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New Attending Physician Home Buying Guide — The Complete Playbook

A PGY-5 resident earning $78,000 becomes an orthopaedic surgeon attending earning $650,000. That income jump happens on day one of the new contract — but a conventional lender will not count it until they see a paystub. A physician loan program counts it the day the contract is signed. For specialties with the largest income jumps (surgery, radiology, anesthesiology, cardiology), the offer letter mechanic is especially powerful because the pre-signing income tells only a fraction of the story.

The Attending Income Jump: Why Timing Matters

A PGY-5 resident earning $78,000 becomes an orthopaedic surgeon attending earning $650,000. That income jump happens on day one of the new contract — but a conventional lender will not count it until they see a paystub. A physician loan program counts it the day the contract is signed. For specialties with the largest income jumps (surgery, radiology, anesthesiology, cardiology), the offer letter mechanic is especially powerful because the pre-signing income tells only a fraction of the story.

Offer Letter Mechanic: What the Contract Must Show

For a physician loan to close on an offer letter, the contract typically must show: (1) your name and degree designation; (2) the employer name and practice type; (3) your start date (within 60–90 days of closing); (4) your base compensation amount (annual or monthly); (5) employment type (employee vs independent contractor — 1099 attending income is treated differently); (6) employment duration (permanent, not a short-term locum contract). Some lenders also want evidence of your medical licence in the practice state. The Own Luxury Homes® Physician Mortgage Assessment™ verifies which offer letter elements specific lenders require before the contract is submitted.

The Offer Letter Window

Most physician loan lenders allow a new attending physician to close on a home up to 60–90 days before their employment start date, using a signed offer letter as income documentation. This creates a specific purchase window: the physician finishes residency in June, receives a July 1st start date, and can close on their new attending home in April or May — before the first paycheck is received — by presenting the signed employment agreement. The offer letter must specify base salary (not only variable/productivity compensation), confirm the employment type (hospital or group employed, not locum), and include the start date. During this window, the physician is still earning residency income — but the physician loan qualification is based on the attending salary in the offer letter. This is one of the most valuable timing advantages of the physician mortgage product and one of the least understood by first-time attending home buyers.

The Attending Income Jump and Why Timing Matters

A PGY-5 resident earning $78,000 becomes an orthopedic surgeon attending earning $650,000 on signing day. The income jump is real and immediate in economic terms — but a conventional lender won’t count it until they have 30 days of paystubs. A physician loan program counts it from the moment the contract is signed. For specialties with the largest income jumps — cardiac surgery ($600K–$1.5M), neurosurgery ($600K–$1.2M), orthopedics ($500K–$900K), anesthesiology ($400K–$700K) — the offer letter mechanic is especially valuable. The new attending can qualify for a $1M–$1.5M purchase on the attending salary from day one of the contract, rather than waiting months for documented paystubs.

First Attending Year: The Financial Priority Order

New attendings face multiple competing financial priorities simultaneously: student loan payments resuming (or continuing on IBR for PSLF), retirement account contributions (401K, backdoor Roth), malpractice tail insurance if leaving an employed position, emergency reserves, and the home purchase. The recommended priority order for first-year attendings: (1) Emergency reserves (3–6 months of attending expenses = $30K–$120K); (2) Employer 401K to match maximum; (3) Home purchase using physician loan offer letter mechanic; (4) Additional retirement contributions (backdoor Roth, 457b if available); (5) Student loan paydown or PSLF continuation. Many attendings try to do all five simultaneously in year one and find their cash flow stretched. The physician loan’s 0% down option reduces the cash required for the home purchase, freeing more for the other priorities.

Related Medical Professional Real Estate Guides

• Physician Mortgage During Residency
• New Attending Physician Home Buying
• Physician Jumbo Mortgage Guide
• Self-Employed Physician Mortgage
• Locum Tenens Mortgage Guide

FAQ

Can I get a physician mortgage before my first day as an attending?

Yes. Physician loan programs accept a signed employment contract or offer letter as employment verification, allowing closing before the first paycheck arrives. The contract must show your start date and compensation. Most programs require the start date to be within 60–90 days of the closing date. This mechanic — unique to physician loan programs — allows the new attending to close on a home during the transition period between training and the first day of work.

What is the maximum purchase price for a new attending on a physician loan?

Most physician loan programs cap at $1.5M–$2M for 0% down. A few programs extend to $2.5M with 5–10% down. For new attendings in high-income specialties (orthopaedic surgery, cardiac surgery, neurosurgery) targeting homes above $2M, either a larger down payment on a physician program or a transition to conventional jumbo or private bank lending is required. The physician loan is the right product for the first attending purchase in the $500K–$1.5M range; above that, the OLH Physician Mortgage Matrix™ identifies the correct alternative.

Should I pay off student loans or buy a house first?

This is the single most financially consequential decision for new attendings. The answer depends on your loan interest rates and repayment strategy. If you are pursuing PSLF (working at a non-profit institution), continuing low IBR payments and pursuing forgiveness is almost always the correct strategy — do not pay down federal loans aggressively if you are PSLF-eligible. If you are not PSLF-eligible, the comparison is between your student loan interest rate (typically 6–8% federal) and your mortgage rate (also 6–8% currently) — mathematically similar, so the choice is about cash flow preference rather than a clear mathematical winner. Buying the home first while maintaining IBR payments on student loans preserves the most optionality.

How long should I wait after starting my attending job before buying?

With a physician loan and an offer letter, you do not need to wait at all — you can close before your first day. If using a conventional lender, you typically need 30 days of paystubs before closing. If purchasing above physician loan limits with a jumbo or private bank product, you generally need 1–2 months of paystubs. The practical answer: most new attendings purchase within the first 3–6 months of attending life, using either the offer letter mechanic (physician loan) or shortly after receiving their first paychecks (conventional or jumbo).

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