Joe Bookout, Healthcare Practice Real Estate

Joe Bookout, Healthcare Practice Real Estate Healthcare Practice Real Estate

Alabama announced the first awards from its Rural Health Transformation Program on August 24: 138 grants totaling more t...
09/10/2026

Alabama announced the first awards from its Rural Health Transformation Program on August 24: 138 grants totaling more than 144 million dollars, reaching rural areas in every county in the state.

Infirmary Health received 5.348 million of it across four awards.

3.5 million for a regional referral and technology network connecting Infirmary with rural hospitals and clinics in Clarke, Mobile and Washington counties.

1.12 million for women's health clinics, prenatal services and mobile telehealth across Baldwin, Clarke, Conecuh and Escambia.

386 thousand for a Rural Women's Health Hub serving Clarke and Washington.

342 thousand to put internal medicine residents into structured rural clinical rotations across five counties.

The referral network and the resident rotations are the two we would watch most closely. Referral patterns and where young physicians train are what decide, five and ten years out, which small markets can support a private practice and which ones cannot.

The funding is federal, routed through the state, and covered fully by CMS.

Ascension Sacred Heart Bay began construction last month on an 11 million dollar, 18 bed inpatient rehabilitation unit o...
09/08/2026

Ascension Sacred Heart Bay began construction last month on an 11 million dollar, 18 bed inpatient rehabilitation unit on the fifth floor of its South Tower. It opens in spring 2027 and brings roughly 50 clinical and support jobs with it, and it is the first inpatient rehab care offered on that campus.

The part that matters for anyone practicing in Bay County is that this is the third inpatient rehab project now in the local pipeline, alongside the 40 bed facility that broke ground in July and the orthopedic and spine unit inside HCA Florida Gulf Coast's expansion.

Three projects, one county, all built around patients who need somewhere to go after a surgery or a stroke.

If you practice orthopedics, neurology, physical therapy or pain management here, that is a referral pattern forming while you read this. The practices that think now about where they sit relative to it will have better choices than the ones who look in 2027, when the space near those campuses is spoken for.

HCA Florida Gulf Coast Hospital announced a $125 million expansion in Panama City. A new patient tower with a 16 bed ort...
09/05/2026

HCA Florida Gulf Coast Hospital announced a $125 million expansion in Panama City. A new patient tower with a 16 bed orthopedic and spine unit, 34 more beds, a fourth cath lab, an expanded women's center, and the NICU converting to a PICU. Design work now, roughly two to three years of construction, open by 2029.

For the independent practices in Bay County, the number to watch is the referral pattern that comes with 50 new beds and a fourth cath lab.

Orthopedic and spine volume brings physical therapy demand behind it. A bigger cardiac program brings follow up care. A PICU changes where pediatric families in that county end up for everything else.

Every one of those is a downstream practice, and the ones that benefit most will be the ones already sitting in the right spot when the tower opens. Three years is enough time to make a real estate decision about that. It is not enough time to make it twice.

Panama City and Panama City Beach owners: does this change where you would put your next location?

Thomas Hospital in Fairhope opened a $40 million tower on August 11. Four stories, 25 medical surgical beds, a rooftop h...
09/03/2026

Thomas Hospital in Fairhope opened a $40 million tower on August 11. Four stories, 25 medical surgical beds, a rooftop helipad, a parking deck. Two of the four floors were built and left empty.

Southeast Health in Dothan is doing a version of the same thing, framing floors it has no announced use for.

Neither of those is a mistake. A system that expects to grow buys the right to grow while the crane is already on site, because space is cheapest to claim before anybody else needs it.

Now think about how a private practice usually signs. Ten years, the exact square footage the practice needs today, no claim on the suite next door, and a rate to add space later that gets set by whoever happens to be standing there when the day comes.

The systems in this market are buying the option. Most practices are buying the square feet.

The good news is that the option is available to a practice too, and it is one of the least expensive things in a lease to ask for. Swipe through for what to ask for and when.

For the owners here in the Panhandle and around Mobile: did your lease give you any claim at all on the space next door?

Ask a practice owner what their space costs and you get the rent number. Ask what it earns and the room goes quiet.Parki...
09/01/2026

Ask a practice owner what their space costs and you get the rent number. Ask what it earns and the room goes quiet.

Parking ratio decides how many patients a full schedule can physically hold. After hours access decides whether a Saturday clinic is even possible. Signage decides how many people find you without looking you up. Ceiling height and room count decide how many providers you can add before you have to move again.

