Professional Consultation

Pros And Cons Of Group Practice (part 1)

A common private practice question is whether a therapist should join a group practice or venture out on their own as a solo practitioner. The answer is different for everyone depending on your strengths, goals, personality, financial needs, and many other factors.

There are also other options in between solo and group practice, like sharing an office space with other practitioners while maintaining your own practice. "There are numerous ways of forming a group practice including cost/office sharing, partnership, and employment as associates under a licensed provider," according to Kansas Psychologist Wes Crenshaw PhD, ABPP of Family Psychological Services, LLC.

To help make your decision easier, here are some of the benefits and drawbacks of joining a private practice group.

Benefits Of Joining A Group Practice

1) Established business systems

If you're considering joining an established practice, a huge benefit is that they already have office systems in place to support the practice. Michigan therapist Jacquelyn J. Tobey, MA, LLP of  Sollars and Associates says, “I have benefited from joining a group because many of the business practices such as marketing and billing are already established.”

2) Shared expenses and responsibilities

Sharing the costs of operating a business can be appealing. Therapists often underestimate the financial requirements when starting a private practice. Sharing operating costs, office space, equipment, marketing, and administrative expenses are just some of the benefits that North Carolina counselor Erika Myers, LPC enjoys about group practice.

Tobey has learned what it takes to run a business by first joining a group practice. She likens a group practice to renting a furnished room in a house that is already built, whereas private solo practice is more like  designing and building the house on your own. I think that is an excellent analogy.

3) Consultation and camaraderie

Meyers enjoys having colleagues to consult with on difficult cases as well as the camaraderie inherent in interacting regularly with colleagues. "The work we do can be isolating, so having fellow professionals around can help you have more social contacts beyond the professional consultation," Meyers says.

Melissa J Templeton, MA, LPC, LMFT compares working in a group setting to a good relationship. “Like a good marriage, it is the ‘fit’ of the various personalities that determines whether the cohabitation is going to work and work well,” shares Templeton.

4) Referral sources

Illinois counselor Melanie Dillon, LCPC, at Center For Wellness, Inc values the internal referrals generated within her multidisciplinary practice.

My business partners are both chiropractors. One provides acupuncture/Chinese medicine and the other chiropractic care/sports medicine. We have also employed a massage therapist. This way we have created a system that supports internal referrals. The other benefit is that all expenses are now shared, and that my income is no longer dependent on how many clients I see, but on the group as a whole.

Now that you have a feel for the benefits of joining a private practice group, check back later this week for part 2 - the drawbacks of group practice.

(c) Can Stock Photo From your experience, what are the benefits of joining a private practice group?

Why I 'Broke Up' With Managed Care (Part 2)

Several months ago I wrote a post titled, "Why I Broke Up With Managed Care" that stirred up some passionate discussion! While I understand that it's not the route for every private practitioner, I have continued to build a private practice free of managed care and recently hired my 12th therapist.

While we don't bill insurance directly, we do give a superbill to clients so they can seek reimbursement from their health insurance so they can still use their benefits. As I've continued to write this blog, I've come across several therapists who have also "broke up" with managed care and asked them why they decided to build a fee-for-service therapy practice. Here's what they had to say:

Increased Reimbursement Rate

I've been in private practice for over 15 years. So, I experienced the first major transition of health care to "managed" care. I had friends and colleagues who began working in the managed care industry, and it quickly became clear to me that despite all the rhetoric about the necessity for evidenced-based care (which can be a very useful model of care), managed mental health care was really about making corporate the work of individual psychotherapists.

I also did the math. The last time I checked, insurance reimbursement was the average rate charged by psychotherapists in the 1980s. Today, I can afford to have two additional office hours available for new clients, by taking just one fee-for-service patient. This also allows me more discretion in seeing clients who are needing a low fee. Will Courtenay, PhD, LCSW "The Men's Doc"

Control Over Therapeutic Work

I wanted the freedom to determine, along with parents, the course and length of treatment and felt managed care would impede on that. Pam Dyson, LPC, RPT

My training is in social work, which is the source of the old adage "start where the client is at." That's my barometer for treatment, not where an insurance company believes my client and I should start or end our work. Will Courtenay, PhD, LCSW "The Men's Doc"

Increased Client Commitment to Therapeutic Process

Being a Christian counselor, by law I cannot bill insurance, even if I could I think private pay gives each person responsibility in the therapeutic efforts. When people  have to pay it makes them take their  therapy more seriously. Natalie Davis

No Diagnosis Required

My services are specialized in that I will work with children as young as three, something many therapists in my area will not do. The problems child clients present with are often not clinical but rooted in the parent-child relationship. I feel strongly that young children do not need a diagnosis on their permanent health record. Pam Dyson, LPC, RPT

