The essentials you actually need to do (and what you can skip if you’re struggling)
Start Here: What This Actually Is
This isn’t a guide to becoming an accountant. This is the minimum viable financial management for someone running their own practice.
Everything marked MUST DO is non-negotiable if you’re managing your own books. Skip these and you’re not doing bookkeeping, you’re just collecting data.
Everything marked NICE TO HAVE is what a bookkeeper would do, but you can defer or skip if you’re overwhelmed without immediate consequences.
Realistic time investment: 90 minutes monthly if you stay current. 4+ hours if you’re catching up.
The 80/20 Rule for DIY Bookkeeping
If you only do three things, do these:
- Reconcile your bank accounts monthly (catches errors and fraud)
- Set aside 30% of profit for taxes immediately (avoids April panic)
- Know whether you made or lost money last month (enables basic decision-making)
Everything else supports these three objectives.
Week One: Make Your Records Match Reality
MUST DO: Bank Account Reconciliation
This is the foundation. If your books don’t match your bank, nothing else matters.
The actual process:
- Log into your bank, download last month’s statement (PDF)
- Open your accounting software’s reconciliation feature
- Enter the ending balance from your statement
- Go through each transaction:
- Check the box if it matches your bank statement
- Don’t check the box if it doesn’t appear on the statement yet
- When you’re done, the difference should be $0.00
🚩 RED FLAG: If the difference isn’t zero, you have one of these problems:
- A transaction was entered twice
- A transaction is in the wrong month
- A bank fee wasn’t recorded
- You forgot to record a deposit or withdrawal
- Someone made an error (you or the bank)
💡 PRO TIP: Most reconciliation problems are timing issues. That check you wrote yesterday won’t appear on this month’s statement. That’s fine. It’ll show up next month as “outstanding.”
⚠️ CRITICAL: Never, ever create a mystery “adjustment” to force reconciliation. Find the actual error. If you can’t find it in 20 minutes, take a break and come back. Still can’t find it? This is when you call someone.
Time required: 15-20 minutes per account
MUST DO: Credit Card Reconciliation
Same process, different account type.
Why this matters: Credit card errors are common. Duplicate charges, subscription services you forgot about, fraudulent charges. You won’t catch them if you don’t reconcile.
The process:
- Download your credit card statement
- Reconcile just like you did with your bank account
- Verify the payment you made to the credit card shows up correctly
💡 PRO TIP: If you use a business credit card for personal expenses (not recommended, but many do), mark those transactions as “Owner’s Draw” so they don’t inflate your business expenses.
🚩 RED FLAG: Credit card balance in your accounting software should match your statement exactly. If it’s off by the same amount every month, you have a systematic error.
Time required: 10-15 minutes per card
NICE TO HAVE: Transaction Categorization Cleanup
Look through last month’s transactions. Are they in the right categories?
Common miscategorization errors:
- Medical supplies coded as office supplies (matters for taxes)
- Equipment purchases coded as equipment expenses (should be capitalized if over $2,500)
- Meals coded as entertainment (different tax treatment)
- Personal expenses mixed with business (dangerous)
💡 PRO TIP: Create rules in your accounting software. When Amazon charges you, it should always prompt: “Is this medical supplies or office supplies?” Set it once, save time forever.
If you’re overwhelmed: Just make sure obvious errors are fixed. Perfect categorization is nice, but getting bank reconciliation right is more important.
Time required: 20-30 minutes
Week Two: Know If You Made Money
MUST DO: Generate and Actually Look At Your P&L
Revenue minus expenses equals profit (or loss). This tells you if your business is working.
The process:
- In your accounting software, run a Profit & Loss report
- Set date range to last month only
- Look at the bottom line
Questions to answer:
- Did you make money or lose money?
- Is revenue roughly what you expected? (Patient panel size × monthly fee)
- Are there any expenses that look weird or unusually large?
💡 PRO TIP: Your “net income” on the P&L is not how much you can pay yourself. You also need to cover loan payments, equipment purchases, and taxes. But it tells you if the core business is profitable.
🚩 RED FLAG: Revenue significantly lower than expected without knowing why. Either patients are leaving, payment processing failed, or something’s miscategorized.
🚩 RED FLAG: Consistent losses for 3+ months. This isn’t a bookkeeping problem, it’s a business model problem. You need to change something (pricing, expenses, or patient volume).
Time required: 10 minutes
NICE TO HAVE: Balance Sheet Review
The balance sheet shows what you own (assets), what you owe (liabilities), and what’s left over (equity).
Key things to check:
- Cash balances match your reconciled bank accounts (they should, exactly)
- Credit card balances match your reconciled statements
- No weird negative numbers in unexpected places
If you’re overwhelmed: Skip this unless something obviously looks wrong. The balance sheet is important for understanding your overall financial position, but the P&L is more critical for month-to-month operations.
Time required: 5 minutes
MUST DO: Tax Money Reality Check
Look at your P&L. See that net income number? You owe taxes on it.
Quick calculation:
- Take your net income
- Multiply by 0.30 (this is roughly federal + state + self-employment tax)
- That’s approximately what you owe in taxes on that profit
Critical question: Do you have that money set aside?
