Green medical clinics are cropping up across the country as environmentally responsible building becomes more popular—and accessable. Though they currently make up a minority of the nation's medical clinics, the number of Leadership in Energy and Environmental Design (LEED) certified practices is steadily increasing nationwide, and a number of practices across all fields of medicine are exploring green building options.

In Fort Smith, Arkansas, that state's first medical clinic to seek LEED certification is now operating under the direction of Drs. Brad and Sandy Johnson. The decision to build a green clinic was a natural one for the Johnsons, a husband and wife dermatology team that has long been involved in environmental issues and that has emphasized community involvement throughout their professional lives. Dr. Sandy Johnson recently spoke with Practical Dermatology about the new clinic. She says that she and her husband/ partner feel it is important to serve their local community and interact with its members. They also seek to serve as positive examples to those around them. For instance, they ensure the whole family dons sun-protective clothing before heading out for hikes or other outdoor events.

Dedicating time and resources to building a green clinic not only provides an example for others, Dr. Johnson says, it's also a way to support the community. “We have felt that it's important to show our community that we are invested and that we practice what we preach.” At a time when there seems to be a lot of negativity in and about the healthcare field, “we wanted to be a positive, visible reminder of our commitment to this community,” Dr. Johnson adds.

Environmental preservation is a dermatologic issue, Dr. Johnson insists. Most obviously, the importance of the ozone in regulating UV radiation exposure should be of concern to dermatologists who deal with the direct consequence of UV radiation exposure: that is skin cancer.

Ahead, Dr. Johnson offers insights on building a green clinic and provides tips for making any practice more environmentally friendly.

Understand LEED Certification

Building a new clinic is never an easy undertaking, but building according to LEED standards and obtaining LEED certification need not significantly increase the burden (for information on LEED certification, see the sidebar). However, all parties involved must understand LEED requirements form the very first phases of planning. Practices that wish to build a LEED-certified facility like the Johnsons' need to do initial research and be sure to identify architects and builders who are LEED professionals. When they bid out a remodeling project for their original practice location five years ago, the builder who won the contract happened to be LEED-accredited. So when they started plans for their new current space, the Johnsons already had a builder in mind. He then recommended a LEED-accredited architect.

A good deal of effort goes into planning, but certified contractors should streamline the process by offering a good deal of knowledge about options and various sources for needed materials and technologies. Building a LEED-accredited clinic need not add time to the construction process. While LEED-accrediting inspectors must review developments at particular stages—in the same way and in addition to local license and inspection regulators that approve code compliance—this did not delay progress. The pace of any building or remodeling project is “only as fast as your slowest contractor,” Dr. Johnson quips.

Practices should be aware that green building may be more costly overall than conventional methods, though long-term savings may be possible. Dr. Johnson emphasizes that it was a desire to be environmentally responsible that promoted the decision to build the green clinic, not a desire to save money. “It is more of a statement,” she says. In fact, she notes, the new clinic cost “a lot more” than alternative approaches, she says. In addition to following LEED requirements, the Johnsons also decided to follow new Medicare guidelines for ambulatory centers, which they were not required to do. In the very long-term, however, the practice may realize some overall cost savings on energy, trash, and water bills. It will probably take about 10 years before the practice realizes a savings on its investment in greener energy.

One area where the Johnsons may save money is with geothermal climate control. Due to current tax credits, it is often actually cheaper to install geothermal heating and cooling systems than traditional ones. Importantly, the new clinic is equipped with various climate zones that allow for optimal temperature control based on building occupancy.

Work with Nature

Building a green clinic isn't just about preserving natural resources. It's also about working in concert with the natural environment. The architect incorporated natural light as much as possible into the design of the building and exam rooms, thus limiting electricity use. Of note, specially selected high-performance glass is used to block all UV light—and associated heat— allowing only visible light into the rooms. According to Dr. Johnson, research suggests that people who work with natural light work more efficiently than those who work in artificial light.

At the new clinic, rain water will be collected for non-potable uses, including to flush toilets, thus reducing water use. Drought-resistant landscaping is in place and there is no built-in irrigation system, thus eliminating the use of community water resources to maintain landscaping. For a full list of green features of the new clinic, see the table (right).