More Time With Clients (Less Time Doing Paperwork)

I had worked in a managed care setting in the past, and I decided that in my practice that I want to avoid the incredible amount of paperwork, defending sessions, and over-diagnosing.  I also think it provides clients with more privacy. Sara Levitsky, LMSW, Birmingham Counseling For Women

Paperwork was the other major decision (in building a fee-for-service practice). I put a great deal of time and energy into my work with clients outside of our scheduled hours, including receiving professional consultation on a consistent basis. I have no time or patience for administrative busywork. Will Courtenay, PhD, LCSW "The Men's Doc"

More Flexibility To Offer Reduced Fees

Like Dr. Courtenay mentioned earlier in this article, when his practice is doing well financially, he has more (not less) time to devote to seeing clients at a reduced fee. I have found the same to be true. As my practice grows I am able to offer more free community workshops and do more pro bono work.

Do you run a fee-for-service mental health therapy practice? What led to your decision?

5 Common Myths About Private Practice

Five1) If you build it they will come

One of the most difficult challenges of private practice is finding consistent referral sources. Come up with a marketing plan and secure a few referral sources before you hang up your "shingle." (Read Private Practice Marketing Made Easy)

2) My only overhead expense will be leasing office space

Not so. Plan on buying software for billing and record keeping, malpractice insurance, business license, incorporation fees, professional consultation, website costs, paper goods, furnishings, marketing materials...

3) I'm a good therapist so I'll have plenty of clients

There are plenty of great therapists who don't make it in a private practice setting. While being a skilled therapist helps you keep clients and makes it more likely that your current clients will refer friends and family to you, it has nothing to do with actually getting clients in the door of your practice.

4) I'll make a lot of money

Unfortunately, most start up businesses fail, and a private practice is a business. While there is potential to become very profitable, that isn't always the case. In my experience there's a lot of ebb and flow in terms of referrals and direct care hours so you can expect some months will not be as profitable as others. Additionally, all of your taxes will come directly out of your profits each year.

5) It'll be much less work than working for an agency

While it is amazing to be the "boss" and have the freedom to set your own schedule, see the clients you want to see, decide what paperwork you'll require, there is a flip side. You'll also be dealing with all of the billing, marketing, client complaints, and practice management tasks that were once taken care of by someone else.

What are some myths you used to believe about private practice?

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Business Planning: Does Your Private Practice Have A Treatment Plan?

Lamy Safari Fountain PenMany private practice therapists don't have a business plan or think of themselves as a "business owner."  A private practice is a business and successful businesses have a plan to help guide their growth. Even if you've never taken a business course you already know how to write a business plan.  Think of your private practice as a "client" in need of a clinical treatment plan.  Here are some tips to transform your clinical assessment and treatment planning skills into a private practice business plan so you have a clear path to grow your practice.


Presenting problems and current complaints Identify current problems or weaknesses in the business aspect of your practice. Do you need more weekly client hours? Are you having difficulty collecting money in a timely manner? Do you have inconsistent billing practices?  Are you barely breaking even because of high overhead?

Strengths and resources What personal strengths do you bring to your practice that will help you address the presenting problems? Do you have extensive referral network with physicians? Are you detail oriented when it comes to paperwork and billing? Are you a creative problem solver? Or maybe your an excellent writer. List your strengths.

Business history What events in your practice that have shaped your business practices? Did you have some rough patches where you weren't profitable that have left you feeling fearful and desperate for referrals? Have you experienced any kind of positive successes or painful experiences in the business end of your practice that haven't been resolved? Write them down.

Business support system Just as you'd assess for client support network, take a look at your business support system. Do you feel isolated? Are you using outdated computer software that makes billing tedious? Do you have some colleagues or business consultants that you can go to for professional consultation? Identify your current support network as well as areas where you could benefit from additional support.

Treatment plan

Setting goals Identify 3 business related goals for your private practice. Break your goals into specific, measurable, timed objectives. Finally, add three action items to move you toward each practice goal. Remember, you know how to do this for clients, just shift your mindset to the goals of your business. Here's an example of a treatment plan for your business:

Goal: Reach 20 clients hours weekly.

Objective: Cultivate 3 consistent referral sources in the next 90 days.

Action 1: Set up practice website on to build online referrals by Nov 15.

Action 1: Send letters and business cards to all family practice doctors within 10 miles of my practice by end of this month.

Action 1: Contact a local TV news station to seek interview on how to successfully blend step-families by this Friday.

Now it's your turn to write a treatment plan for your private practice.

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