Group Practice Growing Pains: Avoid These 7 Traps
Picture this: you’ve just signed a lease for a bigger office space, hired two counselors, and ordered new business cards with “Group Practice” proudly displayed under your logo.
Fast-forward six months, your schedule is chaotic, your team’s frustrated, and you’re working more hours than when you were solo.
Growing from a solo practice to a group can be incredible, but only if you avoid these common pitfalls.
Hiring Before the Numbers Make Sense
We talked about this in an earlier post about how to know when it’s time to bring on staff, but it’s worth revisiting. Bringing on another clinician is exciting, but excitement doesn’t pay salaries. If you haven’t run the numbers, you could end up losing money on each client your new hire sees.
Avoid it:
Know your break-even point per clinician(This number gets higher for every dollar you offer in salary)
Understand your average reimbursement rate (or private pay fee)
Have a financial cushion for slow months
No Clear Processes or Documentation
When you’re solo, you can “wing it” because you’re the only one in the loop. In a group? That’s a recipe for chaos.
Without documented processes for scheduling, billing, client communication, and clinical documentation, every team member will do things their own way—which creates inconsistency and compliance risks. I hate to admit this, but on this site we tell the truth about private practice. We hired a seasoned clinician for a role some years back, knowing that she would be excellent with our clients, which she was, but because we didn’t have a process for tracking billings and claims, she got 3 months behind on notes and we lost thousands in revenue when it was too late to bill the insurance or the client for those sessions AND she had already been paid. Don’t get caught in this jam like we did.
Avoid it:
Create a simple operations manual before your first hire
Use the same practice management system for everyone
Standardize forms, policies, and intake procedures
Make room in your weekly and monthly schedules for auditing files, reports, and billing
Micromanaging Instead of Leading
This may seem counter-intuitive based on the last tip, but there’s managing and there’s micromanaging, and most people in private practice HATE the latter. New group owners often struggle with letting go. You want things done just so, but constantly hovering will frustrate your team and burn you out.
Avoid it:
Have documented processes for the important things, like intakes and client files, so that new staff can have clear examples of expectations
Focus on outcomes, not every detail of how they get there
Schedule regular check-ins, but trust your hires to do their work
Remember—you hired professionals for a reason
Ignoring Culture and Values
It’s tempting to think your culture will “just happen.” It won’t. Without intentional effort, you can end up with a team that feels disconnected or even competitive in unhealthy ways.
The pandemic was hard on our practice because although we had offered virtual before, when it was time to return to office, some people didn’t want to come. As we added new clinicians, it was harder to quantify the culture with people who rarely saw each other.
Avoid it:
Clearly define your practice values and share them during hiring
Lead by example in communication, boundaries, and client care
Create small moments for connection, even if you’re a hybrid or virtual team
Underestimating Marketing Needs
When you’re solo, filling your own caseload is enough. In a group practice, you’re filling multiple caseloads, often for clinicians with different specialties. Your practice is still the brand, but your marketing may now need to speak to completely different people and still come across as cohesive.
Avoid it:
Keep a marketing plan running year-round, not just when it’s slow
Highlight your team members’ unique skills on your website and social media
Build referral relationships beyond your own personal network
Dropping Your Own Caseload Too Fast
Some owners try to pull back on seeing clients immediately after hiring. That can work if your revenue is already stable, but for most new group practices, it’s risky. It can be best to do this organically, by not filling slots as clients close. But remember it can take up to 6 months before a new clinician is fully booked, longer if they are cashpay or if they are just developing their niche, so during that time, you will often have extra expenses. Having a cushion of savings can help, but I recommend not cutting your caseload more than 1-2 clients for every 3-4 your staff takes on.,
Avoid it:
Keep enough client hours to sustain steady income while your new hire builds
Reduce client hours gradually as your team’s schedules fill
Use freed-up time strategically for marketing, systems, and leadership
Neglecting Compliance and Legal Structure
When you add team members, your liability changes. Without proper contracts, policies, and legal guidance, you could face serious problems. Your attorney, accountant and potentially a tax strategist if you have one should all be in the loop as you grow the business. I recommend LegalShield as a great place for new practice owners to start because the monthly cost is low and you can ‘try’ out a firm in your area who could become your long-term partner without a 4-5 figure retainer to start.
Avoid it:
Have an attorney review your contracts and employment agreements
Confirm you have the correct insurance for a group practice
Stay current on state and federal employment laws
Growing into a group practice isn’t about adding people, it’s about building a sustainable structure that supports both your team and your clients.
When you avoid these mistakes, you’ll give your group practice the best chance to thrive.
This completes our three-part series, so you now have a clear roadmap to Know when you’re ready (Part 1) Hire with intention (Part 2) and avoid common pitfalls (this post).
Have questions about logistics or want support with the mindset of a Private Practice CEO? Schedule a mini strategy session and we can discuss how I can support you in your transition.