Perhaps you are fresh out of graduate school and have had a taste of agency life during field experiences or internships. Or maybe you’ve been working in an agency or a hospital for a while now. Private practice beckons. No staff meetings, less paperwork, more money, and the freedom to work with clients you choose to see. Your thoughts regularly give way to fantasies of the ideal practice.
Or maybe you are already in private practice and the dream isn’t living up to the reality. You don’t have enough clients. Your schedule is out of control. Managing insurance forms (or paying someone else to manage them) is a continual challenge. Many of your clients owe you money, and you feel awkward about collecting. Managed care companies are calling, requesting a site visit. This isn’t at all what you thought you were getting into when you opened your office.
Or maybe you already have a private practice that is doing just fine, thank you. So far you’ve been able to do the work you love with personal integrity and sufficient financial reward. But you are worried about maintaining your success in the face of increasing pressures from multiple sources. You want to be sure that you have the information and support you need to maintain a work life and lifestyle that you relish.
The dream of a successful private practice doesn’t have to be only a dream. Many thousands of therapists are seeing many thousands of clients in private practice settings every day. Most are doing so in ways that they personally define as successful. What’s their secret? Most have consciously or intuitively embraced principles that dramatically increase the odds for success.
1. Go into private practice with a clear vision of its challenges as well as its rewards.
Private practice isn’t easier than agency work – it’s different. Understanding the differences and making a clear decision that the differences are worth the effort are the hallmarks of a successful private practitioner.
It’s a mistake to underestimate the supports that agencies provide as a matter of course. Agencies supply office space, steady referrals, colleagues and supervision, support services for billing, paperwork, and emergencies, and perhaps the support of a union. In return, you have to meet productivity standards, do things according to agency protocols and guidelines, and punch a time clock. In addition, your potential earning power is limited by the agency budget and, when a union is present, union pay scales.
Private practice means finding and keeping up your own office, developing a referral base, creating your own professional supports and supervision, doing all of your own billing, and managing your own paper trail.
Private practice also means the freedom to set your own hours, define the work you want to do, create your own working environment, and choose your clients and modes of intervention. Any money you make will benefit you directly because you are no longer paying for agency overhead or union activity.
Only you can decide if the benefits outweigh the fact that in private practice you will have to assume responsibility for many of the support services that an agency provides. With that increase in responsibility, though, comes an increase in freedom and earning power.
2. Create a specialty for yourself.
Successful practitioners conduct a careful needs assessment of their communities. Although most psychotherapists like to work as generalists – seeing people from many walks of life and with many different problems and diagnoses – it’s also important to find something that you can uniquely offer to your referral sources. What makes you different from the other dozen or so private practitioners that people in your area can choose? Identify an area that you genuinely can commit to and get the training you need to be the local expert. Examples might be pain management, sports psychology, dual diagnosis, children who are developmentally delayed, school problems, family businesses, adolescent anxiety and depression, or elder care. Choose something you can get passionate about! This will become a reliable base for your practice.
(Note: Only a few years ago, specializing in trauma work or substance abuse would define a practice niche. These days, nearly everyone in private practice works with those two issues regularly, so they are no longer available as a specialty that will set you apart from others.)
3. Embrace the business end of the business.
Private practice is most definitely a business and as such requires sound business practices. The business of private practice requires that you learn everything from bookkeeping to basic tax law to marketing strategies to good record keeping. If you decide to accept insurance, you’ll need to deal with different billing procedures for each carrier. Even if you decide not to accept insurance, you will still need to deal with collecting money and managing a cash flow that can be erratic.
The people who do best in private practice are those who are able to embrace the business end of the business as a challenge or even as a game. They find gratification, even fun, in setting business goals and achieving them. They know that a good rule of thumb for the first two or three years is to plan on an hour of business activity for every hour of clinical activity. With that kind of time requirement, it only makes sense to find a way to enjoy doing it.
4. Take the time for some business training.
Very few social work or psychology graduate programs include courses in practice building and management. Despite the fact that a substantial number of their graduates will be in business for themselves for at least some part of their careers, schools focus solely on turning out good clinicians.
But very good therapists are not necessarily equally good business people. Being in business means being at least passably good at being in business. It won’t matter a bit, in terms of your personal income, if you are a brilliant theorist and an even more brilliant healer if you can’t bring yourself to charge for your services, to keep good records, or to do the necessary bookkeeping in a timely way. Unless you were reared in a family business or went to social work school after a successful business career, you probably need to give yourself the gift of some additional training – training specifically in business management.
Successful private practitioners attend business seminars, read up on business practices, join the Chamber of Commerce, and take up whatever help is offered to hone business skills. HelpHorizons.com is another source of practical business help. We’ll regularly run articles to keep you in touch with industry trends and provide you with up-to-date information on what you need to do to keep the business end of your business on the cutting edge.
5. Deal with your own issues around money.
Unless you are either independently wealthy or living on someone else’s income, private practice is indeed about money. You are engaged in an exchange: you provide help and support, and your client gives you money. This may seem obvious but for many therapists, setting a fee and dealing with clients about payment are the most difficult aspects of the work.
Clinicians in most agencies are protected from having to deal with the financial end of things because a front desk and billing department take care of collecting fees. But in private practice, you are the front desk and billing department – something that takes some getting used to.
If you can’t get comfortable with being firm and clear about charging and collecting for what you do, you may need to do some of your own therapy around these issues.