Reverse Engineering Your Practice: Start With the End in Mind
- Julie Herres
- Sep 30
- 6 min read
What if we told you that building a profitable practice doesn’t start with spreadsheets, EHRs, or finding the perfect office space—but with a calculator, a little visioning, and some strategic reverse engineering?
No, it’s not magic. It’s just math.
Too many therapists build their practices by accident. They start solo. Cash pay practice owners pick a rate based on what feels “reasonable”. Some will say yes to every expense that comes their way in the name of “you have to spend money to make money” and others will watch each penny so closely they stifle their business. And then they hope it all shakes out in the end.
But you’re not here to hope your business works out—you’re here to design it to work for you. Let’s talk about how to reverse engineer your practice so it pays you well, supports your team, and turns a consistent profit.
First: Why Reverse Engineering?
Reverse engineering simply means starting with your desired outcome and working backward to figure out how to make that happen.
It’s the difference between:
🔁 “I guess I’ll just see how much I have left over at the end of the month”
✅ “I want to pay myself $100K a year. What do I need to do to make that happen?”
When you reverse engineer your practice, you’re intentionally designing a business that works—rather than crossing your fingers and reacting to whatever happens.
Here's what that unlocks for you:
A clear plan for what you need to charge
Confidence when making hiring and spending decisions
Consistent owner’s pay (yes, even during the slow months or even a vacation!)
Actual profit left over, not just what’s leftover after expenses
Relief from the feast-and-famine cycle so many owners face
Sounds pretty dreamy, right?
Reverse Engineering with Profit First
Enter: the Profit First for Therapists method. This is where reverse engineering meets reality—and where your practice becomes financially predictable.
Profit First flips the traditional formula of:
Income – Expenses = Profit
And turns it into this:
Income – Profit – Owner’s Pay – Taxes = Expenses
In other words, you pay yourself first. And you plan your expenses around what's actually available, not the other way around.
So how do you use Profit First to reverse engineer your practice?
Let’s walk through it.
Step 1: Decide What You Want to Pay Yourself
Yes, we’re starting here. Because your pay shouldn’t be an afterthought—it should be a priority.
Ask yourself:
How much do I want to take home each year?
What would allow me to feel financially secure?
What’s enough to cover my personal expenses and reward me for all the risk and responsibility of ownership?
For this exercise to be accurate, it’s helpful if you know how much you need to take home. You know, the amount you need to keep the lights on and everyone in your household fed.
Let’s say your goal is to take home $120,000 per year. That’s $10,000/month.
Now we reverse engineer that goal.
Step 2: Add in Profit + Taxes
The Profit First for Therapists framework recommends setting aside percentages of your income for different purposes. For an established solo practice, the starting targets might look something like:
Owner’s Pay: 50%
Profit: 5–10%
Taxes: 15%
Operating Expenses (OPEX): 30%
If you want to take home $10K/month and that represents 50% of your income, then your monthly revenue target is $20,000.
From that $20K/month:
$10K goes to Owner’s Pay
$2K–$3K goes to Profit
$3K goes to Taxes
$4K–$5K goes to Expenses
Now you have an actual roadmap. And if your operating expenses are higher than $5K/month? That tells you something has to shift—either your revenue needs to increase, or your expenses need to come down.
Let’s look at an example for a 20-clinician group practice. In this case, the starting targets might look something like:
Owner’s Pay: 6%
Profit: 5%
Taxes: 5%
Operating Expenses (OPEX): 14%
Payroll: 70%
Step 3: Translate That Into Sessions or Team Revenue
Next, calculate how much work it takes to hit that revenue goal.
If our solo practitioner is charging $150/session and seeing clients 1:1, they’ll need about 135 sessions a month (or ~34/week). That might be too much—so they can adjust their fee or revenue goal accordingly.
If you run a group practice, you’ll want to figure out how many sessions your team needs to provide each week to reach your target revenue after expenses—while still leaving room for your Owner’s Pay and Profit buckets.
In our group practice example with an average fee per session of $122, the practice will need roughly 1,366 sessions per month or 341 sessions per week to reach the same owner’s pay goal.
This is where Profit First gets powerful. It gives you real data to make smart decisions about hiring, fee increases, or adding services.
Step 4: Set Up the Profit First System
Once you’ve reverse engineered your revenue goals and understand what it takes to get there, it’s time to put the Profit First system into action.
At a minimum, you’ll want to set up these 5 foundational bank accounts:
Income Account – where all your client payments land
Owner’s Pay Account – your personal paycheck
Profit Account – the reward for being a business owner
Tax Account – no more panicking at tax time
Operating Expenses (OPEX) – your spending account for business expenses
Payroll (this account applies only for group practices) – your account for all payroll-related expenses including wages, payroll tax and benefits.
On a regular basis, typically once each week, you’ll transfer money from your Income Account into the others based on your target percentages. You can adjust the percentages over time as your practice grows or changes.
Step 5: Course-Correct as Needed
The first time you do this, you might realize you’re not quite bringing in enough to pay yourself and make a profit. That’s okay!
This process is designed to show you what’s possible—and what needs to change to get there.
If your expenses are too high, start trimming.
If your caseload is full but revenue isn’t where it needs to be, consider:
Raising your rates
Improving your scheduling or no-show policy
Hiring or expanding your team
Focusing on marketing to get your clinicians full
Reverse engineering helps you make informed decisions, not just gut calls. You’re not guessing—you’re planning.
Why This Matters
There’s a big difference between being busy and being profitable.
A lot of practice owners come to us exhausted, burned out, and wondering why their busy practice isn’t translating into personal income.
The problem? They built their business from the outside in—saying yes to sliding scale spots, hiring help, and spending money—without starting from their goals for owner’s pay and profit.
Reverse engineering helps you avoid that trap.
And Profit First gives you the structure to follow through.
You Deserve to Get Paid. You Deserve Profit.
Let’s be clear: you’re not greedy for wanting a profitable business. You’re not selfish for wanting a solid paycheck.
You are the beating heart of your practice. You take the risks. You wear all the hats. You invest your time, energy, and money.
You deserve to be paid well and to have a healthy, thriving business.
Ready to Build Your Practice Backwards (In the Best Way)?
If this blog has you reaching for a calculator and feeling more empowered than overwhelmed—good. That’s exactly what reverse engineering is meant to do.
Now you just need a system to walk you through the steps, track your numbers, and put Profit
First into action in your practice.
🎯 Grab your copy of Profit First for Therapists AND the Profit First for Therapists Official Workbook
In the books I dive deep into the Profit First system and exactly how it can work in your private practice. The workbook is packed with exercises, calculators, templates, and step-by-step guidance to help you implement Profit First with ease. It’s the next best thing to having a CFO in your back pocket.
Final Thoughts
You don’t need a crystal ball to create a profitable practice. You just need a clear goal—and a plan to get there.
Start with the end in mind. Reverse engineer your business. Pay yourself first. And watch how much more clarity and confidence you have as a practice owner.
You've got this. And we’re cheering you on every step of the way.
This article is designed to provide information only and should not be considered legal or tax advice. Because of the complexity of the law and the variables in your own personal tax situation, you can’t rely on our advice specifically related to your unique circumstances. In order to get the best tax savings and legal advice available to you, you should consult with your own accountant, attorney, or advisor regarding your particular facts and circumstances.
GreenOak Accounting specializes in working with private practice owners across the United States. For more information on our services, visit our website.