How do I know which of my clinicians actually make the practice money?
Compute each clinician's contribution: what they collect each month minus what you pay them. Then subtract the costs that follow that specific seat (supervision they receive, benefits, per-clinician software), and compare what is left against their fair share of overhead. A clinician is profitable when their adjusted contribution clears their overhead share. Revenue alone cannot answer this: the top biller is frequently not the top contributor.
The three-step ladder
Step 1, contribution: monthly collected revenue minus comp. A clinician collecting $10,000 on a 60 percent split contributes $4,000. A salaried clinician collecting $8,000 and paid $5,000 contributes $3,000. This one subtraction already answers more than most dashboards.
Step 2, adjusted contribution:subtract what follows this specific seat. Supervision they receive (a senior’s paid hours), the employer share of their benefits, their 401k match, per-clinician software seats, credentialing you cover. These are real dollars that belong to the seat, and folding them into general overhead taxes your part-time clinicians while flattering the expensive seats.
Step 3, the seat hurdle:compare adjusted contribution against the seat’s fair share of fixed overhead (rent, admin staff, practice-wide software). Clears it: the seat makes the practice money. Under it: the seat is subsidized by the rest of the team, which is sometimes a deliberate choice, but should never be a surprise.
Why your top biller is often not your top contributor
A clinician billing $14,000 on a 65 percent split contributes $4,900. A quieter colleague billing $9,000 on a 50 percent split contributes $4,500, and if the big biller also consumes weekly supervision and a premium software seat, the ranking flips outright. Owners who rank their team by revenue are reading the wrong column, and the inversion is structural, not rare: it takes nothing more than a high split sitting next to a moderate one.
The bands worth knowing
A clinician whose raw contribution is below zero is underwater: every session they run costs the practice money before overhead even enters. At the practice level, a net margin under 10 percent of revenue after overhead reads as thin, and a practice keeping under roughly 12 percent of what its team billsis running on a take rate that leaves no room for a slow month, a departure, or the owner’s own paycheck.
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