The Southeast Michigan Dental Office Lease Negotiation Guide

By: Nick Zagar | CEO & Managing Director of Mirlo Real Estate Partners

Short Version: Here is what a fair deal looks like for a SE Michigan dentist looking at a 10 to 12-year lease in 2026: $40-60 per SF Tenant Improvement Allowance (with room to push higher in certain situations); 5-6 months of free rent to cover the time during your construction permits and time after you open; exclusions for big expenses to protect you from paying for the landlord’s capital expenditures; fixed-price renewal options; an exclusivity clause with explicit prohibited uses; assignment language that protects the sale of your practice; and a personal guaranty that includes a 12-24 month cap or a burn-off structure. If your existing lease or proposed lease is materially worse than this on more than two terms, you’re leaving money on the table – usually six figures over the life of the lease term.

Since 2005, I’ve successfully negotiated over 1,000 commercial real estate transactions, and for nearly a decade, I’ve focused on representing healthcare practice owners. Dentists, veterinarians, optometrists, therapists, you name it, these are my clients in Southeast Michigan.

And to help people like my clients, I’ve created this guide inspired by the same common mistakes that show up in almost every lease I review. Most of them are not negotiated by the healthcare practice owner, but they’re terms written by the landlord’s broker, accepted only because the practice owner didn’t know better. And sadly, these mistakes end up costing the practice owner tens to hundreds of thousands of dollars throughout the course of their lease term.

National guides are useful, but they’re written to cover the average market, and Southeast Michigan is not the average market. Oakland County medical office vacancy has been tightening since 2023, Washtenaw County is even worse, and the landlords in Birmingham/Bloomfield have leverage they didn’t have five years ago.

So all of that being said, consider this guide a solid foundation for any healthcare provider in Southeast Michigan seeking to start a new practice, renew a lease, relocate, expand, or buy a building. Note, I’ll be referencing deals for dentists specifically, since they’re buildouts are often the most extensive and costly.

10 Terms That Actually Move The Needle

1. Tenant Improvement Allowance (TIA) 

   What is it? A dollar-per-square-foot contribution from the landlord towards your build-out. It’s the single most negotiated economic term in any dental lease, and the one most tenants leave money on the table.I typically achieve $40-50 per square foot on a 10 to 12 year lease. This is the realistic outcome for most healthy negotiations across SE Michigan submarkets.For brand-new vacant buildings, you could expect $60 per square foot, because the landlord has empty inventory and is competing for tenants.The best I’ve ever gotten is $110 per square foot, but that was a unique situation. The landlord had received an insurance payout on the space and had cash to deploy. I mention this because every now and then a special circumstance like this will exist, and you only find it if you ask.

   For lease renewals, we’ll typically get $10-25 per square foot, but that could be more if you’re willing to commit to a longer extension, such as 7 to 10 years.

   But what do dental buildouts cost in 2026? To know whether the TIA you’re being offered is enough, you’ll need to know what the buildout is going to cost.

   New construction or shell conditions will be $140-200 per square foot for a full dental buildout, including operatory plumbing, vacuum, compressed air, X-ray rough-in with lead-lined walls, finished cabinetry, and all Mechanical, Electrical, Plumbing (MEP). The number will be on the upper end of this estimate for premium finishes or for a specialty practice.

   Second-generation dental space will be the least expensive at $20-30 per square foot for essentially just cosmetic improvements, including new paint, flooring, cabinetry refresh, lighting upgrades, signage. This is assuming all plumbing and operatory layouts will stay as-is.

   Second-generation dental space with modified operatories or floor plan will be $40-80 per square foot, but this could be more. As soon as you move plumbing and add operatories, or change room sizes, the cost climbs fast. The exact number depends on how many ops you’re touching and whether the existing slab can accommodate the new layout.

   General office space converted for dental use needs to be considered new construction, because they are full gut jobs, costing $140-200 per square foot. A standard general office space does not have proper plumbing for dentistry, vacuum lines, compressed air, higher electrical capacity, or other MEP infrastructure for dentists. Converting everything usually means a complete demolition. If a quote sounds too cheap, the contractor is probably underestimating the demo or slab work.

