By Adam Cmejla, CFP, CMFC
August 9, 2017
One of the most important barometers of your practice’s financial health is your profit and loss statement. You should review it once a month or more. Your accounting software should be able to produce it easily.
A profit and loss (P&L) statement, also called an income statement, is one of the pillar-financial statements that a practice owner can systematically review to gauge the financial health of the practice. It is loaded with information that can help guide you on making spending decisions in your practice. I’m fond of telling clients that “you can’t improve what you don’t measure, and what gets measured in a practice gets done.”
Both as my disclaimer (I am not a CPA and nothing in this article should be taken as personalized tax advice), and as a best practice, I highly recommend using the combination of financial accounting software like Quickbooks and a good accountant or CPA with a specialization in optometric practices to produce your P&L statements. While you could certainly use an Excel spreadsheet, or other manual document, your time is too valuable to be spent building your P&L by hand.
A P&L statement is broadly made up of the total amount of income (collected or “gross” revenue) that is brought in, and then also accounts for all expenses incurred by the practice. The difference between those numbers (income – expenses) is your net profit (or loss) in the practice for the report time period.
Editor’s Note: Be sure to remove the personal expenses that you, as practice owner, may run through the practice before tallying up your practice expenses.
The expenses can be broken down as detailed or broad as you’d like – each practice owner can customize the categories (or “accounts” in financial accounting software language) to their own liking. My experience has taught me to not get overly detailed and specific, but you still want to segment your expenses so that you can make targeted improvements to your business. For example, you’ll want to have a separate sub-account for “retirement plan contributions” under your staff expense, but you probably don’t need to create a separate expense accounts for your phone and internet expenses.
Creating too many accounts and sub-accounts can make your P&L look convoluted and difficult to analyze when using it to make business decisions, or changes, in your practice. Your CPA, or other business adviser, can help you determine what type of account structure will be best for your particular practice, as not all practice models will have the same expenses. For example, a corporate-affiliated optometrist may not have any cost of goods sold (COGS), since all dispensary goods are often managed and sold by the retailer from whom they are renting space.
Breaking Down the Expenses
Expenses on an income statement can generally be broken down into fixed and variable expenses. Fixed expenses are those that do not change regardless of production. Examples of this include your technology expenses, occupancy costs, staff and marketing expenses. Variable costs are dependent on the number of patients that you see. The biggest variable cost in a practice is COGS. Other variable expenses can be equipment fees (if you pay for equipment on a per-use basis), lab fees, and possibly, production-related compensation to associate ODs.
On the surface, it’s easy to just see a P&L statement for the numbers that are on the page, but I encourage you to focus not so much on the numbers on the page as what those numbers mean as a percentage of gross revenue collected in the practice. The reason that I encourage percentages is because there are generally acceptable ranges on key metrics in an optometric practice that you want to strive for as it relates to your gross revenue.
All numbers listed below are in relation to collected (not billed) revenue. Some of those metrics are as follows:
• COGS: shoot to keep your cost of goods sold at or below 30 percent
• Staff (non OD): aim for 25 percent. This is one category that I will focus on later in the article.
• Occupancy (includes rent, taxes, insurance, maintenance, etc): 7-8 percent
• Marketing: in a new practice that is in high growth mode, this might be closer to 5 percent. In an established practice, you might be around 3-4 percent.
• Equipment (includes debt service on equipment): 3 percent
• General Overhead: 7-8 percent
There are two reasons that I wanted to spend more time on the staff “expense” on a P&L. My sincere belief is that if there’s any item on an income statement that should be viewed through a different lens than an “expense,” it should be the team that you employ. A good team that surrounds an OD should not be viewed as an expense, but as an investment. The first reason is that a good team allows an OD to focus their energy and talents on one thing: revenue-producing activities in the practice. Typically, this means being with a patient in an exam lane—almost all other tasks should be delegated to other team members. It’s for this reason that I usually subscribe to the philosophy of paying quality talent above-average wages to keep them in the practice.
The second reason is the byproduct of not subscribing to the first reason. I see and hear too many examples where ODs pay below-average wages to their staff. When we connect for periodic reviews of their plan, and I ask them what their biggest challenge is, it usually revolves around something staff-related. They either can’t find or keep quality team members. These same ODs then end up spending more money in the long run because of training new staff, lost productivity and onboarding expenses.
Editor’s Note: Beware of wage creep, in which you pay more for staff than you should. Above-average payroll expenses and average income mean a reduced net for the owner.
The End Result
When you filter income and expenses down through the statement, the end result is a number called your net income. This gives you an after-expense (but before personal taxes) snapshot of the profitability of your practice and how much income you get to “take home” (or how much of a loss you generated). Keep in mind that this includes all professional salaries (associate ODs and the owner’s salary), as well as other expenses not explicitly mentioned. A good number to target for profitability is in the 27-30 percent range of gross revenue.
Importance in Long-Term Planning
Knowing your net income is important, not just to evaluate the monthly and quarterly profitability of the practice, but for long-term planning. For example, if an OD-owner has a practice that files taxes as an S-corporation that is grossing $1 million in revenue with a 30 percent profit margin, this means that the owner is not only collecting a salary from the practice, but is also having $300,000 flow through to their personal income tax return.
Editor’s Note: Keep in mind that in the average case, the owner’s entire income is the 30 percent.
If the OD is in a personal financial situation in which they don’t necessarily “need” that extra business income, the OD now has the “ammunition” to look at various types of retirement plan options to implement in their practice. If the owner already has a SIMPLE IRA, and they are closer to retirement (and thus much older) than many of their team members, they may want to think about transitioning to an age-weight profit sharing plan coupled with a 401(k), allowing them to skew contributions in their own favor.
The benefits to the OD making these contributions is that profit sharing contributions are tax deductible to the business in the year that they were made, thus (in this example) reducing the tax liability that the OD will pay on their personal return.
By systematically reviewing their financials over the course of 2017, the practice owner can be in position to transition to the qualified 401(k)/profit sharing plan in 2018 and leave the SIMPLE IRA at the end of 2017. However, had they not known their numbers throughout the year and forecast out what their profitability was going to be in the practice, implementing this solution in 2018 would not be possible because they would not have known their numbers until they were preparing their taxes in early 2018. Because a SIMPLE IRA can only be closed out at the end of a company’s fiscal year, they would be locked into yet another year of limited retirement planning options and possibly facing another year of higher tax liabilities.
This again demonstrates how being proactive, rather than reactive, in managing a business is more cost efficient and impactful.
Adam Cmejla, CFP®, CMFC®, is a Certified Financial Plannertm and president of Integrated Planning & Wealth Management, LLC, a financial planning and Registered Investment Advisory firm that works with optometrists nationwide. For more information: Contact Adam at or firstname.lastname@example.org or 317-706-4748.