How to choose a contractor for a medical office build-out

Choose a medical office contractor the way you would choose a specialist: by relevant experience, by the people who will actually do the work, and by how clearly they explain what is and is not included. Price matters, but two bids for the same clinic are rarely pricing the same scope. This guide covers what to verify, what to ask, and how to compare proposals.

Why medical experience matters

A clinic has more in its walls and ceilings than an office of the same size. Exam rooms repeat a plumbing and casework layout many times. Procedure rooms may need medical gas, special ventilation, or added power. Imaging rooms need shielding and structure. Many clinics are built inside occupied medical office buildings, where dust, noise, and utility shutdowns affect neighbors who are treating patients.

A contractor who has done this work knows which questions to raise during design, and that is where most of the savings are. A contractor who has not will learn on your project.

What to verify

Texas does not issue a state license for general contractors. Electricians, plumbers, air conditioning contractors, and fire sprinkler and alarm companies are licensed by the state, and most cities require contractors to register before pulling permits. Because there is no general license to look up, an owner has to check other things.

• Insurance. Ask for a certificate showing general liability, workers' compensation, and auto coverage. Your lease may set minimum limits and require the landlord to be named.
• Completed medical projects. Ask for projects similar to yours in type and size, with photographs and an owner you can call.
• References from architects and landlords. They see how a contractor behaves when something goes wrong.
• Financial strength. A bonding letter from a surety or a bank reference tells you whether the firm can carry your job.
• Safety record. Ask how safety is managed on site and who is responsible for it.
• Subcontractors. Ask which mechanical, electrical, plumbing, and medical gas firms they use on medical work, and how long they have worked together.

Questions to ask in the interview

• Who will be the project manager and the superintendent, and when will I meet them?
• How many jobs will the superintendent run at the same time as mine?
• How do you work with equipment vendors, and when do you need their drawings?
• How do you control dust, noise, and infection risk in an occupied building?
• What is your process for the city permit and the Texas accessibility (TDLR) review, and who handles each?
• How are changes priced and approved? What markup applies?
• How often will I get a schedule update and a budget update?
• What does closeout include: warranties, as-built drawings, test reports, lien waivers?
• What does your warranty cover, for how long, and who do I call?

Listen for specific answers. A contractor who builds clinics can describe the last time an equipment drawing conflicted with the architect's plan and how it was caught.

Bid, negotiated, or design-assist

There are three common ways to hire a contractor for a medical office.

• Competitive bid. The architect finishes the drawings and several contractors price them. You get market pricing, but the contractor has no input during design, and the low number often reflects what was left out.
• Negotiated. You select a contractor early on qualifications and fee. The contractor prices the design as it develops, and subcontractor bids are shared with you. You give up a head-to-head number in exchange for budget control during design.
• Design-assist. You hire the architect, and the builder joins during design to price the work and advise on systems and constructability, so the budget and the drawings stay in step.

The right choice depends on how firm your budget is, how complete your drawings are, and how much time you have before rent starts. We work under all three.

How to compare bids that do not match

When bids are far apart, the cause is usually scope, not efficiency. Put the proposals side by side and check each of these items. Ask every bidder to state in writing whether it is included, excluded, or carried as an allowance.

• Permit fees, plan review fees, and TDLR registration, review, and inspection fees
• Medical gas piping, alarms, and independent verification
• X-ray shielding and the physicist's design
• Low-voltage work: data cabling, access control, cameras, nurse call, audiovisual
• Blocking, power, and plumbing connections for owner-furnished equipment
• Millwork and casework, and who supplies exam room cabinets
• Fire alarm and sprinkler changes, including the building's required vendor
• Air balance testing
• After-hours work the landlord requires
• Allowances: what they cover and whether the amounts are realistic
• The schedule each price is based on

An allowance is a placeholder, not a price. A bid with many low allowances will grow. A bid with clear inclusions and a short list of exclusions is easier to hold to.

Contract terms worth reading closely

Read how changes are priced, when payments are due, what you receive with each payment, and what happens if the job runs late. Texas law provides standard lien waiver forms that contractors and subcontractors sign as they are paid. Ask to receive them with each payment application so you know the people working on your space have been paid. Your attorney should review the contract. A good contractor expects that.

Signs to slow down

• A price well below the others with no explanation of what is different
• No medical projects to show, or none you can call
• The people in the interview are not the people who will run the job
• Vague answers about change pricing
• Pressure to sign before the drawings or the lease are settled

Cost and schedule

How long a medical office build-out in Dallas–Fort Worth takes from permit to move-in depends on the condition of the space, procedure and imaging rooms, the building's rules, and equipment lead times. Costs move with materials, labor, and the specific space, so be wary of a cost per square foot that is not tied to your plans. Ask any contractor you interview to show where their numbers come from. Our guide to medical office build-out cost explains what moves them.

Structures and Interiors finishes out and renovates clinics and specialty practices and builds new medical buildings from the ground up across North Texas. See our medical construction page, or look at two completed clinics: Prism Dermatology in Southlake and Argyle Pediatrics in Argyle. For a new building, see GI Alliance Waco Endoscopy Center and Clinic.

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