When should I hire a fractional CFO?
Most clinics should hire a fractional CFO when they cross $2M in revenue, add a second location, raise debt or equity, or start preparing for a sale, typically 12 to 36 months out.
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Definition
A fractional CFO engagement begins when a practice has enough financial complexity to need senior expertise but not enough to justify a full-time hire.
The detail
Five trigger events typically justify bringing on a fractional CFO. First, revenue between $2M and $30M, where finance complexity outgrows the bookkeeper but does not yet justify a $300K full-time hire. Second, multi-location expansion, where you need location-level P&Ls, consolidated reporting, and capital allocation discipline. Third, raising debt for equipment, real estate, or working capital; banks expect a finance leader and lender presentations are CFO work. Fourth, considering a sale, partner buy-in, or PE recapitalization within 36 months; pre-sale financial cleanup typically adds 1 to 2 turns of EBITDA multiple. Fifth, missing your numbers regularly without knowing why; recurring variance from forecast usually means the forecasting process needs rebuilding. The wrong reason to hire a fractional CFO is to fix bookkeeping; that is an accountant's job at one-third the cost. A question that comes up at the same moment is whether the person has to be nearby, and they generally do not — specialty depth matters more than driving distance.
Most fractional CFO engagements start in the $2M to $20M revenue band where finance complexity outgrows in-house capacity.
Source: Sorso engagement data (proprietary, 2024–2026)
BLS data shows financial managers in healthcare command top-quartile compensation, making fractional engagements significantly cheaper than full-time hires.
What this means for clinic owners
From Sorso
If you can answer your own question 'how much cash will I have in 90 days?' within 60 seconds, you do not need a fractional CFO yet. If you cannot, the math almost always works.
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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.
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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?
A fractional CFO typically costs $3,000 to $10,000 per month for healthcare clinics, with most outpatient practices in the $4,000 to $7,000 range. A full-time CFO runs $200,000 to $400,000 per year in base compensation alone.
How much does a full-time CFO cost?
A full-time healthcare CFO costs $250,000 to $450,000 per year in total compensation for mid-market clinics, including base salary, bonus, benefits, and recruiting costs.
How much should I pay my practice manager?
BLS reports a median annual wage of $117,960 for medical and health services managers (May 2024), with the bottom 10 percent under $67,900 and the top 10 percent above $219,080. Outpatient practice managers sit toward the lower half of that range; multi-location administrators toward the upper.
When should I add a second clinic location?
You should add a second location when your first location is at 80 percent or more capacity utilization, has 25 percent or higher EBITDA margins, and you have 6 to 12 months of operating cash plus dedicated growth capital.
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 does a fractional CFO actually do?
A fractional CFO owns financial forecasting, KPI dashboards, cash flow management, capital decisions, and strategic finance work, typically delivering 10 to 25 hours per month on a retainer.
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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