What drives medical office build-out cost in Dallas–Fort Worth
By Structures and Interiors.
A medical office build-out in Dallas–Fort Worth can cost about what a good office finish-out costs or far more, depending on the specialty, the space, and whether you are finishing out a suite or building new. Exam rooms are simple. Procedure rooms, imaging, and the building's own limits are what move the cost. Below we cover what drives the cost, what sets the schedule in each phase, and what a construction price usually leaves out.
We do not list prices per square foot here. Costs move with materials, labor, and the specific space, so S&I gives each project a first budget at no charge and a detailed estimate later from the drawings.
This guide does not give week counts either. How long each phase takes depends on the space or site, the city, and the lead times on equipment and building systems. The table below shows what sets the time in each phase, and S&I works out the calendar for your project alongside the first budget.
Where you start sets the cost
The same practice, with the same rooms, costs a different amount in each of these starting conditions.
| Project type | What it means | What moves the cost |
|---|---|---|
| Finish-out of shell space | A new, empty suite in a medical office building or retail center. Everything inside the demising walls is built new. | The number of exam rooms and sinks, the air conditioning and electrical service the landlord provides, and the finishes. Predictable to price, because nothing existing has to be worked around. |
| Second-generation medical space | A former clinic. Exam rooms, sinks, restrooms, and systems may be reused if the layout suits your practice. | How many walls, sinks, and restrooms can stay, the condition of the rooftop units and electrical panels, and what demolition uncovers. |
| Clinic with procedure or imaging rooms | A build-out that adds procedure rooms, X-ray, CT, or MRI to the exam rooms, with the shielding, power, and air those rooms need. | Shielding, structural support, a larger electrical service, dedicated cooling, and the air changes and pressure procedure rooms require. |
| Renovation or expansion of an open clinic | Work done in phases around patients, with some of it after hours. | The number of phases, after-hours work, temporary walls and dust control, and the building's rules on noise and shutoffs. |
| New medical office building | A freestanding building on its own site, including site work, the shell, and the interior. | Site work and utilities, the city's site approvals, the shell and roof, and then everything a finish-out includes. |
Licensed surgery and endoscopy centers are a different kind of project with their own cost drivers. See what drives surgery center construction cost in Texas.
What drives the cost
The starting condition of the space
Shell space is a blank floor, which makes it predictable to price. Second-generation medical space can save money when the room sizes, sinks, and restrooms fit your practice and the mechanical and electrical systems have life left in them. It saves little when most walls move. A former office or retail suite usually lacks the plumbing and the ventilation a clinic needs. Our guide to second-generation space versus shell explains what to inspect.
Plumbing
Most exam rooms get a sink, and so do labs, soiled and clean utility rooms, and staff areas. Every sink needs a drain line under or through the slab and a vent. The sink count, the distance to the building's sewer line, and whether the slab can be cut freely are the first things an estimator looks at.
Medical gas
Practices that sedate patients or run procedure rooms may need piped oxygen and vacuum. Piped systems are installed and tested under NFPA 99, with zone valves, alarms, and an independent verification before use. Many clinics need none, and that is worth settling before design starts.
Equipment rough-ins
Exam tables, procedure chairs, lights, sterilizers, lab analyzers, and refrigerators each bring power, plumbing, data, or wall backing. The rough-in should be built from the cut sheets of the models you are buying. An item nobody carried in the budget is a common source of late cost.
Imaging and shielding
X-ray and CT rooms need lead shielding built to a design from a qualified physicist. MRI needs radio-frequency shielding, structural support, and a planned path to bring the magnet in. Imaging equipment also brings larger electrical service and dedicated cooling. In Texas, X-ray machines are registered with the Department of State Health Services, and the registration is the practice's to file.
Heating, cooling, and air changes
Clinical rooms call for more outside air and more air changes than offices, and procedure rooms, sterile storage, and soiled rooms have pressure requirements of their own. In a lease space the question is whether the existing units and ductwork can meet them. Replacing rooftop equipment is one of the larger swings in a medical budget.
