Practice revenue doesn't move in a straight line through the year. Many practices see a dip after the holidays as patients delay care, and depending on your patient base, summer vacations or back-to-school schedules can create their own soft patches too. If you haven't built a cushion during the stronger months, the slow stretch is when that catches up with you.

A cash reserve isn't the same thing as having money sitting in the operating account. A lot of that balance is usually already spoken for, whether it's an upcoming tax payment, payroll for the next two weeks, or rent that's due. A real reserve is money set aside specifically to cover a revenue dip, kept separate from day-to-day operating cash so it doesn't quietly get absorbed into regular spending.

A common target is somewhere between one and three months of fixed operating expenses, meaning payroll, rent, insurance, and loan payments, not counting variable costs tied directly to patient volume. Where your practice should land in that range depends on how seasonal your specific patient base actually is, which is something worth calculating from your own historical numbers rather than guessing.

Building that reserve starts with an accurate month-by-month picture of the last year or two, so you can see exactly how much revenue actually dips during your slower stretches, and a current P&L that tells you what you can realistically set aside right now without straining the practice you're trying to protect.

This is where a lot of practice owners get stuck, not from a lack of discipline, but because their books aren't organized enough to answer the question of how much they can actually afford to set aside without creating a different problem next month.

September, while things are settling into a steady rhythm, is a good time to look at this seriously before the slow season shows up on its own schedule.

Jeremy Brewer is the founder of 911 Bookkeepers LLC in Baton Rouge, Louisiana. 911 Bookkeepers partners with MBJA Accounting Service to give chiropractic and MDVIP practices clean, current financials. He is a Xero Certified Advisor.