Opinion: Private Practice: The Pros and Cons

By Ashley Carter Youngblood, LMSW, LMFT, CIMHP, CNRC, ADS, NNP

Ashley Carter Youngblood is the owner of her private practice in Kalamazoo, Inner Peace Counseling, PLC, where she specializes in the connection between nutrition and mental health and counseling worrying women and highly sensitive people. Because of her love of private practice, she also offers consulting services for those who are interested in starting or growing their own private practice.

In my previous article in the Summer 2024 issue of The Bridge, “Private Practice as a Social Worker: My Story, Getting Started, and What You Should Know”, I covered considerations for social workers exploring the option of working in private practice. I even reviewed common business models for private practice offices (e.g. employees versus independent contractors). What I have not yet explored, however, are the pros and cons of actually doing social work in a private practice setting. 

Private practice can be a difficult foray for any healthcare professional. This is because it is an area of practice where you do not know what you do not know until you know it. Because of this, often those considering private practice do not understand what questions to ask or what are the actual practical pros and cons to this area of practice until they take the formal steps to pursue private practice. With my passion for coaching therapists to create and maintain thriving private practices, I hope the following pros and cons are helpful to consider. I hope they will provide you with an exclusive peek into the realities of private practice so that you can confidently make the decision of if private practice is right for you.

In my previous article, I also openly shared my own bias that I personally believe private practice to be the area of social work where we can be most empowered for our self-care, most intentional about the clients we serve and the atmosphere we create, and most supported via financial stability. Again reflecting this bias, I will start with the cons. That allows us to get them out of the way so that we can get to the life-changing stuff. (I told you I am biased!)

The Cons of Private Practice as a Social Worker

Even despite my bias for private practice as a social worker, there are several challenges that come up even for those enjoying their professional life in private practice.

First, private practice can be isolating. Regardless of the business model of the practice, you work alone. If you are in a group practice, you may pass colleagues in the hall between sessions. You also will likely interact with the person doing your billing. Someone may even be scheduling your appointments. 

At its core, though, private practice is really just you doing therapy in a room by yourself. You are rarely collaborating with others. This is in stark contrast with the traditional interdisciplinary setting of an agency where social workers are frequently found. For those laser-focused independent workers out there, this lack of distraction may be ideal. For others who have chosen private practice but who thrive on collaboration, they may need to actively network to connect with other professionals who can offer support for their work in private practice. 

This isolation can also lead to safety concerns. What if you are the only person in the building providing therapy to a client with a serious mental illness or who has a history of violence who is becoming escalated? Because of this concern, private practice may not be ideal for the seriously mentally ill or for complex cases. If those clients are your jam, then you would likely need an extensive series of safeguards.

Other cons of private practice are personal ones. Rarely do private practices, even if their business structure has you working as a formal employee, offer health insurance. Paid time off, including holiday pay, is also a rarity. If you take days off and want to make up that income, it means you have to work more to make up the difference.

When considering the impact of insurance in the world of private practice, another consideration is how much private practice therapists depend on the often-unreliable and ever-frustrating world of health insurance. Credentialing (i.e. becoming an “in network” provider) with an insurance company takes time and, with only a few insurance carrier exceptions, can only be offered to those who are fully-licensed (although there is a method of billing where limited-licensed providers can bill under a fully-licensed provider to get paid).

In private practice, not only do you have to wait months to be credentialed so that you can see clients with a certain insurance, but it can take weeks to months to also get paid by insurance companies following submitting insurance claims. Granted, you can still collect copays, coinsurance costs, and deductibles from clients directly. But, weeks can feel like a long time to wait to earn the majority of your income, especially if you are newly transitioning to private practice. 

Given that insurance payments are often the central source of income for a private practice social worker, this is an unattractive feature of private practice. It is also noteworthy that it is not uncommon for insurance companies to do things like “clawbacks” or “takebacks,” where they suddenly report that they have overpaid you and decide to take money back for past dates of service. A therapist can make an appeal to fight this decision. But, those fights can last for months or years and, in the end, insurance always just does what it wants. 

Depending on insurance network selections (some have better reputations than others), therefore, private practice can be overwhelming. Coupling that with the infinite options for business structures and policies, private practice may be too much for some. 

As a coach to other therapy professionals, I can offer some practical suggestions here. There are some in private practice who only take self-pay clients. The feasibility of this largely depends on the part of the country in which you are practicing (e.g. How likely are clients to be able to afford your self-pay rate in your area?) and your specific niche. However, a way to address this concern is to be intentional about how you market yourself and what insurances you take. While what insurances you accept can be dictated by one’s group practice, Lynn Grodzki’s advice from Building Your Ideal Private Practice: A Guide for Therapists and Other Healing Professionals is good advice: do not make decisions out of fear. Instead, do them out of love.

