Show Notes

Welcome back to the Designer Practice Podcast and I’m your host Kayla Das.

When starting a private practice, you may go through an array of emotions from excitement to overwhelm to worry. For some, the pros of private practice outweigh the cons, while for others, the cons negate ever starting a private practice to begin with.

In this episode, I’ll explain both the pros and cons of private practice so that you can determine if private practice is worth it for you.

Pros and Cons of Private Practice

There are many pros and cons of private practice. Although you’ve probably heard me say time and time again that starting a private practice and being my own boss was a life changing experience. It doesn’t mean, though, that private practice is for everyone. When you’re deciding a private practice is right for you it’s important to weigh both sides to determine which comes out on top.

As I go through the pros and cons, I will be dividing them into three categories business, personal, and emotional. The business category will highlight the pros and cons that are specifically about the act of running a business. The personal category will focus on how private practice influences or impacts one’s personal life. And finally, the emotional category will discuss some of the internal or emotional pieces that some therapists will go through when starting, running, or growing their private practices.

So, let’s first discuss the cons of private practice.

Cons of Private Practice

Business

From a business perspective, here are some of the cons for private practice.

Unlike when you work as an employee, when you work in your own practice, you are managing all of the business aspects of the work, unless, of course, you hire someone to do it for you. For example, in private practice, you’ll be managing your own bookkeeping and accounting, including insurance submissions. You’ll schedule your own client appointments and do the administrative work around that, such as answering emails, telephone calls, while simultaneously doing your own marketing to bring in clients. And all of this, you’re essentially doing for free, with the goal, of course, to bring in clients so that you do get paid.

Also, on top of personal taxes, you’ll also be tracking, filing, and paying business taxes each year.

Also, when you work for an organization, you get access to all of their equipment at no cost. However, when you own your own business, you’re on the hook for paying for your own overhead such as office supplies, rent, laptop, and even private practice management software. A consideration though is usually you can claim these as business expenses come tax time.

One of the cons that worry therapists the most is the fact that if you have no work, you receive no pay. So, if your schedule isn’t full or you find it difficult retaining clients or clients cancel or no show you might miss out on pay. Although it’s advisable to have a policy in place to manage late cancellations or no shows, you may not have a way to obtain your lost payment if a client ghosts you. Sometimes even when you have a credit card on file, the credit card could be denied for various reasons. If you’d like to learn more about how to handle no shows and late cancellations, I actually had an episode a few weeks ago, Episode 67: How to Handle No Shows and Late Cancellations. So, check that out.

In addition, typically when you work in agencies, you’ll have access to superiors for clinical supervision. However, when you are running your own private practice, you’ll likely have to pay out of pocket for your own clinical supervision.

Finally, the dreaded insurance billing. Insurance billing has its perks as many clients like not having to pay out of pocket for their services. However, if you decide to direct bill insurances, it can become an additional headache for you. Depending on the insurances you bill, you may have to navigate several accounts at once and submit your billing manually, especially if you don’t have a practice management software doing it for you. And then you need to wait for the insurance companies to actually pay you, which could be days, weeks, and even in some cases months before you get a payment. When I first started out, I tried direct billing and after going through hoops to process the payment, I never did it again. And honestly, I really don’t think I lost any clients because I didn’t direct bill. Now, I do want to acknowledge that Canadian insurance billing is very different than U.S. So as a Canadian, I’m speaking on behalf of my experience in the Canadian system.

Personal

In addition, to cons for the business side, there’s also cons influencing or impacting one’s personal life as well.

First of all, because you are a business owner, you won’t have access to employer benefits. So, if you want health benefits, you’ll need to pay out of pocket for this. I know this con deters some therapists from going into private practice. But interestingly enough, I haven’t seen much of a difference between my previous employer’s benefits to the family benefits that I contribute to now. For instance, when I worked in agencies, a portion of the employer benefits was always deducted from my paycheck to cover the cost. So I was kind of paying for it anyway. But the only difference is that I noticed in my case is that in the agencies that I worked in, the employer did pay half of the insurance while I pay the other half. So, insurance did cost a little less when I worked in an agency, but overall, I didn’t feel that there was a significant difference.

Next, when you work in your own private practice, you do not have access to paid sick or vacation days. To ensure that you have income during planned or unplanned leave of absences, it’s wise to save a portion of your weekly income as sick or vacation pay for when you need it.

In addition, in some private practices, you won’t have access to employer-employee contribution pension plans. Many agencies have a pension plan where both the employee and the employer contribute to a specific amount. Although you can certainly open a pension plan for yourself in private practice, you just won’t have the employer contribution benefit because, well, you are the employer.

Finally, you’ll need to be in business two years of life before your business income can count towards a mortgage. Now I’m no expert in the financial side nor am I an expert in mortgages. But from my own experience, in Canada, during my first two years of business, I was told that for my income to count for any mortgage, that I would need to be in business at least two years for my income to count for approval. I think this is important consideration because it’s not something that we talk about a lot and if you intend to buy property in the next two years. Going into private practice full time might actually impact your ability to be approved for a mortgage. So, if you are going into private practice, I advise that you consult with a financial advisor or your accountant to see if starting a private practice could impact your eligibility.

Emotional

And finally, there’s a few internal struggles that some therapists navigate through. When in private practice, such as isolation, fear, and navigating competing opinions about going into private practice to begin with. Private practice can be lonely at times, so finding a group of like-minded therapists can really help.

