What to Know Before Starting a Group Practice

Taking the leap from a solo private practice to a group practice is no small feat. And if you’re considering starting your own group practice, you’ve probably spent a lot of time wondering what exactly you need to do to start that process. But the truth is, the key decisions you need to make in order to have a successful and sustainable group practice aren’t in a simple checklist. In fact, they aren’t logistical at all. 

To help you explore all the possibilities that starting a group practice has to offer—and to help determine if that option is really the right one for you—here are some key things you should consider before taking the leap. 

Decide Your “Why” 

Clinicians often stumble into group practice ownership. When we think of how to grow our business, or what to do when our caseload gets too full, it’s simply the first thing that comes to mind. But it’s important to consider the many other ways you can expand your impact. In addition to opening a group practice, clinicians also have options like offering group programs, teaching online courses, providing training, consulting services, and facilitating retreats—just to name a few. 

Group practice ownership is a significant undertaking. But for the right individual, it can be one of the best decisions they can make for themselves and their business. It’s all about making sure it’s truly the right fit before embarking on this journey. 

When considering your “why”, be sure to consider other ways to increase your impact and expand your ability to serve. Then ask yourself which options feel most aligned with your vision, lifestyle, and personality. Which options are most appealing and exciting for you? 

Determine Responsibility

After you’ve determined a group practice is a good fit for you, it’s time to consider the issues of responsibility and control. More specifically, which aspects of the practice will you control and which your clinicians be responsible for on their own?

Some key examples of this include: 

  • Clinical autonomy
    Will the clinicians in your group be practicing various therapeutic modalities, or will you expect them to use specific ones? Will your clinicians have the ability to accept or decline referrals based on clinician-client fit, or will your clinicians be expected to provide services for clients who are assigned to them? You’ll need to make a decision about what works for you and your vision for your practice, and then clearly communicate those expectations to your prospective group members. 
  • Ownership of clinical records
    Who will be responsible for maintaining clinical records? You’ll also need to decide who will be responsible for the retention and destruction of clinical records, as well as responding to records requests. 
  • Scheduling 
    Who will be responsible for answering phone calls as well as scheduling and rescheduling client appointments? Will clinicians in your group be required to offer sessions on specific days or during specified hours, or will they establish their own schedule and availability? 
  • Marketing
    Who will be primarily responsible for marketing tasks? Will your marketing strategy be a coordinated, group-led task? Or will each clinician be individually responsible for marketing themselves?
  • Funding sources and fees
    Will your group practice be cash pay or insurance-based, and will each clinician make this decision for themselves? Will clinicians set their own fee or will fees be established by the practice?

When you’re making these decisions, be sure to consider which aspects will streamline efficiency in your practice. Be sure to also consider which aspects of independence your clinicians will value the most. For example, many clinicians strongly value clinical autonomy and scheduling flexibility in their work, and that’s their prerogative as private practitioners themselves. However, if this doesn’t align with the vision you have for your group practice, it’s important to let them know upfront, so you can avoid conflict later. 

All these considerations also will play a significant role in the legal relationship between yourself and the clinicians in your practice. Some of these decisions will help determine if they would be most appropriately classified as employees or independent contractors. If you’re unclear about how to classify your clinicians, check with an attorney and communicate your expectations to them.

Members of a group practice walk together outside of their offices.

Create Mutually Beneficial Relationships 

Mutual benefit is a key ingredient in recruiting—and retaining—excellent clinicians for your group practice. This is even more important today, as solo practitioners have an increased ability to streamline and simplify their own practices. And as the demand for health and wellness services continues to increase, your ability to clearly articulate the value that clinicians gain by being part of your group practice will become increasingly important. 

During your interviews, be clear about both the benefits clinicians will receive by being a part of your practice, as well as the value you’ll get from them. Not only will this help you confidently identify clinicians who are aligned with your vision for your group practice, but it will also hold you accountable for fulfilling your responsibilities and obligations to the clinicians in your group. 

Create a Group Practice Culture

As clinicians, we understand that the relationship dynamics of any given group will change over time. The culture that you create within your group practice may be the most important aspect of your practice, and can serve as the catalyst for either excellent clinician retention—or high turnover and professional burnout.

Your vision and mindset as the group practice owner significantly impact the group culture of your practice. Think of ways that you can intentionally facilitate a collaborative culture among the clinicians within your practice as opposed to a competitive one. These relationships within the group are often a microcosm of your group practice’s larger relationship with the community as a whole—so it’s up to you to create both with intention. 

Some key considerations here include: 

  • How large do you want your group to be? 
    Group dynamics change significantly based on the size of the group, so it’s helpful to begin with the end goal in mind. 
  • Is clinician retention a key goal for you? 
    Some group practices seek to retain clinicians long-term while others are focused on training clinicians in a specific therapeutic modality and expect that they may leave the group to pursue other opportunities.  
  • How will you address clinicians leaving the group, or being terminated?
    The best interests of your clients are paramount. Consider the logistics of transitioning clients when a clinician separates from your group, and whether this transition is from your group to another practice or to another clinician within your group.  Think about not only how these issues will be addressed with the clinician or staff at issue, but also how the rest of your group will be made aware of the situation.
  • How will you foster relationships within your group?
    Consider how you may be able to accommodate various personality types (i.e., introverts and extroverts) so that everyone has an opportunity to comfortably participate in team-building. 
A woman sits at a conference table having a conversation with her group practice mates.


Transition Your Workflows

Before you scale your practice to a group practice, it’s essential to have solid workflows that are working for you as a solo practitioner that you can transfer to a group setting. Any inefficiencies in your current workflows will only be amplified by adding more clinicians and clients. And not only do those inefficiencies cause frustration, but may cause your clinicians to lack confidence in your group, which devalues your mutual benefits and negatively impacts your group culture.  

For most clinicians, thinking about efficiency and workflows isn’t exciting. But this is an essential element to a profitable group practice that can scale with you. You can begin by looking at the list you created of your areas of control and responsibility, and ensure there are workflows associated with each item on that list.  Once you have streamlined and maximized efficiency within your practice, you can begin making decisions about what kind of team you will need to support your practice.  

Structure Your Finances

The last big consideration you have to make is to decide on your fee structure. There are a lot of options here, which is why many clinicians often make this decision first when they’re thinking about starting a group practice. However, starting with the fee structure often leads to undervaluing other decisions, like the mutual benefits and the costs associated with running a group—which can make it difficult to run a profitable business. 

Without a thorough consideration of all of these questions, it’s extremely difficult to establish the value of what you can offer as a group practice owner and what your clinicians can offer you in a mutually beneficial relationship. After you have clear answers to each of these questions, you should be able to quantify the value of the services you provide as well as the financial needs of your group practice. Because a group practice is ultimately a business, and a significant investment of your time, knowledge, and energy. You should plan for—and expect—a return on that investment. 

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