Believe me, I spent a LOT of time crunching the numbers before committing to this path. I'm somebody who takes this stuff very seriously, works through the numbers diligently, and is not willing to sacrifice my future family for my calling.

To your point, a completely SAHM with kids would be a challenge, but even if my wife works part time, 15 hrs a week or so, or runs a hobby business, things get much easier.

My budget alone in med school would be about the same as someone making $36k a year. I don't know your background or where you're from, but where I live in the midwest, families raise kids on $36k a year. I was raised on much less than that. It's not glamorous but there's enough to go around, families go on small vacations, people own their own homes with kids on $36k.

BUT, if my spouse works only 15 hours a week at $20 an hour (if she's a nurse or something similar, this can easily go up to $40/hour), that brings in $14k-29k extra per year, so now we're talking anywhere from $50k to $65k - more than enough to start a family. Then once I'm in residency I'll make MINIMUM $65k (many residents moonlight, bringing their salary up to $100k), which is plenty for a spouse to SAHM. So we're only looking at her working part-time for maybe the first two, three years of our marriage. After that, I'll be making >$250k a year for the rest of our marriage.