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Having a spouse who works could only help you make a bigger dent into your debt I would think. Also, I guess it also depends what specialty you do. You could be making 150k in family med or 300k+ in a specialty. That's why primary care doesn't seem realistic at all for those of us with 300k+
If you live like a resident you could still be paying 50+k a year on your loans, even with a PC salary. It's only not realistic if you can't budget properly and want to drive a new car because you feel owed one or some BS for becoming a doctor.
Spouse probably not going to help unless they're pulling in 6 figures. Lots of hidden expenses in a dual income household that end up netting you negative. Much harder to live as a resident when you're married than when you're single.