I recently got married and thought about a prenup (not a surgeon though). I did not wind up pursuing it for a few reasons. One of them was that it’s actually pretty expensive (at least on a fellow salary) to get a working prenup. Not only do you have to pay an attorney, but ideally your spouse should have adequate representation of their own. Prenups have been deemed unconscionable because one party lacked independent representation.
The other thing is that it’s often pretty logistically difficult to protect things like income with a prenup. Prenups work pretty well if you want to protect an inheritance or something, but it takes a lot of commitment to separate finances in a way that the prenup actually covers them. It’s not like you can really just say “my income is mine and yours is yours.” You basically have to keep your money in separate accounts. Which is fine until you get into a situation where you’re actually paying for stuff together or paying for something that both of you use.
Like, imagine you’re buying a house and both people are contributing to the mortgage even though the higher earner is contributing more. A lot of times, there is going to be a presumption that this is communal property. Or imagine that the higher earner pays for the car of the lower earner. Whose car is it?
I basically came to the conclusion that having an enforceable prenup was going to be expensive and would result in a strict division of assets that neither of us really wanted in the relationship. My wife earns significantly less than me and I don’t want her to have to live a significantly different lifestyle than I do. That inherently means I’m going to have to pay for some stuff that we can afford but she can’t individually. I felt like doing that was going to make any prenup very difficult to enforce.
Also, my wife supported me through applying to med school, med school itself, residency, and part of fellowship before we ever even got married. We dated for almost 10 years before getting married. As you said, that would be a lot of investment without any guaranteed payoff. I don’t think she’s after any money I might make.