Physician Mortgages

Physician mortgage from a lender who reads hospital W-2, RVU productivity bonus, locum tenens 1099, telehealth platform income, S-corp distributions from private practice, sign-on and loan-repayment packages, and student loan IDR as one income picture.

Working physicians (MD/DO) carry one of the most multi-source income files in U.S. lending. A single year can include hospital W-2 base salary ($240K–$450K typical for established attendings), Relative Value Unit (RVU) productivity bonus compensation paying $25–$75 per work-RVU above a baseline threshold, hospital sign-on bonuses ($25K–$300K depending on specialty and market), employer loan-repayment assistance (commonly $25K–$50K annually for rural and underserved settings), locum tenens 1099-NEC compensation aggregated across multiple agencies (CompHealth, Locumtenens.com, Weatherby Healthcare), telehealth platform 1099 income (Teladoc, Amwell, MDLive), moonlighting W-2 from a second hospital, partnership K-1 distributions for those who have moved into private-practice partner roles, and $200K–$400K of federal student loans on income-driven repayment with actual monthly payments often $0–$1,500 vs the $2,000–$4,000 that 1% of balance would suggest. The right qualifying method (Conventional with IDR-aware DTI, Physician/Doctor Loan with no-PMI low-down, Multi-Source W-2 + 1099, or S-Corp Self-Employed) can swing $400K–$1.2M of qualifying loan amount on a working physician file. Generalist lenders default to the hospital base salary and miss the rest.

Talk to Our Team See how physician qualifying works

Broker NMLS #1072866 · Specialist in physician/doctor loans, RVU productivity bonus, locum tenens 1099, hospital-to-practice transitions, & multi-source attending physician mortgages

$239,200+

BLS OOH May 2024 median annual wage for U.S. physicians and surgeons (top 25% over $400K; specialty attendings commonly $400K–$700K)

$200K-$400K

Typical medical-school plus residency federal student loan burden (mostly on IDR with actual payments far below 1% rule)

60%+

Share of U.S. physicians employed by hospitals or health systems per AMA data (up from under 40% a decade ago)

B3-6-05

Fannie Mae rule counting actual IDR payment in DTI, not 1% of balance — swings $400K-$800K qualifying for physicians

Stairway Mortgage qualifies working physicians on the full income picture — hospital W-2 base salary under Fannie Mae B3-3.1-01 with RVU productivity bonus treated as variable income (24-month average with current-year trending), hospital sign-on and relocation bonus treatment for first-year attendings, loan-repayment-assistance income in employer-paid programs, locum tenens 1099-NEC compensation aggregated across agencies as continuing Schedule C self-employment under B3-3.3-02, telehealth platform 1099 income from Teladoc, Amwell, MDLive and similar platforms, moonlighting W-2 from secondary hospital employment, S-corp W-2 reasonable compensation plus K-1 distributions under B3-3.4-02 for private-practice partners and owners, partnership K-1 distributions from physician groups, signed forward-looking employment contracts under physician/doctor loan programs (allowing residents and fellows to qualify on attending income up to 60-90 days pre-start), federal student loan IDR payments on PAYE/SAVE/IBR documented through Federal Student Aid servicer statements counted in DTI under B3-6-05, and Physician/Doctor Loan products specifically designed for the physician income pattern with low-down or no-down options, no PMI requirement, and IDR-friendly DTI treatment. A first-year hospital-employed attending finishing residency, an established employed physician with RVU bonus and locum supplementation, an attending mid-transition from hospital to private practice partnership, a practice partner with significant K-1 distributions, and an established practice owner each get qualified using methods that fit their actual structure. 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. For the parent hub and other medical professional paths, see our medical professionals mortgage hub.

01 · Physician mortgage at a glance

Key facts every physician should know before applying for a mortgage.

Physician Loan

B3-6-05 IDR

Under Fannie Mae B3-6-05, the actual income-driven repayment payment from Federal Student Aid IDR plans counts in DTI instead of 1% of balance. For a physician with $320K of student loans on PAYE paying $850/month vs the $3,200 the 1% rule would impose, this rule alone swings $500K-$900K of qualifying loan amount.

RVU productivity

Under Fannie Mae B3-3.1-01, RVU (Relative Value Unit) productivity bonus compensation qualifies as variable income with 24-month average plus current-year trending. For established attendings with RVU bonus running 20–40% of total compensation, this adds $80K–$200K of qualifying income that base-salary-only analysis misses.

AMA/ABMS

The American Medical Association (AMA, founded 1847) is the largest physician professional association. The American Board of Medical Specialties (ABMS) oversees specialty board certification across 24 member boards. ABMS board certification supports the case for established-attending qualifying.

02 · Where you are in your physician career

Physician mortgage solutions for every career stage.

