Resident Physician Mortgage: Buy Before Your Attending Salary

Discover How the Physician Mortgage Program Enables Medical Residents, Fellows, and Interns to Purchase Homes Using Signed Employment Contracts, Flexible Student Loan Treatment, and Manual Underwriting—Before Attending-Level Income Begins

You’re earning $55,000-80,000 as a medical resident or fellow while carrying $160,000-350,000 in student loan debt. You’ve completed four to eight years of post-secondary education. You have three to seven more years of training ahead. And every month, you write a rent check that builds someone else’s equity while your own net worth sits frozen—or declines.

The math is brutal. At $65,000 annually in a city where residency programs operate, rent consumes $1,500-2,500/month. Over a three-year residency, that’s $54,000-90,000 in rent payments generating zero equity, zero tax benefits, and zero wealth accumulation. Meanwhile, your training institution’s zip code likely contains homes appreciating 3-6% annually—homes you could own if the mortgage industry recognized what everyone already knows: you are about to earn $200,000-600,000+.

The Non-Conforming Loan for Medical Professionals offered through Stairway Mortgage, Division of NEXA Mortgage LLC, was designed precisely for this transition. The program allows medical residents, fellows, and interns across all qualifying medical professions to purchase homes using signed employment contracts as qualifying income, actual IBR/IDR student loan payments for DTI, zero down payment, zero PMI, and manual underwriting that evaluates your career trajectory—not your current training stipend in isolation.

Use our Conventional Loan Calculator to see what a standard mortgage would cost on a resident’s income—then understand why the physician mortgage transforms qualification through contract-based income and flexible DTI treatment.

Key Details About the Resident and Fellow Mortgage Program:

• Up to 100% loan-to-value (LTV) financing—zero down payment on a training stipend
• No monthly private mortgage insurance (PMI) regardless of LTV, saving $150-400+ monthly
• Loan amounts up to $2 million for primary residence purchases
• Signed employment contracts accepted as qualifying income
• Manual underwriting evaluating career trajectory and income potential
• Maximum debt-to-income ratio (DTI) up to 50%
• Fixed-rate options: 15, 20, 25, and 30-year terms
• Adjustable-rate options: 5/6, 7/6, and 10/6 ARM structures ideal for training timelines
• No prepayment penalties—refinance when attending income arrives
• Non-occupant co-borrowers allowed (income contribution up to 50%)
• Gift funds accepted for reserves
• Purchase and rate-and-term refinance for primary residences
• Eligible properties: 1-unit SFR, PUD, condominiums, townhomes
• Minimum credit score: 680

Ready to explore your options? Schedule a call with a loan advisor or take our Discovery Quiz to identify your best pathway.

Who Qualifies: Residents, Fellows, and Interns Across All Medical Professions

The physician mortgage program for trainees is not limited to MD or DO residents. Every qualifying medical profession’s training pathway is eligible.

Qualifying training positions:

Physician residencies and fellowships:

• MD and DO residents at all PGY levels (PGY-1 through PGY-7+) in all ACGME-accredited programs
• All specialties: internal medicine, family medicine, emergency medicine, surgery (general, orthopedic, neurosurgery, cardiothoracic, vascular, plastic), anesthesiology, radiology, pathology, psychiatry, pediatrics, OB/GYN, ophthalmology, dermatology, urology, otolaryngology, PM&R, and all others
• All fellowship subspecialties: cardiology, gastroenterology, pulmonary/critical care, oncology, rheumatology, neonatology, sports medicine, pain medicine, and all others

Dental residencies:

• GPR (General Practice Residency) and AEGD (Advanced Education in General Dentistry) residents
• Specialty residents: oral and maxillofacial surgery, orthodontics, periodontics, endodontics, prosthodontics, pediatric dentistry

Pharmacy residencies:

• PGY-1 and PGY-2 pharmacy practice residents

Veterinary internships and residencies:

• AVMA-approved internship programs
• Specialty residencies: surgery, internal medicine, dermatology, oncology, ophthalmology, cardiology, neurology, emergency/critical care

Podiatric residencies:

• PGY-1 through PGY-3 podiatric surgical residents

Student Registered Nurse Anesthetists (SRNAs):

