How Physician Mortgage Loans Work and When They Win

Who it is for

Physician mortgages exist for people whose income trajectory looks nothing like their balance sheet. That is a resident or fellow earning a training salary with six figures of student debt and near zero savings. It is also a new attending with a signed contract and a first paycheck that has not arrived yet. Early career physicians may struggle to qualify for a traditional mortgage despite high incomes, and physician loans bridge that gap.

Eligibility by degree is broad. MD and DO are accepted at every program. DDS and DMD are named at nearly every program. Many lenders also include podiatrists, veterinarians, and optometrists, though the list varies by lender. Residents and fellows are eligible at all major programs. Check the specific lender's page for your degree before you apply, because this is the one area where lenders differ.

The loan is almost always for a primary residence. A few lenders allow a multi family home if you live in part of it. Investment properties, second homes, and most condos are out at most lenders.

The 5 signature features

1. No private mortgage insurance, even at zero down

This is the feature that defines the product. A conventional loan with less than 20 percent down requires PMI, which protects the lender and costs you money for nothing. A physician loan charges no PMI at any down payment, including zero. This can save hundreds of dollars a month versus the conventional path.

For scale: conventional PMI runs 0.46 to 1.50 percent of the loan amount per year, depending on credit score and loan to value. That is roughly $30 to $70 per month for every $100,000 borrowed. On a $650,000 loan that is $195 to $455 a month, paid until you reach 20 percent equity, which can take a decade.

2. Low or zero down payment

Most physician loan lenders offer 100 percent financing up to a $1 million loan. Above $1 million, lenders typically want 5 to 10 percent down up to $1.5 to $2 million. The 2026 conforming loan limit is $832,750 in most areas ($1,249,125 in high cost areas). Physician loan programs routinely go above that, which is one of the quiet advantages: they do not care about the conforming limit because they are not selling the loan to Fannie Mae.

3. Debt to income flexibility

Most physician loans allow a debt to income ratio up to 50 percent, versus 36 to 45 percent on conventional mortgages. This matters less than the student loan treatment below, but it is real headroom for a household carrying a car loan and credit card minimums on top of a mortgage.

4. Student loan treatment

This is the single biggest qualification difference. Under conventional rules, deferred or forborne student loans count at 1 percent of the balance in your DTI. A $300,000 deferred balance is a $3,000 monthly payment on paper, even though you pay nothing. Physician programs handle this differently: many exclude student loans deferred at least 12 months after closing, and where loans are not excluded, programs typically use the actual income driven payment, even if it is $0, rather than the 1 percent rule.

5. Your contract counts as income

Many lenders prefer two years of stable employment history. A physician loan accepts a signed employment contract or offer letter instead. Most programs allow up to 90 days between closing and your start date, so you can close on the house before the job begins.

Who offers them

The market is mostly large banks, plus a few mortgage companies: Bank of America, BMO, Fifth Third, Huntington, TD Bank, Truist, Flagstar, KeyBank, and others. Regions publishes 0 percent down up to $1 million with no PMI. SoFi and CrossCountry Mortgage also run physician programs.

Do not pick on brand. Terms, rate premiums, and student loan rules differ by lender, and none of the major lenders publishes its physician loan rates. The useful comparison is three written quotes in the same week, compared on APR including fees, not on the headline rate alone.

The honest trade offs

Physician loans cost more in interest than a conventional 20 percent down loan. Rates typically run 0.125 to 0.5 percent above the conventional average. On a large loan that is real money, tens of thousands in extra interest over 30 years.

Many physician loans are adjustable rate mortgages. If you want a fixed rate, confirm the program offers one. Several do.

Credit standards are not loose. Most programs want a score of 700 or higher. The generosity is in savings, debt, and employment history, not in credit.

Zero down means zero equity. Buy a $1 million house with nothing down and a market correction leaves you owing more than the house is worth. The PMI waiver is a pricing feature, not a safety feature.

And the product only works for a primary residence. If you are buying for residency and leaving in three years, rent. Transaction costs eat the first years of equity on any loan.

What this means

A physician mortgage is a bank weighing your income ahead of your savings. For a resident, fellow, or new attending buying a primary home with student debt and little cash, it is usually the best loan structure available. For a physician with 20 percent down saved and a strong credit file, a conventional loan at the lower rate is usually cheaper. The product is a tool for a specific financial shape, not a reward for being a physician. Match the loan to your shape.

Last reviewed: 2026-10-04. Limits and program terms change. The reviewed date moves when they do.