Sometimes the cleanest answer to a bad lease is to leave. But real life is messier. You have invested in build-out, patients know exactly where to find you, and shutting down to move is not realistic.
Start by telling the truth on paper
Before you react to the landlord’s first renewal proposal, get a clear picture of what this space is actually doing to your practice.
Write it down:
- What you are paying now: base rent, NNN charges (your share of taxes, insurance, and maintenance), and extras.
- What percentage of revenue that represents.
- How your volume, payer mix, and staffing have changed since you signed the original lease.
Seeing the numbers in one place turns a vague sense of “this feels expensive” into a specific conversation about sustainability.
Know your leverage, even if you can’t move
Not being able to move does not mean you have zero leverage. Landlords value stable medical and dental tenants. Vacancy is expensive. Build-outs are expensive.
Even if you are unlikely to relocate, you may still have:
- A solid payment history and low default risk.
- A space that would be hard to re-lease quickly if you left.
- Market conditions where your current rent is above what new tenants are paying.
The goal is to understand where you are genuinely constrained, and where the landlord would also prefer a renewal over a turnover.
Picture it
A two-chair dental practice, ten years into its space, gets a renewal proposal with a 20% bump. The owner can’t realistically move mid-lease with a full patient book. But the landlord knows something too: replacing a plumbed dental suite means months of vacancy and six figures of build-out for the next tenant. Neither side actually wants a turnover. That shared reality, not a bluff about leaving, is where the negotiation starts.
Separate “term” and “price” in your mind
Renewal offers often come as a package: five years at X rent with Y bumps. It is easy to feel like you must accept or reject the whole thing.
In reality, there are multiple dials you can adjust:
- Length of the renewal term.
- Starting rent and annual increases.
- Tenant improvement dollars or landlord work.
- Options: additional renewals, termination rights, expansion rights.
Even if moving is unrealistic, you can negotiate within those dials to make the overall commitment more survivable.
Use your constraints as part of the story, not a confession
You do not have to pretend you are definitely leaving if terms are not perfect. Most landlords will see through that. Instead, be candid about your constraints and frame them as a shared problem to solve.
“We are committed to staying if we can keep occupancy costs within X% of revenue. At the proposed numbers, that will be hard to sustain. Here is what would work for us.”
This keeps the conversation anchored in business realities rather than emotion or bluffing.
Look for relief in structure, not just in rate
Sometimes the headline rent number will not move as much as you would like. You may still get meaningful relief through structure:
- A period of reduced or free rent tied to planned upgrades or expansion.
- Smoother annual increases instead of a large jump at renewal.
- The right to sublease part of the space if you adjust your footprint later.
- A clearly defined purchase option if ownership might make more sense over time. How to tell whether a purchase option is real shows what “clearly defined” means.
When moving is unrealistic, structural flexibility can be the safety valve that keeps the space workable.
Bring in data from the market
Even if you are not planning to tour alternatives, ask your broker to show you:
- Current asking rents for comparable medical and dental spaces nearby.
- Recent deals that closed below sticker price.
- Concessions new tenants are receiving: free rent, tenant improvement allowances.
You are not doing this to threaten a move you will not make. You are doing it to ground the renewal discussion in reality instead of in the landlord’s first draft.
From stuck to stable
When moving is not realistic, renewal becomes less about winning and more about containing risk. You already know this location works for your patients and your team. The job now is to make sure the lease terms work for your practice’s next chapter.
A thoughtful renewal, one that leans on data, structure, and honest constraints, can turn a stuck situation into a stable foundation instead of a slow squeeze. And the earlier you start, the more of that structure you can get: The renewal clock starts two years early. Here’s the calendar.
This article is educational, not legal, tax, or financial advice. Review any lease with your own attorney and accountant before signing.