• SRNAs with signed post-graduation employment contracts

Co-borrower provisions for trainees:

• Spouse income combined regardless of profession
• Non-occupant co-borrowers (parents, family) allowed—income contribution capped at 50%
• Only one borrower needs qualifying medical degree or credential

Browse specialty-specific details: MD Physician Mortgage | DO Physician Mortgage | DDS Mortgage | DMD Mortgage | PharmD Mortgage | VMD Mortgage | DPM Mortgage | CRNA Mortgage

Using a Signed Employment Contract to Secure a Mortgage

The employment contract is the single most powerful tool in the training-stage physician mortgage. It transforms qualification from training-stipend math to attending-salary math—while you’re still earning $55,000-80,000.

How contract-based qualification works:

A PGY-5 surgical resident earning $72,000 with a signed contract at $425,000 starting in eight months qualifies at $425,000—not $72,000. This transforms purchasing power from approximately $250,000 (stipend-based) to $900,000+ (contract-based).

Contract requirements:

• Fully executed — Signed by both the trainee and employer
• Compensation specified — Base salary, guaranteed minimum, or documented compensation formula
• Start date identified — Typically within 60-90 days of closing (some flexibility with longer timelines)
• No disqualifying contingencies — Board passage contingencies may be acceptable if the contract specifies employment regardless; residency completion contingencies are generally acceptable

Types of qualifying contracts:

• Hospital employment agreements for attending positions
• Group practice associate contracts with stated compensation
• Academic faculty appointment letters with salary specified
• Federally qualified health center (FQHC) employment offers
• Military or VA physician appointment orders
• Dental practice associate contracts
• Pharmacy clinical or staff positions
• Veterinary hospital or specialty practice contracts
• CRNA facility employment agreements

Optimal timing for contract-based purchase:

6-12 months before training completion: Sign employment contract → begin pre-qualification → search properties → close near end of training → move directly into owned home.

3-6 months before completion: Accelerated timeline. Requires efficient processing. Pre-approval → targeted search → close within 30-45 days.

During fellowship (with post-fellowship contract): Purchase in fellowship city if remaining, or in post-fellowship destination. ARM option aligns with remaining training duration.

Start the process: get pre-approved or submit a purchase inquiry. Check current rates to evaluate timing.

Deferred Student Loans During Residency: How DTI Is Calculated

Student loan treatment is the second most impactful qualification factor for training-stage purchases. Many residents and fellows have student loans in deferment or income-driven repayment plans with $0 monthly payments—and the physician mortgage uses the actual documented payment for DTI.

How this works in practice:

Scenario: PGY-2 internal medicine resident

• Student loans: $280,000
• Current IDR payment: $0/month (income below repayment threshold)
• Physician mortgage DTI contribution: $0/month
• Conventional 1% rule: $2,800/month
• Qualification difference: $2,800/month = approximately $100,000-135,000 in purchasing power

Scenario: PGY-4 cardiology fellow

• Student loans: $310,000
• Current IBR payment: $350/month
• Physician mortgage DTI contribution: $350/month
• Conventional 1% rule: $3,100/month
• Qualification difference: $2,750/month = approximately $105,000-130,000 in purchasing power

Documentation required:

• Student loan servicer letter confirming current monthly payment amount
• If in deferment: documentation showing $0 payment and deferment end date
• If in IDR: documentation showing calculated payment amount
• Consolidation status (do not consolidate or refinance during mortgage application)

Critical warning: Do not refinance federal student loans to private lenders before mortgage application. This eliminates IBR/IDR eligibility and may increase monthly payment—directly reducing mortgage qualification.

Run scenarios: Conventional Loan Calculator (to see conventional DTI impact) vs physician mortgage qualification with actual IBR/IDR payment.

Relocation for Fellowship: Buying Versus Renting in a New City

Fellowship relocation creates a unique buying opportunity—and a unique risk calculation. You’re moving to a new city for one to three years of subspecialty training, potentially followed by another move for your attending position.

The case for buying during fellowship:

• Equity accumulation: 1-3 years of mortgage payments build equity instead of funding a landlord
• Potential appreciation: Markets averaging 3-6% annual appreciation add $10,000-30,000 in value over a 2-year fellowship
• Tax benefits: Mortgage interest deduction available (especially valuable when income increases)
• Stability: No rental increases, no landlord decisions, housing secured for training duration
• Rental income potential: If you relocate after fellowship, the property can become an investment. See DSCR Loan | Calculator for converting to rental.