Each stage of an attending physician career has its own qualifying logic. A first-year hospital-employed attending right out of residency has a different mortgage path than an established attending mid-transition to private practice, or a senior practice partner with significant K-1 distributions from a multi-physician practice.

First-year attending post-residency (Years 1–2)

"Just finishing residency or completing first year as attending. Hospital W-2 employment with sign-on bonus and loan-repayment package, RVU bonus still ramping."

Annual income $250K–$400K W-2 hospital employment plus sign-on
Sign-on bonus $25K–$150K, loan repayment $25K–$50K annually
Federal student loans $200K–$400K typically on PAYE or SAVE
Physician/Doctor Loan with signed-contract qualifying OR Conventional with B3-6-05 IDR

See first-year attending mechanics

Established employed attending (Years 3–7)

"Established attending with stable hospital employment. Full RVU productivity bonus running. Possibly supplementing with locum or telehealth shifts."

Annual income $350K–$600K W-2 + RVU + locum/telehealth supplementary
2-year average of RVU bonus under B3-3.1-01 variable income
Locum 1099 aggregation under B3-3.3-02 as continuing self-employment
Conventional Jumbo or Physician Loan with multi-source documentation

See established attending mechanics

Hospital-to-private-practice transition (Years 5–10)

"Transitioning from hospital employment to private practice partnership or solo practice. Income picture shifting from W-2 to mixed W-2 plus K-1 or full S-corp."

Annual income $400K–$800K transitioning from W-2 to K-1
Partnership buy-in note becomes personal DTI obligation
Sequencing personal mortgage relative to buy-in timing critical
Conventional Jumbo qualifying on trailing W-2 OR forward K-1 history

See transition mechanics

Private practice partner with K-1 (Years 7–15)

"Established private practice partner. S-corp or partnership distributions are primary income. Possibly equity in practice ownership and ancillary services."

Annual income $500K–$1.2M through W-2 reasonable comp + K-1
Fannie Mae B3-3.4-02 S-corp aggregation with 2-year 1120-S history
Form 1084 cash-flow addbacks for practice equipment depreciation
Conventional Jumbo or Super-Jumbo with multi-entity if multi-location

See practice partner mechanics

Practice owner / multi-location physician

"Established practice owner with possibly multiple locations or significant ancillary service ownership (imaging, lab, surgery center). Complex multi-entity ownership structure."

Annual income $700K–$2.5M+ through multi-entity ownership
Multi-entity B3-3.4-02 aggregation across practice entities
Ancillary service equity (imaging center, ASC) K-1 distributions
Super-jumbo with multi-entity documentation or asset-depletion complement

See practice owner mechanics

03 · The qualification mechanics

How we calculate qualifying income for your physician mortgage.

Four methods cover almost every physician file we’ve closed. The right method depends on your career stage, whether you maintain hospital W-2 employment alongside other streams, the role of RVU productivity bonus and locum supplementation, and whether you have transitioned into private practice partnership or ownership.

Method 1 — Hospital W-2 + RVU productivity bonus (the employed-attending default)

The dominant pattern for working physicians (60%+ of U.S. physicians are now hospital-employed). Hospital base salary qualifies under Fannie Mae B3-3.1-01 as continuous W-2 income with 24-month average. RVU productivity bonus qualifies as variable income with 24-month average plus current-year trending support. Hospital sign-on bonuses ($25K–$300K typical depending on specialty and market) and loan-repayment-assistance income ($25K–$50K annually for rural and underserved settings) qualify when documented as continuing employer benefits. The Physician/Doctor Loan product layer adds low-down or no-down structure with no PMI, IDR-friendly DTI, and signed-contract qualifying for residents transitioning to attending positions.

Method 2 — Multi-W-2 stack (hospital + moonlighting + telehealth)

For physicians stacking multiple W-2 employments: primary hospital position plus moonlighting W-2 at a second hospital plus W-2 telehealth platform employment plus possibly a third hospital coverage W-2. Under Fannie Mae B3-3.1-01, each W-2 stream qualifies as continuing employment with 24-month average. Multi-W-2 stacking is particularly common for hospitalists (block schedule allowing secondary employment), emergency medicine physicians (shift-based), and ICU/critical care attendings. The aggregate often substantially exceeds the primary W-2 alone.

Method 3 — Hospital W-2 + Locum 1099 self-employment (the hybrid path)

For physicians who supplement hospital W-2 with locum tenens 1099-NEC work through agencies like CompHealth, Locumtenens.com, Weatherby Healthcare, and similar firms. Under B3-3.1-01, the hospital W-2 qualifies with 24-month average. Under B3-3.3-02, locum 1099 income aggregates as continuing Schedule C self-employment with 2-year history. Telehealth platform 1099s (Teladoc, Amwell, MDLive) similarly aggregate. The two methods combine into a substantially stronger qualifying picture than either alone.

