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Why Therapists Shouldn't Go Into Private Practice

Updated: Mar 28

Is private practice as good as they say? What are the downsides of private practice? Our comprehensive overview lays it all out, the good and the bad. If you want to make a better informed decision about the next step in your career as a therapist, this article is for you.

Private practice. The promised land for therapists, the inevitable resting place for a career in therapy. Many say that one day they will “end up” in private practice. We all know the positives: you are your own boss, you can make more money, set your own schedule, etc.

Yet there are plenty of downsides to consider. Let's take a look at the other side of the coin...

What is Private Practice?

First of all, what does “going into private practice” mean?

By 'private practice' we mean a therapist who owns their own practice. Many people say “private practice” when they are referring to their contractual position alongside other therapists at a group practice. This is not what we consider private practice. These contracted individuals practice therapy with greater independence, but with none of the headache of running a business.

Private Practice is a Business

We must remember, private practice means you are running a business. And if you have no interest in navigating business tasks such as marketing, accounting, insurance credentialing, networking, liability/legal, then running a business is something you may want to reconsider. Many therapists have little interest in being business owners, yet they express interest in "going into private practice," though they are one in the same.

The question we'll now explore is, do you want to go into the business of private practice?

Let’s take a look at some things to consider to help you decide if this is right for you.

It’s A Lot Of Work

At least we might say, it’s a lot of work to do it right. Because, as a solo business owner, you ultimately have control over how much work you put in. You can be lazy and take shortcuts, many therapists do this. Yet if you're motivated, there are many decisions to be mindful of.

Will you have a business bank account? If yes, how will you determine which bank to work with? What is your marketing plan? If you're doing online work, will you have cyber insurance?

The reason why running a business is so much work is there's no cookie cutter formula. So to answer these questions, you need to do the learning yourself. There are coaches that specialize in helping you build your private practice, and may be a consideration for those feeling overwhelmed by these decisions.

Hidden Extra Costs

As a business owner, you get none of the perks of being an employee. You have to pay for your own health insurance, and you are responsible for all your business taxes. Yes you can deduct expenses, but it takes more work to create a system for tracking your business expenses.

Another common cost, rarely talked about, comes from working with a poor accountant and paying too much in taxes.

And then the little costs... Will you use a biller? How about an attorney? Your EHR system? Office rent? You'll also probably want a CPA to help with your retirement plan. There’s also no paid time off, so every time you take a day off or vacation, you are giving up your money. It can be hard for therapists to see their money suddenly shut off like this.

It’s a Lonely Life

Keep in mind, you are sole owner and employee. Socially, this is isolating. Yes you’re with your clients, but that doesn't really count. There’s no “water-cooler” conversation, no teamwork. Though difficult times and celebrations, these occur in isolation.

If you do not enjoy the people you currently work with, this may not seem like a big deal. And it may not be, but keep in mind you are looking at an entire career of working alone. And if you do online therapy at home, you are even more alone, and may find yourself craving more human connection. In my opinion, this is the biggest drawback.

There's a special fulfillment of being on a team that working alone just cannot replace. After all, we are social beings wired for connection and working in groups.

You Can Easily Get Stuck

You are your own boss. So who will hold you accountable for getting those notes in within 24 hours of sessions? What will your measure be for whether or not you are doing a good job?

As business owner, there is no one telling you what to do, or how to do it. You make all the decisions yourself. For many, this is overwhelming. For others, they get lazy.

When you are working alone, it becomes much easier to fall into bad habits, after all there's no consequences which often can mean no accountability. Those in private practice should join a therapist consultation group to ensure that you are continuing to grow as both a clinician and a business owner.

Dealing With Competition

There is now serious concern about venture capital funded companies such as BetterHelp and TalkSpace dominating the therapy market. We've never seen so much corporate money being pumped into psychotherapy before. This is concerning for both small group practices and private practices.

How are you going to compete with these giant companies who dominate advertising and offer services at much cheaper costs? Of course, it can be done. But to be a thriving private practice owner today is more and more starting to look like an entrepreneurial endeavor. Is this something you are willing to sign up for?

Should You Go Into Private Practice?

Now these reasons are not meant to deter anyone from starting their own business, but are only to present the reality on the other side. Private practice gets championed often, and for many it makes a good business. But like everything in life, if it sounds too good to be true, it is. There are always tradeoffs.

Successful business owners are familiar with having to analyze the pros and cons of all decisions. So, if after reading this you are having some ideas and thinking "bring it on," then private practice is probably a good move for you. If this article raised more questions, then I encourage you to seek out more answers.

If the business of private practice is starting to feel overwhelming, consider finding alternative ways to have a thriving career as a therapist. There are many innovative group practices that offer unique benefits while providing rewarding and engaging experiences for their therapists. I know many personally that promote growth and autonomy in your career while also being part of a fulfilling team experience.


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