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.
In fact, I recall a situation with a new therapist who came highly recommended. She joined our staff, and I immediately gave her a lot of new clients. I usually follow new clinicians carefully when they first start, but because of her stellar recommendations and how busy I was at the time, I took my eye off the ball. Looking at her statistics a few weeks later, I was shocked to see that we’d given her 13 new clients, and 11 of them had come for only one or two sessions before calling it quits. The clients’ needs were clearly not being met, and we were losing money with each client we passed to our new hire.
When I met with her to talk about it, she got defensive, saying we had “terrible clients” at our center. I calmly replied that I was only comparing her performance to the other clinicians on the staff, all of whom get the same type of referrals. In response, she said I was intimidated by her expertise and that our center was a horrible place to work. Her poor performance, unwillingness to discuss it constructively, and negative attitude weren’t tenable for our work environment. “Maybe this just isn’t a good fit for either of us,” I told her. She agreed, and we parted ways. That day, I learned an important lesson: hiring staff is a lot like dating. A lot of people look good on paper, but you never know how compatible you are until you spend time with them.
Casey’s Experience with Reaping the Rewards
I’ve brought mostly senior clinicians into my practice—outstanding therapists with years of experience. Of course, we all understand that a client might miss an appointment here and there or change frequencies from, say, weekly to monthly sessions. However, with my clients, if I feel there’s a clinical need for them to be in therapy regularly, I share my thoughts with them because I believe they look to us to be leaders in their treatment. I follow a 48-hour cancellation policy and look to fee-setting and collection as a clinical issue as well as a practical one. Yet a couple of the associates I brought in felt that fee-setting and collection was “admin work” and were ignoring those issues. I had to sit these senior clinicians down and have a frank discussion with them. Delicately and with a bit of trepidation, I told them that if they ignored late cancellations or allowed clients to change appointments without discussion, then they’d be putting the financial state of the practice in jeopardy. Although they understood immediately, it took additional modeling, training, and encouragement to turn it into a practice in our center.
With a solo practice, you may be used to a measure of personal and financial stability, so the road can be rough for those adjusting to group practices, especially at the beginning. Be prepared for speed bumps and potholes along the way, and know that a positive long-term attitude is necessary. As both Joe and I recall, it was scary putting in the extra expenses needed to get a group practice started. We both grappled with buying more furniture, getting larger, more expensive offices, and hiring an office assistant. At first, thousands of dollars were going out, and not much was coming in. For Joe, the worst part was having someone take over his billing. He was terrified that a typo would cost him hundreds of dollars in lost revenue. But knowing the ins and outs of therapeutic relaxation techniques, meditating, and having a business coach helped him realize that letting go of control was essential for growing his practice. And grow it did! It took three years, but he still talks about the first time he came back from a vacation and discovered more money in the business account than when he left—which would never happen for a solo practitioner.
If you do decide to make this transition yourself, remember to stay focused on your vision for the future. Don’t be discouraged if you make a few rookie mistakes when it comes to hiring, firing, staff management, billing, and office selection. There’s a learning curve here, and changing to a group practice isn’t without risk. It’s a complex undertaking that can be an emotional roller coaster—exhilarating and terrifying, often in the same day. But if you have the dedication to succeed, it’s definitely worth the ride.
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