   One more thing to note is if the building is a multi-tenant building, you can expect more scrutiny from the landlord due to the construction causing utility shutoffs and common area disruption throughout the process. These two factors alone will cause strategic scheduling (including after-hours) and more daily cleanups to be mindful of the other tenants at the property. Ensure you discuss these arrangements ahead of time and budget accordingly.

   In summary, run those numbers against the TIA the landlord is offering. If the gap is too large with a long lease (10+ years), you’ll need to push for more before you sign anything or possibly walk away.

   As for some general tips:
   
   Tip one, ask for a lot. Landlords don’t volunteer TIA; they respond to the number you put on the table. The opening number sets the ceiling for the whole negotiation.

   Tip two, push for a “TI bank”. This means unused TIA can be contributed to other line items, such as free rent, equipment, or signage instead of being forfeited. Most landlords will agree when asked, but most tenants don’t ask.

   Tip three, negotiate progress draws. If the TIA is paid as a reimbursement after construction, this can strain working capital. Therefore, I like to push for payments at different stages of construction, such as 30% at framing, 30% at MEP rough-in, and 40% at Certificate Of Occupancy COO).

2. Free Rent 

   What is it? Formally known as rent abatement, these are months where you pay no base rent. Note I say base rent, specifically, because the abatement period most often does not include postponing the costs for expenses and utilities.To fully grasp the benefits of receiving free rent, you’ll have to understand the construction timeline and the stages of opening your doors to your business. Most lease guides act as if there is a switch, but there isn’t. The right way to think about the opening process is as a sequence of phases tied to your actual cash flow from when you can occupy to when insurance money starts hitting your bank account.Here is the realistic construction schedule for a dental buildout:Month 1, construction drawings. Your architect and dental equipment specialist produce the construction documents. You’ll lock down these hires well before signing the lease. This takes about one month for a typical practice.

   Month 2, municipal approval. The drawings go to the local building department for permit review, and that will take about another month.

   Months 3-6, buildout. These four months are for actual construction, which cannot start until after the permits are in hand. Construction could take longer for a complex build.

   Month 7, Certificate Of Occupancy (COO). Administered by the municipality stating the construction is complete, the permits are closed, and you can finally open your doors.

   Months 7-11, opening. If this is a startup practice, you’ll spend the first several months getting credentialed with insurance carriers while your patient volume builds.

   Month 11/12, cash flow. Insurance reimbursements will now be coming in, and your cash flow will start to look like a real practice.

   Yes, this means it takes roughly 11-12 months from signing for the practice to start funding itself.

   Now, what does this mean for free rent? There are two approaches to how I like to structure free rent against the construction timeline:

   Approach 1, free rent timed to permits (preferred option). Free rent doesn’t start ticking until permits are issued. This way the two months you spend on drawings and municipal review don’t burn any of your free rent allowance, and you’ll have your full free rent period covering the actual construction window and the operational ramp up.

   Approach 2, maximum construction time + post-occupancy free rent (most common). If the landlord won’t agree to approach 1, I’ll push for the most amount of free rent during the buildout months AND an additional three to four months of free rent after you open for business. This way your free rent period won’t end while you’re still waiting on insurance revenue.

   The biggest takeaway here is you need to clarify when the rent clock starts. How many months will be free during construction? After occupancy? If you don’t ask, the answer is always “at signing,” and that’s the most expensive way to take it.

   And for renewals, you’re not building anything new, but you can still receive free rent. Landlords will typically agree to one to two months, but I push for more by pointing out the downtime and all the associated costs the landlord avoided by not having to bring in a new tenant.

