You matched in March. You signed your offer letter in April. You want to close on a physician mortgage in July, two weeks before your first day as an attending. Can you do it?
Yes — but only if your employment contract says the right things in the right way. Physician mortgage lenders have specific underwriting requirements for income documentation, and when you haven't started working yet, your contract becomes your entire income case. A vague or incomplete agreement can stall your closing or push you into a more expensive loan structure.
Here's what underwriters are actually looking for.
Why Physician Mortgages Allow Contract-Based Qualifying
Conventional mortgage programs require at least two years of W-2 or tax return history to verify income. That's a non-starter for residents transitioning to their first attending position — or for new physicians who haven't yet received a paycheck at their new salary.
Physician mortgage programs solve this by accepting a signed employment contract in place of current pay stubs or tax returns. The rationale is straightforward: a licensed physician with a credentialed hospital or group practice employer, a signed agreement, and a confirmed start date represents a very predictable income stream. Default rates on physician loans are historically low, and lenders underwrite them accordingly.
But "accepts a contract" doesn't mean "accepts any contract." Underwriters are verifying specific things. The more cleanly your contract provides those answers, the smoother your close will be.
What Your Contract Must Include
A clear base salary or guaranteed income figure. This is the number the lender will use to calculate your debt-to-income ratio. If your compensation is partially or fully RVU-based, the contract needs to state either a guaranteed base or a guaranteed minimum during a ramp period. A contract that says only "compensation will be determined based on productivity" gives the underwriter nothing concrete to work with.
A firm start date within 90 days. Most physician mortgage programs require that employment begin within 60–90 days of closing. If you're closing in July but your contract says you start in September, some lenders will approve it; others will require you to be actively employed. Know your lender's specific policy before you lock a rate.
Employer name, location, and position title. The lender will verify that the employer is a legitimate, credentialed organization — typically a hospital system, medical group, or healthcare facility. A hospital employment agreement from a named health system is easy to verify. A vague "consulting arrangement" or a contract from a newly formed entity may require additional documentation.
Your signature and the employer's authorized signature. Unsigned or countersigned contracts don't satisfy underwriting. Both parties need to have executed the agreement.
No pending credentialing or contingencies that could void the contract. If your employment is contingent on board passage, DEA registration, state licensure, or hospital credentialing that hasn't been completed, underwriters may flag this as a risk factor. You don't need to have all credentials in hand, but the more contingencies that remain unresolved at closing, the more your loan officer will need to explain.
What Can Delay or Complicate the Process
Signing bonuses counted as income. If your contract includes a signing bonus, don't assume it will boost your qualifying income. Most lenders treat signing bonuses as one-time events and exclude them from your base income calculation for DTI purposes — the same way they treat variable income like RVUs and call pay. The exception is if you can document that bonuses are guaranteed and recur regularly, which requires additional history that a new attendee won't have.
Partnership tracks and equity compensation. If your contract outlines a path to partnership or equity participation in a future period, that's interesting for your long-term compensation — but it's invisible to the underwriter today. What you're qualifying on is your guaranteed base compensation, full stop.
Contracts from academic medical centers vs. private practice. Both work, but the documentation may differ. Academic employment agreements are often detailed and formal. Some private practice agreements are shorter, sometimes more informal, and may reference a separate compensation schedule attached as an exhibit. Underwriters need that exhibit — if it's not attached, the income figure isn't documented.
Part-time or reduced-schedule contracts. If you're starting 0.8 FTE by choice, the lender will underwrite your income at that rate. A 0.8 physician salary at many specialties still supports a substantial loan, but be precise about your FTE designation in the contract.
Two-physician households where both partners are using contract income. When both borrowers are qualifying on pre-employment contracts, underwriters will scrutinize both agreements carefully. The same requirements apply twice. This is manageable, but start gathering documentation early.
What If Your Contract Has a Contingency?
State licensure is the most common contingency in physician employment agreements, and it's generally fine. Lenders understand that a physician must be licensed in the state where they'll practice, and most underwriters will close the loan when the contract is signed even if the license application is still pending — as long as there's no reason to believe licensure will be denied.
DEA registration and hospital credentialing are slightly more variable by lender. Some will close with pending credentialing as long as the employment start date is firm and the employer confirms in writing that credentialing is expected to complete. Others want credentialing confirmed before funding.
If you have any unusual contingency in your contract — an agreement to repay relocation expenses if you leave within a certain period, a non-compete that's a condition of employment, or income tied to achieving a certain panel size — bring it to your loan officer early. Most of these are manageable when they're disclosed upfront. What causes problems is when underwriters discover complications in the final review.
The Employer Verification Call
After reviewing your contract, most lenders will place a verbal verification of employment (VVOE) call to your employer — typically to HR or a designated contact — to confirm your start date, title, and base salary. This is standard for any pre-employment scenario, not just physician loans.
Alert your HR department that this call is coming. A delayed response or a contact who's unreachable can add days to your timeline at the worst possible moment. If your employer uses a third-party employment verification service like The Work Number, let your loan officer know early so they can use the correct channel.
The Practical Takeaway
Physician mortgages are designed to solve the income-documentation problem that conventional loans create for early-career doctors. But they solve it by substituting a contract review for a pay history review — which means the contract itself carries the weight.
Before you start house hunting in earnest, pull out your employment agreement and verify: Is the base salary clearly stated? Is the start date within 90 days of when you want to close? Is the contract fully executed? If the answer to all three is yes, you're in good shape. If any of those answers is uncertain, work with your loan officer to understand whether a letter of clarification from your employer — or a brief delay in your contract start — can resolve it.
The physicians who close smoothly on pre-employment contracts are the ones who treat the contract itself as a mortgage document from the beginning. The ones who run into trouble tend to discover an underwriting gap the week before closing. Neither outcome is inevitable — it comes down to preparation.
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MedPharmaConnect is an educational resource and is not a lender. For personalized guidance, speak with a physician mortgage specialist.
MedPharmaConnect is an educational resource, not a lender. Always verify program details, current rates, and eligibility with licensed mortgage professionals.