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The Biden SAVE plan actually made a massive change that makes it a lot more viable, especially if you do the PSLF program. It's set up so that if you're on an income-driven repayment plan, any interest not covered by your payment does not capitalize. So you might not make any progress on the principal of the loan while you're in residency, but it won't spiral out of control and the reduced payments count towards the 120 PSLF payments. I'm planning on doing a 3 year residency at minimum, maybe more, and probably a fellowship as well, so I'll have 5 years of reduced payments, and then I'll be working in non-profit community/county hospitals after that so I'll be able to use PSLF. Running the numbers, I think the government will be eating about $275k-$300k of my loans.