Clinician's Guide to Business (eBook)

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...