Physician loans · Student loans

How Student Loans Count When a Doctor Qualifies for a Mortgage in 2026

For many new doctors, student loans shape a mortgage approval as much as salary does. The same $200,000 balance can count as $2,000 a month, $1,000, a few hundred or nothing, depending on the loan type and repayment plan.

This page goes deeper on the guide's student loan section: each loan type's published rule, how physician programs differ, the federal plans that started July 1, 2026, and a worked example.

At a glance

  • ConventionalFannie Mae counts a deferred loan at 1% of the balance or an amortizing payment; Freddie Mac uses 0.5% when the reported payment is $0.
  • FHA and VAFHA also uses 0.5%. VA skips loans deferred at least 12 months past closing.
  • Physician programsSeveral leave out loans deferred at least 12 months after closing.
  • New federal plansLoans first disbursed on or after July 1, 2026 repay under the Repayment Assistance Plan (RAP) or the Tiered Standard Plan.
  • Why it mattersA lower counted payment leaves more of the debt-to-income limit for the house.

By Brian Huie, Principal Broker and Realtor, Compass · Figures as of November 2026

How each loan type counts student loans

Lenders count student loans in the debt-to-income ratio (DTI): monthly debts divided by gross monthly income. For a loan in repayment, they generally use the payment on the credit report or servicer statement. The rules below matter when the payment shows $0: deferred, in forbearance or on a $0 income-driven plan.

Published rules when the reported payment is $0, as of November 2026
Loan typeDeferred or in forbearance$0 income-driven paymentRule as of
Conventional, Fannie Mae1% of the balance, or a fully amortizing payment from the documented terms$0 may be used if documentation shows the actual payment is $0Selling Guide B3-6-05, August 5, 2026
Conventional, Freddie Mac0.5% of the balance when the credit report shows $00.5% of the balance, unless documents support a current payment above $0Effective September 28, 2025
FHA0.5% of the balance when the credit report shows $00.5% of the balanceHUD Handbook 4000.1, revised August 12, 2026
VANo payment counted if written evidence shows deferral at least 12 months past closingGreater of the reported payment or 5% of the balance ÷ 12, unless a recent servicer statement shows lessVA guidance as presented by VA in 2023

On $200,000 of deferred loans, the 1% rule counts $2,000 a month and the 0.5% rule $1,000. Under VA's 12-month rule, the same loans can count as nothing.

Rules as published; lenders can add stricter ones. Confirm with the lender.

How physician programs treat them

A physician loan is a lender's own program, so it sets its own student loan rule. Published programs are often gentler in two ways.

  • Loans deferred 12 or more months can be left out. Truist's doctor loan page says student loan debt may be excluded from DTI if it will be deferred for at least 12 months after closing. First Merchants Bank publishes the same test for deferment or forbearance. Fairway Independent Mortgage (article updated March 3, 2026) measures the 12 months from application.
  • Income-driven payments can be used. Truist says reduced payments in an eligible income-driven plan may be acceptable, with documentation.

Bank of America's flyer says student loan debt may be excluded with additional documentation, without stating the test. The Huntington and BMO pages don't publish a rule.

The exclusion fits a narrow window: loans that stay deferred well past closing, as for some graduating students and residents. An attending in repayment is counted at the actual payment. Eligibility by credential and career stage is in who qualifies.

Terms as published by each lender; not an offer of credit or a recommendation. Not every program lends in Washington. Confirm with the lender.

The federal plans that started July 1, 2026

Per Federal Student Aid's repayment form, a borrower with any loan disbursed on or after July 1, 2026 repays all Direct Loans, older ones included, under the Repayment Assistance Plan or the Tiered Standard Plan. Borrowers in PAYE or ICR must leave those plans by July 1, 2028.

Repayment Assistance Plan (RAP)

  • The payment is a share of adjusted gross income (AGI) divided by 12: 1% of AGI from $10,000 to $20,000, up one point per $10,000, to 10% above $100,000.
  • It drops $50 a month per dependent, with a $10 minimum.
  • If an on-time payment cuts principal by less than $50, the Department adds up to $50.
  • Any balance left after 30 years of qualifying payments is forgiven.

Tiered Standard Plan

A fixed payment over 10 to 25 years, set by the Direct Loan balance on entering the plan. As published by Massachusetts: under $25,000, 10 years; $25,000 to $49,999, 15; $50,000 to $99,999, 20; $100,000 or more, 25.

The plan sets the payment the lender sees. RAP follows income, so it can be low in residency and rise with an attending salary. The Tiered Standard payment is fixed.

