Although 22nd in rank for population, Charlotte is one of the fastest growing cities in the nation. Over the past 10 years the population has grown almost 60%! In 2010 the population rank was only 33… Affordable housing and lower cost of living paired with rapid economic growth and a hot job market has generated a population magnet.

Hospital construction across the US is in the midst of a delivery spike as many projects, both new hospitals and additions, open this year. As of the end of 2018 Philadelphia had the largest under construction hospital pipeline of any metro with 4.4 Million square feet and 14 projects under construction, almost double the square footage of the runner up, Washington DC.

In past metro highlights we’ve talked about growth markets with lots of construction activity, interesting markets with innovative health systems, metros with the highest sales volume, but what about the tightest markets? The ones with the highest rent growth, the most expensive pricing and the lowest vacancy? Flipping through our Metro Rankings report, San Francisco clearly fits the bill.

Over the past year or so there have been many headlines speaking to how hot the medical real estate sector is. You see them pop up in your email or news feed: "Sales volume is at all time highs"..... "New investors are entering the sector right and left"...."Medical Real Estate Hitting Post Recession Peak". At times like this, many investors are getting priced out of the 'cream' offerings that trade and the heavy weight health system construction projects. So it would stand to reason that those interested parties would look elsewhere....and they are.

As REITs pull back on acquisitions and focus more on refining their portfolios, private equity groups have more than taken up the slack. Total healthcare real estate transaction volume may have cooled ever so slightly - but not much - and so far this year, private investor buyers are making up 76% of that total.

This unassuming market is number 2 in terms of outpatient building deliveries and 4th for total deal volume. Even rent growth has been consistently surpassing the national average.

The bread-and-butter medical office building (MOB) deal continues to entail the sale of a single building for a price of less $20 million, often quite a bit less. Such deals, of course, do not typically satisfy the appetites of the sector’s largest investors, including private equity funds, the larger publicly traded REITs, and institutions, as well as foreign capital. Such investors prefer deals that provide immediate scale instead of having to accumulate a portfolio by making smaller, one-building acquisitions.

Houston is the number one metro in terms of square feet of hospital space under construction. As of the end of 2017, Houston had roughly 4.2 million square feet of hospital space under way – about a million square feet ahead of the runner up, New York.

Prior to the start of 2018, several members of the Editorial Advisory Board (EAB) of Healthcare Real Estate Insights™ predicted that the sector would see some transactions in which health systems would buy medical office buildings (MOBs) that they are leasing from third-party owners.

Continuing focus on high medical office sales activity might lead one to wonder where all this activity is occurring. In 2017, more than 25% of sales volume was represented in only 5 metro areas. Who's leading the pack?