Key Takeaways
- The structural gap. Mid-market behavioral health and medical operators routinely outgrow their local broker before they are large enough to interest the global tenant representation firms, leaving a service vacuum during the most capital-intensive phase of multi-site expansion.
- Pathway’s response. Founder Jordan White is building a hub-and-spoke brokerage that sits at the center of a custom vendor team, sourcing architects, contractors, and legal counsel for each client engagement rather than locking operators into bundled multi-year contracts.
- What the market evidence shows. PE-backed ABA platforms are chasing the same demographic-rich ZIP codes, multi-state lease cycles run twelve to eighteen months even when execution is clean, and clinical constraints like the five-per-1,000 ABA parking ratio can knock out most available buildings in a target market.
- The path forward. Operators who plan further out, sign longer leases with termination options, and treat real estate as a vendor procurement problem rather than a single-broker problem are better positioned to grow without burning through capital on stalled clinic builds.
On a recent Tuesday morning, Jordan White took a meeting with an urgent care group that had reached the stage every multi-site healthcare operator hits eventually: the moment when the real estate strategy that worked for the first handful of sites stops working for everything after. The contractors were no longer the right contractors. The architect was a placeholder. The local broker was phoning it in.
“They’re used to resources that aren’t really a fit for national growth or even regional growth,” White said in an interview with Acuity Media Network. “They may have a local broker relationship. When they try to drag that local broker into national work, often they say yes, because they’re thinking, I can continue to get work from this client, and I’ll figure it out as I go.”
White, a longtime corporate real estate broker, founded Pathway Occupier Solutions in 2025 to address a problem he had spent years watching from inside a traditional brokerage. The firm targets multi-site behavioral health and medical operators, with retail and select office and industrial work alongside, and its founding bet is that the middle of the market is structurally underserved. Its arrival lands in an industry where private equity firms acquired nearly 600 autism therapy sites in a decade, and where the largest ABA providers are pursuing aggressive de novo expansion that depends on real estate execution more than most operators acknowledge.
The Mid-Market Brokerage Gap
White’s thesis starts with a structural observation about how brokerage actually serves growing companies. On one end, mid-market operators in the early stages of multi-site growth tend to lean on a local broker who knew them when they had two or three sites. That broker, White said, will often agree to follow the client into new states because the relationship is lucrative. The trouble is that real estate practice varies by market in ways that are not obvious from the outside: rental rates are quoted differently, property databases differ. “So they can over time get in a little over their head,” White said. “Not that they couldn’t do it. It’s just, if they haven’t specialized in that, then they’re probably unprepared.”
On the other end, the global brokerage giants tell a different story. White recalled a corporate video on the homepage of one of the world’s largest commercial real estate firms, in which a senior executive said the firm was focused on Fortune 100 clients. Pathway’s own website puts the point in starker terms, telling visitors that global tenant representation firms are “primarily built for Fortune 500 clients, not growing multi-market companies.” That posture, White argued, leaves a wide swath of the market underserved, from the hundred-and-fifty-clinic ABA platform to the regional urgent care group to the specialty medical operator with thirty sites and ambitions for two hundred. “We’ve had people tell us that when they ask for a real estate search, it goes into a black hole for weeks, and they don’t hear back,” White said of clients who came to Pathway after stints with the global firms.
Several of his client engagements at his prior firm reached a point where, even with strong real estate execution, the rest of the table was empty: contractors had been fired, architects were a mess, lease counsel was overwhelmed. The pattern echoed a wider problem Acuity has documented in the operational mistakes that break multi-site behavioral health growth. “If I could have fixed that for them, we could have continued their growth,” White said. “For several of them, it was the only factor that kept them from growing like they had wanted to, or like the PE firm had hoped they would.”
Pathway’s answer is what White calls a hub-and-spoke vendor model. Rather than maintaining a preferred network and routing every client to the same handful of partners, the firm interviews each client at length about budget, timeline, build-out type, and geography, then sources and pre-screens vendors specifically for that engagement. The client picks. Pathway, as the broker, sits at the center and manages the team. “It creates a lot more accountability,” White said, “because they know that they’re not part of a big ‘bundled’ five-year contract.” Operators frustrated with bundled service agreements at the global firms, he said, often discover too late that switching out an underperforming architect or contractor inside a long-term contract is harder than it looks.
ABA Site Selection: Why the Math Looks Worse Than the Map
If the structural argument is about who is at the table, the operational argument is about what happens once everyone sits down. White’s diagnosis is blunt: the most frequent issue Pathway sees is not a vendor problem but an expectations problem. Leadership teams and PE sponsors map dots without a working sense of what real estate in those markets actually looks like. “We’ve had some engagements where people say, we’re ready to start looking, here’s exactly what we need,” White said. “And we come back to them, having to explain, it’s not out there.”
Compounding the inventory problem is competition. Growing operators in the same vertical converge on the same metro areas and, more pointedly, on the same buildings within them. White said Pathway has fielded multiple confidential calls from competing operators in the same industry asking about the same property in the same week. The economics are acute: private equity is pouring capital into behavioral health while ABA visit volume has grown more than 300 percent since 2019, and PE-backed platforms are pursuing demographic profiles, payer mixes, and density thresholds that converge on a relatively narrow set of ZIP codes nationally.
