In my recent blog entitled “Small Hospitals, Big Technology,” I talked about technology enabling healthcare systems to build small hospitals in rural or suburban areas with an eye toward the future.

But what about the explosion of the bedroom communities surrounding some of our sprawling metropolitan areas? When the building boom of five to seven years ago hit, developers were of the mindset to push the boundaries of our suburban communities.

Many jumped on the bandwagon to move out “just a few more” miles, buy land, and build houses for first-time buyers and commuters—satisfying the demand of many who were willing to drive a little (20, 30, or even 50 miles each way) to work in exchange for the dream of home ownership.

Then came the downturn. Those bedroom communities were left with few services for the residents. Sure, they built a school, a Wal-Mart, a gas station, and some fast food restaurants—but never a doctor’s office. With these demographics, there is simply not enough population to warrant a full-time office or a staff.

Enter the large system with its own pool of physicians—employed or contracted—but on the staff. Now they can set up a hoteling MOB where doctors can see patients a day or two per week; and when they are not there, some other doctor is using the rooms and the staff.

Needs-oriented services that are provided in these spaces often include OB-GYN, pediatric, and general practice physicians.

In regions such as the Southwest where I live, an abundance of retirees (particularly in the winter months) create a service demand and niche markets for cardiac and diabetes care physicians, not to mention good hip and knee orthopedists.

If we add in an imaging space with Rad-Fluro and ultrasound, a small lab space, and a few “procedure rooms” or possibly an urgent care component, we have a kind of “Super MOB” that has a captive community of users.

Now build three or four of these around the metropolitan area, and we have doctors with happy new patients who are then being referred to the larger acute care facilities or centers of excellence in the urban area—all providing growth and profit for the healthcare service providers as well as a much-needed service to the public.

Seems pretty simple, but don’t discount the barriers to entry.

It takes a solid balance sheet, top-notch staff, and the right volumes of service and patients to make it work, especially when it comes to calculating and building just the right number of facilities for a given area. The investment required is, naturally, much smaller than for a small hospital.

Tie up enough land, and the hospital can be the second phase of the building program when the numbers are there to support it. The options are endless.

Gerry DeWulf is a project executive for DPR Construction, a forward-thinking national general contractor and construction manager that specializes in technically complex and sustainable projects for the healthcare, advanced technology, life sciences, higher education and corporate office markets. With 41 years of construction management and general contracting experience, DeWulf has extensive skill in estimating, value engineering and project supervision. As one of DPR’s healthcare specialists, DeWulf has played an instrumental role in many of DPR’s recent healthcare projects including Banner Health’s Banner Maricopa Health Center in Maricopa, Ariz., Palomar Pomerado Health Foundation’s Palomar Medical Center West in Escondido, Calif., and two new Hybrid ORs for the University of Arizona Health Network.

For more information about DPR Construction, visit Gerry DeWulf can be contacted at