The Challenges of Private Practice Start-Up

the challenges of private practice start upSo you’ve decided to go into private practice. There is much to support the decision. Being your own boss promises a flexible schedule, the ability to set some of your own policies and procedures. There is no “productivity” to meet except what you set for yourself. There are no tedious administrative meetings or mandatory, but personally irrelevant, trainings to attend. There are no paperwork requirements that serve an agency but have little to do with you.

Freeing yourself from all of that can feel wonderful indeed. But do be aware: There are definite downsides to going solo as well.

This article is not intended to discourage you. Rather, it is to prepare you for some challenges of private work you may not have fully anticipated. Forewarned is forearmed. You will be more likely to succeed in private work if you anticipate these issues from the start.

Scheduling: The shift from agency work to private work often means adapting to a shift in scheduling. Most private practitioners are available for appointments at least a couple of evenings a week and some Saturdays because those are the hours most convenient for employed clients.

Some clinicians start at 7:00 a.m. or even earlier to accommodate clients who want to schedule their sessions before they go to work. If you want to see families, you have to have appointment slots after school hours.

The other reality for clinicians who are beginning their practice is a spotty calendar. Catering to prospective clients’ schedules is the way to generate at least some income at the start.

That may mean having a 9:00 am and a 2:00 pm appointment on Monday, a couple of evening spots filled on Wednesday, and a Thursday with just one scheduled session at 4:00 pm. It’s how to get started but it’s a challenge to keep moving in and out of therapist mode.

Your schedule will have an impact on your family and social life. Because you are working evenings and Saturdays, your spouse/partner will be doing more household management, monitoring homework, and attending such things as parent-teacher nights when they fall on your work nights.

You’ll miss practices and games and performances unless you plan way ahead. If you are a single parent, you’ll be juggling child care and working during some of the important hours of your kids’ days.

As for your social life: Yes, you may have blocks of time with no client on the schedule. But those breaks will probably not coincide with times your partner, kids or friends are available. Spontaneous meetings with friends after work hours or in the evenings may be rare since you will be working when they are free.

It’s common for new practitioners to get so caught up in responding to the demands of the practice that they put off responding to their own and their family’s needs. Finding a work-life balance is essential if you are to maintain a private practice over time.

Overworking: Every client hour means income. Every blank hour is filled with anxiety. It’s understandable that the beginning private practitioner fills as many hours as possible. Yes, filling up a day or two with nine or ten clients looks great when the rest of the week is sparsely committed, but the toll may not be worth it. It can lead to overwork and self-neglect.

It’s important to remember that to be effective and healthy you do need to eat, to get out of the office for some air, and to generally take care of your own needs.

Vacations and sick time: Taking vacations or cancelling a day because of a cold is complicated. You not only have to think about coverage but you lose the income.

Even the best expert in self-care gets sick now and then. It’s no service to you or your clients to work when you’re sick but you will probably work when you are feeling “iffy.” It’s important to have a system in place for those times when you do need to stay home.

How will you inform clients? Will you be available by phone or online chat? If you are down with a bad case of the flu or have to have surgery, how will you provide coverage for a lengthy time out?

Although it can feel like a financial hit to take a couple of weeks off or to enjoy a long weekend now and then, it’s essential to your own effectiveness to give yourself the rest and relaxation you need.

Put aside a percentage of income every week so your expenses are covered during time off and it won’t be as anxiety provoking. Consider developing relationships with other local private practitioners for an exchange of coverage during vacation times or lengthy illness.

The Challenges of Private Practice Start-Up

Marie Hartwell-Walker, EdD

Marie Hartwell-Walker, Ed.D. is an author, licensed psychologist, and a marriage and family therapist who has been in practice for more than 35 years. She is a regular contributor to Psych Central and one of the therapists who answer questions at Ask the Therapist.


APA Reference
Hartwell-Walker, M. (2016). The Challenges of Private Practice Start-Up. Psych Central. Retrieved on August 10, 2020, from


Scientifically Reviewed
Last updated: 20 May 2016
Last reviewed: By John M. Grohol, Psy.D. on 20 May 2016
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