Hit play for a preview, or open in Spotify for the full episode.
Your practice is making money. Your bank account doesn’t seem to know it.
If that sounds familiar, this episode is for you. A lot of practice owners hit a point where the numbers say “profitable,” but the account always feels empty, and they can’t figure out why.
My guest is Emily Bowie, a CPA and Cash Flow Strategist with more than 15 years of experience, including her time as an audit manager in Big Four accounting. She’s the CFO at Thorne Advisors, where she helps entrepreneurs, psychologists, and other service-driven professionals see where their cash is going and build tax plans that match their actual goals.
We get into the leaks she sees in almost every practice, and the small changes that plug them.
This Episode Answers…
Why does my practice feel broke even when it’s profitable?
It usually starts with the books. Most owners only touch their bookkeeping at tax time, which means they’re reacting to decisions they made 5 or 6 months ago. Emily’s first move is always the same: get clean, current books so you can actually see where the money goes. Once you can see it, the leaks show up.
How do I know if I’m undercharging?
Pricing is the leak Emily sees most. Most owners set fees based on the market or on how they feel, and never factor in overhead: rent, software, the costs of keeping the lights on. She looks at those costs as a percentage of your revenue. If you’ve never run that number, there’s a good chance you’re charging too little. When you do raise prices, start with new clients, then bring your existing clients up slowly.
What is my balance sheet telling me that my P&L isn’t?
Your profit and loss shows what happened over a stretch of time. Your balance sheet shows the health of your business right now. Emily gives a simple gut check for sole proprietors: your net income should roughly match your cash plus whatever you’ve paid yourself. If it doesn’t, something’s off, usually debt or a timing difference, and that’s your cue to dig in.
Other Key Takeaways
- Outsource your books before anything else. Aim to have them by the 10th or 15th of the month so you can course-correct early instead of at tax time.
- Run an expense audit at least once a year, quarterly if you can. Ask three things about every expense: what is this, do I still need it, and is it giving me a return.
- Keep personal and business spending separate. Mixing them muddies your numbers and adds real liability risk for therapists.
- If you’re an S-corp, set a reasonable salary first, then work with a strategist on the best way to pay yourself the rest.
- A tax preparer files your return. A tax strategist helps you lower the bill. Those are different jobs, and one person doesn’t always do both.
- Keep a “parking lot” list for broken processes so your SOP review isn’t a once-a-year scramble.
Links mentioned in this episode:
- Thorne Advisors
- Emily on Instagram: @emilyvbowie
Watch The Video:
This Episode Is Brought To You By The Following Sponsors:
Zanda practice management software is excited to partner with Private Practice Elevation Podcast to support practitioners with simple, secure tools that reduce admin and strengthen practice operations. Together, we’re helping practitioners spend less time on paperwork and more time with clients.
If you’re ready to spend less time on admin and more time with clients, visit zandahealth.com to start your free trial.
Alma is on a mission to simplify access to high-quality, affordable mental health care by giving providers the tools they need to build thriving in-network private practices. When providers join Alma, they gain access to insurance support, teletherapy software, client referrals, automated billing and scheduling tools, and a vibrant community of clinicians who come together for education, training, and events.
Learn more about building a thriving private practice with Alma at helloalma.com/elevation.
About Emily Bowie
Thorne Advisors is a modern accounting and advisory firm for high-earning women who want to feel confident about their money, not confused by it. The firm works with clients earning $100K+ in net income, including entrepreneurs, psychologists, and other service-driven professionals who want a clearer picture of their cash flow and a smarter approach to taxes.
Co-led by founder Andrea Mason and CFO Emily Bowie, both CPAs, Thorne Advisors helps women protect what they earn while building sustainable wealth that actually supports their lives. They deliver a true 360-degree view of finances, spotlighting cash leaks, tightening income strategy, and creating tax plans that align with real goals, not just compliance checklists.
What sets Thorne Advisors apart is their commitment to education over intimidation. Emily and the team translate complex financial concepts into clear, practical guidance, so clients can make informed decisions without jargon, judgment, or overwhelm.
Emily Bowie is a Cash Flow Strategist with 15+ years of experience, including her time as an audit manager in Big Four accounting. She’s known for bringing calm, clarity, and structure to financial conversations that often feel stressful or avoided. Outside of Thorne Advisors, Emily leads her church’s financial ministry, is a mom to three young kids, and enjoys a good DIY project almost as much as a well-organized set of financials.
About Daniel Fava
Daniel Fava is the owner and founder of Private Practice Elevation, a website and SEO agency focused on helping private practice owners create websites that increase their online visibility and attract more clients. Private Practice Elevation offers web design services, SEO (search engine optimization), and WordPress support to help private practice owners grow their businesses through online marketing.
Daniel lives in Atlanta, GA with his wife Liz, and two energetic boys. When he’s not working he enjoys hiking by the river, watching hockey, and enjoying a dram of bourbon.
