Physician Loan vs Conventional Nevada — When Each Wins
Program figures verified July 2026 — details change; confirm your scenario with us.
The 60-second answer
For Nevada physicians choosing between a physician loan and a conventional mortgage, the decision usually favors physician loan — but with specific scenarios where conventional wins.
Physician loan typically wins when:
- You have limited cash for down payment
- You have substantial student loan debt (IBR/PAYE)
- You're a new attending using future contract income
- You want maximum buying power
- You can stay in home 5+ years
Conventional typically wins when:
- You have 20%+ down available
- Your student loans are minimal or on Standard 10-year
- You're going for absolute lowest advertised number
- You'll refinance within 3-5 years
- Home is above physician loan max ($2M typical)
Most physicians fit the first scenario. Default to physician loan unless specific reason to use conventional.
Side-by-side comparison
| Factor | Physician Loan | Conventional 20% Down | Conventional 5% Down |
|---|---|---|---|
| Min down payment | $0 (up to $1.5M) | 20% | 5% |
| Mortgage insurance | None | None | PMI required |
| Max DTI | Up to 50% | Up to 50% (with comp.) | Up to 43% standard |
| Student loan treatment | IBR/PAYE actual payment | Same | Same |
| Future-attending contract | Acceptable | Generally not | Generally not |
| Max loan amount | $2M typical | $1.21M conforming + jumbo | $1.21M conforming + jumbo |
| Rate | Slightly higher than conventional (file-specific pricing) | Standard | Standard |
| PMI savings | Avoids PMI vs 5% down | No PMI (already 20%) | Has PMI ($150-$400/mo typical) |
| Closing time | 30-45 days | 30-45 days | 30-45 days |
Real cost comparison: $725K Henderson home
Option A: Physician Loan (100% LTV)
- Loan: $725K
- Down: $0
- Rate: market pricing (slight premium over conventional)
- Monthly P&I: $4,640
- Property tax: ~$350/mo
- Insurance: ~$110/mo
- HOA: ~$50/mo
- Total PITI: ~$5,150/mo
- No PMI
- 30-year interest cost: ~$946K
Option B: Conventional 20% Down
- Loan: $580K
- Down: $145K
- Rate: market pricing
- Monthly P&I: $3,569
- Same tax + insurance + HOA: ~$510/mo
- Total PITI: ~$4,080/mo
- No PMI
- 30-year interest cost: ~$701K
- Saved on interest over 30 years: ~$245K
- But: $145K tied up in down payment
Option C: Conventional 5% Down
- Loan: $689K
- Down: $36K
- Rate: market pricing
- Monthly P&I: $4,240
- Same tax + insurance + HOA: ~$510/mo
- PMI: ~$280/mo (at 5% down)
- Total PITI: ~$5,030/mo
- 30-year interest cost: ~$833K
- PMI cost until 80% LTV (~year 6): ~$20K
- Total cost: ~$853K
Comparison summary
| Scenario | Monthly Cost | 30-Year Total | Down Cash | Buying Power |
|---|---|---|---|---|
| Physician 100% LTV | $5,150 | $946K interest | $0 | Highest |
| Conventional 20% | $4,080 | $701K interest | $145K | Lowest cash retention |
| Conventional 5% | $5,030 | $853K + PMI | $36K | Medium |
Decision:
- No 20% down available? Physician loan wins
- Have 20%+ + want lowest interest? Conventional 20% wins
- Have 5-15%? Physician loan usually beats Conventional 5% + PMI
When physician loan wins decisively
Scenario 1: New attending, limited cash, high student loans
- $295K attending salary (year 1)
- $325K student loans on IBR ($315/mo)
- $25K savings
- $675K target home
- Conventional: Can't qualify (DTI from student loans + low down payment)
- Physician loan: 100% LTV; IBR actual payment counts; qualifies cleanly
- Verdict: Physician loan only viable option
Scenario 2: Mid-career attending wanting to preserve liquidity
- $425K income
- $850K target home
- Has $200K savings but wants to invest, not put all into down payment
- Conventional 20% ($170K down): Possible but ties up liquid
- Physician loan 100% LTV: Preserves $200K for investment
- Verdict: Physician loan preserves liquidity for investment
Scenario 3: Resident pre-attending purchase
- PGY-3 with signed attending contract starting July
- $72K resident salary
- $675K target home
- Conventional: Can't qualify on resident income for $675K
- Physician loan: Uses future attending contract income
- Verdict: Physician loan enables otherwise impossible purchase
Scenario 4: VA-eligible physician
- VA loan + physician loan both available
- VA: $0 down, no PMI, no funding fee (disabled)
- Physician loan: $0 down, no PMI, no funding fee
