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.
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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, scale: finance work has outgrown the bookkeeper but does not justify a full-time finance executive, and BLS puts the median wage for financial managers at $166,570 (May 2025) before benefits. Sorso's own fractional CFO service is scoped for practices with $3M to $50M in revenue. 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; pre-sale cleanup matters because buyers price on EBITDA, and as Foley & Lardner puts it, at nine to 10 times EBITDA every $1 of EBITDA lost in diligence is $9 to $10 of value lost. 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 about half the price (Sorso's accounting starts at $2,000 a month, its fractional CFO work at $4,000). 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.
Sorso's fractional CFO engagements start at $4,000 a month and run month-to-month after onboarding, with a 45-day money-back guarantee on the monthly fee.
Source: Sorso: Virtual CFO services
BLS puts the median financial manager wage at $166,570 in May 2025, with the top 10 percent above $323,270, which is what a fractional retainer is measured against.
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, price one against the cost of the decisions you are making without that answer.
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How clinic owners typically work with us after a question like this
Fractional CFO
Strategic CFO for $3M–$50M clinics
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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.
How much should I pay my practice manager?
BLS reports a median annual wage of $123,860 for medical and health services managers (May 2025), with the bottom 10 percent under $73,390 and the top 10 percent above $224,340. Outpatient settings sit below that headline median: BLS puts offices of physicians at $105,770 and outpatient care centers at $116,060, so budget from those rather than from the all-industry figure.
When should I add a second clinic location?
Add a second location when the first one is full, profitable on normalized numbers and able to run without you every day, and when you can pay for the build-out and the months before the new site collects cash without touching your operating reserve.
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, delivered on a monthly retainer instead of a full-time salary.
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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