Your Chart of Accounts Is a Rigged Carnival Game And It’s Costing Your Practice Time, Clarity, and Automation
- Doctors CFO
- 3 days ago
- 3 min read
You know that carnival game where you toss a ring onto a bottle to win the giant teddy bear? You throw. You miss. You throw again. You miss again. It’s not because you’re bad at throwing — it’s because the game is engineered to be unwinnable. There’s a good chance your Chart of Accounts is built the same way.
The “400 Tiny Buckets” Problem
Most dental and medical practices operate with 300–500 expense categories. You’ve seen them:
Dental Supplies – Clinical
Dental Supplies – Surgical
Dental Supplies – Ortho
Lab Fees – Fixed
Lab Fees – Removable
Software – Imaging
Software – Patient Communication
Office Supplies – Front Desk
Office Supplies – Back Office
Now your office manager is coding a $2,300 invoice from Henry Schein that includes gloves, composite, whitening kits, and impression material. Where does it go? Should it be split? Does it matter?
Your team guesses. Your bookkeeper adjusts it later. Your CPA reclasses it at year-end.
That’s the carnival game.
Why This Is Actually Hurting You
Doctors don’t struggle because they lack categories. They struggle because they lack clarity.
When you ask questions like:
Why did overhead increase?
Are supplies out of control?
Is hygiene profitable?
Can I afford another associate?
Is my second location performing?
You don’t need 47 sub-accounts for supplies. You need clean, consistent, reliable data.
Excess complexity leads to inconsistent coding, noisy reports, and financial statements you stop trusting. Once that happens, your accounting becomes a compliance exercise instead of a decision-making tool.
You’re Also Killing Automation
Modern practices use bank feeds, auto-categorization, AI-based coding, and integrated systems. Automation works on patterns. If you have 5–10 broad, consistent categories, automation works extremely well. If you have 300 hyper-specific categories, it constantly struggles.
Your system cannot reliably distinguish between:
Lab – Fixed
Lab – Removable
Lab – Specialty
Lab – Other
It guesses. Your team overrides it. The system never learns.
You end up paying for automation tools that can’t function properly because your structure is too complex.
The Better Model
For most healthcare practices, this level of categorization is sufficient:
Clinical Supplies
Lab Fees
Payroll – Clinical
Payroll – Administrative
Occupancy
Marketing
Software & IT
General & Administrative
When Henry Schein hits your bank feed, it goes to Clinical Supplies. When Glidewell hits, it goes to Lab Fees. When ADP runs payroll, it goes to Payroll.
No debates. No splitting hairs. Faster closes. Cleaner data. Better automation.
“But I Want to Track Composite vs Gloves”
You should — but not in your Chart of Accounts.
That level of detail belongs in:
Inventory systems
Vendor reporting
Purchase tracking
Practice management analytics
Your accounting system’s job is high-level financial clarity. What matters is:
Clinical supplies as a percentage of collections
Lab fees as a percentage of production
Payroll as a percentage of revenue
Overhead by location
Broad, consistent categories outperform detailed chaos every time.
The Real Goal: Better Decisions
You didn’t go to medical or dental school to manage micro-accounts. You need financials that answer real questions:
Can I afford another provider?
Should I open a second location?
Is my associate profitable?
Is hygiene covering payroll?
Is overhead trending correctly?
Those answers come from clean structure — not complexity.
Stop Playing the Rigged Game
If month-end feels slow, reports feel inconsistent, automation constantly needs correction, or you don’t fully trust your numbers, it’s not because accounting is hard. It’s because your system is overbuilt.
Simplify your Chart of Accounts. Clean vendor names. Let automation work. Focus on provider-level metrics.
Stop trying to land a tennis ball in a shot glass. Build bigger buckets. Win the game.
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