Sample data. Name a decision and get the whole packet — the math, the tradeoffs, the break-even, and a target you can stamp so your next Snapshot checks whether it worked.
Raise a clinician's split
Move Dana to a 65% split
Change to the practice's monthly contribution
-$800/mo
What this clinician now leaves the practice each month, vs. before.
The math
Clinician's monthly take-home, before$9,600
Clinician's monthly take-home, after$10,400
Change to their take-home$800
Practice contribution, before$4,900
Practice contribution, after$4,100
Billings where the new split starts paying them more$100
Below this monthly billings level the new plan pays the same or less — so the raise only rewards growth past it.
The tradeoffs
Keep in mindA higher split is a retention lever — it pays off only if it actually keeps someone who'd otherwise leave.
The case againstThe practice keeps less per month at today's billings. The bet is that the split lifts their hours or their stay.
Keep in mindTheir take-home and your contribution both move with their billings, so this gap widens or narrows as they grow.
If you commit, we’ll check it
Target: $4,900 → $4,100
This lays out the math, the tradeoffs, and the break-even so you can decide. It doesn’t make the call for you — that’s yours. Stamp the target and your next Snapshot scores how it actually landed.
Drop an insurance panel
Drop the lowest-paying insurance panel
Weekly difference if you drop it and refill
+$426/mo
Private-pay revenue on those slots, minus what the panel brings in now — at the fill rate you set.
The math
Panel's real take per session (after denials + admin time)$69
Gap vs. your private rate, per session-$91
Effective hourly, counting the claim admin$53
Panel revenue per week on these slots$694
Private-pay revenue if you refilled them$1,120
Fill rate you'd need to break even43.4%
Refill at least this share of the panel's slots at private pay and you come out even — below it, the panel wins.
The tradeoffs
Keep in mindAn empty slot earns nothing — the panel only loses if you'd genuinely refill those hours at private pay.
The case forAt the fill rate you set, refilling privately comes out ahead of keeping the panel.
Keep in mindDropping a panel can affect referrals and access for clients who need that coverage — that's outside the dollar math here.
If you commit, we’ll check it
Target: $694 → $1,120
This lays out the math, the tradeoffs, and the break-even so you can decide. It doesn’t make the call for you — that’s yours. Stamp the target and your next Snapshot scores how it actually landed.
Make your next hire
Bring on another 1099 clinician
Monthly contribution once they're fully ramped
+$4,400/mo
What the hire adds to the practice each month after their split and any added overhead.
The math
Added profit in year 1 (ramp included)$43,200
Added profit in year 2 (fully ramped)$52,800
The cash low point you front first$0
Month they cover their own added cost1 mo
From this month on, their monthly contribution is positive — before it, you're funding the ramp.
The tradeoffs
Keep in mindThe ramp is the risk: they cost the split from day one but bill at full only after the ramp months.
The case forFully ramped, they add to the practice's monthly contribution.
Keep in mindA 1099 vs. W-2 changes the load, control, and legal classification — that call isn't in this math.
If you commit, we’ll check it
Target: $18,000 → $22,400
This lays out the math, the tradeoffs, and the break-even so you can decide. It doesn’t make the call for you — that’s yours. Stamp the target and your next Snapshot scores how it actually landed.
Elect S-corp
Elect S-corp this year
Estimated net benefit per year
+$7,091/mo
Self-employment tax saved on the distribution, minus the extra cost of running the S-corp. An estimate — confirm with a CPA.
The math
Profit taxed as a distribution (above the salary)$70,000
Self-employment tax saved on it$9,891
Extra S-corp cost per year$2,800
Self-employment tax you'd need to save to break even$2,800
The election only pays once the SE tax it saves clears the extra cost of running the S-corp.
The tradeoffs
Keep in mindThis is a rough estimate, not tax advice — the reasonable-salary line is a judgment call a CPA should set.
The case forAt this profit and salary, the tax saved clears the added S-corp cost.
Keep in mindAn S-corp adds payroll, a separate return, and ongoing admin — real time, not just the dollar cost above.
If you commit, we’ll check it
Target: $0 → $7,091
This lays out the math, the tradeoffs, and the break-even so you can decide. It doesn’t make the call for you — that’s yours. Stamp the target and your next Snapshot scores how it actually landed.
Raise your fee
Raise the standard fee to $175
Change in monthly revenue
+$1,316/mo
Net of the clients the model expects you to lose to the higher fee.
The math
Monthly revenue, before$18,600
Monthly revenue, after$19,916
Sessions you'd expect to lose6.2
Clients you could lose and still break even11.4%
Lose more than this share to the higher fee and the raise costs you revenue; lose fewer and it pays.
The tradeoffs
The case forCash-pay therapy is usually price-inelastic — most clients stay through a modest raise. The risk sits in how many don't.
The case forEven after the clients the model expects to lose, revenue comes out ahead.
Keep in mindElasticity is your guess about your clients, not a measured number — sanity-check it against the break-even below.
If you commit, we’ll check it
Target: $18,600 → $19,916
This lays out the math, the tradeoffs, and the break-even so you can decide. It doesn’t make the call for you — that’s yours. Stamp the target and your next Snapshot scores how it actually landed.
Decided? Here’s the letter.
A starting draft with the parts that actually stall people. Pick the one you need, then make the bracketed bits your own.
A plain offer in writing avoids the most common new-hire misunderstandings. Spell out the split or pay, the start date, and that the terms are the terms — then let your contract do the rest.
Dear [candidate name],
I'm glad to offer you a position with [practice name] as [role / title].
Your compensation will be [the split or pay — e.g. a 60% fee split], with a planned start date of [start date]. The full terms are set out in the agreement that accompanies this letter, which governs the working relationship.
I think you'll be a strong fit here, and I'm looking forward to working together. Please let me know if you have any questions before we make it official.
Warmly,
[your name]
A starting point, not a script. For anything that touches employment law — final pay, benefits, classification — your attorney’s read beats ours.