In most U.S. markets, plan for roughly 24–36 months from concept to opening for a 50,000–150,000 SF medical outpatient building (MOB), spanning preplanning and entitlements (6–9 months), design and procurement (8–12 months), construction (12–18 months), and commissioning and occupancy (1–3 months), with variation driven by AHJ review, delivery model, and long-lead materials.
Why it matters
Time-to-market directly affects revenue capture, physician alignment, and capital efficiency. Each month of delay defers clinic volumes, imaging throughput, and downstream referrals—eroding the project’s net present value. Elevated interest rates also increase carry costs during development, putting a premium on disciplined schedules and early risk mitigation. The Federal Reserve’s H.15 data underscores how rate environments shape the cost of capital, which compounds across multi-year projects.
A realistic, front-loaded schedule protects ROI by sequencing entitlements, design, procurement, and construction in a way that prevents idle time. It also clarifies when to activate physician recruitment, equipment purchasing, and payer notifications so clinical and operational go-live align with substantial completion. In Middle Tennessee, for example, differences between Nashville Metro and suburban jurisdictions can materially affect preconstruction timeline assumptions.
How it works
Stage 1 — Strategy, site control, and entitlements (6–9 months): Health systems validate service line demand, define the program (e.g., primary care, specialty clinics, imaging), and secure the site. Concurrently, teams perform due diligence, zoning checks, and entitlement applications. Authorities Having Jurisdiction (AHJs) set review and permit requirements that become critical path items under the FGI Guidelines for Design and Construction and local codes.
Stage 2 — Design and procurement (8–12 months): Schematic design through construction documents typically runs 5–8 months for a mid-size MOB, overlapping with early procurement of long-lead items. Delivery model matters: Design-build can shorten the handoff between design and construction compared to traditional design-bid-build, according to DBIA/FMI benchmarking. A Guaranteed Maximum Price (GMP) — a contract cap with defined scope and contingencies — is often set after design development and major scope decisions.
Stage 3 — Construction, commissioning, and occupancy (13–21 months): Construction for a 50,000–150,000 SF outpatient building is commonly 12–18 months, with a further 1–3 months for systems commissioning, AHJ inspections, and punch-list closeout. Market data from Dodge Construction Network indicates schedule sensitivity to material availability and trade labor, especially for electrical and mechanical systems. Final occupancy depends on life-safety tests and FGI-compliant spaces meeting the AHJ’s requirements before patient care begins.
Key considerations
Permits and codes define the critical path. AHJ plan reviews, environmental clearances, and life-safety inspections drive the gating of construction starts and occupancy certificates. The FGI Guidelines also influence room sizes, airflow, and infection control provisions, which can extend design iterations and commissioning if addressed late. In Certificate of Need (CON) states, regulatory review can add time; engaging counsel and regulators early helps clarify milestones and sequencing.
Supply chain is still a material driver. Electrical switchgear, air handlers, and imaging equipment have experienced extended lead times since the pandemic; Dodge Construction Network tracking continues to flag persistent constraints. Locking long-lead procurement during design development reduces the risk of crews waiting on gear. Delivery method matters too: DBIA/FMI research finds design-build generally compresses schedule by tightening design-construction coordination, while design-bid-build can add weeks for bidding and submittal cycles under fragmented accountability.
Actionable takeaway
Build a single integrated master schedule in week-level detail that pulls long-lead procurement forward into design, sets a realistic GMP milestone, and reserves float for AHJ reviews. Tie physician onboarding, equipment install, and payer/IT cutover to the commissioning calendar so clinical go-live is synchronized. To see how these steps fit within a disciplined stage-gate approach, review our healthcare real estate services and development process as outlined in our healthcare real estate services, and how we structure execution in our advisory approach on our homepage; if you need a risk-screened timeline for a specific market like Nashville, request a consultation to calibrate assumptions to local AHJ and trade capacity.
our healthcare real estate services
our advisory approach on our homepage
FAQs
What is an AHJ, and why does it affect schedule?
The Authority Having Jurisdiction (AHJ) is the government body that reviews plans, issues permits, and authorizes occupancy. Because AHJs enforce building, fire, and health codes—including FGI-based requirements—approval timelines can extend if submittals are incomplete or life-safety tests need rework.
How does delivery method change timeline?
Design-build creates a single point of responsibility and overlaps design with early construction and procurement, often shortening the overall duration. DBIA/FMI benchmarking indicates it tends to reduce schedule friction compared to traditional design-bid-build by compressing handoffs and accelerating submittal workflows.
What long-lead items are most likely to delay an MOB?
Electrical switchgear, generators, air handling units, and certain imaging modalities are frequent schedule risks. Industry tracking from Dodge Construction Network has highlighted these categories since 2021; aligning early procurement with design milestones is the most reliable mitigation.
Does an ambulatory surgery center (ASC) inside an MOB extend the timeline?
Often yes, because ASCs introduce additional mechanical, electrical, and life-safety requirements and add licensing inspections. An ASC is a facility for outpatient surgical care; its specialized systems and equipment commissioning typically lengthen design coordination and AHJ review compared to clinic-only programs under the FGI Guidelines.
How do interest rates affect when we should start?
Higher interest rates raise the cost of carrying land and construction financing, increasing the value of compressing schedules and minimizing idle time. Monitoring the Federal Reserve’s H.15 series helps finance teams plan rate locks and evaluate whether to phase projects or proceed with a full program given capital costs.
Bremner Healthcare Real Estate partners with health systems to align real estate strategy with clinical performance and capital efficiency.