The day you realize busy does not equal paid…
Sometimes, there is a moment in private practice when your calendar is packed and your bank account still feels thin. It is confusing and a little deflating. You are not doing it wrong… you are measuring the wrong thing.
Step 1: Calculate your real number
Pull the last four weeks of collected clinical revenue. Use deposits that have cleared, not invoices. Include late cancel fees that were paid.
Now count your clinical hours for the same period. Use what was on your calendar, not what you hoped to do. If a 25-minute visit routinely runs to 40, count 40.
Divide the collected revenue by clinical hours. That is your revenue per clinical hour. Write it somewhere you can see it.
Two quick notes:
If you take insurance, use the actual allowed amounts that landed, not the billed amounts.
If you had no-shows with a fee that was collected, include them as revenue and do not add clinical time. That is the point of a policy.
Step 2: Track unpaid admin time for one week
For the next seven days, time yourself on everything that does not require your license for the full duration. Portal messages, refills, scheduling, intake packet chase, directory updates, social posts, and bookkeeping.
Do not guess. Use a timer. At the end of the week, add the hours.
Now compute your effective hourly rate:
Collected clinical revenue for the week ÷ (clinical hours + admin hours) = effective hourly rate.
If that number makes your stomach drop, good. You found the real leak.
Step 3: Pull the levers that move the number
Rates and visit mix
If your 25-minute follow-up always stretches long, offer a 45-minute option and book it on purpose.
Raise rates to a sustainable floor. Put a review date on your calendar.
Protect prime hours for visits that match your clinical strengths and revenue goals.
Policy and schedule integrity
Card on file. Clear 24 or 48-hour cancel window.
Reminder cadence at 72, 24, and 2 hours with a direct reschedule link.
Convert long message threads into brief check-in visits.
Admin containment
Batch refills at set times. Use a portal form that gathers pharmacy, dose, and days remaining.
Use smart phrases for common med classes so safety checks take seconds.
Hire five hours a week of admin help if your unpaid time is above three hours. One eval and one follow-up usually cover it.
Charting on time
Finish notes while the chart is open.
Keep a follow-up template that captures interval history, med changes, plan, and next visit.
End each visit with a one-sentence anchor: what you will review next time and when.
Step 4: Set a simple weekly target
Know your weekly burn, which is your fixed costs divided by 52. Decide on a minimum owner pay. From there, you can back into the clinical hours you actually need.
Example: Burn is 900 per week. Owner pay floor is 1,600. Revenue per clinical hour is 200. You need 13 clinical hours to cover both. Anything above that funds taxes, buffer, and growth.
Step 5: Give it two weeks
For the next two weeks, track your numbers and run the plan. Protect visit length. Batch admin. Enforce policies without apology. Then recalculate the two rates. Revenue per clinical hour. Effective hourly rate.
This is work we do inside Strong Roots. You do not need to grind harder. You need clean numbers and a few steady habits that pay you for the work you already do.
Let’s build the practice your nervous system—and your mission—deserves. Come join us inside Strong Roots Mentorship. We take you step by step from ground zero to seeing patients and beyond, without the overwhelm.