Undergrad + Grad + private MD school
Was a high MCAT / low uGPA applicant with only 1A when after applying so had no choice med school wise. Family was in a precarious position during my undergrad/grad years, and so a lot of my extra income went to them rather than to paying down loans outside of interest.
Think of it like this. The benefit of coming from a background where you're already used to living conservatively is that you will continue to be comfortable living
somewhat conservatively. I don't think you need to sacrifice your career interests when you can simply make the decision based on where to live.
Given the need to pay down such high loans, you will need to prioritize what the income-based repayment amount will be—and it's going to be quite big—over your cost of living choices. So to be quite frank, you should probably just forget about moving to SF, NYC, DC, or Honolulu. All of these cities will offer you a high salary, but you're going to funnel most of it into living expenses if you want to live in anything more than a small box going forward.
Think about where you can still get that high salary and also find suitable living arrangements.
Do you want to live in a city and sacrifice apartment size and/or luxury and have a short commute? Think Chicago, Philadelphia, Boston, Pittsburgh, Cincinnati, Minneapolis.
Do you want to rent or immediately buy a home? Think Midwest and South with commutes, or maybe parts of Northeast. But then that's a guaranteed need for two cars for you and your partner. Think Texas, Georgia, Florida, Utah, Michigan, Ohio, Wisconsin, Iowa, Minnesota. Does your partner's life move to those places easily? I have friends who worked at the Mayo Clinic in Rochester, MN and bought a huge home, but they had to live in a rural McMansion subdivision where the only thing for delivery was pizza from Domino's and the nearest store was a 15-minute drive. It's very give and take.
You can also sacrifice higher salary and go more rural, lots of need for peds in rural Oregon, and you'll find very inexpensive housing. But your earning potential will be reduced by location.
Of course, a lot of this also depends on how much money you can spend to interview far away from where you currently are. It's going to be a lot easier to look local to where you're living after residency.
Good luck! Stay the course!