Buying your first house as a physician is the same process everyone else goes through, with three parts that work differently for you. Your income arrives late and then jumps. Your debt is enormous but structured oddly. And there is a loan product built specifically for that shape.
Here is the whole sequence, in order, with the physician-specific parts flagged.
Step 1: Answer the Timeline Question First
Before budgets, before lenders, before houses. How long do you honestly expect to be in this city?
Buying and selling both cost money. Under roughly three years, those costs usually swamp any equity you build, and renting comes out ahead. Over five, buying usually wins. In between it depends on your market.
If you are a resident who may move for fellowship, work through the break even test before you do anything else on this list. It is the only step that can save you the entire cost of the mistake.
Step 2: Find Out What Your Student Loans Will Be Counted At
This is the physician-specific step, and it belongs here, near the beginning, not after you have made an offer.
If your credit report shows a $0 payment, a conventional loan may count 1% or 0.5% of your entire balance as a monthly obligation. On $250,000 that is $2,500 or $1,250 a month against your ratio. A physician loan will usually use your real payment instead.
Two things to do now. Get a statement from your servicer showing your actual monthly payment in writing. And read our guide to how lenders count student loans so you know what each program would do with yours.
Step 3: Set Your Own Budget
Lenders will tell you a maximum. That number is a ceiling, not a recommendation, and physician programs produce higher ceilings than most.
Work out what payment you are comfortable with alongside retirement contributions, childcare, and the loan payments that resume when your deferment ends. Then treat that as your number regardless of what you get approved for. More in approved versus comfortable.
Remember the payment is not just principal and interest. Property taxes and homeowners insurance can add a third or more, and they are wildly local.
Step 4: Get Pre-Approved, Not Pre-Qualified
These are different and the difference matters when you make an offer.
A pre-qualification is an estimate based on what you told someone. A pre-approval means a lender has looked at documents and run your credit. Sellers take the second one seriously and frequently ignore the first.
Some physician programs run pre-approval on a soft credit pull, which does not affect your score. Worth asking, particularly if you are early in your search.
Step 5: Understand What You Need in Cash
Even at zero down there are closing costs, and on a mid-priced home they typically run somewhere between eight and twenty thousand dollars. The big variables are your state’s transfer taxes and how many months of property tax escrow the lender collects.
Full breakdown, plus three ways to bring less cash, in closing costs and cash to close.
Step 6: Find an Agent Who Has Done This Before
Not a physician specialist necessarily, but someone who has closed loans with contract-based income and unusual timelines. An agent who has never seen a buyer close before their job starts will not know to build the timeline around it.
Ask directly: have you worked with a buyer using a physician loan? The answer tells you a lot.
Step 7: Make the Offer
Your pre-approval letter goes with it. Keep your inspection contingency; waiving it is a genuinely bad trade for a first-time buyer no matter how competitive the market feels.
If cash is tight, ask for seller concessions toward closing costs rather than a lower price. Programs commonly allow up to 6% on a primary residence, and it addresses your actual constraint.
Step 8: The Middle Part, Where Nothing Appears to Happen
Between offer and closing runs roughly 30 to 45 days of appraisal, title work, underwriting and document requests. It feels slow and then suddenly urgent.
Three rules for this stretch. Do not open any new credit, not even store financing for furniture. Do not move money between accounts without a clear paper trail. And answer document requests the same day, because the review starts over in the queue every time you go quiet.
Step 9: Closing
You will get a Closing Disclosure at least three business days before, by law. Compare it against your Loan Estimate. Lender fees should not have moved much; if they have, ask why before you sign anything.
Then you sign a lot of paper and get keys.
The Part Nobody Tells First-Time Buyers
Budget for the first six months, not just the purchase. Something will need fixing, you will own a lawn or a driveway you did not previously own, and furniture for more rooms costs more than you think.
A reasonable habit is to set aside roughly 1% of the home’s value a year for maintenance. Some years you spend nothing. The year the water heater goes, you are glad it is there.
Where to Start
Answer the timeline question. Get your student loan payment documented. Then find out which lenders count it the way you need.
Tell us your degree, your training stage, your state and your numbers, and we will match you with the lender whose rules fit. It takes about two minutes and costs you nothing.
Last verified September 10, 2026. Timelines and concession limits are typical rather than guaranteed and vary by lender and by state.