what it's created. It's created that void and private market's going to step in. So that, that is a solution. It's probably not the best, but it is a solution and with careful planning. And this is where I encourage individuals. Find a financial advisor, even if you're just in, if you're transitioning from, from undergraduate to medical school and you have questions about this, find a financial advisor. You can start here, but I can't work with all of you. But find a reputable financial advisor, perhaps a fiduciary financial advisor that is not trying to sell you something that you can have these conversations with and strategize about your lending packages and how to put it all together. The next option, which Ryan is going to disagree with me 100% because he went through it and he knows how rough it is. You could work. Yeah. Have a job while in medical school. Sounds great, right, Ryan,

Ryan: if you were able to find the time to do that, you know, your time honestly isn't even worth it at the end of the day. But some people will Try.

Yohance: Some people will. I know of a very few. I mean, I can count those people on two fingers that worked through medical school. Okay, again, you. These are people that are unicorns. They're folks that can survive only three or four hours of sleep because that's just how their genes are set up. They can do that and it's fine. It doesn't run them ragged and they don't kill themselves or people in the on the way. But some people can do that. That's going to be very few to population. They can't. But it is an option. No. Now, option two is have a support system that can help support you financially. So I'm not telling everyone to rush out and go marry somebody that can support you financially, but it is an option. Some people do that. They, they, some people are already in those situations and they, they set up their lives where they said, okay, you're going to work and make sure that we have money to pay our bills, and you're going to have. We're gonna have money to pay for my school and I'm going to go to medical school. So we're going to make this sacrifice for the next four or six years, whatever it may be. So that's a thing that can happen. Some individuals choose to have the support system of family, okay, Living at home with mom or dad or grandma or grandpa or aunt and uncle or sometimes a sibling. Those are strategies that may not have been a strategy before, but it may be a strategy that even affects where you choose to go to medical school. Now, I know medical school has to choose you too, but you, you put in the application first. You may say, you know, I'm only going to apply for schools in this city because I have a support system there to help with offsetting the cost of going to school. Because like Ryan mentioned earlier, he was just talking about the tuition. He didn't talk about. He still had to live somewhere. And there's not a lot of schools that have housing included for medical students.

Ryan: Definitely not.

Yohance: It's not, it's not for you. There's not a lot of schools have housing for juniors and seniors, so let alone the medical school. So that's another solution that you may want to consider. Another one which is becoming more and more popular, is being more aggressive with applying for scholarships. There are any medical profession you want to go into, they've got an organization, whether it's where Ryan and I met, which was, how do I do this? Aaem.

Ryan: Correct.

Yohance: Academy. No. American Academy of Emergency Medicine. So many acronyms. There is American College of Emergency Physicians, there's Society of Academic Emergency Medicine, I'll be there in two weeks in Atlanta, there's National Medical association. And even in all these large scale organizations, and we're just in emergency medicine, there's, there's the same thing for cardiac health, the same thing for family practice, podiatry, neurology, you name it. They all have these societies and some of them have local chapters. Those local chapters are usually looking at the undergraduate schools, looking for people to apply for their scholarships so they can help them go to medical school. Now true, sometimes these scholarships are only 5,000, 7,000, $10,000, but there's no limit to how many scholarships you can apply for.

Ryan: Correct.

Yohance: Okay. So I would encourage, if you are a undergrad now and medical school is something you want to do, get, start thinking about those organizations and get into those mailing lists now, apply for those scholarships now. Because as the lending becomes harder to get the scholarship, the folks that are looking for scholarships, that number is going to go up. So you want to get in front of that as quick as you can. And then the other thing to consider, and this is more for my parents out there that are listening, that have children that have expressed that they want to go, that their child wants to go into medicine and be a doctor, and maybe they're not quite an undergraduate or they're there now. Start saving 529 plans, other sort of accounts. Start setting some money aside now so you can help offset the cost of that school with the money that you can save. And the earlier you start, the better. And any little bit will help. Okay. I don't care if it's 50amonth or 500amonth. If you start somewhere and do something, it's going to help offset those costs. So you think I missed anything? Ryan, any other ideas you can think of?

