The Ick Factor: Why Practice Owners Avoid Fee Conversations — And What It's Costing Them – A Special Snack Episode, EP 252
If you've ever looked at your fee schedule and felt a knot in your stomach, you're in very good company. Fee setting is one of the most avoided conversations in private practice — not because practice owners don't care about the financial health of their business, but because the whole topic can feel loaded. In healthcare, there's often a deeply held belief that focusing on money is somehow at odds with the commitment to patient care. It isn't. And in this episode of The Thriving Practice Podcast, Tracy Cherpeski and Miranda Dorta make that case clearly.
This SNACK episode is a focused, practical conversation about the financial foundation every independent practice needs — and the mindset shifts that make it possible to build one. Tracy draws on her experience working with practice owners across medicine, dentistry, therapy, chiropractic, and more to explore what's really going on when practice owners underprice their services, avoid raising fees, or struggle to make sense of why profitable practices still feel broke.
Whether you're a solo practitioner trying to figure out your break-even number, a growing practice owner considering whether to stay on insurance panels, or someone who just knows it's time to take a real look at the financial side of the business, this episode is a solid starting point. No accounting degree required.
Key Takeaways
Helping professions carry a money mindset burden. The discomfort around pricing in healthcare is real — and it's rooted in professional identity. The Hippocratic oath commitment to service is a strength, but when it creates an aversion to financial conversations, it can quietly undermine the sustainability of the practice.
Know your numbers, especially cash flow. Profitability and cash flow are not the same thing. A practice can be technically profitable and still have no money available. Knowing your burn rate — what it costs just to keep the doors open — is the baseline for every financial decision.
The undercharging-burnout connection is direct. Undercharging isn't just a revenue problem — it's a burnout risk. Financial stress affects how you show up in the exam room, how you treat your team, and how long you can sustain the work you've built.
Fear, not math, is what stops most fee increases. Raising fees is harder psychologically than mathematically. The fear of being perceived as money-driven or of upsetting patients often has more influence than the actual market reality.
Insurance decisions should be strategic, not inherited. There is no single right answer on insurance versus out-of-pocket — but there is a right answer for your practice, your population, and your goals. That decision deserves a clear-eyed look, not a default.
Q&A
Why do so many practice owners avoid looking at their fee structure?
The resistance is usually emotional before it's practical. In healthcare and other helping professions, there's a strong cultural narrative that equates financial focus with compromising your commitment to care. That shows up as avoidance — not looking at the numbers, delaying fee reviews, or simply charging what colleagues charge without asking whether it works. Tracy describes it plainly: money in a care context carries an ick factor that's worth naming and working through.
What's the relationship between undercharging and burnout?
It's more direct than most practice owners realize. When fees don't cover true costs — or don't leave room for the unexpected — financial stress becomes a constant undercurrent. That stress affects your clinical presence, your team culture, and your capacity to serve patients well over time. As Tracy puts it: if you want to truly show up as the best provider you can be, you have to be financially sound. One reinforces the other.
How do you figure out what to charge?
Start with the end in mind. What are your goals — for revenue, for growth, for the life the practice is supposed to support? From there, work backward: what's your burn rate (the cost of keeping the doors open)? What level of revenue gets you to break-even, and then to a cushion that gives you real stability? Tracy recommends having at least a few months of total expenses available at any given time — not as a luxury, but as a basic operational buffer.
When is it time to look at the insurance-versus-out-of-pocket question?
Honestly, it's always worth revisiting. Some practices do well staying on certain panels — particularly payers known for fair reimbursement and low administrative burden. Others find that hybrid models (some insurance, some direct-pay) give them more flexibility. And others go fully cash-based, which Tracy notes requires intentional systems, strong patient communication, and a commitment to a hospitality-level experience. The point isn't to pick the trendy model — it's to pick the model that fits your population, your values, and your financial goals.
Episode Highlights
Why money conversations feel loaded in healthcare — and why that matters for practice sustainability
The numbers every practice owner should know: revenues, profitability, burn rate, and cash flow
How to set fees by starting with goals and working backward
The undercharging-burnout connection and why financial stress affects clinical quality
What stops practice owners from raising fees — and why the obstacle is usually psychological
Insurance panels, direct care models, and hybrid approaches: how to think through the tradeoffs
The one number you can pull up right now that tells you something real about where your practice stands
Memorable Quotes
"If you want to be of service, to truly show up and be the best clinician you can be, you have got to be financially sound." — Tracy Cherpeski
"Take off the clinical hat. Put on the CEO hat." — Tracy Cherpeski
"Knowledge is power. Making a wise decision about how your fee schedules are set up is a big piece of the puzzle." — Tracy Cherpeski
"If you paint yourself into a corner, you're going to have to make a mess getting out." — Tracy Cherpeski
"It is an exchange of energy. You are providing something people are seeking out, and it needs to be paid for." — Tracy Cherpeski
Fee setting isn't just an accounting exercise — it's one of the most direct expressions of how you value your work, your team, and the practice you've built. Tracy's message here is practical and clear: get clear on your numbers, make a plan, and stop letting financial stress quietly erode the thing you worked so hard to create. If this episode prompted some honest reflection, share it with a colleague who could use the same nudge. And when you're ready to take a real look at the financial side of your practice, visit thrivingpracticecommunity.com to explore what's available to help you move forward.
To learn about CFO services or schedule a Strategic Finance Consultation: Inquire here
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Miranda’s Bio:
Miranda Dorta, B.F.A. (she/her/hers) is the Manager of Operations and PR at Tracy Cherpeski International. A graduate of Savannah College of Art and Design with expertise in writing and creative storytelling, Miranda brings her skills in operations, public relations, and communication strategies to the Thriving Practice community. Based in the City of Oaks, she joined the team in 2021 and has been instrumental in streamlining operations while managing the company's public presence since 2022.
Tracy’s Bio:
Tracy Cherpeski, MBA, MA, CPSC (she/her/hers) is the Founder of Tracy Cherpeski International and Thriving Practice Community. As a Business Consultant and Executive Coach, Tracy helps healthcare practice owners scale their businesses without sacrificing wellbeing. Through strategic planning, leadership development, and mindset mastery, she empowers clients to reclaim their time and reach their potential. Tracy designs and delivers CME-accredited wellness retreats and workshops in partnership with medical associations, bringing burnout prevention and sustainable practice management to physicians nationwide. Based in Chapel Hill, NC, Tracy serves clients worldwide and is the Executive Producer and Host of the Thriving Practice podcast. Her guiding philosophy: Survival is not enough; life is meant to be celebrated.
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