Comparing Physician Mortgage Lenders: What Actually Matters

Physician mortgage programs differ on seven things that matter: the maximum loan at 0% down, the program's overall ceiling, the debt to income cap, how student loans are counted, whether you can get a fixed rate or only an adjustable rate, whether they lend in your state, and whether the lender holds the loan on its own books or brokers it to someone else.

1. Maximum loan at 0% down. Five lenders publish 0% down up to $1 million: Huntington, TD Bank, Truist, BMO, and Flagstar (MedMoneyGuide, September 2026). Bank of America is the outlier: no 0% tier at all. Its minimum is 3% down on mortgages up to $850,000 (Bank of America).

Residents face lower caps at some lenders. Citizens caps licensed residents, fellows, and interns at $600,000, and unlicensed trainees at $400,000 (Citizens Bank Doctor Loan Program document). KeyBank caps licensed residents and fellows at $750,000 with up to 100% financing (Student Loan Planner). Fifth Third's New Doctor program offers $750,000 with no down payment and up to $1 million for new doctors (Fifth Third Bank). Truist caps licensed residents, interns, and fellows at a $1 million maximum loan (Truist).

2. Program ceiling with a down payment. Once you put money down, the ceilings spread out. Huntington goes to $2.5 million at about 10% down (89.99% financing), with 5% down to $1.75 million (Huntington Bank). TD Bank goes to $2 million at 10.01% down and $1.5 million at 5% down (TD Bank). BMO goes to $2 million at 89.99% financing and $1.5 million at 95% (BMO). KeyBank's ceiling is $3.5 million, the highest published, though it does not publish its down payment tiers (MedMoneyGuide). Bank of America goes to $2 million at 15% down (Bank of America).

Every one of these programs exceeds the 2026 conforming limit of $832,750 ($1,249,125 in high cost areas, per FHFA) without standard jumbo penalties. That is part of what you are paying for.

3. DTI cap. Conventional underwriting caps debt to income at 36 to 45% in most cases (Bankrate). Physician programs commonly allow up to 50%. Huntington publishes a 50% DTI ceiling (Huntington Bank).

4. Student loan treatment. This is the single biggest qualification difference between lenders, and most lenders do not publish their rule, so you have to ask.

The published rules: Truist says student loans may be excluded from DTI if they will be deferred for at least 12 months after closing (MedMoneyGuide, citing Truist). Bank of America says student debt can often be excluded with documentation that payments are deferred (MedMoneyGuide). Fifth Third excludes loans in deferment or forbearance for at least 12 months after closing (Student Loan Planner).

Huntington, TD, KeyBank, BMO, and Flagstar do not publish how they count student loans (MedMoneyGuide). The conventional baseline for comparison: Fannie Mae counts 1% of the balance for loans in deferment or forbearance, and Freddie Mac uses 0.5% when the credit report shows $0 (MedMoneyGuide).

5. Fixed rate vs adjustable rate. Most physician programs are adjustable rate mortgages, though fixed rate options exist at several lenders (Moneywise; Fairway). Fifth Third offers both fixed and adjustable rate options (Fifth Third Bank). TD Bank offers a 30 year fixed as well as adjustable rate options (TD Bank). BMO's program is positioned for buyers who want a fixed rate (MedMoneyGuide). Flagstar is ARM only (MedMoneyGuide).

An ARM is not automatically a bad deal if you expect to refinance or sell within the fixed period, but know which product you are being quoted before you compare rates across lenders.

6. State coverage. TD Bank requires the property to be in a state where TD operates, 16 states from Maine to Florida (TD Bank; MedMoneyGuide). BMO excludes New York entirely and limits seven states plus DC (California, DC, Florida, Hawaii, Idaho, Maryland, Nevada, Rhode Island) to 95% maximum financing (BMO). Truist lends in all states except Alaska, Arizona, and Hawaii (MedMoneyGuide). Huntington does not publish a state list (MedMoneyGuide). Ask this question first. Nothing else matters if they cannot lend where you are buying.

7. Portfolio vs brokered, and who services the loan. Ask directly: do you originate and hold this loan on your own balance sheet, or do you broker it to another institution? A direct portfolio lender sets its own guidelines and its own pricing. A broker adds a layer and typically a premium (List with Clever, quoting Zwiezen). Related: ask who will service the loan. Portfolio lenders usually service what they hold. If a loan is sold, the terms of a fixed rate mortgage cannot change, but your servicer can (AmeriSave; Bankrate).

1. What is your maximum loan at 0% down, and what is the maximum loan for someone at my career stage?
2. What is your DTI ceiling, and exactly how do you count my student loans in it?
3. Can I get a fixed rate, or is this program ARM only, and for how long is the rate fixed?
4. Do you lend in my state, and are there any state level restrictions on financing percentage?
5. Do you hold this loan on your own balance sheet or broker it, and who services it?
6. What reserves do you require, and do the requirements change if I close before my start date?
7. What is the rate premium over your standard conventional rate for the same borrower profile, and what would change it?

Get three quotes. Compare them on the seven dimensions above, not on the monthly payment in the marketing email.