Private Practice 101  “The Leap”

Am I ready for private practice?  Is private practice the right direction for me?  Is this the right time to begin a practice?  So you are thinking about starting a private practice.  You are most likely feeling overwhelmed by questions and anecdotal information you have gathered over time regarding the venture of being a self employed therapist.  For many of us, private practice and self-employment has been a long term career goal and professional dream prior to graduate school.  You may feel that your overall long term goal is clear but setting the foundation and exploring the details of how, if, when, who, where, are the next logical steps.  I suggest taking our own advice; most of us would suggest to an overwhelmed client “ take baby steps towards your long term goals”.

Pros and cons: So what is so great about private practice?  In my experience, working for non profit social service agencies did not fit well with my family goals of becoming a parent.  I really enjoyed the team approach, the ongoing consultation, supervision, and support, however, the case load, long hours on salary, and on call duties, were not a sustainable long term career plan for me.  I fantasized about writing my own schedule, working part time, no longer worrying about whether it was my turn to work a holiday, being able to say no when I was overloaded, working with a variety of motivated clients, having an ideal office space… Independence!

I did consider the possible cons. There will be the added work of managing a business, organizing and marketing my own practice, paying overhead, collecting fees, maintaining my own business boundaries, giving up a set income, giving up my own benefits and company contributions to 401 K’s, and paying out of pocket for supervision.

Preliminary research: As I approached completing my licensure hours, I begin researching this venture in earnest.  I contacted various therapists who were in successful private practices, picked their brains, took notes, and begin to formulate my initial business plan based on feedback and information gathered from those ahead of me.  I applied for an NPI number and researched malpractice insurance.  I followed the advice of my elders, and investigated the insurance jungle.  I compiled a list of insurance companies that accepted LPC’s and begin the laborious process of clarifying requirements and applying to panels.  I perused office space ads to determine the going rates.  I considered advertising approaches.

Qualifications:  This is a very controversial area.  Should you be licensed before going out on your own?  As supervisor of registered interns, I strongly believe that while licensure may or may not be critical, it is critical that you have a solid foundation based in practical clinical experience guided by wise, ethical, skillful, well-grounded supervisors.  Once you are on your own you must be far more reliant on your own resources.  You no longer have the protection and support of an agency.   What is your level of professional confidence in a clinical sense?  Either way it is advisable to continue receiving supervision and mentoring as you head out on your own.  If you do plan to accept third party insurance payments, your license will be necessary in most cases.

Finances: Can I handle the uncertainty of income, especially just starting out?  How will I pay for my overhead until income starts coming in?  How long does it take to build a profitable practice? Will I use a billing service?  What fees will I charge? These are very individual questions you will need to explore for yourself.

The decision:

The freedom of self employment and a part time practice beckoned, and once I completed my license, I sat down with my mentor and was off and running (starting with one day per week). 

My leap was a gradual one.  I begin seeing clients in the evening after long days at my full time job.  I was blessed to have a partner with a steady income and health benefits which covered me.  I was also blessed with the option of reducing my hours to 30 hours/week at my agency position for several months before cutting ties completely.  I surrounded myself with supportive, optimistic people who helped guide me though this transition.  I inhaled Lynn Grodzki’s book “Building your Ideal Private Practice” (which I recommend to anyone building a practice in the healing profession).   I gradually built a small caseload which gave me the confidence to leave my salaried job and put more energy into growing my practice.

I hear of various therapist’s journeys into and out of private practice.   It is not a good fit for everyone.  In order for private practice to be profitable and satisfying you must be able to tolerate some ebb and flow in income, maintain a level of confidence, optimism, and faith that referrals will arrive, discipline yourself to create your own structure, maintain your professional boundaries and attend to and enjoy the business side of the practice.  I have been practicing on my own since 2005, and my business plan has gone through many revisions.  I have expanded my practice from Salem to N. Portland, moved offices three times, taken long vacations and one maternity leave, and have recently settled into my very own space, which I share with several other counselors.  I initially missed the “team” approach, the networking and support of an agency but have created my own support network of professionals in the community and become active on board of ORCA.  Finding a mentor or two or three and developing a network of professional acquaintances, will help to inspire, and focus your practice as well as to reduce isolation.

There have been some financially slow times but when I get discouraged or frustrated I channel it into action (new marketing ploys, organizing resources, revising or updating polices, or researching a clinical issue). I truly enjoy my practice and the flexibility it offers me to balance my profession, family and other passions.

I encourage you to explore how you can best find your personal and professional balance in this field of helping others!

-Rachel Starck is an LPC practicing in North Portland at The North Portland Growth Place, a shared space for independent counselors and healing professionals.  www.thegrowthplace.com