Most physicians have never seen a real P&L from a cash-pay practice.
The numbers are kept private. Other physicians don’t share them. Consultants charge five-figure engagements to show you one. So the entire conversation about cash-pay practice viability happens in vague, anecdotal terms: “I’m finally making good money,” or “It’s been life-changing,” or, on the bad-faith side, “You can’t make a living doing this.”
None of those statements help you decide whether the model works financially.
What follows is a representative P&L for a stabilized solo cash-pay practice — year two, past survival, in a normal U.S. metro market. Numbers are realistic for the profile described, not aspirational. Every practice will look different in detail. The structure and the ratios are what matter.
The model practice
Profile: Solo physician, integrative-leaning concierge model. Roughly 220 active members at an average $275/month. Modest add-on revenue from à la carte visits beyond membership, basic procedures (hormone optimization, IV therapy, light injectables), and a small dispensary. Two staff (one MA, one front desk). 1,500 sq ft office in a mid-tier metro. Year two of operation, having moved past the survival phase.
This isn’t the most lucrative version of a cash-pay practice and it isn’t the leanest. It’s a recognizable middle.
The P&L
| Line Item | Annual ($) |
| REVENUE | |
| Membership recurring (220 members × $275/mo avg) | $726,000 |
| Visit fees & à la carte services | $180,000 |
| Procedures (IV, hormones, injectables) | $90,000 |
| Supplements & dispensary (gross) | $54,000 |
| Total Revenue | $1,050,000 |
| COST OF GOODS SOLD | |
| Supplement cost (≈60% of dispensary gross) | $32,400 |
| Lab passthrough costs | $25,000 |
| IV & procedure supplies | $18,000 |
| Total COGS | $75,400 |
| GROSS PROFIT (92.8% margin) | $974,600 |
| OPERATING EXPENSES — Personnel | |
| Medical Assistant (salary + benefits) | $66,000 |
| Front Desk (salary + benefits) | $54,000 |
| Personnel subtotal | $120,000 |
| OPERATING EXPENSES — Facilities | |
| Rent ($4,500/mo × 12) | $54,000 |
| Utilities, internet, phone | $9,000 |
| Cleaning, maintenance | $6,000 |
| Facilities subtotal | $69,000 |
| OPERATING EXPENSES — Technology | |
| EMR | $6,000 |
| Practice management & scheduling | $3,600 |
| Phone system, telehealth | $2,400 |
| Website hosting & SaaS | $3,000 |
| Technology subtotal | $15,000 |
| OPERATING EXPENSES — Marketing | |
| Digital ads, content, SEO, agency fees | $60,000 |
| Marketing subtotal (5.7% of revenue) | $60,000 |
| OPERATING EXPENSES — Insurance | |
| Malpractice | $12,000 |
| Business liability & property | $4,500 |
| Insurance subtotal | $16,500 |
| OPERATING EXPENSES — Professional Services | |
| CPA / Accountant | $6,000 |
| Attorney (retained as needed) | $4,000 |
| Coaching / consulting | $12,000 |
| Professional services subtotal | $22,000 |
| OPERATING EXPENSES — Other | |
| Office supplies, postage | $5,000 |
| Continuing medical education | $5,000 |
| Payment processing fees (≈3% of revenue) | $30,000 |
| Misc software & subscriptions | $4,000 |
| Other subtotal | $44,000 |
| TOTAL OPERATING EXPENSES | $346,500 |
| EBITDA / OWNER COMP POOL (59.8% margin) | $628,100 |
How to read it
A few things stand out the moment you see real numbers.
Revenue is recurring. Membership accounts for $726K of $1.05M — about 69% of total revenue, paid monthly, predictable, compounding. This is the single most important structural advantage of the cash-pay model. In a fee-for-service insurance practice, every dollar of revenue starts at zero on January 1st. In a membership practice, year two opens with $726K already on the books before anyone walks in the door. That predictability changes every other decision in the business.
Gross margins are huge. Services have almost no cost of goods. The largest direct cost is the dispensary, where you’re selling supplements at a markup. The other COGS lines (lab passthroughs, IV supplies) are minor. Gross margin lands around 93%. Compare that to a restaurant (30–40%) or a retail business (50–60%) and you understand why service businesses are so attractive to own — once revenue exists, most of it survives to the operating expense line.
Personnel is lean. $120K in staff salaries against $1.05M in revenue is about 11.5%. In an insurance-based practice, personnel often runs 25–35% of revenue because billing alone requires a small army. Cash-pay practices don’t have a billing department, don’t fight insurance companies, don’t appeal denials, don’t write off uncollected balances. That entire cost center disappears, and with it the headcount it would have required.
Marketing is the biggest variable. $60K — about 5.7% of revenue — is realistic for a stabilized practice. In year one it should be much higher (often 10–15% of projected revenue) because you’re acquiring patients from scratch. By year three, if your retention is strong, it can drop to 3–4%. Marketing is the line that most often gets cut when cashflow tightens, and cutting it is almost always wrong: marketing’s lag time is 60–120 days, so a cut you make in March shows up as a revenue problem in June.
Payment processing is real. Credit card fees at roughly 3% of revenue is a $30K line item. Most physicians don’t budget for it. It is not optional — patients expect to pay by card, and the fees are a permanent cost of doing business in cash pay.
The owner compensation pool is the real number. EBITDA on this practice is $628K. That’s the money available to the owner before any salary or distribution is taken. Most physicians think of practice profitability as a single number (“how much did I make?”), but the cleaner way to think about it is: how big is the pool the owner draws from, and how does the owner choose to allocate it?
