For many solo practice owners, the idea of starting a group practice begins with a good problem: your caseload is full, referrals keep coming in, and you simply don’t have enough availability to meet the demand. Hiring another clinician can feel like the obvious next step.
But having enough referrals to support another therapist and being truly ready to become a group practice owner are two different things.
When I hired my first clinician in 2021, I quickly learned that growing a practice involves much more than finding a great therapist and sending clients their way. Suddenly, there are decisions to make about compensation, employment structure, policies, onboarding, productivity expectations, marketing, finances, and leadership.
You don’t need to have every detail perfectly figured out before you make your first hire. But having the right foundation in place can make the transition significantly smoother for you, your new clinician, and your clients.
Before you post that first job opening, here are some of the most important things I recommend having in place.
Get Clear About WHY You Want to Grow
Before you start thinking about job postings, compensation, or how many clinicians you want to hire, take some time to think about why you want to grow in the first place.
Maybe your caseload is full and you’re consistently turning away referrals. Maybe you want to reduce your own clinical hours and spend more time working on the business. You may want to increase revenue, expand into new specialties or populations, or build a practice that can eventually operate without you being the primary provider.
All of these can be great reasons to grow but growth should be connected to a larger vision for what you want your practice, and your role within it, to become.
It’s also worth asking whether you’re considering hiring because you’re simply overwhelmed. When you’re carrying a full caseload while also managing every aspect of the business, bringing on another clinician can feel like the solution. But hiring doesn’t necessarily reduce your workload right away. In fact, it often does the opposite.
A new clinician brings additional capacity and revenue potential, but they also require onboarding, training, supervision, communication, administrative support, marketing, and leadership.
Know Your Numbers Before You Determine Compensation
Before you determine compensation, you need to understand the financial picture of your practice and what it will actually cost to employ another person. It’s easy to look at what other practices are paying or choose a percentage that sounds competitive, but a compensation model that works for one practice may not work for another.
Start by understanding what you actually collect for a completed session. If you accept insurance, look at your average reimbursement rates rather than simply your highest-paying payer. If you’re private pay, consider your actual collected rate, including any sliding-scale or reduced-fee clients.
Then look beyond the clinician’s paycheck. Depending on how you’ve structured the position, the revenue they generate may also need to support expenses such as payroll taxes, benefits, paid time off, supervision, administrative support, billing and credentialing, technology, office space, and marketing.
You also need to consider that not every scheduled session is reimbursable. Cancellations, no-shows, clinician time off, holidays, and normal fluctuations in caseload all impact revenue. Building a compensation model around the assumption that every available appointment will generate revenue can quickly create problems.
Who Are You Hiring?
Before you start interviewing candidates, get clear about the position you’re actually trying to fill. It’s tempting to find a clinician you really like and then build the role around them, but ideally, you should determine what your practice needs first.
There are three important decisions to consider: employee versus independent contractor, pre-licensed versus independently licensed, and full-time versus part-time.
Each comes with different financial, operational, supervisory, and legal considerations and the right answer will depend on your practice’s current needs, resources, and long-term vision.
Build the Foundation Before You Hire
Growing from a solo to a group practice can be an exciting next step, but a full caseload and steady stream of referrals are only part of the equation. Before making your first hire, take the time to get clear on why you want to grow, understand the numbers behind the position, and determine exactly what type of clinician your practice needs.
You don’t need to have everything perfectly figured out before you grow. There will always be things you learn along the way-I certainly did. But the more intentional you can be from the beginning, the better positioned you’ll be to create a practice that is sustainable for you and supportive of the clinicians who join you.
The goal isn’t simply to hire another therapist. It’s to build a practice that is ready to support another therapist.
If you’re thinking about making the transition from solo to group practice, start by building the foundation. The hiring can come next.
How we help
At Compassionate Consulting Company, we help therapists navigate the transition from solo practitioner to group practice owner with greater clarity, confidence, and intention. Growing a practice involves much more than making your first hire, and you don’t have to figure out every decision through trial and error.
Through consulting and our Scale Smart Mastermind, we help practice owners think through the foundational pieces of sustainable growth-from employment structure and compensation to marketing, hiring, onboarding, systems, and leadership.
The goal isn’t simply to build a bigger practice. It’s to build a practice that is financially sustainable, supports the clinicians who work within it, provides excellent care to clients, and ultimately supports the life you want to have outside of your business.
If you’re considering growing from solo to group practice and aren’t sure what your next step should be, schedule a free consult to talk through where you are, where you want to go, and how we can help you get there.
