We get this question constantly from practice owners who’ve hit a growth threshold.
You’re stable. You’re profitable. You’re thinking about the next five years. And someone, probably another therapist who just bought a building, mentions that you’re “throwing money away on rent.”
So you start wondering: should I buy or lease your therapy office?
Here’s what we’ve learned working with hundreds of therapy practices: this decision isn’t about real estate wisdom. It’s about understanding what your practice actually needs right now and what buying would actually cost you.
Not just in dollars. In time, flexibility, and financial resilience.
The Down Payment Reality Nobody Mentions
Let’s start with what buying actually requires upfront.
Commercial loans typically need a 10-25% down payment. For a $200,000 property, that’s $20,000 to $50,000 before you’ve done anything to make the space usable.
Before buildout.
Before furniture.
Before you’ve seen a single client in that space.
We see practice owners look at that number and think, “I have that in savings.” But here’s the question we ask: what happens to your emergency fund when you pull that cash out?
Because that money isn’t just sitting there for ambition. It’s your buffer when a therapist leaves unexpectedly. It’s your payroll coverage during a slow referral month. It’s what keeps you from panicking when three clients cancel in one week.
When you move that money into a building, it stops being available for operations. And most practices don’t realize how much financial flexibility they’re trading away until they need it.
The Iceberg Under the Purchase Price
The purchase price is what you see above water.
What you don’t see: maintenance, property taxes, insurance, compliance costs, and capital expenditures that show up on schedules you didn’t choose.
Here’s what the actual costs look like:
- Interior painting: $1,500 to $4,500 for a 1,500 square foot space
- Carpet replacement: $3,000 to $7,500 for the same space
- HVAC servicing: $150 to $200 annually (and that’s just maintenance, not replacement)
- Property taxes and insurance: Ongoing, rising, non-negotiable
One study found that commercial property owners often overpay by 20-40% on maintenance without realizing it. And a common rule in property management estimates that 50% of rental income goes back into property expenses.
When you lease, your landlord absorbs those costs. When you own, you’re the landlord. And every repair, every replacement, every compliance upgrade comes out of your operating budget.
We’ve watched practice owners buy buildings and then realize six months later that they can’t afford to hire the next therapist because too much cash is tied up in property expenses they didn’t forecast.
The Flexibility You’re Trading
Leasing gives you something buying doesn’t: the ability to change your mind.
Your practice changes. Client demand shifts. Your team grows faster than expected or slower than you planned. Telehealth becomes more viable. You want to add group therapy, but need different room configurations.
When you lease, you can adapt. Commercial leases typically run 5-10 years, and while breaking a lease early can cost you months of rent in penalties, it’s still faster and cleaner than selling property.
When you own, you’re locked in. Selling commercial real estate takes time. And if you need to move because your practice has outgrown the space or your client base has shifted geographically, you’re now managing a real estate transaction on top of running your practice.
We’ve seen this create real problems. A practice owner buys a building in a neighborhood that feels perfect. Three years later, referral patterns shift. Clients are coming from a different part of town. But now they’re stuck with a mortgage and a space that’s no longer optimally located.
Leasing keeps your options open. And for most practices, especially those still clarifying their long-term space needs, that flexibility is worth more than ownership.
What Leasing Actually Costs (And What It Includes)
Therapy office space typically rents for $500 to $3,000 per month, depending on location.
The general rule: keep rent close to 20% of gross income.
If you’re bringing in $15,000 a month, you’re looking at around $3,000 for rent. If you’re at $8,000 monthly, you should be closer to $1,600.
But here’s what that rent typically includes: predictable monthly costs, landlord-covered maintenance and major repairs, and the ability to budget without surprise capital expenditures.
Nearly six in 10 small businesses report facing rent increases. That’s real. But leases generally lock in your rate for the term, and you know what you’re paying. You’re not guessing whether the HVAC system will fail this year or next.
