In-house or outsourced: what it actually costs.
Most comparisons put a salary next to a monthly fee and stop. This one includes payroll burden, vacancy, ramp and recruiting: the costs that are real, recurring, and almost never in the spreadsheet.
- SalaryIn-houseThe line every spreadsheet hasCounted
- BurdenPayrollTaxes and benefits on top of payCounted
- VacancyTurnoverCalls and claims while the seat is emptyCounted
- RampTrainingWeeks before a new hire is up to speedCounted
- QuoteOutsourcedYour number until you have a real oneYou enter it
Four costs that are real, recurring, and usually left out
The calculator below counts every one of them, and on plenty of realistic inputs it still concludes that in-house is cheaper. That answer is yours to have.
- 01
Payroll burden
Taxes and benefits sit on top of salary, so a salary next to a monthly fee understates the in-house side before anything else is counted.
- 02
Vacancy
Every departure leaves a gap where calls go unanswered, verification slips and A/R ages. It is a real, recurring cost, not an edge case.
- 03
Ramp
A new hire takes time to learn your system, your payers and your rules. That stretch is paid for whether or not the work gets done.
- 04
Recruiting
Then you pay to hire again. Leaving turnover out is the single biggest reason this comparison usually comes out wrong.
Your in-house cost
Turnover: the part usually left out
The alternative
Annual comparison
Outsourcing costs less by
$66,359
Turnover alone (vacancy, ramp and recruiting) accounts for 9% of your in-house cost. That is the number practices leave out.
Every figure above is yours except one.
The outsourced monthly cost is whatever you typed in. Until that line is a real quote for your locations, your system and the work you actually want covered, the comparison is only as good as your guess at it.
Tell us the shape of your practice and we will put a real number in that box. If it comes back higher than your in-house total, you will have learned something useful for the price of one conversation. What sits behind that number is set out on our dental billing and front office services page.
Why does this include turnover?
Because leaving it out is the single biggest reason the comparison usually comes out wrong. Front-office turnover is high across the industry, and every departure creates a gap where calls go unanswered, verification slips and A/R ages. Then you pay recruitment and ramp costs again. It is a real recurring cost, not an edge case.
Can this conclude that in-house is cheaper?
Yes, and on plenty of realistic inputs it does. A calculator built by a vendor that always favors the vendor is a sales device. If your turnover is genuinely low and your team is stable, keeping it in-house may well be the right answer, and you should have that answer rather than a rigged one.
What isn't captured here?
Revenue effects. A front desk that answers more calls books more patients, and recovered A/R is money you already earned. Those move the picture further than cost alone, but they depend on your specific conversion rate and payer mix, so putting invented numbers in would be worse than leaving them out.
What should we do with the result?
Use it to decide whether to have the conversation at all. If the gap is small, stay in-house and fix retention. If it is large, the next step is scoping one workstream rather than switching everything.