Medical Office Building Checklist
What Healthcare Providers Need to Know in 2026
If you are a physician group, healthcare system, or outpatient provider evaluating medical office space right now, the market is not working in your favor, and that is worth understanding before you start touring buildings.
National MOB vacancy sits in the 7 to 9 percent range heading into 2026, well below the vacancy plaguing conventional office. In the top Sunbelt markets, vacancy in quality product is at 7.5 percent or lower. New construction has been constrained by financing costs and elevated construction expenses, which means the pipeline of new supply is thin. The result is a landlord-favorable market in most metros where well-located, properly configured medical office space is in genuine short supply.
At the same time, tenant improvement costs have risen sharply. Medical build-outs now commonly run $150 to $380 per square foot nationally, depending on specialty, market, and complexity, and those costs are increasing five to eight percent year over year. Average asking rents in the top 50 markets have climbed to $26.35 per square foot, a 17 percent increase over the past eight years.
All of this means that site selection decisions carry more financial weight than ever. A mistake today is not just inconvenient. It can follow your practice for ten years or more. The following checklist is designed to help healthcare providers evaluate potential MOB sites with the rigor this market demands.
1. Location and Access
In a tight market, the temptation is to take what is available. Resist it. Location drives patient acquisition, physician retention, and long-term practice viability in ways that are difficult to reverse once you are locked into a lease.
Evaluate proximity to referring hospitals and your core patient population. Run drive-time analyses for both physicians and patients, not just a radius map. Assess visibility from major roads, ease of patient drop-off, ADA accessibility, and public transit options if your patient base relies on them. In high-growth Sunbelt submarkets especially, traffic patterns shift quickly, and a location that works today may be significantly less accessible five years from now.
2. Parking and Transportation
Parking is a patient experience issue before it is a real estate issue. A ratio of 5 spaces per 1,000 square feet is the standard benchmark for medical office use, and anything below that warrants a hard look at peak-hour demand before you sign. Evaluate the separation of physician and staff parking from patient parking, the availability of covered or structured parking, and access for ambulances or patient transport vehicles if your clinical program requires it.
3. Building Systems and Infrastructure
This is where many healthcare tenants underestimate their exposure. Medical use places demands on building systems that standard office buildings were never designed to handle. Before going further in any site evaluation, verify HVAC capacity for clinical use, including the ability to meet infection control and pressure relationship requirements. Assess life safety systems, backup power, ceiling heights for imaging equipment, and overall code compliance. Buildings that look fine on the surface often reveal significant system deficiencies once a healthcare architect gets involved, and those deficiencies translate directly into build-out cost.
4. Space Configuration
Floorplate efficiency matters more in healthcare than in almost any other use. Evaluate column spacing, the ability to configure exam rooms and imaging suites, existing plumbing infrastructure, and the overall flow of the layout from a patient experience standpoint. Natural light, intuitive wayfinding, and the ability to accommodate future expansion or contraction are all worth assessing upfront. In a constrained supply environment, finding a space that is already configured for medical use, or close to it, can save significant time and capital.
5. Tenant Improvement Allowances and Build-Out Economics
With construction costs where they are, TI negotiation is one of the highest-leverage elements of any medical office transaction. Landlord allowances in most markets have not kept pace with actual build-out costs, which means the gap between what the landlord offers and what the build-out actually costs is being absorbed by the tenant. Understanding that gap before you negotiate, not after, is critical.
Get a preliminary cost estimate from a healthcare architect or contractor before you finalize lease economics. Know what a realistic allowance looks like for your specific clinical program, and negotiate accordingly. Also assess the availability of experienced healthcare contractors and architects in the market, permitting timelines, and whether the landlord is offering a turnkey delivery or a tenant-managed allowance structure.
6. Lease Economics
Base rent is the starting point, not the finish line. Evaluate operating expenses including CAM, utilities, and janitorial costs carefully, as these can vary significantly between buildings and add meaningful cost over a seven to ten year term. Scrutinize escalation provisions, renewal option structures, and landlord concessions including free rent, parking, and signage. In the current market, landlords in well-leased buildings have less motivation to offer aggressive concessions, which makes a competitive process among multiple sites even more important.
7. Landlord Quality and Building Management
A landlord’s experience with medical tenants is not a minor consideration. Healthcare leases involve after-hours access, extended operating hours, specialized maintenance needs, and lease provisions that general commercial landlords often resist or misunderstand. Evaluate the owner’s track record with medical tenants, the responsiveness of on-site property management, and the landlord’s willingness to engage seriously on healthcare-specific lease language. A landlord who views medical tenants as more trouble than they are worth will create problems throughout the lease term.
8. Regulatory and Market Considerations
Confirm zoning and land use compliance for your intended clinical use before investing further time in any site. Address certificate of need requirements if applicable to your state and specialty. Evaluate the local demographics and payor mix relative to your patient population, and take a clear-eyed look at competing providers in the trade area. In high-growth Sunbelt submarkets, demand growth is strong enough to support new entrants. In saturated markets, the same analysis looks very different. Know which situation you are walking into.
Ready to evaluate medical office building options for your practice or health system? Contact Coy Davidson, Senior Vice President at Colliers Houston, for expert guidance on MOB site selection, leasing strategy, and healthcare real estate in Houston and across the country.
Frequently Asked Questions
Q: How do I know if a medical office building can actually support my clinical program before I sign a lease?
The only reliable way to find out is to engage a healthcare architect for a preliminary building assessment before lease execution, not after. Many MOBs, particularly older or converted general office buildings, have HVAC, electrical, and plumbing systems that fall short of clinical requirements without significant capital investment. That investment does not always show up in the landlord’s TI allowance. A pre-lease assessment identifies system gaps, estimates the real cost of bringing the building up to your clinical standards, and gives you the information you need to negotiate from an informed position. Skipping this step is one of the most common and costly mistakes healthcare tenants make.
Q: What lease term should a physician practice or healthcare provider target for a medical office lease in 2026?
In the current market, longer terms generally work in the tenant’s favor from an economics standpoint, because landlords are willing to offer larger tenant improvement allowances and more meaningful concessions in exchange for lease duration. Medical office leases of seven to ten years are standard, and for practices with significant build-out requirements, a shorter term often means absorbing more of the construction cost yourself. That said, a longer term without flexibility provisions is a risk. Renewal options, expansion rights, and where justified, contraction or termination rights, should all be negotiated into the lease structure regardless of term length. The goal is to capture the financial benefits of a long-term commitment while preserving the operational flexibility to adapt as your practice evolves.
