Your First Group Practice Hire—How to Build the Right Foundation
You’ve decided it’s time to bring someone else into your practice. Congratulations! This is one of the most exciting (and nerve-wracking) milestones for a therapy business owner.
The first hire is a big deal. Done right, it’s the start of a team that makes your practice stronger, more profitable, and more sustainable. Done wrong, it can cost you time, money, and more than a few sleepless nights.
Here’s how to approach your first hire with clarity, confidence, and a game plan.
Decide: Employee or Contractor?
Before you start scanning résumés, you’ll need to decide whether you want your hire to be:
A W-2 employee: You control their schedule, client load, and processes. They represent your brand fully, and you cover payroll taxes and possibly benefits.
A 1099 contractor: They have more independence, choose their own hours, and may work for other practices. You don’t cover payroll taxes or benefits.
Depending on your state and business classification, there can be guidelines that you are required to follow, so definitely consult both your attorney and your accountant to avoid misclassifications that can create a problem for you down the road.
There are pros and cons of both classifications and in either event, my recommendation is to always start them off with part time hours, unless you are sure you have a full stream of referrals ready to justify the payroll expense. I recommend Gusto for all things payroll related because they make it so simple and keep track of all the back end needs. As a practice that has clinicians in multiple states this has been the key to simple onboarding and payroll systems. Gusto integrates with Quickbooks and and recommended to us by out accountant.
Hire for Culture First, Skills Second
This is one we learned the hard way. You’re not just hiring a clinician, you’re inviting someone into the values, ethics, and personality of your practice. Clinical skills matter, but if their work style, communication approach, and professional boundaries clash with yours, the relationship will crumble and they can destroy the brand that you are building. Right now, you are the face of the practice and you carry that load like the CEO that you are. Your first hire takes on 50% of that responsibility, so when you’re hiring you want to be sure that they are ready to rise to that occasion.
Ask yourself:
Do they share my commitment to client care and ethics?
Will they adapt to the way we work with clients and colleagues here?
Would I want to share an office (or a virtual coffee) with them regularly?
Watch for Early Red Flags
Even in the first conversation, you can spot signs that this may not be the right fit:
Vague answers about ethics or clinical decision-making
Overemphasis on money without interest in culture or client care
Negative talk about past employers or colleagues
Poor communication in emails or missed deadlines for returning application materials
Remember: skills can be sharpened, but attitude is hard to change.
Ask the Right Questions
Your interview should help you understand three key areas:
Clinical judgment
Client rapport
Professionalism
Here’s a bank of sample interview questions you can adapt:
Skills & Clinical Approach
Tell me about a time you worked with a client outside your primary specialty. How did you handle it?
How do you measure progress in therapy when goals are less concrete?
Client Rapport & Retention
What do you do in the first session to set the tone for a good client relationship?
Describe a time you had to end therapy earlier than planned. How did you handle it?
Teamwork & Ethics
How do you handle a disagreement with a colleague about a client’s treatment plan?
What steps would you take if you suspected a colleague was engaging in unethical behavior?
Stress Management & Boundaries
How do you manage your emotional energy after a challenging session?
What’s your approach to maintaining work-life balance?
Onboard Like It Matters—Because It Does
Hiring is only the first step. You’ll also need a solid onboarding plan to set expectations and integrate them into your practice smoothly.
At a minimum, onboarding should include:
Reviewing policies and procedures
Introducing them to your practice management system
Shadowing (if applicable)
Regular check-ins during the first 90 days
The right first hire can give you breathing room in your schedule, increase your impact, and set the tone for a thriving group practice. Take your time. Choose for alignment. And remember—you’re not just adding a name to the payroll, you’re shaping the future culture of your business.
If you missed part one of the series, check that out here. Still sure this is the right move, but have questions about tightening up loose ends? Schedule a mini strategy session and we can discuss how I can support you in your transition.