Be Creative

Because their new endeavor is as much about preserving natural resources as it is about making a statement, the Johnsons are taking creative steps to publicize their efforts and encourage others to think and act green. They plan to eventually build a trail from their clinic that will link into the city trail system.

All correspondence related to the new clinic emphasizes that it is seeking LEED-accreditation, and a press release went out electronically to describe the new building. The practice website will also offer information on their green efforts. Dr. Johnsons adds, “We will place placards in the building to show what we're doing and h

To encourage and reward environmentally friendly behavior, there are dedicated parking spaces reserved for fuel-efficient vehicles. Better yet, bike racks on the premises encourage patients to pedal to appointments.

Consider Recycling and Waste Reduction

Practices building a new clinic or significantly remodeling an existing space may find it relatively easy to choose green practices over conventional ones. However, some established practices may not be ready or able to go fully green. Still, there are environmentally-friendly options available to all practices.

In their original clinic, which they opened in 2006, the Johnsons took steps to be as environmentally friendly as possible. They implemented electronic health records from the start in order to reduce paper waste. Similarly, they always recycled office waste, and they chose a shredding service that would not only destroy sensitive documents but also recycle the shredded material. They eventually installed a device called a demolizer that melts sharp instruments so that they can be disposed of as non-medical waste.

Being environmentally conscious has been a practice- wide effort. Staff have been instrumental in helping to identify environmentally friendly services and procedures that the practice has implemented, Dr. Johnson says. When they have seen products or services in newspapers, magazines, TV, etc., staff members have brought those ideas back to the office.

Reduce Resource Utilization

Some resource-reduction features of the Johnsons' new LEED-accredited clinic may be adaptable for existing practices. For example, every room in the new clinic is equipped with motion sensor lights so that electricity is not wasted lighting a room not in use. They also selected a steam washer instead of a traditional washing machine, which reduces water use. Several years ago, the practice ditched paper gowns in favor or washable cloth ones, which leads to reduced waste and use of paper.

What is LEED?

The US Green Building Council (USGBC), a 501 c3 non-profit organization headquartered in Washington, DC, is in its words, “committed to a prosperous and sustainable future for our nation through cost-efficient and energy-saving green buildings.” The organization launched the Leadership in Energy and Environmental Design or LEED in March 2000. The internationally recognized green building certification system, “provides thirdparty verification that a building or community was designed and built using strategies aimed at improving performance across all the metrics that matter most: energy savings, water efficiency, CO2 emissions reduction, improved indoor environmental quality, and stewardship of resources and sensitivity to their impacts.” LEED is applicable for all building types, including commercial, medical, and residential, throughout the building lifecycle. For more information, visit:

Table 1. Features of the LEED-Certified Clinic

  1. Rainwater harvesting for non-potable water usage.
  2. Drought tolerant landscaping, with no permanent irrigation.
  3. Recycled Content in many of the building materials, including carpet, porcelain tile, ceilings, and insulation
  4. Light colored roof for solar reflectivity
  5. Concrete parking as opposed to asphalt=greater solar reflectivity
  6. Locally quarried stone
  7. Geo-Thermal heating and cooling
  8. Extensive use of fluorescent and LED lighting
  9. High-Performance Glass to allow more visible light and less infrared and ultraviolet light
  10. Occupant controllability on HVAC and lighting systems.
  11. Occupancy sensors for lighting
  12. Building Management System for heating/cooling, Multiple zones
  13. Recycling of construction waste
  14. Dedicated parking spaces for fuel-efficient vehicles
  15. Bike Racks and trails connecting to the community to encourage walking and biking
  16. Low flow water fixtures (water closets, urinals and faucets)
  17. Reduction of site lighting pollution. Use of downlighting in parking areas
  18. On-site commissioning of all HVAC and electrical equipment
  19. Storage and collection of recyclables
  20. Improved indoor air quality performance: controlled air quality system regularly exchanges inside air with cleaner outside air.
  21. Low-chemical emitting materials used in construction (Adhesives, Paints, Flooring)
  22. Natural lighting provided throughout building for both daylighting and views
  23. Improved acoustic performance