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A structure for the launch budget. Deliberately a worksheet, not a table of “average costs”: published averages are mostly lender and consultant marketing, and variance between specialties swamps any average. Fill it in with real quotes. The categories are what practices get wrong.

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Build-out and space

Design fees, construction (clinical plumbing, electrical, shielding), permits, signage, furniture, deposits. Offset by the negotiated TI allowance. Get local per-square-foot quotes; clinical space costs a large multiple of office space.

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Equipment and technology

Clinical equipment (new vs. refurbished is a real decision), sterilization, IT, phones, and the software stack: EHR/PM implementation plus first-year subscription, clearinghouse, website. Equipment financing often runs separately at equipment-secured rates.

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Professional and administrative

Attorney, CPA, credentialing service (per provider), licenses, malpractice (claims-made starts cheap and steps up), business insurance, pre-opening marketing.

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The line everyone undersizes: working capital

Six months of full operating expenses including your own draw, covering the credentialing gap plus A/R lag. Formula: (rent + payroll + loan service + insurance + supplies + software + owner draw) × 6. If the total makes the project uncomfortable, resize the project, not the working capital. Undercapitalized launches fail on runway, not quality.

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Sanity checks before the loan application

Three tests lenders apply, so apply them first: month-12 revenue covers costs plus debt service with margin; production assumptions match your actual associate history; construction carries 10 to 15% contingency. A conservative model that closes beats an impressive one the underwriter discounts.

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Sources and uses

Practice loan for build-out and equipment (guide), equipment financing where cheaper, the TI allowance, personal liquidity for the share lenders want you to carry. Then land it all in properly structured accounts from day one.