The Complete Physician Mortgage Guide (2026): 0% Down, No PMI, and How to Choose a Lender

Most mortgage advice is written for people who have been working since their mid-twenties, have a decade of savings history, and carry a manageable amount of debt. The math changes completely when you are a physician.

You finished residency at 30 with $285,000 in student loan debt (AAMC data puts the median for indebted 2025 graduates at $215,000, with 28 percent of borrowers owing $300,000 or more). You have been earning $72,000 per year for three years. Your savings account has $18,000 in it. Last month, you signed an employment contract for $340,000 (a typical starting salary based on MGMA compensation data) that starts in eight weeks. On a conventional loan, that profile runs into three problems: putting less than 20 percent down means paying for mortgage insurance, the student loans count against your debt-to-income ratio, and Fannie Mae lets a lender count a job that hasn't started only if it begins within 90 days of closing and you hold extra cash in reserve.

Physician mortgage programs are written for that profile. Most of the lenders we review lend at 0 percent down with no mortgage insurance, and they accept a signed employment contract as income; Huntington, BMO and Bank of America publish a window of up to 90 days between closing and your start date.

For each lender's published down payment tiers, loan limits and eligibility side by side, see our physician mortgage lender comparison. No lender publishes its physician loan rates, so get written quotes from at least two.

A physician mortgage is a useful tool, but it is still a large debt, and borrowing the most a bank will approve can crowd out saving for years.

Before optimizing your mortgage strategy, make sure your financial foundation is in place: disability insurance so your income is protected, a clear student loan strategy so you know whether IBR or refinancing is right for you, and a basic retirement contribution plan so the mortgage does not crowd out wealth building entirely.

With that foundation in place, here is what a physician mortgage changes and what it doesn't.

Problem 1: The Down Payment Gap

A conventional loan can be made with less than 20 percent down, but Fannie Mae requires mortgage insurance on any loan above 80 percent of the home's value. Avoiding it on a $650,000 home takes $130,000 at closing, which a physician finishing a three-year residency at $72,000 a year rarely has. Five of the seven lenders we review (Huntington, TD, Truist, BMO and Flagstar) publish 0 percent down up to $1,000,000 with no mortgage insurance. Bank of America's minimum is 3 percent down, and KeyBank doesn't publish its down payment tiers.

What keeping the $130,000 costs:

Keeping the cash isn't free. You borrow the $130,000 instead, and at the 7.03 percent average 30-year rate Freddie Mac reported for the week of September 24, 2026, that adds about $867 a month in principal and interest, before any difference in rate between a physician loan and a conventional loan. Whether investing the cash would beat that depends on returns no one can promise. The surer value is cash on hand in the first year of practice: an emergency fund, moving costs, and the weeks before your first attending paycheck. Use our Physician Mortgage Calculator to compare down payments at your purchase price.

Problem 2: The PMI Elimination

Private mortgage insurance protects the lender, not you, and conventional loans with less than 20 percent down carry it. Freddie Mac puts the cost at $30 to $70 a month for every $100,000 borrowed. A conventional loan also needs some money down; Freddie Mac's Home Possible program goes as low as 3 percent.

The PMI math on a $700,000 home:

With 5 percent down, the conventional loan is $665,000 and PMI runs about $200 to $466 a month. Under federal rules, you can ask to cancel PMI when the balance is scheduled to reach 80 percent of the home's original value, and it ends automatically at 78 percent. At a 7.03 percent rate, the 80 percent date comes after about 130 payments, just under 11 years. Paid until then, PMI totals roughly $26,000 to $61,000.

Six of the seven programs we review (Huntington, TD, KeyBank, Truist, BMO and Flagstar) state that they charge no mortgage insurance; Bank of America's Doctor Loan page doesn't say. Whether skipping PMI makes the physician loan cheaper depends on its rate, which is covered in the rates section below.

Problem 3: The Student Loan DTI Treatment

How much student loans hurt a conventional application depends on their status more than their size. Under Fannie Mae's rules, the lender uses the payment on your credit report or your student loan documentation, including an income-driven payment, and it can qualify you with a documented $0 payment. Only loans in deferment or forbearance are counted at 1 percent of the balance (or a fully amortizing payment on the documented terms). Freddie Mac uses 0.5 percent of the balance when the credit report shows a $0 payment, unless other documentation supports a payment above zero.