Ryan: The only other route, obviously, and it's, it's more of a, you know, a socially charged one, is that people can do the military route. But that.

Yohance: Ah, thank you. That's true. Yes.

Ryan: Yeah.

Yohance: Actually, no. Yeah, no, there's also, with the military, there's also the community health plans. So the community health. There's, there are cities that have put together plans because they're trying to attract more physicians and any sort of specialty where they say, hey, if you go to school here and you work here and you give us X amount of years, we're going to take care of X amount of your student loans. Okay.

Ryan: Yes, my school had a. Yeah, my school had a similar scholarship program for students from the five boroughs of New York City. So if they choose to go to the school and choose to stay in New York City and you know, basically work in those communities for at least five years afterwards, they can basically have, you know, a pretty much a partially taken care of scholarship or you know, up to 100%. So that plus the military, you know, those scholarships are few and far in between. If you can find them, great. But the military is really the only other option in that sense. And also that does come with its own costs. And I have colleagues who are in the military and you know, at the end of the day it's, it's a lot different than working in the private sector. Like I work at, I truly have freedom anytime versus once you owe the military X amount of years, they will get you wherever you are and put you wherever they need you to be. And that's that. There's no ifs, ands or buts. So that does come with a pretty serious, I mean, when you're getting private loans for things that comes with an underlying interest rate, the interest rate that comes along with the US government is a bit different.

Yohance: So, so you might pay that like you said before, like, you know, co sign with your, with your blood. Yeah. So I want to transition into all the residents that are listening and thank you if you made it this far and didn't skip past it because I know, you know, someone that's in medical school that you can help out or someone that's an undergraduate that's pursuing. And yes, please be a mentor to those and helps them find their way. But for our individuals that are in residency, there are some changes happening to public student loan forgiveness. Now, just as a quick overview, Public Student Loan forgiveness is a program that was started back in 2006, five early 2000s. And the program allowed you to if, and this is not just for medicine, this is for any profession. If you were working for a non profit or a government employer and you are full time and you spent 10 years working in that nonprofit government employee employer, then your federal student loans could be forgiven after making what's called 120 qualifying payments. Now, I'm not gonna get all the details of what is a qualifying versus non qualifying payment. That's for another podcast, another time, do some research on, on your own. But the bottom line is that there was a pathway to get loans forgiven. And I have dozens of clients that are in medicine and in other teachers, things of that nature that have had hundreds. We're probably in the millions worth of loans that have been forgiven over the past five or six years thanks to that program. Well, that program is also changing and the most recent iteration of it, which was known as the SAVE program, Saving America's value Education, was ruled unlawful somehow and now is being terminated. As a matter of fact, it will be terminated for all new participants on July 1, 2020. And if you're currently in the SAVE plan, which most people that are a PSLF, you were in SAVE because there's some huge incentives to get into SAVE during COVID times. If you're in the SAVE plan, you are getting kicked off that plan and you have to change to either the income income dependent repayment plan, the idr, or you have to change to the PAYE Pay as you earn plan. And those are the only two plans that will be eligible for pslf, or if you go to the other plans that are available, they're not PSLF eligible. So we're not going to talk about those. We're going to talk about the PSLF ones. You have to make that change by July 1st. I don't know what the penalty is going to be for not making the change, but I can bet it won't be good. So if you are listening right now, and you are, and you know that you are in a PSLF program, hit pause. We'll be here when you get back. If you were driving, pull over. It's that important. Go to studentaid.gov, don't go to Mohela, don't go to Nelnet, don't go to Aidvantage. Go to studentaid.gov and check your status on studentaid.gov. you can change from the SAVE plan into the IDR or the PAYE. And here's the unfortunate news. More than likely your payment's going to go up. The methods they use to calculate your payments from SAVE versus idr, SAVE was a little bit more generous. IDR is a little bit more aggressive. Your payments are going to go up. I've seen some clients, their payments went up as much as 50%. Okay.

Ryan: So I mean, for most.

Yohance: Yeah, go ahead.

Ryan: For most residents that were on SAVE program, they were effectively just based off their income alone. They were paying $0 per month.

