So you Want to Go into Private Practice? Questions to Ask of your Potential Practice

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.

It is my hope that this Private Practice Series has been helpful in understanding the ins and outs and pros and cons of being in private practice as a social worker. In my original 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 discussed the basics. In my second article, “Private Practice: The Pros and Cons,” appearing in the Fall 2024 edition of that same publication, I clarified both the good things and frustrating things about private practice. Considering all of this information, if you have decided that private practice may still be of interest to you, this article is the perfect one for you!

In my previous articles, I admitted my bias about how I personally believe private practice to be the most empowering area of social work in which one can practice. However, private practice for all healthcare providers, including physicians, does have a reputation for going wildly awry if those who own and manage the business are not skilled in that area.

You may have heard the phrase “Cs still get degrees,” implying that one can earn the credentials or make the cut, but that may not actually be the best in their class. The same is true for private practice offices. While we all have certain talents and areas of weakness and also know that no workplace is perfect, the key when starting your professional life in private practice is to find an office you trust and that has policies and structures to support you. Otherwise, it is common for private practice therapists, whether practicing under an employee or independent contractor model, to feel taken advantage of. 

Because I do not want this to happen to you and I rarely speak to someone who has had experience in private practice who cannot relate to this, I would like to help you be proactive. In this article I will share a bit of my experience as a private practice independent contractor, group private practice owner, and consultant and coach to those in private practice. My hope is that it helps you avoid some of the challenges that can arise in private practice. 

A Business Perspective

First things first. I have shared in my previous articles that my business mind comes naturally given that I was raised by two business people who work for themselves. However, I have found that business mindedness is a rarity for social workers. Most social workers not only see marketing and networking as a four letter word but dread the concept of collecting payments for their services. Even the thought of being responsible for submitting claims to insurance companies to get reimbursed for their valuable services is enough to throw your average social worker into a panic attack.

I get it. But, to really understand the questions to ask a potential private practice for which you are interested in working, it is necessary to understand the business perspective behind a private practice. In my pros and cons article, I shared that a common frustration in (group) private practice is not earning 100% of what a therapist makes. To see the bottom line of what you earned, which often ranges between 60-75% depending on location and practice model, in contrast to the additional income you missed out on will make your stomach drop. (Although, as also discussed in my previous article, some social workers are more than happy to pay whatever it takes to have someone else manage all of the business obligations so that they can focus solely on their therapeutic work with clients.)

However, in my experience, a reminder that the business has to make a significant profit. Private practices have to do this not only keep their doors open for you but also to have the necessary cash flow. They need to have the funds to actively market to bring you new clients or pay for that unexpected expense when your client accidently broke your couch and now you need a new one. You do not want to be a part of a private practice that is struggling financially. And, they need to have their therapists, whether independent contractors or employees, making them enough money to at least cover their own costs.

It cannot end there, though. We all know that only covering costs is not a sustainable business strategy. You want the private practice at which you work to be making a significant profit! You just want to make sure that it is done in the right way so that it feels fair and secure; not exploitative. Here’s where I come in!

The Questions to Ask

One of the ancient debates in private practice is “What do you consider full-time?” Some view 10 sessions a week as full-time. Others view anything less than 25 sessions a week as part-time. So, when considering working at a private practice, you need to ask what they consider to be “full-time” and if they allow for part-time therapists. (Remember, it is hard for part-time therapists to pay for themselves, so often this is not something private practices will accept long-term.)

If the amount of hours required fits with your professional goals and your work-life balance needs, you will want to ask if there are any required work times. Especially for therapists new to private practice who are building their client load, evening and weekend sessions are the highest in demand. Based on our traditional eight to five work and school schedules, those times tend to work for most people. While it doesn’t mean that you have to offer those hours forever, it can be a good strategy to get your schedule filled quickly (and then taper off those offerings as clients fall off your schedule if you desire). Some private practices may not allow this elimination of coveted session times, however. 

So, the next question to ask is what referral support looks like. Too many times I have heard therapists in private practice complain that they are working harder to have a steady stream of referrals than their office is. In some private practices, the culture can be so cut-throat competitive that therapists will make answering the phone their focus so that they can poach the clients they want who have the “good insurance.” 

It is essential to understand the system your potential office has to obtain, manage and fairly distribute new client contacts. Also clarifying what additional marketing, like social media pages or networking meetings, you may be allowed to do would be helpful. Regardless, just be informed and make sure it is in writing so that everyone knows what their roles are. Then you can rely on the safeguard for referrals that is an inherent benefit in working for a group private practice.

As you build your client load, the other question it is helpful to clarify is how often billing is completed and how often you will get paid. Some private practices bill frequently (e.g. daily, weekly) but some bill only as often as monthly or bi-monthly. Knowing when the billing will happen and, therefore, when you will begin to see reimbursements from insurance, will be essential for your own financial planning. Getting financial footing after starting private practice can take a while because payment is rarely immediate. So, clarify when you can expect payments. But, don’t lose hope because, when things get rolling, they really get rolling!

I need to pause here and share a sad story. It is also all too often that I have heard of therapists in private practice actually not getting paid or not getting paid accurately. Offering a business perspective again, there is a lot to keep on top of managing a private practice! Hundreds of billable sessions a week if it is a group practice! But, there should be a level of transparency and communication from your office about billing and documentation that should not require you to chase people who should be actively offering you information. And, when you bring up any discrepancies, it should not be met with anger. A group practice should be just that – a team providing services. Your own self-advocacy should not be met with resistance. It should be met with collaboration. 

To put this into perspective, I have even heard of private practices not allowing their therapists access to billing records. It may go without saying, but this makes it a great challenge to know what you are getting paid for and what is missing. While this is likely not done maliciously, it can lead to a great level of resentment. So many sessions happen in a week that falling behind on billing or information can quickly pile up and feel overwhelming for all. 

So, you SHOULD get paid! You SHOULD have access to records that help you do your job and know what you have been paid for and what is outstanding and needs to be followed up on. Insurance billing practices require that all claims be submitted by no later than one year from the date of service. So, while that seems like a long time, depending on the billing practices and the skill of the business owners, that can actually feel like an urgent deadline. 

All in all, trust your gut. Ask questions. Private practice should be welcoming to (and impressed by!) the questions you ask. To have someone understand the intricacies of private practice is an encouraging sign as a private practice owner! So, do not be shy in exploring what the culture and expectations are of the practice in which you are interested. Ask about benefits. Ask about shared office space. Nothing should be off limits. The best advice I can give, however extreme it may seem, is to have a healthcare attorney review your contract. This simple (albeit costly) step has saved many private practice therapists headaches and tens of thousands of dollars. 

So, do your homework. Explore what works for you. And, ask the questions you need to until you know if it feels right or not.

References:

Youngblood, A. C. (Fall 2024). Private Practice: The Pros and Cond. 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

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

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