Roughly 43 million Americans carry federal student loan debt, but the burden hits hardest — and most invisibly — when it belongs to someone whose income hasn’t caught up yet. Medical residents, for instance, earn a median annual salary of about $58,000 to $64,000 while managing debt loads that can dwarf a home mortgage. When I met Aisha Patel at a coffee shop in Chicago’s Wicker Park neighborhood on a grey Tuesday in February, she pulled up a color-coded spreadsheet on her phone before she even sat down. That felt like the right introduction.
Aisha is 29, sharp, and works as a marketing manager at a SaaS startup, earning $95,000 a year. Her fiancé, Deven, is a second-year medical resident at a large academic hospital, making $58,000. Together, their household brings in $153,000 annually — a number that sounds comfortable, even enviable, in most American cities. In Chicago, it is genuinely decent. On paper, they are fine.
But the spreadsheet told a different story.
The Number That Overshadows Everything
Deven graduated from medical school in 2023 with $280,000 in federal student loan debt — a figure that falls roughly in line with the national average for medical school graduates, which the AAMC reports sits near $202,000 for public school graduates and significantly higher for private institutions. Deven attended a private program. His loans are currently in an income-driven repayment plan, which keeps monthly payments manageable during residency — but that structure has its own consequences.
“The monthly payment right now is only around $300 because it’s income-driven,” Aisha told me, her voice steady but tired. “But when a mortgage underwriter looks at it, they don’t see $300. They see $280,000 sitting there and they calculate what the full payment would be eventually. It completely blows up our debt-to-income ratio.”
She is describing a well-documented problem. Under conventional mortgage guidelines used by Fannie Mae and Freddie Mac, lenders must account for the fully amortized payment on student loans when evaluating borrower risk — not just the current income-driven minimum. For $280,000 in debt, that projected standard payment can land between $2,800 and $3,200 per month depending on interest rate and repayment term. Add that figure to a potential mortgage payment on a Chicago condo, and the math collapses quickly.
The Wedding They Can’t Agree On
Aisha and Deven got engaged in October 2024. Within weeks, the conversation shifted from romantic to financial. She wants a real wedding — something her family has anticipated for years, a celebration with a guest list of roughly 120 people. Deven would rather elope and funnel the money toward his loans. Neither position is unreasonable, Aisha acknowledged, which is exactly what makes it so exhausting.
“I know he’s right from a pure numbers standpoint,” she told me. “If we spend $30,000 on a wedding, that’s $30,000 we didn’t put toward debt that’s accruing interest at 6.5%. I get it. But I also feel like we’re already sacrificing so much. I don’t want to give up this too.”
The average cost of a wedding in Illinois in 2024 was approximately $32,000, according to survey data compiled by wedding industry trackers. For a couple already managing the psychological weight of six-figure debt, that price tag carries a different kind of gravity. Aisha described the planning process as something that oscillates between exciting and paralyzing, sometimes within the same conversation.
They have not yet set a date. As of the time I spoke with Aisha in late February 2026, they were still weighing a small ceremony in late 2026 against a larger celebration pushed to 2027, when Deven will finish his residency and, theoretically, begin earning an attending physician’s salary.
The Condo That Keeps Moving Further Away
Buying property in Chicago has been Aisha’s goal since she took her current job in 2022. She has $42,000 saved — enough for a down payment on a modestly priced condo in several Chicago neighborhoods. She has been pre-screened informally by a mortgage broker and knows her own credit score sits at 748. On her income alone, she could likely qualify for a purchase. The problem is that she does not want to buy alone.
“I want us to buy together. It’s supposed to be our home,” she explained. “But every time we run the numbers with both of our names on the application, Deven’s debt just wrecks the DTI. The loan officer we talked to said if we could show that Deven is in a qualifying repayment plan, some lenders might use 1% of the total balance as the monthly payment figure, not the full amortized amount. That’s still $2,800 a month on paper.”
She is referring to a guideline change that has evolved over recent years. The CFPB has noted that how lenders treat income-driven repayment plans during mortgage underwriting remains inconsistent across institutions, creating confusion for borrowers in exactly Aisha and Deven’s position.
The Public Service Loan Forgiveness Question
Deven is employed by an academic hospital, which qualifies as a nonprofit under section 501(c)(3) of the tax code. That means he is potentially eligible for Public Service Loan Forgiveness, a federal program administered by the Department of Education’s Federal Student Aid office that forgives remaining federal loan balances after 120 qualifying monthly payments — ten years of service in a qualifying public sector or nonprofit role. If Deven stays in academic medicine, his loans could be forgiven entirely.
Aisha knows this. It is, she said, both reassuring and maddening.
“PSLF is the plan. It has to be,” she said. “But ten years is so long. He started counting in 2023, so we’re talking 2033 at the earliest. That’s seven more years of this hanging over us. Seven years of watching other couples buy houses, have kids, take vacations, and us always calculating whether we can afford it.”
The PSLF program has a complicated history. Early approval rates were notoriously low — as few as 1% of initial applicants were approved in the program’s early years — though the Department of Education implemented significant reforms between 2021 and 2024 that dramatically improved approval rates and clarified eligibility requirements. Still, the anxiety around counting qualifying payments correctly, maintaining the right loan types, and staying in eligible employment for a full decade is real and documented among borrowers.
What Staying the Course Actually Costs Emotionally
Aisha is not someone who dwells easily in uncertainty. Her job requires quantifiable outcomes — conversion rates, CAC, pipeline metrics. She applies the same framework to her personal finances, which is partly why the ambiguity of PSLF and the DTI problem feel so destabilizing. The data is all there. The answer, somehow, still eludes her.
“I’m a data person,” she said, laughing a little at herself. “I can model out scenarios all day. Pay down aggressively now versus stay on IDR and hope PSLF survives politically. Buy a condo under my name only versus wait for Deven’s income to change our picture. It’s not that I don’t have information. It’s that every path has a real downside and none of them feel right.”
That last part landed with particular weight. The PSLF program has faced political pressure at various points in its history, and borrowers counting on forgiveness have watched legislative debates about its future with understandable anxiety. There is no guarantee the program remains intact until 2033. That uncertainty is not irrational — it is the actual landscape these borrowers are navigating.
When I asked Aisha what she wished someone had told her earlier — before the engagement, before the loan balances became her problem too — she paused for a long moment.
She is still saving. The $42,000 in her account is growing slowly — she puts aside roughly $1,200 a month. Deven is still making his $300 IDR payments. They are still engaged, still arguing occasionally about the wedding, still running numbers on neighborhoods they want to live in. The spreadsheet is still on her phone.
Reporting on economic hardship usually means sitting across from someone who has lost something — a job, a home, a benefit check that never arrived. Aisha Patel has not lost those things. What she carries instead is a different kind of weight: the grinding awareness that two people who did everything they were told to do — finish school, get good jobs, save money — can still find themselves years behind where they expected to be. That story does not make headlines. But it is, in its quieter way, just as real.
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