Key Takeaways:

• Running a group practice means practicing clinical leadership as well as business management
• You can start a group practice by supervising associates, partnering with other clinicians, or hiring clinicians
• Running a group practice will force you to grow in ways you didn’t expect—and that’s a good thing 

I always knew I wanted a team. I didn't know it would happen this fast, and I didn't know it would look like this.

‍

Today, Calliope Coast Therapy Group has six clinicians. This happened organically, and not at all the way I pictured it. If you're a solo therapist wondering whether group practice is for you, I want to share what the path looked like for me, and what I wish someone had told me before I started.

My journey from solo to group practice

When I started my private practice, I was a few months away from the California requirement that you must be licensed for two years in order to supervise. Hiring someone wasn’t even on my radar. 

Then one of the associates I had worked with at a treatment center reached out asking if I’d be willing to supervise her. Looking back, I'm so glad she did, because otherwise I think I might have waited a lot longer, convincing myself that I wasn’t ready; but it turned out to be a beautiful way to learn what it takes to build and run a real group practice.

‍

How do you know if group practice is right for you?

Running a group practice means you have to fill two roles: A clinical leadership role, and a business management role. Both are important, and you need to make sure you’re ready to take on each one before you start hiring. 

The clinical leadership role

Hiring associates is a great way to get started in group practice. But let’s be honest: Some of us think of supervision as a way to mix things up. We feel burnt out from an overpacked caseload and the idea of doing something other than face-to-face clinical work seems refreshing. We think, “Hey, I’m a great therapist! I could supplement my income with supervision!” But the thing that makes supervision so attractive is the same thing that makes it challenging for those of us who have been primarily focused on clinical work: it is a completely different muscle to flex. 

‍

Supervising demands more: more hours, more admin stuff, more work… and more work on yourself. Getting into it to escape clinical work isn’t just a recipe for faster burnout—it also misses the heart of what it means to be a healthy leader. 

‍

We all remember how tender it felt to be an associate. It’s such a vulnerable time. Being ready to hold that with someone is at the foundation of what it means to supervise. 

‍

I was very lucky that my first career was in leadership development with Disney. I learned that being a leader means putting down your ego, even when you’re “right”. It means that you’re going to make mistakes. And it means that your response to your mistakes is key. You have to show up in a position that holds a lot of power and treat it with the dignity it deserves.

‍

Here are some questions to ask yourself if you’re pondering stepping into a clinical leadership role: 

‍

What is my motivation? Do I have a passion for this? What do I think of teaching? How do I feel about hard conversations? How do I give and receive feedback, even when it's uncomfortable? Am I ready to radically own my mistakes? Am I ready to help others radically own theirs?

‍

The interpersonal work between clinicians anchors everything else. 

‍

Stepping into a leadership position will hit on the stuff inside you that you don't want to look at. That's good. It will make you a better clinician, a better leader, probably a better parent, partner, sibling, friend. It will challenge you, and it will reward you.

The business side

Here is the biggest piece of advice I can give you on the business side: Know that the overwhelm is coming. It is as inevitable to the new group practice owner as winter is for Ned Stark. Knowing this ahead of time can help you avoid the wave of shame that hits when you feel like you’ve done it wrong. You're going to feel confused. You’re going to feel like you’re in over your head. And that's okay, because it's worth it.

‍

Do not be afraid to ask questions! Asking now saves us from a whole lot of difficulty and backtracking later. 

‍

Are you ready to figure out taxes? Payroll? Budgeting? Benefits? Labor laws? Training? Incorporation?

‍

Some genuinely amazing tools exist out there to make the business side of your practice easier. I use Gusto for payroll, and Heard partners with them, which helps my practice keep payroll and bookkeeping connected. Having an accountant who knows what they are doing when it comes to therapy practices is a huge boon. 

‍

But tools don't make up for the digging. The business side takes real work and you’ll find that it comes in waves. Be ready to put everything on hold during big transitions so that you can take care of the stuff hidden behind the scenes. And make sure that when you are negotiating pay with your new team members, you’re considering how you’re being compensated for all the unseen hours. 

‍

Paths from solo to group practice

There's more than one way to grow from solo into a group, and each path comes with different financial, legal, and clinical implications. Most therapists I talk to don't realize they have options.

‍

Here are the three main paths:

‍

Path #1: Start by supervising associates

This is the route I took, and it's the most common for therapists who hit the supervision eligibility mark in their own practice. 

‍

Most states require a set number of post-licensure years before you can supervise, and the number varies by license type and state board. For instance, California's Board of Behavioral Science (BBS) requires two years post-licensure before you can supervise associates.

‍

There are two main benefits of supervising associates:

‍

• Clinical: You get to support and help shape the next generation of therapists using modalities and philosophies you believe in.
• Financial: Associates work under your license, so you act as billing provider and handle insurance paneling and credentialing. You build the infrastructure once, instead of requiring each new clinician to build it themselves. 
• ‍

But there’s a trade-off: You take on more legal and administrative responsibility, including payroll, taxes, and employment law compliance.

