What is the difference between a CFO and a controller?
A controller manages historical accounting (close, statements, audit, compliance), while a CFO is forward-looking (forecasting, capital allocation, M&A, strategy). Most growing clinics need both, sequenced controller first.
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Definition
A controller is the senior accounting leader responsible for accurate financial reporting; a CFO is the senior finance executive responsible for strategic financial direction.
The detail
The simplest distinction: a controller answers what happened, a CFO answers what should happen next. Controllers own the monthly close, the financial statements, the audit, tax coordination, and accounting compliance. CFOs own the forecast, capital allocation, payer contract economics, M&A modeling, banking relationships, and board or partner reporting. Public pay data does not split the two roles cleanly. BLS counts controllers as financial managers, whose median wage was $166,570 in May 2025, and notes that experienced financial managers may advance to CFO; accountants and auditors, the staff who do much of the close, had a median wage of $83,680. In a clinic the controller function is the foundation; without clean books, CFO work is impossible. A fractional CFO layers on top to provide strategic direction; Sorso's starts at $4,000 a month. Most smaller clinics should hire or outsource the controller role first, then add a fractional CFO when forecasting and capital decisions become recurring needs.
BLS counts controllers as financial managers: they 'direct the preparation of financial reports that summarize and forecast an organization's financial position.' The median wage for financial managers was $166,570 in May 2025.
Source: BLS Occupational Outlook Handbook: Financial managers
The median wage for accountants and auditors was $83,680 in May 2025, about half the financial manager median.
Source: BLS Occupational Outlook Handbook: Accountants and auditors
BLS notes that experienced financial managers may advance to become chief financial officers.
Source: BLS Occupational Outlook Handbook: Financial managers
What this means for clinic owners
From Sorso
Hiring a CFO before you have a controller is like hiring a strategist with no data. Sequence matters. Get the books clean first, then add forward-looking finance. The distinction matters most when one of them leaves, because what breaks depends entirely on which seat it was — our interim CFO page has a triage tool that sequences it.
Talk it through
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Fractional CFO
Strategic CFO for $3M–$50M clinics
Forecasts, location-level P&L, exit prep. Starts at $4,000/mo.
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Healthcare-specialist accounting
Books done right by people who understand clinic finance. Starts at $2,000/mo.
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How much does a fractional CFO cost?
Most fractional CFO engagements are quoted at $3,000 to $10,000 a month, rising to $10,000 to $20,000 or more when the work is heavy, according to fractional CFO firm The Good CFO. Sorso's fractional CFO service for clinics starts at $4,000 a month. A full-time CFO costs far more: BLS counts CFOs among chief executives, whose median pay in healthcare and social assistance was $197,090 a year in May 2025, before bonuses, benefits or a search fee.
How much does healthcare accounting cost per month?
Sorso's outsourced healthcare accounting starts at $2,000 a month; we know of no survey that publishes a market rate, so other firms' quotes vary with transaction volume, number of locations and how much review you get. The in-house alternative costs more: one accountant at the BLS median wage of $83,680 (May 2025) comes to about $102,600 a year, roughly $8,550 a month, once benefits are added (Sorso estimate).
How much does a full-time CFO cost?
A full-time CFO's salary alone runs about $200,000 a year: BLS counts CFOs among chief executives, whose median annual wage was $197,090 in healthcare and social assistance and $213,990 across all industries in May 2025. Sorso estimate: benefits add about 23 percent (BLS employer-cost data), taking the healthcare median to roughly $242,000 before any bonus, and a retained search, which SPMB prices at about a third of first-year cash pay for a CFO, adds about $65,700 in year one, a third of the salary alone.
When should I hire a fractional CFO?
Most clinics should hire a fractional CFO when they add a second location, raise debt or equity, start preparing for a sale or partner buy-in, or keep missing their numbers without knowing why.
Does a fractional CFO need to be local?
No. Almost everything a fractional CFO does for a clinic happens inside cloud systems you already reach remotely, and the moments that genuinely benefit from being in the room come to a handful of days a year. Filtering candidates by driving distance narrows the field to whoever is nearby rather than whoever understands outpatient healthcare.
What does a fractional CFO actually do?
A fractional CFO owns financial forecasting, KPI dashboards, cash flow management, capital decisions, and strategic finance work, delivered on a monthly retainer instead of a full-time salary.
What is the difference between a fractional CFO and a bookkeeper?
A bookkeeper records what already happened: daily transactions, reconciliations, and clean financial statements. A fractional CFO uses those statements to plan what should happen next: forecasts, KPIs, strategic decisions, and growth or exit modeling. A bookkeeper on staff earns a median $49,860 a year in healthcare and social assistance (BLS, May 2025), and fractional CFO engagements are commonly quoted at $3,000 to $10,000 a month (The Good CFO). Clean books come first; CFO work pays off once the next decision is large enough to justify it.
Bench vs Pilot vs a healthcare-specialist CFO: which does my clinic need?
Bench is generic small-business bookkeeping on entry tiers, with no healthcare or CFO layer. Pilot is startup-oriented bookkeeping plus CFO, with a health vertical aimed at healthtech, medtech and biotech startups rather than established clinics that bill insurance. A healthcare-specialist firm is built for operating practices: payer-mix reconciliation, billing-to-books tie-out, and provider-level P&L. For an operating clinic that runs on Medicare and commercial contracts, the specialist is the fit; Bench and Pilot fit non-clinic or healthtech businesses.
Does a fractional CFO need to be a CPA?
No. CFO work such as forecasting, budgeting, KPI reporting, cash planning and lender or buyer models needs no license; the CPA license is what the law requires to sign audit or review reports on financial statements and to use the CPA title. For an IRS audit, collection case or appeal, CPAs, attorneys and enrolled agents are the professionals with unlimited representation rights, so the practical setup is a CFO for decisions and a CPA firm for tax and attest work.
Founder of Sorso and a CFA charterholder. Before Sorso, Stan spent 19 years in corporate finance at institutions including UniCredit and Société Générale — managing a $450M loan portfolio and making senior partner at a major mezzanine lender by 29 — then built a fractional CFO firm exclusively for outpatient healthcare clinics.
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