Fractional CFO for medical practices
A fractional CFO is a senior finance executive who runs your practice's financial strategy part-time, for a fraction of a full-time salary. For a medical practice, that means rebuilding your P&L to show profit by provider, location, and service line, reading your payer mix and denials as economics rather than paperwork, forecasting cash 13 weeks out, and keeping the books ready for a lender or a buyer. You get the judgment of a CFO without the six-figure seat, and you keep your bookkeeper for what they already do well.
01 · The role
What does a fractional CFO actually do for a medical practice?
A fractional CFO owns the financial function your bookkeeper is not staffed to build: the forward-looking, decision-driving layer. In a practice, that work is specific. Here is what it covers.
- 01
A P&L rebuilt by provider, location, and line
Most practice P&Ls total everything into one bucket, so you know revenue but not which provider, site, or service line actually makes money. I rebuild it down to cost attribution per case, so profit stops being a mystery and starts being a number you can act on.
- 02
Payer mix and denial economics
Your payer mix is not an administrative detail, it is your margin. I read collections performance, denial patterns, and aging AR as economics: what your mix is actually worth, where a slow or unfavorable payer is quietly costing you, and what a code or contract change did to your top line.
- 03
A rolling 13-week cash forecast
Collections, payroll, tax payments, and big outflows lined up week by week, a full quarter ahead. You see the squeeze before it hits instead of finding out when the balance drops, so a hire or a piece of equipment is a decision, not a gamble.
- 04
The few KPIs that actually drive margin
Not a forty-metric dashboard nobody opens. The handful of numbers that move your practice, like gross margin per case and how fast a dollar of work becomes a dollar of cash, on a live view you check every week.
- 05
Board, partner, and lender reporting
Partners, a board, and a bank all ask different questions of the same numbers. I build reporting that answers each of them from one clean source, so a partner meeting or a lender request is a working session, not a fire drill.
- 06
Payer-contract and compensation-model support
Provider comp and payer contracts are where a practice's economics get made or lost. I give you the math behind both: what each contract is really worth once denials and effort are counted, and whether your comp plan pays for the volume or the margin.
- 07
Exit and diligence readiness
If a sale is anywhere on your horizon, the same rebuild doubles as a stress test. I recast the P&L the way a quality-of-earnings team will want it, flag the add-backs, and keep schedules that hold up in a data room, so you negotiate from strength instead of scrambling.
02 · Where it fits
How is a fractional CFO different from a bookkeeper, a CPA, and a controller?
These are four different jobs, not four names for the same one. A fractional CFO sits above the other three and adds strategy and forward visibility. The short version:
A bookkeeper records the past
They enter transactions, reconcile accounts, and close the month. Essential, and a good one is worth every dollar. But recording history is not the same as planning forward, and that forward layer is usually just missing.
A CPA handles tax and compliance
They file your return and keep you compliant, and most will tell you straight that forward-looking margin and cash work is not their lane. Ask yours; the honest ones point you here.
A controller runs the accounting function
A controller manages close, controls, and the accounting team. That is a full-time seat most $5 to $50 million practices cannot fill or keep busy. A fractional CFO adds the strategy and forward visibility above all three, part-time.
For the full role-by-role breakdown, including a comparison table and when each one is the right hire, readfractional CFO vs controller vs bookkeeper.
03 · The signs
When does a medical practice need a fractional CFO?
Usually somewhere between $5 and $50 million in revenue, when the questions outgrow the bookkeeper's seat but a full-time CFO still does not pencil. If any of these sound like your Monday, it is time.
- 01Cash surprises you. You learn it is tight when the balance drops, not 13 weeks out.
- 02Your P&L arrives on the 20th and tells you what happened six weeks ago.
- 03You know total revenue but cannot say which provider, location, or service line makes money.
- 04Your bookkeeper records the past well, but nobody turns the numbers into forward decisions.
- 05A new provider, a second location, or a piece of equipment still comes down to gut feel.
- 06You have priced a full-time CFO, and the math does not work at your size.
More on each signal, and the ones specific to a practice, inwhen does a medical practice need a CFO.
04 · The cost
What does a fractional CFO cost for a medical practice?
A fraction of the seat it replaces. Market rates for a full-time CFO run $275,000 to $500,000 all-in depending on practice size, and a year of fractional CFO work typically runs $90,000 to $150,000. You are buying senior judgment at the level you actually need, not a salaried executive you have to keep busy.
My own work starts with a fixed-scope diagnostic, the Margin Map, at $7,500 flat, so you see what a CFO is worth in your practice before committing to anything ongoing. What drives the number up or down, and the full fractional-versus-full-time math, is inwhat a fractional CFO costs for a medical practice.
05 · Choosing one
What should you look for in a fractional CFO?
The title is unregulated, so the differences that matter are underneath it. Three things separate a CFO who protects your practice from one who does not.