Yohance: They're paying zero. And now they're paying something unless they have, unless they have a spouse and some kids, it went from zero to about $140 a month, which isn't that bad, but it's still. It's not zero. Okay. Yeah. Now, one of the bad things is that if you decide that you can switch to the IDR plan, but you could say, I want to stay in deferment. So one of the big changes is that if you stay in deferment, you're no longer getting credit towards your PSLF months. I'll say that again. Actually, I'm going to say it differently. If you're in deferment and have been in deferment since August of last year, none of those months since August of 2025 count towards your PSLF. I know they did. Yes, they did, for years, all through Covid. At all your zero payments, it used to count. Well, they don't anymore. And this is again why I'm encouraging you to sign up for the new plan by July 1st. Because I feel like what's probably going to happen if you don't, you're going to lose the opportunity to recapture those months as well. I think that's the next thing you want to get rid of. I don't know that to be for sure, but if I'm looking at the playbook of how things are going, they're making it. They're trying to take the loan forgiveness off the balance sheet of the government and put it back on the American people. The American people mean you, the person who borrowed the money. Okay.

Ryan: So

Yohance: I was gonna say something else there and it lost me. Now we have to cut that part out. So the other thing I want, so as a resident, most residents in most programs, and I'm talking north of 80% of the residential programs out there, RPSLF eligible. Okay. So it's probably in your best interest, if you're a resident, to go ahead and get in the program. Even if, even if you go into firm it. Okay. But if you're in the program and you're in deferment, you say you can't afford the payments right now. I understand you can. There is a method. As long as you're in that program before July 1, there is a method that exists and I hope they continue to grandfather you into it, where you can go back and recapture those months later after you've reached your full 120 months worth of service to a government or nonprofit, those can go back and be recaptured. Okay. But again, this is something that you're going to have to do before July 1st. And we'll get this episode out as quick as we can so that you can hear it and you can do it. So tell me, Ryan, what was your experience with PSLF as a resident? Was it something that you applied for?

Ryan: So you know I always knew I wanted to do more private medicine, so I knew that wasn't something I wasn't going into academia. You know, I knew that at least for my specialty specifically the landscape is very much focused on more private equity, private equity backed medicine and large medical groups running the show rather than community centers. So it's really dependent on your specialty. I have a few colleagues that have went through that process and my message for people is that even if you don't decide that that's something you want to do, remember you're going to get those three years of credit from being in residency. Now if you're in a longer residency, four or five, seven years, it kind of behooves you to at least do that because you're fellowship.

Yohance: Yeah, if you're, yeah, if you think you're, if you think you're doing a fellowship after residency, sign up because your fellowship is going to be at an educational institution which more than likely is going to be nonprofit. At least that part of the school is going to be nonprofit.

Ryan: Yes. And these, these remember the government is giving money to even the companies that are, you know, private for profit based companies, they have graduate medical education, they're still getting these funds from the government. And although you are employed by the company, it is using government funds. So they're always going to be qualifying for pslf. Now again, if you're doing like my friends in internal medicine who end up doing fellowships, that's six years of total training. The reality is they're going to finish that. They can go to it can find, you know, a more public employer for the next four years and they can bite the bullet there. Now they're still going to have to make payments during that time. Obviously you're not getting all of this for free, but it encourages people to work in a community setting that is benefiting the government and the American people. Now obviously if you're not doing that, that is the issue with shorter residencies, the standard being three years like mine was. I wasn't planning on doing a fellowship. I knew that the private sector was going to offer me a couple more benefits that I'd be able to manage my loans with those, the money I was making so it wouldn't really benefit out. Plus I could choose where I wanted to work. But I mean for most people nowadays, now with these new lending strategies that are happening, you have to find an option. Everyone can't be a neurosurgeon, everyone can't make a million dollars a year as much as I'd love for that for medical students, but you have to find an option to do that. And for more and more people, the only option to become a physician is going to be hing on pslf. So and the government has traditionally always changed the requirements every few years and always nickel and dime people just to make sure it's that much harder. So people can't make those qualifications to finally get it, you know, released. But it has to stay around, it has to make it easier for people. And it's important that, you know, residents know that that's an option when they start.

