The Clinician's Guide to Business: How to Create, Sustain, and Grow Your Own Group Practice

By Elizabeth Burke LCSW and Dr. Jessica Renz Psy.D.

Launch your new business and gain control of your career



Are you feeling a bit stuck in your current role? Is your life as a therapist not quite what you imagined it would be? Then maybe it's time for a change.

If you're considering opening your own private practice but don't know where to start, The Clinician's Guide to Business will empower you to overcome the limitations of your graduate training, manage worries about your potential as an entrepreneur, and ultimately build a group practice that matches your skills, interests, and values. Drawing on their extensive experience as therapists and group practice owners, authors Elizabeth Burke and Jessica Renz will teach you how to apply your clinical skills to a business context, make tough decisions about marketing, hiring, and client satisfaction, and develop resilience in the face of unknowns.

• Language: English
• Publisher: BookBaby
• Release date: Feb 29, 2024
• ISBN: 9798350930832

Book preview

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Names and identifying characteristics of clients have been changed to protect the privacy of the individuals involved.

Please note that the authors are not engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this book are for informational purposes only and are not intended as a substitute for consulting with legal, financial, and/or mental health professionals. The regulations and legislation governing psychotherapy practices vary by state and can change from year to year; we encourage you to consult with an attorney knowledgeable about your local laws before making any business decisions. The authors shall not be liable or responsible for any loss or damage allegedly arising from any information in this book, or from any errors, inaccuracies, omissions, or inconsistencies herein.

To our colleagues at Empowered Therapy and MindWell NYC, with appreciation

The Clinician’s Guide to Business:

How to Create, Sustain, and Grow Your Own Group Practice

©2023 Elizabeth Burke, LCSW and Jessica Renz, Psy.D.

All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review.

print ISBN: 979-8-35093-082-5

ebook ISBN: 979-8-35093-083-2

Table of Contents

Introduction

Meet the Authors

Confronting the B Word

PART ONE

Chapter 1: Changing the Narrative

Identifying Your Worry Thoughts

Managing Your Worry Thoughts

Chapter 2: Is Group Practice Right for You?

Case Study: Alexa

Solo Practice: Pros and Cons

Group Practice: Pros and Cons

Chapter 3: Imagining Your Ideal Practice

Your Personal Values

Your Day as a Clinician

Your Clinical Sweet Spot

Your Ideal Private Practice

Chapter 4: Finding Emotional and Professional Support

Emotional Support from Others

Emotional Support from Yourself

Professional and Collegial Support

Mentorship

Chapter 5: Tolerating Uncertainty

Financial Uncertainty

Professional Uncertainty

Personal Uncertainty

Increasing Mindfulness of Your Experience of Uncertainty

Strategies for Moving Forward

Exposing Yourself to Uncertainty and Change

Coping Ahead

PART TWO

Chapter 6: First Steps

Office, Telehealth, or Hybrid?

Choosing an Office

Choosing a Name

Forming a Corporation

Chapter 7: Administrative Needs

Online Presence

Electronic Medical Records

Intake Paperwork and Informed Consents

Client Management Systems

Clinical Documentation

Billing and Insurance

Market Considerations

The Challenges of Insurance

Back Office Systems

Chapter 8: Finding Clients

Building and Optimizing Your Website

Paying for Advertising

Finding the Right Type of Help

Investing in a Marketing Agency

Measuring the Data

The Necessity of Social Media

Handling Reviews

Chapter 9: Hiring: When, Where, How, and How Many?

W-2 Employees or 1099?

Full-Time or Part-Time?

Where to Find Hires

Interviewing Potential Hires

Clinical Questions

Admin & Fit Questions

Onboarding

Capturing Clinical Expertise

Hiring Admin Staff

Practice Manager or Lead Admin

Billing Manager

Intake Manager

Consulting Outside Experts

Employment Attorney

Accountant

Chapter 10: Client Satisfaction

Evaluating the Client Experience

Making the Client Experience Seamless

Educating Clients on Your Services

Streamlining Paperwork

Initial Consultation and Fit

Clinician Availability and Competencies

A Note About Communication with Clients

Chapter 11: Employee Well-Being and Retention

Financial Well-Being

Fee-for-Service vs. Salary

Benefits

Emotional Well-Being

Team Meetings & Checking In with Staff

Self-Care and Time Off

Building Community within Your Practice

Internal Newsletters

Social Activities

Chapter 12: Creating Systems for Employee Growth

Clinical Supervision

Mentorship

Didactics

Career Development

Planning for Growth

Providing Supervisory Opportunities

Providing Program Development Opportunities

Chapter 13: Managing Yourself

Finding Your Role

Externalizing the Business

Chapter 14: Setting Yourself Up for Financial Success

Final Thoughts

Acknowledgments

Appendix 1: Sample Informed Consent (State of Illinois)

Appendix 2: Sample Mental Health Intake & Evaluation Form

(State of Illinois)

Appendix 3: Sample Mental Health Progress Note

(State of Illinois)

Appendix 4: Sample Annual Review

References & Recommendations for Further Reading

Introduction

Think back to when you first decided to become a therapist. What did you imagine that would look like? What kinds of clients or conditions did you anticipate treating? Did you dream of your office looking a certain way, or of working alongside a certain kind of colleague? How did you think you would feel about your career?

