How to get the lowest mortgage rate

I just got done obtaining a mortgage for my first big boy house, Yay!

But I learned a lot about lenders and obtaining a mortgage and some tricks. I haven’t been able to find a post similar to this so I figured it’d be helpful to write my own. So here is a list of tricks and realities with mortgages that I think might be helpful. I used a conventional loan and have a good credit score so some of these tricks may not be applicable to other types of loans.

The reality is, like car insurance, mortgage lending is now extremely regulated so the product that they are providing you and the tricks they historically had to scam us do not fly anymore. So you’re pretty safe to go with any lender. Just make sure you read the loan estimate thoroughly and don’t give them money until you are ready to pay them for something.

  1. Don’t get sentimental about your lender. They are selling you a loan and you are almost certainly not going to have a long term relationship with them like you will with your real estate agent. Treat a mortgage like a commodity like rice or corn-consider buying the grocery store brand rather than the brand name. Shop around to find the best rate. It will save you possibly tens of thousands.
  2. Apply with multiple different lenders, local credit unions, local banks, and large multi-state banks such as Mutual of Omaha, Sage, Better, Old National, etc. Sometimes the local lenders will have the best rates but sometimes it will be the large online lenders. Once you have all the documents you need for an application it takes minutes to apply and the little extra time it takes will be worth your time and it costs nothing to apply. If all your credit pulls for a mortgage are within 30 days it will only ding your credit score once.
  3. Lenders will do a “rate lock” for you meaning they will lock in the terms that are available on that day that you are discussing with them. You can do this at any point after you’re under contract and if you don’t do it, you may risk rates increasing and losing out on the best option. I recommend rate locking with the lowest rate lender on day 1 of you having that available and not rate locking with any other lender at this point. Pin them against each other on day 1 to get them to give you the lowest rate. They are almost always charging you a higher rate than they will be willing to offer. If they are going to play this game by not being transparent with their pricing, don’t feel bad about pinning them against each other.
  4. Do not use the lender’s quoted APR. Use the interest rate and tally up lender costs separately. These will include sections A and B under your loan estimate. All other costs are estimates early in the process and are irrelevant and going to be the same independent of the lender. Some lenders will estimate the taxes or insurance artificially low to make the APR looked better.
  5. You can have multiple lenders go through underwriting, sometimes with a cost but usually without a cost to you. It’s unfortunately extra work for them if you decide to go with a different lender but this is unfortunately the game. To get underwriting started you probably either need 1. an appraisal waiver or 2. to pay for an appraisal of the home you’re purchasing at cost to you (in my city about $750. I highly consider getting an appraisal from two lenders if rates are pretty volatile. That $750 additional cost will allow you to leverage two lenders against each other up until the very end.
  6. Lenders can “re-lock” rates. So if rates drop before closing date and you have two lenders competing for your business you can ask them to beat the next guy. The way I did this was I watched rates drop and then plateau and then told lender B, who had the worse rate, if he could beat lender A with the better rate. He beat the rate of lender A, I went back to lender A and they beat the rate of lender B again. Without having that leverage lender A would never have budged because the rate was “locked”. I re-locked with the lender about 10 days before closing, most of the underwriting was already completed for both lenders and this small move toward the end of the process saved us $12,000 over the life of the loan.
  7. Origination fees and points are two ways lenders will parse their cost for a specific loan but it is always just cost to you. Consider them in the same boat when comparing lenders.
  8. To calculate whether additional cost to you up front is worth it, use an amortization calculator to divide the total costs (points+ origination fees) by the decrease cost per month to see how many months it will take it to be worth it. This estimate will be artificially high however because 1. you should take that upfront money saved and reinvest it and 2. mortgage interest is tax deductible. If you expect to refinance or sell your home within a couple years, don’t buy points that will take 5 years to be worth it.

It’s a complicated process and such an annoying game but is a good one to play. This is the most expensive purchase most of us will ever make in our lives and the difference in cost for us over the life of the loan between the best and worst lenders was $40k and between the best and second best was over $40 a day for the next 15 years. Lenders will try to understate that difference because compared to your monthly payment it looks small but I will never consider $40 a day a small amount of money, even when we are talking about thousands of dollars. Penny pinching should be applied to huge amounts of money just the same as small amounts.

It’s my first time here

In my job I have the privilege of getting to see people age. As a family med physician who has prioritized chronic disease management, most of my visits are caring for a population over 65 years old. I get to see people at all stages of life but focusing on an older population has really driven in how precious our lives are.

I saw a cute comic from Anna-Laura Sullivan where all the characters are commenting on it being there first time being alive. They are struggling and making mistakes and admitting that this is all their first time’s doing this. It was such a beautiful sentiment and I think made me realize that no matter which patient I am treating, this is there first time having this exact experience. I sometimes hold patients to impossible standards, question the med regimens that they are on, want to shake them to have better habits, or engage more with their health. But I realize, this is their first time having hypertension or diabetes, maybe their first time having to see a doctor regularly. They may not have grown up seeing these chronic diseases, don’t fully grasp the potential outcomes they may have.

