CPOMP 2024 Breakout Session | Friday, September 20

Physician-Owned Real Estate 101

The Most Important Course You Never Took in Medical School


Physician-owned real estate has become a vital source of ancillary income that creates advantages in recruitment and retention, enhancing the strength and longevity of the independent practice. It is imperative that physicians understand how to optimize the outcomes and create a sustainable investment.


Economic topics will focus on producing highly favorable returns with minimal investment and personal risk, along with investment fundamentals such as responsible leveraging, financing basics, and maximizing cash-on-cash returns. Operational topics will include the keys to creating an Operating Agreement that will facilitate partner buy-ins and assure funding of buyouts at exit, resulting in a long-term sustainable real estate ancillary.


Any physician or executive involved in decisions related to the practice real estate should attend – particularly new or upcoming physician leaders within the group.



    ➢ Benefits of Physician Ownership 

How a portion of a practice’s second largest expense item is converted  to income through ownership. Discussion of the ramifications of this newfound ancillary income on physician recruitment and creation of practice glue.

    ➢ Understanding the Investment

Assessing the Risk – Why investment in owner-occupied real estate is  NOT a real estate investment. Quantifying and comparing the liabilities of leasing vs. owning and methods of limiting personal exposure.

Leveraging the Investment – Creating maximum cash-on-cash returns with optimal debt vs. equity. Calculating the right mix to maximize debt and minimize equity investment while assuring that established rents provide adequate debt service coverage.

Managing the Returns How to establish rents that are satisfactory to both the practice and the real estate entity. The        determination of amortization schedules to meet expected income and application of depreciation alternatives to create tax advantages.

     ➢ The Importance of the Operating Agreement

Aligning with Practice Objectives – Discussion on the causes of, and methods of mitigating, “haves and have nots” between the practice and real estate investment.

     ➢ Recognizing the Value of Your Lease

Defining the risk and return – The lease is the single most important document for an owner-occupied medical real estate investment. Definition of how-to best position and align that value is imperative.

     ➢ Structuring the Deal

Building Your Project TeamDetermination of member roles, timing, and structure to optimize outcomes.

     ➢ How to Finance Your Project

Understanding Debt vs. Equity – Optimizing capital sources based on the group’s objectives.

Evaluating Bank Terms – Understanding financing structures and provisions to avoid.

Keys to Leveraging Your Best Deal – Adopting strategies to improve terms by addressing lender considerations.

     ➢ Planning for a Profitable Exit

Surety of Exit – The importance of defining an exit strategy at inception.