Why Don’t I Get Paid More? Understanding Pay, Profit, and Margin in Allied Health

The Honest Question

If you’ve ever wondered, “Why don’t I get paid more?” — you’re not alone.

It’s a question many Allied Health clinicians ask, especially when they see the hourly rate they’re billing. If you're bringing in close to $200 an hour, it’s natural to wonder where that money actually goes — and why it doesn’t show up in your pay slip.

The answer lies in understanding the real costs of employment, how margins work in Allied Health, and what it actually takes to run a financially sustainable practice.

This blog is for both clinicians and business owners who want to bridge the gap between billables, pay, and profit — and start having clearer, more informed conversations about the numbers that shape our sector.

Why We’re Using NDIS as an Example

Let’s get this out of the way: the NDIS isn’t the only model in town.

But it’s what most people are familiar with — and because the price guide is public, it makes a great case study for understanding how Allied Health billing and business costs work.

The same principles apply whether you’re billing:

• Private clients

• Medicare

• DVA

• Aged Care

• WorkCover
  

The Classic Misconception

“25 hours × $193.99 × 52 weeks = $250K. So where is that money going?”

It’s simple maths… but it’s based on a flawed assumption.

That number assumes:

• No leave

• No cancellations

• No onboarding

• No professional development

• No admin

• No lost time between sessions

It also assumes a clinician can bill at full rate, year-round, with no interruption — which doesn’t reflect how any real service (or human!) operates.

Why Smart Providers Use 44 Weeks, Not 52

Smart Allied Health businesses don’t assume 52 perfect weeks.

Instead, they should use 44 billable weeks per year, because that accounts for:

• 4 weeks annual leave

• 2 weeks personal leave (sick days, carer’s leave, etc.)

• ~2 weeks public holidays

• Plus any other lost time to CPD, admin, or team days

So when you recalculate: 25 hrs/week × $193.99 × 44 weeks = $213,389

That’s a lot less than $250K — and it’s just the top line.

Now let’s dig into what it costs to generate that revenue.

What a Clinician Really Costs a Business

Here’s the thing: your base salary is just one part of the picture.

When a business employs a clinician, they also carry costs like:

• Superannuation (11.5% and increasing to 12% in July 2025)

• Leave entitlements (you’re paid even when you’re not billing)

• Insurance, WorkCover and Payroll tax

• Admin and team support (reception, scheduling, onboarding, HR)

• Clinical supervision

• Professional development

• Practice management systems, tech, and subscriptions

• Laptops, phones, vehicles

• Office space, rent, insurance, compliance, accreditation

Most sustainable providers use a 1.5× salary multiplier to estimate “fully loaded cost.”

So if your salary is $100,000 — the real cost to your employer is closer to $150,000.

💡 Want to calculate your team’s real costs and margins? 👉 Download the free Allied Health Margin Toolkit to get the checklist, cost calculator, and revenue examples.

A Worked Example

Let’s say you’re working in NDIS, billing at $193.99/hour, aiming for 5 billable hours/day.

Here’s the math:

• 5 hours/day × 44 weeks = 1,100 hours/year

• 1,100 × $193.99 = $213,389 revenue

Now compare that to your cost:

• Salary = $100,000

• Fully loaded cost = $100,000 × 1.5 = $150,000

Gross margin = $213,389 – $150,000 = $63,389 (~29.7%)

Seems good — but only if you're working at full capacity from day one, with zero cancellations and no underutilised time.

Ramp-Up Realities: New Hires Aren’t Profitable Right Away

Even high-performing clinicians take time to reach target.

Here’s a typical ramp-up:

• Month 1: 2.5 billable hours/day (50%)

• Month 2: 3.5 hrs/day (70%)

• Month 3: 4.5 hrs/day (90%)

• Month 4+: 5 hrs/day (100%)

That brings your Year 1 average to 4.5 hrs/day.

So now the revenue looks more like: 4.5 × $193.99 × 44 = $192,050

With a fully loaded cost of $150,000, your margin drops to: $42,050 (~21.9%)

Still sustainable — but tight.

And that’s with no major client issues, system failures, or unexpected leave.

So… Are Businesses Making a Fortune?

In short: no — and many are barely breaking even.

While some providers are profitable, a significant number are struggling to stay sustainable.

Margins in Allied Health are:

• Tighter than ever, especially in NDIS-funded services

• Vulnerable to cancellations, staff turnover, and leave

• Eroded by rising wages, compliance demands, and operational costs

• Highly variable, depending on service model, systems, and scale

Even well-run businesses are often operating on slim margins, reinvesting every spare dollar into:

• Staff recruitment and retention

• Supervision, training, and onboarding

• Tech and system improvements

• Admin and compliance overhead

• Keeping the doors open during slow months

The reality is: most providers aren’t making “good profit” — they’re working hard just to make things work. And that’s why understanding real costs and margins matters so much — for everyone.

