Listen to the podcast here: Can I start a practice if I have student debt?
Episode Summary: This episode explains that pediatricians can start a Direct Primary Care (DPC) practice even while carrying substantial student loans, as long as they plan carefully and intentionally. Phil and Marina share personal examples of launching DPC with 1500–2000 dollar monthly loan payments and original balances around 250,000 dollars to show it is possible but requires realism about cash flow. They describe strategies like keeping a part‑time employed position, timing departure around potential loan‑forgiveness milestones, and building savings and cutting expenses before opening. A major theme is not allowing fear or uncertainty about federal loan programs and politics to be the primary reason for staying in a burnout‑inducing job. They encourage combining detailed financial planning with an internal sense that “this is the right time,” emphasizing that student loans are usually a challenge to plan around, not an automatic deal breaker for DPC.
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you.
Hey everyone, welcome back to another episode of DPC Pediatricians. Today we are answering another question that often comes up, which is, can I start a practice if I still have student loans?
There’s been so much change with the student loans that I feel very lucky that that is a more recent thing of my past, because I know that there were all these different programs to do student loan repayment and everything, and it seems like things are in a little bit of a tizzy in Washington these days, and so I’m less confident that those people will always get their checks cleared or their student loans expunged from the record.
But one of the common questions that comes up is, I still feel beholden to my student loans, which means I feel beholden to the academic center that I’m working at, the federally qualified health center, the large group that I’m a part of. There’s all these reasons that I just can’t jump ship right now and start something new.
And I think we have loads of examples in the pediatric direct primary care community of people that have either started straight out of residency, like Dr. Lauren Hughes, who spoke at the virtual summit, starting straight out of residency with loads of student loans.
And or those that are throughout their early career and i would say the vast majority of them still have student loans when they’re starting their dpc practices and i think from my perspective and marina you’re the very much the finance guru when it comes to like all the numbers and things like that and I’m kind of more of the not that or maybe picture sort of.
The big picture guy. The big picture guy. The vibes check out. The vibes are fine. But I absolutely think that when structured correctly, you can jump into your DPC. You can grow your practice. You can have the money that you need to get off of the ground despite having student loans.
And I can’t think of anybody that I’ve ever said, you still need student loans. Just stick around for a couple more years as you get closer to burnout and keep your fingers crossed that the government comes through for you with the student loan repayment.
If you’re miserable, don’t let something like student loan repayment affect that because that’s like two or three patients per month to pay for your student loans. When you could figure out how to get those patients in the door so that you can leave and start something much better, much sooner.
Yeah. Well, I can speak a bit from personal experience. I still had student loans when I started out my practice and I can definitely attest to the fact that it’s scarier because making the leap into the world of DPC, it’s a leap of faith in large part. It’s like, I think this is going to work.
I’ve done everything I can to ensure that I have a plan that’s going to work. It’s working for other people, but there is no guarantee. Right. I would be lying to you if I said that there is a guarantee that your practice is
going to just like take off and you’re going to be making your dream salary and life is going to be wonderful within a year. Um, first of all, sometimes it takes a lot longer than people expect to get to their salary goal and to their patient panel goal. And sometimes unexpected things happen, right?
Like the COVID pandemic or things that are going on in a federal level and politics that affect healthcare and loan repayment programs and things like that. So you’re never going to have a guarantee. You’re But I’d say if you’ve done all of your mental homework and really planned to the best of your ability,
if you have a good vibe, I believe in vibes. I’m a little woo-woo like that. Like if you have this like internal sense of confirmation that this is the right path for me, this is going to work. I’m willing to take that leap of faith to just do it. then it’s probably going to work out. Right.
And I definitely had to take that leap. Now, there were some security checks in place. Like I had a part time job still working for a large health system. And that helps me to be able to pay my bills in the beginning because I had still life expenses.
And you mentioned that it’s only two to three patients a month bill. It was my student loan payment was about 1500 a month. So that’s a big that’s a big bill. Right. And of course, it’s going to be variable depending on how many Loans you took out in order to get through your education.
I started out with about 250,000 in total of loans coming out of residency. And for many years that felt like, I don’t know, it felt like shackles because it felt like I have to work for this FQHC in order to qualify for loan repayment and all that stuff.
And in the end, I didn’t get to that 10 year loan repayment. Right. sort of threshold, I decided that my loans were down to about 70,000 at that point. That was seven years out of residency. And I felt that that was low enough that I could do it. Like I could do the rest, right?
