As we wrap up the first season of the podcast, it’s worth reflecting on the ground we’ve covered. We’ve dug into the forces reshaping surgical practice—how patient expectations are evolving alongside the push toward outpatient care, and what that means for how surgeons deliver services. We’ve also tackled the harder conversations about reimbursement pressures and provider burnout, issues that threaten the long-term sustainability of healthcare in communities across the country.

Today we’re looking forward. Our guest is Greg Venn, CEO of Nexcore, who has spent more than 25 years working in healthcare real estate. He’s seen firsthand how the physical infrastructure of healthcare has evolved and has a clear perspective on where things are headed. His experience spans the development and investment side of the industry, giving him a unique vantage point on the decisions that will shape surgical practices for years to come.

In this conversation, we’re focused on giving surgeons the insight they need to navigate what’s next—particularly when it comes to ambulatory surgical centers. As ASCs continue to grow in importance, understanding the real estate and investment landscape behind them becomes essential. Greg’s perspective will help connect the dots between infrastructure trends and the practical realities of running a surgical practice in the decade ahead.

In reflecting on where we've been in the first season of on the Brink, it's been a whirlwind of important topics for our surgeons.

We've covered everything from where to begin with a patient and a patient's perspective and expectations that are changing dramatically with the trends that are pushing to more and more outpatient care, to declining reimbursement and burnout of our providers who are just critical to the future of health care for our communities.

So today I want to look forward by looking backward and bringing us full circle.

My guest today has been influencing healthcare real estate over the last 25 plus years.

And with that knowledge and the influence over the past, Greg Benn, CEO of Nexcor, can opine on what the next decade and beyond look like and help our surgeons be prepared for the future.

Well, today we're at the conclusion of season one of on the Brink.

It's been an incredible experience walking through the journey for surgeons as they think about investing in healthcare real estate and ASCs.

Really honored to welcome Greg Benn to the show today.

Welcome, Greg.

Thank you.

Greg is the CEO and founding partner of the Nexcor Group and also an architect.

Yeah, that's a liability sometimes around here.

No, I think it's a strength.

I think it's a strength in how you approach our projects and how we think about problem solving.

Greg, today I'd love to Hear about your 25 plus years experience in terms of how you've seen things evolve and change in that time in healthcare real estate.

Let's start there and then I'm going to ask you to opine on your thoughts about the future.

Okay.

Well the, the idea of healthcare and real estate has changed a lot in that when we first started most of the institutions didn't know what it was and the institutional capital hadn't invested and there was a lot of, I think discussions around was this an asset class that was too complicated and had people didn't understand ground leases from hospitals and the kinds of things that it requires to make it work for the hospital and make it work for the physicians.

And especially when you're bringing a surgery center into the mix.

I'd say what's really changed now is that the institutional capital is mainstream now.

They understand it and that's think a benefit to the physicians.

Right.

Because they get an institutional partner that can maximize value, understands how to create situations where there's ability to have liquidity events in the future for the docs to be able to, you know, practice there for 10 years and have ownership during that time, but also have a way to have liquidity and be able to, to monetize their investment in the future.

So there's, I think that's the main thing is you want to create that flexibility for them.

Right.

So they have that opportunity.

You know, on prior podcast episodes here, we've been talking a lot about that, that surgeons, physicians in general have taken a 30% reduction in their reimbursement and they're really looking for the revenue streams that they can.

So you've already touched on it.

But how should physicians think about the institutional capital, the structure of these deals, such that it does protect their income stream for the future?

Well, I, I think the main.

Given that institutional capital partners understand how to create the economic glue.

Right.

That alignment.

Yeah, having that structure for making sure that you're not building a building, but you're building, you know, the idea of referrals that work between the different groups that you're creating.

You don't want to have a, a developer that's going to turn around and lease some of the space to an insurance company that doesn't have any part of the flow of the project.

You want to make sure that you have an institutional capital partner that understands how to nurture and grow practices so that you're given the ability for groups to be flexing into more space if they need more space.

And how do you think about that?

How do you place those physicians into a building not only just their ownership, Ironically, I start off with finance, but I come back to the design.

I think the earliest ASCs that we did.

One of the physicians told me one of the most important parts of this new building is that my lifestyle is no longer driving halfway across town to get to the surgery center.

My practice is above my surgery center's on the ground floor.

I have the hospital on campus that I can do my patients and, and rounds within, checking in with patients that having all of those design synergies and making sure that they've got a financial investment and a stake and alignment with that outcome.

