Nobody loses a house because the numbers did not work. The numbers were checked in week one.
They lose it in week five, on something nobody mentioned in week one.
Here is what actually goes wrong on physician files, with the rule behind each, from CMG Financial's MedPro Premier guidelines (NMLS #1820, revised 09/11/2026) unless noted.
1. Having too large a down payment
The program notes state that minimum loan-to-value required is 90.01%.
A physician who saved twenty percent is below the floor and not eligible. This is not a small print curiosity, it is the first eligibility question, and running credit before asking it wastes an inquiry and two weeks.
If you have real money down, you are a conventional borrower. That is frequently the better loan anyway.
2. An offer letter that is not a contract
The document must be signed by all parties and must specifically state your position or title, your start date, salary and compensation details, and compensation covering at least a 12 month period. The start date must be no more than 150 days after the note date, or within 60 days of closing if you are a 1099 contractor.
A friendly welcome letter is not a qualifying document. Get the real one before you apply.
3. A contingency the program does not allow
The contract or offer letter may only include contingencies related to your receipt of your medical license, or normal administrative requirements such as background checks, drug testing and fingerprinting.
That is the entire permitted list. Contingent on credentialing at a particular hospital, on a productivity threshold, on board certification by a date, on completing a fellowship: all problems. Read your contract with this in mind while you can still negotiate it.
4. Buying furniture during escrow
This one ends more physician files than any other item here.
If the credit report shows inquiries within the most recent 90 days, you must explain each one, and if you obtained credit, verification of that debt must be provided and you must be qualified with the monthly payment. Confirmation can be required via a new, pre-close or gap credit report.
You are moving to a new city with an empty house and a new commute. The instinct to finance a sofa and a car is overwhelming and it is exactly the wrong instinct. Open nothing from application through closing.
5. Forgetting the condo you kept
You may own four financed one-to-four unit residential properties including the subject, and each additional financed property requires three months of reserves.
The residency condo you rented out instead of selling is a financed property. It costs you three months of reserves on the new file, and physicians forget it constantly because it feels like a background detail rather than a loan.
6. Underestimating reserves when closing early
On projected income you must document reserves covering the full housing payment for each month between the note date and your employment start date, rounded up for partial months, in excess of the minimum requirement.
The guidelines give the example: note date 7/1/2026, start date 9/15/2026, three months required. Stack that on a three month minimum above 95% leverage and you are documenting six months of housing payment at the exact moment you are paying for a move.
7. A frozen bureau nobody checked
Credit reports with bureaus identified as frozen must be unfrozen, and a current report with all bureaus unfrozen is required.
Half of everyone froze their credit after a breach notification and forgot. It is a five minute fix that costs a week if you find it in underwriting.
8. Assuming the student loan payment disappears
Payments in deferment, in forbearance or reporting $0 under an income-based repayment plan may be excluded only if the borrower is currently in residency, or currently in training in a medical clinical fellowship program.
For all other student loans that do not meet the criteria, a monthly payment must be included. If the credit report shows no payment or shows $0, a payment must be calculated another way.
First-year attendings routinely budget as though the exclusion follows them out of training. It does not, and the ratio ceiling of 50% at 95% loan-to-value or below, 45% above that, is where the file fails.
9. Expecting an automated approval to save the timeline
AUS findings are not eligible. A full manual underwrite is required.
There is no automated decision on this program. A human reads the entire file, which is slower and much less forgiving of anything unexplained. Write contract timelines accordingly and get your documentation in early rather than in pieces.
The one that is not your fault
Sometimes the property fails rather than the borrower. On ARM and 15-year fixed rate loans there is a maximum of 10 acres and a 45% debt-to-income cap. Condominium projects carry their own review, and the alternative MedPro Advantage program (revised 07/16/2025) lists Florida condominiums as outright ineligible.
Ask what the property rules are before you write, not after the appraisal.
The five minute audit
- Am I above 90.01% loan-to-value?
- Is my contract signed by all parties with title, start date, compensation and a 12 month term?
- Are the only contingencies license and administrative?
- Have I opened any credit in the last 90 days?
- Have I counted every financed property I own?
- Have I counted gap reserves from a realistic closing date?
- Are all three bureaus unfrozen?
- Am I actually in training, or is my student loan payment going in the ratio?
Eight questions. All answerable today. Every one of them is cheaper now than in week five.
Common questions
What is the most common reason a physician loan falls apart? Opening new credit during escrow. Inquiries in the most recent 90 days must be explained, and any credit obtained must be verified and added to your debt-to-income ratio at the worst possible moment.
Can I be denied for putting too much money down? On this program, yes. Minimum loan-to-value is 90.01%, so a large down payment puts you below the floor and outside the program.
Does an income-based repayment plan showing $0 count as $0? Only while you are in residency or clinical fellowship training. Otherwise a payment must be included, calculated another way if the credit report shows none.
Will a frozen credit bureau stop my loan? It will stop it until you fix it. All bureaus must be unfrozen and a current report pulled with all three open.
How long does a physician loan take? Longer than an agency loan, because AUS findings are not eligible and a full manual underwrite is required. Build that into your contract dates.
Related reading
- Physician and medical professional home loans, the full index for this topic
- Buying Before Your Start Date: The Contract and Reserve Rules for Physicians
- Physician Loan Credit Scores: What 680, 700 and 720 Each Unlock
- Physician Home Loan FAQ: Straight Answers to the Thirty Questions Doctors Actually Ask
Why bring this file to us
- We run this list at application, not at closing. Every item on it is cheaper to fix in week one.
- We read your employment contract against the rules before you sign it, which is the difference between a comment and a decline.
- We tell you what not to do during escrow, in writing, because number four ends more files than anything else here.
- 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.
Send me your contract, your credit and your last two bank statements and I will tell you which of these nine your file is currently exposed to.
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.
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.