Path #2: Partner with a peer

You can also open a group practice with one or more other licensed clinicians. This works well if you've already done clinical consultation with a colleague, or if someone's niche complements yours. You split ownership, costs, and decisions.

‍

The benefits: Shared overhead, shared referrals, shared decisions.

‍

The risk: Partnership disputes happen. If you don’t write a clear operating agreement on Day One, dissolution may be painful later on.

‍

Path #3: Hire licensed clinicians

If you already have a thriving solo practice and a steady referral pipeline, you can skip supervision and hire fully-licensed therapists.

‍

They may work as either W2 employees or 1099 contractors. It depends on your state’s labor laws. It also depends on whether clinicians qualify as either W2s or 1099s under IRS rules for worker classification.

‍

The main benefits of this approach: 

‍

• Speed: You don't wait two years to qualify as a supervisor.
• Liability protection: Since you’re not a supervisor, you don't take on supervisory liability for pre-licensed work.

The trade-off: Paying licensed clinicians costs more, so your pricing and referral pipeline needs to be able to support real salaries.

‍

Managing staff in a group practice

The administrative and legal pieces will swallow you if you let them. Keeping your eye on the relationships—the reason for all that other stuff—can help keep you grounded. The most important work in a group practice happens between clinicians. Here are the key points to consider with your group practice.

‍

Finding a team

My first supervisee found me, and that's a great way to start. The associates and colleagues you've worked with already know your style and trust you. If they're looking for supervision and you're eligible, you're a natural person for them to ask. 

‍

If no one has reached out yet, let people in your network know you're available to supervise or that you want to start a group. You’d be surprised how many people might feel the same way and just don’t know where to start. You might be just what they need!

‍

Salaries

When I was starting my group practice, I felt so passionate about mentoring that I didn't set my salaries in a way that was best for the company. 

‍

Part of what was happening, looking back, was that I wasn't valuing what I was providing as a supervisor and business manager. I was thinking, "How can we make this almost break even? How can I pay them as much as I possibly can?" 

‍

That's a beautiful instinct. But since then, I've had to consider ways to make this work sustainable so that I don’t burnout. After all, that’s not good for me, and it is certainly not good for my team. 

‍

I now set expectations around client minimums and fee minimums. Originally I said, "How many clients do you want? That's fine." Now I say, "Hey, I really need you to hold this minimum so that I can keep paying you what you deserve and pay myself a fair wage too." 

‍

We use an hourly plus commission structure, which works well and stays compliant with California labor law. The more clients my clinicians see, the more they make and the more I make. It works for everyone.

‍

The lesson: You have the right to ask for what you need. And asking for what you need protects your team better than anything else, because it keeps the business sustainable, which is what really supports them.

‍

A false binary lives out there. Either you run a fully predatory, corporate group practice, or you sacrifice yourself to the point of being unhealthy. You don't have to choose either. You can build something that fits and meets the needs of everybody.

‍

Insurance panelling 

When you have associates, they work and bill under your license, meaning you can use your individual NPI number to bill for clients your associates see. You act as the billing provider, they act as the rendering provider. 

‍

And while fully licensed clinicians function a little differently, having a group or “organization” NPI can make their credentialing process much more streamlined. 

‍

The credentialled party is the organization, and the individual therapists are a part of that company. This setup creates an enormous incentive for licensed clinicians to join a group. They skip their own billing. They skip paying for various platforms. They skip credentialing with insurance panels themselves. They concentrate on their clients. Not to mention the emotional support and camaraderie of not being alone in what can often be a lonely position. 

‍

When clinicians leave

Here's a choice I've made that some other group practices don't: If a clinician at Calliope gets their license and wants to leave to start their own practice, they take their clients with them. The clients are theirs.

‍

Some practices use a structure where clients acquired at the company stay at the company. 

‍

I get it. But I want to put the client first. And I remember what it took to build my own practice from absolute zero. I don't want my clinicians to repeat that.

‍

What's happened: Most of my clinicians who are about to get licensed say they want to stay anyway. That's the strongest signal I can imagine that the structure works.

—

Thinking about turning your solo practice into a group practice?

Heard supports group practices with bookkeeping, taxes, and a team of financial experts who understand how therapy businesses work. From payroll integration with Gusto to S corp transitions and quarterly tax planning, we handle the financial side so you can focus on supervising, leading your team, and serving your clients. Learn more about Heard for group practices.

‍

Summary

• In many cases, your first supervisee will come to you—but don’t hesitate to advertise the fact to your network once you’re eligible to supervise
• Supervising associates comes with lower expenses than hiring fully-licensed clinicians, but be prepared to put in serious work as a supervisor
• Generous salaries can help retain staff, but your number one priority should be the financial sustainability of the business—that benefits clinicians the most in the long run
• Associates work under your license, so you handle billing and panelling—a major benefit for associates joining your practice
• As a business owner and clinical leader, be prepared to sometimes have difficult conversations with your clinicians, but recognize that it’s a beautiful part of the journey

‍

‍