The case for renting during fellowship:

• Short duration: 1-year fellowships may not recover closing costs
• Market uncertainty: Declining markets could create negative equity
• Relocation risk: If post-fellowship plans require moving, selling within 1-2 years may not break even
• Simplicity: Renting avoids maintenance, insurance, and property management during intensive training

Decision framework:

• Fellowship 1 year + unknown post-fellowship location → Rent (unless market conditions are exceptional)
• Fellowship 2+ years + likely staying in area → Strong buy candidate
• Fellowship 2+ years + relocating after → Buy if willing to convert to rental or if break-even analysis supports
• Fellowship in high-appreciation market → Stronger case for buying regardless of duration

ARM advantage for fellowship purchases:

The 5/6 ARM offers lower initial rates with a fixed period covering the entire fellowship duration plus initial attending years. If you sell or refinance within 5 years, you never reach the adjustable period—capturing the rate advantage without long-term risk.

Use Private Home Search to explore properties in your fellowship city. Get a Home Value Report on properties you’re considering.

Common Uses for Resident and Fellow Mortgage Loans

PGY-1 Resident Purchasing on Stipend Alone

Scenario: 27-year-old MD PGY-1 internal medicine resident:

• Stipend: $58,000
• Student loans: $265,000 (IDR at $0)
• Savings: $5,000
• Spouse income: $45,000 (teacher)
• Target: $245,000 townhome near hospital

Solution: Combined $103,000 qualifies at training level. $0 IDR for DTI. $0 down critical on training income. No PMI saves $160/month. Spouse as co-borrower strengthens application. Gift funds from family can supplement reserves.

PGY-3 Resident with Signed Attending Contract

Scenario: 30-year-old DO emergency medicine resident, PGY-3:

• Residency stipend: $67,000
• Signed attending contract: $340,000 (starting in 7 months)
• Student loans: $295,000 (IBR at $280/month)
• Target: $495,000 single-family home in contract city

Solution: Contract at $340,000 qualifies. IBR at $280 for DTI. $0 down. Purchase in destination city before starting. Close within final months of residency. Move directly into owned home. No PMI saves $325/month. Estimate: Jumbo Loan Calculator.

Surgical Fellow Purchasing in Fellowship City

Scenario: 33-year-old MD cardiothoracic surgery fellow, year one of two:

• Fellowship stipend: $75,000
• Signed post-fellowship contract: $480,000
• Student loans: $320,000 (IBR at $350/month)
• Target: $550,000

Solution: Post-fellowship contract at $480,000 qualifies. IBR at $350 for DTI. $0 down. 5/6 ARM captures lower rate through remaining fellowship plus initial attending years. Property becomes long-term home or converts to rental. Use the Compare Mortgage Rates Calculator to evaluate fixed vs ARM.

Dental Resident Purchasing Before Practice Acquisition

Scenario: 29-year-old DDS orthodontic resident, year two of three:

• Stipend: $60,000
• Plans to open practice in current city post-residency
• Student loans: $345,000 (IDR at $0)
• Spouse income: $65,000
• Target: $325,000

Solution: Combined $125,000 qualifies at training level. $0 IDR eliminates student loan DTI impact. Purchasing now secures housing before practice acquisition capital demands begin. Builds equity during final training year. See DDS Mortgage and DMD Mortgage for post-training details.

Pharmacy Resident with Post-Residency Hospital Contract

Scenario: 28-year-old PharmD PGY-1 pharmacy resident:

• Residency stipend: $52,000
• Signed post-residency clinical pharmacist contract: $142,000
• Student loans: $165,000 (IDR at $0)
• Target: $290,000

Solution: Contract at $142,000 qualifies. $0 IDR for DTI. $0 down on $52,000 stipend is essential. Purchase in post-residency city. See PharmD Mortgage for pharmacist-specific details.

