Thanks for all your great responses!

In a lot of ways it kind of comes down to the fact that I want both- I want to keep my name and I want to take his (and when I say I want to keep mine, I mean as a last name).

As for the middle name idea- my current middle name is my mother's maiden (or birth name)- so it's not an easy one for me to drop. If I take his name, I'll become first name-mothers birth name- my birth name- his last name. Kind of a pain, but I don't want to pick one parent's name to drop either.

As to which name is more appealing- I like both options.

My fiance will support whichever decision I make (though I'm sure he'd be thrilled if I take his name).

Professionally, it will be confusing. I'm a physician- so there are a ton of people who may get confused (and I don't envy our front office staff who'll have to add an extra line to reminder calls etc for some time). But I've practiced in the same place for more than 5 years- people know me and they'll figure it out (and the fact that I've been wearing an engagement ring since October will probably help ease the confusion).

One part of me would like to consider keeping one name professionally and taking the other for my personal life- but I hesitate because I suspect it will only lead to a lifetime of confusion.

I suppose I just need to think of it as having 2 nice options- instead of what I don't get