I get to see a dozen or more people a day deal with hardship, disease, contemplate their health. Some are facing terminal disease, some age related changes, some anxiety and stress, depression, loss of loved ones. I get a glimpse into my future with each of these cases. I know I will have friends and family die, will have my own injuries and sickness, will struggle with my weight and with habits, with time management, with prioritizing my health. I often can’t fix these problems that patients face. A lot of it is just the reality of life. Our joints degrade and ache, blood vessels narrow and clot, cells mutate and become cancerous. I can do my best to prevent these things from happening, delay them, or heal them, but medicine is limited in 2024.

My patients bring me a beautiful bit of foreshadowing and appreciation for each moment I have now. I know that’s not why they come to me but in the moments that I cannot fix, like death of a spouse, it makes me greatly appreciate my partner. When I lay in bed next to her I hold her tightly, knowing that at some point I may not have her. I hike or ski or bike and think about my 80 year old patients who could’ve kicked my ass in all those sports in their heyday and I appreciate these moments my mobility is preserved. Often, I get to see some patients get better. Their back pain will dissipate with time and when my back aches, I look at it more academically and objectively, knowing that I will likely get better too.

I also hope, despite my sometimes being paternalistic, or tired, or unempathetic, that each visit I have with a patient is also exactly the first time I have had this visit. While it may be a routine visit, the same med I have prescribed dozens of times, it is never exactly the same. I am trying to grow as a provider, to recognize that each patient is and individual with personal goals, risk tolerances, and wishes. It’s hard enough to keep up with the evidence for each decision we make it medicine. But to apply that to an individual who has lived a whole life differently than me is where the real difficulty lies. I just hope for forgiveness from patients when I don’t get it right. I care and I am trying.

I am finally at a point in my life where I get to reap the gratification I deferred for so many years. I have struggled through school most of my life to get to a stable career, stable housing, stable relationships. With things being lovely now I do have a bit of clinginess to the present moment. But I know what my future holds and I just hope to age gracefully, to live this life, my first time here, as well as I can.

A post-pandemic view on medicine

I wonder about the difference in perspectives on medicine having been a doc trained during the pandemic. I see a frame shift in my generation, a sense of humility. I inherit patients from older doctors and see a different practice style, and ideal of manipulating people’s physiology to control disease, to treat sensations.

I was trained during a time where we realized medicine is largely helpless. I began my residency during normal times, watched a global pandemic decimate the healthcare system, kill off a portion of the population while researchers desperately scrambled to find any viable treatments. Physicians made up medicine on the fly, nurses desperately proned and suctioned secretions from patient’s airways. None of it seemed to help. The patients would just die despite your best efforts. Then, even when we found amazing viable treatments, a large portion of the population, unfortunately listening to quacks like Alex Jones and Donald Trump, declined our best evidence based interventions.

Doctors of the prior generation often blanket checked labs on all patients, listened to every patient’s heart and lungs, palpated their abdomens. They did these intensely thorough physical exams to find hidden pathology, palpated every prostate that walked in the door, felt for every breast lump, did a hernia exam on every adolescent boy. What we have found based off that mentality, through extensive population level studies, is that sometimes patients who came and saw us, patients who were poked and prodded, actually died faster than the patients we left alone. Our interventions for prostate cancer often caused incontinence, erectile dysfunction, and even killed people who were never going to have any problems from their prostate cancer. We tested the thyroid of everyone who walked in the office, and we found that the younger population rarely if ever benefited from treatment when they didn’t have symptoms and the older population actually died faster because of our treatment.

I have watched a prescription opioid crisis create a whole population of patients whose pain is worse than had they never been started on the medications. I have watched patients come in emaciated, anxious and sleepless because they were prescribed amphetamines for their very normal, very not-pathologic difficulty concentrating in life. I have seen recovered alcoholics pride in their sobriety be decimated when they learn that the clonazepam their doctor put them on for anxiety is, in reality, just alcohol in pill form.

I believe we have created a population of patients who believe sensations need treatment, that existence alone is enough to need medications, that we can prevent every disease. The reality is that it is always an odds game, always weighing probabilities of risks and benefits. And after seeing a portion of the population die from a slight mutation in a common virus, I think I respect our limitations in medicine.

