Expanding Into the Suite Next Door: Adding Space to an Open Practice

When a practice outgrows its space, the suite next door is often the easiest place to grow. Patients already know the address, the waiting room and front desk can stay put, and you avoid the cost and downtime of a move. But joining two suites is not the same as finishing out an empty one. The wall between them may be fire-rated, the two suites may run on separate systems, and the work has to happen while your practice keeps seeing patients. This guide covers what to check, what to plan, and how to phase the work.

Before you sign for the extra space

An expansion usually starts with a lease amendment, and it deserves the same care as the original lease. Ask the landlord for a tenant improvement allowance for the new space, a rent start date that leaves time to build, and permission for the work you plan, including opening the wall. Find out whether the term of the new space can line up with your current lease, so you are not left with two suites that expire years apart. Our guide on what to ask before signing a medical lease covers those questions.

Walk the suite with your contractor before you sign. A suite that has been empty for years may have aging rooftop units, a small electrical panel, or ceilings and walls that need to come out. A suite built out for another medical tenant may have plumbing you can reuse. Ask the landlord for the building's drawings, and ask whether the slab is post-tensioned, because that affects how plumbing trenches are cut.

Opening the demising wall

The demising wall is the wall that separates one tenant from another. In many buildings it runs from the floor to the roof or floor deck above, and it may be fire-rated. Before you plan a wide opening, find out three things:

• Is it load-bearing? In some buildings, especially older ones, the demising wall carries the roof. A structural engineer can design a beam for an opening.
• Is it rated, and does it need to stay rated? Once two suites become one, the wall between them may no longer need a rating. Any wall that still faces another tenant does.
• What runs through it? Ducts, pipes, and conduit often pass through demising walls and may need to move.

Sometimes the expansion calls for a new demising wall instead, when you take only part of the next suite or a neighbor stays open on the other side. At Fort Worth Plastic Surgery, a 3,300-square-foot suite we completed in 2023, we turned a previously finished office into a suite with two operating rooms and three exam rooms. The work included a fire-rated demising wall built next to an occupied tenant and integrating the new space with an existing practice.

Combining the building systems

Two suites built at different times rarely share systems neatly. Plan for each one:

• Heating and cooling. Each suite usually has its own rooftop units and thermostats. Exam and procedure rooms need more cooling than the old layout may have had, so the units may need to be replaced or zoned differently.
• Electric. You may end up with two meters and two panels. Decide whether to combine them or keep both, and confirm that the service can carry any new equipment.
• Plumbing. New sinks, restrooms, and dental or lab lines usually mean saw-cutting the slab and tying into the existing sewer. Our article on estimating foundations explains why the slab matters.
• Fire alarm, sprinklers, and data. Sprinkler heads move with the new walls, the alarm system has to cover the whole suite, and your phone, data, and security systems need to reach the new rooms.

Exits, accessibility, and permits

A bigger suite can change what the building code asks for. More floor area means more occupants, and that can call for a second exit, wider corridors, or a shorter travel distance to an exit. Your architect will check this early, and it can shape the layout.

In Texas, an alteration also brings the Texas Accessibility Standards into play. Beyond the new rooms themselves, the path of travel to the altered area, including the restrooms that serve it, may need upgrades. Projects above the state's cost threshold need registration with the Texas Department of Licensing and Regulation, a plan review, and an inspection.

The expansion needs a building permit, and the combined suite needs a certificate of occupancy for its new size. Adding X-ray or other imaging brings a state registration, and a licensed surgery center needs state review of the changes. Our guide to building permits for medical offices in DFW walks through each step.

Phasing the work around patients

The usual approach is to build out the new suite first, behind the existing wall, while your practice runs as usual next door. Noise, dust, and deliveries stay on the far side of the wall, with a separate entrance for workers where the building allows one. Most of the project happens before you notice it.

The steps that touch your space come last and are grouped together: opening the wall, tying into your plumbing and power, extending the fire alarm, and remodeling any rooms on your side. Those can often be done after hours or over a weekend, with dust barriers and negative air where patients are close by. Our guide to renovating while you stay open covers barriers, infection control, and exits during construction.

The same approach works for a building addition. At Eagle Ranch Vision Source in Fort Worth, a 3,350-square-foot optometry office completed in 2021, we built an addition with a new reception area, waiting room, and several exam rooms, and remodeled the retail space and lab, while the office remained fully operational. Phased construction kept the practice working through the job.

When the suite next door is not the answer

Sometimes the next suite is not available, or joining it would leave a layout that never works well. If you own your building, an addition may make sense. If you lease, a move to a larger suite or a building of your own may serve the practice better over the long term. Our article on whether to own or lease your practice building walks through that choice.

We prepare a first budget at no charge, so you can compare the options before you commit. It is an early range, and a detailed estimate is priced later from the drawings. Learn more about how we finish out and renovate existing space. We also build new buildings from the ground up for practices ready for their own building.

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