24 years old with ~$330k in student loan debt, living in the Dominican Republic — should I pursue a U.S. dental career through BU or stay in the DR?

Hi everyone. I’m 24 years old and I’m honestly feeling pretty overwhelmed about my financial situation and could really use some outside perspective.

I currently have around $258k in federal student loans, and by the time I finish my current education, I estimate that my total debt could be around $330k. Some of my loans have relatively low interest rates, but others are much higher (2.75-9.07%).

The difficult part is that I currently live in the Dominican Republic, where wages are dramatically lower than in the U.S. If I stay here and work as a dentist, I realistically expect to make around $3,000/month, at least initially. Obviously, that makes paying off $330k of debt extremely difficult.

The thing I struggle with the most is that I took out these loans when I was 17 years old. I was honestly very uneducated about finances, student loans, interest, repayment, and the long-term consequences of borrowing this much money.

At 17, my thinking was basically: I want to study, I want to become a dentist, and I’ll figure everything else out later.

I didn’t understand what $250k–$330k of debt actually meant in terms of my future. I wasn’t thinking about buying a house, saving for retirement, having a family, or what my monthly payments would look like. I just wanted an education and a career.

Now I’m 24 and obviously understand the situation much better, and I’m scared that this debt could hold me back for a huge portion of my adult life.

One option I’m considering

Because I’m a U.S. citizen and internationally educated in dentistry, I’ve been looking at Boston University’s DMD Advanced Standing program.

From what I’ve researched, it’s a 2-year program that would allow an internationally trained dentist to earn a U.S. DMD and pursue U.S. licensure.

However, the estimated cost of attendance is roughly $325k for the two years.

So I’d potentially be taking on another ~$325k on top of the ~$330k I may already owe.

That means I could potentially end up with something approaching $600k+ in student debt.

The obvious benefit is that I’d then have access to the U.S. dental job market, where dentist incomes are dramatically higher than what I could earn in the Dominican Republic.

But I’m terrified of taking on another massive amount of debt just to escape the first massive amount of debt.

At the same time, staying in the Dominican Republic and earning ~$3k/month doesn’t seem like a particularly realistic way to pay off ~$330k quickly.

I’ve also been thinking about trying to build a business or another source of income in the DR, potentially alongside dentistry, but obviously there’s no guarantee that I’ll be able to generate enough income to make a meaningful difference.

What would you do?

I’m trying to look at this rationally rather than emotionally.

Would it make more sense to:

1. Stay in the Dominican Republic, accept the lower income, and try to build a dental practice/business or other sources of income while aggressively paying down the debt?

2. Take the huge risk of going to BU, potentially ending up with ~$600k+ in debt, but hopefully earning a U.S. dentist’s income afterward?

3. Look for some other pathway to U.S. dental licensure that doesn’t involve taking on another ~$325k?

4. Consider income-driven repayment/forgiveness options rather than making paying off the entire balance my primary goal?

I’m also interested in hearing from dentists who graduated with $300k–$600k+ of debt. How has it actually affected your life?

Do you feel like you were able to live normally, buy a house, save/invest, have a family, etc., or did the debt dictate your decisions for years?

And if anyone has experience with internationally trained dentists, BU Advanced Standing, or practicing dentistry in the Dominican Republic, I’d especially appreciate your perspective.

I know I made mistakes by taking on debt without understanding what I was doing. I can’t go back and change that. I’m just trying to figure out the smartest way forward at 24 rather than letting shame or panic make the decision for me.

If you were in my position, what would you do?