3. Expenses 

   What are they? Most dental practices are going to be at properties that have NNN leases. This means the tenant pays their portion of the three “nets” or operating expenses:  property taxes, landlord’s insurance, and Common Area Maintenance (CAM). In SE Michigan, the nets for a medical office are often a quarter to a third of your total occupancy cost. Pay attention to any terms regarding the expenses!My advice, do not waste time trying to push for “capping controllable expenses”. Most lease guides will tell you to do this, but in reality, the fight over what counts as “controllable” vs. “uncontrollable” is hard and rarely lands cleanly. Landlords will define almost everything as uncontrollable when it suits them.The better approach is to negotiate an explicit list of carve-outs for specific items the landlord cannot bill for. My list includes:– Audit rights for property taxes and the landlord’s insurance.

   – Cap-controlled CAM increases at 3-5% per year. (This is hard to get, but worth the effort trying.)

   – Exclude from the CAM charge, by name:  landlord’s capital expenditures, leasing commissions, depreciation compliance upgrades, and general overhead.

   – Exclude big ticket items, by name:  roof replacement, HVAC system replacement, parking lot replacement or resurfacing, structural repairs, facade work, ADA compliance upgrades. These should be considered capital expenditures, not maintenance. Don’t let the landlord bill you via CAM for these as “repairs”.

   If you’re going to do anything, get exclusions for these big capital expenditures. A parking lot replacement charged in CAM is one of the most common items and a perfect example of the bigger pattern:  a $300,000 capital project the landlord labels as “maintenance” and bills back to tenants over a few years. Landlords will use the same tactic for roof replacements and HVAC system replacements. If your lease doesn’t list these as excluded costs, the landlord can and will argue they’re fairly included as maintenance, and if you choose to push back, your attorney will be fighting on rough terrain.

4. Renewal Options 

   What is it? The tenant’s right to extend the lease without renegotiating from scratch. Not only will you negotiate if there is a renewal option and how many, but you will negotiate the terms, because they can vary.Some leases have detailed terms under this clause with an outlined rent schedule, and others are more vague with nothing pre-determined. Some leases can have multiple renewal options too. Whatever the case may be, renewal options will also have a deadline for the tenant to exercise this right. Otherwise, the landlord could deny the tenant’s request to extend the lease.I insist on two 5-year renewal options with the base rent at the start of each period set at the lesser of a. 95% of fair market rent or b. the prior period’s rent escalated to 2.5% per year. This formula protects you if the market spikes and prevents the landlord from holding the renewal hostage when you’ve invested so much into your space and equipment. The 2.5% cap is what we typically achieve. Lower escalations than 3% are attainable when you push for them.My best advice is to be sure to avoid “fair market rate” with no cap or no formula. In this scenario, the landlord will just name a number, and you can’t realistically counter without an appraisal fight. Always insist on a cap or a formula.

   And once your lease is signed, you absolutely need to set reminders of your renewal option expiration dates. Typically, you’ll want to give yourself 12 months prior to your renewal option expiring to make your decision, especially if the base rent has not already been established. Procrastination is the killer of leverage, and landlords will happily let you forget and miss your deadline. Landlords know if you don’t have any other option but to stay put, you’ll take whatever rent and terms they give you, and that’s obviously not the position you’ll want to be in.

5. Exclusivity
   
   What is it? Also known as a non-compete, it’s the landlord’s promise to not lease a nearby space to anyone with the same or similar business. For dentists, you can choose to be as specific as possible, such as including a ban on other tenants performing invisalign, or you may just be satisfied with an exclusion of other general dentists.In my opinion, an exclusivity clause is mandatory for healthcare tenants. I’ve heard about a general dentist discovering, two years into the lease, that the landlord just signed a Smile Direct retail outlet next door. Their exclusivity clause only stated “competing dentistry,” and the landlord argued retail orthodontics wasn’t “dentistry”. The dentist lost a year of revenue while the lawyers fought.I represented an orthodontist recently who walked away from a deal, because the landlord would not agree to include their list of procedures in the exclusivity clause. They opted to go elsewhere to ensure they were protected. The details do matter here.My recommendation, define competing use explicitly. List all your practice’s offerings, or at minimum, list general dentistry, orthodontics, oral surgery, DSO retail outlets, specialty dentistry, etc. Add hospital-system carve outs if relevant. If it matters to your practice, add it.
6. Assignment
   
   What is it? Your right to transfer the lease if/when you sell your practice. Assignment means if you sell the business, the new owner gets the lease too, and you are released from the liability of it. This is the single most important provision for protecting your practice.
   
