So, I just ran numbers for you. For a 400K job in Virginia, filing married, and putting away $1500 per month for your 401K (which gives you $18,000 per year... I don't know enough about retirement plans to think about how to contribute pre-tax beyond that, since I've not yet had that amount to put into retirement), gives you $19286.88 in take home pay each month (assuming no deductions, which you would definitely have at that point given that you'll have a child).
As a resident in an urban area, paying more than I need to for my housing and eating out a fair amount, I live on about $2500 each month (out of my $3400 paycheck, roughly $500 goes towards loans, voluntarily, and between $400-500 goes to savings). I imagine the costs would be slightly higher for you, given that you'll be more than one person, and you might want some nice things when you become an attending. So, we'll give you $5000 to live on. Plus $900 into Roth IRAs for you and your wife.
That leaves you a little more than $13000 each month. Or $156,000 per year.
Now, you'll make 400K by being an orthopedic surgeon, which is a 5 year residency. According to
Student Loan Calculator - Bankrate.com, your monthly interest if your principal is $450K is $2550. I don't know what the breakdown of your loans is, so it's hard for me to estimate the total balance when you're done with med school. So, at the end of residency, your loans will be approximately $603K. This does not account for any payments made during residency, or the interest benefit if you enter REPAYE.
The 10 year standard repayment for that loan (at 6.8% interest) is $6940. Which means on a salary of $400K, you could pay it off in 4.5 years. Or you could do it in 10 and spend the other $6000 on school funds for kids or whatever.
Let's say you want to be a pediatrician like me, and make $200K. Less compensation, but also less time in residency. At the end of your residency, your loans will be approximately $541,800. Standard repayment would be $6240. Which means with the same 401K contribution (but not Roth IRA), you would be living on $3860 per month. Most certainly living like a resident, and it would take the full 10 years to pay it. Of course, with REPAYE, you won't pay more than 10% of your discretionary income, so your loan payments would not be that high, but it would take you longer to pay them off. But you could pay off more than they require so you don't get hit with the tax bomb at the end of 20 years.
Two extremes of the spectrum, but it gives you an idea what you can and cannot do. And YMMV depending on your interest rates and your payments during residency. (You can play around with some of those assumptions with the
Federal Student Loans website).