Can my bookkeeper tell me which of my clinicians are profitable?
Not from the books alone, and that is not a criticism of your bookkeeper. A profit and loss statement is organized by account — rent, payroll, software each get a line — so no clinician has a row, and closing the books perfectly never creates one. A per-clinician answer needs four inputs per seat: the clinical hours actually held, the pay arrangement in force, the employer taxes riding on it, and that seat's share of fixed overhead. None of those are bookkeeping outputs. Which clinician pays for themselves is a different question asked of the same dollars, and the books can be flawless and still be silent on it.
What your books are built to answer
Bookkeeping answers the questions the tax code asks: what came in, what went out, and where each dollar belongs by account. A closed year, a clean profit and loss statement, and returns filed on time mean that job was done well. Tax-ready is a real standard, and a practice whose books meet it is ahead of most.
But tax-ready is not decision-ready. The profit and loss statement groups dollars by account, not by person: rent gets a line, payroll gets a line, software gets a line — a clinician does not. That is the format doing its job, not anyone doing theirs poorly, and it is why the question owners bring to their year-end package every winter comes back unanswered no matter how good the bookkeeping was.
The four inputs the per-clinician answer actually needs
To say whether one clinician pays for themselves, you need four things for that seat: the clinical hours actually held (not the scheduled ones), the pay arrangement in force (split, salary, or hourly, as actually applied), the employer taxes and per-seat costs riding on that pay, and the seat’s fair share of the overhead the practice pays whether or not anyone shows up. Almost no owner has those four in one place — and none of them are outputs a bookkeeping engagement produces, because none of them are needed to file.
So what do you ask of the year-end package?
Ask it the question it can answer: did the practice as a whole make money, and where did the dollars go by category. Then notice precisely what it does not contain — a row with a clinician’s name on it — and treat that as the boundary of the document, not a defect in it. The per-clinician question needs the four inputs above joined to the same dollars, which is a separate exercise, whoever performs it.
We keep a worked version of this boundary, priced: what a year-end bookkeeping package answers, what it costs, and what the per-clinician read costs beside it →
Run this on your own numbers, free, nothing leaves your browser: the is-this-clinician-profitable calculator →
Want the whole picture at once? The free Snapshot reads your practice in about five minutes: see your numbers →
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Link to this page and attribute it to Keystone Practice:
Keystone Practice. "Can my bookkeeper tell me which of my clinicians are profitable?" https://keystonepractice.co/answers/can-my-bookkeeper-tell-me-which-clinicians-are-profitable