What That Unfilled Shift Actually Cost You
A couple weeks ago I wrote my email subscribers about a group practice owner whose associate logged in for a virtual session from her own private practice while a new client sat waiting in the group practice office across town. The client left. She cancelled every future session. She made it clear she would not be rescheduling.
The newsletter hit a nerve. I got replies and voice messages from owners across the country, and almost every one of them circled back to the same question, just from a different angle.
What is this actually costing me, and why am I the only one paying for it?
One owner told me about a thread in a Facebook group where someone asked whether she should give her associate the full fee for writing a clinical letter, since the associate is the one doing the work. Another owner jumped in and said, sure, but your admin team is the one chasing the payment, formatting the document, sending it to the third party, and following up when it bounces back. The original poster paused and said, “Oh. Yeah. I hadn’t thought about that”.
Another owner told me she has two clients with outstanding balances, one from each of her associates. Her admin team has been calling, leaving messages, sending follow-up emails. The associates were told. The associates said the clients would pay. The clients have not paid. The admin team is still chasing.
These aren’t separate problems. They’re the same problem wearing different outfits.
The problem is that group practice owners are absorbing the cost of work they never agreed to absorb, and they are doing it so quietly and so consistently that they have stopped noticing they are doing it.
The Hidden Ledger
Every group practice has two sets of books. One is the QuickBooks file. The other is the one nobody writes down.
The unwritten ledger tracks the cost of every gap. The shift that didn’t fill. The client who didn’t return. The letter your admin team formatted three times before it went out. The phone calls your support staff made to collect a fee your associate didn’t collect. The marketing dollars you spent to bring in the client who walked out of an empty office.
When you don’t have a clear picture of what those things cost, two things happen. You undercharge for the work your practice actually does. And you overpay your associates for work they aren’t actually doing.
I’m not saying your associates are taking advantage of you. Most of them aren’t. Most of them have never sat on your side of the desk and have no idea what it costs to keep the lights on, the office rented, the admin team employed, and the marketing engine running. They see the percentage split and they assume it reflects the work. It rarely does.
That is not their job to figure out. It IS yours.
Reports, letters, and the work behind the work
Let’s take the clinical letter as a worked example, because it’s one of the clearest places where owners give away money without realizing it.
When a lawyer requests a report on a client, here is what actually happens in your practice. Your admin team fields the request, confirms the client has consented, pulls the file, and sends the invoice. The associate writes the report, which takes time outside of a billable session. Your admin team formats it on letterhead, proofreads it, invoices the lawyer's office, follows up on payment, and chases when payment is late. If the lawyer wants revisions, the cycle repeats. If the lawyer wants the clinician on a phone call, that is another billable conversation to schedule, document, and invoice.
The associate did the clinical writing. Your practice did everything else.
If your standard split is 60-40 on session work and you apply the same split to a clinical letter, you are paying your associate 60% for doing maybe 40% percent of the labour, and absorbing the rest yourself. Some owners decide that’s fine, because the relationship with the associate matters and the letter is occasional. That’s a legitimate choice. But it should be a choice, not a default.
The fix is to price the report as its own product. Decide what your practice charges per hour of report writing, what your practice charges for the administrative wrap-around, and what percentage of the total goes to the associate versus the practice. Write it into your contract or your associate handbook. Tell associates up front. Then nobody is surprised.
The same logic applies to court appearances, consultation calls with other professionals, treatment summaries, insurance forms, and any other piece of work that involves your associate's clinical brain plus your practice's infrastructure.
Unpaid balances and whose problem they are
The unpaid balance question is a contract question dressed up as a relational one.
In a number of associate agreements I’ve seen, the practice takes its percentage of billed sessions regardless of whether the client has paid, because the practice is the one carrying the collections risk. The associate gets paid by the practice. The practice gets paid by the client. If those two timelines do not match, the practice carries the gap.
