Get Into Your Space On Time, Under Budget, Ready to See Patients.
From initial site viability through the day you open your doors, our project management team coordinates every component of a clinical construction project — reducing costs, mitigating risks, and making sure nothing falls through the cracks while you focus on your practice.
Site Viability and Pre-Construction Before You Sign Anything
The most expensive mistakes in clinical construction happen before the first drawing is produced — when a physician commits to a space without fully understanding its clinical feasibility, buildout cost, or timeline. We eliminate that risk.
Site Viability Assessment
Before you sign a lease or execute a purchase contract, we evaluate whether the space can actually support your clinical program. Structural review, MEP infrastructure capacity, ADA compliance gaps, HVAC and plumbing adequacy, and zoning confirmation — all assessed before you are contractually committed.
Pre-Construction Test Fits
Preliminary space planning that lays your clinical program into the proposed floor plan — exam room count, procedure space, clinical support areas, patient flow, and staff work zones — to confirm the space actually works for your specialty before any lease is signed.
Pre-Construction Budgeting
A realistic, clinical-specific construction budget developed before design begins — itemized by trade, benchmarked against current healthcare construction costs, and structured to give you a defensible number for lease TI negotiation and financing discussions.
Schedule Feasibility
A realistic construction and permitting timeline before you commit — so your occupancy date, lease commencement, and staff hiring plan are based on what the project will actually take, not what a broker or landlord suggests is possible.
Project Management Process
Coordinating Every Component From Design Through Opening Day
A clinical construction project involves architects, engineers, contractors, subcontractors, equipment vendors, IT and telecom providers, landlords, regulators, and inspectors — all of whom need to be coordinated, managed, and held accountable simultaneously. That is what we do.
Phase 01
Pre-Construction
Site viability, test fits, budget development, architect selection, permit strategy, and contractor bidding. We establish the foundation before any construction contract is signed — protecting your budget and your timeline from the start.
Phase 02
Design Management
Clinical programming integrated into architectural design, drawing review against your specialty requirements, equipment coordination with medical planners, and change management to prevent scope creep before it happens.
Phase 03
Construction Oversight
Weekly site visits, draw request review, schedule tracking, RFI and submittal management, subcontractor coordination, and real-time budget monitoring. Your interests protected at every stage — not reported on quarterly.
Phase 04
Closeout & Opening
Punch list management, commissioning coordination, regulatory inspection prep, certificate of occupancy, equipment installation oversight, and opening-day readiness — through first patient visit.
Cost and Risk Management
Reducing Costs and Mitigating Risk At Every Stage of the Project
Competitive Bidding Management
We manage the GC and subcontractor bid process — ensuring competitive pricing, apples-to-apples bid comparison, and contractor selection based on healthcare construction experience, not just lowest number.
Change Order Control
Change orders are where construction budgets unravel. We review every change for necessity and pricing before approval — eliminating speculative markups and scope additions that serve the contractor, not the project.
Schedule Risk Management
Every week of delay has a real cost — continued rent on your old space, deferred revenue, and staff disruption. We identify schedule risks early and push for resolution before they compound into a formal delay.
TI Allowance Optimization
Your lease’s tenant improvement allowance is a negotiated number. Our pre-construction budget gives you the data to negotiate a TI that actually covers your buildout — rather than accepting a landlord’s arbitrary allowance as-is.
Regulatory Risk Mitigation
Permit delays, inspection failures, and code compliance issues are the most common causes of clinical project delays. We identify potential compliance gaps during design — before they become construction problems.
Equipment & Technology Coordination
Medical equipment, imaging systems, IT infrastructure, and telecom requirements coordinated with design and construction sequencing — eliminating the rework that happens when equipment specifications arrive after walls are built.
Project Types
Every Type of Clinical Construction Project
Medical Office Buildouts
New tenant buildouts, ground-up fit-outs, and practice relocations managed from lease execution through move-in — with clinical workflow expertise embedded in every decision.
Adaptive Reuse Construction
Full project management for ambulatory surgery center development, integrated with our Adaptive Reuse team for regulatory navigation and clinical commissioning.
Imaging & Procedure Centers
Radiology suites, imaging centers, and outpatient procedure facilities requiring specialized infrastructure, shielding, medical gas, and equipment coordination.
Ground-Up Facilities
Owner’s representation for ground-up medical office buildings and outpatient facilities from permit application through certificate of occupancy.
