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The Challenge of Becoming the Boss: How to Make a Group Practice Work

By Joe Bavonese and Casey Truffo

Q: My full schedule won’t allow me to take on more clients, but I still want to grow my practice and finances. Would starting a group practice be a smart career move?

A: Congratulations on your full calendar of clients! If you’re like most successful therapists in the field, it’s taken years of hard work to build up your practice to this point. But what now? There’s only one of you and only so many hours in a day to see clients. Sure, maybe it seems you’ve reached the promised land of private practices, but—unless you continually raise your fees on your client base—you’ve also hit a glass-income ceiling. The bottom line is this: if you’re a therapist with the enviable problem of having too many clients, adopting a group-practice model could certainly be a good career move, especially if you don’t feel like other ways of padding your wallet, such as writing a bestselling psychology book, are in the cards for you right now.

As it seems you already suspect, a group-practice model is a great way to create a relatively passive income stream. Another benefit of hiring other therapists to work in your practice is having extra associates to help you with marketing and outreach tasks. After all, today’s business of therapy is faster paced and more competitive than ever before, meaning clinicians must approach their work as equal parts therapist, salesperson, and manager. Creating a group practice might seem a far cry from the less versatile “one unit of income for one unit of time” model we learned as fledgling therapists straight out of graduate school, but that’s when therapy as a business took a backseat to therapy as a saintly calling. Nowadays, to succeed in private practice, most therapists need to engage in at least some business-savvy marketing activities—no matter how cringeworthy that task may seem to them.

Laying the Foundation

Switching from having a solo practice to running a group practice is a major transition, so be prepared to ask yourself some serious but practical questions. Once you move from having sole reign over all aspects of your practice, can you be an effective boss and delegate tasks with authority and confidence? Are you ready to let go of a certain amount of control when it comes to dealing with clients? For instance, if you heard someone speak to a potential client on the phone in a tone different from yours, how would you react? And what if an associate mishandled a high-risk client? What would you do?

There’s also the obvious but often overlooked issue of office space. Do you have enough to support a growing practice? In general, you need at least five hours a week of unused office space to start a group practice. This can simply be the time you aren’t in your office (or would rather not be in your office, such as evenings or weekends). One mistake people sometimes make is to get a larger office before they have the clients, staff, or income to support the extra expense. We suggest you wait until you have the cash flow to support a larger office before taking this particular leap.

Additionally, for a group practice to run smoothly, you need to create, test, and revise clear systems for every aspect of the business and make sure this protocol is clearly outlined at the beginning of each clinician’s tenure. It’s easy for a business to fall into chaos when employees aren’t following uniform procedures, including handling money, processing session information, assessing staff performance, handling phone and email inquiries, and assigning new clients to clinical staff. And don’t think that being in charge necessarily makes you exempt from the minutiae of office work. Group practices bring with them a slew of new logistical responsibilities, including carefully tracking where referrals come from, creating monthly reports on therapist and group performance, calculating profit-and-loss statements, and doing payroll. Computer skills are a major benefit in this regard. You can delegate this work to team members or share these responsibilities with them.

Joe’s Experience with Tending the Flock

Leading a business is sharply different from being a colleague or a therapist: it means accepting the responsibilities of being a boss. Not only will you have to hire people, but you’ll have to manage them and regularly assess their performance. Learning to oversee others when you’re used to being your own boss can be tricky. Out of habit, many therapists tend to bring the same compassionate approach they use with clients to their dealings with associates. But being a boss demands that you sometimes say no, disappoint people, and make rules that others feel are unfair or unreasonable. Also, you’ll likely have to make unpopular financial decisions, like foregoing annual raises, based on the health of the business. And yes, those who underperform may have to be fired. But above all, it’s important to be decisive when it comes to making your goals and expectations clear, even if it means people may not always like you. Associates will often assume you make much more money than you do, and they may resent you for it. Or maybe sibling rivalry-like scenarios arise when you seem to favor one clinician over the other, or take on a new hire when an existing therapist has openings in his or her schedule.

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