Some of the ones I know spend like they're making millions. But I look up their area, and they're making maybe a few hundred grand. Great money, but not crazy money.

Do they just get used to being in debt up to their necks for med school and then keep that going?

Lawyers and bankers and others I know making same amounts seem to typically (not always) live more conservatively.

Seems to be a difference between those who chose medicine because they wanted to be in medicine versus those who chose it for income reasons. Best ER doc I know lives in a bad part of town and bikes to work.