How to pay therapists: salary, per session, per hour or percentage

Paying therapists is probably a therapy centre's biggest expense, and one of the most sensitive conversations within a team. How you pay them affects who stays on the team, how sessions get shared out, and how much time you spend on calculations at the end of the month.

Here are the four most common models, what each one encourages, and what needs to be settled from the start so there are no surprises.

Fixed salary

The therapist receives the same amount every month, regardless of how many sessions they have run.

Advantage: security for the therapist and stability for the team. Children's absences do not affect their income.
Risk: the salary does not follow the workload. A therapist with a full schedule and one with gaps are paid the same, and that can become a source of resentment.

A fixed salary suits the stable core of the team well: coordinators and full-time therapists.

Per-session pay

The therapist receives a fee for each session they run.

Advantage: pay follows the work, and therapists who take on more sessions earn more.
Risk: children's absences hit the therapist's income directly, even though they did not cause them. Without a clear rule, arguments crop up at every cancellation.

The definition matters here: what counts as a session "run"? Usually, a session where the child attended. If you want unannounced absences, which the centre bills for, to also be paid to the therapist, write that down explicitly.

An adult’s and a child’s hands among red and blue counters on a table.

Per-hour pay

Similar to per-session pay, but calculated on the actual length of each session. It suits centres working with sessions of different lengths: long assessments, 45-minute sessions or 90-minute sessions.

Advantage: fairness when durations vary.
Risk: durations must be recorded correctly, otherwise the end-of-month calculation no longer matches reality.

Percentage of revenue

The therapist receives a percentage of what families pay for their sessions. This model appears often in collaborations with partner therapists, who sometimes bring their own clients too.

Advantage: the therapist's income follows the centre's income from their work directly.
Risk: the calculation base needs to be clear. A percentage of what was billed, or of what was actually collected? Are billed absences included? Do discounts given to families also reduce the therapist's share?

Combinations

Many centres use a mix: a base salary plus a per-session fee above a certain number, or a salary plus a monthly bonus. Deductions are added on top of these, for example for an advance payment. Any combination works, provided it can be explained in one sentence.

Two colleagues talking at a wooden table, looking over a handwritten notebook.

What to put in writing from the start

What gets paid: attended sessions, unannounced absences, make-up sessions.
Group sessions and sessions run by two therapists: who receives the session, and how much.
When payment is made, and how the bonus is decided.
Who checks the calculation before payment.

A month-end without surprises

Most calculation errors come from two causes: data gets copied by hand from a calendar into a spreadsheet, and some sessions get marked after pay has already been calculated.

Two habits help a great deal. The calculation starts directly from attendance marked in the calendar, not from a list rebuilt separately. And once a month is paid, it "freezes": the paid figures stay as they are, and any session marked afterwards appears separately, so you can decide whether to add it to the next payment.

Contracts and tax

The type of contract, whether an employment contract or a collaboration contract, has different tax consequences for the centre and for the therapist. Decide it together with an accountant before you settle on a pay model.

In TempoApp

In TempoApp, every team member has their own pay mode: monthly salary, per-session fee, per-hour fee, or a percentage of what families paid for their sessions, plus a monthly bonus and deductions. The calculation starts from attendance marked in the calendar, and a month marked as paid keeps its figures. If new sessions appear after payment, the app shows you.