In brief
- The standard 30-year spreadsheet leaves out the first years of a practice.
- Renting, buying, and waiting are each rational at a specific stage. The skill is knowing yours.
- Where a structure like Medre’s fits, and where it does not.
The spreadsheet everyone shows you
You have seen the chart. Thirty years of payments, two lines, one labeled rent and one labeled own, and somewhere past year ten the owning line drops below the renting line and stays there.
The message is simple: buy, look how much you save. It is not wrong. It is just not written for you yet.
Those charts assume three things most practice owners do not have on day one: a large down payment, a stable picture of your market, and the appetite to be a landlord while the practice is still proving itself. The math is clean because the life behind it has been simplified away. This piece puts those assumptions back in.
What the math actually measures
Rent-versus-buy math compares two costs. The long-term cost of paying market rent to a landlord, and the long-term cost of paying a mortgage, taxes, insurance, and maintenance on a building you own.
On paper, owning almost always wins over 30 years. Part of every payment builds equity, and you are not paying someone else’s margin. Over enough time, that outpaces the rent checks.
That is the 30-year story. Your decision is rarely a 30-year decision. For most practice owners the real question is: given my capital, my market, and my appetite today, which path gives me the healthiest next decade? The spreadsheet does not answer that. You have to.
Decide in the time frame you are actually in
The decision looks different at three stages. The 30-year spreadsheet collapses all three into one line. You should decide in the one you are actually in.
Years 0–5
Proving the practice. Cash is tight and flexibility matters more than equity.
Main risk: over-committing too early.
Years 5–10
Stabilizing and growing. Revenue is clearer and you can see whether this location is home.
This is where ownership starts to make sense.
Years 10+
Compounding or exiting. You know whether you are staying, expanding, or selling.
Real estate becomes a cornerstone or a complication.
When renting is the rational choice
Renting is not failure. It is often the correct call in the first phase. Rent makes sense when:
- Your capital belongs in equipment, staff, and the first years of payroll.
- You are still testing your market and do not know yet whether you will stay.
- Your lender wants a personal guarantee you are not ready to give (see What a personal guarantee actually costs you).
- You would have to stretch for the down payment and live tight for years to cover it.
In those circumstances, owning the building is a second risk sitting on top of the first. The spreadsheet does not show that. It assumes the practice is already stable and the owner already certain. If you are not there yet, a fair lease in a good but modest space is often the smartest move you can make.
When buying is actually cheaper
Buying your first building is the cheaper move when three things line up.
You have real capital. Not the minimum down payment scraped together, but enough to fund the building without starving the practice.
Your market is stable. You know you want to be in this town, in this trade area, for a decade or more. You are not guessing.
You have appetite for being a landlord. Owning comes with repairs, decisions, and risk, and you are willing to add that to your plate.
When those three are true, the 30-year charts start to match your life. You pay yourself with every mortgage payment, you control your own renewal terms, and the equity becomes a real part of your balance sheet. In those cases we would tell you to buy the building yourself. It is cheaper in the long run, and putting Medre in the middle does not make sense. We make the fuller case in When owning your first building is actually the cheaper move.
The wait option the spreadsheets skip
The third option is the least visible in most discussions: wait. Waiting is not indecision. It is keeping your options open on purpose while you gather the information the other two paths assume you already have.
Waiting looks like signing a shorter initial lease in a good location to test your market (Short lease or long lease covers how). Avoiding personal guarantees until the practice has a track record. Keeping capital in the practice while you build revenue and reserves. Letting the first five years answer whether this is where you plant a flag permanently.
This is often the right move for first-time owners or anyone entering a new market. You are not saying never. You are saying not yet, and not on guesses.
Rent
Best when: capital and certainty are still in the practice, not the building.
Main tradeoff: every check builds someone else’s equity.
What to watch: renewal leverage grows against you over time.
Buy
Best when: real capital, a stable market, and landlord appetite all line up.
Main tradeoff: a personal guarantee and a down payment the practice can’t use.
What to watch: the building competing with the practice for attention.
Wait
Best when: you want ownership eventually but the answers aren’t in yet.
Main tradeoff: keeping the choice open has a cost, in rent or premium.
What to watch: waiting by default instead of on purpose.
Where a structure like ours fits
Medre exists in the space between renting forever and buying with a personal mortgage. The structure is built for owners who want eventual ownership, who want their capital in the practice for the first years, and who want a written path to ownership instead of a handshake.
You lease at fair market rent plus a small premium. In exchange, your name stays off a mortgage, the ownership decision is yours to make in any year from 5 through 10, and the option price is set by independent appraisal at that time, plus a purchase premium that declines the longer you lease, instead of negotiation. (For how to interrogate any option, ours included, see How to tell whether a purchase option is real.)
The tradeoff, plainly
- The option fee and premium are real money, paid for keeping the choice open.
- Today’s price is not locked. The appraisal at exercise sets it, up or down.
- If you already have capital and certainty, buying yourself is cheaper.
Whether that trade is worth it is a math question, not a marketing one.
Questions to take to your spreadsheet
- What am I assuming about my practice’s stability and growth?
- What am I assuming about my market and whether I stay?
- What am I assuming about down payment size and personal guarantees?
- What happens if I sell the practice or add a second location?
- How sensitive is this picture to interest rates, vacancies, and repairs?
If a chart cannot answer those questions, it is a picture, not a plan.
Your attorney and accountant should be at that table with you. So should any lender or firm offering you a structure, ours included.
This article is educational, not legal, tax, or financial advice. Review any move with your own attorney and accountant before you sign.