Now, that’s not the situation that everyone else is in. I know people that are many, many years out of practice and they still have really large student loan bills. And so it really depends on your situation. And maybe you’re contemplating DPC and maybe the answer that you get for yourself is that it’s not the right time yet,
but maybe in a couple of years, maybe you have to be strategic about okay, I’m going to continue working for the system. I’m going to make it to that 10-year mark and then it’s going to be right. Or maybe I’m going to build up my savings and cut down on my expenses and be more
thoughtful about how I spend money and save up for a few years so that I have that safety net necessary to keep paying my student loans while I start up. So I can’t say exactly what the answer is going to be for you if you’re in that position, but I can say that
Most of the time, there’s a way to make it work, even if you have student loans. But it does take thought and planning and also consulting with your inner sense of what’s right for you.
Well, number one, you’re absolutely right that I’m glad you called me out on my bad math. I had student loans when I started my DPC and they were $2,000, some $2,000 something per month. So I don’t know where I was getting that initial number of like $500. That’s okay. But you’re absolutely right.
And I think that it is something certainly to keep in mind and consider. And it’s also something that for the majority of people, that there’s a way to figure it out and to figure out how to make it work. And so I don’t think that if we have to look at like,
the main things that if you’re in a job that you hate and you’re struggling with burnout and it’s okay, I can keep doing this and I might not even make it in medicine for the next five years, then let’s talk and figure out a plan. I mean,
you have the best calculators and tools on dpcpediatrician.com where people can get and figure out the startup guide and the money and all of those things that help to then have the vibes be like, okay, I can make this work. And so I would encourage anybody that’s the only thing that’s keeping them as their
student alums to really re-examine that. If that’s the only thing that’s stopping you from doing something that you’re dreaming of, I bet there’s a way through that you can figure out how to make your DPC happen sooner rather than just, I can’t do it now. I’ll hopefully be able to do it in five, 10 years.
Yeah. I’ll also add that I know that there’s a lot of fear because of things going on at the federal level regarding student loans and that whole landscape is changing. I would just remind people that politics and who’s in power changes every couple of years, right?
That’s just the history of what happens in this country and in most countries, right? So just because things in politics are changing right now, it doesn’t mean that they’ll be like that forever. And again, do as much of the mental calculations and as much of the thinking and planning as you can. But then also…
consult your intuition or whatever you want to call it. That vibe that we’re talking about, is this going to work for me? Is this something that I can make happen? And are things going to be okay? Right? When I talk to my, actually, it’s interesting. When I talk to my families about a lot of things,
including things like vaccines and decisions for their children, I say, do all the thinking that you can about this issue. And write the pros and cons out and do all that stuff that you need to do in the reading and the investigation. But then ultimately, what’s that feeling? What’s that feeling inside that you have?
Is this the right decision or is that the right decision? And if you feel like fear is getting in the way, fear is not a good way to fear is not a good influence on making optimal decisions, right? If you’re making decisions out of fear, you often end up making the wrong decision because you’re letting your brain,
your mind get hijacked by that amygdala and by that fear response, right? And fear is going to keep you from doing a lot of things that would actually be wonderful in your life, right? We see a lot of families not vaccinating Because of fear, because they’ve seen. Right. And because of misinformation and all of that.
And so I often tell my parents and I would advise you as well to like really step back and say, am I making this decision purely out of fear or really out of. bigger umbrella of information and knowledge and thought that I have put into this.
Right. Yeah. I think that that helps to guide things and it’s always helpful to, to talk with somebody else. Like I said, I will be the vibes check guy. That’s like, yep. I’m sure you’ll be fine. But Marina does one-time consults where you can talk through in much more specific detail than I can help you to,
to solve on. for is this the right time? What do I need finances-wise? So I would consider doing that if you’re on the fence about it too.
Yeah, absolutely. But as we have said many times before, we really believe in this model, the DPC model as a path to a brighter professional future. Then if you really feel like DPC is calling to you, please don’t let just the issue of student loans hold you back.
Even if it means that you’re going to say right now is not the time, but I’m going to make a plan for To make this happen in the future, that’s okay too, right? But there are ways. There are many people who have made it work.
I know many other DPC pediatricians in the community and friends that I have who started their DPC even though they had quite a bit of student loans that they still had to pay off. Right. It does not have to be a deal breaker.
I have heard people saying that I could never start a DPC because I have student loans. And that’s not necessarily true. Now, it may be true for you, but it’s not true as a blanket statement. And that’s why we’re talking about this, because we want to reassure you that just because you have student loans,
it doesn’t mean that this is impossible for you. But there’s a lot of planning that has to take place. All right. Well, thanks everyone. Hopefully this answered a couple of your questions about this. If you have other questions that you’d like to ask on this topic or other topics,
you can email us support at DPC pediatrician to request episodes you’d like us to talk about. Also, we had a fantastic summit back in September, our first ever virtual summit. The recordings are available on our website for purchase dpcpediatrician.com. And you can find out more information about what the sessions covered, the speakers,
and you can purchase the recordings there. Lots of great stuff, including inspiring stories from other DPC pediatricians, as well as stuff about the finances of DPC, vaccines, and a lot more. So thanks for listening until next time.
