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.
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Definition
A fractional CFO is a part-time senior finance executive who provides CFO-level work on a recurring monthly engagement instead of as a full-time employee.
The detail
A fractional CFO engagement typically delivers six recurring work streams. First, monthly financial review, where the CFO reviews close output, identifies variances from forecast, and presents to ownership in a structured monthly meeting. Second, rolling 13-week cash flow forecasting and management, especially critical for practices with seasonal revenue patterns or growth investments. Third, KPI dashboards covering revenue, AR, productivity, and margin metrics that turn the financial statements into operating decisions. Fourth, capital allocation decisions: equipment buy versus lease, expansion timing, debt structure, partner distributions. Fifth, strategic projects: payer contract analysis, lease negotiations, M&A diligence on acquisitions or sale preparation. Sixth, banking and partner relationship management. Engagements are priced as a monthly retainer and meet with ownership on a fixed cadence; Sorso's is two strategy calls a month. The work is recurring and senior; it is not project-based consulting, which is the line that separates it from a practice management consultant.
Sorso's fractional CFO engagements start at $4,000 a month and run on two strategy calls a month.
Source: Sorso: Virtual CFO services
Median financial manager wage was $166,570 in May 2025, with the top 10 percent above $323,270.
The recurring core is a monthly close review, cash forecasting, profitability by location and provider, and support on lending, expansion and exit decisions.
Source: Sorso: Virtual CFO services
What this means for clinic owners
From Sorso
If you have ever asked 'why did we make less money this month than last?' and not gotten a clear answer within 24 hours, you have the problem a fractional CFO solves.
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How clinic owners typically work with us after a question like this
Fractional CFO
Strategic CFO for $3M–$50M clinics
Forecasts, location-level P&L, exit prep. Starts at $4,000/mo.
Explore Fractional CFO →Accounting
Healthcare-specialist accounting
Books done right by people who understand clinic finance. Starts at $2,000/mo.
Explore Accounting →Free Assessment
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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 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 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.
What financial KPIs should I track for my clinic?
The core 8 financial KPIs every clinic should track monthly are revenue, EBITDA, net collection rate, days in AR, denial rate, revenue per provider, overhead ratio, and rolling 13-week cash forecast.
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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