PVR

Facilities & real estate

Office build-out and lease workbook

Medical build-outs typically run $150–$400 per usable square foot depending on plumbing, mechanical, and imaging needs. Always demand a healthcare-experienced GC. Negotiate at least $40/sf TI allowance on a 5-year lease and confirm permit timelines before signing — most delays are permitting, not construction.

By Jordan Alderman, MBA, CMPE · Reviewed by Rania Hassan, JD, CHC · Last reviewed · Methodology

Disclosure: Independent editorial. No pay-for-placement, no affiliate rankings. Full editorial standards.

Who this is for: Physicians and administrators opening a new location or relocating.

Site selection

  • Drive-time analysis vs target patient population
  • Payer-mix density (commercial vs Medicare vs Medicaid)
  • Referring physician proximity
  • Parking ratio (min 4 per 1,000 sf for primary care)
  • Visibility + signage rights
  • ADA accessibility on entrance, restrooms, exam rooms

Lease negotiation

  • 5-year with 5-year option is standard; longer for expensive build-out
  • TI allowance $40–$100/sf depending on shell condition
  • Base rent + NNN (Net-Net-Net) — confirm cap on NNN increases
  • Free rent during build-out (typically 3–6 months)
  • Exclusive use clause (no competing specialty in center)
  • Assignment / subletting rights
  • Right of first refusal on adjacent space
  • Landlord permit-delay remedy

Space program (typical primary care, 4-provider)

  • 8–12 exam rooms (2–3 per provider)
  • 2 procedure rooms
  • 1 lab draw room
  • Nurse station / MA workstation
  • Physician offices (1 per provider or shared)
  • Reception + waiting (1.5–2 sf per patient/hour)
  • Business office / billing
  • Break room + staff restroom
  • Storage + IT closet
  • Total: 3,500–5,500 usable sf

Build-out timeline (16–28 weeks typical)

  • Space plan + architect (weeks 1–4)
  • Permits (weeks 3–10 — varies wildly by jurisdiction)
  • GC bidding + selection (weeks 4–7)
  • Construction (weeks 8–20)
  • Furniture, fixtures, equipment install (weeks 18–24)
  • IT / low-voltage cabling (weeks 16–22)
  • Final inspection + CO (weeks 24–26)
  • Move-in + operational shakedown (weeks 26–28)

Equipment planning

  • Exam room package (table, stool, otoscope, BP, etc.)
  • Procedure equipment specific to specialty
  • Refrigerated vaccine storage with alarm + logging
  • Autoclave for sterilization if in-office procedures
  • Point-of-care lab if applicable (CLIA-waived only if not CLIA-certified)
  • Imaging: X-ray requires state licensing + shielding — plan permitting for 4–8 weeks