Avoid us. We will poke and prod you and test you and “treat” you until we have caused more harm than good. The most fundamental tenet to the hippocratic oath is “do no harm”. The reality is that there is no way to do no harm. I wish Hippocrates had gone with my high school economics teacher’s motto: “TANSTAAFL” an acronym for “They’re ain’t no such thing as a free lunch”. I tell my patients this all the time when I am trying to talk them out of unnecessary lab testing, unnecessary physical exam maneuvers. Anything I do comes with a cost. I listen to your heart and we lose a few seconds where I could be talking about tobacco cessation or healthy diet with you. Or worse, I hear a murmur that never would’ve caused you trouble and now I’m getting an ultrasound of your heart to evaluate that and I find a mildly dilated thoracic aorta and now I put you on beta blockers which slow your heart rate to a point where you lose your ability to hike up your favorite trail and I do annual monitoring of your aneurysm because that’s what the guidelines say to do and it costs you hundreds of dollars a year, money which you could be spending on a dietician, or a physical therapist, or going to a show with your family, or taking your partner out for a lovely date.

Don’t just avoid doctors. Avoid all of us. “Alternative medicine” practitioners are no better. Naturopaths, chiropractors, functional medicine, homeopaths, will poke and prod you, empty your pockets, convince you of pathology that has no basis in reality such as “being out of alignment” and bring you back in for repeat “treatments”. Avoid all of us unless you need us.

Nothing I do is benign. Nothing I do is without risk. Doctors are not gods. There is a 100% mortality rate to this existence. Don’t fix it if it’s not broken. TANSTAAFL.

Open access scheduling

I am working on implementing a different type of scheduling in primary care. I know that is probably the most un-exciting way to begin a blog post so bear with me for a second because I think it is kind of interesting. Every other primary doc I know of is booked out for weeks. They have different backlogs of patients with half a dozen queues for patients. They have different slots for different types of visits each day, for example: two annual exams a day, one procedure slot, two same-day appointments, two medicare wellness visit slots, six follow up slots. They may be booked out for months for medicare wellness visits but their same-day slots may not even get filled. Continue reading Open access scheduling

The harm of the over-attentive doctor and the incidentaloma

I was talking with one of my former co-residents tonight, reflecting on our practices with regards to lab and imaging investigations on various patients. In residency I was probably one of the most conservative providers. I ordered only a handful of MRIs my whole residency, rarely ordered X-rays, avoided routine laboratory blood work, and rarely follow up imaging or labs on various mild abnormalities. She is in line with me, one of the least investigative providers in our residency. As interns we classically order very little imaging and labs, and often they were inappropriate if we did order them. As we get further along we learn what really truly needs investigating and are asking more questions, balancing more diseases and patient concerns and our ordering goes up. Continue reading The harm of the over-attentive doctor and the incidentaloma

My three rules for placebo

Placebo or practices that are poorly or not based in evidence is an ethically questionable practice in medicine. Is it okay to prescribe medications for patients knowing that they will have limited or no benefit? Because of this I’ve established three rules for myself with regard to placebo. To some extent they are unattainable but I’ll keep trying. Continue reading My three rules for placebo

My style in primary care

I’ve been suffering an identity crisis as a new primary care physician. I’ve had guidance with nearly every decision up until this point but now I’m on my own. I reflect back a distinct interaction with one of my attendings in residency. He is an osteopath, manipulates people’s muscles, and fascia for the bulk of his work. I was precepting a patient with him one afternoon. The patient had terrible sleep habits, drank caffeine in the evening, took naps at 5pm, watched tv in his bed, had untreated anxiety and would contemplate the next day’s plans all night. He didn’t work, didn’t exercise, had nothing to exhaust him during the day. He wanted a medication to make him sleep and instead I counseled him on sleep hygiene, a strategy to fix the problem rather than masking it with meds. My attending, disagreed with me and said I should just give him the med. Continue reading My style in primary care

Intrinsic joy

When I was in high school and college, most of the activities I was doing were to obtain validation of others. I had quite an overpowering fear of death, or rather of being forgotten. I remember having this fear around my junior year of high school that one day I was going to die and no one would care. I quickly realized that theism was an easy way out of facing this angst and that was not going to be the solution for me. I needed something more tangible. For years that solution was to be greater, to have influence on the world, to be remembered. I pursued that through racing triathlons for a while. A few people noticed me and a couple people knew who I was. I was the first to cross the line at some little local races and I thought I was somebody. That was really hard. I tried so hard. Continue reading Intrinsic joy

What it’s like to die from covid

I had an odd interaction with a patient a few weeks ago. I was encouraging him to get the vaccine, telling him it was safe and effective. I dispelled all his fallacies claiming lack of research, rushed to the market, lack of long term data, and that as a late 40s guy he was at low risk for adverse effects or death from covid. I pointed out that he deferred to experts in his everyday life, trusted driving on a brand new bridge the day it was built (did not need any long term data there), and told him of several 40 year olds I had seen who had died or maybe wish they had died from covid. His response was that he was not scared to be dead. He said, if I am dead, I will be dead, so I won’t care. He has a young daughter. I told him his daughter would care. He said she would be alright without him. I told him it is not the being dead that is so scary, it is the dying part. He said he thought he would be sedated and unaware for that whole process. That is what baffled me the most. He had literally no idea how people die from covid. I want to dispel that. Continue reading What it’s like to die from covid

Adventures of a medical student