I really appreciate that.

And we've talked a little bit about that, that we've got to start with vision.

And I think that's something that you've really taught me is it's not a one size fits all approach.

Right.

To the, to the real estate and to the ASC that really talking to our physicians about what their goal is both for themselves and their practice, to your point, their well being, getting home for dinner on time, that efficiency, but also their patients is just really Critical as that starting point.

Yeah.

Well, having.

I think that we've seen a lot of the technologies driving more and more surgeries into these projects, that they're becoming their own healthcare campus in itself.

And they really are important that you're taking into account what the ambulatory needs are for the patients, but also the staff.

And how does the staff be able to be efficient and maximize and have quality of life working for the physicians and working for these groups that all of those things want to be taken into account.

I think I really appreciate that.

And you're an expert in the design.

So as you think about those multiple variables that have to be considered, what should physicians look for in their.

Their architect partner and.

And what specifically should they think about from a design element?

That's a great question.

I think that for sure, when someone uses the term, you know, prototype or cookie cutter run, go the other way.

Yeah.

Because there's no such thing as a prototype.

I think for healthcare design is a very customized, like residential customization of residential homes.

You want to create something that works for that family.

And what these.

These particular.

Some.

Some of the projects that we do, we might have the asc, the orthopods, the.

The hand surgeons that might be independent groups, but you might also need to very, in a collaborative way, work with the hospital and maybe their employed physicians.

And how does that impact overall workability of the surgery center and the flow that's going to come through and of course, the patients.

So having those.

An architect that is looking for.

Listening.

I appreciate that.

And making sure that they're asking the questions.

And we try to vet the firms that.

And there are some great firms that they are making their decisions based upon inquiry, not just based upon.

This is what we did the last three surgery centers.

And because each one is customized.

And I think that they want to be looking at the newest technologies that are still out there, because we see that happening.

I think after Covid, we saw a lot more of the kind of virtual and remote possibilities for some of the practices that can be in this medical office building and surgery center building.

So having those firms that are willing to look at how did we used to do it and how do we want to do it today?

So I really appreciate that and I think that's a great pivot point for us.

You've clearly influenced health care, real estate over the last 25 years with your expertise and the magnitude of projects that you've done.

I know that you're serving on a lot of conferences and boards and other things.

I'd love now for you to think about the future.

We've got a lot going on in the macroeconomics.

Where do you think this is going to go?

So as surgeons that are starting to think about the journey, what does the next 10 or 15 years look like in your crystal ball?

Well, for sure the pressure to continue to grow outpatient services will continue to, to happen.

And the whole idea, I'm sure it's been spoken about numerous times about the retailization of healthcare and being in the community where the services are being delivered.

I think that there's going to be a more deliberate move to see medical be a part of the mixed use community that real estate has an ability to offer.

We still see a medical office building sort of isolated and standing out on the corner.

We often do.

And I think that that's maybe a missed opportunity that I would like to see that these projects can start to become more of what you might see when you're walking down the activated pedestrian space in Cherry Creek or that there's medical office buildings that are more incorporated as a part of other mixed use.

You still have to make sure that has that destination parking and then it's going to work for the patients that are coming that way.

I think we see it in urban markets.

We're starting to are.

And so I think that, that we're going to.

I also think that the future for investing, the more institutional investment that's made into these buildings, the more solid foundation that, that the business has.

We kid about it, but when we started 23 years ago, we asked on a, on a panel about would medical office buildings ever be considered for institutional capital?

And one of the individuals on that said it'll never be institutional.

And now there's, I guess we probably have trillions of investments, maybe hundreds of billions that are out there for the entire medical office building market with many of those assets still being held by hospital systems.

So I think that that will continue to drive institutional capital more and more into the space, which gives physicians more opportunities, I think, to get greater value for what they invest in.

The idea we used to have medical office buildings where the physicians were invested.

And I think there was a question of 10 years when I want to retire, who's going to buy my ownership?

Right.

That's not really a question anymore because the institutions are creating flexibility where they'll create that ability to create liquidity for that individual or a group or the entirety of the building.

And that's changed and I think that will continue.

There's an understanding of institutional capital, that that's an important facet for being in the space and at least the institutions we want to work with.

I will admit there were some that said they don't want to do that.

Right.

They said it's our money, we want to do it the way we do it.

And that isn't the kind of institution, not the partner we want, that's not who we want involved in our projects.

