Hi Reader,
When I graduated, I was shocked by how natural patient care felt. All that schooling had actually worked. What didn’t come naturally? Literally everything else.
Like many of us in this field, I came out of training knowing how to build rapport, diagnose, and treat—but not how to run a business.
I became fascinated by business models and systems for delivering care. But it wasn’t until nearly five years in—and after many full patient weeks and very modest paychecks—that I finally sat down and crunched the numbers.
That single exercise didn't just improve my practice—it saved it.
I calculated my true monthly business expenses. Then I divided that number by the number of patient hours I could actually work. Not the fantasy 40-hour clinical week (which is unrealistic for most of us), but my real capacity—factoring in what burns practitioners out: the emotional labor of each encounter, the two hours of inbox time after a "full day," the weekend calls from worried patients.
What I found was sobering.
My hourly overhead at the time was nearly $130. I was charging $160. After taxes and variable costs, I was paying myself about $2,000/month. Despite seeing plenty of patients and bringing in $5–10K in monthly revenue, I couldn’t get ahead.
I was essentially working full-time to barely cover my rent.
Let that sink in. Years of education, mountains of student debt, countless hours of continuing education—all to make less than minimum wage.
Like so many of us, I had been looking around at what my peers charged, telling myself I wasn’t “experienced enough” to charge more. I also wanted to be “accessible.” But here’s the truth:
Affordability without sustainability is not accessibility.
If your practice model doesn’t support your basic needs, it’s not sustainable. And if it’s not sustainable, it’s not accessible for the long term—because it won’t exist.
I'd been telling myself a story that my modest rates were a service to my community. The reality? I was slowly heading toward burnout and resentment and was actually strongly considering surrendering my medical license and going into nonprofit work.
Think about that. I was ready to abandon my calling because I couldn't make the math work.
Let's pause here and acknowledge the massive guilt many of us carry around charging "too much." We entered healing professions to help people, not to get rich. The cognitive dissonance can be paralyzing.
But here's what nobody tells you in school: Undercharging isn't noble—it's a form of self-sabotage that ultimately hurts your patients.
What I've learned is this: when patients invest more, they engage more deeply. When people pay, they pay attention. This isn't just a convenient rationalization—I've witnessed this pattern hundreds of times. The therapeutic relationship transforms when both parties are fully invested.
I’ve learned the hard way: You can't sustainably deliver concierge-level care at discount prices.
So what's the solution? It begins with getting crystal clear on your numbers.
This is the calculation I recommend every clinician do (and wish I had done way sooner):