Virtual Assistant vs. In-House Admin: A Cost Comparison for Therapy Practices

If you’re running a therapy practice and feeling stretched thin, you’ve probably asked yourself at some point: Do I need to hire someone? And if you’ve started researching, you’ve likely run into two options — bringing on an in-house administrative employee or working with a virtual assistant. Before you decide, it’s worth doing a real virtual assistant cost comparison, because the numbers tell a story most practice owners don’t expect.

This isn’t a post designed to talk you into anything. It’s a breakdown of what each option actually costs, what each one gives you, and how to think through the decision for your specific situation.

The True Cost of an In-House Admin Employee

When practice owners think about hiring in-house, they usually think about salary. But salary is only part of the picture. Once you add up everything an employee actually costs, the number climbs fast.

Here’s a realistic breakdown for a full-time in-house admin in a therapy practice:

Base salary: The average administrative assistant in healthcare earns between $36,000 and $48,000 per year, depending on experience and location.

Payroll taxes: Employers are responsible for Social Security and Medicare taxes (7.65% of gross wages), plus federal and state unemployment taxes. On a $42,000 salary, that’s roughly $3,200 to $4,000 annually.

Benefits: Health insurance, dental, vision, and paid time off add significant cost. Even a modest benefits package runs $6,000 to $12,000 per year per employee. Many small practices also offer retirement contributions.

Onboarding and training: Recruiting, interviewing, and training a new hire takes time and money. Industry estimates put the cost of onboarding a new administrative employee between $1,000 and $3,000, not counting the hours you spend doing it yourself.

Office space and equipment: A dedicated workstation, computer, phone line, and supplies add another $1,500 to $3,000 upfront, plus ongoing costs.

Turnover risk: Administrative roles in healthcare see meaningful turnover. If your hire leaves within the first year, you absorb those onboarding costs again.

Realistic annual cost of one full-time in-house admin: $55,000 to $75,000+

And that’s before you factor in the time you spend managing that person, handling HR issues, or covering their hours when they’re out sick or on vacation.

What a Virtual Assistant Actually Costs

A straightforward virtual assistant cost comparison shows a dramatically different number on this side of the ledger.

At Therapy Practice Solutions, pricing is transparent and tiered so practices can start with exactly the support they need:

Hourly Rate: $45/hour, billed as a $180/month package for 4 hours. A great entry point for practices just getting started with delegation.

Minimalist Package (most popular): $340/month for 8 hours, billed at $42.50/hour. Ideal for practices that need consistent light support — scheduling, follow-up, reminders — without a large commitment.

Economy Package: $480/month for 12 hours at $40/hour. A strong fit for solo practitioners managing a full caseload who need regular, reliable backend support.

Professional Package: $608/month for 16 hours at $38/hour. Best for busier practices managing insurance, billing, intake coordination, and client communications on an ongoing basis.

Every plan includes an itemized usage invoice, and all TPS virtual assistants are US-based and HIPAA-certified.

No payroll taxes. Because VAs work through an agency, you are not responsible for employment taxes.

No benefits. No health insurance, no PTO accrual, no retirement matching.

No office space or equipment. Your VA works remotely with their own setup.

No turnover cost. If your assigned VA is ever unavailable, Therapy Practice Solutions handles the transition.

Realistic annual cost with TPS: $2,160 to $7,296 — depending on the package, and scalable as your needs grow.

Beyond the Numbers: What Each Option Gives You

A virtual assistant cost comparison isn’t only about dollars. There are practical differences in what each model delivers, and they matter.

Flexibility

With an in-house employee, you’re committed. You’re paying for 40 hours per week whether your practice is slammed or slow. A VA relationship, especially through an agency, can scale with your needs. Busy season? Add hours. Slower months? Pull back. That flexibility is genuinely valuable for a small or growing practice.

Specialization

A general administrative hire may have little to no experience with therapy practice workflows, EHR systems, insurance verification, or the sensitivity required when communicating with mental health clients. Training takes time, and mistakes during that learning curve can cost you clients and revenue.

A healthcare-specialized VA comes with relevant experience already built in. At Therapy Practice Solutions, our VAs are trained in the specific workflows of mental health, PT, OT, and speech therapy practices before they ever touch your calendar.

Oversight and Management

An in-house employee requires active management: performance reviews, HR compliance, handling interpersonal dynamics, and coverage planning. For a solo practitioner or small group practice, this overhead is often underestimated.

A VA relationship, particularly through an agency, offloads much of that management layer. If performance isn’t meeting expectations, the agency handles it.

Presence and Culture

This is where in-house has a genuine advantage. An employee who is physically present can absorb your practice’s culture organically, build rapport with colleagues, and handle tasks that require being on-site. If your front desk is a high-touch, in-person environment, an in-house presence may be worth the premium.

For most administrative tasks in a therapy practice– scheduling, billing follow-up, insurance verification, intake coordination, client communication — remote delivery works just as well, and often better.

A Side-by-Side Virtual Assistant Cost Comparison

So Which Is Right for Your Practice?

The honest answer is: it depends on your practice size, volume, and the nature of the work.

If you’re a solo practitioner or a small group practice primarily doing remote or hybrid work, the virtual assistant cost comparison almost always favors the VA model. You get capable, specialized support at a fraction of the cost, with far less administrative burden on you.

If you’re running a larger practice with a physical front desk, high walk-in volume, or complex in-office coordination, an in-house hire may make sense for certain roles — but even then, pairing an in-office receptionist with a VA handling backend tasks (billing, insurance, documentation follow-up) is a model many practices are adopting to get the best of both.

The worst outcome is staying stuck: continuing to do everything yourself because the decision feels complicated, while your time and energy quietly drain away.

The Bottom Line

When you run the actual numbers, the virtual assistant cost comparison is clear. For most therapy practices, a healthcare-specialized VA delivers comparable or better administrative support at a fraction of the cost of an in-house hire — with more flexibility and less management overhead. With TPS plans starting at $180/month, the barrier to getting real support is lower than most practice owners expect.

What you do with those savings — whether that’s seeing more clients, investing in your practice, or simply getting your evenings back — is up to you.

If you’re curious what this could look like for your specific practice, Therapy Practice Solutions is here to help you figure it out.

Therapy Practice Solutions provides HIPAA-trained virtual assistants for mental health, PT, OT, and speech therapy practices of all sizes. Contact us today to learn more.

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