My wife and I own four units and we’re making the jump to double digits. Do you take out a second mortgage on an Airbnb that you never wish to sell that’s almost paid off  or do you take out 100 grand against your pri...

Codie Sanchez will get you motivated, I just ordered her new book Main Street Millionaire, but have not read it yet.Sail with the wind, not against it. 

In my experience strictly med buildings are generally developed in the same way as part of a campus or off the path a bit from the main retail corridor, so it really is only suited for that use. 

So the main advantage of a DSCR in this case is just the fixed rate? 

A restaurant or café with outdoor dining could thrive in this environment (there are not so many around the area), benefiting from the steady local traffic while also enhancing the appeal of the residential units.

I think the main thing would be access to the books to make sure of the expenses.

Its certainly not "guaranteed return" - thats a word to always stay away from in real estate (in finance or even investing in general)high level - its because HMLs are going to be secured by the real estate, meaning in event of default, the lender can get the property to be made whole - somewhat trust is involved, but thats the main mechanism behind it

I think your last point about starting near infrastructure and moving backwards is very interesting.How much value do you put on a property being on a main vs side street?

Plex has some rough areas but mine are on the main road full of apartments for students.  

The main objective is regulation and taxation.