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Discovery QuizPhysicians, surgeons, nurse practitioners, PAs, pharmacists, residents, and veterinarians share a uniquely difficult mortgage profile: substantial guaranteed future income, large current student-loan balances on income-driven repayment, hospital W-2 with stipend and on-call mixed in, locum tenens 1099 side work, and partnership or productivity bonuses paid quarterly. Generalist lenders see the student debt and the variable income, calculate DTI using 1% of the loan balance, and either decline or qualify you for half what you can afford. We read the IDR statement, the locum 1099, the productivity contract, and the residency-completion letter — and we qualify you on what you actually earn.
Stairway Mortgage qualifies medical professionals on the income they actually earn and the debt they actually pay — not 1% of the student-loan balance and not just the hospital base salary. An attending physician with hospital W-2 plus productivity bonus plus locum 1099, a resident with a signed fellowship contract starting in six months, an NP with $90K of student debt on PAYE, and a pharmacist with hospital W-2 plus retail moonlighting each get qualified using the income method that fits their pattern. We pick the right door before we quote. Or skip ahead: browse every loan program, run numbers on 100+ mortgage calculators, or check today's rates.
Each guide is built around the comp structure, debt profile, and qualifying mechanics of that specific medical profession. Pick the one that matches yours.
"My W-2 is $290K. My productivity bonus is another $80K. The lender used only the W-2."
"My specialty earns $500K. Most lenders have never underwritten income this complex."
"My stipend is $68K. My signed attending contract starts in eight months at $340K."
"I’m a nurse practitioner with $90K of debt. The lender qualified me on the wrong payment."
"Retail W-2 plus hospital per-diem plus some consulting. Three income streams, one mortgage."
"I just bought into a practice. My income tripled. The lender averaged it down."
DOs with full MD scope post-2020 ACGME merger. OMM/NMM specialty unique to DOs. ABMS + AOA dual-board pathways. Multi-source W-2 + S-corp K-1 + IBR/IDR.
Hospital-employed + ASC equity multi-entity + locum multi-state. ABA + ASA + fellowship subspecialties. W-2 + K-1 with multi-entity Form 1084.
CRNAs with DNP-by-2025 mandate. NBCRNA + AANA + COA. Hospital + CRNA-only groups + locum + subspecialty (dental/GI/plastic surgery/OB).
DPM doctorate = MD/DO equivalent for qualifying. ABFAS surgical + ABPM non-surgical. ASC equity + sports + wound care subspecialty.
Medical pay is highly structured but rarely simple. Hospital W-2 plus productivity. Resident stipend plus signed future contract. Heavy student debt with low actual IDR payments. Locum 1099 stacked on top of staff W-2. Each pattern has a documented qualifying path under Fannie Mae, Freddie Mac, the physician-loan programs, or our Non-QM options.
Medical school plus residency leaves the average new attending with $200K–$400K in federal student loans. Most are on income-driven repayment where the actual monthly payment is far below what 1% of the balance suggests. Under Fannie Mae B3-6-05, the actual IDR payment from the servicer counts in DTI. For a resident on PAYE with a $0/month payment against $280K of loans, that single rule swings $500K-$800K in qualifying loan amount.
Several lenders offer specialized physician-loan products that allow qualifying on a signed-but-not-yet-active employment contract. A graduating resident with a $340K attending position starting in 60-90 days can close on a home today using the new contract as the qualifying income. Down-payment requirements are often 0–10% (vs. 20% conventional). PMI is waived. The trade-off: rates can be 0.25–0.50% higher than conforming. Sometimes worth it, sometimes not. We model both.
Many attendings, NPs, and pharmacists work multiple income streams: hospital W-2 for staff position, locum tenens 1099 for additional shifts, moonlighting W-2 at a second hospital, sometimes a small consulting or expert-witness 1099 on top. Each stream has its own qualifying treatment. CFPB Reg Z’s Ability-to-Repay rule permits all of them when documented. Generalist lenders default to the main W-2 only. We stack them correctly.
Private-practice physicians, surgeons, and veterinarians often structure as an S-corp paying a "reasonable" W-2 salary plus a distribution that avoids self-employment tax. Fannie Mae B3-3.4-02 allows the distribution to count as qualifying income with a two-year history. Generalist lenders default to W-2 only and qualify a $500K-earning surgeon on $180K. We pull Form 1120-S, the K-1, and the personal 1040, and use the full picture.
I run a national mortgage practice from Fort Lauderdale, and a substantial share of my originations come from medical professionals — the attending physician relocating for a new fellowship, the surgeon buying into a practice, the resident closing on her first home using a signed-contract physician loan, the NP refinancing after a hospital-system move. The common thread is that the file is more complex than a generic W-2 file, and most lenders fail because they read only the most obvious income source and ignore the rest.
The reason most lenders fail medical clients is that the loan officer never reads the employment contract carefully, never asks about the RVU productivity formula, never requests the IDR statement showing the actual monthly student-loan payment. They feed your AGI into automated underwriting, the engine applies 1% of your loan balance to DTI, and you’re declined or under-qualified. Our process: we read the contract, we map every income stream, we get the IDR payment in writing from your servicer, and we route the file to the program that fits — whether that’s Fannie Mae with proper IDR treatment, a physician-loan program with future-income qualifying, or Non-QM bank-statement for practice owners with aggressive deductions.
