If you're a PA, NP, pharmacist, or physician trying to figure out what to do with your student loans, you've probably asked some version of this question:

“Should I refinance my federal student loans to a lower rate and just pay them off faster?”

It seems like an obvious move.

Lower interest rate. Faster payoff. Done.

But this decision is far more complex than it looks, and for medical professionals in particular, refinancing can either save you a lot of money… or cost you access to some extremely valuable protections.

In this conversation, I sat down with Kaitlin Hile, PharmD, BCCP, a cardiology clinical pharmacy specialist who has undergone specialty training in federal student loan strategy. 

We walked through some of the most common questions clinicians ask about refinancing, forgiveness, and repayment strategies.

Let’s break down the key takeaways.

The First Question to Ask Before Refinancing Student Loans

One of the first questions that came up was from a medical profess...

If you’re applying to PA school right now, I know what’s taking up 90% of your brain:

Getting in.

And that makes sense. But I want to say something most people don’t hear until after they’ve borrowed a life-changing amount of money:

Student loan strategy has to be part of your PA school decision before you take out the loans.

Because once you graduate, you don’t get to “undo” your debt-to-income ratio. You just have to live with it.

In this conversation, I’m joined by my colleague Kaitlin Hile (a clinical pharmacy specialist with training in federal student loan strategy) and Savanna Perry (a Dermatology PA and the founder of The PA Platform) to walk you through what’s changing in student loans, what repayment paths actually look like, and what I want you thinking about now, while you still have leverage.

Why I’m So Passionate About This: I Borrowed Without a Plan

I didn’t do this the smart way.

I blindly signed up for loans. I didn’t know anything about anything. And it wasn’t...

If you’re a PA, NP, pharmacist, physician — and:

• You’re not investing at all
• Or your version of investing is 4% into your 401(k)
• Or you’re “waiting until things settle down”

This might be the most expensive episode you’ll ever ignore.
And I’m not being dramatic.

I became a millionaire at 31 as a PA.

Not because I sold a company.
Not because I inherited money.

But because I understood one simple truth:

Time is the most powerful wealth-building tool you have.

And every year you delay investing, you are quite literally setting money on fire.

Let’s talk about the math.

Why Medical Professionals Are Already Behind

Most of us delayed investing before we ever earned our first real paycheck.

Think about it:

• 4 years undergrad
• 2–4 years graduate school
• Possible gap years
• Possible residency or fellowship
• Limited income during training
  

By the time a PA, NP, or pharmacist starts earning six figures, they’re often 25–30 years old.

That’s 6–10 prime investing years gone.

Le...

If you’ve ever taken a job that looked perfect on paper… but felt awful in real life?

This is for you.

As a PA with nearly a decade in hospital medicine, critical care, and cardiology — I’ve signed a lot of contracts. I’ve also worked multiple PRN/per diem jobs, and through Millionaires in Medicine, I’ve helped hundreds of medical professionals navigate their careers.

So yes… I’ve seen the good, the bad, and the ugly.

Before you sign your next contract, you need to understand one concept that prevents most job regret:

Your scope of practice ramp + your compensation ramp.

If those two don’t grow together, you’ll eventually feel trapped — clinically, financially, or both.

The #1 Contract Mistake Medical Professionals Make

Most clinicians focus on the salary number and stop there.

But the real question is:

“What does this job become in 1–2–3–4 years?”

Your scope should expand as your skills expand. Your pay should expand as your value expands.

If your employer has no plan for ...

Most medical professionals think real estate investing means one of two things:

1. Buy a long-term rental and hope it cash flows.
   
2. Run a short-term rental and accept the headaches.
   

But there’s another option more clinicians should know about: Residential Assisted Living (RAL).

It’s a real estate + business model that can create meaningful monthly cash flow — while also improving senior care in a way many big-box facilities can’t.

In this conversation, I’m joined by Dr. Alex Schloe, a family medicine physician, Air Force serviceman, real estate investor, and entrepreneur, to explain how RAL works and how clinicians can participate without leaving medicine.

What Is Residential Assisted Living (RAL)?

Residential assisted living is typically a large home in a normal neighborhood that’s been renovated to care for seniors — usually 6 to 16 residents depending on the state.

It supports activities of daily living like:

• bathing, toileting, dressing, mobility
• meal support, cleaning, ...

