There are many reasons but near the top of the list is their cost versus the value add. 

You can always add some bells and whistles here and there. 

But there might be ways to treat the building and the medical practice as a single activity and then unlock a bunch of depreciation via cost segregation.Probably too late if we're talking about 2024 but if 2025?

Not to put too much stock in hindsight, but wasn't the noise there when you toured the place?

There is so much cost to running a (any) business, even changing a light bulb is expensive for a PM.

Pick the comps.....if there are questions, explain them.  

With the potential for construction delays, increased renovation costs, rising interest rates on the HELOC and final refinance on the DSCR loan, being 100% leveraged in a deal feels risky.Most of the deals I have been 100% financed in have required me to dump a lot of cash into them consistently because there is no margin between debt, cost, and revenue. 

Residential investing is not rocket science, knowledge is not the issue: there are many good books out there that walk you through every detail you need to know.

I also think there's invaluable growth in just taking action.

But I still would not let potential renters in without someone there.