Method 4 — S-corp self-employed with W-2 + K-1 (the practice-partner path)

For physicians who have transitioned into private practice partnership or full practice ownership. Under IRC Section 1361 and Fannie Mae B3-3.4-02, qualifying income combines S-corp W-2 reasonable compensation (typically $200K–$300K for physician practice owners) plus K-1 distributions from Form 1120-S with 2-year history. Form 1084 cash-flow addbacks recover non-cash depreciation on practice equipment under IRC Section 167 and Section 179 expensing. For multi-location practices or physicians with ancillary service equity (imaging center, ASC), multi-entity B3-3.4-02 aggregation applies.

04 · What generalist underwriting misses

The income most lenders refuse to count on a physician file.

Six income streams that show up consistently on working physician files and that generalist lenders typically either ignore, mis-categorize, or refuse to apply correctly. Each one is documentable; the lender just has to read the physician multi-source pattern, employment contract structure, and IDR documentation properly.

RVU productivity bonus compensation

Most hospital-employed physician contracts include RVU (Relative Value Unit) productivity bonus paying $25–$75 per work-RVU above a baseline threshold. For an established attending with 6,000–9,000 wRVUs annually above threshold, productivity bonus runs $90K–$300K—commonly 20–40% of total compensation. Under Fannie Mae B3-3.1-01, RVU bonus qualifies as variable income with 24-month average plus current-year trending. Generalist lenders see the base salary and miss this.

Hospital sign-on, loan-repayment assistance, and relocation packages

First-year and recently-hired attendings receive hospital sign-on bonuses ($25K–$300K depending on specialty and market — psychiatry, primary care, and rural family medicine top the tables), employer loan-repayment assistance commonly $25K–$50K annually for rural and underserved settings, and relocation reimbursement $10K–$30K. These benefits qualify as continuing employer compensation under B3-3.1-01 when contracted with multi-year continuation. Generalist lenders treat them as one-time and exclude.

Locum tenens 1099-NEC aggregation across agencies

Many physicians supplement hospital W-2 with locum tenens 1099-NEC work through agencies (CompHealth, Locumtenens.com, Weatherby Healthcare, AB Staffing, Onyx M.D., etc.). Each agency issues a separate 1099-NEC. Under Fannie Mae B3-3.3-02, multi-agency locum 1099s aggregate as continuing Schedule C self-employment with 2-year history. Generalist lenders see multiple 1099s and refuse, missing $50K–$200K of supplementary income.

Telehealth platform 1099 income

The telehealth platform market expanded substantially post-COVID. Platforms like Teladoc Health, Amwell, MDLive, PlushCare, Doctor on Demand, and specialty platforms (psychiatry-focused, women’s health-focused, men’s health-focused) contract with physicians as independent contractors for asynchronous and synchronous telehealth visits. 1099-NEC income from telehealth platforms aggregates with other physician 1099 income under B3-3.3-02 as continuing self-employment.

Federal student loan IDR payment in DTI (B3-6-05)

Medical school plus residency leaves the typical new attending with $200K–$400K of federal student loans. Most are on income-driven repayment (PAYE, SAVE, IBR, REPAYE/SAVE) with actual monthly payments often $0–$1,500 against balances where the 1% rule would impose $2,000–$4,000. Under Fannie Mae B3-6-05, the actual servicer-statement payment counts in DTI. This single rule swings $500K–$900K of qualifying loan amount for new attendings.

Forward-looking signed employment contracts

Residents finishing training and physicians switching positions can qualify on forward-looking signed employment contracts up to 60-90 days pre-start under Physician/Doctor Loan programs. The signed contract documents future attending income before residency completion or before new position start date, allowing home purchase coordination with practice or hospital start. Particularly useful for residents finishing training in June or July who need to close on housing before the position formally begins.

05 · Match the program to your physician situation

Which loan program fits your physician mortgage situation.

Seven loan-program categories cover essentially every physician file we’ve closed. The mix tilts toward Physician/Doctor Loan (the differentiating product for physician borrowers) and Conventional Conforming with IDR-aware DTI treatment under B3-6-05.

Physician/Doctor Loan (key product)

MD/DO designation with low-down or no-down structure
No PMI requirement, IDR-friendly DTI, signed-contract qualifying
Loan amounts to $1M-$2M+ depending on specialty lender

Best for: Most physician borrowers

Conventional Conforming (IDR-aware)

Hospital-employed attendings with student loan IDR
Fannie Mae B3-6-05 uses actual IDR payment in DTI
Loan limits to $766,550 (FL) 2024-25

Best for: Employed attending under conforming limit

Conventional Jumbo

Established attendings with W-2 + RVU + supplementary streams
Combines B3-3.1-01 W-2 with B3-3.3-02 self-employment
Loan amounts above conforming limits

Best for: $766K+ loan amount

Multi-Source W-2 + 1099 Conventional

Physicians combining hospital W-2 + locum + telehealth
B3-3.1-01 W-2 + B3-3.3-02 self-employment combined
2-year history of each supplementary stream

