Alright, time for a reality check. We’ve talked about the exciting parts of a group practice and the mindset you need – but what about the gritty, real-world challenges?
I believe in being transparent: expanding your practice will come with some growing pains. Here are some realistic expectations to have when you decide to scale, and how to handle them:
Hiring Can Be Hard (and Vital):
Your first hire is a huge step, and it can be tricky to get it right. There’s no magic formula for knowing exactly when or whom to hire, but there are telltale signs it’s time – like consistently turning away business, or feeling chronically overworked.
When you do hire, be prepared to invest significant effort into the process: writing job descriptions, interviewing, and onboarding. It’s common for therapists new to hiring to make mistakes such as bringing someone on just because you’re desperate for help, rather than ensuring they’re truly a fit.
I’d go as far as to say, the biggest mistakes therapists make when hiring their first team member often stem from rushing or not having clear expectations.
Take your time to find people who align with your values and work ethic, it will save you tons of headache later. And once you hire, pour energy into training and integrating that person.
Remember, they aren’t a mind-reader or a clone of you; they need guidance to succeed.
More People, More Personalities:
One of the blessings and curses of a team is that it’s made up of human beings – each with their own personality, habits, and quirks. Inevitably, conflicts or issues will arise.
Maybe two staff members don’t get along, or a therapist consistently shows up late, or there’s drama over how to split weekend shifts. As the owner, you become the de facto problem solver and mediator.
Office politics and interpersonal dynamics are now on your plate. “The workplace environment will always have personality conflicts and ethical dilemmas, It’s normal!
The key is to set a positive culture from the start. Be clear about expected behaviors, and don’t shy away from addressing problems early and directly. Having an employee handbook or a set of “house rules” can help everyone know what’s expected.
And if you’re not comfortable managing conflict, get some mentorship or training in HR basics, it’s a skill you can learn.
Clients Will Have Preferences:
When you introduce other therapists, you may encounter situations where a client says, “Actually, I’d rather see Therapist B next time instead of Therapist A.” The first time you hear that, it can sting or cause internal friction. But it’s natural – clients will gravitate to the practitioner that fits them best.
In a group practice, you have to keep egos in check (including your own) and focus on the client’s best interest. There might even be instances where a long-time client of yours decides they click better with your new hire!
Rather than seeing that as a threat, view it as a win for your business.That client has chosen to stay with the practice, and you’ve freed up time to serve someone else. Do prepare your team for this reality so no one takes it personally.
Handle any client switching professionally and gracefully.It’s not about competition; it’s about offering the best care as a team.
Higher Overheads and Financial Complexity:
With growth comes more expenses – additional treatment rooms or a larger facility, employee wages or contractor payouts, extra supplies, maybe software subscriptions for scheduling multiple people, and so on.
In the beginning, you might actually take home less money until your team is fully utilized. For example, when you hire your first therapist, you may only be 50% booked for them at first; during that ramp-up period, you’re paying salary or commission without full revenue offset.
It’s important to budget and plan for these growing expenses. In a perfect world, you’d have some savings or steady cash flow to invest in the new hires until they become profitable.
Also, your accounting will get a bit more complex, you might consult with an accountant to set up payroll, taxes, and bookkeeping for a multi-therapist operation. The good news: if you manage it well, the long-term payoff is there.
Remember Tara, who reached $30k months? In her case, she was strategic from day one about finances, ensuring her growth was profitable. Scaling is a bit of a short-term sacrifice for long-term gain scenarios. Go in with eyes open that your profit margins might dip before they rise.
The “Boss” Burden (Responsibility and Stress):
When you become an employer (or even just the lead in a group of contractors), the sense of responsibility can at times feel heavy. You’re no longer just worried about your livelihood; your decisions now affect your team’s income and career satisfaction.
If business slows down, you’ll feel pressure to fill schedules because others are counting on you for work. If someone on your team makes a mistake with a client, ultimately your business reputation is on the line.
It’s a new kind of stress compared to solo life. I won’t sugarcoat it…there will probably be days you wonder, “Why on earth did I sign up for this?” (Every group practice owner has had that thought at some point.)
This is why having systems, support, or even a coach/mentor can be crucial. It helps to remember why you chose to scale, whether that be maybe to have a bigger impact or to eventually create a better lifestyle.
Also, know that the “boss burden” gets easier with experience. You’ll grow into the role. And when you find the right team members, they actually lighten the burden because you share it together.
Avoiding the Headache Practice
Perhaps the biggest warning I give to folks making the leap is not to inadvertently create a job that’s harder than the one you left. If you scale haphazardly, you can end up with a group practice that becomes a 24/7 headache – constant calls, emergencies, people quitting, clients complaining.
Much of it comes down to planning and boundaries: set up your operations thoughtfully, hire slowly and intentionally, implement policies, and maintain work-life balance for yourself as the owner.
Yes, there will be challenges but a well-built practice should not run you into the ground. If you find yourself more burned out than you were solo, take a step back and reassess – perhaps get help to streamline things.
The goal of scaling is to eventually give you more life, not less.
The bottom line on challenges: be prepared, not scared. Every business – solo or group – has challenges; they’re just different at each stage.
Knowing what’s coming is half the battle. If you anticipate these hurdles, you can meet them with solutions instead of surprises. And remember, every single problem you encounter has been solved by someone else before. There’s a wealth of knowledge (books, podcasts, mentors, peers) to tap into when you face an obstacle in your scaling journey.
Want To Go Deeper?
Are You Ready To Scale?
Facing the realities of running a group practice can feel overwhelming at times—but knowing the challenges upfront means you can prepare for them, plan around them, and avoid the most common pitfalls.
The next question is… are you ready to take that step?
In the next part of the Beyond Fully Booked series, we’ll walk through how to know if you’re truly ready to start a group practice and the red flags that suggest you should wait.
