Do not borrow as much as the lender will lend you. Just because you can make the payments doesn't mean you should. A good rule of thumb is to keep your mortgage amount to no more than 2 times your gross income. In very expensive areas of the country, you may have to stretch that a bit (perhaps to 3-4X but not 10X) but realize that comes with very real financial consequences including working longer, having less in retirement or for college, and having less to spend on lifestyle stuff like vacations, automobiles, and toys. It is a very rare physician who cannot dramatically improve her financial situation by moving inland from the West or East Coast. Another good rule of thumb is to keep your total housing costs (mortgage, taxes, insurance, utilities, maintenance etc) to less than 20% of your gross income. Since doctors need to save 20% of gross for retirement, and may pay 30% of gross in taxes, they cannot spend the 30-40% of gross on housing that a bank will lend them and expect to live “the good life.”