International medical graduates make up roughly a quarter of practicing physicians in the United States. If you trained abroad and matched into a US residency, there's a good chance you've spent years thinking about visas — H-1B, J-1, maybe an O-1 or a Conrad 30 waiver — long before you ever thought about a mortgage.

So when the time finally comes to buy a home, a familiar worry surfaces: Will a lender even work with me if I'm not a permanent resident yet?

The short answer is yes. The longer answer is that 2026 made the path both narrower in one place and clearer in another — and the physician mortgage sits right at the center of it.

The quiet change: FHA closed a door in 2025

For years, one fallback for borrowers without a green card was the FHA loan, with its low down payment and flexible credit requirements. That option largely disappeared. Under HUD rules that took effect in 2025, non-permanent residents — including most H-1B visa holders — are no longer eligible for FHA-insured loans.

This matters because it removes a low-down-payment safety net that visa-holder doctors used to count on. What's left for most international physicians are conventional loans and physician (doctor) mortgage programs. And here's the part that's genuinely good news: the physician mortgage is often the better of the two for this audience anyway. It's designed to offer 0% or very low down payment with no private mortgage insurance, and many physician-loan desks explicitly welcome visa holders. So a change that sounds like a loss actually pushes IMG physicians toward the product that tends to serve them best.

How lenders see each visa class

Not all visas are treated equally. The differences come down to one question lenders keep asking: how stable and long-lasting is your authorization to stay and work here?

H-1B is the most lender-friendly of the common physician visas. Because it carries "dual intent" — meaning you're allowed to pursue permanent residency while on it — lenders view it as a strong signal of stability. H-1B holders qualify for conventional loans and for most physician mortgage programs. You'll typically need a credit score in the low-to-mid 600s or better, about two years of work history (residency and fellowship usually count at physician lenders), and a reasonable amount of time left on your visa. A common rule of thumb is at least one year of remaining authorization, though more is better.

J-1 is harder. The exchange-visitor status and its two-year home-country residency requirement make some lenders cautious, because there's a built-in expectation that you may have to leave. Many J-1 physicians can still buy, but they often face a larger down payment — frequently 20% to 25% — or need a physician lender that specifically understands the visa. If you're on a Conrad 30 waiver (working in an underserved area to waive the home-residency requirement), say so early; it materially strengthens your file because it points toward staying.

O-1, TN, and green-card-pending cases are evaluated individually. The pattern is consistent: the clearer your path to permanence and the longer your remaining authorization, the more comfortable a lender becomes — and the closer your terms move toward what a citizen colleague would get.

Why a specialized physician lender matters more for you

When you're a visa holder, who you apply with matters even more than it does for other borrowers. A generic conventional lender may technically be able to work with you but default to its most conservative settings — larger down payment, extra documentation, a higher rate — simply because visa files are unfamiliar to them.

A physician-loan desk that regularly works with international doctors is a different experience. These lenders have already built guidelines around offer letters, residency income, and non-permanent residency, and several market directly to visa-holder physicians with 0%-to-low-down, no-PMI programs. The practical takeaway is the same advice we give every physician buyer, just with sharper teeth: shop at least three to five lenders, and ask each one directly, in writing, how they treat your specific visa. The spread in what you'll be quoted is wider here than almost anywhere else in mortgage lending.

A pre-application checklist for visa-holder physicians

Before you talk to a lender, get these in order:

A copy of your current visa and I-797 approval notice, plus any pending green-card or waiver paperwork. Two years of work or training history documented, even if some of it was as a resident. Your signed employment contract or offer letter — physician lenders can often qualify you on a future attending salary that hasn't started yet. A credit profile you've actually checked; if you're newer to US credit, give yourself a few months to build it before applying. And a realistic note of how much time remains on your authorization, since that single number shapes more of the decision than most borrowers expect.

The bottom line

Being on a visa is not the barrier to homeownership it once felt like — but the rules shifted in 2026, and the smartest move is to work with people who know them. With FHA largely off the table for non-permanent residents, the physician mortgage has quietly become the main road for IMG doctors who want to buy with little money down. Choose a lender who treats your visa as a routine file rather than a problem to be solved, and the rest of the process looks a lot like it does for any other physician.

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Practice Path is an educational resource, not a lender or immigration advisor. Loan terms, visa policies, and program eligibility change frequently and vary by lender and individual circumstance. Always confirm current requirements with a licensed mortgage professional and, where relevant, a qualified immigration attorney.

MedPharmaConnect is an educational resource, not a lender. Always verify program details, current rates, and eligibility with licensed mortgage professionals.