Also, fear often shows up prior to and during your time as a private practitioner, as everything you do is going to be new to you. You might experience fear of judgment, fear of repercussions, such as being sued or receiving a regulatory board complaint. You might have fear of making mistakes or fear of failure. You might even fear success. Fears can stop many therapists from ever going into private practice. Although I’m considering it a con because feeling fearful doesn’t feel great. It is actually a natural process of starting anything new, and as therapists ourselves, we help our own clients when they experience fear. So I want to assure you that if you are experiencing fear, you’re not alone, and as you start moving towards new things in your private practice and you start building that confidence, the fear does dissipate.

In addition to navigating fear of judgment, there’s also mindset issues, especially when it comes to navigating our colleagues, friends, family, or even other professionals’ opinions about going into private practice. One thing that I hear time and time again from prospective private practice owners is the worry that they’re going to be unethical, a sellout, or the big C word, a capitalist, for going into private practice. First of all, I want to say that you are not unethical. a sellout, or a capitalist just by opening a private practice. But it doesn’t mean that our colleagues, our professors, or even our clinical supervisors think the same way. Everyone has their own values, beliefs, and that includes what it might mean to be a therapist in the public, non-profit, or private sector.

So, when deciding if private practice is right for you, it’s important to consider, does working in the private sector align with your values, beliefs, and vision? And how are you going to navigate conflicting opinions about going into private practice if you experience that?

Pros of Private Practice

Even though there are several cons to private practice, there are also many pros for it as well.

So, let’s start with the business pros.

Business

First, in private practice, you can choose the type of clients you want to work with, how many clients you take on, and how often you meet with them. When you get to work with the type of clients that excite you while also choosing the number of clients you see each week, you’re less likely to feel drained after sessions and also prevent burnout overall. When you’re not bound by an arbitrary number of sessions, your clients are also more likely to achieve the results that they’re seeking. Unfortunately, it’s not uncommon for therapists in the public or non-profit sector to be mandated to work with an unrealistic number of clients per day or week with varying needs, while also being mandated to provide a limited number of sessions per client. All due to agency budget constraints. Which can leave therapists feeling burnt out and clients not feeling like they’re meeting their goals.

Next, you don’t have a necessary or irrelevant agency required meetings. I don’t know about you, but when I worked in agencies, I had been a part of so many meetings that afterwards I would wonder why I was expected to be there as the concepts were irrelevant to my role or was just a plain waste of my time. Fortunately, in private practice, such meetings are of the past.

Also, there’s no office politics in private practice. It’s really because it’s just you. And even if you do grow your practice and hire employees or independent contractors, you get to form the organizational culture. And you get to hire individuals that you jive with and who you believe will be an asset to your team and organization.

You also get to set your own fee and have control over your pay instead of being told what your income will be. When you work in agencies, you’re told your pay is X amount of dollars per hour. Whereas you have the ability to set and change your fee. You also have the choice to accept insurances or not.

And you get to develop your own policies, procedures, and way of running your practice instead of being told what you need to do and how you need to work.

Personal

Now let’s discuss some of the personal aspects.

You get to make your own schedule so you can be there for your family whenever they need it. Since having my daughter, I’ve appreciated this much more than I ever did before. As her care provider only works 8:30 to 4, I know that I won’t be rushing to pick her up because I know when to schedule appointments and when not to. Whereas when I worked in agencies, I really worked on the agency time, not my own.

Also never having to request time off from someone and getting those requests denied. In private practice, you get to take whenever you want off. You just won’t book clients for the week that you’re away. This was definitely my biggest pet peeve when I worked in agencies. I couldn’t get on board with the fact that I have so much available vacation and sick time, but I couldn’t always take it when I wanted or needed to.

You can also work from home by providing virtual and telehealth therapy so that you can be closer to your family and not have to travel so far. I love not having to travel a half an hour to 45 minutes every day in rush hour to go to work.

Emotional

Now let’s dive into some of the emotional factors of the pros of private practice.

First of all, because private practice provides autonomy, flexibility, and freedom, therapists often report that they feel more in control and have better work life balance than they did before. For me, this was definitely the case. The number one reason I went into private practice was to gain autonomy. Prior to going into private practice, I was in senior leadership positions in non-profits, and even as someone who ran the organizations, I didn’t feel that I had the autonomy or freedom due to bureaucratic red tape. But once I was my own boss, I started feeling more in control and I was able to develop a much better work life balance than I ever did before.

The fact that private practice therapists get to design a practice from scratch helps some therapists feel autonomous in their work because they get build and design a life for themselves that they never thought possible. Although, I recognize that for other therapists, this could also be a con. Because starting from scratch can be a lot of work.

Conclusion

Like any career, there are many pros and cons for private practice. So before starting a private practice, you may want to weigh each so you can determine if it’s right for you. The great thing though about starting a private practice is that you could start practice part time while continuing your employment or independent contract work elsewhere, and that could mitigate some of the cons that we discussed. So, you don’t necessarily have to jump in with both feet to get the benefits of starting a private practice.

Thank you for tuning in to today’s episode. If you like this episode, and you’re listening on a major podcasting platform, I would be forever grateful if you would take the time to leave a comment or a review.

Until next time, bye for now.

Credits & Disclaimers

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