So I really appreciate your comments about physicians that might be a little bit further along in their career and they're thinking about an exit strategy.

Do you think that there is capital and funding structures available for some of our newer physicians that are coming out of school with a big debt load and starting their life that are still interested in beginning this journey?

Yeah, I do.

I think we've known that sometimes there's.

We often used to kid about it when we were early on in our careers, we wanted to invest.

And sometimes the value that you provide isn't just based upon the check that you can write.

A lot of it is based upon the value of the tenancy, the value of the physicians are bringing to the project.

So we have different structures that we try to employ into the projects that allow ownership.

Sometimes it's.

It's based upon almost an earn in kind of requirement where we can say you earn in by the number of years that the tenant is signing in the building.

And there can create certain ownership percentages.

Sometimes the physicians are able to write a bigger check and want to take a bigger equity portion.

So we've tried to create a half a dozen different vehicles that hopefully aren't confusing and are just trying to say we can be flexible to make sure that we can let everybody participate as much as we can.

And I think that's what our physicians want to know.

Right.

That there are options and starting where you were of.

We got to understand what you want and what works and it's right.

Not the same for everybody.

So as you commented about a location change, which I agree with you, I think the future likely includes more medical space integrated with where people live, work and play.

I think that can be beneficial for physicians as well.

Right to your point, avoiding the drive.

Well, especially when you start talking about some of the younger staff, maybe the younger generation physicians that are more likely to want to be closer to work, maybe even ride the bike to work, maybe even walk to work.

I, I think that the, the urbanization of suburbs is happening as we speak.

There's, there's centers in suburban areas that are starting to create new Density And I think that that is a real opportunity.

Some of the cities around the country, we see it.

Right.

And, and I think that will continue and a real opportunity for medical to be located not only in the good retail located spaces where people can get to them, but also where the people who work there, the staff, the patients, you know, a lot of patients might actually, you know, start commuting and riding, you know, a light rail or something closer to the community rather than everything being thought about how do you drive.

To the, to the hospital campus sort of parking lot.

Right.

It's gonna, it's.

It's already happening in some markets and I think it will continue.

I think that from a opportunity of quality, you know, I, I've got to believe that there's staff and physicians that would love to get midday if they want to go take their lunch break, they can walk, take a walk.

Instead of, you know, going to the hospital cafeteria on campus, they could go take a walk and go to a, a restaurant that's along one of the pedestrian ways of that mixed use project.

So yeah, I think that our providers will really appreciate that.

There was remember a lot of concern during COVID and others where some people get to work from home.

Right.

For the most part, surgeons in particular need to be on site.

It wasn't remote surgery.

No.

And instead of being able to take a break, a little bit of a respite, even take care of their own health, you know, get some steps, I think is, is really helpful.

So we've talked a little bit about a future where the locations may be different.

Right.

Maybe housing and other retail elements around them.

Do you see elements or design changes for the medical outpatient building or the ASC itself in the future?

Well, it is still a highly, I don't want to say restricted, but guided by a lot of codes that are important.

Absolutely.

That there are going to be those kinds of things that will continue to influence how.

You know, I think about an ASC that, that ASC needs to have a.

If, if at all possible, you want to have the roof exposed so that you can have the mechanical equipment that's very specific to them and the separation of the use for their occupancy that is easily partitioned away from the rest of the building so that you can avoid an over costly building by trying to make it all the certain level of eye occupancy.

With all of that said, I think that it's the design elements that are the public spaces and the activated spaces that are going to continue.

We're Seeing a change so dramatically than it was 20 years ago.

The medical office buildings used to be a pretty plain, pretty sterile.

Right.

Not a lot of public spaces.

And that's changed a lot.

I think it's changed especially in campus environments Now.

I, and this is my, maybe it's my hope, but I don't know if it's, if it's vision or if it's hope or whether we'll see this happen given the idea that there's more of a mixed use environment coming in all of our lives.

But I think that those buildings could be completely different in how they interact with the other types of spaces like residential.

I think that we've seen it happen where the senior living is very integrally tied into campuses where it makes sense.

There's intergenerational themes that are working where they're, they're seniors and then there's also younger people that are in apartments.

I think those will be interesting spaces for people to have their practice as well as potentially grow their, their patient base of where they're at, where they're located.

I really appreciate that We've seen some universities trying to integrate to your point around multi generational functional uses and learner.

They might be, they might be leaders of that that might force that.

I think some of the projects.