Now, admittedly, no one loves working with insurance companies. But, one can choose to work with only the companies that pay well, pay promptly, and that have actual humans you can speak within a reasonable amount of time when you call their offices with a problem. For me, if the paperwork side of things begins to interfere with the quality of care I can provide a client, that is not an insurance company with which I will work. (Although I am jumping the gun a bit here, to put this into perspective, one pro of private practice is that the paperwork amount is miniscule compared to a traditional agency setting. Just a couple sentences for a session note is your average expectation.)

Another personal consideration is space. Most private practices will require therapists to share office space so that they can maximize the value they get from their lease. So, unless you are the leading earner therapist at a private practice who is always in session, you will likely not have your own office space and therapeutic tools (e.g. play therapy dolls) that are only used by you.

The key variable here is the growing popularity of telehealth. Since the COVID-19 pandemic, the ability for private practice therapists to be remote is unprecedented. However, it is important to note that interstate legislation still restricts where you and the client have to be physically located when providing therapy. And, every state has different legislation regarding allowances for telehealth therapy (Johnson, 2021). So, even telehealth private practice has many considerations. 

Even if someone is amenable with all of the above cons, a common complaint about private practice is that, in a group setting, you do not get 100% of what you make. Whether it is supervision costs (e.g. if you are billing as a limited-licensed provider under a fully-licensed provider), fees from a billing company, or the percentage the practice earns from your work so that they can cover not only their business expenses but also make a profit, therapists find it very frustrating to see the potential of what they could make if they were simply working for themselves.

This, of course, is where the “pros” of private practice for social workers come in!

The Pros of Private Practice as a Social Worker

Because I was raised by two business people who work for themselves, I have a naturally business-oriented mind. Despite this, I was surprised by the amount of empowerment and pure joy I felt when I finally took the leap to start my own private practice. It took me many months to research and consider the cons but also to recognize that the pros of private practice far outweighed them for my situation. 

Unless required by your group practice to fill certain in-demand slots (e.g. evenings and weekends), you work when you want in private practice. Want to have a three day weekend every week so that you can travel more? You can work four 10 hour days. Want to pay off your mortgage quicker? Move from part-time to full time. Burned out? See only a max of four clients a day. Tired? Take a nap during the session you had scheduled for the client who cancelled last minute. Since your income in private practice is based on the amount of billable sessions you provide, it’s that simple.

In private practice, you can also be the kind of social worker that you want. Although clients served can be dictated by group practices (e.g. a children only practice), in general, you can specialize in what you want. You can even create a supportive interdisciplinary community around yourself based on your niche, especially if you are feeling a bit isolated.

If you like the power of having your success depend on you but you do not want to be a business owner, join a group practice you trust. After the COVID-19 pandemic, private practices are desperate to expand to meet client demand. In a group practice, someone else takes on the business liability, finds the office space, collects from clients who do not pay, and creates the policies so that you can do the important healing work you are doing with clients. That may be the best of both worlds for some.

Similarly, the marketing aspect of private practice may be intimidating. If you are a part of a group practice or networking community, you should (the key word here is “should”! Check back in for my next article about what questions to ask of a potential private practice for which you would be interested in working so that you are not taken advantage of) have referral support to create a buffer and a consistent client schedule. It does take time to build a steady client schedule. But, especially since the COVID-19 pandemic, when the demand for mental health support has skyrocketed, I do not know of any therapist who has started in private practice who has not been full with a consistent client schedule within a month or two. 

It is possible to be successful in private practice! And, the time is ripe for social workers just like you! Unlike other healthcare professionals who need inventory and exam tables, social workers just need two chairs. The overhead, both material and emotional, is very low in private practice. So, consider the pros and the cons. For me, my final decision came when I realized there were just too many costs to not being a social worker in private practice. I hope you will join me!

References:

Grodzki, L. (2015). Building your ideal private practice: A guide for therapists and other healing professionals. W.W. Norton & Company. 

Johnson, D. (Fall 2021). Frequently Asked Email Questions from Private Practitioners. National Association of Social Workers’ Practice Perspectives, page 1. https://www.socialworkers.org/LinkClick.aspx?fileticket=FnTHyQV7g_4%3D&portalid=0

Youngblood, A. C. (Summer 2024). Private Practice as a Social Worker: My Story, Getting Started, and What You Should Know. National Association of Social Workers’ The Bridge, page 19-20. https://www.nasw-michigan.org/news/674343/Opinion-Private-Practice-as-a-Social-Worker-My-Story-Getting-Started-and-What-You-Should-Know.htm

Next article:

• Things to ask a private practice (to not be taken advantage of)