A doctor loan lets medical professionals buy a home with 0% down, no PMI, and student debt excluded from the DTI calculation. A conventional loan offers a slightly lower rate but requires 20% down to avoid PMI — and it counts every dollar of your student loan balance against your qualifying income. The right choice comes down to how much you've saved, how much student debt you carry, and where you are in training.
I've closed loans for over 1,000 physicians in 23 years at this. Most of them walked in thinking they had to choose between a doctor loan and a conventional — like picking a restaurant. That's the wrong frame. The right question is: which one costs you less over the years you'll actually own this home?That's the math I want to walk through.
The Short Answer
If you're a resident, fellow, or early-career attending with student debt and less than 20% saved, a doctor loan almost always wins. If you're five years into practice with loans paid off and $130,000+ saved, conventional typically wins on rate alone. Everybody in between needs to run the numbers — which is what the rest of this post is for.
What a Doctor Loan Actually Is
"Doctor loan" is interchangeable with "physician mortgage" and "physician home loan." It's the same product under three names. The defining features are:
- 0% down payment available up to roughly $1M purchase price (higher with some equity).
- No private mortgage insurance even at 0% down — this is the single most valuable feature.
- Student debt excluded from DTI, or calculated on your actual income-based repayment amount instead of the full balance.
- Future income underwriting — residents and fellows are qualified on their signed attending contract, not their current training salary.
- Eligibility extends beyond MDs. Most programs accept DO, DDS, DMD, DVM, OD, DPM, NP, and PA credentials.
What a Conventional Loan Brings to the Table
A conventional loan is the plain-vanilla mortgage. Lower rate (typically 0.25-0.75% below doctor loan rates), widely available, and when you put 20% down, no PMI. Conventional gets you the best long-run cost of capital if you have the down payment and the DTI headroom to qualify.
The catch: doctors leaving training almost never have both. Average medical school debt is $203,000 per the AAMC's 2025 data. Resident salaries average $60,000-$75,000. Conventional lenders count that full monthly student loan payment — or 0.5-1% of the total balance — against your DTI. That math alone disqualifies the majority of graduating residents from a conventional mortgage at the purchase price they can actually afford on their future attending salary.
Down Payment — 0% vs 20%
On a $650,000 home, a conventional loan at 20% down means writing a check for $130,000 at closing. Put less than that and you're paying PMI. A doctor loan lets you close with $0 down and no PMI — end of story.
The $130,000 gap is real money. Invested in a diversified index fund averaging 8% annually, it grows to roughly $280,000 in 10 years. Or it's a 12-month emergency fund for a family of four. Or it covers relocation, furnishing a new home, and closing out a car loan — all at once.
Even at the conventional minimum of 3% down ($19,500), you still trigger PMI. You're borrowing $630,500 plus paying an extra $350-$540 tacked onto your payment every month until you hit 20% equity. That's seven to ten years of PMI under normal amortization.
PMI — Why This Is the Biggest Structural Advantage
Private mortgage insurance exists to protect the lender, not you. On a $650,000 conventional loan at 5% down, PMI runs $270-$540 per month — call it $400 as a middle-of-the-road number. That's $4,800 per year, paid by you, benefiting the bank.
Over the typical seven to ten years until you hit 20% equity, PMI costs you $22,680-$64,800. That money builds zero equity. It doesn't reduce your principal. It's a pure cost of not having the down payment.
A doctor loan eliminates PMI entirely, even at 0% down. For a surgery resident at Emory starting at $68,000, $400 per month in PMI is the difference between a comfortable mortgage and a paycheck-to-paycheck one. This product was designed specifically to remove that burden for physicians leaving training.
Student Debt — Where Conventional Kills Physician Applications
Here's the DTI math for an internal medicine resident at Houston Methodist with $280,000 in student loans, a $68,000 salary, and an income-based repayment (IBR) of $2,100 per month.
Conventional DTI: Monthly gross income is $5,667. Mortgage payment on a $650,000 home (5% down, 6.25% rate, 30 years) is roughly $3,804 with taxes and insurance. Add $2,100 in student loan debt. Total monthly debt: $5,904. DTI: 104%. Conventional caps at 45-50%. Denied. Not even close.
Doctor loan DTI:Same resident, same income, same home. Student debt is excluded from DTI entirely. Monthly debt drops to $3,650 (no PMI, slightly higher rate). But here's where the magic happens — the doctor loan underwrites on the signed attending contract showing $265,000 starting salary ($22,083/month gross). Adjusted DTI: 16.5%. Approved.
That's not a nice-to-have. For most graduating residents with normal student debt loads, that's literally the only path to home ownership before their attending paychecks start. Conventional math says "come back in five years." A doctor loan says "close before your first shift."
Interest Rates — Where the Trade-Off Lives
Doctor loans aren't free money. The rate premium — typically 0.25-0.75% — is the cost of the flexibility. On a $650,000 loan, the difference between 6.25% (conventional) and 6.75% (doctor loan) adds roughly $220 per month, or $79,200 over 30 years if you never refinance.
Stack that against PMI savings: $400 per month for 8 years on the conventional side is $38,400. The doctor loan rate premium over those same 8 years costs $21,120. Net savings with the doctor loan during that window: $17,280 — plus you didn't have to come up with $130,000 at closing.
