The influx of developers into the medical office arena has created "many opportunities," Rutson says. "We analyze what the developers are producing. That's what we like to do."

In the summer, Rutson sold his stake in Texas Medical Realty Group, a brokerage firm he co-founded in 2005 to service one nationwide management group. "I saw the opportunity to take this beyond one practice," he says.

The medical office industry's fast-paced growth has attracted many top-notch developers. But, Rutson says the typical game plan is build, hold for two years and sell. For a physician with a seven-year lease, he says that could be a problem. "How does this affect the practice? Does it make sense seven years down the road? I've seen too many physicians who haven't really understood development," he says. "They really need a neutral firm to review all options."

Rutson says he's preparing his clients that developers, in limited partnership arrangements, might start expecting personal guarantees for leases in light of the present fiscal crisis. "Doctors need to understand all their options rather than one option, what they need long term and what they're signing up for," he adds.

According to Rutson, existing medical office space generally costs $20 per sf to $22 per sf for a full-service lease whereas the new space is fetching $27 per sf to $28 per sf, triple net. He says past restrictions kept negotiations at a minimum, but more medical office buildings are owned by REITs and investment groups, neither of which has the same mandates as a hospital-owned building.

"It was the right time to start this up," Rutson says. "And with what has happened in the financial market in the past two to three months has given me more comfort that this is the right time."