Yohance: Yeah. So now for, for the folks that are, that will be entering into residency next year, your PSLF plan is going to change as well. It will no longer be a 10 year repayment program. The last I saw, I believe that's going to a 20 year repayment program. I was trying to pull it up really quick. I didn't have it in front of me. But the bottom line is it's you're going to have to pay more for longer and commit yourself to public service for a longer period of time. But again, these things could all change with a different Congress, different president, things of that nature. These are just the rules that we are set with right now. So this is what we have to work through. For those of you that are past residency and you are a brand new attending, probably just graduating here over the last week or so, I do encourage you to do the same thing. Log into studentaid.gov, take a look at where you stand with your payments. Determine if you, if you're going into private, excuse me, into public or nonprofit, then maybe you want to stay with some sort of PSLF option or if you feel like that your payments, because your income is going to be at a certain amount, that your payments are going to be so high that there's nothing to forgive. When you're in the student aid program, there's a little button when you do calculate your payment. It says CPSLF options. You turn it on or off. And if you turn it on, there's a column that will show you how much will be forgiven after how many payments. If the amount forgiven is zero, that means the government assumes that the payments that they're going to require you to pay are going to be so much that you're going to pay the loan off and there'll be nothing to forgive. When you're in that situation, you may not want to be in a PSLF program because you're going to pay for 20 years and pay it all off. When you could probably pay it for 15 years or 10 years and pay it off even faster. Okay. Now, if you are in one of their repayment plans, the IDR or the paye, the Nelnet, Mohela and Navient, well, you have to be in Mohela, I believe, if you're PSLF now, but those programs will not allow you to make extra payments. If you're on autopay, you have to physically make those extra payments. It's so, it's so aggravating, like, no, we're not going to take your money. So if you want to be on one of those programs so that you know that your required payment is only $800 a month, but let's say if you do a little moonlighting on the side, you want to be able to make that extra payment, you're going to have to do that physically yourself. You can't set it up so it automatically takes it out of your account. So again, they're making it a little bit difficult for us when it's really just a click of a button. But who am I? I can't solve those world's problems, so. Well, Ryan, thank you so much for just having this conversation with me about the new rules that around student loan forgiveness and student lending and how our medical students and how or excuse our rising medical students, our rising residents as well, and those that are going to attending can start to think differently about their loans. I wanted to. We like to do this with every episode when we have a physician here with us. We'd like to learn a little bit about some of the mistakes that you made or some things that you've learned now where you could say, oh, if I could go back and do that a little bit differently, I, I would. Or maybe you wouldn't because you like that you have the lesson. But let's start with your transition from graduate school to medical school. What was the biggest financial mistake or financial aha that you had as you were making that transition into medical school?

Ryan: I mean, probably the biggest mistake was, you know, thinking that, oh, you know, I'm, I'm very intelligent. You know, I'll figure this out. If I make a ton of money, it won't be a problem. Problem, you know, coming from someone who wasn't budgeting, had no financial literacy whatsoever. A friend in first year medical school said, hey, you should really read this book called the White Coat Investor. I said, yeah, yeah, I'll get to it, but I'm busy studying now.

Yohance: Right.

Ryan: I mean, that was probably the that was now, you know, now as a. As a, you know, as a usual thing, I gift a copy of that to every single one of our scribes that goes on to medical school. And I say, listen, you need to. Before you start school, you know, forget about residency or anything else. You need to read this book, you know, you need to become that book or any other, you know, financial books, because you need the literacy. So not having financial literacy is probably the worst possible thing. And anybody who gains that basic financial literacy, the first thing they'll always say is that I'm kicking myself because I didn't learn this earlier. So that's probably the first mistake. And, you know, those students that are coming in, smart people, you know, no one ever taught them these things. And that, you know, not having that financial literacy, you know, stems into, well, yeah, I just got a loan for medical school. I don't know what the interest rate was. And so they're much more apt to just sign on the dotted line, hey, I can be a doctor. I'll sign wherever. So they don't understand the math and the ramifications of these things. Things. So my biggest mistake was not having the financial literacy. I was at least cognizant enough of, you know, what I was borrowing and how much it was and what my interest rate was likely to be. So I kind of had an edge on that. But, you know, I've waited far too long to truly get. You know, I waited till pretty much the end of medical school, the start of residency, before I truly became financially literate. And had I made those changes earlier, it would have definitely changed. Not just I wasn't making money in medical school. So it wouldn't have changed how I balance my finances, maybe how I budgeted, but it would have changed the mindset. And if you don't have the mindset, if you don't have the small tools to make that thing, it doesn't matter if you make a million dollars a year. I know plenty of neurosurgeons who are broke. Oh, so that's the idea.