Now compare that dream to your current work environment. How do they match up? Are you providing the kind of care you always wanted to provide, or are there discrepancies between your ideal vision and your day-to-day reality? Do you feel regularly fulfilled in your current position, or are you feeling a bit stuck? We have no doubt that you’re fully committed to your clients and your chosen profession. Even so, there’s no shame in admitting if the precise conditions of your current work environment aren’t quite what you imagined as a bright-eyed trainee. Many clinicians end up languishing in a position that’s not the best fit for them, either because they’re unaware of the alternatives or unsure of how to pursue other paths within the mental health profession. If this sounds familiar, and if you’re ready to consider other options, then this book will open your eyes to the thrilling (and terrifying) possibility of opening your own private practice.

Many of you are probably intimately familiar with private practice already. After all, the APA’s 2021 Survey of Health Service Psychologists reported that 59% of clinicians work in a private practice (either solo or group) as their primary work setting. However, there’s a clear gulf between working in someone else’s practice and launching your own business. Joining an existing group practice can be a great way to learn about the business side of the profession while also gaining valuable clinical experience, but you may have reached a point where you find yourself wanting more. If you picked up this book, then you’ve probably already been thinking about pursuing some changes in your career: maybe you’re looking for more autonomy, more income, or a practice that better matches your values and interests. Whether you’re fresh out of grad school or a seasoned clinician who’s been practicing for decades, it may be time to stop building someone else’s business and start building your own.

Creating your own practice has countless possible advantages: the potential for better work-life balance and higher earnings; the freedom to choose the kind (and number) of clients that you want to work with; greater diversity in your day-to-day tasks; and the ability to mentor fellow clinicians and create a positive, fulfilling work environment for an entire team of people. Given this laundry list of benefits, why doesn’t everyone open their own group private practice? Well, this model has challenges, too. Filling caseloads can be difficult, especially at first; overhead costs can be quite high; and there are a million different balls to juggle beyond just clinical care. Moreover, the market for private sector businesses is fiercely competitive. According to the United States Bureau of Labor Statistics, close to 20% of businesses fail within their first year, marking one in five businesses as dead in the water. Even if you make it past the first year of operations, you may not be in the clear: the number of failed businesses triples over the course of the first five years and quadruples within ten.

Those numbers are certainly daunting—but that doesn’t mean you should abandon the idea of entrepreneurship altogether. While some aspects of the overall economy—and of the therapy market in particular—are unpredictable and outside your control, there are many elements of private practice ownership that you can control in order to better ensure your survival during those uncertain early years and ultimately emerge with a thriving business. The demand for mental and behavioral health services is certainly there: according to the APA’s 2022 COVID-19 Practitioner Impact Survey, six in ten practitioners report that they no longer have openings for new patients; nearly half (46%) say they are unable to meet the demand for treatment; and nearly three-quarters (72%) have longer waitlists than before the pandemic. In short, more people than ever want and need therapy—and you have an opportunity to meet that need. The trick to minimizing risk is to develop a business plan that’s tailored to you: to your ideal clients, your clinical competencies, your interests and values, and your local market. Moreover, you’ll need a crash course in certain aspects of the business world, including accounting, marketing, and human relations—domains that likely weren’t covered in your graduate education. The good news is, you don’t need an MBA—or any formal training at all—to run a successful private practice. All it takes is a bit of preparation, some self-education, a reliable support system, and a willingness to tolerate some risk and uncertainty.

The purpose of this book is to outline a clear, achievable path from the already complex job of working as a clinician to the even more complex job of operating a successful group private practice, complete with concrete guidelines and milestones along the way. But before we dig into the details of what it takes to make this professional leap, you may be wondering: who are we (the authors)? And what makes us qualified to offer this kind of guidance?

Meet the Authors

Who are we? The short answer is: we’re clinician-entrepreneurs who each run our own group practice and who have spent years consulting with other therapists looking to make that same career leap.

Jess is one of the co-founders and co-owners of Mindwell NYC, where she and her team have been offering in-person services for over six years and telehealth for three. She specializes in working with young adult women with challenges related to depression, anxiety, life transitions, and overall health. The team at Mindwell NYC consists of psychologists, social workers, and a licensed mental health counselor, with a mix of clinical specialties that allows them to treat almost every age range, from child to adult. MindWell recently added psychological testing services to their offerings as well. Currently, Jess spends her days doing a combination of therapy work in client-facing interactions while also managing some of the backend admin work for the business. Both activities allow her to experience greater freedom and flexibility as a clinician and ultimately feel life-giving to her as a business owner.