Fannie Mae's debt-to-income ceiling is 36 percent for a manually underwritten loan, up to 45 percent with the required credit score and reserves, and 50 percent through its Desktop Underwriter system. Student loans push a conventional application past those limits in two situations:

• Deferment or forbearance. $285,000 in deferred loans counts as $2,850 a month under Fannie Mae, or $1,425 under Freddie Mac if the credit report shows $0, even though you pay nothing.
• A large income-driven payment. Once you recertify at attending income, the documented payment can run into the thousands, and Fannie Mae and Freddie Mac count it at that amount.

The physician programs that publish a rule differ mainly on the first situation. Truist says student loans may be excluded from DTI if they will be deferred for at least 12 months after closing, and that a reduced income-driven payment may be acceptable. Bank of America says it can often exclude student debt from your total debt, with documentation that the payments are deferred. Huntington, TD, KeyBank, BMO and Flagstar don't publish how they count student loans, so ask.

The DTI math for a resident earning $72,000 ($6,000 a month) with $285,000 in federal loans and a $1,900 monthly housing payment:

The IBR figure assumes adjusted gross income equal to the $72,000 salary and applies the 10 percent IBR formula: AGI above $23,940 (150 percent of the 2026 HHS poverty guideline for a household of one), times 10 percent, divided by 12, or about $400. With that payment documented, a conventional loan counts the student loans the same way a physician loan would. The physician program's student-loan advantage is for deferred or forborne loans. For RAP and attending-income scenarios, see How Student Loans Affect Your Physician Mortgage.

Lender Comparison at a Glance

For each lender's published terms and application links, see our Physician Mortgage Lenders Review page.

Physician mortgage rates are quoted loan by loan, and none of the seven lenders we review publishes them. The public benchmark is Freddie Mac's weekly survey: for the week of September 24, 2026, the 30-year fixed averaged 7.03 percent and the 15-year fixed 6.42 percent. Freddie Mac and Fannie Mae buy loans only up to the 2026 conforming limit of $832,750 in most counties ($1,249,125 in the highest-cost areas). Above that, a conventional loan is a jumbo loan, and the survey average is only a rough guide.

Freddie Mac notes that lenders offering loans without PMI often charge higher interest rates in exchange. Some physician lenders publish discounts that narrow the gap: Truist takes 0.25 to 0.75 points off with $100,000 or more in Truist deposits and investments, KeyBank advertises 0.25 points off for its clients, and BMO takes 0.125 points off for autopay from a BMO checking account.

The PMI-versus-rate break-even:

Take the $665,000 loan from the PMI example above (5 percent down on a $700,000 home) at 7.03 percent. Each 0.125 point of rate costs about $56 a month, so PMI of $200 to $466 a month is worth roughly 0.44 to 1.02 points of rate. A physician loan with the same 5 percent down costs less each month than the conventional loan with PMI if its quote is less than about 0.44 points higher when PMI is at the low end, or about 1 point higher at the high end.

Two things cut the other way. PMI ends after about 11 years on schedule, while a higher rate lasts until you sell or refinance. And at 0 percent down you borrow $35,000 more, which adds about $234 a month at 7.03 percent.

With 20 percent down, a conventional loan carries no PMI, so the physician loan's remaining advantages are in underwriting: how it counts deferred student loans and a job that hasn't started. Either way, get a physician loan and a conventional loan quoted on the same day and compare the Loan Estimates.

For this week’s national average rates and how physician loans compare, see our Mortgage Rates page.

The usual advice is that a fixed rate gives certainty and an ARM carries risk. Both are true. The question for a physician is whether you expect to sell or refinance before the ARM's fixed period ends, and what happens if you can't.

Product choice varies by lender. Flagstar offers only ARMs (5/6, 7/6 and 10/6, adjusting every six months after the fixed period), Huntington lists 3- to 15-year ARMs, and BMO, TD and KeyBank publish both fixed and adjustable rates. No lender we review publishes its ARM rates, so compare quotes.

Three physician scenarios where an ARM can fit:

Scenario 1: Resident buying before the end of training. A PGY-2 expects to move when residency ends in about three years. On a $600,000 loan, each half point of rate below a 7.03 percent fixed saves about $200 a month, or about $7,200 over three years. A 5- or 7-year fixed period covers the plan with room to spare. The risk is not being able to sell on time, because of a soft market or a change of plans, and carrying the loan into its adjustment period.

Scenario 2: First attending job you may leave. If you expect to move or refinance within five to seven years, a 7-year ARM's fixed period matches that plan. If you stay, the rate resets under the loan's caps.

