If I'm understanding this correctly, that is around a $1,600/mo payment for the entire duplex (Estimated total PITI), and in this slower market could rent for $1200/side.

Are you selling or leasing to medical staff, retail managers, tradesmen, etc?

And if you pay yourself a management fee, you should be able to setup Solo 401K plan (best for further RE investments) and MERP (medical reimbursement plan - thus shifting medical expenses from personal to business side).

I’m thinking if rates went up or economy dipped they might’ve had to sell at $290k and I have to think that would have been a significant money loser, especially factoring in holding costs.I guess the difference in our thinking is that you feel they may have an advantage in a slower longer DOM scenario by being the owner of the property. 

My wife and I own a townhouse in Calvert county but we're looking to purchase a row home in Ridgley's Delight/Pigtown area, as my wife has recently opened a boutique in downtown Baltimore.Our plan is to purchase a 3 br owner occupied rental and rent out the other two rooms, preferably to medical professionals/residents from UMMC. 

You can optimize furnished finder, which is a short-term rental service specifically for traveling medical staff.

Of course, this will be a little more tedious and slower than option 1), but it is free.

Maybe a loan medication is exactly what I am describing, but when I hear the term, I assume it would require extensive documentation and headache and possible credit implications.

For example, a few weeks ago I learnt that some hospital networks provide a 0% down CONVENTIONAL loan program for medical professionals in their system.

I personally do not worry about the decline it has seen as the city is back to thriving from opening a new medical school soon to different projects the city has going on.