Good Profit vs. Profiteering

Let’s name the elephant in the room: “profit” often gets treated like a dirty word.

But there’s a huge difference between:

✅ Good profit:

• Supports growth and stability

• Reinvests into team and infrastructure

• Enables quality and continuity of care

❌ Profiteering:

• Prioritises short-term gain

• Undervalues staff

• Cuts corners or exploits funding

In my experience, the vast majority of providers are doing their best to run fair, values-driven businesses in a tough system.

📊 Curious about how your margins compare? 👉 Book a free 30-minute strategy call — we’ll look at where you’re losing profit and how to fix it.

Why Margin Still Matters

Margins aren’t optional — they’re essential for survival.

In a sector like Allied Health, where so much time and energy goes into care delivery, it’s easy to forget that behind the scenes, margin is what keeps the business functioning. It’s the difference between a team that thrives and one constantly scrambling to keep up.

Here’s what a healthy margin makes possible:

Withstanding Cancellations and Client Churn

No-shows, cancellations, and temporary client disengagement are part of everyday life in Allied Health. A business without margin has no buffer — meaning a few bad weeks can derail payroll, service delivery, or team morale.

Paying Staff Through Quiet Periods

Utilisation ebbs and flows. School holidays, public health crises, or staffing gaps can all cause dips in revenue. Margin allows businesses to keep paying their team even when billables dip, providing financial and emotional security for staff.

Investing in CPD, Supervision, and Innovation

Ongoing development is critical for both clinical quality and staff retention. But CPD costs time and money — especially when clinicians are taken offline. Without margin, there’s no space to fund learning or grow internal capability.

Upgrading Systems and Reducing Admin Fatigue

Running lean can save money in the short term, but poor systems lead to inefficiency, frustration, and burnout. Margin enables investment in automation, better platforms, and admin support — so clinicians can spend more time doing what they’re trained to do.

Providing Real Job Security

Without healthy margins, every resignation, cancellation, or audit feels like a crisis. Margin helps businesses withstand external shocks — and ensures people have jobs that last longer than one funding cycle.

Ultimately, margin isn’t about making money for the sake of it — it’s about creating space for sustainability.

When a business has no margin, it can’t invest in people, systems, or quality care. It runs reactively, not strategically. And that affects everyone — from leadership to the frontline, and ultimately, to the clients.

What Clinicians Can Do

If you’re a clinician who cares about sustainability (and wants to help make room for higher pay long-term), here’s what helps:

• Understand your targets — and why they matter

• Track avoidable cancellations and help rebook

• Use systems that reduce admin drag

• Be proactive during onboarding

• Communicate openly about resourcing, caseloads, and capacity

• Ask questions with curiosity, not confrontation

Financial literacy isn’t just for owners — it empowers everyone.

Large vs. Small Providers

Larger providers

Often have:

• Higher overheads (management, HR, systems)

• More structure, training, and career pathways

• EAP, internal CPD, supervision

• Consistent policies and processes

But may offer:

• Slightly lower base pay

• Less flexibility

Smaller providers

Often offer:

• Higher pay or performance bonuses

• Closer culture and quicker decisions

• Flexibility and visibility

• Opportunities to shape how things work

But may have:

• Less structure or supervision

• Leaner systems and admin
  

Clinic vs. Mobile Models

• Mobile services (home/community visits) usually have fewer overheads — so may offer higher pay

• Clinic-based services carry extra costs (rent, reception, fitout) — but offer co-located teams, stability, and in-person support

There’s no “best” model — just trade-offs. It’s about finding what aligns with your goals and personality.

Transparency Builds Better Teams

The most productive, positive teams aren’t just well paid — they’re well informed.

When clinicians understand the real numbers, and owners share honestly, everyone benefits:

• Trust improves

• Engagement rises

• Culture deepens

• Performance lifts

These aren’t just “business problems” — they’re shared challenges.

Final Thought

We all want to do meaningful work — and be fairly rewarded for it.

But if we don’t understand the real costs behind Allied Health, we risk falling into blame, burnout, or unrealistic expectations.

The truth is: most providers aren’t hiding money — they’re working hard to keep the doors open, care flowing, and teams supported.

And when profit and purpose are aligned? That’s when sustainable, impactful Allied Health happens.

👉 Want to go deeper?

Download the free Allied Health Margin Toolkit — a practical resource with checklist, cost calculator, and real-world examples to help you strengthen your margins and build a sustainable practice.

Let’s make sense of the numbers — so we can all keep doing work that matters.

📞 Want help making sense of your margins?

If you’re unsure where your biggest profit leaks are — or just want a fresh set of eyes on your numbers — I offer a free 30-minute strategy call for Allied Health business owners and practice leaders.

We’ll look at where you are, where you’re stuck, and what smart, sustainable strategies could help you move forward.