Resident with Non-Occupant Co-Borrower Parent

Scenario: 26-year-old MD PGY-1 pediatrics resident:

• Stipend: $56,000
• Student loans: $240,000 (IDR at $0)
• Father as non-occupant co-borrower: $95,000 income
• Target: $280,000

Solution: Father’s income strengthens qualification (capped at 50%). $0 IDR for DTI. $0 down. Combined qualifying income enables purchase on training-stage timeline. Property builds equity through 3-year residency.

See case studies: Conventional Loan: Physical Therapist Purchases First Home | Down Payment Assistance: Teacher Purchases First Home | VA Loan: Marine Veteran Purchases First Home | FHA Loan: Physical Therapist Achieves Homeownership | USDA Loan: Medical Technician Purchases Home with Zero Down.

The ARM Strategy for Training-Stage Purchases

Adjustable-rate mortgages deserve special attention for training-stage purchases because the fixed-rate period can be strategically aligned with your training timeline and early attending years.

How ARMs work in the physician mortgage:

• 5/6 ARM: Fixed rate for 5 years, then adjusts every 6 months
• 7/6 ARM: Fixed rate for 7 years, then adjusts every 6 months
• 10/6 ARM: Fixed rate for 10 years, then adjusts every 6 months

Why ARMs make strategic sense during training:

Lower initial rate: ARMs typically offer 0.25-0.75% lower rates than 30-year fixed. On a $400,000 mortgage, that’s $83-250/month in savings during the fixed period.

Training timeline alignment: A PGY-2 resident with 2 years remaining plus a 3-year initial attending period fits perfectly within a 5/6 ARM fixed window. The resident never reaches the adjustable period if they refinance or sell within 5 years.

Refinance trigger: When attending income arrives, the resident can refinance into a 30-year fixed at a potentially better rate—using higher income, lower DTI, and established credit history to secure optimal terms. Visit Refinance or HELOC Journey for refinancing guidance.

ARM timeline matching:

No prepayment penalty: If you sell, refinance, or accelerate payments during the fixed period, there’s no penalty. The ARM preserves maximum flexibility.

Use the Compare Mortgage Rates Calculator to model fixed vs ARM scenarios. Check current rates across all structures.

Frequently Asked Questions About Resident and Fellow Mortgage Loans

Can I really qualify on a $58,000 residency stipend?

Yes—through multiple pathways. Stipend alone qualifies for modest purchases. Add spouse/co-borrower income for stronger qualification. Add a signed attending contract and qualification jumps to $200,000-600,000+. $0 IDR student loans and $0 PMI maximize purchasing power on limited training income.

What if I don’t have a signed contract yet?

You can still qualify on stipend plus co-borrower income. Once a contract is signed, qualification increases dramatically. Begin pre-qualification on current income, then update when the contract is executed.

Do I need to be in the last year of training?

No. PGY-1 through PGY-7+ and all fellowship levels qualify. Earlier purchases mean more years of equity accumulation. Contract-based qualification is available whenever a post-training contract is signed.

What if my contract has a board passage contingency?

Many contracts are still acceptable. If the contract specifies employment regardless of initial board results (with remediation provisions), it may qualify. If employment is entirely contingent on board passage, discuss specifics with your loan advisor. Schedule a call for guidance.

Should I choose fixed rate or ARM?

ARM often provides strategic advantage during training. Lower initial rate saves money during training years. Refinance into fixed when attending income arrives. See ARM Strategy section above for timeline matching. Use the Compare Mortgage Rates Calculator.

Can I buy in a different city from my training program?

The property must be your primary residence. If you’re purchasing in your post-training destination city (where you’ll move within 60-90 days of closing), this qualifies. Purchasing in a city where you won’t reside does not qualify under this program. For investment properties in other markets: DSCR Loan | Calculator.

What about VA loan benefits for military residents?

Military residents may have both options. VA Loan | Calculator offers zero down with no PMI. Compare physician mortgage terms side-by-side. Use the VA Entitlement Calculator to check eligibility.

Can I use this for a condo near the hospital?

Yes—condominiums qualify. Warrantable condos in eligible projects are accepted. For non-warrantable condos: Non-Warrantable Condo Loan | Calculator.

What if I want to keep the property as a rental when I relocate?

The physician mortgage requires primary residence at purchase. After living there as primary residence, you may convert to rental when relocating. Future rental financing: DSCR Loan | Calculator. Calculate returns: Rental Property Calculator.

