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. Let's take a look at the other side of the coin...
First of all, what does “going into private practice” mean?
By 'private practice' I 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 I consider private practice. These individuals practice therapy with greater independence, but with none of the headache of running a business.
And that is exactly what private practice is, running a business. And if you have no interest in navigating marketing, accounting, credentialing, networking, liability/legal, running a business is something you may want to reconsider. I’ve seen people who have little interest in being business owners, yet they express interest in "going into private practice."
So, let’s take a look at some things to consider before deciding if you want to be a business owner (i.e. private practice owner)
It’s A Lot Of Work
At least we might say, it’s a lot of work to do it right. Although, as a business owner, you ultimately have control over how much work you put into it. You can be lazy, many therapists do this. Yet if you want to do the work, 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 you need to do the learning yourself. You can hire an online private practice coach, but they're likely not familiar with your state policies and special characteristics of your local practice area.
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 taxes. Yes you can deduct expenses, but that’s more work to keep track of your business expenses. Many people do not invest in getting a good business accountant, and end up paying too much in taxes. This is a cost rarely talked about. And then the little costs... Will you use a biller? How about an attorney? You'll also 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’s Lonely
Keep in mind, you are sole owner and employee. Yes you’re with your clients, but that hardly counts. There’s no “watercooler” conversation. If you’re introverted, or 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 because there's a special fulfillment of being on a team that working alone cannot replace.
You Can Easily Get Stuck
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 people 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 is no oversight for your work accountability. I firmly believe everyone working in private practice needs to be in a consultation group that meets with other therapists 1-2 times a month 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 get put into the practice of 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 the marketing 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?
Now these reasons are not meant to deter anyone from starting their own business, but are only to present the other side of the coin. Private practice gets championed often, but keep in mind that if it sounds too good to be true, it likely is. There are both pros and cons. 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 this is probably a good move for you. If this is not your reaction, then keep doing your research. If you decide it's too much, consider finding alternative ways to have a thriving career as a therapist. There are many group practice owners who are building innovative therapy practices that provide rewarding and engaging experiences for their therapists.