What is the difference between a CFO and a controller?
A controller manages historical accounting (close, statements, audit, compliance), while a CFO is forward-looking (forecasting, capital allocation, M&A, strategy). Most growing clinics need both, sequenced controller first.
Definition
A controller is the senior accounting leader responsible for accurate financial reporting; a CFO is the senior finance executive responsible for strategic financial direction.
The detail
The simplest distinction: a controller answers what happened, a CFO answers what should happen next. Controllers own the monthly close, the financial statements, the audit, tax coordination, and accounting compliance. CFOs own the forecast, capital allocation, payer contract economics, M&A modeling, banking relationships, and board or partner reporting. Compensation reflects scope: BLS data shows accountants and auditors median wage of $81,680 in May 2024, while financial managers median wage was $161,700. In a clinic, a strong controller often costs $90K to $140K and is the foundation; without clean books, CFO work is impossible. A fractional CFO at $4K to $8K per month layers on top to provide strategic direction. Most clinics under $5M in revenue should hire or outsource the controller role first, then add a fractional CFO when forecasting and capital decisions become recurring needs.
Median accountant and auditor wage was $81,680 in May 2024; median financial manager wage was $161,700.
Source: BLS OES May 2024
Controller scope covers GAAP-compliant financial statements, monthly close, and audit coordination.
Source: AICPA Controller resources
CFO scope covers forecasting, capital allocation, M&A, banking, and strategic finance.
Source: AICPA CFO Roundtable
What this means for clinic owners
From Sorso
Hiring a CFO before you have a controller is like hiring a strategist with no data. Sequence matters. Get the books clean first, then add forward-looking finance.
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How much does a fractional CFO cost?
A fractional CFO typically costs $3,000 to $10,000 per month for healthcare clinics, with most outpatient practices in the $4,000 to $7,000 range. A full-time CFO runs $200,000 to $400,000 per year in base compensation alone.
How much does healthcare accounting cost per month?
Outsourced healthcare accounting typically costs $1,500 to $5,000 per month for a single-location clinic, depending on transaction volume, locations, and whether you need controller-level oversight.
How much does a full-time CFO cost?
A full-time healthcare CFO costs $250,000 to $450,000 per year in total compensation for mid-market clinics, including base salary, bonus, benefits, and recruiting costs.
When should I hire a fractional CFO?
Most clinics should hire a fractional CFO when they cross $2M in revenue, add a second location, raise debt or equity, or start preparing for a sale, typically 12 to 36 months out.
What does a fractional CFO actually do?
A fractional CFO owns financial forecasting, KPI dashboards, cash flow management, capital decisions, and strategic finance work, typically delivering 10 to 25 hours per month on a retainer.
What is the difference between a fractional CFO and a bookkeeper?
A bookkeeper records what already happened: daily transactions, reconciliations, and clean financial statements. A fractional CFO uses those statements to plan what should happen next: forecasts, KPIs, strategic decisions, and growth or exit modeling. Bookkeepers typically cost $400 to $1,500 per month for a clinic. Fractional CFOs typically cost $3,000 to $10,000 per month. Most clinics above $1M in revenue need both, sequenced.
Founder of Sorso. 19 years in corporate finance. Managed a $450M loan portfolio before building a fractional CFO firm exclusively for healthcare clinics.
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