None of that sits on the rent line, and all of it shows up in collections.

For the owners around Pensacola, Fort Walton Beach, Destin, Panama City and Mobile: which one of those has cost you the most, and did you know about it before you signed?

A landlord's floor plan is drawn for general commercial use. A medical build out is not general commercial use, and the ...
08/22/2026

A landlord's floor plan is drawn for general commercial use. A medical build out is not general commercial use, and the difference is where the surprises live.

Most of what a practice needs is invisible on a floor plan. It sits in the electrical panel, above the ceiling, and under the slab. A generalist has rarely had to price any of it, which is how a number that looked fine in a proposal becomes a change order six weeks into construction.

The timing matters more than the list does. Inside the deal, every one of these is a design conversation and something a landlord can contribute to. After the lease is signed, each one is a check the practice writes alone.

Swipe through for six that a floor plan almost never accounts for.

For the practice owners around Pensacola, Fort Walton Beach, Destin, Panama City and Mobile: which of these did you end up paying for yourself?

What surprised you most about the cost of building out your space?We ask because the answer is almost never the same twi...
08/20/2026

What surprised you most about the cost of building out your space?

We ask because the answer is almost never the same twice. For one practice it was the electrical service the building could not carry. Another spent real money on slab work for an imaging suite. And more than one has paid six weeks of rent while a permit sat on somebody's desk.

Landlord floor plans are drawn for general commercial use. A practice needs things that plan never contemplated, and those items have a way of arriving as change orders rather than as line items inside the deal.

For the practice owners around Pensacola, Fort Walton Beach, Destin, Panama City, Tallahassee and Mobile: what was the one you did not see coming?

Medical space and office space are not the same market, and the price gap is 55%.Medical outpatient buildings sold for a...
08/18/2026

Medical space and office space are not the same market, and the price gap is 55%.

Medical outpatient buildings sold for an average of $310 a square foot in the first quarter. Traditional office averaged $200. That is CBRE's national number, and the reason behind it is something every practice owner already knows in their gut.

You cannot move an exam room. Plumbing, medical gas, specialized electrical, shielding where imaging lives, and a patient base that found you at that address. A practice is tied to its space in a way an insurance office is not, and the people who finance buildings price that difference.

There are two sides to it. If you own your building, the asset under your practice is holding value that ordinary office is not. If you lease, your landlord understands all of this too, and it tends to show up when the renewal comes around.

For the practice owners around Pensacola, Fort Walton Beach, Destin and Panama City: when your last renewal came up, did the number move more than you expected?

There is a door in a well designed veterinary clinic that exists for one reason, and it is on no retail floor plan we ha...
08/15/2026

There is a door in a well designed veterinary clinic that exists for one reason, and it is on no retail floor plan we have ever been handed.

It is the exit a family uses after they have said goodbye to a pet. It lets them leave without walking back through a lobby full of puppies and wagging tails. Every veterinarian reading this knows exactly what that walk is like, and knows a client who stopped coming because of it.

That door costs square footage that will never see a patient. It usually costs a change to a wall the landlord drew somewhere else. It is worth all of it, and it belongs in the deal rather than showing up later as a change order. In the deal it is a design conversation and a landlord contribution. After the signature it is a check the practice writes alone.

It is one of several things a veterinary build needs that a generalist has never had to price. The rest of that list runs through sound isolation, relief areas, drainage, heavier utility loads, boarding runs, plus the surgery suite. CARR's veterinary work runs from two thousand square foot spaces in a retail center up to fifty thousand square foot specialty hospitals, and those requirements travel with the practice at every size.

Swipe through for the six a landlord's floor plan almost never accounts for.

For the veterinarians around Baldwin, Mobile, Santa Rosa and Okaloosa: which one did you end up paying for yourself?

Does your optical need the front of the building more than your exam rooms need the back of it?It sounds like a small qu...
08/13/2026

Does your optical need the front of the building more than your exam rooms need the back of it?

It sounds like a small question and it decides more about an eye care practice than the rent does. The dispensary is retail. It wants the window, the sign, the people walking past. The exam lanes are clinical. They want depth, quiet, and control over the light.

Almost no space does both well. So the site picks a winner, and the lease is the only place left to make it up to the side that lost. Signage rights. A use restriction next door. An exclusive that keeps another optical out of the center.

We work through this one a lot with vision care practices across Northwest Florida and South Alabama.

For the optometrists and ophthalmologists here: which half of your practice do you think your current space was chosen for?

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