The three finance roles, and what each actually does.
A bookkeeper records what happened: categorizing transactions, reconciling accounts, and running payroll. A controller owns accuracy and control: closing the month properly, ensuring inventory and deferred revenue are handled correctly, and producing financials you can rely on. A CFO looks forward: interpreting the numbers, forecasting cash, modeling decisions, and advising on growth, financing, and eventual sale.
Five questions a generalist bookkeeper usually cannot answer.
- What is our optical capture rate?Requires exam counts tied to eyewear sales — a practice-management-to-accounting reconciliation most bookkeepers never set up.
- What is our gross margin on frames versus lenses?Requires a chart of accounts that splits optical categories rather than one materials line.
- How much of our cash is committed to undelivered annual supply orders?Requires deferred revenue to be carried as a liability rather than booked on receipt.
- Which vision plan pays us slowest?Requires collections tracked by payer with days-to-payment, not a single accounts receivable balance.
- Can we afford the second location?Requires a forecast, which is CFO work and outside the bookkeeping function entirely.
Rough thresholds
These are not rules, but they hold up reasonably well. A single-OD practice under roughly $750,000 in revenue usually needs solid bookkeeping with optometry-appropriate structure, and little more. Between roughly $750,000 and $2 million, controller-level rigor starts to matter because inventory, deferred revenue, and payer mix have grown complex enough to distort the picture if handled loosely.
Above roughly $2 million, or at the point of adding a second location or a second doctor, forward-looking CFO work stops being optional. The decisions get expensive enough that modeling them beforehand is cheaper than learning from them.
The in-house versus outsourced question
A full-time in-house controller is a substantial salary plus benefits for a practice of most sizes, and the role is rarely full-time work in a single-location optometry practice. The more common structure is an in-house administrator handling day-to-day, with outsourced controller and CFO capacity layered on.
The thing to avoid is the common middle state: a part-time bookkeeper doing generalist work, an owner interpreting the output alone, and nobody responsible for whether the numbers are structured correctly in the first place.
What good looks like
Books closed by a fixed date every month. Optical and clinical separated. Inventory carried and turns reported. Deferred revenue on the balance sheet. Collections by payer with days to payment. And a scheduled conversation each month where someone walks the statements with you and says what they mean.
Frequently asked.
When does an optometry practice need a CFO?
Typically around $2 million in revenue, or earlier at the point of a major decision — adding a second location, bringing on an associate OD, buying a building, or responding to an acquisition approach. The trigger is the size of the decisions rather than the size of the practice.
Can a general bookkeeper handle an optometry practice?
They can record transactions accurately, but most will not structure optical inventory, split materials margin by category, or carry annual supply orders as deferred revenue unless specifically asked. Those are the things that make optometry financials useful rather than merely correct.
What does a fractional CFO cost compared to hiring one?
A full-time CFO is a six-figure salary plus benefits. Fractional arrangements deliver the forecasting, modeling, and monthly interpretation for a fraction of that, which is why most practices below platform scale use them.
Optometry resource center.
Or read the cross-practice version: finance roles in practice accounting →
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