Best for: Multi-stream attending

S-Corp Self-Employed Conventional

Private practice partners and practice owners
W-2 reasonable comp + K-1 distributions under B3-3.4-02
Form 1084 addbacks for equipment depreciation

Best for: Practice partner or owner

Signed-Contract Qualifying

Residents and physicians switching positions pre-start
Qualify on signed forward contract up to 60-90 days pre-start
Physician Loan product with contract-based qualifying

Best for: Residency-to-attending transition

Asset-Depletion Non-QM

Senior physicians with accumulated retirement and reserves
Liquid assets amortized over 360 months as implied income
Useful during practice transitions when current income variable

Best for: Senior physician or transitioning

06 · Why this mortgage requires specialty expertise

The physician mortgage in context: 6 forces shaping how physicians qualify.

Physician income sits at the intersection of accelerating physician shortage and signing bonus inflation, the multi-decade trend toward hospital employment, private equity rollups of physician practices, post-COVID telehealth proliferation, AMA and ABMS specialty board credentialing context, and Public Service Loan Forgiveness eligibility for physicians at nonprofit hospitals. Each force shapes what a working physician’s qualifying picture looks like.

Force 1 — Physician shortage and signing bonus inflation

Per Association of American Medical Colleges (AAMC) physician workforce projections, the U.S. faces a substantial physician shortage projected across primary care, surgical specialties, and rural settings. The shortage drives signing bonus inflation: psychiatry, primary care, family medicine, and rural settings now offer $100K–$300K signing bonuses, multi-year loan-repayment assistance packages, and aggressive RVU bonus structures to attract candidates. The mortgage implication: first-year attending income substantially exceeds the trailing residency W-2 by 4-6x, but only specialty lenders know how to qualify against a forward attending position that hasn’t yet generated tax-return history.

Force 2 — Hospital employment trend (60%+ now employed)

Per American Medical Association Physician Practice Benchmark Survey data, the share of U.S. physicians employed by hospitals and health systems has risen from under 40% a decade ago to over 60% today. The trend reflects mounting administrative burden in independent practice, capital requirements for EHR and equipment, and consolidation pressure. The mortgage implication: most working physician income files are now W-2 hospital employment with RVU productivity bonus, simplifying qualifying mechanics relative to the older private-practice K-1 pattern but requiring proper RVU bonus treatment under B3-3.1-01 variable income.

Force 3 — Private equity rollups of physician practices

Private equity has aggressively consolidated physician practices across specialties (dermatology, ophthalmology, gastroenterology, urology, anesthesiology, radiology) over the past decade. PE-backed roll-ups typically purchase practices, convert physician partners to employed positions with multi-year contracts and earnout structures, and then optimize operations across the consolidated platform. The mortgage implication: physicians at PE-backed practices may have transitioned from K-1 partner income to W-2 employed income with earnout/incentive components. We coordinate qualifying around the transitional income structure and any earnout-payment timing.

Force 4 — Telehealth proliferation post-COVID

The COVID-era telehealth expansion permanently reshaped physician practice patterns. Telehealth platforms (Teladoc Health, Amwell, MDLive, Doctor on Demand, PlushCare, specialty-focused platforms) contract with physicians as independent contractors for asynchronous and synchronous virtual visits. Many employed physicians now supplement hospital W-2 with telehealth 1099 work, providing flexible additional income. Reimbursement parity policies for telehealth visits remain in active regulatory flux at federal and state levels. The mortgage implication: telehealth 1099 income is now a standard supplementary stream we routinely aggregate under B3-3.3-02 alongside hospital W-2.

Force 5 — AMA and ABMS specialty board credentialing

The American Board of Medical Specialties (ABMS) oversees specialty board certification across 24 member boards covering essentially all U.S. clinical specialties. Board certification (Initial Certification + Maintenance of Certification) supports the case for established attending qualifying and signals long-term physician income stability to underwriters. State medical licensure plus specialty board certification represent the baseline credentialing documentation for physician qualifying. We document board status and licensure as part of the physician income file.

Force 6 — PSLF for nonprofit hospital physicians

Physicians employed by 501(c)(3) nonprofit hospitals or government hospitals (VA, Indian Health Service, county hospitals) qualify for Public Service Loan Forgiveness after 120 qualifying IDR payments. The 10-year PSLF clock often aligns with the early-career window (residency + first 6-7 years of attending practice) when home purchase is most likely. PSLF eligibility shapes IDR payment selection (PAYE/SAVE optimized for lowest payment + forgiveness) and the mortgage qualifying picture under B3-6-05 favorably.

07 · The mortgage shifts as your physician career develops

Physician mortgage by career stage.

A timeline view of how the right mortgage program changes as you progress from first-year attending through established employed physician to hospital-to-practice transition and private practice partnership.

