The Keystone Standard

Per-clinician profitability, defined precisely.

Most owners know their total revenue. What each clinician actually earns the practice, after the full cost of that person, is harder to see. This page shows how to measure it, and which costs the quick math leaves out.

Compute it for your own numbers

Enter one clinician’s numbers. Nothing leaves your browser. This runs entirely on your device.

Example numbers to start. Change the fields to see your practice.

Gross monthly billings · Enter what you'd bill if every slot were full and kept. The next line takes off what never lands. (Bill $10,000 and collect $9,000: that's 10%.)$What never lands · % of a full schedule that doesn't pay: no-shows and late cancels (minus any fees you collect for them), openings that stay empty, cancellations you can't refill, time off%

How they’re paid

Hybrid or stipend model? Enter the blend: their typical total monthly pay under Salary, or their overall percentage under % split.

Their split (% they keep)%Employer payroll-tax load · ~7.65% FICA; add FUTA/benefits if you pay them%Non-billable supervision · Time paid for supervision that ISN'T billable to a client — a senior training an associate, an external consultant. This subtracts from net (it's a cost the practice absorbs).$Billable consult time · Consult team or supervision time that IS billable as part of the treatment package (DBT-style consult teams are the classic case). Include the revenue side in gross billings above; entering it here just documents the portion. Does NOT reduce net — it's already in revenue.$Overhead share · The slice of rent, admin, software, and malpractice that belongs to one clinician. There's no perfect split. By hours, headcount, or rooms, applied consistently, beats allocating zero.$

The result is what this clinician actually earns the practice each month, after everything they cost: their pay, the payroll taxes on top of it, any supervision or consultation, and their share of the rent and admin. We call that the fully-loaded net. Most dashboards stop early, at billings minus pay — and that stopping point can make a money-losing hire look fine.

$1,368/mo

Fully-loaded net (Keystone Standard)

Healthy

$8,100

What actually collects

$900/mo missed or unfilled

$5,232

Their pay, all-in

Take-home $4,860 + taxes $372

$2,868

Left before overhead

where most dashboards stop

$16,419

Annual fully-loaded net

This clinician contributes $1,368/mo to the practice — a 17% net margin after pay, overhead, and supervision. Over a year: $16,419.

Inputs are your own estimates, and nothing leaves your browser. Employer payroll taxes, supervision, and overhead are the items most dashboards omit; that is why the fully-loaded number differs from a simple billings-minus-split read.

Want the full picture across every clinician? Run the full Snapshot free.

What does the number tell you?

These are the bands we use, drawn from running our own practice and from the Snapshot’s defaults.

Underwater

Negative net. The practice subsidizes this clinician from other revenue. Can be temporary (new hire ramping, supervised clinician). The question is whether it resolves.

Thin margin

Net is positive but under 10% of effective billings. It covers its costs, but one bad no-show month can put it underwater.

Healthy

Net margin 10-30%. This clinician covers their full cost and puts real money toward overhead and owner pay. Healthy is what most of a working practice should look like.

Strong

Net margin above 30%. Getting here usually takes a high rate, low admin drag, and a light benefits load.

Status labels are derived from per-clinician net margin (net / effective billings). They’re a starting point for a conversation. Context matters: tenure, ramp stage, supervision stage.

Want to see how the number is measured?The three costs the quick math misses, the four steps, and every formula — open them when you’re ready.

The quick math misses three costs

When most owners try to figure out if a clinician is profitable, they do a quick subtraction: billings minus the clinician’s pay. That is not wrong, but it is incomplete in three ways that matter:

Employer payroll taxes are a cost of employment. FICA alone adds roughly 7.65% to a W-2 wage, and the practice pays it.
Missed and empty slots shrink what actually collects. A 10% no-show rate on a $10,000/mo clinician costs $1,000/mo before anything else — and openings that stay unfilled, cancellations nobody refills, and time off cut the same way. If you charge no-show fees, count what you actually recover.
Overhead, and often supervision, land on the practice. Every clinician uses a share of rent, admin, and software; a pre-licensed clinician also uses supervision hours, and for licensed clinicians, paid consultation plays the same role.