There's a project in California that happened and university system was involved there and I think that that's coming.

It probably won't be 90% of mainstream, but I think it will become a bigger component of what medical think of medical potential future.

Right.

Work there.

All right.

The other question that I did want to ask before we wrap this up is we hear from a lot of physicians that are employed, for example by health systems that are also interested in investment in either the real estate and or the asc.

Are you starting to see some models or thinking about models where we can offer hope to them as well?

We are.

I think that some of the, the.

I think some of the systems are finding a way that it makes sense.

Of course it's important that those employed physicians have a way to make an independent investment.

But also because we as the developer, as the owner and the general partner with the institutional capital, we can separate it so it doesn't create a conflict.

And I think the systems are looking at it more and more.

As you know, we've got several systems that are asking, are indicating that they are okay to proceed with that.

And I would say 15 years ago.

We didn't see that.

Right, right.

And I think that's a good Indication because of course, the employment model has increased in some markets.

Right.

But now this gives all those physicians the ability to have that ancillary investment that's going to create alignment, create glue, and the systems will of course, embrace it because it creates an alignment with everybody to do good work and to be able to make an investment in where they work.

Yeah, I really appreciate that.

So, Greg, any last advice?

These are physicians listening to us providers.

We've been encouraging them to take the first step advice as they think about the future.

How do they stay up to date?

I would say well into.

My first advice would be is that absolutely have an, an investment with somebody that is looking out for their interests but is also looking at what are the things that can influence this investment that are outside of just the hospital, just the physicians, and try to do good, sound investment with.

And I've already reinforced that the institutional type of investment with private investors I think is the best of both worlds in terms of.

Of what to what.

What was a question you asked in terms of.

To show.

Oh, to stay up to date, to stay relevant.

Right.

I. I think that the.

There's really good data out there that talks about where this, you know, the REITs have invested into this space, the other institutions and the other pension funds have invested in the space and there's good data to know what is market value and what generates good transactions.

I think that you want to stay up to date with someone that's willing to, willing to share that data with you.

Right, right.

It's a lot of, a lot of developers or builders that are.

They might kind of hide behind the, the curtain.

The curtain and say, you know, we'll take care of that for you.

But if, if you have someone that's willing to sit down and say, no, this is what Nay creef's returns are for this return on this asset.

And this is what institutions are investing are.

It will allow the.

Them to get a better sense of a transparency of what is out there and an ability to invest knowing what, what the world is trying to do with these types of investments and knowing that there's someone willing to share it with you.

Not keep it.

Yeah.

Not hide from it.

I really appreciate that.

It's been a common theme throughout our episodes that physicians, surgeons in particular want more control over the practice.

So I think leaving them with your advice to partner with somebody that will be transparent.

They're obviously very intelligent individuals that that's how they can take more control.

Well, and you reminded me another thing that we often talk about is, I mean, physicians have spent so much of their lives reading and studying and information.

Right.

So as a developer, we need to understand that that information is so much of a lifestyle that they have, that having that information is a way for them to make good decisions.

And the more that we can give them that information, I think secures the, the decision that they're trying to make and the relationship.

Yeah.

Right.

All right.

And for sure, it's all about the relationship.

It really is.

Yeah.

And it is.

It's what our surgeons are used to with their patients, their peers, their team as well.

So it all works together.

Yeah.

All right.

Well, as I expected, you've opined in a very robust way about the past and into the future.

So I really appreciate the conversation.

Thanks.

Thanks, Greg.

Okay.

Well, as expected, Greg did an amazing job on our wrap up here.

Greg was able to bring the concepts that we've talked about throughout the season into the future state.

As we've talked about, we've been talking around medical offices and we're moving to medical outpatient.

We are moving from patients driving to campuses and outside of their communities and instead bringing healthcare, real estate and assets, ambulatory surgery centers into retail areas, into areas where patients are living, working and playing.

And for surgeons, it's often where you live, work and play, really focusing on your well being and integrating that with patient demand and need, finding your team members that you need to work with you to be effective.

So really the future being all around this bringing of comfort and warmth and integration, health and well being into much more of a health centered future.

Focus on the go forward.

I certainly hope that throughout these episodes we've given you data we know as physicians, you are trained in taking data, in assessing the accuracy of it, making good decisions based on the data.

So our intent has been to give you the data that you need to be courageous, to be curious and to take action steps to take more control of your practice through ownership in real estate and ASCs.

Thank you very much for joining us.