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There is a difference between "I wouldn't want to be with someone who worked these hours forever" and "I am really unhappy and will be unhappy for the next three years. It's a foolish dream I suppose. We all know people who know that the gospel is true but they will not accept it. The church creates massive guilt and shame in children and adults usually through sex related shaming. If your heart longs for children, a family and love- why should you stop yourself holding out for some mystical Mormon man to swoop you off your feet. I just happened upon your blog I'm a doctor's wife as well - rural family medicine and I just wanted to agree with you that "have no expectations" is awesome advice. If you marry him, you are committing to accepting him without the church and all that this entails. When I taught GD we discussd the lessons. Can I leave him now. In any case; I can assure you from your post that he doesn't sound like he's being selfish; the behavior does sound like its residency related and not selfishness related.
The most important thing is an open dialogue, as you say, and utmost respect for the other person. It interrupts meals, sleep, shopping trips, conversations, romantic time, and even fights. Follow the footnotes and you start to find the lies.