Electrical capacity
Exam rooms need little power, but imaging, lab analyzers, sterilizers, and added air conditioning can outgrow the panel in a suite planned for offices. A new panel or a larger service from the utility adds cost, and the utility's schedule can add time.
Finishes
Clinical rooms need floors, walls, and ceilings that stand up to cleaning, and the waiting and consultation rooms are what patients see. Finishes move the cost less than plumbing, air, and imaging do, but they are the easiest line to adjust once the rest of the budget is set.
Accessibility
Texas projects must meet the Texas Accessibility Standards, administered by the Texas Department of Licensing and Regulation (TDLR). Door clearances, restrooms, exam room turning space, reception counters, and the route from parking all count. In an older suite, corrections can be a real part of the cost.
The building's rules
Medical office buildings often require noisy work, slab coring, and utility shutoffs to happen after hours, and some require the landlord's own contractors for fire alarm, roofing, or controls. Both add cost that does not show on the drawings.
The tenant improvement allowance
The landlord's allowance reduces what you pay, not what the work costs. Read the work letter with it: it says what the landlord builds before you take the space, such as restrooms, the air conditioning, and the electrical service, and what is left for your contractor. Read what the allowance may be spent on, when it is paid, and whether a supervision fee is charged against it. See what to ask before signing a medical lease.
Site work and utilities on a new building
A freestanding medical office building adds what a lease space already has: grading, paving and parking, storm drainage and detention, and water, sewer, electric, and gas service brought to the building. These costs follow the site, not the size of the building, so a small building on a difficult lot can cost more than a larger one on a ready pad. City site plan approval and any owner association review also come before the building permit. Our guide to leasing and site obstacles covers what to check before you buy.
Phasing an open clinic
Renovating around patients means temporary walls, dust control, and several mobilizations of each trade. Where feasible, we phase the work so the clinic stays open. Phasing and after-hours work add cost and time. The trade-off is that you keep seeing patients during construction. Our article on renovating while you stay open covers phasing in more detail.
Schedule and permitting
Time costs money on both sides of the contract. Every week of design, permit review, and inspections is a week of rent or loan interest before the first patient, and a longer job carries more supervision and general conditions. Landlord review of the drawings, imaging equipment lead times, and electrical gear can set the finish date. From the first concept we often schedule design, permitting, and construction together, and order long-lead items as early as the design allows.
How long it takes
Construction is one part of the calendar. Design and permit review come first, and on a new building the city approvals before the permit can take longer than the construction.
| Phase | What sets the time: lease space (finish-out or renovation) | What sets the time: new building |
|---|---|---|
| Design and drawings Layout, equipment selection, and architectural, mechanical, electrical, and plumbing drawings. | The size of the suite, the number of exam, procedure, and imaging rooms, and how early equipment is chosen. | The same choices as lease space, plus the site, the building shell, and the exterior design. |
| Site approvals Platting, site plan approval, and any owner association review. | Not usually required | The city's platting and site plan process, its meeting calendar, and any owner association review. Often longer than construction. |
| Permit review City plan review, landlord review, and the Texas accessibility plan review. | The city's review workload, landlord review, and how many comments come back for correction. | The same as lease space, with the site and the whole building under review. |
| Construction From permit to substantial completion. | The condition of the existing space, procedure and imaging rooms, the building's rules on after-hours work, and equipment lead times. | Site work, weather, and the building shell come first, then the same interior work as a lease space. Rooftop units and electrical gear can set the finish date. |
| Final inspections City and fire inspections and the certificate of occupancy. | How quickly the city and fire inspectors can be scheduled, and how cleanly the last items close out. | The same as lease space, with the site and the whole building inspected. |
| Total First concept to first patient. | Usually the shorter path: no site approvals, and the design is limited to the suite. | Usually the longer path, mostly because of the site approvals before the permit. |
S&I usually submits for the building permit, and we schedule the city, fire, and state accessibility inspections. Long-lead items such as electrical gear, rooftop units, and imaging equipment should be ordered as early as the design allows, because they often set the finish date.
