The short version: Medical practices are lender favorites. Default rates are low, the cash flow is steady, and the borrower is usually a high-income professional, so banks compete for the loan instead of dodging it. A handful of national lenders run actual healthcare and practice-finance groups, and those are the ones to call first for a clinic acquisition, a de novo build-out, or owner-occupied medical real estate. Below are six banks with the balance sheets to fund deals like yours, plus what their underwriters will want to see. One honest note up front: the call report numbers here are real, but it does not break out lending by industry, so the practice-finance fit reflects each bank's public reputation, not a clinic figure on a filing.
Why clinics are easy borrowers, until they are not
Run a clinic and you start from a good position. Banks like medical and outpatient practices for the same reasons they like dental: defaults are rare, collections are predictable, and the person signing the note tends to have a stable, high income. That is a borrower a credit committee can defend. So instead of the cold-call grind most small businesses face, a practice owner often finds banks willing to compete.
SBA 7(a) money shows up across the practice life cycle. Owners use it to buy an existing practice, open a de novo clinic, finance medical equipment and imaging, fund an expansion or build-out, cover a partner buy-in, fit out an ambulatory surgery center, refinance pricier debt, and purchase owner-occupied medical office real estate. The 7(a) program stretches across all of it, which is why it is the default tool for healthcare borrowers who do not want to drain personal cash.
The catch is that "easy borrower" does not mean "automatic yes." The same things that make clinics attractive also create the questions underwriters chase. Payer mix matters: a practice leaning hard on Medicare and Medicaid reads differently than one with mostly commercial insurance. Reimbursement rates can move. Credentialing and regulatory rules add friction. Specialty concentration, goodwill-heavy acquisitions, and key-physician risk all sit in the file. The deal is fundable. It is just not unconditional.
What lenders look for in clinic and practice borrowers
Start with collections and production. An underwriter wants to see what the practice actually bills and brings in, then trace how much of that survives once the new debt service is layered on. Post-deal cash flow is the number that decides most of these loans. If the practice still covers the note comfortably after the acquisition or build-out, the rest of the file is a formality. If it is tight, every other risk factor gets heavier.
Payer mix is the next thing they read. Medicare and Medicaid pay reliably but at set rates, and those rates can be cut. Commercial insurance pays more but varies by contract. A book over-concentrated in one payer is a flag, because a single reimbursement change can swing the whole income statement. Lenders also look at provider productivity, credentialing continuity through the transition, and the local demographics that feed the patient base. If the loan includes owner-occupied real estate, the property gets underwritten too.
The pitfalls that sink clinic deals are predictable. Reimbursement cuts that compress margins. Over-reliance on one payer. A key physician walking out the door and taking the patients with them. And overpaying for goodwill, which is the most common mistake in practice acquisitions, because a price that looks fine on the seller's spreadsheet can leave the buyer underwater the day the deal closes. Good lenders price these risks rather than ignore them, and the ones with healthcare groups have seen each pitfall enough times to coach you around it.
Six banks that compete for clinic loans
These six are credible first calls for a clinic or outpatient-practice deal. Every asset, C&I share, CRE share, and equity-to-assets figure below is real Q1 2026 FFIEC call report data. The practice-finance reasoning is a different thing: it reflects each lender's public reputation in healthcare and SBA, not a clinic line on the call report, because the call report does not split lending out by industry. Read the numbers as facts and the fit notes as informed context.
Live Oak Banking Company (Wilmington, NC)
Assets: $15.2B · C&I share: 37.1% · CRE share: 46.3% · Equity/assets: 7.7%
Live Oak is the country's largest SBA 7(a) lender by dollars, and its book is built around specific industries, healthcare and medical practices among them. The call report shows a balance sheet tilted heavily toward business and commercial-property credit, with ROA at 0.89% and NIM at 3.19%. For a clinic acquisition or a practice expansion, this is the specialist that has likely funded your exact deal type before. The equity-to-assets ratio is the lowest on this list, so expect a lender that knows the vertical cold but underwrites it with discipline.
Huntington National Bank (Columbus, OH)
Assets: $284.1B · C&I share: 28.1% · CRE share: 20.3% · Equity/assets: 11.7%
Huntington is the top SBA 7(a) lender by loan count, and it runs a practice-finance group that has been at this for a long time. The call report backs the commercial story: a C&I share well above its CRE share, healthy capital at 11.7% equity-to-assets, ROA of 0.99%, and NIM at 3.12%. A bank that closes a high volume of SBA loans is statistically more likely to close yours, and Huntington's count leadership means its team has standardized the clinic playbook. Ask for the practice-finance desk by name.