Lizzie runs an equally successful practice as the founder and owner of Empowered Therapy in Chicago. With extensive training in (and passion for) working with women, Lizzie launched her practice in 2016 with the specific goal of treating women with anxiety, depression, and relationship issues. Since opening its doors, Empowered Therapy has grown to a practice of almost 40 employees, with telehealth services for individuals, couples, and families, as well as an in-person office in downtown Chicago. Empowered also recently added medication management services to augment the therapy services they offer. In addition to her work as a clinician and group private practice owner, Lizzie also enjoys consulting with other clinicians who are looking to start their own individual or group practices.

We’re frequently asked how we managed to create successful practices that have withstood the test of time, especially when so many businesses fail in the first few years. One of the only resources we had when starting this venture was an outdated textbook from the year 2000—a book that obviously hadn’t kept pace with the rapid changes in the industry, technology, and the world at large. There were very few formal courses or certifications specific to private practice ownership, and we received almost zero information on the topic in our graduate education. But despite these limited resources, we both figured out (after much trial and error) how to sustain a healthy business.

Though both of our journeys have been quite positive (albeit complex), we couldn’t help but feel that opening a new practice shouldn’t be so daunting or isolating. It shouldn’t require clinicians to reinvent the wheel each time, or to make the same mistakes that other ambitious practitioners have made before them. Thus, we wanted to share our experiences in the hope of streamlining the path from clinician to entrepreneur, thereby raising the overall success rate of new practices.

Confronting the B Word

Despite the dated advice in that textbook we found, we quickly realized that it was, at its core, a business book—something that most clinicians learn nothing about as part of their graduate training. In other words, we recognized that while clinicians have the expertise needed to successfully treat their clients, they’re often in the dark when it comes to the many non-clinical components of running a practice. Most mental health professionals don’t really think of themselves as business people, which sets them up for failure when it comes to starting a commercial venture of any kind. In fact, most failed practices are not the result of a lack of clinical skill or even external circumstances in the industry, like increased costs or the demand for virtual care. Instead, they fail because mental health service providers lack essential knowledge about the business of mental health. Graduate training is almost exclusively focused on client-facing work; it simply does not prepare you to develop a thriving practice—a process that requires a careful balance of clinical acumen, entrepreneurial insight, and administrative precision.

Given this likely (and glaring) gap in your training, where can you go from here? Faced with the ever-changing landscape of therapeutic work and the dizzying array of unknowns associated with opening a new business, some clinicians wonder if they should have pursued business school instead of (or in addition to) their clinical training. This perceived dichotomy between being a mental health provider and being an entrepreneur is what creates the most frustration, anxiety, and confusion for would-be practice owners. Without a clear way forward and concrete guidance, you’re likely to stumble into self-doubt, dissatisfaction, and burnout. Your future success as a private practice owner will depend on your ability to make the shift from helper to leader, from employee to employer. But at the end of the day, these two roles are not antithetical or mutually exclusive. Though it may be difficult to see now, many of the skills and qualities common to clinicians have immediate applications in a business setting (a topic we discuss in more detail later). Most importantly, many clinicians glean immense satisfaction from making the leap into private practice ownership. We hope you won’t count yourself out of private practice simply due to self-doubt or a perceived lack of resources.

This book is grounded in the experiences (positive, negative, and in between) that we each had when opening the doors to our respective group practices. It represents the culmination of the lessons we learned from navigating the ever-changing road of private practice ownership and showcases our desire to contribute to the literature about both entrepreneurship and mental health. We know firsthand how monumental a life change opening a business can be. Thus, we begin the book with some self-assessment to help you determine if private practice ownership is the right fit for you at this time. We also offer advice on how to build a support network, find mentors, and cope with the many stresses associated with launching a new business. The second half of the book is more focused on logistics, covering the concrete skills and strategies that will help you lay the groundwork for a successful and sustainable business.

In addition to drawing from our own experiences, we’ve also included a case study from one of Lizzie’s consulting clients, Alexa (this name has been changed to protect the client’s privacy). Alexa came to Lizzie for help negotiating the bigger picture of owning a group practice. She was running a solo practice at the time, but things were starting to become wearisome after the birth of her third child. She was no longer able to pour countless hours into direct clinical work; she needed the flexibility to spend more time with her growing family and diversify her daily tasks. She envisioned creating a thoughtfully-designed work environment with an expert group of in-house therapists who were uniquely qualified to assist her ideal clients: women who were either in the perinatal or postpartum period. She was committed