As someone in a similar situation (different state), I suspect your wife is going to need to work. Unless you can save four years worth of living expenses (for her and your child) before you start. Otherwise, you are going to have to take out personal loans to cover their living expenses, because you can only borrow cost of attendance for yourself. Furthermore, since the federal loans are based on cost of attendance, going to a cheaper medical school doesn't increase the amount of borrowed dollars available for dependents. The federal government provides no loans for dependents as far as I'm aware. The loan system is not the most family friendly process to be honest, but even if it were the debt burden would be huge at the end. If anyone has advice counter to this, I would be keen to hear about it as well.