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Welcome to the latest episode of the Physician Cents Podcast, where we explore complex financial topics tailored specifically for physicians. Whether you're a medical student, resident, fellow, or attending physician, you're going to find valuable insights that can help you increase your financial IQ, further your financial journey, and improve your overall well-being. Hosted by Chad Chubb and Tyler Olson, let’s dive in!
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You know that feeling when you see an envelope from the IRS and your stomach drops a few inches? Same. Even tax pros get that gut punch, sometimes it’s just the IRS telling you they tweaked your ZIP code.
That little story is a funny opener, but the bigger point is serious: for Physicians (and med students, residents, fellows, and early attendings), taxes and student loans aren’t two separate chores. They feed off each other. The way you file, and even when you file, can change your monthly payment, your forgiveness timeline, and your stress level.
Here’s how to think about it, based on insights from tax pro and Certified Student Loan Planner (CSLP) Adam Markowitz.
Student loan recertification is basically your repayment plan asking, “So, how much do you make now?” And the system usually answers that question using your most recently filed tax return.
This is where Adam’s favorite phrase shows up fast: it depends.
If you’re heading toward an income jump (hello, finishing training), the timing of your tax return can quietly steer what income your servicer uses for your next payment calculation.
Here’s the core idea:
That difference can be huge when your income changes fast year to year, which is basically the job description for medical training.
Let’s say you finish residency or fellowship, then start as an attending in the next tax year. Your income can jump from “I can pay rent” to “wait, why is my loan payment now a mortgage?”
If you can legally time things so your recertification uses your last full resident or fellow year of income, you can buy yourself 12 months of cheaper payments. That can mean real breathing room while you’re moving, adjusting to a new job, and trying to build a financial cushion.
This is not about being sneaky. It’s about knowing the rules and using timing to avoid unnecessary pain.
Even if you’re not chasing Public Service Loan Forgiveness, lower required payments early on can help your cash flow. After the COVID-era pause, a lot of borrowers went years without making payments, and now the reality check is loud.
Keeping payments manageable for longer can help you stockpile cash for things you actually need, like:
As Adam put it, the goal is to:
“Give yourself an opportunity to breathe a little bit.”
If your future payment is going to be $1,500 to $2,500 per month (or more), buying time matters.
Picture a pretty common situation: you’re a PGY-3 internal medicine resident, you made about $65,000, and you’re on the SAVE plan. You want to know what to do next, and you want an answer that’s clean and universal.
You won’t get one. Because, again, it depends.
Adam’s first fork in the road is the biggest one: are you going for PSLF, or not?
If you’re on a PSLF track and you’re on SAVE during a period where payments are effectively $0 but not counting toward PSLF, you can end up standing still. And standing still is expensive when the finish line is 120 qualifying payments.
In many cases, the conversation turns into, “How do you get the PSLF clock moving again?” That might mean switching plans (often to IBR, depending on your situation) so your payments count and you’re stacking qualifying months instead of wasting time.
The vibe here is simple: a $0 payment feels great, but a $0 payment that doesn’t count can be a trap.
If you want broader context on the moving pieces that Physicians are dealing with, you may also like Chad's breakdown on student loan changes for Physicians, since the rules and plan mechanics have been shifting.
If PSLF isn’t your path, the math and emotions change. Now you’re looking at questions like:
Do you just pay interest for a while?
Do you pay what you can?
Do you wait until the Department of Education forces a change?
Do you plan for an aggressive payoff once your income rises?
Adam’s point is that people assume student loan plans are cookie-cutter. They’re not. He described working through dozens of cases where the end goal might look similar, but the path to get there was different every time. Career stage, household income, tolerance for payment swings, all of it matters.
If you need a quick gut-check, you get the most clarity by answering these in order:
You can also follow Tyler’s ongoing commentary and links to resources on Tyler’s Twitter profile if you like staying plugged into what’s changing.
If you’re married, taxes and student loans get more “choose your own adventure.” If you’re married in a community property state, the adventure adds dragons.
In a community property state, half of your income is generally treated as your spouse’s income, and half of your spouse’s income is treated as yours (for state law purposes, and it can affect how income is handled on tax filings).
That matters because income-driven repayment plans are income-sensitive. If your filing and income reporting effectively “blend” income, your payment can jump.
The community property states discussed were:
If you want a straightforward reference list, here’s one: community property states explained.
Same rule, totally different outcome, depending on who earns what.
Example A (often hurts the lower earner):You’re a resident earning $60,000. Your spouse earns $140,000. In a community property framework, it can look like you each earn $100,000.
If you’re trying to keep your required loan payment low based on your resident income, that can be a problem.
Example B (can help the higher earner):You’re an attending earning $250,000. Your spouse earns $50,000. Now it can look like you each earn $150,000.
