You do this once a decade. They do it every week.

I represent healthcare practices — dental, medical, veterinary, optometry, and related specialties — on the space they occupy. That covers new leases, lease renewals, relocations, expansions, additional locations, buying a building, and the real estate side of a practice acquisition.

The work is roughly: figure out what the practice actually needs, find every option that could work (including space that is not publicly listed), run them against each other, negotiate the terms, and stay involved through build-out and occupancy. Most of the value shows up in the terms, not the address.

No — and that is deliberate. CARR represents healthcare tenants and buyers only. We never represent landlords or sellers, in any market, at any time.

That matters because a broker who also lists space for landlords has to manage a conflict every time the two sides diverge. I do not have that problem. There is exactly one side of the table I am on.

Nothing. My clients do not pay. The landlord or seller pays the commission, and that fee is already in the deal whether you have your own representation or not.

Without your own broker, that money goes to the agent working for the other side. With one, it pays the person sitting on your side of the table. Same dollars. Different loyalty.

Because a single-property negotiation has no leverage in it. If a landlord knows you have nowhere else to go, the terms reflect that.

The approach I use is to take three or four viable properties into negotiation simultaneously so the landlords are effectively competing for the practice. It works on relocations, and it works on renewals — a renewal where the landlord knows you are seriously evaluating alternatives is a very different conversation than one where they do not.

Renewals are often where the most money is left on the table. A renewal feels like an administrative step, so it gets treated like one — and the practice ends up accepting a rate and a set of terms it never tested against the market.

The right time to start on a renewal is well before the deadline, typically twelve to eighteen months out, while there is still time to make alternatives credible. Starting three months out means negotiating without leverage.

Real estate is usually a practice's second-largest expense after payroll, and a lease locks that number in for five or ten years at a time.

Because it compounds across the full term, small differences in rate, escalations, tenant improvement allowance, and free rent add up to real money — savings in the tens to hundreds of thousands of dollars over a ten-year term are a realistic outcome, though every deal turns on its own facts. Nobody can promise you a number in advance, and you should be skeptical of anyone who does.

It depends on the practice, not on a rule. Buying converts rent into equity and gives you control of your own occupancy costs, which is a strong fit for an established practice with a stable patient base and a long runway ahead of it.

Leasing preserves capital and flexibility, which usually matters more for a start-up, a practice that may outgrow its footprint, or an owner within a few years of transitioning out. I run both scenarios with real numbers and real available properties so the comparison is concrete rather than theoretical.

Second-generation space is a suite that was already built out for medical or dental use — plumbing in the operatories, appropriate power, a layout that already assumes clinical flow.

Taking over that kind of space instead of building from a shell can remove a large share of the build-out cost and months from the timeline. It is also the kind of opportunity that often never appears on a public listing site, which is why I keep a running list of it around Puget Sound.

I am licensed in Washington and Oregon and work primarily across the greater Seattle area and Puget Sound — Seattle, Bellevue, Kirkland, Redmond, Everett, Lynnwood, Tacoma, and the surrounding communities.

CARR operates nationwide, so a practice opening outside my territory can be handed to a colleague who covers that market rather than starting over with a stranger.

I came to brokerage from the build side. I sold 200+ buildable lots to builders in Southwest Florida, then spent years as a real estate developer and licensed contractor — fix-and-flip, taking raw land through entitlement to permit-ready, and running build-outs — so I read plans, understand what a landlord's tenant improvement allowance really has to cover, and can tell early when a space is going to cost more to make clinical than it looks.

Before that I authored more than 400 capital reserve studies covering over $250 million in assessed assets, which is a long apprenticeship in what buildings actually cost to own over time. And I build software: the market analysis behind my recommendations comes out of tooling I wrote myself. A public slice of that is a free five-minute drive competitor map for Washington addresses at https://practicehunter.com/.