Scenario 3: Larger purchase with plans to move up. A physician buying a $1,200,000 home who expects to sell in seven to nine years can match a 10-year ARM's fixed period to that plan.

When the 30-year fixed is right:

A physician who has settled on a practice community, plans to stay 15 years or more, and wants a payment that never changes should use the 30-year fixed. Refinancing out of an ARM later depends on rates and your finances at that time, so the longer you expect to stay past the fixed period, the stronger the case for fixing the rate now.

For the complete rent versus buy analysis including break-even calculations for residents, see our Should Residents Buy or Rent guide.

Which degrees qualify depends on the lender. This is who each of the seven lenders we review names on its program page; down payment tiers are the lender's, not the degree's.

Residents and fellows: All seven lenders accept residents and fellows, but several name a license. TD and Truist say “licensed” residents and fellows, Flagstar requires a resident to hold an educational license, and KeyBank requires a current license. Ask whether your training license meets the requirement before you apply.

Closing before you start: Huntington, BMO and Bank of America publish a window of up to 90 days between closing and your start date; Bank of America limits it to salaried jobs and requires extra reserves to cover your debts until you start. TD, KeyBank, Truist and Flagstar don't publish a window. For comparison, Fannie Mae accepts a signed, non-contingent offer for a start date up to 90 days after closing if the loan is delivered before your first paystub, with six months of housing payments in reserve or enough to cover your debts until you start plus one month. A physician finishing residency in June and starting August 1 fits either window.

International Medical Graduates on J-1 or H-1B visas:

None of the seven lenders we review publishes a visa policy on its program page. Raise it on the first call: give your visa type and expiration date, and get the lender's answer and its document list in writing before you apply or pay for an appraisal.

Moonlighting income during residency:

Moonlighting paid on a 1099 is self-employment income. Fannie Mae generally wants a two-year history of it, and accepts less when your most recent tax returns show a full 12 months of that income and you earned similar income in the same field before. None of the physician lenders we review publishes its moonlighting rule, so ask how yours will count it.

Purchasing a condo:

Four of the seven lenders name condos on their program pages: BMO, TD, KeyBank, and Flagstar, which limits it to warrantable condos. A warrantable condo is one in a project that meets Fannie Mae or Freddie Mac project standards, which the lender checks before closing. Huntington, Truist, and Bank of America don't address condos on their program pages. Ask the lender to review the project before you sign a purchase contract.

Professional verification:

• Medical degree diploma or completion certificate
• State medical license, or the training or educational license your state issues residents (TD, Truist, Flagstar, and KeyBank name a license requirement)
• Signed employment contract or residency/fellowship appointment letter
• DEA registration if applicable

Income documentation:

• Two most recent pay stubs or offer letter if employment has not started
• W-2s for the past two years or explanation letter if in full-time training
• Federal tax returns for the last two years
• 1099 forms and Schedule C if moonlighting income will be used
• For self-employed or partnership income: two years of business tax returns plus year-to-date profit and loss

Student loan documentation:

• Current servicer statements for all student loans
• IBR, PAYE, or RAP documentation showing monthly payment amount
• Deferment letter if loans are in deferment
• PSLF certification if pursuing Public Service Loan Forgiveness

Assets and identity:

• Two months of bank statements for all accounts
• Retirement account statements — most recent quarter
• Government-issued photo ID
• Gift letter if any funds are gifted for closing costs

Mistake 1: Not comparing quotes from at least three lenders. On a $700,000 loan at 7.03 percent, a rate a quarter point higher costs about $118 a month, or about $42,600 over 30 years if you keep the loan. Every lender must give you the same standard Loan Estimate within three business days of your application, which makes quotes easy to compare, and mortgage credit checks within a 45-day window are recorded as a single inquiry.

Mistake 2: Buying the most expensive home the bank will approve. Qualifying for a $1,500,000 loan doesn't make a $1,500,000 home a sound purchase. Our suggestion is to keep the price nearer two to two and a half times your gross income than the lender's maximum, so the payment leaves room for retirement saving and student loans. For how housing fits into physician net worth, see our Physician Net Worth by Age guide.

Mistake 3: Opening new credit accounts before closing. An inquiry typically has a small negative effect on your credit scores, and the CFPB advises against applying for other credit right before or during the mortgage process. From pre-approval through closing, open no new cards or auto loans and avoid large purchases on credit.

