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By Ken Jorgenson, CARR Healthcare Realty
For most health care practices, real estate is the second highest expense behind payroll. The difference between a properly or poorly negotiated transaction can benefit or cost a practice tens to hundreds of thousands of dollars over a 10-year period. Additionally, you typically get only one opportunity every five to 10 years to take advantage of a new negotiation. With this much at stake, every transaction is paramount to maximizing profitability. Being educated on commercial real estate fundamentals can increase the potential to make your practice a success. The following are key considerations to understand:
There are many property considerations to evaluate when choosing an office space for your practice. One of the most important considerations and first question to be asked is: What size space are you looking for?
Choosing the proper square footage for your new office space is a balancing act between size and money. You need to choose between how much space you need right now and how much space you will need in the future, say in five years from now or as you grow your practice. You also need to understand the cost of what you can afford now compared to what you can afford in the future.
If you play it too safe, you can end up limiting your upside and ability to grow your practice. On the other hand, if you acquire too much space, you can dramatically hurt your profitability in your first few years.
In an ideal scenario, you can find a space that gives you a healthy amount of room to grow, but also allows you to successfully manage your budget and profitability both at the beginning of the lease and through the completion of the term. Your goal is to be profitable as soon as possible, but not to the detriment of future profitability, which comes through growth.
Each real estate location and market also impacts the size you can afford. The real estate market in San Francisco, Calif. is completely different than the real estate market in Omaha, Neb. or even Denver, Colo. The more competitive the market and current economy is, the more limited your choices will most likely be.
If you are borrowing money from a lender, they may require your total monthly rent to be below a specific amount during the first few years of the lease or set a cap on the average monthly mortgage payment if you are purchasing. The specific amount of money these numbers are typically based upon is derived from the lender’s underwriting guidelines and are aimed at keeping the monthly payments to a manageable amount, especially in the first few years.
The best way to understand how to choose between the ideal amount of space and budget, is to work with several partners who can each help you balance the two decisions. A lender will tell you what your maximum budget is. An architect or general contractor can help you determine how much you can build inside the space and at what cost. An experienced health care real estate agent can make sure you evaluate your top options that best fit your requirements, and then how each option compares to the others — both financially and through other important business considerations.
Selecting the proper square footage for your new office is an extremely important decision that you should make based upon market knowledge, current and future needs, and most importantly — budget.
Another vital property consideration for your office space is parking, for both your staff and your patients. When evaluating the parking needs for your patients, you have three groups to consider: patients who are coming to your office, patients who are already inside your office and patients who are leaving your office.
Depending on your schedule, there can be a high demand on the parking allotted to your space due to other tenants sharing your parking lot. While most medical office buildings and retail centers have a higher parking ratio for this reason, its important to make sure the property you are considering has ample parking both for your needs and the needs of other tenants that ebb and flow throughout the day.
While some landlords allow specific tenants to have a few reserved parking spaces, the majority of landlords do not grant exclusive parking spaces for patients. This means it’s important to ensure the locations you are considering can accommodate your current practice and future growth.
Two of the most requested property considerations for new offices are strong visibility and exterior signage, either on the building itself or on a prominent monument sign in front of the building. These requests also are two of the most important items for nearly every national retail tenant. Large, national retailers count on the visibility and signage of their locations for marketing, brand awareness and most importantly, driving business to their stores.
Since the early 2000s, more and more health care providers have been seeking the same benefits that come from the positive exposure of both visibility and signage. It helps patients find your location and provides built-in marketing and brand awareness.
That being said, visibility and signage usually come with a higher price tag. In the majority of commercial real estate markets, landlords charge a premium for high visibility properties, spaces and signage. Landlords understand the value that visibility and signage offer, and properties that benefit from them typically are priced higher than similar properties that don’t have the same exposure.
Even government agencies, such as real estate assessors, recognize this when valuing properties. You can expect the majority of properties that offer high visibility and signage to be assessed with higher property taxes and as a result, will have higher operating expenses. It’s important to weigh the increase in your real estate evaluation and, if applicable, evaluate if the increase in monthly rent or mortgage will benefit your practice proportionately. There are many times that the exposure and signage is worth the added expense. An alternative and potentially stronger position could be to select a property that would save you more money on a monthly basis and use the savings to invest in a targeted marketing strategy.
