Group Practice and its Discontents By Joe Bavonese, PhD on 1/16/20 - 3:06 PM

Group practices are taking the field of outpatient psychotherapy by storm. In just the last five years, thousands of group practices have started in all corners of North America. The dream of passive income, coupled with the somber realization that a full solo practice does not yield enough money to pay for college, retirement and the lifestyle that most practitioners desire, has fueled this rise.

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As someone who has run a group practice for 20 years and has coached over 200 psychotherapists in starting and growing one, I see both the promise and pitfalls in this trend.

At the first naive glance, group practice seems almost too easy. If you have a successful solo practice, you know how the therapy game works. So you hire a good therapist, give them an office and a few referrals, sit back and rake in the money. Hire a few more, and more money rolls in while you bask in the sun or stroll along the beach.

Not so fast. The reality is that group practice is a complex, dynamic beast that challenges you in ways that a solo practice never will. It requires the owner to simultaneously juggle numerous plates, while still performing therapy during the early stages of growth, sapping your time and energy. Group practice also demands that you learn a bevy of new skills. For example, you need to learn how to hire, manage and evaluate clinical and admin staff (and fire them when necessary), manage the irrational projections staff throw at you as the resident authority figure, expand your marketing, track much more complex metrics, develop a profitable compensation model, stay current with the latest ethical issues and clinical strategies and, finally, develop a work culture that people enjoy working in.

I know many group practice owners like myself who have mastered these skills and currently employ staffs of twenty or more clinicians, generating revenue over $2 million per year. But these tend to be group practices that have been around for at least five years.

As a group practice owner, I am always balancing three things: referrals, office space and clinical staff. The dirty little secret of group practice these days is that with its exponential growth, finding and keeping good clinicians is MUCH more difficult than ever before. The best clinicians already work in other group practices or have their own solo practices. One measure of the competition for good clinicians is this: the number of ads for therapists for group practices on job sites such as has increased tenfold in the past four years.

The new kids on the block may find themselves competing with practices that offer a host of benefits such as healthcare, retirement accounts, paid vacation and paid trainings for an increasingly limited pool of qualified clinicians.

So what can you, as a newer or existing group practice owner, do if you want to expand? Here are five specific strategies that can help:
  1. Develop an internship program - there are still many pre-licensed clinicians who need hours and are hungry to learn from an experienced, successful therapist. You can pay them less than a licensed clinician, and if they like working for you, they will often stay on after they are fully licensed.
  2. Stress the benefits of joining a newer group practice - it’s exciting to be part of something new, to be able to have an immediate impact on policies and procedures. If you join a larger group with 20+ clinicians, all of that will have been established years ago, and you will have very little say in what happens.
  3. Use your personal network of colleagues to find therapists - don’t forget your friends and colleagues who know many other therapists in your community. Personal introductions that build on your experience in the field can be an invaluable way to attract new staff members.
  4. Develop a unique specialization that is not commonly served in your community. Many group practices are one-stop shops that serve a general range of clients. Practices that specialize in one or two niches can attract clinicians who already are -- or want to become -- experts in a particular clinical specialty.
  5. Promote your practice to people who are working in low-pay agencies that have endless paperwork and hours of boring meetings. These people are often seasoned clinicians who are thrilled to make more money and work with higher-functioning clientele.
Group practice is here to stay, and when done correctly, can fulfill the dream of an affluent lifestyle, meaningful work, and providing help for thousands of people in your community. But without solving the staffing problem, this dream will remain a distant fantasy.

File under: Musings and Reflections, Business & Marketing