San Francisco’s hospital system draws physicians from across the country, and the city’s geography of care is genuinely distinct. UCSF Health’s Parnassus campus, home to the Helen Diller Medical Center, is consistently ranked among the top hospitals in California and the nation. Zuckerberg San Francisco General Hospital and Trauma Center is the only Level I trauma center serving all of San Francisco and northern San Mateo County — the highest trauma designation awarded by the American College of Surgeons. Sutter Health’s California Pacific Medical Center operates its flagship Van Ness campus, a 274-bed facility built at a cost of $2.1 billion, with nationally recognized transplant programs in liver, kidney, pancreas, and heart. The San Francisco VA Medical Center, a 344-bed inpatient facility with an additional 120-bed nursing home, serves as a major referral center for veterans across Northern California.
Physicians relocating into this system — whether starting a UCSF fellowship, joining CPMC’s transplant team, or beginning a residency at Zuckerberg San Francisco General — face a housing market where the conforming loan limit tops out at $1,249,125 and median prices run well above that. Physician mortgage programs exist to bridge the gap between a signed employment contract and the down payment and documentation a conventional loan would otherwise require.
Reduced or No Down Payment. Many physician loan programs allow financing with 0-10% down, a meaningful advantage in a market where standard Jumbo down payments often start at 20%.
No Private Mortgage Insurance (PMI). Physician loans typically waive PMI even with less than 20% down, which matters given San Francisco's loan amounts.
Employment Contract as Qualifying Income. For physicians starting at UCSF, CPMC, or Zuckerberg San Francisco General before their first pay period, a signed offer letter or contract can qualify in place of pay stubs.attending practice.
Student Loan Flexibility. Physician loan underwriting typically calculates student loan debt using income-driven repayment terms rather than a standard amortization estimate, which can materially change your qualifying debt-to-income ratio.
High Loan Amounts Without Standard Jumbo Down Payments.Physician Jumbo programs allow San Francisco's above-conforming loan amounts to be financed without the larger down payments a standard Jumbo loan would require.Mapleton Hill, Chautauqua, or the $1.5 million-plus tier of Table Mesa to access physician program benefits at the prices Boulder actually demands.
Closing Before Your First Paycheck. Structured specifically so incoming residents, fellows, and attendings can close on a home around their start date, not months after their first pay stub arrives.
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For loan amounts within or near San Francisco’s conforming range, offering reduced down payment and no-PMI structures for practicing physicians and eligible professionals.
For San Francisco’s above-conforming loan amounts — the norm rather than the exception here — combining Jumbo-level financing with physician-specific down payment and student loan treatment.
For physicians building new construction in San Francisco, combining construction and permanent financing into a single closing, with underwriting that still recognizes an employment contract as qualifying income.
Experience underwriting physician contracts from UCSF, Sutter Health/CPMC, and Zuckerberg San Francisco General
Comfortable qualifying residents and fellows on contract income before their start date
Physician Jumbo financing structured for San Francisco's above-conforming price point
Student loan documentation handled correctly under income-driven repayment guidelines
Confidential, direct communication from application through closing
Ryan Lehrman, NMLS #235295
Employment verification: A signed offer letter or employment contract, typically effective within 60-90 days of closing
Credit profile: Generally 700+ credit score, though some physician programs allow flexibility for residents with limited credit history
Down payment: As low as 0-10% depending on loan amount and lender program
Debt-to-income: Calculated using income-driven repayment terms for qualifying student loan debt, rather than standard amortization
Initial consultation — We review your contract, start date, and target San Francisco neighborhoods.
Pre-approval on contract income — I structure your file using your employment contract, even if your first paycheck hasn't arrived
Property search — You shop with a physician-specific pre-approval, which matters in San Francisco's competitive offer environment.
Underwriting — I coordinate underwriting around your specific documentation, including student loan and start-date considerations.
Closing — We time closing to align with your move and start date at your San Francisco hospital or practice.
Yes. Physician loan programs are built to use your signed employment contract as qualifying income, which means we can move forward with pre-approval and closing timed around your start date rather than waiting for pay stub history.
Yes. Given that San Francisco's conforming limit tops out at $1,249,125 and median prices run well above that, most physician borrowers here need Physician Jumbo financing — which combines physician-specific down payment terms with above-conforming loan amounts.
Not directly, but it does affect how I document your file. CPMC's Van Ness campus is a large, well-established Sutter Health facility, and I've underwritten physician loans for staff there before, which means I know how to verify employment and structure the contract-based income correctly.
Ready to finance your San Francisco home with a program designed for your career? Let’s talk through your situation.
Originally from Harrisburg, Pennsylvania, I moved to Phoenix to attend Arizona State University and have proudly called Phoenix home ever since.
My journey into the mortgage industry began with a friend’s encouragement, who saw how my energy and people-first mindset could make a difference. He was right — I found my calling.
I’ve always embraced what makes me different. With ADHD as my secret weapon, I thrive in fast-paced, detail-heavy environments. I’ve built my career on clear communication, creative problem-solving, and putting clients first, always.
Outside of work, my greatest motivation is my wife and three amazing kids. I’d be honored to help guide you through your lending journey with care, clarity, and commitment.
