Building out a new healthcare clinic involves a lot more than just the general contractor's bid. It's an exciting time when an innovative care model is ready to take physical form, but for founders and leaders, the financial realities of scaling brick-and-mortar footprints can hide significant, unexpected complexities. Understanding these true costs upfront is absolutely critical to turning your vision into a sustainable reality.

From a venture capital perspective, firms see countless promising care models. However, the transition to physical locations often introduces unforeseen financial complexities that can quickly derail even the best plans. Many founders significantly underestimate the total capital outlay required, beyond just the core construction.

Unmasking the Hidden Costs: Where Budgets Go Sideways

Based on my experience guiding numerous healthcare startups, here are the most common "hidden" or "underestimated" costs that often turn into painful surprises across the project lifecycle:

Leasing Phase

Investing in a specialized real estate attorney (not just your general counsel friend) is crucial. While their fees might range from $5,000 to over $25,000 per lease, their expertise in negotiating landlord terms can save immense risk and capital down the road – for example, securing an SNDA (Subordination, Non-Disturbance, and Attornment Agreement) ensures your lease isn't wiped out if the building faces foreclosure.
Equally critical is upfront due diligence on the site. Investing in structural, electrical, and architectural surveys prevents signing a lease only to discover you need to spend hundreds of thousands of dollars of your own capital to level a sloped floor, upgrade power, or replace a sewer line.

Construction Phase

Beyond the build itself, technology costs are frequently underestimated. This includes IT infrastructure (cabling, networking), security systems (cameras, card readers, alarms), and audio-visual equipment (conferencing technology).
Founders are unprepared for the cost of commercial-grade furniture and equipment. While an Amazon desk is cheaper upfront, it pales in comparison to commercial furniture's durability and long-term employee/patient experience.
Finally, and most critically, contingency planning is often insufficient. Especially in 0-to-1 efforts, changes are inevitable, whether from new insights during framing walk-throughs or inspector-required modifications that appear post-plan approval. These mid-stream changes are never inexpensive. You must have a healthy 10%-15% contingency budget to dip into when these changes inevitably arise.

Launch & Ongoing Operations

Once the physical space is ready, don't forget the ongoing service costs. Nearly all technology components require license-based fees (security systems, network equipment).
Beyond tech, essential services like shredding, waste removal, HVAC maintenance, and fire system monitoring carry recurring costs. Individually small in a multi-million-dollar development budget, these expenses add up and can materially impact long-term margins.

The Perils of Mismanaging the Budgeting Process

These hidden costs become painful surprises when budgeting is mismanaged. Founders, often trying to go it alone, create budgets without getting a reality check from strategic partners on realistic development cost ranges. There's a tendency to under-scope expenses. It's challenging to discern who is providing a realistic, conservative timeline and cost versus just telling you what you want to hear to get your business.

This lack of vetting, particularly around project timeline projections, creates a dangerous double hit: you're locking in spending (on EMR contracts, hiring staff, marketing) aligned to a launch date that slips, meaning you're burning cash on something you can't use while also missing out on revenue from delayed patient acquisition.

Proactive Strategies: Bridging Vision and Financial Reality

So, how do you bridge that gap between ambitious vision and financial reality? From my experience, these proactive strategies are essential:

Set a Conservative Internal Go-Live Date: Model your proforma around a conservative launch date, but keep this date internal. Share a more aggressive (e.g., 10-20% earlier than your internal conservative date, 20-30% earlier than a true "drop-dead" date) target with your contracting partners. Projects tend to regress to the mean, and giving an earlier target significantly increases your likelihood of hitting your actual conservative date. It's always better to be early than late.
Plan for Tradeoffs (Leverage Optionality): As discussed in my recent post on "The Power of Optionality in Healthcare Real Estate," having strategic levers in play – like flexible infrastructure, multi-purpose rooms, or adaptable lease terms – helps maintain budget and timeline when unforeseen circumstances arise, without compromising your ability to deliver quality care.
Contingency Plans for Your Contingency Plans: Build layers of backup into your schedule. For instance, we had a 3-week setup period planned, then a 2-week contingency, and finally, a "hit the red button" emergency plan for a 1-week setup. Due to factors beyond our control (like difficult inspectors), we had to hit the red button. But because we maintained open communication with our vendor partners about these scenarios, they adapted quickly, allowing us to avoid a very costly (7-figure) delay in launching.

Mastering these financial realities is crucial for any healthcare founder. It's about empowering you to make confident decisions and build sustainable growth, ensuring your significant real estate investment truly brings your vision to life.

To help you get started with this crucial planning, I've created a comprehensive Healthcare Clinic Project Budget Template. This template breaks down all the essential line items – including those commonly overlooked costs – and provides a framework for building robust financial projections.

Download your free template now and gain clarity on the true cost of bringing your vision to life!

The True Cost of Scaling: Beyond Construction Budgets in Healthcare Real Estate