> Breakout #1: Physician-Owned Real Estate 101

An essential course for physicians and executives involved in decisions related to the practice real estate. See description & 101 agenda here.

> Breakout #2a: The Overlooked IRS Election That Can Cost Doctors a Fortune

Discover how a single IRS election—if made within the first 12 months—can dramatically impact physician-owned real estate by enabling continued basis adjustments for new partners, boosting depreciation, and deferring capital gains.

> Breakout #2b: The Hidden Value of Swaps: When & How to Unlock Them

Swap value—positive or negative—can be strategically managed by experienced professionals to strengthen your debt structure. From boosting cash flow and lowering interest rates to unlocking needed equity for additional financing and supporting partner buy-ins or buyouts, learn how to use this powerful tool to optimize real estate outcomes.

> Breakout #2c: Short-Term vs. Long-Term Rates: Understanding & Profiting from the Disconnect

At last—a clear, no-nonsense explanation of why the Fed’s short-term rate moves often have little to do with long-term rates. Despite what your mother (or your banker) may have told you, the two are not tethered. Over the past year, borrowers have lost millions by either waiting for long-term rates to fall with projected cuts or locking in too early ahead of expected hikes. This session breaks down the disconnect in plain English, arming you with the insight you need to make smarter, more timely financing decisions.

> Breakout #2d: Leveraging Real Estate Ownership to Attract and Retain Top Mid-Level & Executive Talent

Real estate ownership has long been a proven strategy for recruiting and retaining physicians—but what if the same approach could be extended to mid-level providers and executives without the long-term ties? This panel composed of physicians and executives, along with a legal expert, will break down how to structure these opportunities in a way that attracts talent while preserving flexibility for both the practice and the employee.

> Wins, Losses, and Lessons: Unfiltered Confessions from Your Peers

Discover how other physician groups have tackled three key opportunities in physician-owned real estate: optimizing sale-leaseback terms in a changing interest rate environment, consolidating ownership to foster stronger physician alignment, and identifying crucial loan provisions to better protect and position your investment strategy.

> The Sale-Leaseback Recapture Opportunity

If your group previously sold a property and leased it back from a buyer who used debt to finance the purchase, a rare opportunity may now be emerging. With market conditions turning against those buyers and loan maturities approaching, many are under serious pressure. This session explores how those challenges can become your advantage—and how your lease position could give you exclusive leverage to negotiate a highly favorable repurchase deal.

> Consolidation of Disparate Ownership of Your Real Estate: How & Why

Disparate ownership of multiple facilities leased to a common medical practice isn’t just inefficient—it’s a recipe for conflict. Routine decisions, like setting rent, turn into win-lose battles between owning and non-owning partners. More serious issues—like closing a facility owned by only a few—can spark major disputes. Contrast that with a unified ownership model, where every partner has a stake in every facility, aligning incentives and simplifying decisions. This session shares lessons from a group that transitioned from fragmented to shared ownership across a dozen facilities, unlocking long-term strategic and financial benefits.

> Recognizing & Preventing “Killer Clauses” in Your Loan Agreements

Real-world examples reveal how banks have leveraged seemingly harmless loan terms to trigger covenant defaults—raising interest rates or even calling loans outright. This session uncovers how to spot and avoid so-called “killer clauses,” including unrealistic debt service coverage ratios, overly broad guarantor performance and reporting covenants, and lingering post-close LTV requirements that can become traps in a declining market.

> Optimizing Real Estate Opportunities – Strategic Vision, Collective Execution

Successful physician real estate investments don’t happen by chance—they’re built on strategy, vision, and long-term thinking. Aligning partners to create sustainable investments that benefit both the practice and its people takes more than luck—it takes leadership who can recognize needs as opportunities and formulate a strategic plan to secure the ultimate benefits. In this session, two forward-thinking practice executives share how they turned smart planning into real-world success.

> Think You Have a Good JV deal? These 8 Tests Will Tell You

The savviest physicians investing in real estate are those who understand what they don’t know, especially when it comes to development. In this session, you’ll review an example Joint Venture (JV) Letter of intent (LOI) and hear from seasoned physicians, physician advocates, and a leading developer who will discuss eight overlooked provisions that can allow physicians to enhance their position, protect their interests, and achieve fair, successful outcomes—with the right experts by their side.

> Breakout #1: From the Pro’s Perspective: The Keys to Unlocking Elite Lending Terms

What makes a lender say “yes”—and on the best terms possible? This session breaks down what underwriters really look for in medical practice real estate deals and how your group can present a more compelling case. Topics include the role of detailed financial reporting, key inclusions in proposed budgets, pre-tested debt service coverages and the types of guarantees (beyond personal). Even how banks value the role of a project manager. You will walk away with clear, actionable insights to enhance your financial presentation and position your project for success in today’s lending environment.

> Breakout #2: The Real Estate Impact of Private Equity Sale of the Practice: Valuation & Structure

Explore why the inclusion of real estate is essential to negotiating a favorable, holistic transaction. Industry experts and practice leaders will examine how a weakened landlord-tenant relationship impacts risk and returns—and share strategies to remediate those challenges.

> Keys to Planning New Projects in a Volatile Economy

In a time marked by economic uncertainty, how can practices confidently decide to either greenlight or pause on new projects? Seasoned CEOs and economic experts who’ve made those tough calls will share how they evaluated added revenues versus risk and leveraged analytical tools to guide smart decision-making. Those same experts will also reveal proven methods that can work to control or mitigate those variables to provide the greatest surety of expected outcomes. And, if the decision is to move forward, control and mitigate those variables to provide the greatest surety of expected outcomes. Opportunity costs of standing still, analytical tools employed, lessons from COVID, and the support from their trusted advisors will all be revealed and discussed.

> Cracking the Code: A New Take on Real Estate Valuation

Valuation has always been the biggest obstacle to reaching long-lasting agreements on buy-ins and buyouts. But in 2024, a leading CPA developed a groundbreaking approach worthy of consideration. This presentation will lay out the method that claims to check all the boxes. Then, a further discussion and exploration will put it to the test and discuss alternatives. Ultimately, you will decide: does this new model truly meet the challenge?

FACULTY