Reasons owners refinance
Lowering debt service is the obvious one, but it is rarely the only motivation. Owners refinance to pull equity out for practice expansion or partner buyouts; to escape a balloon maturity before it forces a sale on someone else’s timeline; to consolidate several properties under a single facility; or to move off a personally guaranteed loan onto one secured by the asset. Each of these points toward a different loan structure, so the objective should drive the product rather than the reverse.
What lenders look at
Debt service coverage ratio — net operating income divided by annual debt service — is the gating metric, and most lenders want meaningful cushion above 1.0. Loan-to-value typically runs 65 to 80 percent depending on the lender and asset. Beyond those, underwriting weighs lease term remaining against loan term, because a lender does not want the lease expiring before the loan matures, and it weighs the borrower’s practice financials where the practice is also the tenant.
Where the options come from
Local and regional banks often offer the best relationship pricing, particularly where you already bank. SBA 504 financing can work well for owner-occupied practice real estate, with lower down payments than conventional debt. Life insurance companies price competitively on stabilized assets with credit tenants. CMBS can provide non-recourse debt at scale but with limited flexibility afterward. We are not a lender and do not originate — we connect you with the lenders that actually underwrite this asset class and help you compare what comes back.