TD Bank, N.A. (Wilmington, DE)
Assets: $345.6B · C&I share: 14.0% · CRE share: 18.4% · Equity/assets: 14.5%
TD is a large East Coast bank with a known healthcare practice-finance group. Its call report shows a lower C&I share than the specialists here and the strongest capital cushion on the list at 14.5% equity-to-assets, with ROA at 0.73% and NIM at 2.91%. The commercial slice is a smaller part of a very big book, so a clinic loan lands with a dedicated healthcare team rather than a generalist. If your practice is in TD's footprint along the Eastern Seaboard, the relationship plus the healthcare group is a real combination.
First Internet Bank of Indiana (Fishers, IN)
Assets: $5.7B · C&I share: 29.3% · CRE share: 37.3% · Equity/assets: 7.6%
A branchless national lender with healthcare and practice-finance programs and small-balance SBA offerings. The call report shows a commercial-leaning book, ROA at 0.32%, NIM at 2.37%, and the thinnest capital ratio here at 7.6% equity-to-assets. Being branchless is a feature for a busy clinic owner: the process is built to run remotely, which suits a borrower who cannot leave the practice for bank meetings. Good fit for smaller equipment or build-out loans where you want a lender comfortable funding across state lines.
U.S. Bank, N.A. (Cincinnati, OH)
Assets: $683.4B · C&I share: 22.2% · CRE share: 12.0% · Equity/assets: 9.9%
Among the big banks, U.S. Bank is a top national SBA 7(a) lender and is active in practice finance. The call report shows the strongest profitability on this list, with ROA at 1.17%, a C&I share comfortably ahead of its CRE share, solid capital at 9.9% equity-to-assets, and NIM at 2.54%. A bank this size funds a clinic loan as routine business, and its SBA volume means the approval path is well-worn. The trade-off with a mega-lender is process over hand-holding, so come prepared.
Wells Fargo Bank, N.A. (Sioux Falls, SD)
Assets: $1.85T · C&I share: 20.1% · CRE share: 12.9% · Equity/assets: 9.3%
The mega-bank option, and a national SBA participant with reach into nearly every market. The call report shows ROA at 1.30%, the highest here, a C&I share ahead of CRE, capital at 9.3% equity-to-assets, and NIM at 2.85%. Wells does not specialize in clinics the way Live Oak or Huntington do, but its scale and SBA participation make it a legitimate candidate, especially if you already bank there. Use it as a parallel conversation rather than your only one, since a focused practice lender will often out-coach a generalist on the medical-specific risks.
How to get a yes faster
The borrowers who close quickly are the ones who hand the underwriter the file they were going to ask for anyway. For a clinic deal, that means walking in with the documents and answers that resolve the standard questions before the banker has to chase them. You already know what they will check, so pre-empt it. The goal is to make the easy yes actually easy.
Bring this to the first real conversation:
- Practice financials, including the collections and production numbers, not just the tax return.
- A clear payer-mix breakdown, with the Medicare, Medicaid, and commercial split spelled out.
- Provider productivity by physician, so the bank can see how the income holds up if someone leaves.
- A credentialing and transition plan that shows continuity through the deal, plus the use of funds and any owner-occupied real estate details.
Two other moves matter. Call the SBA or healthcare desk directly instead of the general commercial line, because the team that knows practice finance will move your file faster than a generalist who has to route it. And run the math on your own deal first: a quick pass through an SBA loan calculator and a DSCR calculator tells you whether the post-deal cash flow clears the bar before a banker tells you it does not. If your debt-service coverage looks thin on your own numbers, fix the structure before you apply, not after the decline.
The six banks above are a starting shortlist, not a ranking for your specific practice. Which lender is your best first call depends on your specialty, your state, your loan size, and whether real estate is in the deal. That is exactly what our $49 Borrower Assist report sorts out: it scores lenders against your scenario and hands you a phone-call order instead of a directory, so you spend your time on the conversations most likely to end in a funded loan.
Photo by Martha Dominguez de Gouveia on Unsplash. Bank figures from FFIEC call reports for the quarter ending March 31, 2026; SBA-vertical and industry-appetite notes reflect each lender's public lending reputation, not the call report.