Most clinicians do not become a CEO intentionally. Often times, the expansion of our private practice results from the desire to help more people and create something that is sustainable long-term. One client quickly becomes a full caseload and one hire turns into a team. Before we know it, we can be operating in survival mode, leading a business we did not plan for.
What I didn’t realize at the time was that building a group practice isn’t just a clinical expansion, but a leadership transition where we step into a new role as CEO. Looking back, there are several things I would do differently if I were starting my group practice all over again. These are the components we prioritize in my work as a business consultant. In this post, I am sharing the five biggest changes I would make that are a focal point in my work as a business consultant, helping other group practice owners shift from clinician to CEO faster than I did.
I wouldn’t do everything myself
It is normal in the beginning to wear all the hats and bootstrap to save money. From answering calls and submitting insurance claims to onboarding and marketing, we find ourselves spending more time working than we anticipated and more susceptible to burnout. When a practice depends entirely on one person it is not scalable or sustainable and can easily lead to reacting instead of leading. When we become the bottleneck in our own business, we often find ourselves working harder instead of smarter.
Learning to delegate is not about doing less, but about spending out time on the right things. By trusting others, creating clear roles and expectations, and transitioning from clinician to CEO, we begin to let go of the belief that we have to be ones doing everything to ensure quality and instead of the practice suffering, it stabilizes and grows.
If I were starting over, I would build support sooner, even if it felt uncomfortable because a healthy group practice isn’t built by one person doing everything-it’s built by a leader who knows when not to.
I would document processes from the beginning
If you are considering expanding to group practice, there will come a time when you are onboarding and training someone to work within your practice. When everything lives in your head, it can be difficult to convey this knowledge to another person. If you do not have a centralized location where expectations and processes are documented, when you expand your team, every question will come back to you. Not only will this be time-consuming and inefficient but every new hire feels like you are starting from scratch instead of building on what already exists. Documenting systems also protects the practice so it can function when the owner is away.
If I were starting over, I would document earlier, even imperfectly. Over time, these early documents become living guides that create flow and freedom while supporting sustainable growth.
I would know my numbers sooner
Many mental health professionals turned business owners avoid numbers. They can feel unimportant in the beginning and overwhelming over time. Without clear financial data, especially as you are building a team, you end up making decisions based on emotion rather than strategy. Understanding the basics-revenue, expenses, payroll, and profit margins-changes everything because you have the clarity and confidence to make proactive decisions instead of constantly playing catch-up.
If I were starting over, I would know my numbers from the beginning so that I could identify trends over time, plan ahead, and respond strategically rather than reactively.
I would not hire out of urgency
When you have a long waitlist and are headed for burnout hiring can feel like the fastest solution. What we may not realize if we have never been a boss before is that hiring too quickly can create more work. When it is driven by urgency, we can compromise fit, overlook issues, and find ourselves questioning why we hired in the first place.
If I were starting over, I would hire intentionally. I would define the role clearly, assess capacity honestly, and implement a multi-step process to increase the likelihood of alignment.
I would embrace the role of CEO sooner
It is common to see yourself primarily as a clinician who happens to own a practice. Leadership can feel secondary to client care. Stepping into the role of CEO can feel unfamiliar and at times uncomfortable. When we avoid our CEO identity, we can remain in reaction mode, values become harder to protect, growth can feel chaotic, and the business can run us. By building systems early, hiring thoughtfully, and making data-driven decisions, we give ourselves permission to work on the business, rather than in the business.
If I were starting over, I wouldn’t wait for permission to lead. I would trust that being a strong CEO is essential for building a practice that is not dependent on me to survive and creates long-term stability.
How we help
The consultants at Compassionate Consulting Company have been there. We all know what it feels like to wear all the hats, avoid the numbers, hire out of urgency, and feel uncomfortable in our CEO role. We also know what it feels like on the other side-having a team of the right people working toward same goals, documented processes, and profitable. We help clinicians at every stage in practice build a business without losing their values or burning out. Learn more here.
