Sale-Leaseback

Unlock the Capital in Your Medical Office Building

The building you practice in is often the largest asset on your balance sheet and the least productive. A sale-leaseback converts it into capital you can redeploy into physicians, service lines, and new sites of care, while you keep control and continue to practice in the building on a long-term lease.

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See What We Buy

What We Hear

“We Don’t Have the Cash to Expand. We Need a Funding Partner.”

Costs are rising, reimbursement is tightening, and care is moving outpatient. While health systems carry real estate risk on the balance sheet, bond ratings, and daily cash on hand come under pressure, physician groups watch senior partners’ equity stay locked in a building that younger physicians cannot afford to buy into. Over the next 10 years there will be tremendous growth in outpatient development.

Montecito Can Help Fund the Growth to Capitalize on This

We acquire your medical office building and lease it back to you long term. The result is a growth partnership, not a transaction: the capital goes to work, and your physicians can stay invested in the building through co-investment (PREP).

How We Monetize Your Medical Real Estate

Start With Your Practice Strategy

The first conversation is about where you are adding providers and sites over the next three to five years. Montecito partners receive a complimentary North Star Growth Assessment of their market before any real estate discussion.

Letter of Intent

Our investment team values the building on its real estate fundamentals and the strength of the practice, and sets out the lease terms alongside the price, so you see the whole structure at once.

Due Diligence and Lease Structure

A long-term net lease, typically 10 to 15 years with annual escalations, shaped around your clinical model. Tenant improvement plans and lease incentives are structured where they make sense.

Closing, and the Partnership Begins

Depending on how quickly we receive a signed LOI and the amount of due diligence required, we can often complete a transaction within 60 days. After closing, your asset manager, SmartMOB, and the co-investment program keep the relationship working.

What You Keep. What You Unlock.

You keep

You unlock

Control of your clinical space on a long-term lease

The equity in the building

The location your patients and referring physicians know

Capital for recruiting, technology, new sites, and debt reduction

A pure play medical real estate landlord with deep operational experience

A stronger liquidity and credit profile

The option for physicians to stay invested through co-investment

A succession and recruitment tool for the practice

Full discretion over timing, scope, and structure

A partner already mapping where you grow next

You cannot just make operational cuts to maintain profitability, you have to grow. Let Montecito help you accomplish your goals and be your Chief Growth Officer in your practice.

Partnership in Practice

EmergeOrtho: First Partnered in 2016. Reacquired Assets in 2026.

Montecito first partnered with EmergeOrtho’s Coastal North Carolina group in 2016. Ten years later, after two years of off-market dialogue, Montecito reacquired the real estate from its interim owner. The practice received a significant lease incentives, plus a tenant capital improvement plan funding renovations, mechanical capex, and building expansions. A large contingent of EmergeOrtho physicians invested at closing, and the group’s physicians and leadership are investors in Montecito funds.

Read the Case Studies

EmergeOrtho medical office building with an urgent care entrance

Sale-Leaseback Questions Physician Groups and Health Systems Ask

What Is a Medical Office Sale-Leaseback?

A transaction in which the owner of a medical office building sells it to an investor and simultaneously signs a long-term lease to keep operating in it. The owner converts equity into capital; the practice stays in place. With Montecito, the buyer specializes in medical outpatient buildings and offers physicians the option to co-invest.

Montecito has over 20 years of being a pure-play buyer of medical outpatient buildings and considered an expert in this real estate vertical.

How Is the Building Valued?

On its real estate fundamentals, the lease that will be in place at closing, and the credit of the practice or health system occupying it. Montecito buys at fair market pricing; the lease terms and the price are set together so neither is negotiated in isolation.

What Happens to the Practice's Control of the Space?

Nothing changes operationally. The lease gives the practice control of the space for 10 to 15 years with extension options, and tenant improvement plans can fund renovations or expansions as the practice grows.

Can Physicians Keep an Ownership Stake?

Yes. Through the Provider Real Estate Partnership (PREP), sellers can co-invest part of their proceeds into the acquiring entity for a minority stake of up to 49%, structured for tax deferral on long-term capital gains, with distributions during the hold and a share of the proceeds if the larger portfolio sells at a later time.

How Long Does It Take?

Often within 60 days of a signed letter of intent, depending on due diligence. The first conversation, including a growth assessment of your market, can take one meeting.