How understanding total people expense helps practices hire smarter and protect profit margins.
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Episode 27
When Brandon asks practice owners what percentage of their total people expense goes beyond wages, most guess 15–20%. The real answer? Usually 18–40%, depending on the organization's structure. If you're not measuring the full scope of your employee costs, you're flying blind. According to SHRM, the average cost per hire in the US is $4,700 — and that doesn't include lost productivity, which can run 3–4 times the position's salary.
Variable expenses are those that go up or down directly with your headcount — EMR charges per appointment, liability insurance per clinician, clinical tools specific to a role. Fixed expenses are those allocated across all employees regardless of individual changes. When you add staff, fixed costs per employee actually decrease. That math matters when building your compensation model.
Brandon highlights an often-overlooked expense: supervision time. If an SLP supervises an SLPA for eight hours a month, those eight billable hours of an SLP's time belong on the SLPA's TPE ledger. It's revenue lost on the supervising clinician — a real cost that should inform hiring decisions and scheduling models. Using tools like QuickBooks or your EMR to categorize and track these costs gives you a clear picture.
Brandon's boldest benchmark: he would personally pay $10,000 to find his ideal, fully-qualified unicorn hire. The ROI math justifies it. Unicorn employees generate significantly more revenue, stay longer, and elevate team culture — making the recruitment investment trivial by comparison. Measure every variable of your people expense, as Peter Drucker said: if you can't measure it, you can't improve it.
