Most practice owners can tell you what they pay their receptionist, but ask them what their accounting function really costs and the answer gets fuzzy. The wage is easy to see. Everything around it, like leave, super, software, training and the cost of mistakes, tends to hide in other lines of the budget.
That hidden cost is why this question isn’t as simple as comparing one salary with one monthly fee. Both models can work well, and both can quietly drain money if they don’t suit your practice. Let’s look at what each one really involves.
What Does an In House Accounting Setup Cost?
When you hire someone to handle your books, the salary is only the beginning. As a rough guide, you’ll also pay superannuation at 12 percent, leave entitlements, payroll tax where it applies, workers compensation, equipment and accounting software subscriptions. Recruitment and training add more, and a bad hire can set you back months.
There’s also the single point of failure problem. If your bookkeeper gets sick, resigns or goes on holiday during BAS week, the work doesn’t pause. You’ll either scramble for a temp or fall behind, and falling behind on compliance carries penalties.
When Does In House Make Sense?
For a large multi site clinic with high transaction volumes, an in house team can be the right call. You get immediate access, someone who knows your people and systems, and tight control over processes. A full time finance role may be easier to justify once you’re running dozens of staff and thousands of transactions a month.
The catch is that one employee rarely has every skill you need. A bookkeeper isn’t a tax strategist, and a part qualified accounts clerk may not spot a structure problem. Many practices that go in house still end up paying an external accountant for advice and tax work, so the costs stack up.
That gap is often where business advisory support for medical practices comes in, covering planning, profitability and growth decisions that a single employee can’t realistically handle. Even practices with a strong internal team sometimes bring in outside advisers for that layer. It’s worth deciding early which tasks you want to keep close and which you’d rather share.
What Do Outsourced Medical Accounting Services Include?
Outsourcing means a firm handles some or all of your financial work for a fee, usually monthly. That might cover bookkeeping, payroll, BAS, tax returns, financial reporting and planning, delivered by a team rather than one person. You get several skill levels for the price of a single service.
For a solo specialist or a small practice, this often works out cheaper than a salaried hire, and the quality tends to be higher. You’re not paying for idle hours, and you don’t carry the risk of a single person leaving. A summary of what to weigh up is below:
- Predictable monthly fees instead of wages and on costs
- Access to accountants who work with doctors every day
- Built in cover for holidays and illness
- Technology and software often included
- Less training and management time for you
To see how this looks day to day, you can read about outsourced bookkeeping for medical practices and the tasks it typically covers. It’s a practical way to compare a package against what an employee would handle. Pay attention to what’s included, because scope is where most cost differences hide.
What Are the Downsides of Outsourcing?
It isn’t perfect. You’re relying on an external team, so communication matters, and a firm that doesn’t understand medical practices will frustrate you quickly. Response times can be slower than having someone down the hall, and you need to be comfortable sharing financial data online.
The fix is to choose carefully. Ask how often you’ll hear from them, who your main contact is, and whether they’ve handled practices like yours. A strong outsourced provider should feel like part of your team rather than a distant vendor.
It also helps to know who is behind the service. Reading the about page for the MediSuccess team gives a sense of their background and the experience they bring to medical clients. Credentials, years in the industry and a clear point of view are all worth checking, whichever firm you choose.
Which One Actually Saves More?
For most solo doctors, small clinics and growing practices, outsourcing usually wins on cost and quality. The numbers tip toward in house mainly when volume is high and the workload justifies a dedicated person. Even then, many owners keep an outside accountant for strategic advice.
Imagine a three doctor clinic weighing a part time employee against a monthly outsourced package. The employee costs wages, super, leave and training, plus an external accountant for tax. The package bundles bookkeeping, payroll, BAS and advice together, and covers the workload when someone’s away. It’s worth running the real numbers for your own situation, not just the headline figures.
How Can You Decide for Your Practice?
Start by adding up what you spend now, including your time. Then ask what skills you’re missing and what a single mistake would cost. Compare that against a written quote that spells out exactly what’s included.
If you’d like to talk it through with someone, the contact page is a simple way to start a conversation without any commitment. Bring your current costs and your biggest frustrations, and you’ll get far more from the discussion. A good adviser will tell you honestly if staying in house makes more sense for you.
Wrapping Up the Cost Comparison
In house accounting offers control and proximity, and outsourcing offers breadth, flexibility and predictable cost. For many practices, the savings come from not paying for capacity you don’t use and not depending on one person. The right answer shifts as your practice grows.
My suggestion is to revisit the decision every year or two, because what suited a solo practice may not suit a five doctor clinic. Pull out your real costs and compare them honestly. When was the last time you checked what your accounting function truly costs?
Frequently Asked Questions
Beyond salary, you pay superannuation at 12 percent, leave entitlements, payroll tax where applicable, workers compensation, equipment, software subscriptions, recruitment and training. A bad hire or unexpected absence adds further expense, so the true cost is well above the wage.
In-house suits large multi-site clinics with high transaction volumes. You get immediate access, someone who knows your systems and tight process control. A full-time finance role becomes easier to justify with dozens of staff members and thousands of monthly transactions.
Outsourcing means a firm handles some or all of your financial work for a monthly fee. This can cover bookkeeping, payroll, BAS, tax returns, reporting and planning, delivered by a team, so you access several skill levels for one price.
For solo specialists and small clinics, outsourcing is often noticeably cheaper than a salaried hire and delivers higher overall quality. You avoid paying for idle hours, carry no single-person risk, and get predictable monthly fees instead of wages and on-costs.
You rely on an external team, so communication matters. A firm that doesn’t understand medical practices will frustrate you quickly, response times can sometimes be slower than someone down the hall, and you must be comfortable sharing financial data online.
Ask how often you will hear from them, who your main contact is, and whether they have handled practices like yours. Check credentials, industry experience and exactly what the written quote includes, because scope is where most cost differences hide.
One employee rarely has every skill you need. A bookkeeper isn’t a tax strategist, and sickness, resignation or holidays can leave compliance work undone. Many in-house practices still pay an external accountant for advice and tax, so costs stack up.
Revisit the decision every year or two, because what suits a solo practice may not suit a five-doctor clinic. Add up your real costs, including your own time, list any missing skills, and compare them against a detailed written quote.
