Physician Loan Down Payment: What 0%, 5% and 10% Actually Cost You

Everyone leads with the same line. Zero down, no mortgage insurance, doctors only.

It is true, it is genuinely valuable, and taking it without running the alternative is how physicians end up qualified for less house than they could have bought.

Here is what each tier actually does to your file, from CMG Financial's MedPro Premier guidelines (NMLS #1820, revised 09/11/2026).

The three tiers

100% financing. To $1,500,000 at a 680 score, or to $2,000,000 at a 720. One unit, primary residence only, purchase or rate and term refinance.

95% financing. To $2,000,000 at a 680 score.

Below 90% financing. Not available. The program notes state that minimum loan-to-value required is 90.01%.

That third line is the one nobody says out loud. If you have twenty percent saved, this program is closed to you. Not disfavored, not more expensive. Closed. You are a conventional borrower and you should be priced as one, and a lender who runs your credit before telling you that is wasting your inquiry.

What each five percent actually buys

Debt-to-income ceiling. This is the big one.

• 50% at 95% loan-to-value or below
• 45% above 95% loan-to-value
• 45% on ARMs and 15-year fixed rate loans regardless of leverage

So five percent down does not just reduce your loan. It raises your allowable ratio by five points.

For a physician carrying student loan payments that are being counted, which is every attending who is no longer in training, five points of debt-to-income is usually worth far more purchasing power than five percent of equity costs. The borrower who puts nothing down often qualifies for less house than the borrower who puts five percent down, and that is completely counterintuitive until you see the ceiling.

Reserves. The requirement roughly halves:

• 95% or below: zero months from $100,000 to $1,500,000, three months from $1,500,001 to $2,000,000
• Above 95%: three months from $100,000 to $1,500,000, six months from $1,500,001 to $2,000,000

Note the top left cell. At 95% leverage under $1,500,000, the minimum reserve requirement is zero months. Cross into 100% financing and it becomes three. That is real cash you now have to document and leave sitting there, which partially undoes the point of putting nothing down.

Structural freedom. Above 90.01% loan-to-value, secondary financing is not allowed and escrow and impound accounts are required unless prohibited by state law. Those constraints apply across all three tiers here, since the whole program lives above 90.01%.

The reserve requirement people get caught by

If you are qualifying on projected income from a contract that has not started, there is an additional requirement on top of the minimums above.

You must document reserves covering the monthly principal, interest, taxes, insurance and assessments for every month between the note date and your employment start date. Partial months round up. The guidelines give the example directly: a note date of 7/1/2026 with a start date of 9/15/2026 requires three months of housing payment in reserves, on top of the program minimum.

So a physician closing in July for a September start at 100% leverage is documenting three months of minimum reserves plus three months of gap reserves. Six months of housing payment, liquid, at the moment you are also paying moving costs and furnishing an empty house.

That is a planning problem, not an underwriting problem, and it is solvable if you see it in May instead of in June.

Where the money can come from

Gift funds are eligible. Under these guidelines, gifts from eligible donors may be used to meet 100% of down payment, closing costs and prepaids, and reserve requirements, with no minimum contribution required from your own funds. Gift funds are eligible for reserves specifically.

Two limits: gift funds may not be used to pay off debt, and gifts from relatives who are interested parties to the transaction are not allowed unless it is a gift of equity.

That first limit is worth internalizing. If your ratio is tight, family money cannot fix it by retiring a car loan. It can only fix the cash side.

How to choose

Work it in this order, not in order of what sounds best.

1. Calculate your ratio with every debt counted, including the student loan payment if you are past training.
2. If it lands between 45% and 50%, you need the 95% tier. The decision is made. Find the five percent.
3. If it lands comfortably under 45%, then compare: 100% financing preserves cash, 95% cuts your reserve requirement and your loan size. Pick based on what your first attending year actually looks like.
4. If you have twenty percent, stop. You are below the program floor. Price conventional.
5. If you are closing before a start date, add the gap months to whatever reserve number you just calculated.

The physicians who get this wrong are not the ones who cannot afford a down payment. They are the ones who assumed less down was always better and never saw the ceiling move.

Common questions

Is zero down always the best option on a physician loan? No. Moving from 100% to 95% financing raises the debt-to-income ceiling from 45% to 50% and lowers the minimum reserve requirement. For a physician whose student loan payment is counted, that trade frequently qualifies you for more house.

What is the minimum down payment on a physician loan? On this program the question is inverted. Minimum loan-to-value is 90.01%, which means there is a maximum down payment of just under ten percent. Put more down and you are not eligible.

How many months of reserves do I need? Zero at 95% loan-to-value or below up to $1,500,000, three months above 95% up to $1,500,000, and three or six months respectively between $1,500,001 and $2,000,000. Projected income adds a month of housing payment for every month between closing and your start date.

Can my parents gift the down payment? Yes. Gifts from eligible donors may cover 100% of down payment, closing costs and reserves with no minimum contribution from your own funds. Gift funds cannot be used to pay off debt.

Can I use a second mortgage to avoid going to 100%? No. Secondary financing is not allowed at 90.01% loan-to-value and above, which is the entire program.

Related reading

• Physician and medical professional home loans, the full index for this topic
• Physician Loan or Conventional: Which One Is Actually Cheaper on Your File
• Physician Loan Reserves: The Requirement That Quietly Decides Your Price Range
• Buying Before Your Start Date: The Contract and Reserve Rules for Physicians

Why bring this file to us

• We solve for the binding constraint. For most physicians that is the ratio, not the cash, and the two move in opposite directions across these tiers.
• We count the reserve requirement before you write the offer, including the extra months a pre-start-date closing adds.
• We tell you when you have too much money for the program, which is a real and frequently missed outcome.
• 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 and a Certified Mortgage Planner, NMLS #173141, originating mortgages 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.

Tell me what you have liquid and what your student loan payment is, and I will show you which of the three tiers actually qualifies you for the most house.

Program figures in this post come from the CMG Financial (NMLS #1820) guideline set named above, as published on the revision date given. CMG Financial is the parent company of EPiQ Lending. These figures 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.