The Keystone Standard: four steps, one number

The fully-loaded per-clinician net takes four steps, in order. Each step answers a more complete version of the same question: what does this clinician actually earn the practice?

Step 1: Start from what actually collects (effective billings)

What their sessions bring in, minus everything that never lands: no-shows and late cancels (less any fees you charge for them), openings that stay empty, cancellations that don’t refill, time off. If you take insurance, one more thing never lands: part of what you bill. Contracted rates, denials, and write-offs mean the collected number is the honest one, so start from that. This is what the practice actually collected (or expects to collect), not a projection at a perfect, full schedule.

Show the math

Formula: Gross billings × (1 − no-show rate)

Step 2: Subtract what employing them really costs

Their take-home pay plus what the practice pays in payroll taxes on top of it. For a W-2 employee that adds about 7.65% (FICA). A 1099 contractor skips the employer load, though that comparison rarely survives contact with benefits and compliance.

Show the math

Formula: Take-home + (Take-home × employer load %)

Step 3: Subtract supervision, if they get it

The cost of the supervision hours this clinician receives, if any. A pre-licensed clinician using two hours of a supervisor’s time a week at $80/hr costs the practice roughly $690 a month, and that cost rarely shows up anywhere an owner looks. Licensed clinicians often still get paid consultation — count it here the same way. And if this clinician supervises others, that time is a cost of the clinicians they supervise, not of this one. It is also credited back to the supervisor as income, because the practice pays for that supervision once and someone is doing the work.

Show the math

Formula: Supervision hours/mo × supervisor rate

Step 4: Subtract their share of the overhead

Every clinician uses a share of the fixed costs: rent, admin payroll, software, malpractice, utilities. The simplest split is total fixed overhead divided by the number of active clinicians. More precise methods exist; this is the floor.

Show the math

Formula: Monthly fixed overhead ÷ number of active clinicians

Want the whole formula in one place?

Effective billings
− Total comp cost (pay + employer taxes)
− Supervision cost
− Overhead share
= Fully-loaded per-clinician net

This is a decision-support metric, not a certified accounting figure. The assumptions (overhead allocation method, supervision rate) belong to the owner. Confirm cost categorizations with your accountant. The point is to surface a number that is honest about what each clinician costs.

Common questions

Questions owners ask about this number

What is the fully-loaded per-clinician net?

It's what a single clinician nets the practice after every cost they create: effective billings minus total comp cost, minus supervision, minus that clinician's share of overhead. It's the number that tells you whether a clinician is actually profitable, not just busy.

Why isn't billings minus pay enough?

Billings minus pay ignores three real costs: no-shows and unfilled slots reduce what actually collects, the employer pays payroll taxes on top of wages, and every clinician uses a share of supervision and overhead. Leave those out and a clinician who's underwater can look profitable.

How is this different from a contribution margin?

Contribution margin stops at billings minus their pay and payroll taxes. The fully-loaded net keeps going: it also subtracts supervision and a share of fixed overhead, so it answers whether the clinician covers their full cost, not just their direct pay.

Related tools and pages

What is this clinician really worth? →: the standalone version of the calculator above
Is this clinician profitable? →: a quick contribution view, without the full load
What does losing a therapist cost? →: flips the fully-loaded net into a retention case
A second opinion on your current report →: runs this standard on your own export, in your browser
Bring your own data →: scores every clinician from a file you already have, nothing uploaded
See the whole thing live →: the full Snapshot on an invented six-clinician practice, with numbers you can change
Full Snapshot →: every clinician, your draw, and where the money goes, in one run

Use the standard

The full Snapshot runs the Keystone Standard on every active clinician at once, using your real comp structure, overhead, and supervision rates, in about five minutes.

Run the full Snapshot free →

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