ACA Blog

Anthony Centore
Mar 13, 2012

Should I Grow my Solo Practice into a Group Practice?

Benjamin Franklin is known for his strict schedule. His personal notes show that he was asleep at 10pm, awake at 5am—and he spent most of his waking hours working, or reviewing his tasks. Starting a counseling practice isn’t a 40-hour a week job. Successful entrepreneurs either “Do the Franklin,” or burn the midnight oil. Or both! This is because an aspiring counselor-entrepreneur must stay relevant with the practice of counseling while learning (and executing) the myriad aspects of running a business (e.g., enacting a business plan, managing finances, setting up an office, getting the word out, etc.).

After a year of hustle...

Once you’ve “done the Franklin,” for about a year, you’ll notice some changes. Your phone is ringing, and your caseload is filling! People will tell you that they’ve read your articles, or saw you on the news. New clients will tell you that they heard you speak, or watched a YouTube video of one of your talks. New clients will tell you that another client, to whom you provided great care and service, referred them!

If all goes well, at some point in year two your caseload will reach 35 sessions a week. At 35 sessions, you’re with clients 26.25 hours a week. You spend 13.75 hours a week on clinical notes and managing your one-office company. You’re working a comfortable 40-hours a week, and bringing home net earnings of six figures a year.

Your private practice is Thriving! And you have options...
1. Stay Small
While nothing needs to change, there are several options for your small practice to consider.
a. Hire administrative help.
Perhaps there are some tasks you wish to delegate: reception and scheduling, billing and bookkeeping, or general office upkeep. This can sometimes be done without reducing net profit.
If a counselor earns $65 per clinical hour, as long as an employee (a) costs less than $65 an hour, and (b) completes their tasks efficiently, an increase in the counselor’s caseload could compensate for the administrative costs. This approach won’t reduce the counselor’s workweek, but will allow the counselor to trade administrative tasks for clinical work.
b. Raise your rates.
Your caseload is full, and you’re even turning some clients away because you’re too full to schedule them. You may have the luxury of raising your rates. This is supply and demand: There is limited supply of you, and there’s overwhelming demand.
By raising rates, you will reduce demand—so finding a balance is important. Don’t overdo it! Raise prices slowly, for new clients only. Or raise rates for your most desirable appointment times (Note: If you accept insurance, you will need to provide services at your contracted rate. However, one can reserve premium times for the highest paying insurance companies, or block out some times for cash-only clients.).

2. Get Big
Perhaps, after years of counseling, you decide that spending the majority of your workweek in session with clients isn’t for you. Or, you decide that you want to capitalize on your practice’s extra client leads, without raising prices. A desirable option may be to bring on another counselor.
a. Bring on a counselor.
Bringing on a counselor to work in your practice is a big decision (and responsibility), as it involves much more than funneling surplus client leads. For many, to execute this well, one will need to transition from full-time clinician to full-time manager. Counselors expect a lot in exchange for a split of their session fees. Traditionally, a practice will provide:
• Office Space: Two counselors sharing one office won’t work. Even if one counselor is part-time, there will be scheduling conflicts during the most desirable session hours.
• Ample Leads: The attrition rate for clients is around 8 sessions. Therefore, a counselor needs 4.5 new clients a week to build and maintain a full caseload.
• Billing / Credentialing: Reliable, timely medical billing is crucial. Also, even if a counselor is previously paneled with insurance companies, additional credentialing is necessary to allow him/her to bill through your practice.
• Reception and Scheduling: Counselors expect a high level of front-end administrative help. Printing forms, ordering supplies, and other office tasks are often the responsibility of the practice.
• Insurance: To recruit great counselors, consider a 50% split on health insurance, and 100% of professional liability insurance.
• Community: Counselors often wish to be part of a community, and even seasoned clinicians expect the practice to offer some clinical supervision.
Changing from a solo-practice to a group practice isn’t a small change; it’s the start of a new business (with more risk, and more reward). Get ready for a new journey, and to again “Do the Franklin!”

A Solo or Group Practice—which is right for you?


Anthony Centore is a counselor, and helps other counselors build successful practices. For more information on private practice and insurance panels go to http://thriveworks.com .

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