Medical and dental practices are profitable businesses, right? Not necessarily.
A practice can be busy every day of the week and still make very little. Having a solid business plan and the right systems and processes in place is what separates a practice that pays its owners well from one that runs its owners into the ground.
Here are four areas worth reviewing, and a fifth that has changed more than any of them in recent years.
1. Review your fee structure
Take the time to review your fee structure. Are you charging your patients enough?
For medical practices, the arithmetic behind that question changed on 1 November 2025. Bulk billing incentives can now be claimed for any Medicare-eligible patient, not just children under 16 and concession card holders. Separately, the Bulk Billing Practice Incentive Program pays participating practices an additional 12.5% of the MBS benefit earned on eligible services, split between the practice and the provider.
The catch is that the program is all or nothing at practice level. You bulk bill every eligible patient for every eligible service, or you do not join. For a practice with a strong private fee base, joining can cost more than it pays. For a practice already bulk billing most of its book, it can be a clear gain. Plenty of practices sit close enough to the line that the answer depends on their mix of long consultations, care plans and health assessments, which makes it a modelling exercise rather than a judgement call.
Whichever way you bill, there should be a clear written policy on when you bulk bill and who decides, agreed by all practitioners. Fee decisions made appointment by appointment at the front desk are how margin quietly disappears.
2. Take control of your costs
Like any business, managing your practice costs is fundamental to your profitability. Start with your largest ones: wages and occupancy.
Wages are difficult to move. You need to keep good staff and pay them what they are worth. Occupancy is more controllable. Practices with consulting rooms sitting empty part of the week often bring in allied health practitioners to use them, which offsets the rent, adds services your patients want under one roof, and can lift the value of the practice.
One important caveat that did not apply a few years ago: how you document that arrangement now matters as much as whether you do it. A genuine commercial lease and a service-fee arrangement where patient money flows through your practice are treated very differently for payroll tax. Get the paperwork right before the practitioner starts, not after. See point five.
3. Get patient management right
Matching demand and supply is the single greatest operational challenge in most practices. Too little capacity and you turn patients away. Too much and you have practitioners sitting in empty rooms, earning nothing for themselves or for you.
Three things move the needle. Your online booking system: is it as efficient and transparent as it could be, and can a patient see real availability and book the right appointment length without calling? Your reception team: do your staff know the questions to ask so patients land in the right appointment type, for the right duration, with the right practitioner? And clinical support: do your doctors or dentists have the nursing and assisting help they need to work at the top of their scope? A practitioner doing work a nurse could do is the most expensive labour in the building.
4. Get the right advice
As a doctor or dentist you are one of the busiest professionals there is. That busyness makes it very easy to spend all your time working in the practice and none working on it.
Making time to sit down with your accountant and your lawyer, properly rather than in passing, is what surfaces the issues you cannot see from inside the treatment room. It can save you time, money and tax. Occasionally it saves the business.
One more thing you cannot ignore: Know where you stand on payroll tax
This is the one that has caught the most practices out, and where medical and dental have ended up in very different positions.
If you are a Queensland general practice, wages paid to a GP, whether contracted or employed, have been exempt from payroll tax since 1 December 2024. That exemption was made permanent when legislation passed in February 2025. It is not tied to bulk billing thresholds, and it covers registrars and telehealth consultations. If you restructured your contracts or payment flows to manage payroll tax risk before that, it is worth reviewing whether you still need to.
If you are a Queensland dental practice, you are not in the same position. The amnesty for payments to contracted dentists ended on 30 June 2025. It only ever covered historical liability, and only for clinics that registered and made a voluntary disclosure in time. From 1 July 2025, payments to contracted dentists are subject to payroll tax unless a specific exemption applies.
If you are a specialist or allied health practice, the GP exemption does not extend to you.
Where there is no exemption, what determines your exposure is the substance of the arrangement: who collects the patient fee and how it reaches the practitioner, whether rooms and facilities are provided as a service or leased, how much control the practice has over hours and methods, and who the patients belong to. These are answerable questions, and they are much cheaper to answer now than during an audit.
Talk to us
Your medical or dental practice can be highly profitable, and a solid business plan with the right systems behind it is what makes that happen.
Crest Accountants has been working with Gold Coast medical, dental and allied health practices since 1973. We take the time to understand how your practice actually runs, so the advice you get fits it.
Contact us to book an appointment and talk through your practice’s profitability.
This article is general information only and does not take your circumstances into account. Payroll tax treatment of health practitioners varies between states and has changed several times in recent years. Please get advice specific to your practice before acting.
