Stop Selling the Private Practice Dream
It's not what you think
Maybe the title is off putting because it is written by a private practice owner. But the glorification of starting your own private practice must stop. In today’s world, it is completely oversaturated and actually can cost you significantly more money. I remember being in graduate school and always having the dream of having my own practice. Before I did, I worked in community mental health, a hospital, a day program, and at a group practice for someone else. All of these experiences gave me well-rounded knowledge and had I known all I know now, would I do things differently? Maybe?
But here is my advice to the baby therapist, or anyone considering starting their own private practice, think long and hard. Not once. Not twice. Not three times. A dozen times. Running your own practice isn’t a straight shot to success, it’s a maze of overhead, competition, and tough lessons.
Here’s the unfiltered truth about private practice…
1. It’s expensive as hell! You have the big expenses: rent, utilities, malpractice insurance, business insurance. And then you have the “smaller expenses” that add up QUICK! Monthly EMR costs, advertising and marketing, paying for your website and email addresses, fees for claim submissions, fees for running credit cards, phone service fees, cleaning fees… the list does not end. Add it all up, and it’s way more than you think. Here’s the kicker: I’ve had therapists working for me walk away with bigger paychecks than I did at the end of the year. So much for “being your own boss,” right?
2. It’s completely oversaturated. Starting your own practice sounds like the dream, right? Well, here’s the problem: when everyone’s chasing the same dream, it quickly turns into a crowded nightmare. Recent research from 2024–2025 shows that many solo practice owners actually make less than therapists in group practices. Why? Because when it’s just you, it’s tough to keep a steady client flow. Bigger practices have bigger brands, more visibility, and the ability to pull in more clients, while the solo therapist is left hustling just to be seen. Yes, there are exceptions. But most of the time, the one-person show struggles to compete with the main stage.
3. But I want to just do telehealth… I wouldn’t. Over the last 3 years, we’ve seen a MAJOR swing away from telehealth, and this continues to rise consistently. COVID times pushed everyone into the virtual world. Now, people are swinging back. Telehealth still serves its purpose, but the number of clients that call my office asking for in-person therapy is significantly more than those calling for telehealth.
4. Get ready to become best friends with insurance companies. Think you’ll spend your days doing deep clinical work? Think again. Once you own a practice, you’re not just a therapist, you’re also the billing department, the insurance negotiator, the tech support, marketing team, and the office manager. Want to outsource the admin so you can actually focus on therapy? Great, add another expense to that ever-growing pile.
5. But I’ll just accept cash pay clients. Okay, some clients do pay cash, but the build up to a full case load will be significantly longer than if you partner with insurance providers.
These are just SOME examples of why private practice ownership isn’t what you think. If I were baby therapist, or just someone thinking about starting their own practice, I’d say don’t do it right now. Maybe the tide will shift again one day, but today isn’t that day.
The smarter play for now… partnering with a well-established group practice can give you everything you are looking for: freedom, flexibility, higher pay all without all the additional work.
So, think smart, think critically, and don’t let society sell you the dream that’s not as "dreamy" as it looks.