In some cases, that can soften the income number used in certain calculations.
A few states have optional community property rules (the conversation mentioned Alaska, Florida, Kentucky, South Dakota, Tennessee). It’s tempting to hear that and think, “So… could you opt in, drop the student loan payment, opt out next year, and ride off into the sunset?”
Slow down.
Adam’s warning was blunt: opting into community property can have major legal and asset consequences. Once something is treated as community property, it’s not just your income. It can touch assets too. That’s attorney territory, not a casual tax move.
If you ever hear this pitched as an “easy student loan trick,” treat it like a late-night infomercial. Interesting, but risky.
A lot of residents and fellows feel stuck. You’re smart, you can read instructions, and you can use tax software. So why pay $400+?
Adam’s take was refreshingly balanced: in many cases, you’ll get the same outcome whether you DIY, use a chain, or hire a pro. He put it around 6 out of 10.
The issue is the other 4 out of 10, plus the fact that the “right” outcome is not always the same thing as the “best” outcome for your student loan plan.
Here’s what tends to go wrong.
If you’re married, the default instinct is “married filing jointly.” That might be correct for taxes, but bad for income-driven repayment, depending on how your plan counts spousal income.
If you miss that interaction, you can accidentally lock yourself into higher payments for a full year.
For a physician-specific discussion of tax filing strategy and student loans, this overview is worth a read: student loans and tax filing strategies for doctors.
This is where planning gets real. Adam highlighted a few examples of things people miss because they don’t know they exist:
You don’t need to memorize every credit and phaseout. You just need to know these opportunities exist, because DIY software won’t always wave a giant flag and say, “Hey, you’re missing free money.”
Even when your life feels basic, your tax forms aren’t.
A W-2 can turn into:
Adam also pointed out that laws keep changing, and the IRS doesn’t always update forms and guidance quickly. So you can be doing your best and still get caught in the mess.
At the time of the conversation, the IRS was described as overwhelmed, and notices were flying out, including incorrect ones.
One resident received a notice claiming they owed $2,500, and it wasn’t even clear why. For a resident budget, that’s not a minor inconvenience, it’s a crisis.
Adam’s real-world advice when that IRS envelope shows up is simple: don’t spiral. Get it scanned, then get help interpreting it.
Even Adam gets the same fear response when he sees “IRS” on an envelope. In his case, it was an official letter to say they updated the last four digits of his ZIP code.
His reaction?
“You scared the hell out of me for that.”
That’s the point. The letter looks the same whether it’s nothing or a nightmare.
If you’re trying to decide whether professional help is “worth it,” the best way to frame it is this: you’re not just paying for data entry, you’re paying for a plan.
Adam runs Luminary Tax Advisors and focuses on the overlap between taxes and student loans. If you want to see how he describes that combined approach, start here: Luminary Tax Advisors student loan planning.
He also shared general fee ranges to set expectations:
He also noted they work with clients nationwide (and joked about the handful of states he hasn’t covered yet).
If you’re already plugged into the Physician Cents ecosystem, you can also explore their broader planning resources through WealthKeel and Olson Consulting.
If you want something practical to do right now, keep it tight:
Taxes and student loans don’t just “connect,” they can collide, especially when your income is changing fast. If you remember nothing else, remember Adam’s mantra: it depends, and timing plus filing status can swing your payment more than you’d expect. When that IRS envelope shows up, don’t panic, get clarity first. The goal is simple: make choices that match your plan, not choices that accidentally make your life harder.
The best of the best list is a paid sponsorship, but these are professionals/companies that Tyler and Chad collaborate with within their own practices or have been vetted to earn a spot on this list. By supporting our sponsors, it allows Chad & Tyler to dedicate more time to you and the Physician Cents community. If you ever have a question (or not a great experience, which we don’t expect!) about a sponsor, please let us know. We call it the “best of the best” for a reason, and we will maintain that standard for our listeners & viewers.
This information is for general purposes only. This information is not intended to be a substitute for specific professional financial, tax, or legal advice, as individual circumstances vary. Please see a financial professional, CPA, and/or an attorney in regards to your own individual situation.
Wealthkeel’s Advisory Services and Financial Planning offered through Vicus Capital, Inc., a Federally Registered Investment Advisor. WealthKeel LLC, 615 Channelside Drive, Suite 207, Tampa, FL 33602 -- 267.590.9533.
Olson Consulting LLC, Offering Advisory Services and Financial Planning, is a State-Registered Investment Advisor.
A podcast designed specifically for physicians, offering a breakdown of complex financial topics to help you develop your financial IQ, further your financial journey, and improve your well-being. Whether you're a medical student, resident, fellow, or attending physician, you're sure to learn something new that will benefit your journey.
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Conversations helping graduating medical students to attending physicians build a strong financial foundation
