When should I hire a fractional CFO?
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.
Quick answer
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.
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.
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)
Pre-sale financial cleanup typically adds 1 to 2 turns of EBITDA multiple per Pitchbook M&A analyses.
BLS data shows financial managers in healthcare command top-quartile compensation, making fractional engagements significantly cheaper than full-time hires.
Source: BLS OES May 2024
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.
Related questions
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 based on practice size and engagement scope.
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.
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. 19 years in corporate finance. Managed a $450M loan portfolio before building a fractional CFO firm exclusively for healthcare clinics.
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