Every lender conversation ends at the same number. It is sitting on your student loan statement, it has six figures in front of the decimal, and the moment anyone sees it the tone of the call changes.
You are working eighty hour weeks. You have a signed offer for what comes after. You are being told to rent for another four years and try again.
Physician loan programs will exclude that student loan payment from your debt-to-income ratio entirely under defined conditions. That exclusion, not the down payment, is usually what actually makes a resident's file work.
The conditions are narrow, they are written down, and they are the first thing to check on your file rather than the last.
The exclusion, as written
Under CMG Financial's MedPro Premier guidelines (NMLS #1820, revised 09/11/2026), student loan payments that are in deferment, in forbearance, or reporting as $0 due to an income-based repayment plan may be excluded from the borrower's debt-to-income ratio if the borrower is currently in residency, or currently in training in a medical clinical fellowship program.
That is the gate. Residency or clinical fellowship. Not "recently finished." Not "starting soon."
For all other student loans that do not meet the exclusion criteria, whether deferred, in forbearance or in active repayment, a monthly payment must be included in your monthly debt obligations. If the credit report shows a monthly payment, that figure may be used. If the credit report shows no payment or shows $0, the guidelines require a payment to be calculated another way.
So the difference between a resident and a first-year attending with the same balance is not marginal. For one, the payment is often invisible to the ratio. For the other, it is fully counted.
Why the programs are built this way
The MedPro Premier guidelines state the reasoning directly. These programs exist for medical professionals with strong long-term income trajectories, limited savings early in career, significant student loan balances, exceptionally low historical default risk, and career stability unmatched by most professions.
That is an underwriting judgment about a population, not a favor. Residents default at very low rates. The program prices that in and lets the forward trajectory carry the file.
Qualifying before you have been paid
The second lever matters as much as the first: qualifying income on these programs may be based on future income from a fully executed contract.
That means a resident finishing training with a signed attending contract can be underwritten on the attending salary, not on the resident stipend. For anyone moving into a Phoenix or Scottsdale practice, that is the whole timeline. The offer letter is not enough. It has to be fully executed.
Practically, plan the sequence: contract executed, then loan application, then offer on a house, with the closing timed against the start date. Programs have rules about how far ahead of a start date they will close, and those rules vary by investor. Ask before you write.
Who is eligible
The designation list is explicit and residents, fellows and interns are included provided they hold one of the qualifying degrees: MD, DO, DDS, DMD, PharmD, DVM, VMD, DPM or CRNA, along with the other designations the guidelines name, including Nurse Practitioners with an MSN or DNP.
There are no profession exceptions or alternatives. The guidelines say so in those words. If your degree is not on the list, you are looking at a different program, and there is a good one for graduate and professional degrees covered separately in this series.
What the leverage looks like
On MedPro Premier, a one-unit primary residence can go to 100% financing to $1,500,000 at a 680 score, or to $2,000,000 at 720. Mortgage insurance is not required regardless of loan-to-value. Above 90.01% loan-to-value, secondary financing is not allowed and escrow accounts are required unless state law prohibits them.
The adjustable alternative, MedPro Advantage (revised 07/16/2025), runs to 95% but tightens elsewhere: 720 minimum score, a 43% maximum debt-to-income, and six months of reserves.
Look at that 43% ceiling in the context of student loans. If your payment is excluded, 43% is comfortable. If it is counted, a resident-sized income against a large payment can blow through it immediately. Same borrower, same balance, completely different outcome depending on which side of the exclusion you sit.
The question nobody asks until it is too late
Your fellowship ends. The deferment ends. The income-based repayment recalculates against attending income. The payment that was excluded is now real and large.
The house still has to work on that day. Before you buy at the top of what the exclusion allows, run the payment you will actually owe in two or three years and see whether the budget survives it. A program that lets you exclude a payment is not telling you the payment disappears.
That is not a reason to avoid the program. It is a reason to buy deliberately inside it, which is a conversation worth having before you are under contract rather than after.
Why bring this file to us
- We check the exclusion before you shop. Whether your student loan payment counts is the difference between approved and declined, and it is answerable in one conversation.
- We plan for the day the exclusion ends. Fellowship finishes, the payment rejoins the ratio, and the house you bought has to still work. We model that with you.
- We coordinate with the contract start date. Qualifying on a signed contract has timing rules, and relocating to a Valley program makes those rules load-bearing.
- Broker model. Multiple investors rather than one bank's shelf, which is what a file like this needs when the first answer is no.
- You talk to the principal. Ricky Khamis is President of EPiQ Lending, NMLS #173141, lending in Arizona since 1999. Direct line: (480) 999-9842.
EPiQ Lending is NMLS #1936984, at 7975 N. Hayden Road, Suite A-101 in Scottsdale. Verify all of it before you trust any of it: Ricky's EPiQ Lending profile, the Scottsdale branch, and the license itself at NMLS Consumer Access. Hold every lender to that standard, including us.
Send me your residency or fellowship verification and your student loan detail, and I will tell you whether the payment comes out of the ratio on your file.
Program figures in this post are from the CMG Financial (NMLS #1820) guideline set named above, as published on the revision date given. They describe one investor's program at one point in time. Other investors price and underwrite the same borrower differently, guidelines change without notice, and nothing here is an offer of any specific program or terms. Confirm current eligibility on your own file before you plan around any of it.
Equal Housing Opportunity. This is general information, not a commitment to lend or an offer to extend credit. Rates, terms, and program guidelines change and depend on credit approval, property appraisal, income and asset verification, and other qualifying factors. Not all applicants will qualify. Non-QM, asset-based and business purpose financing carry different pricing, terms and consumer protections than agency financing. Consult your tax advisor regarding the tax treatment of any income or distribution strategy.
Find out what you qualify for before you start looking
Tell me where you are in training or practice and I will tell you which structure fits your file, what it needs, and what it does not. No credit pull to have the conversation.
