How Much House Should a Physician Buy

Most physician loan programs allow a debt to income ratio up to 50 percent, versus 36 to 45 percent on conventional mortgages, per Bankrate. Huntington Bank publishes a 50 percent DTI ceiling outright, per MedMoneyGuide's September 2026 lender review.

Do the math on a $350,000 attending salary. Gross monthly income: $29,167. At 50 percent DTI, the lender allows up to $14,583 per month in total debt payments. That includes the mortgage, student loans as the program counts them, car loans, and credit card minimums.

Read that number again. $14,583 a month in debt payments. On $29,167 of gross income, before a dollar of tax is paid. If your student loans are excluded from the physician loan's DTI, nearly all of that $14,583 can be housing. A $14,000 monthly housing payment at current rates buys roughly a $1.9 million house with nothing down. The lender will happily approve it. The lender is not buying your groceries.

Build the housing number from the bottom up. Start with gross income and subtract everything the lender's ratio ignores.

Step 1: start with your actual income, not the average. Medscape's 2026 Physician Compensation Report puts average total compensation at about $386,000, up 3 percent from $374,000, based on a survey of 5,916 physicians. But the range is enormous: orthopedics averages $611,000, pediatrics $266,000. A pediatrician budgeting to the $386,000 average is planning with someone else's money. Use your contract number. If you are choosing between offers, use the lowest one you would accept.

Step 2: subtract taxes. Use 30 to 35 percent of gross as a planning figure for a high income W2 household in a state with income tax (illustrative; your CPA knows your real number). On $350,000, that is roughly $10,000 to $10,200 a month gone before anything else.

Step 3: subtract the actual student loan payment. Not the DTI fiction, the real one. If you are on an income driven plan at attending income, get the actual recertified payment from your servicer. If loans are still deferred, price the payment that arrives when deferment ends. A $300,000 balance on a standard plan is around $3,000 to $3,500 a month. This is the number the physician loan's DTI calculation may pretend is zero. Your budget cannot.

Step 4: subtract the life being built. Childcare for two kids in a metro area runs $2,500 to $4,000 a month. Add the cars, the insurance, the actual cost of the household you are running. New attendings consistently underestimate this line because they have been living on a resident budget for years and have no recent data on what their life costs.

Step 5: pay yourself first. Twenty percent of gross toward retirement and taxable savings is the planning floor for a physician starting late. Physicians start saving a decade behind their peers; the savings rate has to be higher to compensate. On $350,000, that is $5,833 a month.

Step 6: housing gets the remainder. On $350,000: $29,167 gross, minus ~$10,200 tax, minus ~$3,300 student loans, minus ~$3,000 childcare and household, minus $5,833 savings, leaves roughly $6,800 a month for all in housing: principal, interest, taxes, insurance. At current rates, that supports roughly a $850,000 to $950,000 purchase with a physician loan, depending on property taxes. The lender would have approved nearly double.

That gap between the lender's number and your number is the entire point. The lender's number is what you can borrow. Your number is what you can afford while building wealth.

Keep total housing (principal, interest, taxes, insurance) at or under 28 percent of gross income as a planning ceiling, well inside the lender's 50 percent. On $350,000, that is $8,167 a month. It leaves room for the student loan payment the lender ignored, the childcare the lender never asked about, and the savings rate that determines whether the high income turns into wealth.

The physician mortgage is a good product. It solves the down payment problem and the student loan qualification problem in one structure. But its generosity is a qualification generosity, not a budget. The bank approves the maximum. You decide the right amount. Those are different numbers, and the second one is the only one that matters.