The reason most owners stay with an accountant they have outgrown is not loyalty. It is the imagined pain of switching. Here is the actual sequence, what we need from you, and how we handle your current accountant.
Onboarding is the part every firm describes. It is also the least interesting part. What actually decides whether this was worth doing is what the engagement looks like once the books have been clean for eighteen months.
Cleanup, chart of accounts rebuilt to your specialty, systems connected, first full close delivered. The goal is a number you can trust, not advice. Advice on bad data is worse than no advice. The day-by-day plan →
The year the money usually shows up. Entity and S-election review, reasonable compensation set and documented, payroll and 1099 classification cleaned up, retirement plan evaluated, the compliance calendar built and worked ahead of. Most of the one-time savings on a practice this size land here.
With four clean quarters behind you, the reporting stops being a rear-view mirror. Rolling cash forecast, clinician-level profitability, payer mix against margin, a hiring model that answers whether the next clinician pays for themselves and when. This is the year the monthly call changes from “what happened” to “what should we do.”
Clean books held over multiple years are what make every future option cheap: adding a location, taking on a partner, borrowing, or selling. A practice with three years of reconciled, defensible records goes through diligence in weeks. One without them either discounts or does not close. If a transaction is on the horizon →
Most firms describe onboarding as a feeling. This is the sequence, with the column that matters most in the middle.
| When | What we do | What you do | What you get |
|---|---|---|---|
| Days 1–3 | Engagement letter and Business Associate Agreement issued; secure portal opened. | Sign two documents. | Portal access and the names of the people on your account. |
| Week 1 | Sixty-minute kickoff call. We request view-only access to your systems. | Take one call. Approve read-only access. | A written onboarding plan with dates against it. |
| Weeks 1–2 | We assess the books, entity structure, payroll setup and tax posture. | Nothing. | A findings summary — what is wrong, what it is costing, what we will do. |
| Weeks 2–4 | Cleanup, chart of accounts rebuilt to your specialty, systems connected. | Answer the occasional question. | Books current through the last closed month. |
| Weeks 4–6 | Payroll moved onto our process. Compliance calendar built for your entity and states. | Confirm pay dates and filing details. | Your filing calendar for the next twelve months. |
| By day 45 | First full month closed under our process. | Read it. | Statements, scorecard and a written summary of what moved. |
Timing assumes your books are in reasonable shape. A practice several years behind takes longer, and we will tell you that before you sign rather than after.
The full list. If it looks short, that is the point.
Roughly two hours of your time across the first forty-five days. That is the whole ask.
This is the question owners ask last and worry about first, so we will answer it plainly.
No black box, and no vague promises about timing. Your books close by the 15th, your strategy review lands within thirty days of each quarter close, and anything you send us gets a reply inside one business day.
Every practice runs the same calendar. The difference is whether someone is watching it in November or in April.
Representative for a California practice. Your exact calendar depends on entity type, state footprint, payroll size, and whether you sponsor a retirement plan — we build yours during onboarding.
You already run a practice that takes protected information seriously. The finance side is where that discipline usually slips — bank statements in email threads, a spreadsheet of payroll on someone’s desktop, a former bookkeeper who still has portal access. These are the controls we bring on day one, and they are part of the engagement rather than an upgrade.
Most practices are not missing effort. They are missing someone who connects the financial dots. These are the six we check on every assessment, roughly in the order they tend to pay — with what is actually at stake, and where you can read the working before you ever call us.
Reasonable compensation is the single most common place a practice either quietly overpays payroll tax or invites an examination. The number has to be defensible against comparable-role data, not picked to hit a target. Getting it wrong costs real money every pay period — and it compounds, because it sets the baseline for the S-election arithmetic below.
The IRS defense playbook →On a practice with meaningful profit above a defensible salary, the election is often the largest single lever available — but only once payroll cost, the Social Security wage base, and the administrative burden are netted out. We publish a full worked example with every line shown, including the costs, so you can see whether it clears at your revenue rather than trusting a rule of thumb.
See the worked example →Growth, liability, and tax treatment all shift when you add entities or locations — and in California, professional-corporation and corporate-practice rules constrain what you are even permitted to build. We map whether a second entity fits where you are headed rather than where you have been, and say so plainly when it does not.
How the structure works →A solo 401(k), a SEP, a safe-harbor plan and a cash-balance plan shelter very different amounts and carry very different obligations to your staff. The right one depends on your W-2 compensation, your headcount, and how long you intend to fund it. The wrong one is an expensive commitment that is awkward to unwind.
Planning we actually run →Practices routinely find that one or two clinicians, or a single payer, are carrying the rest — and that a service line they are proud of loses money once payroll taxes, supervision time and no-shows are loaded onto it. This is not a tax question. It is the one that changes hiring and contracting decisions.
What CFO-level reporting shows →All three run on the same thing: consecutive years of reconciled, defensible records a stranger can follow. Practices that have them clear diligence in weeks. Practices that do not accept a discount, spend months reconstructing history, or watch the deal die. The cheapest time to fix this is years before you need it.
What diligence looks for →The assessment works through all six against your actual numbers, and you get the findings in writing whether or not you engage us.
Book a Free Assessment →The assessment is a working session, not a pitch. We look at your books, entity structure, payroll setup and tax posture, then come back with what we would change, what it is worth in dollars, and what it would cost. If the honest answer is that you do not need us yet, that is what you will hear.