IMHO it is not a big problem if you take into account the generous dividends they pay. However, my MPW research history has shown that they can practice creative accounting with no punishment. Also, the market is quite efficient. Dividends well above average inevitably mean there is some problem. So I decided that I would only deal with the REITs index, for example, VNQ. IMHO it's overkill to spend a lot of time and effort analyzing their reports when managing only my own money. Also, on Twitter, I subscribed to the author of the bearish article on MPW. I have posted above the link to that article.