By Bea Armstrong –
Do you come from a big family? Or are you an only child? Or somewhere in the middle? Were there also a lot of extended family members in your childhood household?
I am asking how many people you feel familiar, or even comfortable, living with in your daily environment.
Why? Because those numbers will impact on the size of the private practice you create. And sometimes in inverse correlation. Meaning that, for various reasons, you might want to try the opposite situation from the one in which you grew up.
I am one of two siblings – and the typical oldest child. I like running things, organizing them, being in charge. My sister would heartily agree when it came to organizing her!
Given the isolation of the work that we do, I knew from the start that I wanted to be part of a group practice and that I would likely be an instigator regarding making that happen. So while this is an article about the size of the practice you decide to work in – which includes going solo – let me state up front, that I am biased toward a group set-up.
Oh, Solo Mio
But there are advantages to going it alone…
You get to call all the shots – where your office will be located, what the waiting room will look like (furniture, paint color, art), what amenities you’ll offer (water, magazines, books) and how the suite will be laid out.
If you’re an introvert, you might revel in not having to deal with people, other than your clients. And you could get all of the socializing you need or want by attending networking events and conferences. Or, if you only do clinical work part of the time, and say, teach as well, you will interact with others that way.
On the other hand, you get to call all the shots – paying for all the TIs (tenant improvements) yourself as well as any future assessments the management requires; dealing with infrastructure: electrical (outages), water (floods or dry taps), parking lot problems; paying for the waiting room furniture and amenities; setting up WiFi and fax. And – no small thing – being totally liable for a maximum 5-year lease. And negotiating that lease – though you can get help with this from your real estate broker.
The obvious advantages of a group situation include sharing all of the above costs, but also sharing the decision-making, which, dependent on the number of lease signers, can be a slow process and a disadvantage. I have had personal experience with this in my first group where all of the licensed clinicians were lease signers and quite frankly, it seemed to take ages to decide even simple things, like what call-light system we wanted.
And because that group had more than 10 licensed persons, and at least another 10 interns at various times, just having everyone be heard in an hour-long business meeting or case consultation was a Mt. Everest effort.
Somewhere in the middle size-wise is Goldilocks’ “just right!” I am in a group practice now – Bay Area Psychotherapy Associates – that has 7 therapists. Over our nearly 10 years together, we have come to know each other very well and are comfortable together. And this feels “just right” for me.
But not all 7 are lease signers. In fact, only one colleague and I are. That doesn’t mean that we don’t consult with the other 5 regarding decisions, but since we signed on the legal line to bear the risk of the 5-year lease, we are the ultimate deciders. And that means less wasted time.
As partners, we also share handling the behind-the-scenes running of the office. For example, taking turns with the financial necessities of bill paying, rent check deposits, ordering magazines, and other concerns, such as making sure water is delivered on time, and interacting with the building management as needed.
I wish that it went without saying that the people you include in your group practice should work well together, be comfortable with each other, even enjoy each other. Unfortunately, we’ve all heard the tales of a Controlling Clara or Negative Nigel making group interactions a pain.
If you’ve known your potential group members for a long time before you come together as a group, remember that seeing them once a month or less on a social basis is not the same as seeing them and working together daily. Trust any doubts you might have about their fitting in. Better to have fewer group members and pay more rent for that space than have someone on board who is prickly to be with.
The professional advantages of working in a group practice with people you trust and even admire are amazing.
First, as I said earlier, the work we do is socially isolating. Hour after hour, we are behind closed doors with our clients and typically have a scant 10 minutes between sessions to use the bathroom, pick up voice mail and e-mail messages, jot down a few notes regarding the past session (to be fleshed out later), and read case notes in preparation for the next client. So even when you are in a group practice, you and your colleagues might often be ships passing in the night.
But they are there when you need a quick consultation, want a lunch partner, or just need to vent!
And those colleagues are also there should something more serious arise. Just recently, one of my colleague’s clients attacked her physically in a session, which naturally rattled her. She was able to vent and be comforted by group members. I can’t imagine dealing with that solo.
The advantages of in-house referrals, especially when the group members have different specialties and treatment populations and modalities, is a huge plus. Two of my colleagues focus on working with couples, another with adolescent males, another is bilingual. Two are men, which is also a huge advantage regarding client referrals, and getting a male perspective in consultations.
When I need a referral, it is so much easier to just walk down the hall and ask if a colleague has any openings versus calling therapists I know and waiting for return calls.
Ditto when I need special resources – such as a psychiatrist in another city, or an in-patient treatment center in another locale, or a group for a client who has a particular addiction. I can look on the Web, of course, but it is so much faster when that information is in-house.
Just doing the math is interesting. There are 7 colleagues in my group, including myself. Let’s say that each of us knows 10-25 referral resources and using the 25 as the multiplier that means in our group we have access to 175 names of people and agencies to meet the needs of our clients. Of course, there is some overlap, but even deducting for those, it’s an amazing font of information.
Plus we are sharing working experiences – good and bad – regarding these resources, so it’s a little like having an in-house Yelp.
And then there are the marketing advantages of a group:
- Having a group website, which gives us another presence on the web.
- Sharing of the costs, work, and invitation lists for group events such as open houses, book signings, etc.
- Letting colleagues know of groups or presentations that we will be doing to get their clients tuned in, as well as their personal support and attendance at the latter.
- Teaming up to do a joint group or presentation.
And, certainly not the least advantage of a group practice, are the weekly case consultations that I wanted to be sure to have. When you have worked with the same people for close to 10 years, there is hopefully trust that develops so that you can not only talk about difficulties regarding patient treatment, but also regarding counter-transference blocks. We know each other well enough to know what some of our blind sides are. And we are also aware of some personal issues in each other’s lives that could be impacting our work with particular clients, where there is likely a parallel process.
Case consults are good ways to also take care of business concerns, ethical issues, and information about upcoming conferences that we are attending (and that our colleagues might be unaware of), as well as any interesting postscripts regarding conferences we did attend.
If the group is a training center for interns, or just if some of the therapists in the group do intern supervision, case consults are another intern benefit that is gold for them.
Sometimes It’s Just Fun!
So, while there are many professional reasons to create a group practice, one of my favorite reasons to do so is that it is fun working with people – and not just our clients!
Sharing this work, which has its quirks and macabre humor, can lighten the stressors that are intrinsic to this profession.
Our group wanted to make sure that we got to know each other better and so approximately twice a year, we have a weekend social event, typically a dinner party that we take turns hosting and bringing food to. That allows us to meet the spouses, significant others – including pets – of our colleagues. And spend some relaxed time together.
But even apart from those planned events, working in a group includes the everyday interactions with colleagues, some of whom become friends, over time. The in-house joke sharing, the yummy treats that find their way to the communal kitchen, and the support during difficult personal times.
The bottom line is there is no “right” or “wrong” size of a private practice – only what’s right, or wrong, for you. Like most important decisions, it’s about knowing what fits for you – whether it’s going solo or assembling a group of whatever size. And enjoying what you create that works – and learning from what doesn’t.
Be sure to let us know your questions and what works best for you by leaving a comment below. We look forward to hearing from you!