The question of percentage pay is one of the most hotly debated topics in private healthcare. For many practitioners, handing over 40, 50 or even 60% of their earnings to the clinic can feel unfair. But from the clinic’s side, the reality is often more complex. We take a look at things from both angles and look at alternatives to this norm.
Having run a clinic & been an associate ourselves, we know both sides of the story. We’ve been on each side of the coin – both thinking that the clinic is taking an obscene amount of our pay, and thinking “is it worth having associates when it barely covers our costs”. In this article, we’ll unpack the arguments, highlight the hidden costs, and suggest how clinics and practitioners can work together more fairly.
In essence, the clinic / practitioner relationship has to be a partnership. As a clinic, you have a duty to attempt to fill your associates diary, market them and give them the premises that they can work from, taking on the majority of the “risk” and expenditure, on the proviso that the practitioner strives to represent your clinic in a positive light and provide quality patient care. As a practitioner, you want to feel supported, offered progression in your career, that the percentage of each patient is going towards something that furthers your position in the clinic and that you are getting “value for money”.
Running your own business is not for everyone, and therefore you are hoping to find somewhere to call home where you can earn a good wage and be able to switch off at the end of the day. The partnership works both ways, and you are both mutually working for the benefit of the company and yourself.
🤔 Why 50% Can Feel Unfair to Practitioners
"I feel like sometimes I get all of the downsides of being self employed (no paid holiday and no sick pay) while the clinic I work for has all the upsides of me being self employed. I answer calls, emails and I'm responsible for marketing myself to clients. I don't feel I get value for money for the 50/50 split in pay."
Many practitioners see the 50/50 model as disproportionate — especially when they:
Handle their own patient calls / bookings and/or admin.
Contribute to clinic marketing or website updates.
Work evenings or weekends without extra support.
Do not feel supported and/or undertrained
Are unaware of the realities of running a busy clinic.
In these situations, it can feel like the clinic is taking a large share of income without giving much back. And if practitioners don’t see tangible value for that 50%, resentment can build quickly. It is super important to keep open communication between practitioner and clinic to ensure that both sides are aware of what the partnership looks like and that all duties are fair and equal.
It is fair to expect that the clinic manages certain aspects of your day-to-day work for the percentage that they take. In reality, you maybe expected to go above and beyond just treating patients. You are, after-all, self employed and your duties can vary depending on what needs to be done. You maybe, for instance, expected to join in on marketing exercises, occasionally help out cleaning or on reception if a receptionist has called in sick. A good clinic boss will communicate these needs to you and also respect and recognise the additional help that you’ve given them. The vast majority of these exercises should be there to bring additional patients to the clinic, therefore helping to fill your diary and to further the reputation of the business.
🏥 The Clinic’s Perspective: Hidden Overheads
"The hassle that comes with having "staff" and multiple team members far outweighs the wafer thin profit margins we get from each appointment. When you add up all of our costs and the lack of downtime we get as clinic owners, it does make me wonder why I do it in the first place"
From the outside, it might seem like clinics are pocketing half of every treatment fee. But here’s a taster of what they are paying out to just keep the clinic operational:
Room rental and utilities – heating, lighting, water, business rates, maintenance (electrical testing, boiler servicing, air con servicing, cleaners), insurance.
Front-desk staff (if applicable) – wages, training, sick pay, pension contributions.
- Consumables – plinth roll, massage lotion, tape.
Software and systems – booking platforms, clinical notes, GDPR compliance. Card providers take a cut of all card payments.
Marketing and advertising – website hosting and maintenance (if not managed by the clinic), SEO, social media, print materials and email newsletters.
Insurance and compliance – professional indemnity, health & safety, fire regulations.
- Start-up costs – These are often forgotten about, but just starting a clinic costs thousands of pounds. Furniture, computers and other materials can mean debt before the company even opens.
When you add up these overheads, profit margins can be far smaller than practitioners imagine. In some cases, the clinic may only be left with 10–15% after costs – for a large step-up in administration.
Where the Balance Should Be
The 50/50 model can work — if the clinic is genuinely providing value:
High-quality premises in a good location.
Front-of-house (be it virtual reception or physical) support (calls, bookings, admin).
Ongoing marketing that brings in patients.
Professional development opportunities and mentoring.
- A reputation built over years of building in the local community.
All these things bring value to the practitioner and ensure they feel supported and valued as a member of the clinic and not just a cash cow for the bosses. In reality, profit margins are always lower than you forecast (for a practitioner OR as a clinic – practitioners often find themselves doing unpaid work around work hours (doctor letters, exercise plans) and clinics have a multitude of costs associated with having associates and also more work outside of standard clinic hours).
This must all be factored into the percentage pay model and communicated between both associates and clinic bosses. With open and fair communication, it is much easier to manage potential conflict and misinformation within your clinic.
Towards a Fairer Model
The key is transparency and flexibility. Other options could include:
Sliding scales: A lower percentage for senior practitioners who bring their own caseload.
Tiered models: 60/40 or 70/30 splits where the clinic provides less admin but still offers space and basic support.
Rental model: Practitioners pay a fixed room hire fee and keep 100% of earnings.
Added value: Clinics taking 50% should clearly show what practitioners are getting — from marketing to patient management.
We’ll cover some of these other options in a further article, as they each have advantages and disadvantages.
Final Thoughts
Ultimately, percentage pay only works if both sides feel it’s fair. Practitioners deserve to see where their money is going, and clinics need to ensure they’re offering enough value to justify their share.
The conversation around 50/50 should be less about percentages and more about partnership — building sustainable models where both practitioners and clinics thrive.
What do you think? Have you worked under a 50/50 model? Did it feel fair? Let us know in the comments