PSLF and why a lower payment helps

Public Service Loan Forgiveness forgives the remaining Direct Loan balance after 120 qualifying payments made while working full time (30 or more hours a week on average) for a government employer or 501(c)(3) nonprofit. Income-driven plans qualify. Edfinancial, a federal servicer, says RAP borrowers pursuing PSLF may be eligible after 10 years.

Doctors pursuing PSLF often keep the lowest qualifying payment, since any balance left at 120 payments is forgiven. That low payment also helps with a mortgage: lenders count the documented payment, so a lower one leaves more of the DTI limit for the house.

  • Income is recertified yearly, so a payment based on residency pay rises after training. Lenders qualify on today's payment; the budget should plan for the higher one.
  • Employer and plan decide eligibility. Confirm both with the servicer.

A worked example

Two balances counted under each rule. The example income is $90,984, the 2026-27 first-year resident salary on the UW Medicine pay schedule. The example RAP payment assumes AGI equals that salary, one filer and no dependents: 9% of $90,984 is $8,189 a year, about $682 a month. It is an example, not a quote.

Monthly student loan debt a lender would count
Rule$200,000 balance$300,000 balance
1% of balance (Fannie Mae, deferred)$2,000$3,000
0.5% of balance (Freddie Mac, FHA, $0 reported)$1,000$1,500
5% of balance ÷ 12 (VA threshold)$833$1,250
Example RAP payment at $90,984 AGI$682$682
Deferred 12+ months, excluded (some physician programs, VA)$0$0

Now apply a 45% DTI limit. Monthly income is $90,984 ÷ 12 = $7,582, so the limit is $7,582 × 45% = $3,412 a month for all debts, including the house payment.

Left for the house payment and other debts, at a 45% limit and $90,984 income
Rule$200,000 balance$300,000 balance
1% of balance$3,412 − $2,000 = $1,412$3,412 − $3,000 = $412
0.5% of balance$3,412 − $1,000 = $2,412$3,412 − $1,500 = $1,912
5% ÷ 12 (VA threshold)$3,412 − $833 = $2,579$3,412 − $1,250 = $2,162
Example RAP payment$3,412 − $682 = $2,730$3,412 − $682 = $2,730
Excluded$3,412$3,412

At $300,000 under the 1% rule, $412 a month is left, too little for a mortgage payment. With the loans excluded, all $3,412 is available. Same balance; different counting.

After training it shifts. At an example attending AGI of $250,000, the RAP base payment is 10%, about $2,083 a month, against a 45% limit of about $9,375. At that income, a RAP payment on $200,000 counts more than the 0.5% rule's $1,000.

Example figures, rounded; not a loan offer. Lenders also count other debts, taxes and insurance, and DTI limits differ by program. How Brian plans around these numbers with clients is in Brian's buyer's guide (client section).

Questions about student loans and qualifying

Do deferred student loans count when buying a home?

On most loans they do. Fannie Mae counts 1% of the balance or an amortizing payment; Freddie Mac and FHA use 0.5% when the reported payment is $0. VA and several physician programs leave them out if deferred at least 12 months after closing.

Can a $0 income-driven payment be used to qualify?

Fannie Mae allows a documented $0 income-driven payment. Freddie Mac and FHA require a payment above zero and use 0.5% of the balance instead. Under the new Repayment Assistance Plan, the minimum payment is $10 a month.

Which repayment plans apply to loans borrowed after July 1, 2026?

A borrower with any federal loan disbursed on or after July 1, 2026 repays all Direct Loans under the Repayment Assistance Plan or the Tiered Standard Plan. PAYE and ICR end by July 1, 2028.

Does pursuing PSLF help with a mortgage?

It can. PSLF rewards a low income-driven payment, and lenders count the documented payment, so a lower one leaves more room under the debt-to-income limit. The payment is recalculated yearly and rises with income.

Is a physician loan always better for a doctor with large student loans?

No. The 12-month exclusion helps most when loans stay deferred well past closing. A doctor already in repayment is usually counted at the actual payment on any loan, so pricing a conventional loan the same day still matters.

Next steps

The full picture lives in the main guide: who qualifies, how the terms work and how physician loans compare. When it is time to talk through a specific purchase, Brian is a quick call away.

Talk with Brian

This page is general information, not a loan offer or financial advice. Brian Huie is a real estate broker, not a lender, and Brian is not paid by any lender. Confirm loan terms with a licensed loan officer. Figures as of November 2026.

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