The uncomfortable math that saved my practice and transformed my patient care
When I graduated, I was shocked by how natural patient care felt. All that schooling had actually worked. What didn’t come naturally? Literally everything else.
Like many of us in this field, I came out of training knowing how to build rapport, diagnose, and treat—but not how to run a business.
I became fascinated by business models and systems for delivering care. But it wasn’t until nearly five years in—and after many full patient weeks and very modest paychecks—that I finally sat down and crunched the numbers.
That single exercise didn’t just improve my practice—it saved it.
I calculated my true monthly business expenses. Then I divided that number by the number of patient hours I could actually work. Not the fantasy 40-hour clinical week (which is unrealistic for most of us), but my real capacity—factoring in what burns practitioners out: the emotional labor of each encounter, the two hours of inbox time after a “full day,” the weekend calls from worried patients.
What I found was sobering.
My hourly overhead at the time was nearly $130. I was charging $160. After taxes and variable costs, I was paying myself about $2,000/month. Despite seeing plenty of patients and bringing in $5–10K in monthly revenue, I couldn’t get ahead.
I was essentially working full-time to barely cover my rent.
Let that sink in. Years of education, mountains of student debt, countless hours of continuing education—all to make less than minimum wage.
Like so many of us, I had been looking around at what my peers charged, telling myself I wasn’t “experienced enough” to charge more. I also wanted to be “accessible.” But here’s the truth:
Affordability without sustainability is not accessibility.
If your practice model doesn’t support your basic needs, it’s not sustainable. And if it’s not sustainable, it’s not accessible for the long term—because it won’t exist.
I’d been telling myself a story that my modest rates were a service to my community. The reality? I was slowly heading toward burnout and resentment and was actually strongly considering surrendering my medical license and going into nonprofit work.
Think about that. I was ready to abandon my calling because I couldn’t make the math work.
Let’s pause here and acknowledge the massive guilt many of us carry around charging “too much.” We entered healing professions to help people, not to get rich. The cognitive dissonance can be paralyzing.
But here’s what nobody tells you in school: Undercharging isn’t noble—it’s a form of self-sabotage that ultimately hurts your patients.
What I’ve learned is this: when patients invest more, they engage more deeply. When people pay, they pay attention. This isn’t just a convenient rationalization—I’ve witnessed this pattern hundreds of times. The therapeutic relationship transforms when both parties are fully invested.
I’ve learned the hard way: You can’t sustainably deliver concierge-level care at discount prices.
So what’s the solution? It begins with getting crystal clear on your numbers.
This is the calculation I recommend every clinician do (and wish I had done way sooner):
REALITY CHECK PRICING EXERCISE
How many patient hours can you actually work per month?
What are your total monthly expenses?
What’s your minimum sustainable rate?
What else would you need to afford in order for your work to be sustainable?
This last one came from a business workshop I took with Jordan Robertson of the Confident Clinician Club (highly recommend for clinicians, by the way). She encouraged us to look at the personal costs of showing up in our office—like childcare—and factor them into our rates. Because if your work isn’t covering that, what exactly are you doing all this for?
Are you sacrificing your family’s well-being at the altar of “affordability”? It wasn’t easy for me to face this, but I was doing just that.
This exercise has been the single most clarifying thing I’ve ever done for my business.
When I first did this exercise, the number I calculated was nearly double what I was charging. I felt physically ill. Who was I to charge that much? What would my colleagues think? Would any patients come?
But what’s the alternative? Continuing to quietly go bankrupt? Working yourself into illness? Abandoning your practice altogether?
What Actually Happens When You Raise Your Rates
Let me address the question I know is burning in your mind: “What happens when I raise my rates?”
Here’s exactly what happened when I raised my rates by 60%: The patients who valued my unique approach stayed. Some patients stayed but decided to come in a little less frequently. About 30% left amicably. One person said something negative before they left, but they had already been pushing boundaries for months before that. And new patients who were ready to invest in themselves started showing up—patients who were actually easier to work with and got better results.
I didn’t give extensive notice about my rate change - I simply updated my booking page and let patients make their own decisions. In my experience, overexplaining these changes can create unnecessary drama. The results spoke for themselves: my schedule remained full, but with patients who truly valued the work.
The transformation wasn’t just significant—it was revolutionary.
Within 9 months, charging appropriately allowed me to move from a nondescript second-floor office in an old creaky building to a beautiful, physically accessible main-floor space. I was able to hire the administrative support I desperately needed. I became the primary breadwinner for my family which gave my partner the flexibility we needed to care for our child.
Most importantly, I gained the bandwidth to explore truly accessible care models. I’ve already tested group acupuncture sessions, and I’m now developing workshops and courses.
The irony is stark: I had to charge more in order to eventually serve more people at various price points.
The most surprising outcome? My work quality improved. With fewer patients at higher rates, I could be fully present for each one. I had time for research between appointments. I started seeing clinical results that weren’t possible when I was rushing from patient to patient just to make rent.
Your Next Steps
Block an hour this week to do the Reality Check Exercise
Calculate your minimum sustainable rate
If there’s a gap, develop a plan to bridge it
Remember: you can’t pour from an empty cup
You didn’t invest years in training to struggle financially while providing exceptional care.
You get to build a business that actually supports your life.
You deserve that. We all do.