For Colleagues: Starting My Private Practice
Updated: Jan 25, 2021
I field many emails and phone calls from colleagues who dream of opening a private practice and wonder where to begin. I can't tell anyone if private practice is right for them, I am not an attorney, and I cannot give legal advice - but I can share a little about how I came to own my very own thriving private practice.
I did the legal handiwork all by myself at first. I am not an attorney, although I did work in the legal field prior to becoming a counselor, and I also owned a successful business for 10 years prior, so I'm more comfortable navigating legal requirements than most. In my state of Colorado, the secretary of state website made it simple to file both my tradename and articles of organization; they provide forms for you to fill out and file online for a reasonable fee. I can't tell you what sort of business organization you need (PLLC, LLC, S-Corp, etc.), you need to do your own homework there and possibly consult with an attorney. After doing my initial due diligence, a DIY PLLC fit my needs at first, but down the road, I needed more and an attorney helped me. I also came up with a list of business names and polled some friends and family, which quickly uncovered that one my potential names had an inadvertent meaning I was unaware of - for this reason, I recommend running your business name by a few others before you "etch it in stone." Also, my local small business association offered free guidance and classes - I recommend looking into yours for free resources for small business owners.
Second, I opened a business-only bank account at a local credit union and I made sure my malpractice insurance protected me thoroughly.
Third, I subscribed to great software - Simple Practice for practice management, QuickBooks for financial management, etc.
Fourth, I started to set up forms and systems for my practice. Important forms included Disclosure Forms, Practice Policies, Telehealth and EMDR consent forms, and many more. I also had to set up systems to make sure I was maintaining the fundamental responsibilities of my practice: administrative tasks, case management tasks, financial tasks, licensure maintenance tasks, basic housekeeping of my office, etc. These lists are not exhaustive, and I add to them often.
I outfitted my entire office with furniture for a whopping $200 by carefully scouting local garage sales and online resale marketplaces. This included my large oak rolltop desk, numerous large oak bookcases, a sturdy 4-drawer filing cabinet, a leather couch, two chairs, an ottoman, a coffee table, and more. I had to buy new locks for the desk and filing cabinet to keep files secure, and I bought a few lamps over time which added to the cost of startup. But I remain quite proud of that initial garage sale blitz that resulted in a pretty comfortable office space. When I expanded to a larger office space, I purchased a number of additional pieces from my local Goodwill store and spray painted them to match my office decor.
LOCATION: My practice has now been in two great locations. I was surprised to find how much some differences between locations mattered. Here are some things to consider when you look at locations:
Does the location have plenty of parking? (I recommend checking during the times your clients will be coming, because some parking lots fill up with all other tenants clients too - so an empty lot on a drive-by might not equate to enough spaces when clients need them.)
Does the location feel safe at night?
Does the location have public transportation access?
Does the location have accessibility for all potential clients? Are there stairs, elevators, ramps, wide entries, etc.?
Is the location the appropriate size to serve your counseling population? Will you need room for whole families, play therapy supplies, groups, etc.?
CLIENTS?: Marketing tasks included making my own logo and business cards, joining Psychology Today, creating letterhead and email signature, creating my own website, linking Simple Practice's helpful booking feature to my website, and much more. I bought a couple books and spoke to a couple coaches but, honestly, all the stuff I tried that was suggested didn't make the initial acquisition of clients go any faster than normal. I pounded the pavement, shook lots of hands, kissed lots of babies, wrote letters to referral sources, hosted classes and workshops, posted on social media, and so on. It still took me slightly less than a year before my practice was reliably full - and this is without accepting any insurance. It turns out that most clients find me through Psychology Today, referrals from other clinicians, and referrals from other clients.
GET GOOD SUPERVISION. This has honestly been the most helpful part of creating my thriving private practice. I chose several supervisors, who I pay out of pocket and are worth all those pennies and more. These supervisors each had businesses and professional qualities I hoped to emulate. These supervisors shared wisdom, confidence, and inspiration that carried me through my first year and continues to inspire me today. I also participate in group supervision, and find it helpful to have a wide variety of perspective on my cases, however, when it comes to discussing non-clinical business issues, I find my individual time with supervisors is the best investment.
TIMING: I have been asked if I wish I had waited until some magical point of "readiness" before taking the leap to private practice. I chose to jump right into full-time private practice as an LPCC - still requiring supervision. I did not find it to be "too early" and between my internships and the supervision requirements for LPCCs, I felt like I had enough experience to hit the ground running. I imagine for someone with less business and legal experience, some tasks might seem daunting and time consuming, but I was ready and I don't regret my timing. I have continued to work with several other organizations as a volunteer crisis counselor while I built my practice up, to make sure I was working full-time, even if it wasn't all with my own clients. I will become a fully independent LPC this Summer, and although it will not be required, I intend to continue with supervision because I value their input and feedback so much.
SOLO: Another question I often get is whether private practice is lonely. At first, it was. But as I've come to know colleagues in my immediate area, join local professional organizations, and even host a meeting of local colleagues on a regular basis, I find that I'm definitely not lonely anymore. Indeed, when I have a stretch of alone-time in my office, with just my fish in their bubbling tank to keep me company, it feels like a vacation for my brain from all the attention-switching demands of running a full time practice.
FULL TIME: And finally, the question I get asked the most - how many clinical face-to-face hours is full time? The nice thing about private practice is there is some flexibility here, if you need it. I have spoken to some clinicians who work 12-15 sessions per week for sanity, and others who cram in 25-30. My sweet spot is around 20. A rule of thumb someone told me long ago is that for every hour you spend in-session, there are two hours of other work that needs to be done: notes, treatment planning, returning phone calls, logging emails and texts, business management, supervision appointments, licensure, marketing, continuing education, billing, reading clinical books, housekeeping, etc. I find that this "1 clinical hour requires 2 administrative hours" rule of thumb is often true. If I see 20+ clients in a week, I really do end up working around 50-60 hours that week. As I streamline systems, this number goes down - and I recently stopped accepting new clients with the hope of bringing that number down some more. But then, if I decide to add in a new modality, and the training/consultation that goes along with it adds time. Or if I buy new books, or join a new organization, or volunteer for a new endeavor, and that number goes back up.
BUFFERS: Strong boundaries and intentional time and financial management are required to sustainably run a private practice, and this is definitely an area I have been challenged in since the pandemic began. I tell you all this to urge you to build in buffers in your schedule and in your budget because surprises with both will definitely happen. I am grateful that after all the surprises that transpired in 2020, my practice is still solvent and full with a waiting list, and I can see a light at the end of this stretched-thin tunnel. Although 2020 had some new challenges, I know that they are not unique to a pandemic, and having a plan for facing them in any circumstances is a wise plan.
If you have additional questions, please feel free to email me and we can set up a time to chat or stop by my office for a coffee. I'm always happy to offer a little complimentary encouragement or referrals to clinicians wondering about private practice.