Medical Office Feasibility Study in Missouri

Missouri medical office lending runs light against the national pattern

Physician office buildings are a mid-sized class in Missouri, ranking 12 of 39 on the state's own list, and a location quotient of 0.55x says they take roughly half the share of SBA lending that they take across the country. Even so, 71 loans approved from FY2017 to FY2026, worth $35.9 million, place Missouri 23 of 53 among states, a mid-table position. Missouri's typical $300,000 loan sits at 0.88x the national midpoint, and requests mostly fall between $150,000 and $500,000. A Missouri borrower is usually financing a practice purchase, an equipment package or a modest tenant build-out, not a large medical building.

Program use, lenders and counties

SBA 7(a) carried 64 loans and SBA 504 carried 7, so owner-occupied real estate deals through the debenture structure are rare here. Franchise affiliation is 2.8% of loans, reflecting that physician practices seldom operate under a brand. UMB Bank, National Association is the only lender in the file with five or more loans, holding 5 worth $2.2 million; the rest of the volume is spread across many institutions with smaller counts, so a borrower will often be dealing with a lender that has done few of these. Saint Louis County has 14 loans and Jackson County 11, followed by Greene with 7, Cape Girardeau with 6, and Saint Louis City with 5.

Cancellation floor, and what cannot be reported

Cancellations account for at least 10.9% across the FY2017 to FY2024 loan approvals, and counting the undisbursed adds nothing to that 10.9%. About one in nine approvals did not fund, which is worth planning around when a practice acquisition depends on a closing date. No Missouri charge-off rate is published: the disbursed group has fewer than 30 loans, too few to publish a rate, and a blank here should never be read as zero. Approvals have wobbled, with 12 loans in FY2025 against 4 in FY2019, and 9 loans worth $9.4 million in FY2021 the biggest dollar year.

What the numbers ask of a medical office study

A Missouri study has to test demand with care. Physician supply, payer mix and referral patterns decide whether a practice or building can fill, and the light location quotient means local lenders may have little precedent. Costs should be built up from the tenant build-out and equipment, with a contingency, and compared with the moderate tickets seen in this file. Debt service coverage must hold through the ramp of a new provider. The appraisal should say how much of the value is the real estate and how much is the practice.