Years 1–2

First-year attending post-residency

Comp profile: $250K–$400K W-2 hospital base salary plus $25K–$150K sign-on bonus plus $25K–$50K annual loan-repayment-assistance plus ramping RVU productivity bonus. Dominant qualifying method: Physician/Doctor Loan with signed-contract qualifying OR Conventional with B3-6-05 IDR-aware DTI. Common purchase: $500K–$1M primary residence. Watch-out: $200K–$400K of federal student loans require IDR enrollment AND properly-documented servicer statement showing actual monthly payment for B3-6-05 treatment. Make sure IDR recertification is current.

Years 3–7

Established employed attending

Comp profile: $350K–$600K with full RVU productivity bonus running, possibly supplemented with locum tenens 1099 and telehealth platform 1099s. Dominant qualifying method: Conventional Jumbo or Physician Jumbo Loan with multi-source documentation under B3-3.1-01 W-2 + B3-3.3-02 self-employment. Common purchase: $800K–$1.5M primary residence. Watch-out: Multi-source supplementary income requires 2-year history of each stream. New telehealth platform engagements within the past 24 months may not yet count toward qualifying.

Years 5–10

Hospital-to-private-practice transition

Comp profile: $400K–$800K transitioning from hospital W-2 to private practice partnership with K-1 distributions. Partnership buy-in note becomes personal DTI obligation. Dominant qualifying method: Conventional Jumbo qualifying on trailing hospital W-2 BEFORE buy-in closes, OR forward K-1 with 2-year practice income history AFTER buy-in stabilizes. Common purchase: $1.2M–$2.5M primary residence. Watch-out: Buy-in note personal-guarantee debt appears on personal credit. Sequence the personal mortgage BEFORE buy-in closing using stable employed-period W-2.

Practice partner / owner

Private practice partner or established practice owner

Comp profile: $500K–$2.5M+ through S-corp W-2 reasonable comp plus K-1 distributions plus possibly ancillary service equity (imaging center, ASC, lab) K-1s. Dominant qualifying method: Multi-Entity S-Corp Conventional Jumbo or Super-Jumbo under B3-3.4-02 with Form 1084 addbacks. Common purchase: $1.5M–$5M+ primary residence. Watch-out: Multi-entity complexity at scale requires careful upfront documentation. Surface all entity returns, K-1s, ownership percentages, and ancillary service equity early in underwriting.

08 · What physicians say

What physicians say about their Stairway mortgage.

Names abbreviated for client privacy. Practice details anonymized. Numbers are real.

"Finishing internal medicine residency, signed hospital contract for $295K base plus $75K sign-on plus $40K annual loan repayment for 4 years plus RVU productivity bonus. Wanted to close on a home before the July start date. $345K of federal student loans on PAYE with $385/month payment. The first lender said they needed me to have 6 months of W-2 history at the new position before they could qualify me — meaning I couldn’t close until January. Jim’s team ran the Physician/Doctor Loan with signed-contract qualifying, used the documented PAYE payment under B3-6-05 instead of 1% of balance, included the sign-on as continuing employment benefit, and qualified me on the forward attending position. $895K close on a Coral Springs home with 5% down and no PMI, closed 30 days before my official start date."

Michael R., MD

First-year internal medicine attending · Coral Springs

"Hospitalist for 6 years, block schedule allowing supplementary work. Primary hospital W-2 at $340K plus locum tenens 1099-NEC across two agencies (CompHealth and Locumtenens.com) averaging $115K combined plus Teladoc 1099 averaging $48K. Total $503K across the three streams. The first lender looked at the primary W-2 alone, called the locum and telehealth 1099s ‘contractor work, not stable,’ and offered me $720K. Jim’s team aggregated the hospital W-2 under B3-3.1-01 plus the locum and telehealth 1099s under B3-3.3-02 as continuing Schedule C self-employment with 2-year history per agency. $1.42M close on a Weston home in 41 days."

Priya S., MD

Hospitalist w/ locum + telehealth · Weston

"Established gastroenterology partner for 9 years in a multi-physician practice. S-corp structure with $245K reasonable-comp W-2 plus $485K in K-1 distributions plus $95K K-1 from the surgery center partnership where my group has equity. Total $825K through W-2 plus two K-1 streams. The first lender refused the surgery center K-1 as ‘ancillary income, not core practice,’ and tried to qualify me on W-2 plus main practice K-1 only. Jim’s team aggregated the W-2 under B3-3.1-01, the main practice K-1 under B3-3.4-02 with 2-year 1120-S history, AND the ASC K-1 under B3-3.4-02 as a separate continuing partnership distribution. $2.4M close on a Boca Raton home in 48 days."

Robert C., MD

GI practice partner w/ ASC equity · Boca Raton

09 · Physician mortgage FAQs

Physician mortgage questions, answered.