Independence from PE, buyers, and billing vendors
Your CFO should be paid by you and only you. I take no fee, commission, or referral cut from any private equity firm, buyer, or billing company, ever. Whatever the numbers say, I have no reason to say anything but that.
Healthcare-finance fluency
Payer mix, denials, RVUs, provider comp, and a case-level export should be a language your CFO already speaks. I ran hospitals, hold an MHA, and am a Fellow of the American College of Healthcare Executives, so a physician-owned P&L is not new territory.
Works alongside your existing team
A fractional CFO should make your bookkeeper and office manager more valuable, not replace them. I plug in above the people you already have, hand them better tools, and leave the function stronger than I found it.
06 · How I do it
The Command Center Method
I ran finance organizations in the Army, where a command center is a real room: live data on the wall and one person accountable for every number on it. Your practice deserves the same thing, sized to fit. The method runs in three phases.
Phase 1 · 3 weeks
The Margin Map
A fixed-scope, $7,500 diagnostic. You get a P&L rebuilt by provider, location, and line, a 13-week cash forecast, and an opportunity list with a dollar value on every item.
Phase 2 · About 90 days
Build
I build your command center: a live dashboard, a monthly close that lands on time, and the handful of numbers that actually drive your margin.
Phase 3 · Ongoing
Operating cadence
A weekly KPI flash and a monthly operating review. You run the practice on current numbers instead of reacting to old ones.
One line on how I work: I am an independent fractional CFO, paid only by you. No fee, commission, or referral cut from any private equity firm, buyer, or billing vendor, ever. I do this work personally, so retainer capacity is capped at 5 clients at a time. You can read the whole build end to end in areal practice case study.
07 · Questions owners ask
Fractional CFO for medical practices, answered
What does a fractional CFO do for a medical practice?
Runs the financial strategy a full-time CFO would, part-time. That means a P&L rebuilt by provider, location, and line, payer and denial economics, a 13-week cash forecast, the KPIs that drive margin, reporting for partners and lenders, and books kept ready for an eventual sale. It is the forward-looking layer your bookkeeper is not staffed to build.
How is a fractional CFO different from a bookkeeper or controller?
A bookkeeper records what already happened and a controller runs the accounting function. A fractional CFO adds the strategy and forward visibility above both: where margin hides, where cash is headed, and what to do about it. You keep your bookkeeper. I build the layer nobody currently owns. The full role comparison is in the controller versus bookkeeper guide.
How much does a fractional CFO cost for a medical practice?
Far less than the seat it replaces. A full-time CFO runs $275,000 to $500,000 all-in depending on practice size, and a year of fractional CFO work typically runs $90,000 to $150,000. My own work starts with the Margin Map, a fixed $7,500 diagnostic, so you see the value before committing to anything ongoing. The cost guide breaks down what drives the number.
When does a practice need a fractional CFO instead of just a bookkeeper?
When the questions have outgrown the bookkeeper's seat. If cash surprises you, if you cannot say which provider makes money, or if big decisions still come down to gut feel, you have hit that line. Under about $5 million in revenue, a solid bookkeeper usually serves you better than a CFO.
Can a fractional CFO help me sell my practice or prepare for private equity?
Yes, and that is where clean numbers pay off most. Private equity is rolling up practices in almost every specialty, and those platforms show up with better math than most owners have on their own side. I sat as sell-side CFO on five closed transactions, building the recast P&Ls and roll-forwards that survived diligence. I make your numbers ready so you negotiate from strength.
Will a fractional CFO replace my bookkeeper or office manager?
No. I work alongside them. Your bookkeeper keeps recording the past, your office manager keeps the practice running, and I build the forward-looking layer on top and take accountability for it. In most engagements your existing team ends up more valuable, because the books finally have a structure that answers owner questions.
Does a fractional CFO need healthcare experience?
For a practice, it matters a great deal. Payer mix, denials, provider comp, and case-level costing are their own world, and a generalist CFO will spend your money learning them. Healthcare is my flagship specialty precisely because I have built practice finance down to cost per case before.
How quickly will I see value from a fractional CFO?
Weeks, not quarters. My first engagement is the Margin Map: in three weeks you get a rebuilt P&L, a 13-week cash forecast, and a ranked opportunity list with a dollar value on every line. If it does not identify at least $22,500 in margin opportunity, three times its fee, you do not pay.
Start here
See what a fractional CFO would find in your practice
The Margin Map is the first three weeks of exactly this work: your P&L rebuilt by provider, location, and line, a 13-week cash forecast, and a ranked opportunity list with a dollar value on every item.
If the Margin Map does not identify at least $22,500 in margin opportunity, three times its fee, you do not pay. If you continue to a retainer, the full $7,500 is credited to month 1.
I do this work personally, so retainer capacity is capped at 5 clients at a time.