The Hardest Part Was Already Over
What a checkout line taught me about finding hidden profit in your group practice.
I recently took my kids shopping while we were on vacation. The real reason we walked into the store? Air conditioning. It was one of those brutally hot afternoons where stepping into a cool store felt amazing.
The store itself was beautiful. Everything was neatly organized, the displays were inviting, and within minutes my kids had arms full of clothes they wanted to try on. The dressing rooms were empty, so I spent the next several minutes running back and forth grabbing different sizes. Eventually, we made our way to the checkout line. And then...we waited.
We stood in line for about fifteen minutes just to pay. The line snaked from one end of the store to the other. Every few minutes, someone would let out a loud sigh. People glanced at each other with those silent "Why is this taking so long?" shrugs that happen when everyone knows they're stuck. As we waited, I looked around the store. There were at least eight employees working, but only one person was running the register. During those fifteen minutes alone, I watched two different customers get frustrated, step out of line, put their clothes back, and walk out the front door without buying anything.
That's when my accountant brain kicked in.
If two customers gave up in just the fifteen minutes I was standing there, how many people walked away throughout the entire day? Let's say that happened to eight customers over the course of an hour. If each person planned to buy two items at around $25 each, that's roughly $400 in lost sales every single hour.
The scariest part?
I don't think anyone in the store even realized it was happening. No one stole anything. The marketing didn't suddenly stop working. Customers were literally standing in the store with products they wanted to buy. But because no one noticed the bottleneck, that revenue simply disappeared.
The Hardest Part of the Sale Was Already Over
Think about everything that store had already done right. They invested in marketing to get people through the door. They created a beautiful shopping experience. The merchandise was appealing enough that people browsed, selected items, and spent time trying them on.
The hardest part of the sale was already over. The customers wanted to buy. But because one system broke down at the very end of the process, revenue simply walked out the front door.
The company will probably review its sales reports and wonder why revenue wasn't higher. Maybe they'll think they need more advertising. Maybe they'll think they need better promotions. Maybe they'll even blame the economy. But from where I was standing, they didn't have a marketing problem. They had a systems problem.
After working with thousands of private practices over the years, I can tell you that I see this happen all the time.
Practice Owners Often Solve the Wrong Problem
Practice owners are incredibly good at recognizing when something isn't working. What's harder is identifying why. Revenue isn't where you want it to be, so you assume you need another clinician. New client inquiries feel slow, so you assume you need more marketing. Your administrative team feels overwhelmed, so you assume it's time to hire another admin.
Sometimes those assumptions are right. But sometimes you're solving the wrong problem. And when that happens, you spend time, money, and energy fixing something that wasn't actually broken.
Hidden Profit Is Often Hiding in Your Existing Systems
Recently, we worked with a group practice owner who was convinced they needed to hire more clinicians.
From their perspective, it made perfect sense. Revenue wasn't where they wanted it to be, so hiring more therapists felt like the obvious next step.
But when we looked at the numbers, we found something surprising.
Most of their eighteen clinicians were operating at only 65-75% of their expected capacity.
Instead of adding more people to recruit, onboard, credential, supervise, and support, they had an opportunity to increase revenue simply by filling the schedules of the clinicians they already had. That's a tremendous amount of hidden profit. And in today's hiring market, it's probably a much easier solution than finding, hiring, and training another great clinician. Hiring has a cost. Recruiting takes time. Onboarding costs money. New clinicians need marketing to fill their schedules. Someone has to train and manage them.
If you can accomplish your financial goals by optimizing the team you've already built, that's often the simpler—and more profitable—solution. Just like the clothing store didn't necessarily need more customers. They needed a better checkout system.
Here Are a Few More Examples
This is something we see over and over again.
"We need another admin."
Maybe. Or maybe your phone volume hasn't increased, your client inquiries haven't increased, and your administrative team is spending hours doing duplicate work because of inefficient systems. Adding another salary won't fix a broken process.
"Our marketing isn't working."
Maybe. Or maybe inquiries are coming in consistently, but prospective clients are waiting too long for a callback. Or perhaps only half of your consultation calls are turning into appointments. Before increasing your marketing budget, it's worth asking whether your intake system is the real bottleneck.
"My clinicians need a raise."
Maybe. But if your clinicians are paid on a fee-for-service model, the fastest path to earning more might be helping them consistently reach the caseload they're already expected to maintain. When clinicians have fuller schedules, everyone wins. The clinician earns more. The practice becomes more profitable. And more clients receive care.
The solution isn't always changing compensation. Sometimes it's improving the system that supports your clinicians.
Looking Beyond the Obvious
When people think about accounting, they usually think about bookkeeping, tax returns, or financial statements. Those things matter. But CFO-level work is different. A good CFO doesn't start by solving the problem you describe. They start by making sure you've identified the right problem in the first place.
When someone tells us they need to hire, our first question isn't, "How quickly can we find another clinician?" It's, "Why?"
When someone says profitability is down, we don't immediately recommend cutting expenses. We want to understand what's driving the numbers. Where is the bottleneck? Where is the breakdown? What system isn't doing its job?
Because once you identify the real problem, the solution often becomes much more obvious—and much less expensive.
Audit Before You Act
The next time your practice feels stuck, resist the temptation to jump straight to the solution.
Instead, pause and ask yourself:
What do the numbers actually tell me?
Where in the process is the breakdown?
What system could solve this?
Am I solving the root cause or the symptom?
Have I asked my accountant, CFO, coach, or another trusted advisor for an outside perspective?
These questions aren't flashy. In fact, the answers are often hiding in the boring, behind-the-scenes systems that keep your practice running every day. But after working with thousands of private practices, we've learned something important. That's often where profitability is hiding.
Final Thoughts
The clothing store probably thought they had a sales problem. Maybe they even thought they had a marketing problem. After all, customers were walking out the front door without making a purchase.
But the real issue wasn't getting people into the store. The hardest part of the sale was already over. The real problem was what happened in the final few minutes before customers reached the register.
The same thing happens in private practice.
The next time you're convinced you know what your practice needs, pause before jumping to the solution. Ask yourself if you're looking at the checkout line—or the register. Because sometimes the biggest opportunity in your practice isn't finding more referrals, hiring another clinician, or adding another team member. Sometimes the hardest part is already over. You simply need to fix the system that's quietly keeping you from collecting the profit you've already earned.
Ready to Find the Hidden Profit in Your Practice?
At GreenOak Accounting, our CFO services help group practice owners look beyond the financial statements to uncover the systems that are quietly impacting profitability. Sometimes the biggest opportunity isn't adding something new. It's optimizing what you already have.
Schedule a consultation today and let's find the hidden profit in your practice together.
Disclaimer: 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.