   With this clause, we push for this specific language:  landlord consent required, but “not to be unreasonably withheld, conditioned, or delayed.” We also fight for no assignment fee or a small fixed fee, such as $1,500-3,000 max. You also do not want a requirement that the new tenant meet the same net-worth status as you. And you certainly want the clause to state that the original tenant shall be released from liability after assignment if the assignee’s financial profile is comparable.Beware of recapture language. This is when the landlord retains the right to cancel the lease and re-lease the space at higher market rent when you try to sell your practice. You want to immediately strike this. This recapture language destroys your buyer’s financing assumptions, which will then make it more difficult to sell your practice. If the landlord won’t get rid of this clause entirely, narrow it to specific scenarios and require the landlord to pay a recapture fee equal to the diminution in your practice sale price.
7. Relocation

   What is it? The landlord’s right to move you to comparable space with the building. Relocation clauses are the most common in larger Medical Office Buildings (MOB) or standard office buildings. Landlords want this because it gives the flexibility to accommodate new tenants or other tenants who need to expand.However, there are two big reasons why relocation clauses impact a dental practice more than a regular office tenant:First, a move can be an operational hassle. It can require weeks of downtime and confusion for your patients. Now, sometimes moving a practice can be worth it if it’s on your own terms and planned to either save money or accommodate growth, but a landlord initiated relocation to a “similar or comparable space” will not make up for the obstacles of a move.Second, your buildout is much more extensive compared to an office tenant, and this can actually be used as your defense. A dental buildout runs approximately $140-200 per square foot in 2026. If the relocation clause forces the landlord to pay 100% of this cost, they are certainly going to think twice before exercising those rights. It would be much cheaper for them to move a standard office tenant with a cheaper buildout.

   This leads me to my recommendation. If you can’t get rid of the relocation clause entirely, structure it to make relocating as expensive as possible for the landlord. Include:

   – The explicit definition of “comparable size, configuration, and visibility”. Do not leave it up to the landlord’s discretion.

   – The landlord must pay 100% of the moving and rebuild costs, including the operatory plumbing, vacuum, compressed air, X-ray rough-in, signage, marketing (for the change of address), and lost revenue during the transition. For a 6-operatory practice, this will cost the landlord at least $150,000 just for the operatory rebuild.

   – At least 12-month written notice.

   – No rent increase at the new space with any TIA carry over.

   – The tenant has the right to terminate the lease in lieu of relocating with no penalty.

   Do not settle for boilerplate lease relocation language! Standard language for a relocation clause was written for standard office tenants (and to favor the landlord). It will not include the points above. Landlords of strip-malls and office buildings often present a relocation clause casually, because relocating is not as big of a deal to other tenants. But remember, you are not a standard office tenant, and this clause should not be standard for a dental practice.

8. Holdover
   
   What is it? The official way of saying the tenant stays in the space after the lease expires. This clause will state the consequences in this scenario.Fact is, holdover is a punitive measure, and the landlord can apply the terms in this clause at their discretion. They’ll go hard if they’ve got a tenant lined up to take your place. Once you’re in holdover, you’ve handed the leverage over completely. And although it is important to never end up in holdover in the first place, the language in the lease matters.You may be wondering, if holdover is a bad situation to be in, why would a tenant let themselves end up there? It’s not as uncommon as you think. One situation may be that you’re leaving because you bought a building or signed a new lease, but the buildout is not quite yet finished. After all, buildouts almost always run longer than planned. If this is you, the best and practical move is communication. Talk to your current landlord as far in advance as possible – six months is good, three months is a minimum. Ask them for a short extension that matches your realistic move-in date. If they agree, this will be much cheaper than holding over. And you may be surprised to learn that most landlords will actually agree if you ask early. They’d rather collect rent for a known period of time, and it usually takes months – or even years – of vacancy before they lease a space anyway.So, back to negotiating the holdover clause. You’re still going to want to push for some language. Even with the communication-first approach I described, you’ll want some guardrails if you find yourself in a sticky position. These are the holdover terms I try for:– Holdover capped at 125-150% of base rent.

