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The best way to start a private practice? Leave a group practice.

Updated: Oct 20, 2023



I'm going to bury the lead.


The best way to start a solo therapy practice is to leave a group practice.


A while back I asked my buddy Paul Peterson to build a calculator which would tell a therapist how long it takes them to get full.


We call it the Time to Full Calc.


Brilliant naming. I know. 😉😉😉

 

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Why leaving your group practice is the best way to start a solo therapy private practice

When I asked Paul to design the Time to Full Calc, we found out some really interesting things about building a caseload. Turns out if you:

  1. Get 5 calls a week,

  2. and half of them become clients,

  3. and you retain clients for 10 sessions.

...it takes about 11 weeks to get full.

Chart showing it takes 11 weeks to get full if you have 5 clients calling per week.

But when you're first starting out, getting clients is the hardest part.


When I first started out I was lucky if I got one call a week. Which, just isn't enough to build a caseload.

chart showing you have a max caseload of 5 if you have 1 call a week.

In fact I had gotten 4 calls a week, or if clients had only come for 8 sessions I would have never gotten full.

But everything changes if you start off with a caseload. If you start off with 20 clients, and only get 1 call a week, you can get full in 11 weeks and stay full forever.

Chart showing that stating with a caseload of 20 you can build a practice if you get one call a week.

Which is crazy. If you start with a high caseload you can have horrible marketing and still make a living as a therapist.


Now it's totally possible that after you leave your group practice not all of your clients would come with you. Still it may be financially worth it to leave your group practice. Say that you only took 10 clients with you, with an average nation wide insurance rate of $130, here's how much you'd gross. (Gross just means money you make before expenses).

Chart showing yearly gross of 90k if you start with a caseload of 10.

But, I think this is unrealistic. You can take more than 10 clients with you. 15 is a more reasonable number. So if you leave your group practice and 15 clients come with you, here's how you'd do.

Chart showing yearly gross revenue of 121k if you start with a caseload of 15.

You'd gross over 120k and probably take home 6 figures.


All of which brings us back to the big idea: the best way to start a solo therapy practice is to leave a group practice.


Of course starting out with a caseload makes intuitive sense, but seeing the numbers, for me, added a whole other dimension.


Why you should ignore traditional advice about how to start your solo therapy private practice

When I first tried to build my practice I asked other counselors for advice. They'd say things like "you've got to network," "hand out business cards," and other advice which I've found... less than helpful.


Their advice didn't work for me. Then I started to ask them about how they had started their practice.


Each of these counselors started their practice by leaving their group practice. None of them started a practice from scratch.


They'd worked at a group practice for a few years, had a few people in the community who would refer to them, became unhappy with their group practice, and then decided to start a solo therapy private practice.


What they did was totally different than what they were telling me to do.


Running the numbers confirms that we should ignore what they say and instead do what they did.


How to leave your group practice with a full caseload and start your solo therapy private practice

Saying that the best way to start a solo therapy practice is to leave a group practice sounds nice, but in reality you've got to address two big problems:

  1. You got to make sure clients come with you.

  2. You've got to make sure they pay you money.

How to make sure clients come with you to your solo therapy private practice.

When we coach counselors to start a solo therapy private practice we teach them a simple technique called "shaking your caseload."


At many group practices you own your client data. You have to take it with you when you leave, and you have to maintain your records for 5-7 years.


What we recommend is that first you email all your current clients and see how many of them want to come with you to your new practice. Let's say you see 25 clients a week and 15 of them want to continue on with you.


Then you go into your EHR, download all your previous clients' email addresses and then send them ALL an email saying you're leaving your group practice to start your own practice.


Say you see 100 clients a year and have been working in your group practice for 5 years. That's 500 clients.


Some number of those past clients will think "oh, I haven't seen you in a while. I've been meaning to come in for a check up," and then try and schedule. Let's say it's 1%. That's 5 more clients.


That means you leave your group practice with 20 clients. Which, as we've seen, is plenty to get you started.


How to make sure clients in your solo therapy private practice pay you money.

How do you make sure clients pay you when you're first starting out? Here's the trick: take only 1 insurance, whichever pays the most.


Oftentimes there's 1 insurance which pays a high rate, say $150, and then a bunch of other ones which pay less, like $100.


Don't take the lower paying ones. It's not worth it. You're better off learning to get more clients than lowering your standards.


The other trick is to let your EHR do your billing. We recommend Simple Practice. They really do make billing simple and they run your insurance for you.


Starting your solo therapy private practice is difficult but doable

Now there's a ton of nuance here. Like if you take insurance Simple Practice doesn't automatically connect to insurance companies. You've got to fill out paperwork, and there's a wait. You've also probably got to do a change of data form, which takes time, and of course, if you take clients with you you've got to know if you have an NDA, and also you need to think about how you'll let clients know you're leaving, it's not as simple as sending an email, ectara, ectara, ectara.


So if you get hung up, know it's normal. I just can't cover everything in one blog post. Just keep pushing forward.


Still these are the general steps.

  1. Work at a group practice.

  2. Build a case load

  3. Tell your past and present clients you're leaving

  4. Take the highest paying insurance in your state

  5. Leave your group practice and gain your freedom.

This is the part where I'm supposed to pitch my services and tell you all about how I can help you navigate the nuances of starting your solo therapy private practice.


Instead my ask is something different. I know most of what I know because of my buddy Paul Peterson. Our friendship has changed my life in many different ways. So my ask is that you be the kind of buddy that Paul is. One of your buddies is nervous about leaving their group practice. Be the kind of buddy to them that Paul has been to me and show them this article.


Best,


Jordan (the Counselor)


-Fin-


 

If you liked this post, consider reading this next. I think you'll like it ;) It's about building a private pay practice.

 

Jordan Harris, Ph.D., LMFT-S, LPC-S received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com

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