Develop Sustainable Ownership Structures

Develop Sustainable Ownership Structures

Aligning Medical Practices and their Real Estate | Buy-ins, Buyouts, & Operating Agreement Provisions


Develop Sustainable Ownership Structures

Have you joined a medical group with an excessive real estate buy-in?

New physician partners are often afforded the opportunity to buy into their practice’s real estate holdings as a subsequent step to becoming a shareholder in the practice. This may be perceived as onerous because the capital requirement for entering the real estate is generally substantial and oftentimes disproportionately larger than the buy in for the practice, or other ancillaries. As the investment matures, debt is repaid and buildings appreciate. There is typically an increased buildup of equity and, therefore, an increased buy-in for new partners. Compounding this, young physicians are often encumbered with substantial student debt, making a large real estate buy-in less appealing.

CMAC creates sustainable and reproducible equity ownership structures that allows for new partners to afford and participate in real estate investment, therefore, enhancing physician practice continuity.


"Probably the biggest impact from CMAC was their expertise with a re-syndication effort. They ran multiple models, probably 40 to 50 total, between different options we had."
David Morris, MD, President - Urology Associates, P.C., Nashville, TN

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Recent News


A New Management Tool Assures Groups of Partner Buy-in/Buyout Success

Physician real estate succession planning is consistently a primary conversation amongst medical practices....

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Partner Buy-In

Turnkey Solution Developed A worst-case scenario came true for an orthopedic practice in Washington state...

Turnkey Solution Developed A worst-case scenario came true for an orthopedic practice in Washington state when 8 of the 11 partners told the remaining 3 who owned the real estate that they...


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Funding Buyouts & Buy-ins

Buying out the old and bringing in the new In the beginning, it was easy. The practice partners decided to own...

Buying out the old and bringing in the new In the beginning, it was easy. The practice partners decided to own their medical office building and, in turn, they all became real estate partners...


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The Three Key Elements of an Operating Agreement

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The Crucial Importance of Maintaining Debt in Physician-Owned Real Estate

Debt = Leverage = Sustainable Investment When members of a practice group decide to become investors in the...

Debt = Leverage = Sustainable Investment When members of a practice group decide to become investors in the practice real estate, there are two primary questions they need to ask: Can I...


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Perfection is the Enemy of Progress

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Real Estate Roll Ups

Bringing Disparate Ownership Together Takes Center Stage There is an issue that is growing more and more common -...

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Maintaining Practice Glue in a Sale-Leaseback

Sale-leasebacks can be beneficial under the right conditions, but they can also unknowingly bring...

Sale-leasebacks can be beneficial under the right conditions, but they can also unknowingly bring pitfalls. What many practices don’t realize is that, in a typical sale-leaseback...


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Why More Doctors Are Saying “NO” to REITs

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