What does it actually cost to run a therapy practice?

The honest answer is that it varies a lot, and I can still give you a range to start from. Established solo practices commonly run somewhere between $1,500 and $5,000 a month in overhead. A lean virtual practice can come in well under that, sometimes only a few hundred dollars a month. Treat those figures as a starting point, since costs shift year to year and change quite a bit depending on where you practice.

Here is what usually makes up that monthly number. Office rent is the biggest swing factor, and for a lot of practice owners it is the largest single line. After that comes your EHR or practice management subscription, malpractice coverage, license renewals, professional association dues, and continuing education. Then the smaller recurring items pile up faster than most people expect. Website hosting, a business phone line, directory listings, scheduling and video tools, a secure email plan, card processing fees, bank fees, and whatever you pay for bookkeeping and tax preparation.

A telehealth practice run from a home office skips rent entirely, which is why online-first practices tend to land at the low end. What they usually pick up instead is a bigger software stack. When I clean up a set of books, I almost always find two or three subscriptions the owner signed up for during a busy month and stopped using.

Two things get left out of most cost estimates. The first is revenue that never arrives. No-shows, late cancellations, sliding scale adjustments, and unpaid balances all reduce what you actually collect, so measuring your practice against your fee schedule gives you a rosier picture than your deposits do. The second is money that leaves for taxes and retirement. Those sit in their own place on the books, and they still come out of the same checking account. The amounts and the planning around them belong with your tax preparer.

You will also see it said that the gap between a practice’s gross revenue and the owner’s actual take-home runs near 28 percent. That is a reasonable sanity check and worth verifying against current sources, because it moves with your fees, your payer mix, your staffing, and how lean you keep the rest.

All of which brings me to the part I care about most. Every benchmark in this answer is a guess about someone else’s practice. Your own books give you your real number, sorted by category, month after month, and that beats any average you will find online. Keeping that picture current is exactly what full-service bookkeeping is for.

Bookkeeping for therapists is mostly about this kind of clarity, knowing what your practice costs to run and what it truly earns. If you would like to see your own numbers instead of a range, book a consultation with me and we will take a look together.