The Simple Answer
Bookkeeper = Backward-looking. Records transactions, reconciles accounts, produces financial statements. Tells you what happened last month.
Fractional CFO = Forward-looking. Analyzes data, forecasts cash flow, guides strategic decisions. Helps you decide what to do next month.
Most healthcare practices need both. The question is when you need to add CFO-level support to your team.
The Quick Test
If you look at your P&L and think "okay, now what?"—you need more than a bookkeeper. You need someone to translate those numbers into decisions.
Side-by-Side Comparison
📚 Bookkeeper
The Scorekeeper
- Records daily transactions
- Reconciles bank accounts
- Produces P&L and Balance Sheet
- Manages accounts payable/receivable
- Prepares files for tax accountant
- Strategic planning
- Cash flow forecasting
- Growth advice
Cost: $300–$1,000/month
📊 Fractional CFO
The Strategist
- Cash flow forecasting (13-week)
- Profit analysis by location/service
- Financial dashboards & KPIs
- Growth & expansion planning
- Pricing strategy
- Hiring & compensation decisions
- Partner/owner alignment
- Bank & investor relations
Cost: $1,500–$5,000/month
When Do You Need Each?
You Need a Bookkeeper When:
- You have any business with financial transactions (everyone needs this)
- You want accurate, timely financial records
- You need to file taxes
- You want to know where your money went last month
You Need a Fractional CFO When:
- Revenue exceeds $1M but cash always feels tight
- You have multiple locations and can't tell which is profitable
- Partners disagree about financial direction
- You're planning to expand, hire, or take on debt
- You make big decisions by gut feeling instead of data
- You look at financial statements and don't know what to do with them
The Hierarchy: Who Does What?
| Role | Primary Function | Reports To |
|---|---|---|
| Bookkeeper | Record transactions, produce reports | Controller/CFO |
| Controller | Oversee accounting, ensure accuracy | CFO |
| CFO | Strategic financial leadership | Owner/CEO |
| CPA/Tax Accountant | Tax compliance, audit, advisory | Owner (external) |
For most healthcare practices with $1M–$10M revenue, you don't need all these roles full-time. A fractional CFO often handles both CFO and controller functions, working with your bookkeeper and tax CPA.
What We Offer
At ProfitUp Advisory, we provide both:
- Clean Books ($500/month) — For practices that just need accurate financials
- Fractional CFO ($1,500/month) — For practices ready for strategic financial guidance
Most clients start with both, getting clean books as the foundation and CFO guidance to actually use those numbers to grow.