Is love enough to make it work? (28m & 28F)

I’ve (28M) been with my girlfriend (28F) for over 3 years. We live together, but I work 4 hours away and stay in that city 4 days a week, returning for long weekends. This setup has only been going on for 2 months. She just started a demanding 5-year medical residency in the US as a general surgeon, which requires long hours and a lot of emotional support.

Recently, she told me I need to be “all in” — meaning I should leave my job and find work locally so we can live together full-time.

I love her, but I also love my job. It’s fulfilling, my team feels like family, and it pays significantly more ($160–180k vs. $80–100k locally). There’s no guarantee I’d find the same meaning or community in a new role, but I know my current work environment can change over time too.

We’re also misaligned on some big life issues: I want kids someday. She’s unsure - learning towards yes but she also may never want them.

I would like to move back to the East Coast long-term to be near my family. Being an east coaster is an integral part of my identity and I take tremendous pride being from there. She doesn’t want to move back to the east coast in the future.

She’s had some trust concerns around a coworker, however there has been no cheating or lying. We had past trust issues (lying, not cheating - which I was in the wrong) that we’ve worked through.

Right now, I feel like I’m being asked to sacrifice a lot — my job, future plans, family — whereas I'm not sure she is compromising as much on her side of things. I understand sacrifices aren’t always equal in a relationship, but I’m trying to figure out if we are just not compatible?

Has anyone been through something similar and made it work?

TLDR: My girlfriend and I have been together 3 years. She just started a demanding residency and wants me to move with her full-time or break up. I love her but also love my job. We also differ on kids, future location, and have some issues with trust history