More physician mortgage resources at Stairway

→ All medical professional mortgage programs
→ Surgeon mortgage guide
→ Resident & fellow mortgage guide
→ NP & PA mortgage guide
→ Physician/Doctor Loan details
→ Conventional conforming details
→ Start your physician mortgage pre-approval

I have $345K of medical school loans. Can I still qualify for a $1M+ mortgage?

Yes, with the right DTI calculation. Under Fannie Mae B3-6-05, the actual monthly payment from your income-driven repayment servicer counts in DTI — not 1% of balance. If you’re on PAYE/SAVE/IBR, that payment may be $0–$1,500/month against $345K of debt vs the $3,450 the 1% rule imposes. We document with the servicer statement and qualify you correctly. This rule alone swings $500K–$900K of qualifying loan amount.

What’s a Physician/Doctor Loan and is it always the right product?

Physician/Doctor Loan programs from many specialty lenders accept MDs and DOs with low-down or no-down structures (0–10% down even on jumbo amounts), no PMI requirement, IDR-friendly DTI treatment, and signed forward-looking contracts (residents qualifying on attending income up to 60-90 days pre-start). It’s the most powerful product for many physician borrowers but not always optimal — we compare Physician Loan vs Conventional vs Jumbo pricing case-by-case based on down payment availability, loan amount, rate environment, and whether PMI removal matters at your specific equity level.

I’m finishing residency and want to close before my July attending start date. Can I?

Yes. Under Physician/Doctor Loan signed-contract qualifying, you can close on a home up to 60-90 days pre-start using the signed forward attending contract as income documentation. The signed contract documents the future attending income before residency completion. Particularly useful for residents finishing training in June or July who need to close on housing before the position formally begins.

My RVU productivity bonus is a significant chunk of total comp. How does it count?

Under Fannie Mae B3-3.1-01, RVU productivity bonus qualifies as variable income with 24-month average plus current-year trending support. For established attendings with RVU bonus running 20–40% of total comp ($90K–$300K annually), this adds substantial qualifying income that base-salary-only analysis misses. We document the RVU schedule from your employment contract and the 24-month productivity history.

My hospital sign-on bonus paid $150K. Does that count?

Sign-on bonuses with multi-year continuation provisions can qualify as continuing employer compensation under B3-3.1-01 when properly documented through the employment contract. Single-payment sign-on bonuses without continuation may be treated as one-time and excluded. Multi-year retention bonuses ($25K-$50K annually with 3-5 year stipulation) typically qualify as continuing employer compensation. We review the employment contract structure to determine treatment.

My income is hospital W-2 plus locum tenens 1099. Will both count?

Yes, with documentation. We use your hospital W-2 as continuous income under B3-3.1-01, your locum 1099 as continuing self-employment under B3-3.3-02 with 2-year average. Multi-agency locum 1099s (CompHealth, Locumtenens.com, Weatherby) aggregate together. The two-stream stack often qualifies you for $300K-$600K more home than the W-2 alone.

I’m buying into a private practice. How does that affect my personal mortgage?

The practice buy-in note becomes a debt obligation in your personal DTI when personally guaranteed. 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 employed-period W-2 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.

My specialty is psychiatry and I work telehealth 4 days a week. How does that file?

Telehealth-heavy psychiatry practice typically involves 1099-NEC income from one or more telehealth platforms (Talkspace, Brightside Health, specialty psychiatry platforms) plus possibly W-2 hospital outpatient psychiatry. Under B3-3.3-02, telehealth platform 1099s aggregate as continuing self-employment with 2-year history. The income stability of psychiatry telehealth practice generally supports strong qualifying.

What documentation do I need for a physician mortgage?

Typically: two years of complete federal 1040s with all schedules including Schedule C if applicable; if S-corp owner, Form 1120-S returns with K-1s; all W-2s from primary hospital and any moonlighting; all 1099-NECs from locum agencies, telehealth platforms, consulting; the signed hospital employment contract showing base salary, RVU schedule, sign-on, loan repayment, and benefit details; current servicer statement showing actual IDR payment; 60 days of personal bank statements; ABMS board certification documentation if applicable; state medical licensure verification.

Are mortgage rates higher for physicians?

Physician/Doctor Loan rates are competitive with Conventional Jumbo, typically within 0.125–0.375% of standard jumbo pricing in exchange for the low-down structure and no PMI. Base conventional rates are the same for physicians as for any other borrower at the same credit profile. For physicians with substantial down payment and high credit score, Conventional Conforming or Jumbo may price better than Physician Loan; for physicians with limited down payment or wanting to avoid PMI, Physician Loan is typically optimal. We compare both case-by-case.

Do AMA membership or ABMS board certification affect my application?

Indirectly. AMA membership is not mortgage-relevant per se. ABMS board certification (Initial Certification + Maintenance of Certification) supports the case for established-attending qualifying and signals long-term income stability to underwriters. State medical licensure plus board certification represent baseline credentialing documentation. We document board status and licensure as part of the physician income file.