💡 PRO TIP: Open a separate bank account called “Tax Holding.” Every time you pay yourself, immediately transfer 30% to this account. Don’t touch it until quarterly taxes are due.
🚩 RED FLAG: You’re profitable on paper but your bank balance is decreasing. This means you’re spending money that should be going to taxes or you’re making loan payments that don’t show as expenses. Either way, you need to understand where cash is actually going.
⚠️ CRITICAL: Quarterly estimated taxes are due April 15, June 15, September 15, and January 15. Missing these creates penalties that compound. Set phone reminders now.
Time required: 5 minutes
Week Three: Don’t Create Problems for Future You
MUST DO: Documentation Spot Check
The IRS doesn’t care what you say you bought. They care what you can prove.
Quick audit of last month:
- Do you have receipts for your 10 largest expenses?
- For any meal expenses, do you know who you met with and why?
- For any travel, do you remember the business purpose?
💡 PRO TIP: Take a photo of receipts immediately after purchase. Email them to yourself with the subject line “Receipt: [Vendor] [Date] [Amount].” Takes 10 seconds, saves hours later.
🚩 RED FLAG: If you can’t document more than 50% of your expenses, you’re creating tax audit risk. The IRS can (and will) disallow expenses without proper documentation.
Acceptable documentation:
- Receipt (physical or digital)
- Bank/credit card statement (secondary, not primary)
- Invoice marked “paid”
Not acceptable:
- “I remember buying that”
- Calendar entries
- Emails without payment proof
Time required: 15 minutes
NICE TO HAVE: Expense Category Analysis
Look at your largest expense categories. Do they make sense?
Questions to consider:
- Are marketing expenses generating patient growth?
- Are software subscriptions actually being used?
- Are supply costs consistent with patient volume?
If you’re overwhelmed: This is strategic optimization. Important for growth, but not critical for basic financial management. Save this for when you have breathing room.
Time required: 15-20 minutes
Week Four: Plan Ahead (Just a Little)
MUST DO: Next Month’s Tax Money
You know what you owe in taxes on last month’s profit. Do you have it set aside?
If yes: Great. You’re in the 20% of small businesses who handle this properly.
If no: Calculate the shortfall. Add it to next month’s tax obligation. You’re playing catch-up now, which means tighter cash flow until you’re current.
💡 PRO TIP: If you’re consistently short on tax money, your owner’s compensation is too high. You’re essentially borrowing from the IRS to pay yourself. This ends badly.
Time required: 5 minutes
NICE TO HAVE: Key Metrics Tracking
Track these numbers monthly:
Patient metrics:
- Total active patients
- New enrollments
- Cancellations
- Net growth
Financial metrics:
- Total revenue
- Net profit
- Operating expense ratio (expenses ÷ revenue)
💡 PRO TIP: Keep a simple spreadsheet with one row per month. After 6 months, you’ll see trends that inform strategic decisions.
If you’re overwhelmed: This is incredibly valuable for growing your practice, but it’s not bookkeeping. It’s business analytics. If you’re struggling to keep up with reconciliation, skip this until that’s under control.
Time required: 10-15 minutes
The Real-Talk Troubleshooting Guide
“I’m two months behind on reconciliation”
Don’t panic. Here’s what to do:
- Start with the most recent month first (this month or last month)
- Get that reconciled correctly
- Then go backward to older months
- Why? Because recent stuff is easier to remember, and getting current is more important than fixing the past
💡 PRO TIP: If you’re more than 3 months behind, the economics probably favor paying someone $300-500 to catch you up rather than spending 8+ hours doing it yourself.
“My reconciliation won’t balance and I’ve been staring at it for an hour”
Common culprits, in order of frequency:
- Duplicate transaction – Did a payment processor deposit show up twice? Very common.
- Wrong month – Transaction dated to wrong month, so it’s on the wrong statement
- Deposit in transit – You deposited money on the last day of the month; bank processed it the next day
- Outstanding check – You wrote a check that hasn’t been cashed yet (totally normal)
- Bank fee you forgot – Check statement for any fees, then record them
- You entered the wrong ending balance – Seriously, check this. It happens.
What to do: Take a break. Come back in an hour. If still stuck, email your CPA or bookkeeper the specific discrepancy amount and ask for guidance.
“I don’t know if this is a business expense or personal”
Simple rule: If you wouldn’t have bought it if you didn’t have the practice, it’s a business expense.
Clear business expenses:
- Medical supplies for patients
- EHR software
- Liability insurance
- Marketing your practice
- Office rent/lease
Clear personal expenses:
- Groceries for your family
- Your personal cell phone (unless you legitimized a business use percentage with your CPA)
- Commuting from home to office (not deductible)
- Clothes, even if you wear them to work (not deductible unless they’re uniforms)
Gray area (ask your CPA):
- Meals with potential referral sources
- Conferences that mix education and vacation
- Home office expenses
- Vehicle used for both business and personal
💡 PRO TIP: When in doubt, ask your CPA before deducting, not after the IRS asks questions.