Most medical professionals don’t feel “bad with money.”

You have a six-figure income.
You contribute to your 401(k).
Maybe you max out your Roth IRA.

And yet… you still feel behind.

If that’s you, I want you to know something:

It’s not because you’re irresponsible.
It’s because you’ve likely believed one of three lies that quietly derail wealth-building for PAs, NPs, CRNAs, and PharmDs.

Let’s break them down.

Lie #1: “I Should Just Pay Someone to Invest for Me”

I hear this constantly.

“I’m too busy.”
“I’m not good at math.”
“I don’t understand investing.”
“Successful people hire advisors.”

When I was a brand-new PA, I hired a financial advisor at a large national firm. He was a wonderful human. Truly.

But when I ran the math on the 1% assets-under-management (AUM) fee I was paying?

It was going to cost me over $1 million across my investing lifetime.

Here’s what that can look like:

Assume:

• Age 32
• $100,000 invested
• Investing $18,000 per year
• 8% annual return
  
  

A 1% AUM fee...

Signing an employment contract as a nurse practitioner or physician assistant can feel deceptively simple. An offer is on the table. The role sounds exciting. 

Yet, the fine print in APP contracts often shapes your workload, compensation, autonomy and long-term satisfaction far more than the job description ever will.

Whether you’re early in your career or an experienced APP considering a change, understanding the key elements of your contract and where problems commonly hide can help you avoid costly missteps—protecting your career.

Below are practical, recruiter-backed tips every NP and PA should know before signing—plus three bonus insights for dermatology NPs and PAs to pay attention to.

1. Compensation Is More Than a Base Salary

Many nurse practitioners and physician assistants / associates focus first on base pay, but NP/PA contracts often include additional components that significantly affect total compensation.

Pay close attention to: 

• Productivity bonuses (RVUs, coll...

Your income drives every financial goal - paying down debt, owning a home, saving for retirement, and building financial freedom.

At Millionaires in Medicine, the focus is on building confidence and structure around budgeting, investing, and long-term planning. That progress depends on consistent income.

What happens if you can’t work?

Disability insurance exists to protect cash flow – the same way diversification protects a portfolio or insurance protects a property. During the accumulation phase of your career, income continuity is the foundation of every financial strategy. Without it, even disciplined savers and investors are forced into damage control.

A medical professional earning $100,000 at age 32 is on track to generate nearly $7 million over his or her career. Shouldn’t that multi-million dollar asset be insured?

Disability Risk is More Common Than People Realize

Many people assume disability only applies to catastrophic events, like paralysis from a car accident or a ...

Most physician assistants don’t earn less because they aren’t valuable.

They earn less because they’re too polite to ask.

I’ve seen it over and over again—smart, capable PAs leaving tens of thousands of dollars on the table simply because negotiation feels uncomfortable, intimidating, or “ungrateful.”

I’m Kristin Burton, PA-C, and I’ve been a PA for nearly a decade. I’ve negotiated primary jobs, per diem roles, investment deals, and business contracts. And I can tell you this with certainty:

Failing to negotiate doesn’t just affect your next paycheck—it compounds into decades of under-earning and lost wealth.

Why Negotiation Feels So Hard for PAs

I still remember my first PA job offer.

I was on rotation when the email hit my inbox. My heart was racing. I was thrilled. They could have offered me almost any number and I would’ve said yes.

I was just grateful to have a six-figure job as a new grad.

Negotiation wasn’t even on my radar.

And that mindset—“Where do I sign?”—follows ...

What if I told you that you might be leaving millions of dollars on the table for your future retirement?

And what if that loss came down to one small mistake most medical professionals make without realizing it?

I’m talking about a simple setting inside your employer retirement portal… a single button you likely clicked once, years ago… and never looked at again.

It’s one of the easiest financial pitfalls to fix, but the impact is massive. And with new IRS rules coming in 2026, ignoring it could cost you more than you think.

Today, I want to show you the exact retirement mistake 90% of PAs, NPs, CRNAs, and PharmDs are making — and how to correct it before 2025 ends.

The One Button Most Medical Pros Never Re-Check

A cardiothoracic surgery PA I’ll call Sarah came to us after investing for years. She had originally set her 401(k) contribution to the maximum back when she started her job five years earlier… and then never touched it again.

The problem?

IRS contribution limits chan...