Last, there are some specific types of practices that are 100% driven by referrals of other practitioners, where little benefit is obtained or needed from either visibility or signage. If the vast majority of your new patients are coming at the recommendation of a referring doctor, paying the premium for signage and visibility may not be worth it.
As with most financial decisions, a detailed evaluation provided by your agent should help you weigh the difference between cost and benefit.
Another main consideration alongside visibility and signage is access to your office. In other words, if a patient is driving to your office, what is the closest major intersection to your property? Where do you turn to get into your property’s parking lot? Does the property have great visibility but challenging or poor access? That problem can occur when the primary access point to a property is a location you need to turn into before you can actually see the building. When that happens, a new patient drives by the building and sees your office, but then has to pull a U-turn or make multiple turns to get back to the main access point of your location. Thankfully, the majority of new patients will rely upon GPS and mapping software on their phone to find your office the first time. However, the easier the access is for the patient to get to your building and the more recognizable the major intersections or known landmarks are to your property, the more ideal the patient’s experience is in finding your office. Thus, the more likely patients or referral practices will recommend you.
The next property consideration we are going to discuss is the impact of what are commonly referred to as anchor tenants as well as complimentary health care providers. This often is an overlooked but important consideration when it comes to commercial real estate fundamentals.
Anchor tenants are most commonly found in large shopping centers and areas that are located nearby your office space or in the same building or complex. Anchors often are identified as grocery stores, warehouse clubs, depots, large retailers and other prominent tenants that drive a significant amount of foot traffic into stores and shopping areas. Anchor tenants attract other businesses and retailers who desire to be located nearby for the same reasons. Overall, anchor tenants increase the number of customers or clients in a specific area.
Anchor tenants also can be smaller in size, as long as they drive significant traffic to a property. For instance, a prominent coffee shop might bring several hundred visitors to a property in a single day. Other restaurants or retailers with a smaller size also may be able to attract a noteworthy amount of potential new patients.
A health care practice within an office building, medical office building or on a hospital campus that has complimentary practices located in the same building or campus can have a huge impact on the success of your practice. For instance, if you are pediatric dentist, being in a building with a pediatric physician could have a huge impact on the number of new patients you see. Many health care providers will seek out buildings or campuses that allow themselves to be surrounded by other providers who are both complimentary and can provide tangible opportunities for referrals.
In summary, there are pros and cons to nearly every property, and each consideration needs to be weighed. The space you are the most excited about might be the most expensive or above your budget. The center that has the most traffic and visitors per day might have the most challenging parking if you are competing for parking against other busy tenants. A property that is priced the most competitively might not offer the visibility and signage you would ideally like.
It’s incredibly important to truly understand all the property options that meet your requirements. To do this, you should hire professional representation and make sure you are evaluating and negotiating with multiple owners whenever possible. This allows you to compare multiple spaces, buildings, landlords and offers against the other options, so you are able to make the best decision possible. Real estate will make a major impact on your practice’s profitability. Make the most of every opportunity.
CARR Healthcare is the nation’s leading provider of commercial real estate services for health care tenants and buyers. Every year, thousands of health care practices trust CARR to achieve the most favorable terms on their lease and purchase negotiations. CARR’s team of experts assist with startups, lease renewals, expansions, relocations, additional offices, purchases and practice transitions. Health care practices choose CARR to save them a substantial amount of time and money, while ensuring their interests are always first. Visit CARR.US to find an expert agent representing health care practices in your area.
By Cirrus Consulting Group
There’s an old saying that goes, “Leave it to the professionals.” When you need a haircut, go to a barber. When you need your car fixed, see a mechanic. Seems obvious when you put it in these terms, but in today’s do-it-yourself (DIY) culture, business owners are increasingly circumventing professional services to go it alone. In the world of dentistry, negotiating a risk-free dental office lease with fair and reasonable economic terms is an essential component to mitigating risk and running a successful practice — and yet — it’s not always obvious to practitioners why they should consult a professional dental office lease negotiator.
Signing your lease is one of the most important, expensive and significant commitments you’ll ever make as a dentist, and going in blind or ill-prepared can have lasting implications. Here are a few reasons why you should leave your lease negotiations to the pros.