That’s fine as long as everyone knows it is fine. Where it gets messy is when the associate is the one who told the client the balance was due, the associate is the one with the relationship, and the associate stops following up the minute the client says they’ll pay. Then your admin team inherits the file, makes the calls, sends the emails, and absorbs the time and emotional labour of chasing money the associate could have collected during a session.
You have three options here. You can keep absorbing it and stop complaining about it. You can write a collections clause into your contract that says the associate is responsible for confirming payment before the next session, or for following up directly on outstanding balances over a certain age. Or you can charge a collections fee that comes out of the associate's split when admin has to chase. All three are valid. None of them happen by accident.
The finder's fee question
This one is different from the others, and worth slowing down for.
When you’ve built a reputation that brings opportunities to your inbox, those opportunities have value. The workshop request from someone who can’t afford your rate is not nothing. It’s a lead that you generated. It exists because of the years you put into your name.
If you pass that lead to an associate without any structure around it, you are giving away an asset. Not a favour. An asset.
That doesn’t mean you have to charge for it. There are good reasons to hand opportunities to associates with no strings attached. You’re building their confidence, their client base, their portfolio, and your bench strength. You’re investing in them. That investment may pay you back in retention, in referrals they send your way, in their willingness to take a difficult client when you ask. That’s a legitimate business decision.
But there are also good reasons to charge a finder's fee or a referral percentage, and they’re not greedy or unkind. A typical structure looks like this. The associate runs the workshop under their own banner or under your practice's banner, you agree on a one-time finder's fee or a percentage of the workshop revenue, and that fee acknowledges that you sourced the opportunity. Industry-standard referral fees in professional services often sit somewhere between 10-25% of the engagement value, but in our field the number matters less than the principle.
The principle is that work has value, leads have value, and reputations have value. If you give all three away without thinking about it, you are training yourself and your associates to believe that what you bring to the practice is worth nothing.
Here’s the question I would ask before deciding which way to go. If I hand this opportunity to my associate with no expectation of return, am I doing it because I have made a deliberate choice to invest in her, or because I feel uncomfortable charging for something I generated?
If it is the first, hand it over with both hands. If it is the second, you have some thinking to do.
The cost of doing business
I want to say something about the phrase “cost of doing business”, because I see it tossed around in Facebook groups like it means whatever the speaker wants it to mean.
The cost of doing business doesn’t mean you absorb every loss without question. It means you have looked at the numbers, you understand what each activity in your practice costs, and you’ve made a deliberate decision about which costs you’ll carry and which costs you’ll pass on.
If you’ve decided that you will eat the cost of an unfilled shift because you value giving your associates flexibility, that is a legitimate business decision. If you have decided that you will eat the cost because you don’t know how to have the conversation about it, that is not a business decision. That’s avoidance with a financial cost.
The same is true for unpaid balances, for clinical letters, for the no-shows your associate didn’t charge for, for the cancellation policy you never enforced. Every one of those is either a deliberate choice or a default you fell into.
What to do this week
Pick one activity in your practice that you suspect is costing you more than you are charging for. A clinical letter. An unfilled shift. An unpaid balance. A no-show.
Sit down and count what it actually costs. The clinician's time. The admin time. The overhead. The opportunity cost. Your time.
Then look at what you’re charging, the split you’re providing or what you’re absorbing, and ask yourself one question.
Did I decide this, or did I default into this?
If you decided it, carry on. If you defaulted into it, you have a conversation to have. With yourself first, and then with your associate or your admin team or your contract.
The owners who stay in business long term aren’t the ones who avoid every loss. They’re the ones who know what their losses are, name them out loud, and decide what to do about them on purpose.
That’s what valuing your work looks like. Not charging more for the sake of charging more. Knowing what the work is worth, and refusing to absorb costs you never agreed to absorb.
Where in your practice are you absorbing a cost you never decided to carry?
Shoot me an email and fill me in. I am reading every response, and the answers are shaping where my newsletter and blogs go next.