Yohance: Preach it, brother. Preach it. I'll tell you a really sad story on that note, when you said the, yeah, I'm a sign up for this loan. I don't know what the interest rate is, but I need it. I got to go to school. So the story about. About an existing client, we've overcome it now, but here's her story. Came from a impoverished background, did not get enough federal loans to fully cover the cost of the private school that she got accepted to and really wanted to go to. So she took out additional loans, private loans, not backed by the government, but private loans. And those loans were all deferred as long as she was in school. And so with this fear of, I don't have to pay those loans, she just kept going to more and more schools. So she spent five years in undergrad, spent four years in graduate school, and then spent another three years in residency and another four years in doing fellowships. Okay, so let's do it. Let's do all that math. Five, four is nine, three is 12, plus another. It was three or four. Somebody. So it was 15 years is at the end, 15 years. That first loan that she took out her freshman year was only for $25,000. The interest rate on it was only 7%. Here's the funny thing about interest rates. When you're not making any payments, there's a shortcut to figure out, okay, how fat, how. How big will this loan get with the interest accumulating? The shortcut's called Rule 72, which is in white coat investor. He talks about in there. So divide 7 and 72. The answer you get is 10. So that means by the time she had had that loan for 10 years, the 25, 000 was 50. 50. By the time she had another five years, that 50,000 was now nearly $75,000. That was just for the first year of school. She was taking out private loans because she was taking out private loans so she could live off campus and live or let not have to. Of course, she just thought that was the right thing to do. By the time she was done with all of her schooling, she owed nearly a million dollars in loans, both student loans, federal student loans, and private loans. But the private loans, the principal balance was a third of the full balance. So 2/3 of what she owed was interest. And that's the trap sometimes you can fall into without the financial literacy. And I just. Why did you do this? She's like, I. I didn't know. It's just like, it was like, do I want an apartment or not? I do. Sign here. And they just kept giving me money every year. They're like, hey, do you want another 40,000? Sure. Okay. And the lack of financial literacy led to a lot of just poor decisions along the way because some of that money was like, girl, you didn't need that money. You were living a lifestyle as if the money was yours. Like you were already making money. Okay? And it's going to take her two decades to get all this stuff paid Off.

Ryan: Yeah.

Yohance: Okay. So that's some of the traps you can fall into. Oh, Ryan, thank you again for mentioning White Coat Investor. I'll make sure to put a link to the book in the show notes so you can learn more about it. You can pick up a copy of Amazon or you can find somebody like Ryan and guess what? He'll gift you a copy. So if you happen to be in the Florida area and you're in medical school, go find Ryan and say, hey, Ryan, can you get a copy of that book? Because guess what? He's attending now. He can afford the book. He can. Ryan, are there any parting words that you want to share with our listeners about this, the, about the transition, about becoming a physician, about lending or anything else?

