Mortgage guidance built for medical careers
The doctor loan, without the small print.
A physician mortgage loan lets new and practicing doctors buy a home with little or no money down, no PMI, and an offer letter in place of pay stubs. We’ll explain what it is, who qualifies, and how to tell a real program from a repackage.
Free to explore. No obligation. A request is not a mortgage application or credit pull.
IN THIS REFERENCE . 7
CHAPTERS
A start-to-finish read on the physician mortgage — what it is, who qualifies, the honest math, and how to use it without getting hurt. About a fourteen-minute read.
01
Definition
02
How it works
03
Eligibility
04
Pros & cons
05
Compare
06
Afford
07
Guardrails
01
DEFINITION
What is a physician mortgage loan?
The plain-English version. A loan product a handful of banks created for doctors — designed around an offer letter and a student-loan-heavy balance sheet, not around the standard W-2 underwriting box.
A physician mortgage loan is a portfolio mortgage built by a small number of banks specifically for physicians and a handful of other high-credential professionals.
The bank keeps the loan on its own balance sheet, which means it can rewrite the rules everyone else has to follow. In a conventional mortgage, the lender plans to sell the note to Fannie Mae, Freddie Mac, or a similar agency.
To do that, the file has to match the agency’s box — two years of W-2s, a debt-to-income ratio under 43%, and a down payment large enough to avoid private mortgage insurance.
Most new doctors don’t fit that box. They have a six-figure offer letter that hasn’t started paying yet, six figures of student debt on income-driven 90 days early.
VERIFIED repayment, and no down-payment savings. A real doctor mortgage program takes those facts as a given and underwrites around them.
There are four mechanical things a real program will do that a conventional loan won’t. They’re listed on the right — and hey show up, in writing, on the closing disclosure.
THE FOUR RULES
What a real program does
i Closes on an offer letter
Up to 90 days before your first day of work — with no pay stubs required.
.
ii Uses your IBR/PAYE payment
Or 0.5-1% of balance — not the fully amortized number.
.
iii 0-10% down, no PMI
Up to high loan amounts covering most metro markets.
.
iv Underwrites for physicians
Income trajectory is recognized as unusually predictable.
02
HOW IT WORKS
The three things a real program actually does.
Each one is acolumn on your closing disclosure. If your lender can’t produce it in writing, the program isn’t a real physician loan — it’s a conventional loan wearing the label.
i. Down payment
O-10%
Little or nothing down
A real physician program funds 90—100% of the purchase price up to high loan amounts. You bring earnest money and closing costs — not a year of saved-up cash you don’t have yet.
ON THE DISCLOSURE . DOWN PAYMENT 0-10%
ii. Mortgage insurance
No PMI
No private mortgage insurance
Less than 2 down on a conventional loan typically adds $150-$400/mo in PMI. A real doctor loan eliminates it entirely — saving most borrowers $40k+ over the life of the loan.
ON THE DISCLOSURE . PMI = $0
iii. Income proof
Offer letter
An offer letter is your income
A real program funds up to 90 days before your first day — using the signed contract from your hospital, group, or fellowship as proof of income. No stubs, no W-2s.
ON THE DISCLOSURE . EMPLOYMENT OFFER
03
ELIGIBILITY
Who qualifies for a doctor loan?
Eligibility is by credential, not by guess. Lenders publish the exact degrees and career stages they accept. Below: the credentials in our network, with answers to the questions readers actually ask.
FROM THE INBOX
Common questions, frankly answered.
A.
Yes. Most real programs will write a loan to a resident, fellow, or attending. Residents and fellows are typically capped at lower loan amounts (often $750k-$1m) because the income is lower; attendings get the full envelope.
Q.
Can I qualify during residency or fellowship?
A.
A real program will use your actual income-driven payment (IBR/PAYE/REPAYE), or 0.5-1% of the balance — not the fully amortized number a conventional lender uses. That single rule is the difference between qualifying and not qualifying for most new physicians.
Q.
What about my student loans?
A.
Most programs want a 700+ middle score, with best pricing at 740+. A 680 will still typically qualify at a small rate adjustment. Below 660, fix the score first — it’s the highest-leverage three months of your financial life.
Q.
What credit score do | need?
A.
Yes — no lifetime cap. Most physicians use a doctor loan twice: once for a residency-city starter, then again for an attending home. Some programs even allow it on a refinance or second home, though rates are higher.
Q.
Can I use a doctor loan more than once?
