Capital Protection vs. Coordination: The Most Expensive "Savings" in Healthcare Real Estate
In the early days of a healthcare startup, cash is oxygen. Founders scrutinize every line item, run the numbers twice, and stretch every dollar in ways most established organizations never have to.
Eventually, they get to the "Real Estate Leadership" or "Project Management" line. They see the fee, do some quick mental math, and think: "I’m organized. I’ve managed teams before. I can handle this myself and save the cost."
It is the most expensive money you will ever save.
I call this the Coordination Tax. Unlike a number on a spreadsheet, you don’t see the cost until it’s too late. You pay it in change orders. You pay it in delays. And you pay for it with your own time—usually at the worst possible moment for the business.
The "Hub" Fallacy
The misconception starts with a simplistic mental model of what a buildout actually is:
Hire Architect → Get Drawings
Hire Contractor → Build Clinic
Open Doors
It never works that way.
Founders imagine themselves as the "hub," passing information between the architect, GC, landlord, IT vendor, low-voltage team, equipment suppliers, and everyone else with a stake in the project. But a hub is not a reconciler. A hub connects; it doesn’t integrate.
Here is the reality:
The Architect is focused on drawings, code, and aesthetics.
The Contractor is focused on the contract documents and schedule.
The IT Vendor is focused on their rack, cabling, and endpoints.
The Equipment Vendor is focused on power, clearances, and install windows.
The Landlord is focused on protecting the building.
No one owns the gaps between them.
When you make yourself the hub, you become the shock absorber for every disconnect.
When the equipment list changes but the electrical plans don’t? That’s on you.
When the reception desk shows up and the data drops are on the wrong wall? That’s on you.
When the landlord’s HVAC fails inspection two weeks before go-live and the GC says, "That’s base building"? That’s on you.
These are not anomalies; they are structural features of the construction process. Friction is guaranteed in construction. Expensive surprises are optional. You can either manage them proactively or pay for them reactively.
Where the Money Actually Disappears
The Coordination Tax shows up in the grey zone between trades—the places where everyone believes someone else is responsible.
Architects design to the standard of care. Contractors build what is in the contract documents. If a detail isn’t explicitly drawn, the contractor isn’t obligated to build it, and the architect isn’t necessarily liable for omitting it.
Clinical workflow is where I see this gap most clearly.
A founder might tell the architect: "We need telemedicine capability in Exam Room 3." It sounds clear. Everyone nods. But on install day:
There’s no backing framed for the monitor.
The outlet is at standard height instead of monitor height.
The lighting throws a shadow across the provider’s face.
The camera angle is wrong because of room orientation.
Fixing this after drywall is up isn’t a quick tweak. It’s a change order. It’s a schedule slip. It’s a first-day provider frustration you can’t fix with a pep talk. Individually, each of these issues is small. Together, they compound into real money and real delays.
The Hidden 25–50% Overrun Risk
When founders see my proposal, I often hear: “These fees seem high for project coordination.”
That is exactly the point.
If you are paying for coordination—someone to update the schedule and host the weekly call—you should pay a junior rate. That is a commodity.
I don’t sell coordination. I sell capital protection.
As a Fractional VP of Real Estate, my work begins months before a hammer swings—often at the LOI stage, where we define the tenant improvement allowance and work letter that funds the project. The savings start at the LOI, but the protection happens in the buildout.
The reason expert guidance costs more than standard project management is because we are preventing the silent 25–50% project overrun that standard coordination misses entirely.
I see this pattern often. A well-intentioned internal team takes on a healthcare buildout believing they can “figure it out as they go,” and the early misses start stacking up:
Missed due diligence that changes the scope mid-project
Design decisions that need to be reworked once the care model is pressure-tested
Code triggers that weren’t caught early
Sequencing issues that push contractors into premium pricing
Late-stage change orders that could have been prevented at schematic design
None of these look catastrophic in isolation. But together, they push projects dramatically over expectations. That delta is not a construction problem. It’s an expertise gap—a gap founders don’t realize they’re carrying until the budget is already outpacing the plan.
When you stack that hidden overrun risk against the cost of an experienced partner overseeing an 18–24 month project, the math becomes obvious. You’re not paying for coordination. You’re paying to avoid the structural mistakes that turn disciplined budgets into runaway ones.
This is the part most founders don’t run the math on: the fee you think you’re saving is tiny compared to the cost you’re already incurring by not having an expert in the room.
The Opportunity Cost of Founder Hours
Then there’s the time cost. Your "hourly rate"—measured in enterprise value—is enormous. Your job is to recruit providers, secure payor contracts, refine the care model, and raise capital.
Every hour you spend debating low-voltage diagrams, coordinating vendors, or chasing a landlord for a permit signature is an hour you’re not doing any of the things your company actually depends on.
Founders often believe they’re saving thousands of dollars by managing the work themselves—or delegating it to someone who has little exposure to the complexities of healthcare real estate development. But what they’re really doing is quietly paying for project management with their focus, their momentum, and their equity.
Speed vs. Fidelity
In software, you can iterate instantly. In marketing, you can test and optimize. Construction does not give you that luxury.
Concrete does not care about your timeline. Plumbing trenches do not get "version 2.0." You cannot A/B test walls.
This is why you need more than a coordinator. You need integrated oversight—someone who can:
Translate clinical operations into room-by-room design.
Challenge decisions that will create downstream staffing inefficiencies.
Anticipate code triggers early.
Catch the assumptions each trade thinks someone else will handle.
You don’t need a messenger to forward emails between the architect and the contractor. You need a strategic translator who works in three directions.
I translate clinical needs into construction reality for the build team. But just as importantly, I translate complex construction issues into plain business language for you.
My job is to filter the noise. I handle the thousand daily micro-decisions so you don't have to. I bring you only the critical strategic forks in the road—clear, data-backed options that require your specific sign-off—ensuring you stay in control of the business without getting buried in the blueprint.
Stop Being the General Manager of Construction
If you’re scaling a healthcare company, your real estate strategy is not about "getting the clinic open." It’s about creating the physical infrastructure your care model depends on.
Managing your own buildout isn’t a sign of grit. It’s a diversion from the work only you can do.
If you’re serious about growth, your time is the one resource you cannot afford to reinvest in construction administration.
Preserve your focus. Protect your capital. Build the business. Let us build the clinic.
