What’s the total timeline from concept to opening for a medical office building?

Most medical office buildings take about 20–30 months for ground-up development and 12–18 months for adaptive reuse, based on healthcare construction benchmarks from sources such as CBRE’s 2025 U.S. Healthcare Real Estate Outlook and schedule data from the Dodge Construction Network Outlook.

Why it matters

Accurate medical office building (MOB) timelines drive capital planning, physician alignment, and market-entry strategy for health systems. When schedules slip, the impact shows up in delayed ambulatory volumes, missed revenue targets, and higher carrying costs on capital projects.

Advisory research on ambulatory care growth highlights that outpatient volumes are a key lever in system performance, making on-time openings critical for strategic execution and margin stability Advisory Board. A six-month delay on a 30,000 SF ambulatory clinic modeled for 40,000 annual visits at $75 contribution margin per visit can defer roughly $1.5 million in margin, not including staffing and reputational effects.

How it works

Pre-development (4–5 months). This phase includes strategic definition, clinical programming (about 4–8 weeks), site identification and letters of intent (8–12 weeks), and due diligence such as environmental studies, utilities, surveys, geotechnical analysis, and title review. Straightforward sites often clear due diligence in 30–60 days, while complex parcels may require up to 90 days.

Entitlements and permitting (3–9 months). Municipal processes vary widely by jurisdiction. By-right sites may move through zoning and permitting in 60–90 days, but rezonings, traffic studies, or off-site improvement requirements can extend timelines to 6–9 months and involve multiple public hearings or design review cycles.

Design and procurement (4–7 months, overlapping entitlements). Schematic design commonly takes 4–6 weeks, design development 8–12 weeks, and construction documents 6–10 weeks. Long-lead procurement for electrical switchgear, major HVAC equipment, generators, and elevators should begin 12–24 weeks before construction start to protect the critical path, consistent with long-lead patterns described in national construction outlooks Dodge Mid-Year 2024 Outlook.

Financing and internal approvals (1–2 months). Board approvals, credit review, and lease or development agreement finalization usually take 4–8 weeks. Lease transactions often require ASC 842 analysis and detailed landlord work letters; owned projects must align bond or debt timing with GMP execution and internal capital budgeting.

Construction (4–16 months). Ground-up core and shell construction for a 30,000–60,000 SF MOB typically requires 10–16 months depending on site complexity and weather. Interior build-outs or adaptive reuse projects can often be completed in 4–8 months, with imaging, lab, and procedure infrastructure driving additional structure and MEP scope.

Activation and occupancy (1–3 months). This phase includes commissioning, testing and balancing, life-safety inspections, Authority Having Jurisdiction (AHJ) clearances, IT cutover, medical equipment installation, staff training, and operational readiness. Most health systems require 6–12 weeks between substantial completion and first patient day.

As a planning baseline, ground-up 30,000–60,000 SF MOBs typically span 22–32 months end-to-end, while adaptive reuse or second-generation shell build-outs often deliver in 12–18 months. For examples of how these steps integrate with capital strategy and delivery models, see the advisory overview on our healthcare real estate services page.

Key considerations

Schedule drivers. Entitlements, utility coordination, and long-lead equipment are the most consistent drivers of delay. Sites requiring new utility extensions, off-site roadwork, or complex drainage can add 3–6 months. Electrical switchgear, air handlers, and elevators frequently carry 30–40+ week lead times, which national construction forecasts flag as continuing risks in 2024–2025 Dodge Construction Network.

Delivery model. Design-build and programmatic developer partnerships can shorten timelines by 8–12 weeks through overlapping design and early procurement, while Construction Manager-at-Risk (CMAR) allows early GMP and trade buyout but requires disciplined scope management. Traditional design–bid–build tends to extend preconstruction by 6–10 weeks and offers less flexibility for early long-lead release.

Clinical scope. Imaging (CT/MRI), procedure rooms, infusion, and oncology programs add shielding, structural, and MEP requirements that lengthen design and inspection. If a future ambulatory surgery center (ASC) phase is contemplated, rough-in structural loads and utilities now to avoid months of rework later, a best practice often highlighted in healthcare outpatient facility guidance CBRE Healthcare Real Estate Outlook.

Regulatory and capital alignment. While the MOB shell rarely requires a Certificate of Need (CON), services inside the building—such as ASC, advanced imaging, or radiation therapy—may trigger CON or equivalent approvals in some states. In parallel, capital timing must align board cycles, lender milestones, developer negotiations, and lease structures with design freeze and GMP award, as described in the portfolio strategy frameworks on our Bremner Real Estate homepage.

Actionable takeaway

Use a 22–32 month timeline for ground-up MOBs and 12–18 months for adaptive reuse as your starting assumption, then refine it by stress-testing entitlements, utilities, and long-lead equipment risk. Establish decision gates in the first 60 days, launch long-lead procurement as early as schematic design, and run weekly critical-path reviews with locked clinical scope until GMP to keep concept-to-opening timelines realistic. For organizations seeking a project-specific schedule and delivery plan, an initial discussion can be initiated via the consultation form on our contact page.

What is the typical total duration for a ground-up medical office building?

Most ground-up MOBs of 30,000–60,000 SF require about 22–32 months from concept to first patient, including pre-development, entitlements, design, construction, and activation. The exact duration depends on site complexity, clinical program, regulatory path, and long-lead equipment risk.

How much time can adaptive reuse or second-generation space save?

Adaptive reuse or second-generation shell build-outs can often open in 12–18 months because site work, utilities, and major structural systems are already in place. Actual savings depend on the condition of existing systems, required imaging or procedural upgrades, and the speed of permits for interior alterations.

What causes the most delays on healthcare projects?

The most frequent delay sources are municipal entitlements, utility upgrades, and long-lead equipment such as electrical switchgear, air handlers, generators, and elevators. Scope changes after design freeze and late decisions on imaging or ASC components also extend timelines by triggering redesign and new AHJ reviews.

Do medical office buildings require a Certificate of Need?

The building shell itself typically does not require a CON, but certain services housed within it—especially ambulatory surgery, advanced imaging, and radiation therapy—may trigger CON or similar approvals in some states. Aligning CON strategy with early programming and zoning helps prevent downstream schedule risk.

When should we order long-lead equipment and building systems?

Long-lead equipment should be released as early as schematic design or early design development, often 12–24 weeks before construction start, using early procurement packages. Coordinating vendor submittals with engineering ensures that switchgear, major HVAC units, elevators, and medical equipment arrive in line with the critical path.

Bremner Real Estate partners with health systems to align real estate strategy with clinical performance and capital efficiency.