Ryan: Yeah. So, you know, the biggest thing is, you know, you just have to go back and think of, you know, what did you do all this for? You know, was it that you had a family member who was sick and you wanted to be that doctor that could hopefully help that person? You know, did you choose this for the money? And I'm telling you, this is not a profession you choose for the money. You know, the opportunity cost that you lose, the amount of birthdays that you miss, the amount of weddings that you miss and processes in Life. In your 20s, you'll be giving your 20s away to, you know, a computer screen and books. Don't forget the reason why you wanted to do this in the first place. But that being said, you know, you're. It's a process. You have to go through that and don't think that you're going to be smart enough to, you know, not have to pay attention to the financial aspect because things in the world still cost money. The world goes around the same way, and it still costs money. The, you know, the carousel is still going round and round and you have to keep up with that said thing. So my biggest thing for people now is, you know, if you want to go into medicine, I think you should. I tell people that you, you, you should do it because if you're not going to be happy in any other sense of any other career, you should do it. That being said, the biggest thing you need to do is you need to gain that financial literacy. And, you know, it's a lot to learn, and I get that. And that's okay if you don't want to do it. But find the right people who can point you in the right direction for that. Find a financial advisor. Pay them what, spend $1,000 and talk to somebody just for the advice you will save yourself years of interest payments and multiple financial mistakes if you just get the actual advice from someone who's certified to offer that professional advice for you and know that at the end of the day, it's still all worth it. You're going to be able to do a profession that you love. You're going to be able to help people. But at the end of the day, you should also be compensated properly for that. And I don't want to see people fall into those same type of traps. So find somebody that is trustworthy, that has those credentials that you can talk to, that you can get advice from, and they will help guide you through this. Because for anybody, whether your family was rich or your family wasn't like mine, you want to make sure that you have opportunity to make money, help people and do good service. Because at the end of the day, you're just going to resent your job if you're in hundreds and thousands of dollars of debt. And it just is relentless. So we want people to become physicians. I want people to help people, but I also want them to have somewhat of a good lifestyle. And if we want the future of medicine in America to be as successful, we need to find ways to do that, whether it's for ourselves or whether it's the. Through government programs. But, you know, get the financial literacy in now and you know, you'll have a very successful career if you just take those steps right now.

Yohance: What he said. Ryan, I appreciate you. Thank you so much for joining us on becoming an attending podcast. We really appreciate your sage advice and the fact that you, I mean, you're walking the walk, you took the walk and still walking the walk, and we appreciate that. And again, if you are in the Central Florida area, it sounds like Ryan is definitely willing to be a resource for you if you're thinking about this profession. If you want to learn more. If you're looking for a copy of the White Coat Investor, please reach out to Ryan. We'll make sure we put ways that you can connect with them in our show notes. So until next time, we appreciate you. And hey, don't forget, log in. I. I know you were driving and you said you'll do it later. You're not driving now. Okay. Log in. Student A.gov. it's okay. It's. It's already there. The information is there. It's not going to change between the time that you type your information in and log in and pull it up. It's already there. Okay? So don't be scared. Log in and see what your status is and see if you need to make any changes. Talk to you next time. Thanks. All right. Good stuff, sir. I appreciate you. That was amazing. All right, so for your intro, so Dr. Ryan Kelly, you're in. You. Excuse me, Emergency Medicine, Central Florida. Let's see, what else do we want to say? Oh, yeah. Where'd you go to school?

Ryan: I went to school at St. George's University.

Yohance: St. George's University. All right. St. George's University. Okay.

Ryan: And.

Yohance: Oh, I do have something here. You assisted in the first iteration of the introductory Introduction to Critical Care and Anesthesia course through aam.

Ryan: Yeah, so I've taught, I've taught that course for the past six years. Yeah.

Yohance: Oh, nice. Okay. I was, I was teaching. Awesome. And you did mention that you were

Ryan: a

Yohance: first generation college graduate. Nice. Okay. All right. I got everything I need. So this will probably be out in about two weeks. Actually, we might try to push out a little bit faster since I said so many things about deadlines in there. But Jessica will be in touch. She'll let you know when it posts. The only thing that we ask that you do is share it. You know, we'll send you the links forward and stuff, just like. And share. If people start commenting and you happen to be there, hop in and share in the comments because, yeah, really just want to help people do better with all this information. So.

Ryan: Of course.

Yohance: Cool. Any questions for me?

Ryan: No, thank you so much for having me. I enjoyed it.

Yohance: Thank you. One last thing I'll share with you is I did get approached by another gentleman about a conference in Florida.

Ryan: Probably there's a couple. So there's, there's one that Florida College of Emergency Physicians does, is called Symposium by the Sea.

Yohance: Okay.

