What a clinician actually costs you

Last issue we found a clinician who looked profitable and wasn't, once we counted the supervision and benefits their comp never priced in. This is the rest of that math, the part most owners never run.

Think of each clinician as a small business inside your practice. They bring in revenue, and they cost you money. The space between is what they actually contribute. Most owners only ever see the first half.

The revenue half is easy. Sessions they bill, times their rate, times the share you actually collect. If someone bills $9,000 in a month and you collect 95%, that's about $8,550 in real revenue.

The cost half is where it gets expensive, and easy to underestimate. Their pay is the obvious piece. Then your half of payroll taxes. Benefits, if you offer them. Supervision hours. And the part almost everyone forgets: admin time. For every hour a clinician spends with a client, they spend part of an hour on notes, scheduling, no-shows, and email. You pay for that time too, even though it never bills.

That admin-to-clinical ratio is the number that makes or breaks a clinician's economics. Someone with two hours of admin for every clinical hour costs you far more than someone at half an hour, even if they bill the exact same amount. Almost nobody measures it.

So the real picture for one clinician is this: collected revenue, minus pay, payroll taxes, benefits, supervision, a fair slice of overhead, and the cost of all those non-billable hours. What's left is their fully-loaded net. Run it across your team and a few people will surprise you. Usually the ones whose admin time crept up while nobody was watching.

You don't have to track this to the minute. A rough monthly version, done consistently, tells you more than a perfect number you calculate once and never again. Start with the clinician you're least sure about.

The clearest case we ever caught was a clinician whose admin time kept climbing while their caseload stayed flat. Against our own guidelines it was running about $120 extra a paycheck. But the money was the smaller half of it. The creep was a signal, and the conversation it prompted was the real payoff: they'd been doing a lot of extra study on the side, and their notes had slipped behind, so they were writing them long after the session, slower each time as the details blurred. We fixed the note habits. The work got easier for them and cheaper for us.

It runs the other way too. We've flagged a clinician logging far fewer admin hours than we'd expect, which opened an honest conversation about whether their notes were getting the time they needed. Watch this number long enough and it tells you more than what a clinician costs. It tells you where to look.

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