1. The Doomed DIYer
The obvious upside in not hiring a professional dental office leasing negotiator is that you won’t have to pay their fees. Often, this is the single biggest motivator for dentists who view the task as one they can easily tackle themselves. Of course, as with many such tasks, you get what you pay for.
Consider the amateur handyman who decides to build his own furniture; he can save money by building his own bookcase, but what happens one month later when the shelves give out because it was poorly constructed? The bookcase collapses, the objects on the shelves end up broken, it creates a mess and leaves the “handyman” right back where he started — no bookcase, plus one mess and minus several treasured objects. Because poor planning and mismanagement of a dental office lease permeates every aspect of a practice, this is one area where an investment today can save big bucks tomorrow.
If you sidestep the experts, you won’t be getting their professional guidance and advice that exposes you to significant financial repercussions and the unnecessary risks that come with a poorly negotiated lease agreement. Every time you renegotiate or renew your lease, you are committing to another $500,000 to $1 million contract. Spending a fraction of this contract value to ensure that your future is protected just makes good business sense. The value that a professional dental office lease negotiator brings — both economically and in terms of risk reduction — is worth far more than the initial investment of their fee, not to mention the substantial, long-term savings that can be achieved with proper representation.
2. More Time to Dedicate to Your Practice
The most immediate benefit to working with a professional lease negotiator is the amount of time saved. Spending more time chairside is critical to the practice’s success. When you decided to open a dental clinic, you probably didn’t realize you were signing up for all of the administrative burdens required to run a successful practice. Whether you’re just starting out or are growing an established practice, taking chairside time away to review the lease, research market rental rates, negotiate with your landlord and understand tenant rights is a time-consuming nuisance.
Don’t be fooled into thinking that the only step in lease negotiations is the initial review and signing of the contract, or that your landlord has prepared a fair lease that will see you through your career. Lease negotiations are a dynamic and potentially lengthy, ongoing process that require a dedicated time investment — if you’re doing it right. A reactive tenant acts only when prompted, or upon finding themselves up against a deadline. Often, this means it’s too late to get a favorable outcome, i.e., when your lease is about to expire and you’re at the mercy of your landlord. A smart dental tenant is pro-active, and by working with a professional negotiator, you will ensure that you have both the leverage and knowledge to be successful in securing a favorable lease agreement for the practice.
3. Reap the Benefits of Comprehensive Services and Support
Working with a professional dental office lease negotiation firm is an eye-opener for most practitioners because they don’t realize how much more they can be doing to optimize their practice. Professionals will not only identify landlord-set lease traps and negotiate the best deal for you, but also provide a wealth of business acumen and resources to improve your practice. Lease negotiation is a core function, but there is a wide spectrum of services that a lease negotiation firm provides, including insight from market research and data analysts, in-house brokers, attorneys and ex-landlords. Whether designing asset protection terms, or leveraging emerging market trends to help you map out practice goals, your lease negotiator is backed by a team of experts who put all the pieces together, and deliver a results-focused business solution for your peace of mind.
4. Your Future Self Will Thank You for Strategy-Planning Now
Most dentists are naturally eager to build out the practice and open their doors. However, in their haste, they often fail to consider their mid-range and long-term goals. The details in your office lease dictate key aspects of your business, such as the ability to bring in associates or specialists, the conditions under which you sell the practice, obligations and restrictions for remodeling or expanding, etc. — which is why the details within the lease should not be taken lightly. A skilled dental office lease negotiator will outline a comprehensive negotiation strategy that aligns with both your short- and long-term goals, and takes the big picture into account — so your lease doesn’t hinder you as you progress in your career.
5. Relax! Someone Else Will Fight Your Battles
Lease negotiations with a current or prospective landlord sometimes means playing hardball, and some individuals are simply not comfortable with, or capable of, getting tough and asking for what they want and deserve. But it’s not just about being assertive; you also have to know what the stakes are, and how to best achieve the desired results. A lease negotiator acts as your own personal advocate to represent your best interests, and ensures that your leasing needs are being met. For example, as a dental tenant, you may not immediately appreciate the importance of addressing “relocation language” that prevents your landlord from moving your clinic, or the amendment of the “assignment” clause, preventing your landlord from taking 50 percent or more of your practice sale proceeds at transition time. Your negotiator, however, knows that strategic tactics today will certainly pay off later, and that every word in your lease agreement can have major implications down the road.