Then there are the landlords. A surprising share of the freestanding pads attractive to medical and retail operators, particularly those with ample parking and no shared-wall concerns, are owned by mom-and-pop investors who have held the property for fifteen or twenty years and have neither in-house counsel nor a standard lease document. White described one recent engagement in which a landlord took a month to produce a draft lease because his cousin’s attorney had to write one from scratch. There was nothing his client could do, White said: “We have no other options in the market.”
White’s general timeline guidance for clients planning multi-state growth is twelve to eighteen months from the day a market list is finalized to the day a clinic opens, with another six months added for jurisdictions like California where permitting is its own protracted process. Operators hoping for six- or eight-month turnarounds, he said, are working with a calendar the market does not honor.
Lease Structure and the Short Vendor List
Clinical constraints unique to behavioral health add another layer of difficulty. ABA providers in particular often need parking ratios that the available real estate is not built to deliver. “Some of them will say they want eight per 1,000 parking, and general standards are three per 1,000,” White said. “Even four per 1,000 can be sometimes hard to find in a certain market.” Industry benchmarks for retail and medical office tend to run higher, in the four-to-six range, but the five-per-1,000 ask common in ABA is well outside what most landlords can offer. Leasing more space than the clinical program needs solely to capture the parking raises occupancy cost and can push operators toward cheaper buildings in industrial-adjacent submarkets that families may be reluctant to drive into.
Stack a few constraints together, the parking ratio, the demographic and payer-mix profile, the wish to avoid a shared wall with a non-compatible tenant, and available inventory can collapse to a small fraction of what was on the original tour list. “You keep stacking them on each other,” White said, “and all of a sudden we’re looking at 2 percent of available properties that could actually potentially check every box.” Flexibility on at least one of the wants and needs, where the business model permits, is often the difference between a viable search and a stalled one.
Lease structure is the other lever. To capture the tenant-improvement dollars needed to fit out a clinic, operators typically commit to longer-term leases of seven to ten years. White recommends those leases include termination options, even at a cost. “If your site is just not performing, you’d rather write a check for a couple hundred thousand dollars and move on,” he said. The same logic applies in reverse for high-performing sites: a right of first refusal on adjacent space gives an operator room to grow without reopening a full search. White and his team have also handled nationwide lease buyouts, calling landlords directly to negotiate exits at twenty or thirty cents on the dollar.
None of these levers solve the underlying market dynamic, which is that ABA and broader behavioral health are scaling at a moment of acute Medicaid rate pressure and intense competition for the same submarkets. White is candid that real estate cannot solve a reimbursement problem or a BCBA and RBT workforce shortage. What it can do, in his framing, is stop being a constraint of its own. “The better you perform for your client, the more successful they are,” he said. “The more you are ingratiated to continue the relationship with them.” For a multi-state operator with a PE clock ticking, that alignment may matter more than the commission line on any single deal.
Frequently Asked Questions
How long does it take to open a new multi-site behavioral health clinic?
White’s working benchmark is twelve to eighteen months from the day a market list is finalized to the day the first clinic in that wave opens. States with longer permitting cycles, such as California, can add another six months. Operators hoping for six- or eight-month timelines can sometimes hit that window when move-in-ready space is available, but a shell build-out typically pushes a market closer to a full year on its own.
What is the most common real estate mistake mid-market healthcare operators make?
In White’s experience, the most frequent issue is a lack of respect for what the market will actually deliver. Leadership teams map dots and assume that buildings matching their specifications exist in each location, that timelines will be short, that landlord tenant-improvement allowances will cover most build-out costs, and that competing operators will not be looking at the same buildings. None of those assumptions reliably hold.
Why are ABA and behavioral health providers struggling with parking at clinic locations?
ABA clinical models typically require parking ratios closer to five spaces per 1,000 square feet, with some operators asking for as many as eight, while general retail and medical office parking is closer to three or four per 1,000. Operators who insist on the higher end of that range often have to lease more space than they need, drive their occupancy cost up, or compromise on building quality and submarket profile to find a property that meets the spec.
Should multi-state behavioral health operators lease or buy their clinic real estate?
White recommends leasing in most cases for the flexibility it provides, particularly given that the long-term performance of any single site cannot be predicted. Owning works for operators with strong site selection certainty and the capital to absorb a building they cannot easily exit, but a well-structured lease with a termination option, expansion right, or sublease right typically gives a multi-state operator more room to adapt as the portfolio matures.
How does a hub-and-spoke vendor model differ from a bundled brokerage contract?
In a bundled contract with a global brokerage, a client signs a multi-year agreement under which the same firm provides brokerage, project management, architecture, and construction oversight. Switching out an underperforming category mid-contract is technically possible but practically difficult. A hub-and-spoke model keeps the broker at the center and sources each vendor category separately, on the theory that the operator can replace any single seat without unwinding the whole arrangement. That flexibility matters more for operators preparing for a sale, where ABA platforms positioning for transaction face heavier scrutiny on contract liabilities and vendor commitments.
What lease structures help mid-market operators stay flexible during multi-site growth?
White points to three common levers: termination options at year five or seven on a ten-year lease, expansion rights or rights of first refusal on adjacent space, and sublease rights that allow an operator to exit a non-performing site without writing the landlord a full buyout check. Each carries a cost in negotiated rent or fees, but each also preserves optionality at the moments when most operators need it most.
