You bought with nothing down. The signing bonus landed, or the first real year of production did, and now you have a pile of cash and a large loan and an instinct to do something about it.
Before you call anyone about refinancing, understand two things about the loan you already have.
Physician programs do not do cash-out
Under CMG Financial's MedPro Premier guidelines (NMLS #1820, revised 09/11/2026), the eligibility matrix runs purchase and rate and term refinance on a primary residence. That is the transaction list.
There is no cash-out physician loan here. If you want to pull equity, you are leaving this program for a different one, and you should price that as a completely separate decision rather than a continuation of the one you made when you bought.
There is a related restriction worth knowing even on the purchase side: cash-out proceeds from the subject transaction may not be used to satisfy judgments, tax liens, charge-offs or past-due accounts, and payment plans on prior year tax liens or liabilities are not allowed and must be paid in full.
The listing rule that stops refinances cold
Two lines, and they catch people every year:
- Properties currently listed for sale at the time of application are not eligible for refinance transactions.
- Properties listed for sale within six months of the application date are not acceptable for refinance transactions.
So if you put the house on the market in the spring, pulled it off in June, and want to refinance in September, you are inside the window. The listing has to be six months behind you.
This matters more to physicians than to most borrowers, because the two-year relocation is common and houses go on and off the market during a job search. Check the listing history before you start the process, not after the appraisal.
The recast almost nobody mentions
Here is the option that actually fits the signing bonus situation, and it is not a refinance.
A recast keeps your existing loan, rate and term, applies a lump sum to principal, and re-amortizes the remaining balance over the remaining term. Your payment drops. Your rate does not change. There is no new loan.
The recast policy on this program:
- The loan must be current, with no record of 30-day delinquency
- ARM products are not eligible for recast until after the first reset, subject to the note provisions
- No limit on the number of recast requests
- No waiting period for recast requests
- A recast will take around 60 days to finalize
- There is no guarantee a recast will be approved
Read the third and fourth points again. No limit and no waiting period. A physician with lumpy income, a bonus each January and a production distribution each summer, can apply cash to principal repeatedly and have the payment re-amortize each time, without paying closing costs over and over.
Compare that to a refinance: new appraisal, new title, new closing costs, new full manual underwrite, and a new rate that may be worse than the one you have.
If your goal is a lower payment and you have cash rather than a rate problem, the recast is usually the better instrument and almost nobody offers it to you, because nobody is paid to.
When a refinance actually makes sense
Rates moved meaningfully in your favor. The plain case. Run the breakeven on closing costs against your realistic hold period, not against thirty years. Physicians move. Use the number you actually believe.
You want out of an adjustable structure. If you took the adjustable program to reach 95% leverage and you are now planning to stay, converting to fixed before the reset is a real reason. Note the ARM qualifying rule on these programs: a 5/6 ARM qualifies at the greater of the fully indexed rate or the note rate plus 2%.
Your credit tier moved. If you bought at 680 and you are now at 720, or your ratio improved because a student loan resolved, a rate and term refinance can capture that.
You need to remove someone from the loan. Divorce, a co-borrower buyout, a partner leaving the file. That is structural and a refinance is the mechanism.
When to leave it alone
In the first year or two after a zero down purchase, the usual honest answer is: do nothing.
You have little equity. Closing costs would be rolled in or paid from cash you should be keeping liquid. Your income is still stabilizing. And the mortgage insurance argument that drives most refinance conversations does not apply, because mortgage insurance is not required on this program regardless of loan-to-value. You have nothing to cancel.
The physicians who do best in years one and two are the ones who build reserves, let the file season, and keep the recast in their pocket for the first real bonus.
Ask these four questions
- Is a recast available on my loan, and what would the payment be after applying my cash?
- Has this property been listed for sale in the last six months?
- What is my breakeven on a refinance over three and five years, not thirty?
- Is the reason I want a refinance actually a cash-out, and if so, what does that cost outside this program?
Common questions
Can I take cash out on a physician loan? Not on this program. The eligibility matrix covers purchase and rate and term refinance only. A cash-out would mean moving to a different program entirely.
What is a recast and can I do one? A recast applies a lump sum to principal and re-amortizes the remaining balance over the remaining term, keeping your existing rate and loan. The loan must be current with no 30-day delinquency, ARMs are not eligible until after the first reset, there is no limit on requests and no waiting period, and it takes roughly 60 days. Approval is not guaranteed.
Why was I told I cannot refinance? A common reason is the listing rule. A property currently listed for sale is not eligible, and a property listed within six months of the application date is not acceptable for a refinance.
Should I refinance out of my physician loan to drop mortgage insurance? There is no mortgage insurance to drop. The program does not require it at any loan-to-value, which removes the most common reason borrowers refinance early.
How soon after buying should I refinance? Usually not soon. With little equity and stabilizing income, most physicians are better served building reserves and using a recast when a bonus lands.
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
- The Second-Year Attending: What Changes When Your Contract Income Becomes History
- Physician Loan Reserves: The Requirement That Quietly Decides Your Price Range
Why bring this file to us
- We price the recast against the refinance. One of them costs a servicing fee and the other costs a full set of closing costs, and physicians are rarely shown the first one.
- We check the listing history before we start. A property listed in the last six months is not eligible for a refinance here, and finding that out at week three is avoidable.
- We tell you to leave it alone when that is the answer, which is most of the time in the first two years.
- 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.
Before you refinance, ask me about a recast. On the right file it does most of what you want for a fraction of the cost.
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.
