Physician Loan or Conventional: Which One Is Actually Cheaper on Your File

You saved twenty percent. You did the responsible thing, you waited, and now a lender is telling you about a physician program that would let you put nothing down.

So you ask the obvious question: which one is cheaper?

On the program below, that is not the first question. You are not eligible for it. Under CMG Financial's MedPro Premier guidelines (NMLS #1820, revised 09/11/2026), the program notes state plainly: minimum LTV required is 90.01%.

Read that again, because almost nobody leads with it. This is not a program you can use with a large down payment. It has a floor, and the floor is high. If you are putting twenty percent down you are a conventional borrower, and the entire physician loan conversation is moot on your file.

That single line saves a lot of people a lot of time, and hardly any lender says it out loud.

When the comparison is real

The comparison matters when you are putting down less than ten percent, which is where most physicians early in career actually are.

There, the MedPro Premier eligibility matrix runs a primary residence purchase or rate and term refinance at:

• 95% loan-to-value to $2,000,000 with a 680 score
• 100% loan-to-value to $1,500,000 with a 680 score, one unit only
• 100% loan-to-value to $2,000,000 with a 720 score, one unit only

And the line that sells the program: mortgage insurance is not required regardless of loan-to-value.

What no mortgage insurance is actually worth

On a conventional loan above 80% loan-to-value you pay mortgage insurance. It is a real monthly cost, it buys you nothing, and it exists to protect the lender.

It is also temporary. Under the federal Homeowners Protection Act, borrower-paid mortgage insurance on a primary residence must be cancelled automatically once the balance reaches 78% of the original value on the amortization schedule, and you can request cancellation at 80% if you are current and the servicer's conditions are met. Appreciation can get you there sooner through a new appraisal, subject to the servicer's rules.

So the honest framing is not "no mortgage insurance forever versus mortgage insurance forever." It is: how many months of mortgage insurance would you actually pay, and what does the physician program charge you in rate to avoid them.

Niche programs are not free. They are manually underwritten, they carry no agency guarantee, and they are priced accordingly. Sometimes the rate difference is smaller than the mortgage insurance. Sometimes it is not. The only way to know is to price your file both ways on the same day, because the answer moves with the market and with your score.

The constraints that come with the higher leverage

These apply at the top of the matrix and they change the shape of the deal:

• At 90.01% loan-to-value and above, secondary financing is not allowed. No piggyback second to bridge anything.
• Escrow and impound accounts are required above 90.01% unless state law prohibits them. If you were planning to pay taxes and insurance yourself, plan differently.
• AUS findings are not eligible. A full manual underwrite is required. No automated approval, so a human reads your whole file. That is slower and it is less forgiving of anything odd.
• Debt-to-income is capped at 50% at 95% loan-to-value or below, and 45% above 95%, as well as 45% on ARMs and 15-year fixed loans.

That last pair deserves attention. Going from 95% to 100% financing costs you five points of debt-to-income headroom. For a physician carrying student loans that are being counted, five points of ratio is often worth more than five percent of down payment.

Reserves move with leverage too

Under the same guidelines, minimum reserves are:

• At 95% loan-to-value or below: zero months from $100,000 to $1,500,000, and three months from $1,500,001 to $2,000,000.
• Above 95% loan-to-value: three months from $100,000 to $1,500,000, and six months from $1,500,001 to $2,000,000.

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

The comparison nobody runs for you

Ask for this, in writing, before you choose:

1. Rate and payment on the physician structure at your actual score and leverage.
2. Rate, payment and mortgage insurance on conventional at the same leverage.
3. The month the mortgage insurance would cancel on the conventional loan, on the amortization schedule and at 78%.
4. Total cost of each over three, five and seven years. Not thirty.
5. Whether you are even above the 90.01% floor.

If a lender will not produce that grid, you are being sold the product they would rather write.

The case for each

Take the physician structure when you have little or nothing to put down, your forward income is contracted, and preserving cash matters more than the rate. Keeping six months of living expenses liquid in your first attending year is worth real money that does not show up in a payment comparison.

Take conventional when you have ten percent or more, clean documentable income, and a strong score. You will frequently pay less, and you keep the option to recast or refinance without leaving a niche product.

Neither answer is universal. Anyone who gives you one without seeing your file is guessing.

Common questions

Can I use a physician loan with 20% down? Not on this program. The MedPro Premier program notes set a minimum loan-to-value of 90.01%, so a borrower putting twenty percent down falls below the floor and is not eligible. Other investors structure their physician programs differently, so confirm on your own file, but do not assume a large down payment and a physician program go together.

Is a physician loan always cheaper than conventional? No. Avoiding mortgage insurance is worth real money, and niche programs price for the risk they carry. Which one wins depends on your score, your leverage, the market on the day you lock, and how long you actually hold the loan.

Does the physician loan have mortgage insurance? Not on this program. The guidelines state mortgage insurance is not required regardless of loan-to-value.

Can I put a second mortgage behind a physician loan? Not at high leverage. Secondary financing is not allowed on transactions at 90.01% loan-to-value and above.

Will an automated approval speed this up? There is no automated approval available. The guidelines state AUS findings are not eligible and a full manual underwrite is required, so build a longer timeline into your contract.

Related reading

• Physician and medical professional home loans, the full index for this topic
• Physician Home Loans in Scottsdale: How Doctors Buy With No Down Payment and No Mortgage Insurance
• Physician Loan Down Payment: What 0%, 5% and 10% Actually Cost You
• Physician Loan Reserves: The Requirement That Quietly Decides Your Price Range

Why bring this file to us

• We price both and show you the math. Not a recommendation with the losing option left out of the email.
• We check eligibility before we compare. The minimum loan-to-value rule below disqualifies more physicians than any credit issue does, and it is knowable in one question.
• We use your real hold period. Thirty year totals are a sales tool. You are not keeping this loan thirty years and both of us know it.
• 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 score, your down payment and how long you actually plan to hold the house, and I will price both and show you the crossover month.

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.