CPA vs bookkeeper: which does your clinic need?
TL;DR: Most clinics over about $2M in revenue need both. A bookkeeper keeps the books accurate day-to-day. A CPA handles tax strategy, compliance, and advisory. Paying a CPA at $200-$400/hr to reconcile bank statements is an expensive way to do data entry. Below: scope, cost, and when to hire each.
Option A
CPA (Certified Public Accountant)
Licensed professional focused on tax strategy, compliance, audit, and financial advisory. They look at the big picture: are you structured correctly, paying the right amount in taxes, and positioned for growth or exit?
Option B
Bookkeeper
Handles the daily financial operations: recording transactions, reconciling accounts, processing payroll, managing accounts payable and receivable. They keep the books accurate and current so everyone else can do their jobs.
| Category | CPA (Certified Public Accountant) | Bookkeeper |
|---|---|---|
| Scope of work | Tax planning, tax filing, financial statement preparation, entity structuring, audit support, compliance advisory | Transaction recording, bank reconciliation, accounts payable/receivable, payroll processing, monthly close |
| Qualifications | CPA license (150 credit hours, passing CPA exam, continuing education). Legally authorized to sign tax returns and audit financials. | No required license. Ranges from self-taught to certified bookkeeper credentials. Quality varies significantly. |
| Typical cost | $200-$400/hr ($300-$500+ for specialized tax planning) or $2,000-$5,000/yr for annual tax prep. Advisory retainers $1,000-$3,000/mo. | $20-$35/hr or $40,000-$65,000/yr salary. Outsourced bookkeeping $500-$2,000/mo. |
| Tax strategy | Proactive tax planning. Entity structuring, retirement plan optimization, depreciation strategies, quarterly estimated taxes. | Does not do tax strategy. Provides the data the CPA needs but does not make tax decisions. |
| Financial analysis | Can analyze financial health, profitability trends, and provide advisory. Some CPAs do this well; many stick to tax compliance. | Not their role. They produce accurate numbers. Interpreting those numbers is someone else's job. |
| Daily operations | Not involved in daily bookkeeping. Engages quarterly or annually. | Manages daily and weekly financial operations. The person in the trenches. |
| When to use each | Every clinic needs a CPA at minimum for tax filing. Above $2M, you need a CPA who does proactive tax strategy, not just compliance. | Every clinic with more than a handful of transactions per month needs a bookkeeper. By the time you hit $500K revenue, this is essential. |
You probably need both. They do different jobs.
This is not an either/or decision. A bookkeeper keeps the books accurate day-to-day. A CPA handles tax strategy and compliance. They are complementary roles. Most clinics over $2M in revenue need a dedicated bookkeeper (in-house or outsourced) plus a CPA for tax planning and filing. The mistake we see most often: clinics using a CPA for everything. Your CPA bills $200-400/hr for routine work and up to $500/hr for specialized planning. Paying them to reconcile bank statements is an expensive way to do data entry. Get a bookkeeper for the daily work and let your CPA focus on strategy.
Frequently Asked Questions
Not sure which is right for your clinic?
Take the 4-minute financial assessment and we'll tell you exactly what your practice needs.