   – Month-to-month status, not a forced new long-term commitment.

   – Six-month minimum before either party can terminate.

   – No consequential damages language. This is to protect you from the landlord billing you for their lost rent of not being able to lease the space to a new tenant.

   Beware, do not accept 200-250% or more base rent and/or consequential damages baked in. These terms could really be costly. For example, if a practice sale slips by two months and your lease has this language, the holdover rent alone could be over $30,000.

   In conclusion, strip the consequential damages and cap the multiplier before you sign. Then, if you find yourself in a holdover situation, communicate early.

9. Hazardous Materials
   
   What is it? Permission to use the materials a dental practice actually uses:  amalgam, nitrous oxide, controlled substances, sterilization chemicals, and X-ray equipment.This clause may not be top of mind, and general office tenants wouldn’t need to bat an eye at it, but healthcare practices need to pay attention. I insist on explicit carve-outs listing the materials customary to dental practices, along with stating the tenant will comply with applicable laws, and the landlord cannot require the tenant to remove the materials customary to use.Do not accept generic “no hazardous materials” language. This is another clause where the boilerplate lease is not going to work for healthcare tenants. If left as-is, the terms could be used to weaponize against you in the future. You never know what circumstances you’ll encounter. For example, if the landlord plans to sell several years into your lease to a new owner who would love any reason to terminate your lease. If poorly negotiated, this clause could be an opportunity.
10. Personal Guaranty
    
    What is it? Your personal liability if your practice defaults on the lease. This is an additional section of the lease, and you’ll have to provide some personal financial history before signing.The honest read is that you will most likely have to sign one, especially if you have a startup or younger practice. We’re negotiating aggressive terms with TIA in the tens of thousands, months of free rent, exclusivity protection, etc. The landlord is putting real money on the table, and they’re going to want you on the hook for some of it. That’s the dynamic. So, our fight regarding the personal guaranty is the scope and duration – not whether it exists.What counts as a win? There are two factors we typically push for:Factor 1, rolling guranty. This means your personal liability is capped at the next 12 months of rent plus expenses at any given time. As the lease moves forward, the exposure stays at one year; it does not accumulate.Factor 2, removal after no default. Otherwise referred to as a “burn off” provision, this is where the personal guaranty falls away once you’ve performed a certain number of years without missing payments. We’ll typically shoot for five years. Some landlords will agree to a shorter window for stronger tenants, but some will require longer. Five years is a reasonable target.

    Either of these terms for the personal guaranty should count as a win. Again, pushing for no personal guaranty at all rarely lands for a lease with a serious buildout, because the landlord’s economics don’t support it.

    Warning, a “good guy guaranty” can be a trap. This language sounds limited, but it triggers on any default, rather than just an early surrender. It depends on the exact details, but essentially the guarantor could still be on the hook, even if the practice is no longer occupying the space. Study this clause – read the personal guaranty word for word, and ensure your real estate attorney does the same.

How A Tenant Representative Saves You Money
First, a commercial real estate agent whose client is the tenant is officially called a tenant representative. Choosing an agent who specializes in representing tenants is best, because they have little to no listings, and this means they do not work for landlords. They are not going to be biased towards any properties.

Second, in commercial real estate, the landlord pays the tenant representative’s commission. This is part of the deal structure. The commission, paid by the landlord, is split between the agents of the landlord and the tenant, so the tenant is not involved.