Ryan: That one, I believe is in Jacksonville. My wife's actually a recruiter for our private company, so she goes to all of the different conferences. But there's that one. There's also one done by Florida. Florida Academy of American Academy of Emergency Medicine.

Yohance: Who's that one?

Ryan: That, yeah, that one's probably going to be in Fort Lauderdale this year. I sat on the. Yeah, I, I said I sat on the Florida board for the last two years for that. Um, it's a much, much, much smaller conference.

Yohance: You tell me.

Ryan: Yeah, it's very, very small. Um, uh, so. But it's usually, it's like usually just a one day. They might have meetings the day before or like an event the night before and then it's a one day thing with like courses in between. But it's very Very resident heavy, especially for. For South Florida. I know the program director from Mount Sinai's program in Miami beach, and he was the previous president for the past few years. And so all of his residents are there. There's, you know, over five residencies in South Florida, so we've had a good turnout. The last three years there, there's been at least 100 people. I gave a financial talk actually, three years ago at that conference.

Yohance: We did okay. Yeah, that's. That's what they've asked me if I was willing to do.

Ryan: So, yeah, I think it's a really great idea for people to have it. People. I was the only person literally in the last, like, three years that has done anything with finance. So for the whole thing, and that's the same at Florida College of Emergency Physicians. I literally was the only person that ever gave a talk on finance. And that's like the last five years. So it's. It's kind of ridiculous. And that's why I always talked about it in residency. But either of those are good opportunities. You're getting a lot of people in a very high cost of living area as far as Miami, and they get some of the residents that come down from Orlando, but it's mostly residencies from South Florida, and that's where I went to residency as well. That kind of hub in that area. But you're looking at roughly like a hundred people that will probably go to the country.

Yohance: Okay. All right. Yep. I think it's in November, I believe, or something like that. So I. I said, yeah, count me in. Get me some more details. I haven't heard anything back yet, but I did say. I went ahead and said, yes. I was like, yeah, my brother lives in Orlando, so any excuse to come to Florida, take it.

Ryan: Of course.

Yohance: Indeed. Ryan, I appreciate you again, sir, and I will say we'll be in touch once everything comes out. And if there's any. Any. If there's ever anything I can do for you, let me know.

Ryan: Appreciate it. Thanks so much.

Yohance: Indeed. Thank you. Foreign. Welcome to the Money Script podcast. This is the Becoming an Attending channel. Yes. This channel is dedicated for individuals that are working their way from undergraduate to medical school, medical school to residency and residence residency to becoming an Attending. We're so happy to have you here today. It's been a while. Yes, I took a small break. I was studying for my cfp. Kind of like some of you out there have to study for board exams. It's kind of our financial equivalent of a board exam. But we only have to do it once. So I probably shouldn't try to associate it with the board exam, but I was just trying to get you to understand that I was studying for something, so I had to take a break. But I'm back, and I'm back at a very critical time. Today. I have with us Dr. Ryan Kelly. Dr. Ryan Kelly is an attending physician in emergency medicine in Central Florida. He was a graduate of St. George's University. He does some teaching of critical care and anesthesia. Anesthesia course at aaem. Matter of fact, AAEM is where I met him. And I said, hey, I have a podcast. We talk about financial literacy for doctors. He said, count me in. I'd love to do that. Come to find out, he gives financial literacy talks all the time. We both like to nerd out on the White Coat Investor, a book that we both read and also gifted to many other positions over the years and residents over the years. And our critical topic today is the changing student loan landscape. So a lot of things have changed for student loans. This is definitely an episode where if you're out taking a run or if you're driving or if you're just doing something else and you're not in front of your computer, you don't, you can't pause and do some things. Go ahead and listen to the episode so you can get some of the information. But mark this so you can come back and you can sit down and actually look at where you stand with your student loans, because things are changing quickly and there's some deadlines that are coming up, and if you miss those deadlines, I don't know what all the ramifications are going to be, but it's probably not going to be good. So with that, let's get to Ryan and let's talk about the ever changing student loan landscape, because I'm sure we're going to have to do this again because it's probably going to change again. But until then, let's talk about what it is. Now let's get started.