Why Change Orders Cost More Than You Think
Every construction project starts with a vision.
Perhaps you're building your first medical office. Maybe you're expanding into a larger space to accommodate a growing patient base. Whatever the goal, you likely have a budget, a schedule, and an opening date in mind.
Then, somewhere along the way, you hear two words that every owner dreads:
"Change order."
For many people, a change order sounds harmless. After all, you're just making a small adjustment, right?
Maybe you want to move a wall a few feet. Add another exam room. Upgrade the flooring. Install different lighting fixtures.
How expensive could it be?
The answer is often far more than people expect.
What Is a Change Order?
A change order is any modification to the original construction contract after work has begun.
Sometimes the owner requests the change.
Sometimes it's caused by unforeseen conditions discovered during construction.
Sometimes it's the result of incomplete plans or coordination issues.
Regardless of the reason, change orders almost always affect three things:
Cost
Schedule
Project complexity
Even a seemingly minor revision can create a ripple effect throughout the entire project.
The Domino Effect
Imagine your contractor has already framed several exam rooms.
Then someone decides one room needs to be two feet wider.
At first glance, it sounds simple.
Move a wall.
But moving that wall may require:
Revising architectural drawings.
Relocating electrical outlets.
Extending plumbing lines.
Adjusting HVAC ductwork.
Updating fire sprinkler locations.
Revising permits.
Ordering new materials.
Reworking completed construction.
What looked like a one-day task suddenly involves multiple trades returning to redo work that was already finished.
Everyone's schedule changes.
Materials may need to be reordered.
Inspections may need to be repeated.
A small decision becomes a much larger expense.
Time Is Money
Every change order affects more than construction costs.
It affects your opening date.
For physicians, delays can be particularly costly.
Each week a practice remains closed means another week without seeing patients. Rent, loan payments, insurance, payroll planning, and other overhead expenses continue even though revenue has not yet begun.
A single change order might delay one subcontractor. That delay affects the next trade, and then the one after that.
Construction schedules are carefully coordinated. One disruption can impact the entire timeline.
Why Most Change Orders Are Preventable
Not every change order can be avoided.
Unexpected conditions behind walls or beneath concrete sometimes require adjustments.
However, many of the most expensive change orders stem from decisions that could have been made earlier.
We've seen projects where equipment dimensions were not finalized before design.
We've seen owners change room layouts after framing was complete.
We've seen contractors discover missing information in the construction documents that should have been addressed during planning.
None of these situations happen because people are careless.
They happen because planning was rushed or coordination was incomplete.
The earlier these issues are identified, the less expensive they are to resolve.
Planning Costs Less Than Rework
One of the greatest misconceptions in construction is that spending more time planning delays the project.
In reality, thorough planning often shortens the construction schedule.
When architects, engineers, contractors, equipment vendors, and owners coordinate before construction begins, fewer surprises arise during construction.
Finalizing equipment selections before drawings are completed.
Reviewing layouts with physicians before walls are framed.
Confirming utility requirements before permits are submitted.
These conversations may take extra time upfront, but they prevent expensive rework later.
In construction, planning is almost always cheaper than rebuilding.
The Value of an Owner's Representative
An Owner's Representative plays an important role in reducing change orders.
Rather than waiting for problems to appear, they work to identify potential issues during the planning phase.
They coordinate communication between architects, engineers, contractors, consultants, and equipment vendors.
They review drawings for completeness.
They monitor schedules and budgets.
They ask difficult questions before construction begins instead of after construction has started.
Most importantly, they help owners make informed decisions when changes are still inexpensive.
Because once drywall is installed and mechanical systems are in place, every revision becomes significantly more costly.
Change Orders Are Sometimes Necessary. They Shouldn't Be Routine.
Construction projects are complex, and no project is completely immune to change.
The goal is not to eliminate every change order.
The goal is to minimize avoidable ones.
The projects that stay on budget are rarely the ones that never encounter challenges.
They are the ones that invested enough time in planning to prevent unnecessary surprises.
Every hour spent coordinating before construction can save days of rework after construction begins.
Build Smarter From Day One
The easiest change order to manage is the one that never happens.
At MD Advising Group, we help physicians and healthcare organizations reduce risk through thoughtful planning, detailed coordination, and proactive project management. By bringing the right people together before construction begins, we help clients avoid unnecessary changes, control costs, and keep projects moving forward.
If you're planning a medical office, renovation, or healthcare facility, let's talk before construction starts.
Schedule a complimentary consultation today.