Keep in mind that your landlord will draft a lease that benefits them, not you. In their hands, the lease is a tool towards achieving financial flexibility and power. Your lease negotiator can convert a bad lease into armor to protect your assets, family and estate, and optimize the lease in your favor. They will negotiate the best terms and rental rates possible so that you, not your landlord, are in control of your financial future.
6. Do you speak “Legalese?” We do!
Dental office lease agreements can be complex and lengthy, full of technical legal jargon and contain terms that aren’t tenant-friendly for the average business owner. Navigating the tricky and complex language is just one challenge. The bigger obstacle is identifying expensive traps and risks, and understanding what must be done to reduce or eliminate them. Most leases leave the tenant vulnerable to expensive penalties and inconvenient pitfalls that can have devastating effects on their career or practice. Before signing, it’s your responsibility to review the proposed terms. But how will you know what to look for? A seemingly innocuous statement may harm you down the road, and similarly, the absence of a key clause can leave you, your assets, your family and your practice exposed.
For example, did you know that you can be held financially responsible for the practice even after a sale or transfer of the lease? Or that you could be forced to bear the financial burden of a forced relocation? Dental office leasing professionals will review your lease and identify risky terms that have been intentionally buried or obscured by your landlord. The negotiator will use their skills to revise the lease to work in your favor — something that an untrained professional simply cannot do. This is one of the key differences between a professional dental office lease negotiator and a general commercial lawyer/attorney. While lawyers can be experts in contract management and negotiation, they often lack dental industry and real estate experience to produce a lease agreement that both protects and enhances the value of a dental practice. If you’ve retained an attorney, ask them how many dental office leases they’ve negotiated. Dental lease negotiators have specialized expertise in contract negotiation, dental tenant rights, practice optimization — and, they understand the industry inside and out.
Would you go to a mechanic to get your haircut, or a barber to fix your car? If the answer is “no” to both, why would you, as a dentist, handle your own lease negotiation? Gambling with the fate of your entire practice hardly seems worthwhile when you have a team of specialists just a phone call away. Some things are just better left to the experts! For more information, go to www.cirrusconsultinggroup.com.
By a Fellow FDA Member
Call it intuition, but I had the feeling we —and the entire east coast of Florida — dodged a bullet last year with Hurricane Matthew. It just seemed like a matter of time before our 13-year dry spell was going to end.
I desperately wanted to be wrong, as I watched CNN every evening for the latest update on Hurricane Irma, and the National Hurricane Center for the more elaborate interpretation.
The memories of spending another post-Labor Day weekend away from home (Hurricane Frances, 2004) sadly is still too vivid in our memories. I worked as a dentist a total of four days that month, and two of those were without air conditioning — which is a testament to the determination of my staff and my patients to create a sense of “normalcy” in the aftermath, despite the obvious disruption to our personal lives.
Doctors, it is time for “Plan B.”
Depending on where you are in your practice career, it may not make economic sense to “build over” before or after your insurance adjuster has given you the final assessment. For dentists with more than 25 years of practice, the return on investment may not be in your favor at such a late period, as the current tax laws for business owners after 50 provide decent “catch-up” provisions in a defined benefit (like a government pension) and defined contribution (401K-type) plans that would be more beneficial.
For a mid-career solo practitioner, you have been faced with rising overhead costs since 2007, and along with diminished income (ADA Health Policy Institute has the data), the time is ripe for a multi-doctor practice formation, which should always be created with expert legal and financial advice.
Look “around the neighborhood” and reach out to other dentists who may share the same dilemma you do. If you have damage to your office, and someone nearby does not, now would be the time to construct a well-defined contract that outlines the term and time limit for this new arrangement. And if the relationship works on a limited basis, you may find the new arrangement something you want to solidify.
Likewise, if your office came out unscathed, reach out to your colleagues in this period and strategize. This is not a DIY project, so retain the professional advice you need to make this happen. Involve your bankers and financial advisors for expert advice.
In closing, I want you to know that I understand what you have gone through, and I look at 2004 as a defining year in my professional career. The decisions I made after these disasters guided me to where I am today, and my family is better for it.
Make the right choice for your loved ones and your staff members, and don’t be afraid to execute “Plan B!”
Beyond the Bite 