Stairway Mortgage is a division of NEXA Mortgage LLC, the nation’s largest mortgage brokerage. That means access to 300+ lender programs, including the physician-loan, asset-depletion, and bank-statement options that fit medical-professional income. I personally read every medical loan file before it’s submitted.
Names abbreviated for client privacy. Practice and hospital names anonymized. Numbers are real.
"I had $310K in student loans on PAYE with a $180/month actual payment. Two lenders used 1% of the balance and disqualified me. Jim pulled the servicer statement, applied Fannie Mae B3-6-05, and got me approved at $1.4M. Closed on a Coral Gables home."
"My income comes from hospital W-2 plus RVU productivity plus a partnership K-1 from the surgical group. The big bank used only the W-2 and offered me half what I needed. Jim’s team used all three streams. Closed on Pinecrest in 31 days."
"I had a signed fellowship contract starting in seven months at $340K but my current resident stipend was only $68K. Jim routed me through a physician-loan program that qualified on the future contract. Closed before I started the new position."
Yes, with the right DTI calculation. Under Fannie Mae B3-6-05, the actual monthly payment from your servicer counts in DTI — not 1% of the balance, not a 10-year-amortization estimate. If you’re on PAYE/SAVE/IBR, that payment may be $0–$500/month against $300K of debt. We document it with the servicer statement and qualify you correctly. This single rule routinely swings $500K-$800K in qualifying loan amount for residents and new attendings.
Yes, through a physician-loan program. Several specialty lenders qualify on a signed-but-not-yet-active employment contract starting within 60-120 days. You provide the signed contract, the residency-completion letter, and proof of state license (or pending license). The physician-loan typically offers 0-10% down with no PMI, in exchange for a rate 0.25-0.50% higher than conventional. We model both physician-loan and conventional with future-income to show you the right math.
Yes, with documentation. We use your hospital W-2 as continuous income (full credit), your locum 1099 as variable income (two-year average with current-year support per Schedule C with allowed add-backs), and if you have an active locum engagement letter, that counts as forward-looking support. The two-stream stack often qualifies you for $200K-$400K more home than the W-2 alone.
Functionally yes for income-qualifying. BLS reports NP median wage at $132,050 and PAs at $133,260 — well into the income tier that supports significant mortgage qualification. The physician-loan programs typically extend to NPs and PAs with similar terms (low down, IDR-friendly DTI, signed-contract qualifying). Where they differ from physicians: the highest tier of physician-loan products (super-jumbo, $2M+) is often restricted to MDs/DOs.
Yes, as variable income with a two-year average. Your employment contract showing the RVU formula and the prior two years of pay stubs/W-2s establishing the bonus pattern allow us to qualify you on the average. If you’ve had a recent productivity ramp (new specialty board certification, new procedural privileges, larger panel), we can sometimes use trailing-12-month or current-year run-rate with an employer attestation letter. The structure of the variable income matters more than its variability.
The practice buy-in note becomes a debt obligation in your personal DTI. If the note is paid from your share of partnership distributions, the monthly payment counts in DTI calculation. Sequencing matters: close your personal mortgage either before the buy-in (qualify on employee-period income) or after a year of K-1 history establishes the new income level. For SBA-financed acquisitions, see our business acquirer mortgage guide for coordination logistics.
No. Physician-loans solve specific problems (low down payment, IDR-friendly DTI, signed-contract qualifying) but the rates are usually 0.25–0.50% higher than conventional. If you have 20% down, no IDR student debt issue, and a clean two-year W-2 history, conventional jumbo often produces a lower total interest cost. We run the numbers both ways. About 40% of our medical clients end up in physician-loan programs and 60% in conventional or non-QM options that fit their specific situation better.
Conventional Fannie Mae and Freddie Mac (with proper IDR student-loan treatment), Physician-Loan programs (low/zero down, IDR-friendly, signed-contract qualifying), Jumbo and Super-Jumbo (for high-purchase prices in Florida), Non-QM bank-statement (for private-practice owners with aggressive deductions), Asset-Depletion (for senior physicians with portfolio assets), and SBA-coordinated personal-mortgage timing (for physicians acquiring practices). We pick the program after we read your contract and your full income picture — not before.
Many of our medical clients are at career inflection points — residency-to-attending, attending-to-partner, hospital-employed to private-practice owner, established physician acquiring a colleague’s practice. Each transition has mortgage timing implications. The personal mortgage interacts with SBA practice-acquisition financing, partnership buy-in notes, hospital exit timing, and (for residents) signed future contracts. For SBA-specific acquisition logistics, see our business acquirer mortgage guide under Professional Services.
Chief resident in internal medicine, three months from completion, with a signed cardiology fellowship contract starting at $340K base. Current resident stipend: $68K. First lender required two years of attending-level income before they would qualify her. Second lender qualified her on the resident stipend only, capping her at $310K of buying power. We routed her through a physician-loan program that qualified on the signed future contract, no PMI, 5% down. Approved at $1.1M. Closed on a Coral Gables condo two months before her fellowship started. No bridge financing, no rental gap, no surprises.
No application. No credit pull. A 20-minute conversation where we look at your contract, your student-debt situation, your locum or moonlighting income, and your goal — then we tell you which loan program fits and roughly what the numbers look like. If we’re not the right shop, we’ll tell you that too.
Stairway Mortgage is a division of NEXA Mortgage LLC. Jim Blackburn NMLS #1072866.
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