Renovation & Expansion
Existing facility renovations and practice expansions managed to minimize disruption to active clinical operations — phased construction planned around your patient schedule.
Multi-Site Rollouts
Coordinated project management for physician groups or DSO platforms opening multiple locations simultaneously — with standardized processes that ensure consistency and reduce per-location cost.
Frequently Asked Questions
Questions We Hear Most Often
Substantive answers to the questions physicians and healthcare investors ask most frequently about this service.
What does a construction owner’s representative do for a physician building project?
An owner’s representative — also called an owner’s rep or project manager — acts as the physician’s agent throughout the design and construction process, managing all relationships with the architect, engineers, general contractor, and subcontractors on the owner’s behalf. Specific responsibilities include: coordinating the design process to ensure clinical requirements are accurately reflected in construction documents; managing the competitive bidding process for general contractor selection; reviewing and approving contractor pay applications and change orders; monitoring construction schedule and budget in real time; serving as the primary point of contact for all project-related communications; and managing the closeout process through certificate of occupancy. For physicians who are running a practice while managing a construction project, an owner’s rep is the difference between a project that delivers on time and on budget and one that does not.
What is a construction test fit and why does a physician need one before signing a lease?
A test fit is a preliminary space plan that lays your specific clinical program into a prospective space — mapping exam rooms, procedure areas, clinical support spaces, staff work zones, waiting areas, and patient flow — to verify that the space actually accommodates your program before you execute a lease. Test fits are produced quickly and at low cost relative to the commitment they inform. They answer the question every physician should ask before signing: will this space actually work for my practice? Test fits also produce a preliminary square footage requirement and buildout scope that informs tenant improvement allowance negotiation, construction timeline estimation, and lease commencement planning. We produce test fits as standard pre-lease advisory for every new location or major renovation engagement.
How do I budget for a medical office buildout?
A medical office buildout budget should include: hard construction costs (demolition, framing, MEP rough-in and finish, flooring, ceilings, doors and hardware, painting); clinical infrastructure costs (medical gas, specialized plumbing, enhanced electrical for medical equipment); architectural and engineering fees (typically 8 to 12 percent of hard costs for medical office); furniture, fixtures, and equipment (FF&E); medical equipment procurement and installation; IT and telecom infrastructure; permit fees; and a contingency reserve of 10 to 15 percent for unforeseen conditions. Clinical buildouts in the northeastern United States typically run $75 to $200 per square foot in hard construction costs depending on specialty, existing conditions, and market. We prepare detailed, trade-by-trade budgets before any construction contract is awarded.
What are the most common causes of medical office construction delays and cost overruns?
The most common causes are: inadequate pre-construction planning that produces an incomplete scope of work and inaccurate budget at contract signing; change orders driven by design errors, owner-requested scope changes, or unforeseen existing conditions discovered during demolition; permitting delays due to incomplete or non-compliant drawings submitted for review; equipment specification conflicts where medical equipment requirements were not integrated into the design documents early enough; subcontractor coordination failures in multi-trade projects, particularly when medical gas, radiology shielding, or specialized clinical infrastructure is involved; and supply chain delays for long-lead clinical equipment items. We address each of these through our pre-construction process — site viability assessment, complete test fits, trade-by-trade budgeting, and permit-ready drawing review before a contract is awarded.
How does physician tenant improvement allowance negotiation work and how much should I expect?
Tenant improvement allowance (TI) is the amount the landlord contributes per square foot toward your buildout cost. In medical office leases, TI is negotiated as part of the overall lease economics — larger allowances typically correspond to longer lease terms, stronger tenant credit, and higher base rent. Medical TI allowances in the northeastern United States range widely: $40 to $80 per square foot for warm-shell spaces requiring full buildout, and $20 to $50 per square foot for second-generation medical spaces with existing clinical infrastructure. The single most powerful tool in TI negotiation is a pre-construction budget — when you can show a landlord exactly what your buildout costs and document it trade by trade, the negotiation shifts from the landlord’s arbitrary allowance to the actual number. We produce this documentation before every lease negotiation.
Have a Space? Have a Project? Let’s Make Sure It Works Before You Commit.
A pre-construction site viability review and test fit can save significant cost and time — and confirm you’re in the right space before you sign. The earlier we engage, the more value we deliver.