Cutting down Costs vs. Increasing Production

Pretty much every owner wishes to increase their net income. Factually, there are only two ways to accomplish that: (1) cut back on expenses and (2) increase production. Now, while it is wise to do both, you might be surprised as to which one generates the most profit. Let’s take a look.

We’ll examine a single-doctor practice that is grossing $600,000 per year and we’ll set the following two parameters:

  1. If the practice runs efficiently, it could generate $1,000,000 per year.
  2. In this particular profession, the staff salary is supposed to be 22% of the gross, but is currently running at 26% – 4 percentage points above the conventional norm.

If the executive pared their staff salary expenses down to the norm (i.e., reducing it from 26% to 22%), that would increase profit by $24,000. Not bad.

But what would the profit be if the executive were to focus on expanding the practice up to the $1,000,000 mark? At that higher level, there would be an additional $400,000. Obviously, not all of that is profit. But how much of it is?

To sort this out, you would need to look at the difference between fixed costs and variable costs. Fixed costs are those that remain constant, regardless of the production level. Rent, certain insurances, license fees, etc., are expenses that are the same amount whether the practice produces $1 or $1,000,000 per year.

Variable costs, on the other hand, are costs that vary with production. Depending on the type of practice, the two greatest variable costs are 1) payroll and 2) either inventory or lab/clinical supplies. Combined, they represent anywhere from 40% to 50% of income, depending on the profession. There are a few other variable costs that will increase the percentage slightly; but for the sake of ease of explanation, we’ll focus on just those two costs.

Let’s factor in the fixed and variable costs to this $400,000 increase and see what our profit is. First, the fixed costs have already been paid from the original $600,000 income; you obviously don’t have to pay more rent because you earned an additional $400,000. The same is true of the costs of the annual license fees and probably accounting, legal and other such fixed expenses. Those bills have already been paid.

The only additional expense you incur when you produce an extra $400,000 are the variable costs. We’ve already calculated that the combined fixed and variable costs will be as much as 50% of production; so, producing an additional $400,000 will cost $200,000. The remaining $200,000 is profit.

While the choice may be abundantly clear, let’s take a look at the ramifications of the direction you decide to take and the effect that it could have on both you and your practice. Read the final half of this article by filling out this form.


Fill out the form to read the rest of this article (Highly Recommended).

How to Guarantee a Satisfactory Retirement Fund

It is never too early in your career to start funding your retirement. You may only be one day out of school, but you should be thinking about and planning out a retirement fund.

We have found from our surveys that an ongoing decline of interest in practice ownership is making it increasingly difficult for practice owners to sell their practices, and this is causing many doctors to work in their practice years after they wanted to leave.

Unfortunately, less and less new graduates want to own a practice. More of them are looking to become associates in a practice, work 35–40 hours a week and start out with full benefits.

As part of my research, I recently spoke to a doctor in Ohio that was at retirement age. He had been in practice for over 38 years and was ready to retire. I asked him if he had adequately funded his retirement, and he told me that he had always thought that when the time came, he would sell his practice and have plenty to retire on. He found out that he was mistaken.

When I talked with him, his practice had been up for sale for over 3 years, and he couldn’t find a buyer. And of course, he was still working as he had not adequately funded his retirement outside of a practice sale. He was counting on the sale of the practice to handle his retirement. He found out, way too late, that such a plan is not always workable.

I’m hearing this story more and more from doctors all over the country.

Here are a few things that you can do to protect yourself from this situation:

  1. Place a portion of your monthly overhead into your retirement fund. Budget this in from the start. Retirement is something that needs to be figured into the overhead so that it is taken care of every month. Treat it as you would an equipment lease, a mortgage or employee salaries. Make it an ongoing expense.
  2. Find a financial planner that can properly advise you on what to do with the money that you set aside each month. Get a professional involved to help you find the best vehicle for your retirement plan.
  3. Own your practice real estate. This is a big one. Real estate is something that you can always fall back on. Even if you can’t find a buyer for your practice, you can sell real estate. If you own the building, and you find someone to buy the practice, you can lease the building to them and make a residual monthly income off the lease and have that extra income.


Fill out the form to read the rest of this article (Highly Recommended).

Looking Toward the Future: 10 Steps You Must Do Before Selling Your Practice

In the course of your career, you might decide to sell your practice. There are ten important aspects of your practice that you should consider NOW, so that when the time arrives, you will have developed a truly marketable practice.


Professional respect has value. Do you have good relationships with other professionals in your community? You should. If so, are those relationships so strong that you can transfer them to a new owner?