How owners typically allocate the pool
Of the $628K EBITDA in this example, a defensible allocation:
| Owner Compensation Allocation | Annual ($) |
| Owner salary (W-2 — reasonable comp) | $250,000 |
| Distributions / pass-through profit | $300,000 |
| Reinvestment / retained earnings | $78,100 |
| Owner take-home (salary + distributions) | $550,000 |
That’s the headline number for this profile of practice. A solo physician, doing the medicine they want to do, on their schedule, taking home roughly twice the salary of an employed primary care physician — at a similar gross revenue level — because the structural costs of insurance-based practice are absent.
The ratios that actually matter
When you’re evaluating any cash-pay practice P&L (yours, a friend’s, a model in a coaching program), watch these ratios more than absolute dollars:
- Recurring revenue as % of total: Above 60% means the business is stable. Below 40% means you’re running a transactional clinic that has to refill the funnel constantly.
- Gross margin: Above 85% is healthy. Below 80% suggests COGS is bloated, usually from over-discounted dispensary or pass-through pricing on labs.
- Personnel cost as % of revenue: 10–20% is the band. Above that, you’re overstaffed for the volume. Below 10% in year three or later, you’re probably under-investing in staff and the owner is doing too much manual work.
- Marketing as % of revenue: 5–10% is healthy maintenance. Less than 3% means you’re harvesting old patients without replacing them. More than 15% in year three or later means your retention or pricing is broken.
- EBITDA margin (before owner pay): Should be 50–65% in a stabilized cash-pay practice. Below 40% means something structural is off.
- Owner take-home as % of revenue: 35–55% is the realistic band for solo owners. Higher than that and you’re underinvesting in the business; lower and the business isn’t paying you what it should.
If your practice’s numbers are far outside any of these ranges, that’s a signal — not necessarily a problem, but worth a conversation with someone who knows the model.
How this compares to the employed-physician math
The honest comparison.
Employed primary care physicians earn around $285–300K on average in recent compensation surveys (Medscape’s 2026 report puts the figure at roughly $298K). That’s W-2 income. They do not control their schedule, their patient panel, their fees, their staff, or their growth rate.
The owner in this P&L is taking home $550K — roughly twice the employed compensation — while controlling all of those variables. They’re working comparable or fewer clinical hours. They’re practicing the medicine they trained for, not the version compressed into seven-minute visits. And they own an asset (the practice itself) that has independent valuation, can be sold or scaled, and compounds over time.
The downside, honestly stated: the employed physician shows up Monday with predictable income, no ownership risk, and somebody else handling the headaches. The practice owner carries the risk of the entire enterprise. In year one, when the model is breaking even or worse, the math is uncomfortable. In year three, when this P&L is recognizable, the math has flipped decisively.
The cash-pay model isn’t free money. It’s a different structure with different tradeoffs. The numbers above show what those tradeoffs look like when the model works.
What changes the picture
Variables that shift this baseline meaningfully:
- Higher membership pricing. $400/mo instead of $275 lifts revenue by ~$330K with minimal cost increase. Most of that flows to EBITDA. Pricing is the highest-leverage variable in any cash-pay practice.
- Larger member base. Going from 220 to 350 members with the same staff is structurally possible up to a ceiling, but most solo physicians find clinical capacity capping out around 250–300 deeply-served members.
- Higher add-on revenue. A practice with serious procedure capability (hormone optimization, aesthetics, IV suite, regenerative therapies) can add $300–500K in service revenue without much additional overhead.
- A second provider. Adding an NP or a second physician roughly doubles capacity but adds payroll and oversight load. Margins per provider are usually a bit thinner than solo, but total practice EBITDA grows.
- Lower-cost real estate. Practices in suburban or rural markets often run identical revenue with $30–40K less rent.
- Worse marketing efficiency. Practices that aren’t disciplined about marketing spend two to three times this much for the same patient flow. Marketing efficiency is mostly about the website, the offer, and the funnel — not about ad budget.
The baseline practice in this P&L is achievable. Many physicians clear it. The variables that lift the practice from this baseline to a $2M–$3M operation are knowable — they just have to be operated on deliberately.
Why physicians underestimate this
Most physicians, when they first see numbers like these, assume they’re outliers. They aren’t. They’re representative of solo cash-pay practices that are operating reasonably well at the two-year mark.
The reason the numbers feel surprising is that the volume-based reimbursement model has trained physicians to think of revenue per visit as the lever. In a 99214 world, the math looks bleak: 25 patients a day at $120 average reimbursement is $3,000/day, $750K/year gross before any expense. That’s the ceiling employed physicians live under, and it explains why so many of them are skeptical of practice ownership — the math they’re modeling from is the math of the system they’re trying to leave.
In a cash-pay practice, the lever is revenue per relationship. A patient who pays $275/month for 36 months produces $9,900 over the relationship, with a fraction of the visit volume. The math compounds in a way the visit-based model can’t.
This is what physicians mean when they say cash pay changed their financial picture. It isn’t that the dollars are larger per encounter — they are, but not enough to explain the gap. It’s that the structure of the dollars is different. Recurring instead of transactional. High-margin instead of squeezed. Owner-controlled instead of payer-controlled.
Reading your own P&L
If you’re already running a cash-pay practice, take this template and overlay your actual numbers. Where are you above the ratios? Below them? The lines that are out of whack are your priorities for the next quarter.
If you haven’t launched yet, build a forward-looking version of this P&L with your assumptions and your local cost data. Most physicians who fail at the launch failed because they didn’t model the business honestly before they signed the lease. Spend a weekend on this. The exercise pays for itself many times over.
The cash-pay model works. The math is real. The gap between I think this could work and I know what the numbers look like in year two is one spreadsheet away.
Maverick Medical Ventures helps physicians design and build practices outside the insurance system — across the four pillars of medicine, marketing, finance, and operations. [Learn more]
