Increasingly unpopular opinion: I do not think pre-licensed clinicians should go into solo private practice. Keyword: *solo*
To understand why I believe this, first we need to understand the current trends.
Even just 10 years ago when I was in grad school, believing that pre-licensed clinicians shouldn't go into private practice at all was the norm. It was assumed that you would work “in the trenches” somewhere, be it a hospital, agency, school, nonprofit, residential facility, etc. at first, and then perhaps make your way to private practice at some point in the future. But over the last 10 years, the mental health landscape has changed significantly, and more and more new therapists are starting their own practices shortly out of grad school. Why?
I think that part of it is the long-term effect of the pandemic. Those of us in mental health were some of the unspoken front line workers during the pandemic. We weren't praised like doctors and nurses (praise which was 100% deserved and should have been much more tangible), but we were right there with clients processing the trauma of covid, supporting grieving families, and working with clients struggling to adjust to a new normal, all while dealing with the same things ourselves. Most of us never stopped working or ever got any kind of raise. As a result, there's been a huge reckoning around burnout in the field. And the reality is that private practice is one of the most burnout-friendly career paths in mental health. It offers autonomy around when and how much you work, your income potential, and your client base.
The other primary reason, in my opinion, is that the traditional student base is now Gen Z. Of course, grad programs are almost always multi-generational. But traditional post-college grad students are still the largest percentage in most cohorts. And Gen Z young professionals are, in many ways, much more proactive about preventing burnout than Millennials and Gen Xers were at the same age. Many of them have seen the effects of burnout, systemic oppression, low pay, overwork, and political ramifications that affect mental health, and they want to do things differently from their predecessors.
With this in mind, it's probably much less surprising that more new therapists are striking out on their own right away. And it probably even sounds like a great idea! There are definitely some positives here, like new clinicians with more autonomy, better boundaries amongst mental health professionals, and shifting views about the “trenches” hazing mentality in the mental health field. And again, I the keyword is solo practice. I think group practices can be great for new grads.
But as a seasoned therapist and a clinical supervisor, I truly believe that solo private practice is not the best environment for new grads and pre-licensed therapists. But at any rate, let's get into why.
1. Going into Private Practice Doesn't Necessarily Prevent Burnout
Starting a private practice requires numerous skills that typically aren't taught in grad school: entrepreneurship, marketing, paying self-employment taxes, administrative functions, billing, website maintenance, etc. If you’re still working on mastering your clinician skills, adding another skill set can be overwhelming. There are also complex details regarding regulatory requirements, licensing, insurance stuff, and ethical complexities. Managing those details often involves institutional knowledge that you gain over time. Finally, it can also be pretty isolating. Solo practice means having no true colleagues. Even your clinical supervisor still doesn’t work with you day to day if you’re in solo practice. This results in not having much support during a time in your career when having support is essential.
Because of all that, starting a practice can ultimately be more overwhelming than sustainable for pre-licensed clinicians, and quickly turn into failed businesses that leave the new therapist doubting their clinical skills and their path forward. This can result in wonderful therapists leaving the field simply because they went into private practice too early.
Typically, when I have seen pre-licensed clinicians go into private practice successfully, it's because mental health was their second career. These folks already had a lot of professional experience and business skills that helped them navigate the learning curve.
2. You Can Take Whatever Clients You Want in Private Practice.
I know that sounds like a great thing, so hear me out.
The general population of clients who see private practice therapists is less acute than the population receiving care in many other areas of the mental health field. Plus, therapists can agree to take or not take certain clients. That’s all part of the autonomy.
So if you’re newer to the field, you’re likely to take clients you feel most comfortable with (as anyone would)... which tends to mean “easier” those first few years. Lower acuity, common concerns, middle of the road age ranges (often excluding young children, couples, and seniors). This is removing a HUGE portion of the general population needing care from your practice, and therefore from your future expertise.
Most new therapists are nervous to take on clients who have really complex needs. And without that support of colleagues, this makes sense. But it’s detrimental to your skills as a clinician. You need to see a wide variety of clients with a wide variety of diagnoses and presenting concerns. Most states allow independently licensed therapists to diagnose, so you need to be able to diagnose clients accurately. You need to be comfortable with crisis intervention. You need to be able to work with a wide variety of populations and age ranges. You need to earn the scope of practice of your license.
Does that mean you need to work in the trenches? Not necessarily. But it does mean you should do your best to expand your comfort zone. Which is really hard to do in solo practice.
3. It's the Slowest Way to Earn Your Licensure Hours
The reality is that starting solo practice means you will have some ramp-up time, often months, before you're full. And the hours you get per week are often not that consistent due to cancellations, holidays, and other conflicts. Plus, you'll need to see fewer clients in general in order to accommodate for your unpaid time running the business. When you're also trying to obtain clinical hours for licensure, often against a running clock, this is truly not an efficient way to get them done.
I have met many pre-licensed therapists who want to earn their license as quickly as possible, but who only want to work part-time seeing clients on an outpatient basis. Or they're struggling to fill their practice, but they don't have a Plan B for obtaining their licensure hours. It's really hard to have it both ways.
I got my independent license as soon as I was eligible to apply. And the reason I could do that is because I worked in hospitals. I clocked almost all of my time as clinical hours every single shift, because I was doing clinical work almost every hour. You just can’t do that in private practice. So if you're not necessarily on a timeline, this might not be an issue. But for many new therapists, the increase in pay and job opportunities are incredibly motivating.
So What's a Better Option?
I think that group practices offer a wonderful alternative to solo practice. They are still outpatient environments that tend to be less stressful that community mental health agencies, but can still offer a lot of growth. It's important to vet a group practice before applying! I would look for one that offers clinical supervision, opportunities to engage with colleagues like staff meetings and trainings, group supervision ideally, and a wide variety of clients served. Other basics like office space, the EHR, and marketing should be taken care of as well. Working at a group practice can also give you a lot of insight into the business aspects of running a practice, and help you prepare to open your own in the future. Some group practices have W2 positions, and others are all 1099. There are pros and cons to both, and you should consider what makes the most sense for you.
Another good option is to work at a hospital. The work is intense, I can't tell you otherwise. But there are a lot of benefits too. I've worked in both psychiatric hospitals and general hospitals (in the ED), and I preferred the ED. It's shift work, so you likely work fewer days per week, with a 10 or 12 hour shift in many cases. It's typically an above average salary, with differentials (aka a higher hourly pay) for evenings, nights, and weekends. You see all kinds of folks for all kinds of reasons, which will sharpen your assessment, rapport building, case conceptualization, and documentation skills really quickly. And most hospitals have pretty good benefits, including great health insurance and quickly accruing PTO. And like I mentioned above, you can clock almost all of the hours you work toward your license. And that's not cheating- you are doing clinical work basically from clock in to clock out! Another benefit- you leave the work at work. I can't say I was always able to do that mentally, to be honest. But I never did notes at home (I wasn't allowed to leave my shift without them being done), and didn't even have access to my work email outside of the hospital. This helped me feel truly "off" on my off days. If you have a part-time job elsewhere, you can pick up a PRN hospital gig and just work a few shifts here and there. Hospital work is not for everyone. But it is an efficient way to learn a lot and progress in your career.
Take my opinion with a grain of salt if you choose to. Only you know your circumstances and what is best for your career. But also know that I say this as a clinical supervisor who deeply cares about the growth and strength of the next generation of therapists. Consider what kind of work environment is going to help you meet your licensing goals, challenge you clinically, and support your work/life balance needs. In many cases, that is just not solo practice.
If you have thoughts, questions, or are interested in professional consultation, I'd love to hear from you! Reach out through the contact form on the home page.