Most doctors walk in asking three GCs to bid the same drawings. That's how you get the wrong number — and the wrong builder. The X-ray analogy explains why.
Here is the pattern I see on repeat. A doctor decides to build. They hire an architect, wait four to six months for construction documents, then send the drawings to three GCs for bids. The bids come back. One is low. They pick the low bid. Six months into construction, the change orders start. By the time they get their Certificate of Occupancy, the 'low bid' is the highest number on the table.
The mistake wasn't picking the low bidder. The mistake was designing the project without a builder in the room — and then shopping the result after the most important cost decisions were already locked in.
The X-ray analogy
Stephen Pereff uses this comparison with every new client who asks for a bid before construction documents are complete: 'It would be like asking a restorative dentist to give you a price for dental implants before he takes an X-ray of your mouth to see what's there. They add four strategically placed titanium implants — All on 4s. So I say, the construction documents are the X-ray you need to quote a proper price. You have to know what's there, doctor.'
True design-build — where the architect and the builder are the same team — is the only delivery method where the 'X-ray' (the construction documents) is designed with the price in mind from day one. Every other delivery method creates the X-ray separately, then asks someone to price it. That's where holes and busts happen.
Why the lowest bid is rarely cheapest
A bid is a point-in-time number against a specific set of documents. It tells you what one contractor believes the work costs on the day they bid it. It tells you almost nothing about:
- Scope gaps — items present in the project but not in the bid scope (often intentionally, to win the job). These become change orders.
- Qualifications and exclusions — read a low bid's qualifications list carefully. Items excluded from the bid price are items the owner will pay for later, outside the base contract.
- Contingency adequacy — an honest GC prices in contingency for unknowns. A GC chasing a win prices it lean and bets on change orders to recover margin.
- Subcontractor quality — the lowest general contractor bid often implies lowest sub bids, which can mean schedule delays, rework, and warranty callbacks.
Most contractors will give a fake cheap price per square foot up front to get the contract, then charge the doctor tens of thousands of dollars in change orders. This is not what Pereff does. Our method tells the client up front where they will be — with a loan proforma we create for the banks during the construction document phase. [Pereff operating principles]
The buyer who picked the lowest design-bid-build price and absorbed a 15% change order rate paid more than the buyer who ran a design-build process with a GMP and rigorous preconstruction. The bid was cheaper. The outcome was not.
What designing in a vacuum costs you
There is a well-documented principle in project delivery: the decisions made in the first 15–20% of a project's timeline — programming, schematic design, and design development — lock in 60–80% of the final project cost. By the time an architect hands over construction documents, most cost decisions have already been made.
60–80%
Share of total project cost locked in during programming and early design phases [construction project delivery research, 2026]
If a builder isn't in the room during those phases, the design is developed against aesthetic and functional goals — not against a real budget. The architect is not to blame for this. Architects are trained to design buildings, not to price them in real time against subcontractor rates in Frisco in April. That's a contractor's job.
By the time the bid documents go out, the structural system is chosen, the MEP concept is set, the finish level is specified, and the site plan is approved. A GC reading the drawings can identify value engineering opportunities, but many of the high-cost decisions are already load-bearing — changing them means revising drawings, which costs time and design fees, which buyers rarely have.
What true design-build does differently
True design-build isn't just combining architecture and construction under one contract. The real value is that it changes when cost decisions get made and by whom.
- Budget validation at schematic design, not at bid: In a design-build process, the GC is running cost models alongside the architect from the start. If the schematic design is 20% over budget, you know it in week four — not after 16 weeks of design and three rounds of bidding.
- Buildable design from day one: The architect designs with a contractor looking over their shoulder — not adversarially, but collaboratively. Details that would have become RFIs or change orders get resolved in design. The drawings that go to permit are the drawings the contractor intended to build.
- Fewer disputes, because there's one team: In design-bid-build, the gap between what the architect specified and what the contractor bid is frequently the source of claims. In design-build, there's no gap — the designer and the builder are the same team.
- A Guaranteed Maximum Price (GMP) earlier in the process: Because cost is tracked through design, a GMP can be established earlier and with more confidence. The owner knows what they're spending before construction starts.
Pereff's value engineering with a real design-build has ensured we meet doctors' bank budgets or come in under budget. So far 100%. [Pereff operating principles]
Start with a range, not three bids
The question to ask first isn't 'which GC will bid the lowest?' It's 'what is a realistic budget range for this project, and can we design to that range?' Get a directional number from a GC who knows your project type and your market, use that number to test feasibility, and then bring the design and construction process together from the start.
That's a 30-minute conversation, not a 4-month design cycle. If the directional number doesn't pencil, you've saved four months and design fees. If it does, you go into design already knowing the budget is real — and you have a builder who helped create it.
Ask Pereff for a directional range on your project before you hire an architect. It's a free conversation. If another GC or delivery method is the right fit, we'll tell you — with the reasoning. The goal is the right outcome, not the next contract.
Want a project-specific take?
Every number in this post is directional and dated. A 30-minute preconstruction conversation with Pereff gives you a project-specific range you can actually use for budgeting, financing, and scheduling.