I work at a nonprofit hospital. Does PSLF affect my mortgage qualifying?

Indirectly but importantly. If your hospital qualifies for Public Service Loan Forgiveness, your IDR payments count toward forgiveness AND count in DTI under B3-6-05 during the qualifying years. After 120 qualifying payments the remaining balance discharges. The 10-year PSLF clock often aligns with the early-career window (residency + first 6-7 years of attending) when home purchase is most likely. PSLF-eligible physicians often have lower IDR payments (optimized for forgiveness) which favorably affects DTI.

My practice was acquired by a PE-backed platform. How does the income transition affect qualifying?

Post-acquisition physicians typically transition from K-1 partner income to W-2 employed income with multi-year retention contracts and earnout payment structures. The W-2 portion qualifies under B3-3.1-01. Earnout payments may qualify as continuing income with proper documentation showing scheduled payments under multi-year structures. We work with the practice CFO and your employment contract to document the post-transition compensation structure. The trailing K-1 history from pre-acquisition years also supports the case for established physician income.

My spouse is also a physician. How does that affect us?

Two-physician households produce strong joint qualifying. Both files combine as co-borrowers with W-2s, RVU bonuses, 1099 supplementary streams, K-1 distributions if practice partners, and IDR payments. Two-physician households commonly qualify for $2M–$5M+ mortgages even with significant combined student loan balances when both are on IDR with documented servicer payments.

I have $80K of credit-card debt from medical school living expenses. Will that hurt?

High-balance unsecured debt does impact DTI but is manageable. Under B3-6-05, the minimum monthly payment from each credit card account counts in DTI calculation. Paying down high-balance unsecured debt 60-90 days pre-application improves qualifying. Many physicians use the first year of attending income to consolidate or pay down accumulated training-period debt before applying for a mortgage.

My RVU bonus dropped 18% last year due to fewer clinic days during my parental leave. Is that a problem?

Documentable income reductions for life events (parental leave, FMLA medical leave, etc.) typically receive favorable treatment under B3-3.1-01. We provide a letter of explanation documenting the parental leave timing and the expected return to historical RVU productivity. The 24-month average smooths the temporary reduction. Underwriters generally accept legitimate documented life events as one-time variances.

When should I elect S-corp instead of staying employed?

For physicians transitioning to private practice, the S-corp election decision involves practice CPA consultation around self-employment tax savings on K-1 distributions and the "reasonable compensation" requirement under IRC Section 1361. We don’t advise on tax election — that’s your practice CPA’s call — but we structure the mortgage around whichever election you’ve made. Most physicians at $500K+ practice income elect S-corp for the SE tax savings.

My practice has ancillary service equity (imaging center, surgery center). How does that K-1 count?

Ancillary service equity K-1s (ambulatory surgery center, imaging center, lab partnership) qualify as continuing partnership distribution income under Fannie Mae B3-3.4-02 with 2-year history per entity. Each entity needs separate 1120-S or 1065 tax returns and K-1s documenting your ownership percentage. We aggregate the practice K-1 plus all ancillary service K-1s for the consolidated qualifying picture.

I do expert witness or medical-legal consulting on the side. Does that count?

Expert witness and medical-legal 1099-NEC income aggregates with other physician self-employment income under B3-3.3-02 with 2-year history. Expert witness work is often higher per-hour ($300–$800/hr) but lower-volume than locum or telehealth. The 2-year average smooths the volume variability.

How is my IRS Section 199A QBI deduction affecting my qualifying?

Medical practice is a Specified Service Trade or Business (SSTB) under IRC Section 199A with phase-out at $191,950-$241,950 for single filers (2024 indexed). Most established physicians sit ABOVE the phase-out where the QBI deduction zeroes out. The deduction’s absence reduces the AGI line that some underwriters use for affordability. We coordinate with your CPA to document the right numbers for qualifying.

My specialty pays a J-1 visa physician less than U.S. citizens at my hospital. Does that affect qualifying?

J-1 visa physician income qualifies the same as any other W-2 income with proper documentation. What matters is the stable employment, the documented compensation level, and the work authorization status. J-1 visa physicians often have additional considerations around the 3-year service commitment in underserved areas and the J-1 waiver pathway, but these affect career planning not directly mortgage qualifying.

Are there mortgage programs specifically for physicians beyond Physician/Doctor Loan?

Physician/Doctor Loan is the primary specialty product. Beyond that, what matters is finding a broker who understands hospital W-2 plus RVU productivity bonus under B3-3.1-01 variable income, multi-agency locum 1099 aggregation under B3-3.3-02, telehealth platform 1099 income, S-corp distributions plus K-1 aggregation for practice partners under B3-3.4-02, federal student loan IDR documentation under B3-6-05, and signed forward-looking contract qualifying for residency-to-attending transitions.

