The orthopedic physicians of Signature Medical Group realized the real estate buy-in for incoming physicians had become unaffordable and prohibitive. Through a series of analyses, they decided their optimal outcome was to complete a cash-out refinance on their primary location that, at the time, was free and clear of any bank debt. The group learned that leverage has the upside of allowing the younger physicians to become real estate owners and benefit from the significant ancillary income, providing more glue to retain the partners. In the process, the group was able to enhance the return on equity through the amplification of that return through bank leverage. CMAC assisted the group to negotiate the best terms from more than two dozen banks while working on a tax-efficient process for distributing the loan proceeds.