Therefore, a tenant who does not hire a tenant representative and negotiates for themself, does not actually save money. They were not on the hook for the commission in the first place. Instead, the landlord’s agent simply just gets to keep both halves. So, the practical question is whether you’d rather have an experienced advocate to fight for your best interest – at no cost to you – or hand over all the economic value to the landlord’s agent.

When To Start The Process
Engage with your tenant representative about 12-18 months before your current lease expiration or your target opening day for a startup practice. The earlier the better, because if you’re too early, we can decide on the best time. However, if you’re too late – especially within 90 days of your lease expiration – your leverage sharply drops, and the landlord knows it. They know if you run out of time, you’ll be forced into holdover, and I’ve already discussed the downside to that above. And if your back is against the wall, you’ll be more likely to accept unfavorable terms.

FAQs:

• How do I find a tenant representative who specializes in dental in SE Michigan?
  There’s four criteria to look for:
  1. Physically based in SE Michigan – this means they’ll have a deep understanding of the markets, properties, and landlords in the areas you’re looking at.
  2. Tenant Rep only – this means they don’t also represent a bunch of landlords. If they did, they would be biased towards certain properties and have conflicting interests.
  3. Healthcare-focused – this means they know how to structure deals in a way that best benefits you. They know which terms to fight hardest for and what criteria properties/landlords need to meet to ensure your success.
  4. Experienced – this is the number of dental deals they’ve actually closed in the last 2 years. Ask for references.
  Mirlo checks all four of these boxes, but we’re happy to refer you to another broker if it’s not a good fit.
  How long should a dental office lease be in Michigan?
  For most practices, expect a 10-year primary lease term with two 5-year lease renewal options. If you try for a shorter term, you’ll have to cut your Tenant Improvement Allowance and/or other concessions, and like with all leased spaces, committing to a longer term starts to chip away at your flexibility of being able to move if you outgrow the space or the neighborhood declines.
• Do Michigan landlords offer free rent to dentists?
  Yes, but pay attention to the structure – not just the number. If your free rent starts right at lease signing, 2 of those months are going to get absorbed during municipal permit approval. Instead, push for free rent to start once the permits have been issued, or at least negotiate 3-4 months of free rent after you open. This is important, because it takes a new dental practice about 4 months to get credentialed with insurance carriers, so the cash flow won’t start until then.
• What’s a fair base rent for dental space in Oakland County?
  In 2026, you can expect $22-32 per square foot NNN for second generation space or $28-40 for new construction. However, pay attention to the NNN number. These are the operating expenses you’ll be billed for on a monthly basis, and the amount can end up being a quarter to a third of the base rent. Once you account for the operating expenses, your total rent will look more like $32-48 per square foot.
• Should I sign a personal guaranty?
  For independent healthcare providers, you probably don’t have a choice. Especially for new practices, it’s not a matter of if you have to sign one, but it’s the terms that are negotiable. The dynamic is mutual, you’re asking the landlord to commit real capital – Tenant Improvement Allowance, free rent, etc. – and in exchange, they want you on the hook for some of it.

The fight is over the scope and duration of the personal guaranty, not whether or not it exists. The two structures worth pushing for are a 1-year rolling guaranty or a burn-off after 5 years of no default. Getting either of these would be considered a win.

• What is a triple net (NNN) lease?
  The Triple Net lease gets its name, because the tenant is responsible for paying the three nets in addition to the base rent. The lease will state how each of these expenses are paid. A typical set up is that each net will be calculated to a per square foot, per year figure, and then the property manager will charge each tenant based on their square footage. If the property manager underestimates these costs, the tenant will receive a bill at the end of the year for the difference, or if the property manager overestimates, the tenant will receive a credit to go towards next year’s nets. The landlord or the property manager will be able to tell you what the projected costs are for each of these nets. However, keep in mind, you should ask for the approximate net costs during initial negotiations, because they don’t typically advertise the net rates, only the base rent figure.
• What is a Tenant Improvement Allowance?
  Sometimes called TIA or a TI package, Tenant Improvement Allowance is a negotiated concession, which is a designated amount of money provided by the landlord to the tenant to contribute to the construction costs of the tenant’s space build out. These funds can only be used for actual construction labor and materials – not equipment or furniture items.

