What would you do if the person you were planning to build a life with was carrying a debt larger than most mortgages — and making less than $65,000 a year while doing it?
That is the question Aisha Patel, 29, has been living inside for the past two years. When I met with her at a coffee shop in Chicago’s Wicker Park neighborhood on a Tuesday afternoon in late March 2026, she had a spreadsheet open on her laptop before I even sat down. That detail told me almost everything I needed to know about her.
Aisha is a marketing manager at a SaaS startup, pulling in $95,000 a year. Her fiancé, Dev, is a second-year medical resident at a large academic hospital in the city, earning roughly $58,000 — a wage that sounds reasonable until you remember he spent four years accumulating the debt that funded it.
The Number That Rewrites Every Plan
Dev graduated from medical school in 2024 with $280,000 in federal student loans. That figure is not unusual — according to the Association of American Medical Colleges, the median debt load for indebted medical school graduates has exceeded $200,000 for several consecutive years, with many graduates at private institutions crossing $300,000. What makes Dev’s situation complicated is the timing: he entered residency before either of them had fully mapped out what that number would mean for their shared future.
“We knew he had debt,” Aisha told me, pushing her coffee to the side. “But when we actually sat down and added it up with interest, I had a physical reaction. Like a cold feeling. We had been talking about buying a condo in Logan Square, and that number made the whole conversation feel fake.”
The math on a mortgage is brutal in their situation. Lenders typically require a debt-to-income ratio — all monthly debt obligations divided by gross monthly income — to stay below 43 percent for a conventional loan, and most prefer closer to 36 percent. Even on an income-driven repayment plan that kept Dev’s monthly payment low, that $280,000 balance flags in underwriting. Aisha had already been told as much by a mortgage broker she consulted in January 2026.
“He basically said come back when the debt is lower or the income is higher,” she said. “Which is a polite way of saying come back in three years. That’s a long time to keep renting in Chicago.”
What Public Service Loan Forgiveness Actually Looks Like From the Inside
The program that changed the tenor of their conversations — though not necessarily their anxiety — is Public Service Loan Forgiveness, or PSLF. Under PSLF, borrowers who work full-time for qualifying nonprofit or government employers and make 120 qualifying monthly payments under an eligible income-driven repayment plan can have their remaining federal loan balance forgiven, tax-free. According to the Federal Student Aid office, the forgiven amount is not treated as taxable income under current law — a significant distinction from some other forgiveness programs.
Dev’s residency hospital is a large academic medical center designated as a 501(c)(3) nonprofit. That means his time in residency — typically three to seven years depending on specialty — counts toward the 120-payment threshold. If he completes a three-year residency and then takes a position at another qualifying hospital or academic medical center, he could potentially reach forgiveness in approximately seven more years of post-residency practice.
When I asked Aisha when she first learned about PSLF in detail, she paused. “Honestly? Not until last fall. Dev’s loan servicer mentioned it during a call about repayment options, but they didn’t walk him through it properly. We found most of what we know through a Reddit forum for medical residents. Which is insane, given how much is at stake.”
That gap in official outreach is well-documented. The PSLF program has a historically troubled reputation — its initial approval rate when forgiveness first became available in 2017 was under 2 percent, largely because borrowers were enrolled in the wrong repayment plan or had the wrong loan type. Reforms passed in subsequent years, including a limited PSLF waiver period and the IDR Account Adjustment, have corrected many of those earlier errors, but awareness remains uneven.
The Wedding Question That Has No Clean Answer
Separate from the mortgage and the loans, Aisha and Dev are trying to plan a wedding. This is where data-driven Aisha admitted the spreadsheet starts to break down emotionally.
The average cost of a wedding in the Chicago metropolitan area runs between $30,000 and $45,000 according to wedding industry surveys, though costs vary enormously depending on guest count and venue. Aisha’s family has offered to contribute, but the conversation has become layered with obligation and expectation.
“Dev keeps saying we should elope and put the money toward the loans. And part of me agrees. But another part of me thinks — we’ve already delayed so many things because of this debt. Do we delay this too?” Aisha said. She didn’t phrase it as a rhetorical question. She genuinely wanted to know if other couples in the same situation had found an answer.
I told her what I’ve found in reporting on this: they usually haven’t found a clean answer. They’ve found a trade-off they could live with.
The Programs That Exist — and the Ones That Stalled
Beyond PSLF, Aisha and Dev have been researching income-driven repayment options for the residency period. The SAVE plan — Saving on a Valuable Education — was introduced in 2023 as the most borrower-friendly IDR option, capping payments at 5 percent of discretionary income for undergraduate loans and offering faster forgiveness timelines. For Dev, it would have substantially reduced his monthly payment during residency years when his income is lowest.
However, as of early 2026, the SAVE plan has been blocked by federal court injunctions and remains in legal limbo. According to reporting by NPR, borrowers enrolled in SAVE were placed in an interest-free forbearance period while litigation continued, but those months in forbearance do not count toward PSLF’s 120-payment requirement — a significant setback for borrowers like Dev who are trying to accumulate qualifying payments during residency.
“That part honestly made me angry,” Aisha said when I explained the forbearance issue. “He’s doing everything right. He’s at a nonprofit hospital, he signed up for the program, and now he finds out the months don’t count because the government is fighting with itself about the plan. That feels like bait and switch.”
It is a frustration I have heard from multiple borrowers in my reporting. The structural problem is that PSLF requires a decade of consistent, qualifying payments — and policy instability in the underlying repayment plans creates compounding uncertainty for anyone trying to plan around the program.
Where Aisha and Dev Stand Now
When I asked Aisha what she wished she had known earlier, she didn’t hesitate. “That you have to be your own case manager. Nobody is going to call you and say ‘hey, here’s the most efficient path through this.’ You have to go find it, verify it, and then check again six months later because it might have changed.”
As of March 2026, Dev has accumulated approximately 18 qualifying PSLF payments — 102 short of forgiveness, assuming the remaining months proceed without further program disruption. They have pushed the condo purchase to 2028 at the earliest, when Dev will be out of residency and earning closer to an attending physician’s salary. The wedding question remains unresolved, though Aisha said they are leaning toward a smaller ceremony with a larger celebration later.
The $280,000 balance has not moved meaningfully. On an IBR plan during residency, Dev’s monthly payments are low enough that they barely cover accruing interest. That is by design — IDR plans are structured to make payments manageable during low-income periods, with forgiveness intended to absorb the balance that accumulates. But watching a six-figure debt grow while making payments is psychologically difficult, and Aisha was candid about that.
“I know intellectually that the balance going up doesn’t mean we’re losing,” she said. “If PSLF holds, the balance doesn’t matter. But emotionally? Watching a number that big go the wrong direction is hard. I won’t pretend otherwise.”
Sitting across from Aisha, what struck me most was not the complexity of the programs she had researched or the spreadsheets she maintained. It was the specific kind of exhaustion that comes from making high-stakes decisions in an environment where the rules keep changing. She and Dev are not behind. By most measures, they are ahead. But the architecture of their financial life has been built around a federal program that has spent much of its existence being litigated, reformed, or mismanaged — and that uncertainty has a cost that doesn’t show up in any spreadsheet column.
Some stories end with resolution. This one is still in progress, filed somewhere between residency year two and payment number 120.
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