My hospital’s parent system was just acquired by another health system. How does that affect my employment?

Hospital system M&A typically does not affect individual physician employment contracts in the short term — existing contracts continue under the acquiring entity. Long-term implications (compensation restructuring, RVU schedule changes) depend on the specific deal. For mortgage qualifying, we use your current employment contract and trailing W-2 history. If you receive a new employment contract from the acquiring system, we review the new structure for any impact on qualifying.

When should I start the mortgage conversation relative to a home purchase?

Ideally 90–120 days before you intend to make an offer. Physician files often take longer than standard files because of multi-source income aggregation (W-2 + RVU + locum + telehealth), employment contract review for sign-on and loan-repayment treatment, possible S-corp 1120-S review for practice partners, IDR servicer documentation, and signed-contract qualifying for residency-to-attending transitions. For residents finishing training, starting the conversation in February or March gives the right runway for a June or July close.

Why do generalist lenders refuse physician files when there’s clearly significant income?

Three reasons: (1) the $200K-$400K of medical school debt looks alarming until B3-6-05 IDR documentation reduces the DTI impact; (2) the multi-source income pattern (W-2 + RVU + locum + telehealth) feels unfamiliar to generalist lenders defaulting to single-W-2 borrowers; (3) signed-contract pre-start qualifying under Physician/Doctor Loan programs is unfamiliar to lenders without specialty expertise. The income is all there and verifiable — the file just needs a broker who reads physician multi-source income, IDR documentation, and signed-contract qualifying correctly.

10 · Companion guides & calculators

More on physician mortgages, RVU productivity bonus, locum tenens 1099, and IDR-aware DTI.

Other medical paths

Loan-program details

Calculators & tools

11 · Sources & further reading

Sources & further reading.

AMA / AAMC / ABMS & physician industry

IRS & tax guidance

Cornell Law — statutory references

Mortgage program & student loan guidelines

BLS & legislation

12 · What "right door first" looks like

Physician mortgage, structured right.

Internal medicine resident finishing PGY-3 training in late June, signed hospital employment contract effective July 1 for $295K base salary plus $75K sign-on bonus paid at start plus $40K annual loan-repayment-assistance for 4 years plus RVU productivity bonus paying $42 per work-RVU above the 5,500 annual threshold. Federal student loans of $345K from medical school plus residency on PAYE with documented servicer payment of $385/month based on PGY-3 income. Wanted to close on a home in mid-June to coordinate with attending start date and avoid a 3-month rental period between residency end and new position start. The first lender said they needed 6 months of W-2 history at the new attending position before they could qualify, meaning closing wouldn’t be possible until January — 7 months after residency ended. Treated the PAYE payment as 1% of balance ($3,450/month theoretical vs $385 actual), pushing DTI well above acceptable. Refused to count the sign-on or loan-repayment as continuing employer compensation. Offered $385K maximum loan amount if the borrower waited until July. We pulled the signed employment contract showing the base salary, RVU schedule, sign-on bonus terms, and the 4-year loan-repayment-assistance provision, the IDR servicer statement showing the $385 actual PAYE payment, the ABMS board-eligibility documentation, and the state medical licensure verification. Ran the Physician/Doctor Loan with signed-contract qualifying on the forward attending position, counted the actual $385 IDR payment under Fannie Mae B3-6-05, treated the 4-year loan-repayment-assistance as continuing employer compensation, and structured the file for 30-day pre-start close. Approved at $895K with 5% down (no PMI under physician loan structure) for a Coral Springs home. Closed on June 14, two weeks before the official attending start date. The signed contract was real, the IDR payment was documented, the loan-repayment was contracted — the first lender just didn’t know how to read a physician file with forward-looking qualifying.

Pre-start close · Coral Springs, FL

Talk to a physician mortgage specialist

Get a physician mortgage from a lender who reads hospital W-2, RVU productivity bonus, locum 1099 aggregation, telehealth income, S-corp distributions, signed forward contracts, and IDR-aware DTI as one file.

No application. No credit pull. A 20-minute conversation where we look at your hospital employment contract showing base salary plus RVU schedule plus sign-on plus loan-repayment terms, any locum agency or telehealth platform 1099s, any consulting or expert witness 1099 work, your trailing W-2 history if attending or signed forward contract if residency-finishing, your S-corp 1120-S returns and K-1s if private practice partner, any ancillary service equity K-1s (ASC, imaging), your IDR servicer statement showing actual payment, and your ABMS board status and state medical licensure — then we tell you whether Physician/Doctor Loan or Conventional Conforming or Jumbo fits and roughly what the numbers look like. If we’re not the right shop, we’ll tell you that too.

Talk to Our Team Back to the medical professionals hub

Jim Blackburn NMLS #1072866 · Stairway Mortgage