What is usually not in the construction price
The construction price is not the cost of opening. Several items are usually bought outside the builder's base contract, and two contractors' numbers only compare if they treat these the same way. Ask each one for a written list of what is in and what is out.
- Equipment. Exam tables, imaging machines, sterilizers, lab equipment, and other clinical equipment are normally bought by the practice from its vendors. The construction price covers the power, plumbing, shielding, and wall backing that equipment needs.
- Phone and data cabling. Not typically in our base contract. We can provide it if you want one contract.
- Security, access control, call systems, and sound. Not typically in the base contract. We can provide them.
- Signage. Building and suite signs are not typically in the base contract. We can provide them. The landlord and the city both usually have sign rules.
- Furniture. Desks, seating, and other loose furniture are bought by the owner. S&I does not provide furniture.
- Design and other owner costs. Architect and engineer fees when you hire the architect directly, the physicist's shielding design and survey, computers and practice software, and any landlord review fees. Ask whether permit fees are inside the contractor's number.
Add these to the construction number before you compare the total with your loan or your allowance.
How to get a first budget
You do not need drawings to start. S&I puts together a first budget at no charge. It is an early range, not an estimate, and it is meant to tell you whether a space or a site fits your budget before you commit to it. If you are looking at a lease space, we will walk it with you before you sign.
It helps if you can tell us:
- The suite or site you are considering, or the two or three you are comparing
- The specialty, and the number of exam and procedure rooms
- Any imaging, lab, or sedation planned
- The allowance and work letter the landlord has offered
- When you need to open
A detailed estimate comes later, priced from the drawings as they develop. From the first concept we often schedule design, permitting, and construction together, so the calendar and the budget are worked out side by side. Call 817-329-4241 or send us a note.
See the work
Our medical office construction page covers these decisions in more depth, and how to choose a contractor for a medical office build-out explains how to compare bids. Completed medical offices include Argyle Pediatrics in Argyle, Prism Dermatology in Southlake, and Fort Worth Heart North Clinic, a ground-up building in Fort Worth.
Common questions
Why does a medical office cost more to build than a regular office?
A clinic has more plumbing, more walls and doors per square foot, more air and exhaust, more electrical capacity, and finishes chosen for cleaning. Procedure rooms, imaging, and medical gas add shielding, structure, and testing that an office never needs.
Why don't you publish cost per square foot?
Because costs move with materials, labor, and the specific space, a published range would soon be out of date or wrong for your project. Structures and Interiors gives each project a first budget at no charge, an early range built from your space or site and your plans. A detailed estimate is priced later from the drawings.
Is second-generation medical space cheaper than shell space?
It can be, when the exam rooms, sinks, and restrooms fit your practice and the mechanical and electrical systems are in good condition. When most of the walls and plumbing have to move, the saving is small, and demolition and hidden conditions add cost of their own.
Does the construction price include medical equipment?
Usually not. Clinical equipment is normally bought by the practice from its vendors. The construction price covers the power, plumbing, shielding, and wall backing the equipment needs. Phone and data cabling, security, and signage are also commonly outside the base contract.
What does a tenant improvement allowance pay for?
Whatever the lease says it does. Some allowances cover construction only, and others also cover design fees, permits, and cabling. The lease also sets when the money is paid. An allowance paid as a reimbursement means the tenant funds construction first.
How early can I get a budget for a medical build-out?
Before you have drawings, and ideally before you sign the lease. Structures and Interiors prepares a first budget at no charge. It is an early range, not an estimate, based on the space, the room count, and the specialty. A detailed estimate follows from the drawings.
Planning a new building, a finish-out, or a renovation? Tell us about it.