What your first clinician really costs
If you collect $150 per session and pay your clinician 50 percent, their $75 share is not your full hiring cost.
Add estimated employer costs and $1,000 in monthly overhead, and the example below breaks even at about four sessions a week. That’s a planning estimate, not a profit forecast. Your numbers will differ.
The important part: you can calculate your own break-even before you make an offer.
Cost 1: The clinician’s pay
Many group practices pay clinicians a percentage of what each session collects. A 40 to 60 percent split is common, though the right arrangement depends on your practice.
At a $150 collected fee and a 50 percent split, the clinician receives $75 per session.
That split applies to what you collect, not what you bill. Your collection rate matters. If you’ve promised a guaranteed minimum, you may also owe that amount while the clinician’s caseload is still growing.
Cost 2: Employer costs
If you hire a W-2 employee, budget for payroll costs on top of wages.
For 2026, the employer portion of Social Security is 6.2 percent and Medicare is 1.45 percent. Together, that’s 7.65 percent, subject to the applicable wage rules. State unemployment insurance and workers’ compensation add costs that vary by state. IRS Publication 15
For planning, I use 9 to 12 percent of wages as an estimate for total employer costs. Confirm your actual rates with a payroll provider.
At 10 percent, a $75 session payment adds $7.50 in estimated employer costs.
Cost 3: Added overhead
A new clinician may need an EHR seat, telehealth license, directory profile, marketing, or office space.
List the monthly costs you’ll add for this hire. Don’t round them down to zero just because each one looks small by itself.
Cost 4: The wait for insurance revenue
Credentialing can delay in-network billing. SimplePractice says credentialing commonly takes 60 to 120 days per payer. Timelines vary, and approval may not be the final step before billing can begin. SimplePractice
Start applications as early as you can. Ask each payer about its effective-date rules. Consider whether private-pay or EAP clients can see the clinician while credentialing is underway.
I recommend planning for three months of the hire’s fully loaded costs in reserve. That’s my planning rule of thumb, not a guarantee that every credentialing process will fit that timeline.
The break-even math
Use the example above:
Average collected fee: $150
Clinician’s 50 percent share: $75
Estimated employer costs at 10 percent: $7.50
Remaining per session: $67.50
If the hire adds $1,000 a month in overhead, divide $1,000 by $67.50. That’s about 15 sessions a month, or roughly four sessions a week.
Under these assumptions, those sessions cover the added overhead and estimated employer costs listed here. They don’t include every expense or your time for interviews, onboarding, consultation, and supervision.
Put in your own fee, split, payroll costs, and overhead. Your break-even will change with them.
The math doesn’t decide whether you’re ready
A break-even number can answer one question: how many sessions cover the costs you included?
It can’t tell you whether demand is steady or seasonal. It can’t tell you whether you’re ready to trade clinical hours for interviews, onboarding, consultation, and the work of managing a team.
Answer those questions, too.
Run your own numbers
The free First Hire Readiness Check puts the break-even math and those readiness questions on one page. It includes eight readiness signals and a five-line calculation you can fill in with your own numbers. It takes about ten minutes.
If you’re ready to plan the hire, the First Hire Kit includes an employment agreement and HIPAA templates for your attorney’s review, an interview system, a compensation guide, a capacity calculator, and an onboarding checklist through day 90. I built it from my own group practice.
** This post is educational information, not legal, tax, or accounting advice. Confirm your numbers and your state’s requirements with your accountant and attorney.