What Happens When You Decide to Manage the Project Yourself

There is a version of this story that sounds reasonable at first. You are a capable person. You run a business. You have managed employees, dealt with vendors, navigated insurance companies, and kept a practice running through a pandemic. You understand the value of money. You know that a general contractor earns somewhere between 10 and 15 percent of the total project cost as a management fee. On a $1.5 million build, that is $150,000 to $225,000. And you think: how hard can it be?

The answer is that it is not a single hard thing. It is fifty medium-hard things happening simultaneously, in a sequence you have never navigated before, in a language you do not speak fluently, with vendors who have worked together for years and have their own loyalties and assumptions about how information flows. And you will be doing all of it while also trying to see patients.

Here is a partial list of the people you will be coordinating: an architect, a structural engineer, an MEP engineer (mechanical, electrical, and plumbing — sometimes three separate firms), a civil engineer if the project involves site work, a general contractor (or multiple contractors if you are self-performing that role), subcontractors in no fewer than eight trades, your equipment vendor, a permit runner or expeditor, and the relevant city or county planning and inspection departments. Each of these entities speaks its own dialect of construction. Each has its own schedule, its own deliverable, and its own definition of "done." And none of them will coordinate themselves.

The coordination problem sounds abstract until it becomes concrete. The MEP engineer draws the ductwork routing based on the schematic ceiling height. The structural engineer, working in parallel, specifies a beam at an elevation that puts it directly in the path of the main supply trunk. Neither firm noticed because they are not looking at each other's drawings — they are looking at the architectural base plan they were both given, which does not yet show what the other discipline is doing. This gets discovered on a Friday afternoon when the framing crew pulls up the structural drawings and realizes that the HVAC duct shown on the MEP set cannot physically exist in the same space as the beam they are about to install. The crew stops. You get the call. You now have to reach the structural engineer and the MEP engineer at the same time to adjudicate whose drawing governs and what the revised solution is. Neither firm is on retainer to take Friday afternoon calls from owners who don't know what RFI stands for. The crew goes home. The week is lost.

The equipment problem is different but equally expensive. Dental chairs, medical imaging equipment, and veterinary procedure tables all have rough-in requirements — specific locations for plumbing, electrical, and medical gas connections that have to be built into the walls and floors during framing, before anything is closed up. The equipment vendor gives you a rough-in spec. The spec has to make it to the MEP engineer before the plumber sets pipe. The timing on this sounds manageable until the chair order is delayed by six weeks due to a supply chain issue, the revised rough-in spec comes in different from the original, and the plumber has already set pipe in three operatories based on the old spec. Now you are paying to move pipe.

The time problem is the one operators consistently underestimate. A typical commercial build has an active coordination period lasting six to nine months. During that time, the project generates a constant stream of decisions, emails, questions, submittals, and required approvals from the owner. These do not cluster neatly into dedicated project management hours. They arrive as phone calls during morning block, emails that require a response before the end of business, and site visits that cannot be rescheduled because the framing inspection is tomorrow and something is wrong. One operator described it this way: somewhere around month three, he realized he had seen patients four days in the previous three weeks. The rest of the time he had been running a construction project. His office manager was fielding calls from patients who could not get scheduled. His hygienists were working reduced schedules. The revenue loss from four partial weeks of production was not something he had included in his financial model when he decided to be his own general contractor.

The math on what a project manager actually costs is straightforward. On most projects in the $500,000 to $2 million range, a dedicated project manager costs between $5,000 and $15,000. That is the actual market rate for the service when it is scoped correctly. Compare that to the GC fee you are trying to avoid. The fee is real, but so is what you get for it. What you are paying for is someone who has done this before, who knows what questions to ask before they become problems, who has relationships with the subcontractors and knows when a crew going quiet is a problem versus a normal delay, and who is responsible for the outcome in a way that a part-time owner-PM is not.

The operators who try to save the GC fee and succeed are the ones who have done it before — who have been through a full project cycle, know the terminology, have managed construction before, and can dedicate genuine time to it without that time coming out of production. For most practice owners, that description does not fit. And the people who try it and fail do not usually fail by losing control of the entire project. They fail incrementally, in a series of small coordination failures that each add a week and a few thousand dollars, until the project has run 10 to 15 percent over budget and two months behind schedule. Which is roughly what the GC fee would have cost.

Saving money is a reasonable goal. Saving money in ways that cost more money is not. This is one of those areas where the math is genuinely against you.

Primus builds on a fixed-price, single point of contact model — one team managing design and construction from the first conversation through the certificate of occupancy. More at primus-companies.com.