How quickly can I close?

30-45 days typical. Need faster? Same-Day Approval. Start: get pre-approved or submit a purchase inquiry.

Is down payment assistance available for residents?

Yes. Down Payment Assistance | Calculator programs may apply based on income level and location. The physician mortgage already offers $0 down, but DPA can provide additional grant funds for closing costs or reserves.

Alternative Solutions for Medical Trainees

For primary residence purchases:

• Conventional Loan — 5-20% down | Calculator
• FHA Loan — 3.5% down, flexible credit | Calculator
• VA Loan — Zero down for military trainees | Calculator
• USDA Loan — Zero down in rural training areas | Calculator
• Jumbo Loan — Above $2 million | Calculator
• Down Payment Assistance — Grants for training-income qualifiers | Calculator

For complex or alternative income:

• Bank Statement Loan — Deposit-based | Calculator
• P&L Loan — CPA statements | Calculator
• 1099 Loan — Moonlighting income | Calculator
• Asset Based Loan — Portfolio qualification | Calculator

For future investment building:

• DSCR Loan — Rental income qualification | Calculator
• Fix and Flip Loan — Renovation projects | Calculator
• Hard Money Loan — Fast acquisitions | Calculator
• Portfolio Loan — Non-standard properties

For equity access and refinance (post-training):

• Home Equity Loan — Fixed lump sum | Calculator
• HELOC — Flexible line | Calculator
• FHA Streamline Refinance — Lower payments | Calculator
• VA IRRRL — VA streamline | Calculator

For construction and renovation:

• Construction Loan — Custom builds | Calculator
• Jumbo Construction Loan — Luxury homes | Calculator
• FHA 203k Loan — Buy and renovate | Calculator
• HomeStyle Renovation Loan — Conventional renovation | Calculator
• Home Improvement Loan — Value-add improvements

Explore all loan programs | Browse all case studies | Run numbers with any loan calculator

Not sure which fits? Take our Discovery Quiz.

Ready to Buy Before Your Attending Salary Arrives?

Every month of rent during residency or fellowship is money that builds someone else’s wealth. The physician mortgage through Stairway Mortgage transforms your training-stage financial position from “can’t qualify” to “ready to purchase”—using signed employment contracts, actual IBR/IDR student loan payments, zero down payment, zero PMI, and manual underwriting designed for the unique financial transition every medical trainee navigates.

Whether you’re a PGY-1 intern purchasing on stipend with co-borrower support, a senior resident leveraging a signed attending contract, a fellow buying in a subspecialty training city, a dental resident securing housing before practice acquisition, or a pharmacy resident purchasing before clinical practice begins—this program exists for your exact situation.

Take action today:

• Take the Discovery Quiz to identify priorities and programs
• Schedule a call for resident/fellow mortgage guidance
• Submit a purchase inquiry to begin pre-qualification
• Get pre-approved to start your application
• Check current rates across all programs
• Search for homes in your training or destination city
• Get a home value report on any property

Start your journey: Buy a House | Build a Wealth Plan | First-Time Buyers | Homeowners | Active Investors

Helpful Resources for Medical Trainees

Official Medical Training and Financial Resources:

Accreditation Council for Graduate Medical Education (ACGME) — Residency and fellowship program accreditation, trainee resources, and program requirements.

Association of American Medical Colleges (AAMC) — Medical education data, student debt resources, and financial planning tools for trainees.

National Resident Matching Program (NRMP) — Match data, statistics, and resources for medical graduates entering residency training.

Consumer Financial Protection Bureau (CFPB) — Federal homebuying education, mortgage tools, and borrower protection.

Explore by Client Type: 

Stairway Mortgage Resources:

Loan Programs Overview — All financing options including all physician specialty pages

All Loan Calculators — 90+ calculators

All Case Studies — 75+ real-world examples

Buy a House Journey — Step-by-step guidance

Build a Wealth Plan Journey — Wealth-building strategies

First-Time Buyers Journey — Specialized first-purchase guidance

Current Rates — Today’s rates

Guides — Downloadable resources

Blog — Latest articles

Need local expertise? Get introduced to trusted partners experienced with medical trainee homebuyers in your training city.