04
HONEST TAKE
Is the doctor loan actually a good idea?
Yes — if you treat it like a tool, not a trophy. The product is good. The most common way to get hurt with it is to use the bigger qualifying amount to buy a bigger house. Read both columns.
For .05
In the right hands – why it works
You buy with the money you actually have
No 12-month savings sprint to get to 20% down before you close on the house you've already moved to.
PMI disappears
Skipping mortgage insurance saves the average borrower $40,000+ over the life of the loan — a real, in-pocket number.
Your student loans don’t lock you out
The income-driven payment, not the fully amortized one, drives your debtto-income ratio.
The bank treats your offer letter as income
You can close before day one — up to 90 days early — meaning you move once, not twice.
The price is competitive
A real program typically prices within 0.125-0.375% of a conventional 20%- down loan. PMI savings usually erase the gap.
AGAINST – 05
Where it goes wrong – how to avoid it
It pre-approves you for more house than you should buy
A bigger qualifying number is not a bigger budget. The same trap as any first-time buyer, just at a higher dollar amount.
You start with little or no equity
If you have to sell in two years, you'll likely write a check at closing. Don’t use it for a house you'll outgrow in 24 months.
The rate is slightly higher
Expect 0.125—0.375% more than a 20%-down conventional. Worth it if you'd otherwise pay PMI; not if you have the cash.
Some repackages charge fees a conventional won't
Real ones don’t. Always compare line-by-line on the Loan Estimate, not just the headline rate.
An ARM is still an ARM
Don't take a 5/1 ARM unless you have a specific, dated plan to refinance or move before the reset.
05
COMPARE
Doctor loan vs. conventional, line by line.
Six rows decide whether the physician program is the right move for you. Run your situation against the table. If three or more rows favour the physician column, the math is on your side.
OPTION A. RECOMENDED
Physician loan
DOWN
O-10%
100% financing common up to high loan amounts
PMI
$0 / month
No private mortgage insurance, ever
INCOME
Offer letter accepted
Close up to 90 days before first day of work
SL DTI
IBR / PAYEused
Or 0.5-1% of balance — not fully amortized
RATE
Slightly higher
+0.125 to +0.375% vs. conventional
KNOWS MDS
Yes — specifically
Offer letters, RVUs, locums, 1099 — all familiar
vs.
OPTION B - STANDARD
Conventional w/ 20% down
DOWN
20% required
..to avoid PMI on a standard conforming loan
PMI
$150-$400 / mo
Until 22% equity, if less than 20% down
INCOME
30 days of stubs
Often a full month after you start work
SL DTI
Fully amortized
Often the difference between approve and decline
RATE
Slightly lower
..jf you actually have 20% to put down
KNOWS MDS
No — generic box
File kicked out on anything non-standard
06
AFFORD
How much can I actually afford?
The honest answer is smaller than the qualifying answer. Most physicians do well at 2x gross income on the first home and no more than 28% of gross income on principal, interest, taxes, and insurance combined.
Slide your real numbers in.
A back-of-the-envelope estimator using the “28% of gross” rule with realistic taxes, insurance, and a 6.75% rate for a 30-year doctor loan. Planning tool, not a pre-approval.
07
GAURDRAILS
Should you really do this?
Use the doctor loan if you can answer “yes” to all four. If a question lands as a “no” or a “maybe,” rent another year. The product will still be here when you’re ready.
01
Will you stay in this market for at least five years?
A doctor loan starts with little or no equity. If you sell in year two, you’ll likely write a check at closing — a five-year horizon turns that math from a coin flip into a near-certainty.
YES
5+ yr horizone
NO
Rent another year
02
Is the payment under 28% of gross income?
That’s the line where physicians comfortably absorb the cost of a house and still save 15-20% of income. Above 35%, the budget gets tight fast — especially if you’re still paying down loans.
SAFE
PITI < 28% gross
DANGER
PITI > 35% gross
03
Do you have an emergency fund?
Three to six months of expenses outside of the down payment, in cash. A doctor loan is a great product. It is not a substitute for liquidity when the water heater dies in month three.
HAVE
3-6 months, cash
NOT YET
Build first
04
Have you compared two real lenders, side by side?
Pricing varies more across “physician” programs than across conventional ones. A real program comes from a bank that holds the note; a repackage comes from a broker shopping a wholesale wholesaler. Get two Loan Estimates.
GOT
2 Load Estimates
ONLY ONE
Get a second
Done reading? Pick your move.
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