Mistake 4: Not accounting for total monthly housing cost. At 7.03 percent, principal and interest alone on a $700,000 loan is about $4,671 a month. The CFPB lists what else goes into the monthly cost: property taxes, mortgage insurance, homeowner's insurance, flood or other supplementary insurance, and HOA fees, with taxes and insurance able to rise over time. Maintenance, repairs, and utilities come on top. Get the property's actual tax bill, an insurance quote, and the HOA dues before you make an offer.

Mistake 5: Not getting pre-approved before house hunting. A pre-approval letter tells you what the lender will actually approve under its own rules, and it shows a seller that your financing is lined up.

Mistake 6: Ignoring the buy versus rent calculation during training. The CFPB puts closing costs at 2 to 5 percent of the purchase price, or $9,000 to $22,500 on a $450,000 home, and selling adds the agent's commission and the seller's own closing costs. A resident who buys in year 2 of a 3-year program and sells soon after training ends has little time for appreciation to cover both. See our Should Residents Buy or Rent guide for the break-even analysis.

Mistake 7: Choosing an ARM without understanding the adjustment terms. Every ARM has three rate caps: how far the rate can move at the first adjustment (most commonly 2 or 5 percentage points), at each later adjustment (typically 1 or 2), and over the life of the loan (most commonly 5). With a 5-point lifetime cap, an ARM that starts at 6.50 percent can reach 11.50 percent. Flagstar doesn't publish its caps, so get them in writing from any lender before you accept an ARM.

Mistake 8: Refinancing federal student loans before the mortgage application. Conventional and physician lenders both count a documented income-driven payment, so there is rarely a mortgage reason to refinance. Refinancing into a private loan ends PSLF eligibility for those loans, and the lender will then count the private loan's required payment instead. Run the PSLF math before you decide.

Mistake 9: Not consulting a financial advisor before the purchase. A home purchase interacts with your student loan strategy, retirement timeline, PSLF eligibility, and tax situation at the same time. A fee-only advisor who works with physicians can model how the purchase affects your plan over the next ten years. See our Best Financial Advisors for Physicians guide.

• Resident or fellow:
  BMO: 0% down to $1,000,000, fixed or ARM, start date up to 90 days after closing. Available in every state except New York, with 0% down not offered in seven states and DC. Truist lends to residents up to $1,000,000.
• Graduating medical student:
  Huntington (with a signed contract) and Bank of America (salaried residency starting within 90 days of closing) both name medical students.
• Deferred student loans:
  Truist excludes loans deferred at least 12 months after closing; not available in Alaska, Arizona, or Hawaii. Bank of America can often exclude deferred student debt, with documentation.
• New attending on the East Coast who wants a fixed rate:
  TD Bank: 0% down to $1,000,000, fixed or adjustable, in 15 states and DC from Maine to Florida. Requires a TD checking account and fewer than 10 years out of residency.
• Loan between $1,500,000 and $2,500,000 with little down:
  Huntington: 5% down to $1,750,000 and about 10% down to $2,500,000, with a published 50% DTI ceiling.
• Loan above $2,500,000:
  KeyBank: up to $3,500,000, the highest ceiling of the seven. Its down payment tiers and state list are not published.
• NP, PA, CRNA, pharmacist, or a state other lenders exclude:
  Flagstar Bank: no state is excluded on its program page. Adjustable rate only, to $1,500,000.
• IMG physician on J-1 or H-1B visa:
  No lender we have reviewed publishes its visa policy. Call two or three from the lender comparison, state your visa type and expiration date up front, and ask whether the physician program is open to you.
• Resident uncertain whether to buy or rent:
  Read our Should Residents Buy or Rent guide first. Buying and selling costs weigh heavily on a stay of three years or less.

A physician mortgage solves specific problems: 0 percent down with no mortgage insurance at five of the seven lenders we review, a signed contract counted as income, and, at some lenders, deferred student loans left out of DTI where Fannie Mae would count 1 percent of the balance. If your loans have a documented income-driven payment and you have 20 percent to put down, a conventional loan may do as well or better, so price both.

Use it with care. Keep the price nearer two to two and a half times your gross income than the maximum a bank will approve. Get Loan Estimates from at least three lenders. Know an ARM's caps before you accept one. And run the PSLF math before refinancing federal student loans for a mortgage.

No lender publishes its physician loan rates, so the quote is where the comparison happens. Use the published terms to narrow the list, then let written quotes decide.