For example, if you have several professionals who continually refer patients/clients to you, you would want to ensure that those referral sources will continue to send patients/clients to the new owner. Otherwise, the buyer might want to discount the practice price by the amount that would be lost from not getting referrals from just those few sources.

Most professionals will continue to refer to the practice after your departure, as long as they are assured that those clients/patients they refer will receive the same good care that you currently provide them. It is also important for your referral sources to know that the new owner will reciprocate with referrals to them (assuming that is the type of relationship you currently have).

Keeping up with and then transferring these relationships will help your patients/clients too. That maintains continuity and quality of care for them, which will help them to always think well of you.


Everyone is inclined to pay more for something if it looks attractive. The same principle applies to buying a practice. If your facilities are pleasing to the eye, you might be able to command a higher price. While a clean carpet is only just that, it might demonstrate to the buyer that every aspect of your facility and practice is probably well maintained.

Well-maintained, state-of-the-art equipment also speaks well of you. It says that you have a growing practice that is keeping in step with technology.


The best indicator of the value of a practice is its cash flow. Your successor will want assurance that he is acquiring a reliable income stream. Now is the time to concentrate on reactivation of old patients/clients, increasing your marketing budget to attract new patients/clients, setting goals for the staff and moving the practice toward maximum productivity.


Part of selling a practice requires that you develop and present an accurate picture of what you have accomplished. You will want to be able to disclose good financial figures. Plan to have at least five years’ worth of good financials because the buyer wants predictability. Have an outside professional prepare “compiled statements.” That adds credibility. The practice buyer will find that well-maintained, accurate accounting records help with forward planning. Additionally, good records can even help you explain a slump period.


Very few practice owners supply the buying owner with a transition plan. If you were to do that, you will be far ahead of other owners who want to sell their practices. You should develop a plan because it not only can increase the worth of your practice, it can make life easier for everyone. Put the transition plan in writing, then review and outline all the systems and how they work. The marketing plan, referral sources, management policies and accounting systems should all be put down in narrative form.

Indicate a time frame in which the practice will be transferred to the new owner. That will give him an idea of how long he will have to learn the ropes. Don’t expect to make the deal and run with the money. An adequate time frame to transfer a practice in which you will be working side-by-side with the new owner, will range from 30 to 120 days, depending on the size and complexity of the practice.

Part of an effective, valuable transition plan can involve a good loan package. It shows that you have put together a transition plan that is easily understood by a third party. It indicates that you have a good relationship with the bank. That can enhance the value of your practice, since the banker knows that the systems will remain in place and generate cash flow to repay any loans.

Fill out the form to the right to continue reading “10 Steps You Must Do Before Selling Your Practice – Part II”(highly recommended). Scroll to top


Fill out the form to continue reading this article 10 Steps You Must Do Before Selling Your Practice – Part II (highly recommended).

12 Steps to Collect Past Due Accounts

Collecting on past due accounts is a function that the Accounts Manager will find herself/himself having to do. Any contact with a patient/client, even under these circumstances, should be kept on a friendly, professional and dignified basis. This will promote respect for the office and its business practices.

Always remember the following points with regard to your patients/clients:

  • Most people have good intentions and want to cooperate with agreements that they have made.
  • Although a person’s account may be overdue, most people still have a good intention to take care of it.
  • Most people prioritize their bills and will first pay those that they feel are most pressing.
  • Most people with past due accounts will pay those bills where someone is actively requesting them to pay.

Bearing in mind the above, your role is to arrange to be one of the creditors that your patients/clients will not delay paying. The following points may be helpful in this regard:

  1. Bill promptly every month.
  2. Ensure that your bills are accurate.
  3. Ensure that you have the original signed financial agreement from your patient/client.
  4. Contact the patient/client as soon as you realize the account has become delinquent.
  5. When you speak with the patient/client, let them know that you believe that they are able to make payment.
  6. Let the patient/client know that you expect to be paid, and refresh their memory on the signed agreement.
  7. Allow the patient/client their self-respect; never back them into a corner, insult or badger the patient/client.
  8. Explain to the patient/client that you want to help him/her work it out so that they can maintain the agreement that they made with your office.
  9. Be prepared to offer some options to the patient/client that they may not have considered.
  10. Be willing to really communicate with the patient/client so that a true understanding and agreement can be reached.
  11. If absolutely necessary, utilize the credit reporting associations. Let the patient/client know that you are planning to do so and that this will go on their credit rating.
  12. As a last resort, utilize the services of a collection agency, and let the patient/client know that you plan to do so.

If you would like more information on collecting past due accounts or any other management topic, fill out the form to your right, and we will be more than happy to assist you. Scroll to top


Receive a complimentary service (highly recommended).