And if your practice model is evolving, there are even more flexible options now. Coworking therapy spaces in major cities charge as little as $40 per hour, letting you access high-quality space without long-term commitment. Some therapists sublease part-time for around $100 per month, renting just a few hours per week.
For practices testing expansion or unsure about full-time space needs, these models let you grow without overcommitting.
When Buying Actually Makes Sense
We’re not saying never buy. We’re saying buy when the conditions are right.
Here’s when we’ve seen ownership work well:
Your practice has stable, predictable revenue. You’re not in a growth phase where cash flow is uncertain. You have consistent client volume and aren’t dependent on a few large contracts or referral sources that could shift.
You have significant cash reserves beyond the down payment. You can cover the down payment and still maintain 6-12 months of operating expenses in liquid savings. You’re not choosing between buying and having a safety net.
You’re confident about your location for the next 10+ years. Your client base is geographically stable. You’re not planning to expand to multiple locations. The neighborhood isn’t in transition.
You want the building as a long-term asset, not just office space. You’re thinking about this as part of your retirement plan or wealth-building strategy, not just as a place to see clients.
You’re prepared to manage property on top of managing your practice. You have the time, interest, or team support to handle maintenance, tenant issues if you rent out extra space, and property management decisions.
If all of those are true, buying might make sense. But if even one or two don’t align, leasing probably serves you better.
The Question We Ask Every Practice Owner Considering This
When someone comes to us asking about buying, here’s what we want to know:
What problem are you trying to solve?
If the answer is “I want to stop paying rent,” that’s not a strong enough reason. Because rent isn’t waste. It’s paying for flexibility, predictability, and the ability to focus your capital on growing your practice instead of maintaining a building.
If the answer is “I want a long-term asset, and I have the financial stability to manage it,” that’s different. That’s a strategic decision based on where your practice actually is.
But if the answer is “Someone told me I should,” or “I feel like I’m supposed to at this stage,” we usually recommend waiting.
Because ownership doesn’t make you more successful. It just changes what you’re responsible for.
How to Think About This Decision
Here’s the framework we use with clients:
Look at your current cash position. Can you cover the down payment and still maintain a healthy operating reserve? If pulling that money out makes you nervous about covering payroll or unexpected expenses, you’re not ready.
Evaluate your growth trajectory. Are you stable and predictable, or are you still figuring out your optimal size and service model? If you’re still evolving, leasing gives you room to adapt.
Consider your risk tolerance. Are you comfortable with the maintenance costs, property taxes, and capital expenditures that come with ownership? Or would you rather have predictable monthly expenses?
Think about your time. Do you want to spend time managing property, or would you rather spend that time on clinical work, team development, or business growth?
Assess your location confidence. Are you certain this is where you want to be for the next decade? Or might your client base, team needs, or service model shift?
If you’re uncertain on any of these, leasing is probably the smarter move.
What We Tell Clients Who Are Unsure
When you’re not sure, default to flexibility.
Leasing doesn’t close doors. You can always buy later when your practice is more established, your revenue is more predictable, and you have clearer long-term space needs.
But buying too early can create problems that are hard to reverse. You can’t easily undo a mortgage. You can’t quickly sell commercial property when your needs change. And you can’t get back the cash you’ve tied up in a down payment when you need it for operations.
We’ve seen too many practice owners buy because they felt like they were supposed to, only to realize a year later that they’ve limited their ability to grow, hire, or adapt.
The right decision isn’t about what other practice owners are doing. It’s about what your numbers actually support and what your practice actually needs.
If you’re trying to figure out whether buying or leasing makes sense for your specific situation, we can help you look at the numbers and see what’s actually sustainable. That’s what we do. We handle the financial structure so you can focus on the work that matters.
Let’s Look at Your Numbers Together
We work exclusively with therapists to build financial clarity around decisions exactly like this one.
Whether you’re evaluating a purchase, trying to understand what your practice can actually afford, or just want someone to dig into the numbers with you, that’s what we’re here for.
We’ll help you see what’s sustainable, what’s risky, and what makes sense for where your practice actually is.