Southeast Michigan Healthcare Submarket Update 2026
Before I get into the submarkets, I want to point out a trend we are seeing for buyers:  former bank branches on busy roads. These are very popular with our dental and veterinary clients for a few reasons:

1. Signage- banks are built for visibility in high traffic areas. They already have large existing monument and facade signage – better than most multi-tenant buildings – along with the benefit of inheriting those signage rights.
2. Accessibility- these are single-story, ADA-compliant buildings with ground-floor entries and no shared lobbies. This is the ideal set-up for any healthcare office, because it is easier on patients, especially those with mobility challenges.
3. Parking- banks have a typical parking ratio of 5-8 spaces per 1,000 SF, and that is generous for a medical or dental practice. Healthcare use requires a lot of parking per zoning requirements, but a former bank will put you in the clear.
4. Pricing- believe it or not, but we’re finding we can get these buildings at a good price. With banks consolidating, they’re wanting to release the real estate at attractive market cap rates.

• Ann Arbor (Washtenaw County) is tight. The leased medical office space vacancy is under 6% in most clusters. This comes with landlords being very firm on base rent, but a little more flexible on Tenant Improvement Allowance (TIA) for long-term tenants, which healthcare tenants are. The toughest spots are:  Plymouth Road, State Street, and the South Industrial Corridor. Buying is even harder in this market and requires patience for that rare find. If you’re willing to go out to Dexter, Chelsea, or Saline, you’ll find better pricing.
• Northville/Novi/Plymouth is very actively constructing medical office space, but you’ll pay for it. Leasing is probably easier with landlords acting more competitively and higher TIA is achievable, whereas buying will price you at $400-600+ per square foot for a built-to-suit. If you’re price sensitive, look one ring out.
• Birmingham/Bloomfield has premium pricing for their strong patient demographics for both leasing and buying. You’re going to find aggressive landlords who want high base rents and offer lower TIA packages compared to other areas. And for owner-occupied opportunities, move fast or lose it, and expect to pay $400-650 per square foot.
• Royal Oak/Berkley/Ferndale is a great choice for growing and younger practices. It offers a younger demographic and makes for an easier startup market. For buying, there’s more available stock at around $300-450 per square foot, and for leasing, there’s more flexible landlords than Birmingham but a tighter market than Northville.
• Rochester Hills/Troy has a well-established medical office market with well-established landlords who’ve been in the industry for generations. This means it’s common to find relationships matter more here than just the economics, and there are no one-size-fits-all rules for both leasing and buying. Purchase prices here are around $325-475 per square foot.
• Warren/Sterling Heights/Shelby Township/Clinton Township (Macomb County) is very active for owner-occupant buildings, especially with former bank buildings. This submarket is very underrated, in our opinion. It is less dense, but that is part of the appeal. You get more for your money with less competition. We’re seeing buildings sell for $200-350 per square foot.
• Dearborn/Dearborn Heights, we’re finding, is very tough for buyers. Properties are going for well-above asking prices. You’ll have an easier time moving further to the west in Wayne County or plan to be patient.
• Canton/Livonia/Westland (Western Wayne County) behaves more like Oakland County with buying, but its landlords are more flexible. Some of the best base rents and TIA are achievable here, which is the most attractive for startups. Landlords are also offering more favorable terms for lease renewals here.
• Detroit Core has a different playbook than the suburbs, because the market is mostly controlled by the large hospital systems. This means the lease terms are more standardized with not as much room for negotiation. If you’re buying, you’ll find some of the friendliest pricing at $250-375 per square foot, which is a good value for buyers who want suburban density without the Oakland County premium price tag.

Talk To Me
If you’re approaching a lease decision – as a startup practice, lease renewal, relocation, expansion, building purchase, etc. – I offer 30-minute lease reviews – again, for free! Send me your current lease with your questions, and I’ll get back to you with my top three recommendations to negotiate.