“I used business money for personal stuff”
This happens. Here’s how to handle it:
- Categorize the transaction as “Owner’s Draw” (not an expense)
- This removes it from your business expenses
- The money still came out of the business, but it’s recorded as you taking compensation, not as a business cost
Why this matters: Owner’s draws aren’t tax deductible. Business expenses are. Mixing them up either overstates your expenses (tax audit risk) or understates them (you pay too much in taxes).
“I can’t tell if I’m profitable because my cash keeps going down”
This is the #1 confusion point. Here’s why it happens:
Your P&L might show $5,000 profit, but your bank account is lower than last month because:
- You made a $3,000 loan payment (only the interest is an expense; principal isn’t)
- You bought a $4,000 piece of equipment (it’s an asset, not an expense, until you depreciate it)
- You took a $2,000 owner’s draw
- You set aside $1,500 for taxes
All of those used cash but don’t all show as expenses.
💡 PRO TIP: This is why “profit” and “cash flow” are different concepts. You can be profitable and cash-poor (common in growth phase) or unprofitable and cash-rich (common if you’re living off savings).
The Absolute Bare Minimum
If you’re truly overwhelmed and can only do three things:
1. Reconcile your bank accounts monthly
Why: Catches errors and fraud before they compound
Time: 20 minutes
Skip and risk: You won’t know if money is missing until it’s too late to fix
2. Set aside 30% of every deposit for taxes
Why: Avoids catastrophic tax bill you can’t pay
Time: 2 minutes per deposit
Skip and risk: April penalty and interest, plus scrambling for cash you don’t have
3. Track whether you made or lost money
Why: Tells you if your business model actually works
Time: 10 minutes
Skip and risk: You could be losing money for months without realizing it
Everything else can wait until you have bandwidth.
When DIY Stops Making Sense
You’re not failing if you recognize these signs. You’re succeeding at recognizing capacity limits.
Strong signals to outsource:
🚩 You’re more than 2 months behind consistently
🚩 Reconciliation takes more than an hour per account
🚩 You avoid looking at your books because they stress you out
🚩 You’re making business decisions based on bank balance, not actual profit
🚩 Tax time requires your CPA to “fix everything first”
🚩 You hired employees (payroll tax compliance is genuinely complex)
The calculation that matters:
Your time is worth at least $150/hour (probably more). If bookkeeping takes you 4 hours monthly, that’s $600 of your time. A bookkeeper costs $300-450 monthly.
You’re not saving money doing it yourself. You’re subsidizing bookkeeping with clinical income.
Quick Reference: Your Monthly Checklist
Print this. Keep it visible.
Week 1 (Days 1-7)
- ☐ MUST DO: Reconcile all bank accounts to $0.00 difference
- ☐ MUST DO: Reconcile all credit cards to $0.00 difference
- ☐ Nice to have: Clean up obvious transaction categorization errors
Week 2 (Days 8-14)
- ☐ MUST DO: Generate P&L and know if you made money
- ☐ MUST DO: Calculate tax owed on profit
- ☐ MUST DO: Verify tax money is actually set aside
- ☐ Nice to have: Review balance sheet for obvious errors
Week 3 (Days 15-21)
- ☐ MUST DO: Verify you have documentation for major expenses
- ☐ Nice to have: Analyze expense trends
Week 4 (Days 22-30)
- ☐ MUST DO: Ensure next month’s tax obligation is covered
- ☐ Nice to have: Track key practice metrics
Before closing this out
- ☐ Save all statements to organized folder
- ☐ Schedule next month’s reconciliation on calendar
- ☐ Note any issues that need CPA guidance
The Tools That Actually Help
Accounting software worth using:
- QuickBooks Online (industry standard, good bank feeds)
- Xero (cleaner interface, works well for simple practices)
- Wave (free, genuinely adequate for very small practices)
Don’t use:
- Excel as your primary system (too error-prone)
- Shoebox + panic (this isn’t a system)
💡 PRO TIP: Bank feeds are your friend. Connect your bank accounts and credit cards. The software automatically imports transactions. You just categorize and reconcile. This cuts time in half.
Final Reality Check
Bookkeeping isn’t hard because it’s intellectually complex. You’re smart enough to learn this.
Bookkeeping is hard because it requires:
- Consistent attention to detail
- Discipline to do it monthly, not “when you have time”
- Comfort with financial concepts
- Enough time to actually do it properly
If you have all four, DIY can work. If you’re missing even one, you’re probably better off outsourcing.
The goal isn’t to prove you can do everything yourself. The goal is to build a sustainable practice that uses your time wisely.
Sometimes the smartest financial decision is paying someone else to handle the books so you can focus on the clinical and strategic work that only you can do.
Questions about this protocol?
Email: daniel@dpcbookkeeper.com
Ready to delegate this?
Schedule a consultation: dpcbookkeeper.com
About the Author
Daniel is the founder of DPC Bookkeeper. This checklist represents the minimum viable process we’d recommend for any physician attempting DIY bookkeeping. We’ve also cleaned up the mess when DIY breaks down for hundreds of practices, so we know where the pain points actually are.
DPC Bookkeeper – Financial infrastructure for independent practices.