Two audiences read a midwifery group's books
Ontario midwifery is funded through Transfer Payment Agreements between the Ministry of Health and each practice group, so the group's ledger answers to two audiences at once. The funder expects billings, operational spending and reporting that reconcile to the agreement. The members, who are self-employed practitioners rather than employees, each need an accurate statement of fees earned and costs shared for their own tax filings. Almost every bookkeeping mess we untangle in this niche comes from serving one audience and forgetting the other.
Our End-to-End Accounting service covers the whole cycle under one roof: monthly bookkeeping in QuickBooks Online, payroll for clinic staff, the February slip run, the funder reporting, and a year-end package for each member.
Course-of-care billing is a revenue cycle, not a sales ledger
A course of care runs from early pregnancy through six weeks postpartum, so a single unit of revenue is earned over the better part of a year, at Ministry rates that rise with each midwife's experience level. Transfers of care create partial courses at partial rates. The books therefore need to track courses by midwife and by status: opened, completed, billed, paid.
We reconcile that ledger to Ministry remittances every month. A remittance that disagrees with the course log in November is a phone call; the same discrepancy found at year-end, buried in twelve months of activity, is an archaeology project. Monthly closes are what make the annual reconciliation the agreement requires an export instead of a scramble.
Three funding streams, three reconciliations
| Money in | What it pays for | It must tie to |
|---|---|---|
| Course-of-care fees | Members' clinical work, at each midwife's experience level | Every member's course log and her share of the year's distributions |
| Operational funding | Clinic rent, administration and supplies | The overhead budget and the actual spending reported back to the funder |
| Per-birth payments | Second attendants and locum coverage | Birth records and the T4A totals issued in February |
Dumping all three streams into one income account is the classic error. Each stream has its own reconciliation and its own reader, and the chart of accounts should be built to keep them separate from the first entry. Where a funding agreement calls for more formal year-end statements, our Compilation & Review Engagements work sits on top of books that already reconcile, which keeps that engagement short.
Paying people on the right paper
A practice group pays four kinds of people, on two kinds of slip. Clinic administrators and reception staff are employees: payroll with source deductions remitted on schedule, and T4s by the last day of February. Midwife members, locums covering a leave, and second attendants paid per birth are generally self-employed, which puts their fees on T4A slips, box 048, due the same day.
The second-attendant file deserves its own care. Ontario midwifery standards put two attendants at every birth, so these per-birth payments recur constantly, in small amounts, across many payees. Tracked casually, they surface in February as a pile of unmatched e-transfers. We log them per birth as they happen, so the slips are a report, not a reconstruction. Get any of this paper wrong and every member starts her T2125 from a number she cannot verify.
A member's leave adds a bookkeeping wrinkle worth naming: while a locum carries her caseload, the course fees follow the locum, but the member's overhead share usually keeps accruing. The books have to show both cleanly, month by month, or the return-from-leave statement turns into a negotiation. Receipts flow in through Dext, so the record is built the day the expense happens, not at year-end.
Overhead sharing without the December argument
Groups split clinic overhead by equal shares, by caseload weight, or per course of care. The method matters less than writing it into the practice agreement and applying it identically every month, because new registrants building a caseload and members on reduced practice are exactly where an equal split quietly becomes an unfair one. Our monthly member statements show each midwife her fees, her overhead share and the arithmetic between them, which is how the December argument gets cancelled in January.
One structural fact sits under every overhead decision: midwifery services are HST-exempt, so the group registers for nothing and recovers nothing. The 13% on rent, software, clinic supplies and equipment is simply part of the cost, and a budget that quotes sticker prices understates real overhead by design. We build the tax into the budget from the first draft, for practice groups in Mississauga and across the GTA.
