Orthodontist CFO services: the cash-flow gap between a case start and a paid-off case

What CFO work looks like inside a case-based practice

Your bookkeeper records what already happened; CFO work models what happens next. For an orthodontic DPC that means a monthly cadence on top of clean accrual books, built around the practice's actual sales cycle: new consultations booked, cases started, appliance and lab cost per case, and a rolling cash forecast that separates earned revenue from the deferred-revenue liability still sitting on the balance sheet. Fixed fees, quoted after a discovery call.

Owners usually bring us in at a specific decision point — a lease renewal, a second location, a consolidator's purchase letter, or a slow quarter that doesn't match how busy the schedule looks. The recurring dashboard exists so those moments get priced from your own numbers rather than a broker's projection.

Case starts and acceptance rate are the practice's real leading indicators

Production per hour matters less here than in general dentistry, because a chair full of monitoring visits generates modest revenue per appointment on its own — the money is in new case starts. We track new-patient consultations, the case acceptance rate those consultations convert to, and average case fee, month over month, because a soft month often shows up in consultations booked eight to ten weeks before it ever shows up in the bank account.

None of this replaces clinical judgment about which cases to accept — it exists so the business side of that judgment is visible before a quiet month becomes a quiet quarter.

Multi-location practices need one more layer: the same dashboard broken out by office, because a struggling second location can hide inside a healthy combined number for months. We report case starts and acceptance rate per site so a capacity problem at one office is visible long before the annual review, not folded into an average that looks fine on paper.

The cash-flow mismatch a P&L alone won't show you

A new case start creates cost almost immediately — the aligner manufacturer's fee, lab charges for a fixed appliance, the treatment coordinator's commission — while the fee itself arrives over the next one to three years on a monthly plan. A practice growing its case volume can show healthy accrual profit while genuinely running short of cash, because this month's growth is financed by last year's collections. We build a rolling cash forecast, distinct from the P&L, that lines up expected collections against the cost already committed on active cases — a version of the same discipline behind building a 13-week cash flow forecast, adapted to a treatment-length horizon rather than a weekly one.

The same mismatch shapes financing decisions. A line of credit sized to bridge new-case costs against a growing book of collectible contracts is a different, and usually smaller, ask than one sized to cover a general operating shortfall — but only if the forecast actually separates the two.

Owner pay decisions get tested against the same forecast rather than set once and forgotten. A salary that made sense when case volume was flat can strain cash during a genuine growth quarter, so we revisit the salary-and-dividend mix alongside the cash plan rather than as a separate, once-a-year exercise.

Growth, referral relationships, and sale prep

A second location or an added chair is a capacity decision, not a revenue guess: the model needs realistic new-patient flow from referring dentists in that catchment area, the added coordinator and assistant cost, and the lease term, before a signature goes on anything. Because referral relationships — not walk-in traffic or hygiene recall — drive most new starts, we track referral concentration as a risk metric: a practice fed heavily by two or three general dentists carries more downside if one relationship cools than a practice with a broader referral base.

When a sale or partnership eventually comes up, buyers and consolidators price on normalized case volume and acceptance rate, not on the headline production number, and a corporation's lifetime capital gains exemption eligibility depends on qualification tests met years before closing, not arranged the month a letter of intent arrives. Our tax team handles that qualification work alongside the CFO forecast, and if your own training or savings history runs through the US, our cross-border tax page for orthodontists covers what that side of the file needs.

Source: CRA — Capital gains deduction (line 25400).