The break-even point — where the cumulative rate premium exceeds the cumulative PMI savings — typically lands between year seven and year ten. After that, the conventional borrower who has dropped PMI starts paying less per month. But most physicians refinance or sell before year ten anyway. The average doctor stays in their first home five to seven years.
Who Should Pick a Doctor Loan
- Residents and fellows.Future income underwriting plus DTI exclusion is the only way most of you qualify for a home in the city where you matched. Don't wait three more years.
- New attendings relocating.You've got 30-60 days to find housing in a new city while carrying $200,000+ in student debt. 0% down and a 15-30 day close is the product that fits that window.
- Any physician with $150,000+ in student loans. Conventional DTI math will either disqualify you or cap you well below what your attending salary would actually support. Doctor loan math treats you like the earner you are.
- Doctors optimizing for liquidity. Even well-capitalized attendings sometimes choose 0% down to keep their capital invested. $130,000 at 8% annual return is $280,000 in 10 years — versus home equity that appreciates at a fraction of that rate.
Who Should Pick Conventional
- Attendings with zero student debt and 20%+ saved. You have no use for DTI exclusion or PMI elimination. A conventional rate saves you money from month one. On a $650,000 loan, a 0.50% lower rate is $175 per month — $63,000 over 30 years.
- Buyers purchasing a second home or investment property. Doctor loans are for primary residences only. For a rental, a DSCR loan is usually the right move; for a vacation home, conventional.
- Physicians planning to stay in the home 15+ years. After the PMI-drop window closes, the conventional rate advantage compounds. If this is truly your forever home, the math flips.
Quick Comparison
| Feature | Doctor Loan | Conventional |
|---|---|---|
| Down Payment | 0-5% | 3-20% |
| PMI | None — ever | Required under 20% |
| Student Debt in DTI | Excluded or IBR | Fully included |
| Max Loan Amount | Up to $2M (some $3.5M) | $766,550 conforming |
| Future Income | Considered with contract | Not considered |
| Rate Premium | +0.25-0.75% | Baseline |
| Close Timeline | 15-30 days | 30-45 days |
| Eligibility | MD/DO/DDS/DMD/DPM/OD/NP/PA | Any borrower |
What I Tell Every Physician Client
Run both scenarios. Not just the headline rate — run the full monthly payment including PMI on the conventional side, and the full 10-year cash flow including the opportunity cost of the down payment. Nine times out of ten for physicians leaving training, the doctor loan comes out ahead by $15,000-$45,000 over the first decade. For attendings with a different profile, it flips.
I build both quotes side by side for every physician I work with. No pitch, no pressure — just the numbers. Then you pick the one that costs you less. That's how this should work.
Frequently Asked Questions
What is a doctor loan?
A doctor loan (also called a physician mortgage or physician home loan) is a specialized mortgage for medical professionals that offers 0% down, no PMI, and excludes student loan debt from the debt-to-income calculation. Residents, fellows, and attending physicians all qualify. The program extends to dentists, veterinarians, optometrists, podiatrists, nurse practitioners, and physician assistants at most lenders.
Is a doctor loan better than a conventional loan?
For most doctors carrying student debt with less than 20% saved for a down payment, a doctor loan wins. You skip the 20% down payment requirement and eliminate PMI — which typically runs $270-$540 per month on a conventional loan. The doctor loan's rate premium of 0.25-0.75% costs far less than those PMI savings during the first seven to ten years of ownership. After that window, a refinance to conventional often makes sense.
How much is PMI on a conventional loan for doctors?
Private mortgage insurance on a $650,000 conventional loan with 5% down runs $270-$540 per month depending on your credit score. That's $3,240-$6,480 per year, and you pay it until you hit 20% equity — typically seven to ten years on a 30-year amortization schedule. PMI builds zero equity. It exists to protect the bank, not you.
Do doctor loans have higher interest rates than conventional?
Yes, typically 0.25-0.75% higher for the same credit profile. On a $650,000 loan, that difference adds roughly $220 per month. But a conventional borrower at 5% down is also paying $350-$540 per month in PMI. Net, the doctor loan costs less per month during the first seven to eight years — often by $130-$320 after you stack PMI against the rate premium.
Can residents and fellows qualify for a doctor loan?
Yes. Most doctor loan programs accept residents, fellows, and even applicants within 60-90 days of starting residency. The lender uses your signed employment contract or training program agreement as proof of future income — so you're underwritten on your attending salary, not your current resident pay of $60,000-$75,000. That's the only way most graduating residents can qualify for a home in a major market.
What credit score do I need for a doctor loan?
Most doctor loan programs require a 700 minimum credit score, though some accept 680+. Higher credit scores unlock better interest rates and can reduce the rate premium to the low end of the 0.25-0.75% range.
What's the maximum loan amount on a doctor loan?
Most doctor loan programs allow up to $1 million at 0% down, and up to $2 million with 5-10% down. Some lenders extend to $3.5 million for high-income attendings. The 2026 conforming conventional loan limit is $766,550 — and conventional still requires 20% down at that amount to avoid PMI. Doctor loans blow past that cap without triggering PMI or requiring a jumbo conventional structure.
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