- Verdict: Compare rate + closing costs; often VA wins for eligible vets
When conventional wins
Scenario 1: Established attending with 20%+ down
- 8 years attending, $425K income
- Significant equity from previous home sale
- $1.4M target home
- $300K available for down (21%+)
- Physician loan 100%: Still works, slight rate premium
- Conventional 20% down: Lower rate, no PMI
- Verdict: Conventional 20% wins by ~$25K-$50K over 30 years
Scenario 2: Home above physician loan max
- $2.8M Paradise Valley home target
- Physician loan caps at $2M
- Physician loan: Insufficient for purchase
- Jumbo conventional: Required
- Verdict: Jumbo conventional for the $800K+ above program max
Scenario 3: Short-term hold (under 3 years)
- Resident anticipating fellowship move in 3 years
- $475K starter home
- Physician loan: Rate premium over 3 years = $5K-$8K extra cost
- Conventional 20%: No premium but ties up $95K
- Verdict: Close call; depends on liquidity priorities
Scenario 4: Refinance planning within 3 years
- Resident with attending contract starting next year
- $425K home now
- Plan: Buy with physician loan, refi to conventional 80% LTV in 3 years
- Both work — same eventual outcome
- Verdict: Physician loan for purchase; refi to conventional once attending income established
NV-specific considerations
Las Vegas + Henderson market
- Most physician loan programs apply
- NV conforming limit $832,750 = boundary for jumbo
- Multiple physician loan lenders available
Reno market
- Same products apply
- Northern NV physician community uses physician loan substantially
- Renown + Saint Mary's physicians well-served
Tahoe NV-side
- Most properties exceed $2M physician loan max
- Jumbo physician or standard jumbo required
- Specific Tahoe lender expertise helpful
Pahrump + rural NV
- Physician loan applies (most areas)
- Some properties may need USDA or jumbo combinations
- Specific scenarios vary
Common questions
Should I always go with physician loan if eligible?
For most physicians: yes. Specific scenarios favor conventional (20%+ down, ultra-low rate priority, above program max).
What's the rate premium for physician loans?
Typically file-specific pricingabove conventional. The PMI savings + buying power often outweigh the rate premium.
Can I refinance from physician loan to conventional later?
Yes — common move once you have 20%+ equity. See [Resident-to-Attending Refi page] for details.
What about specific NV physician loan programs?
Multiple programs available — Mike will compare Redwood Sequoia, BoA, BMO, KeyBank, Flagstar for your specific scenario. See Best Physician Loan Lenders NV.
Are physician loans more flexible on credit?
Generally similar to conventional credit requirements (680+ typical, 720+ for best terms). No fundamental flexibility advantage.
Can I use physician loan for second home or investment?
No — physician loan is primary residence only. Investment property requires conventional or DSCR.
What about physician loan for Tahoe NV-side?
Tahoe properties typically exceed $2M physician loan max. Specialty jumbo physician programs available for some scenarios. Standard jumbo for higher-priced Tahoe properties.
What if I qualify for VA + physician loan?
Compare both. VA often wins for disabled vets (no funding fee + no PMI + strong program fit). Physician loan competitive for non-disabled vets.
Can I combine physician loan with HIP / Worker Advantage?
Physician loan typically beats HIP/Worker Advantage benefits for physicians. Specific scenarios where stacking helps; Mike will model.
What about DTI for physicians with rental property income?
Rental income counts as documented. Schedule E rental income + W-2 + 1099 + future-attending contract — all sources count.
Talk to Mike about your physician loan vs conventional decision
Free 30-minute call. Mike will model both paths + compare 2-3 physician loan programs against conventional for your specific scenario.
(480) 296-6513 · Mike Certo, NMLS #260555 · Cornerstone First Mortgage NMLS #173855
Sources
- Redwood Residential Acquisition Corporation — Sequoia Medical Professionals Program Eligibility Guide v1.1
- Fannie Mae Selling Guide
Mike Certo · NMLS #260555 · Cornerstone First Mortgage NMLS #173855 · Equal Housing Lender. Educational content, not a loan commitment. Loans subject to buyer and property qualification.