Below is the full episode from March 17, 2026. If you have 25 minutes, watch it. If you don’t, scroll past. We’ve pulled out the takeaways and the transcript.
How ASC Sale-Leasebacks Work
Jon Vick on This Week in Surgery Centers: how physician-owners use ASC sale-leasebacks to unlock capital, fund expansion, and time their exit.
The short version
Most physician-owners of surgery centers have no idea what their real estate is worth. The short answer: usually almost twice what the practice itself is worth, on a multiple basis. A sale-leaseback is the transaction that converts that value into cash you can use. You sell the building to a passive investor, sign a long-term triple-net lease, and keep operating exactly as you did before. The timing that matters: the best window to do this is 10 years before you want to retire, not 2. And if you’re planning to sell the practice to a strategic partner at some point, you almost always want to sell the real estate first, not after.
“The real estate represents significant value that can be used to improve or expand the property, or diversify into investments that have higher returns.”
Jon Vick. On why physician-owners consistently undervalue the building they own.
Five things worth knowing before the next conversation
1
The real estate is worth more per dollar than the practice is.
Surgery center real estate currently trades at 14–17x annual rent. ASC operations trade at 6–9x EBITDA. On the same property, the real estate multiple is roughly twice the practice multiple. Most physician-owners haven’t seen these numbers side by side.
2
Selling the building doesn’t mean giving up control.
In a sale-leaseback, the buyer is a passive investor, typically a REIT, private investor or real estate fund. They usually don’t manage the facility. Under a triple-net lease, the physician-owner still handles taxes, insurance, and maintenance exactly as before. Monday morning does not change.
3
The lease is what the buyer is actually buying.
Five factors drive the sale price: location, lease length, rent, growth potential, and financial performance of the center. The lease itself is the largest controllable variable. A 10-year triple-net lease at market-rate rent can add millions to the valuation versus a short-term or under-rented lease.
4
If you’re selling the practice eventually, sell the building first.
Once you bring in a strategic partner, you lose unilateral control over the lease. Your goals and theirs diverge. They want to maximize practice EBITDA. You want to maximize the value of both the real estate and the practice. Selling the real estate while you still control the lease lets you set favorable terms for yourself and the center before outside interests are involved. It also removes debt from the balance sheet, which makes the practice transaction easier and more valuable.
5
The window is 10 years out, not 2.
Buyers pay the most for properties with long remaining lease terms. A physician who comes to the table 10+ years before retirement can sign a 10-year lease and capture maximum value. A physician 2–3 years out usually can’t, and the difference in sale price can be substantial.
“The best time to sell real estate is 10 years before you want to retire.”
Jon Vick. On the timing mistake he sees most often.
Want to see what your building is worth?
Jon and Jason offer a complimentary lease review and real estate valuation. You get a written analysis of what your ASC or medical office property would sell for today, an audit of your current lease, and specific recommendations.
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“You should always sell the real estate before you do a [strategic transaction]. Because before the transaction, you have 100% control over the lease.”
Jon Vick. On sequencing when a partnership or PE deal is on the horizon.
Frequently asked questions
How much could my building actually be worth?
Every property is different, but as a directional answer: surgery center real estate currently trades at roughly 14 to 17 times annual rent. A building generating $400,000 a year in rent might sell in the range of $5.6 to $6.8 million. The exact number depends on lease length, location, rent terms, and the financial performance of the center. The complimentary lease review gives you a specific number based on your specific property.
How long does the whole process take?
About four to six months from engagement to closing for a sale-leaseback transaction. We typically receive serious interest from six-to-ten buyers, who submit letters of intent. We present those to you with our recommendations. You select the buyer and terms. We then negotiate the purchase contract and manage due diligence through closing. At closing, you receive cash and sign a long-term triple-net lease. The complimentary lease review at the start of the relationship is a separate, shorter process and takes about two to three weeks.
What does this cost me to explore?
Nothing. The lease review and real estate valuation are complimentary. We only get paid when we represent a physician-owner in a completed transaction, which means there is no fee, no retainer, and no obligation to pursue a sale just because you requested the review. If the review concludes your situation is not a good fit for a transaction right now, or that your current lease is already well-structured, that is what we will tell you in writing.
Who Jon and Jason are
Jon Vick started his first surgery center development company in 1983, when there were fewer than 300 surgery centers in the country. Today there are more than 6,000. Across 40+ years, Jon has been involved in over $3 billion in transactions spanning more than 500 physician-owned ASCs, endoscopy centers, and surgical hospitals.
Jason Winokur is Jon’s partner at ASC Realty Advisors. Jason brings deep commercial real estate expertise. He has been recognized by CoStar Group as a Power Broker and has advised on complex healthcare real estate transactions nationwide. Together, Jon and Jason work exclusively with physician-owners on sale-leasebacks and strategic sales of ASC and medical office properties.
They’re the team behind the complimentary lease review offered above, and the people on the phone when you book the intake call.
Episode 141 of This Week in Surgery Centers, produced by HST Pathways. Originally published March 17, 2026. Full episode and archive: hstpathways.com/podcast