How many sessions a week does my practice actually need?
The arithmetic is simple. Having honest numbers to put into it is the harder part.
Start with what the practice has to bring in each month. Add your real overhead, the pay you want to take home, and the tax reserve your tax preparer has you setting aside. Divide that total by what you actually collect per session on average, and you have the number of sessions you need in a month. Divide that by about 4.3 and you have your weekly number.
Here is how it looks with real figures. Say overhead runs $1,800 a month for rent, your EHR, liability insurance, phone, CEUs, and the rest of your software. You want $7,000 in take-home pay. Your tax preparer has you reserving $2,300. That means the practice needs to collect $11,100 in the month. If your average collected amount per session is $122, you need about 91 sessions a month, which is roughly 21 a week.
That $122 is where most of these calculations fall apart. Your posted fee might be $150, and very few practices collect the full fee on every single session. Sliding scale spots, contracted rates, no-shows, late cancellations, and balances that never get paid all pull the average down. The number you want is total money collected divided by total sessions held over at least three months. That is exactly the kind of figure monthly bookkeeping hands you, because it comes from what actually landed in the bank rather than what was scheduled.
It is worth running the annual version too. Overhead runs all twelve months while most clinicians work something like 45 to 48 weeks. At 91 sessions a month, you are looking at around 1,092 sessions a year, and spread across 46 working weeks that is closer to 24 a week. The weeks you take off get paid for by the weeks you work.
As for benchmarks, a sustainable full caseload is commonly described as somewhere around 18 to 22 sessions a week, with full-time monthly counts landing near 60 to 80 sessions. Those are figures people in the field cite, and they are worth checking against your own specialty, your documentation load, and your setting, because they vary quite a bit.
If the math asks for more sessions than you can hold well, that is information about your fee, your overhead, or how your practice is built. What you do with it belongs to you. Bookkeeping for therapists comes down to this for me. I keep the numbers clean and honest so that when you sit down with a question this important, you are working from what really happened in your practice instead of a guess.
If you would like help getting to those real numbers, book a consultation with me and we can look at what your practice is actually earning per session.
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Tell me where your books stand right now, even if the honest answer is that nobody has looked at them in a year. I'll ask a few questions and give you a clear idea of how I can help.
More Questions
How should associate compensation splits be recorded in a group practice's books?
Record the full amount collected as practice revenue and the clinician's share as a compensation expense, never netted together. Track collections by clinician so the split is calculated from a number both sides can see, and apply the written agreement exactly as it reads.
Read answerWhen can my practice afford to add another clinician?
You can afford an associate when the arithmetic works, meaning their pay, the extra overhead that comes with them, and several months of a partial caseload all fit inside what your practice actually collects. Your books supply those numbers, and the decision stays yours.
Read answerWhat's the difference between catch-up and clean-up bookkeeping?
Catch-up is for books that were never done, meaning months or years with nothing recorded. Clean-up is for books that exist but cannot be trusted because things are miscategorized, unreconciled, or duplicated. Both end the same way, with accurate current books and a monthly rhythm going forward.
Read answerWhat does it actually cost to run a therapy practice?
Established solo practices commonly run somewhere between $1,500 and $5,000 a month in overhead, and lean virtual practices often come in well under that. Those figures move around and are worth verifying. The number that matters most is your own, and your books can tell you exactly what it is.
Read answerWhat does working together month to month actually look like?
After a short setup, most months are quiet on your end. I categorize your transactions, reconcile your accounts, send you a small list of questions, and deliver reports with notes written in plain language.
Read answerWhat should I look at in my reports each month if I only have ten minutes?
Look at four things. Revenue compared to last month and the same month last year, the few expense lines that actually move, profit for the month, and cash on hand. That is enough to know whether the practice is healthy, and anything that looks strange can be a quick conversation.
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