Why Many Counselors and Therapists Choose Private Practice After Licensing

After graduation, many counselors and therapists find themselves at a crossroads, with opportunities in clinics and private practices each presenting unique pros and cons. In this article, we explore the reasons why so many mental health professionals choose private practice shortly after receiving their licenses.

Experiences and Insights

Having spent five years working in various clinics, both as a resident and then as a staff psychotherapist, I was able to see a wide variety of patients with diverse issues. The experience was extremely educational and highly fulfilling, but it also came with long hours and meager pay. I decided that the corporate environment of a hospital or mental health clinic was not my ambition for the future. Looking back, the discrepancy between the training and education received and the practical realities of working in a clinic was a major factor in my decision to embark on a private practice career.

Why Not Clinic Work?

The following highlights the drawbacks of working in a clinic:

Low Hourly Rate and Missed Opportunities

Working in a clinic, especially in a fee-for-service clinic, means earning around $25 to $30 per hour, which isn’t as lucrative as it seems. With no base salary and only being paid for the hours spent with patients, the income can be highly unpredictable. Expect to work 23 hours a week, and any cancellations or no-shows significantly reduce earnings. The rest of the week is spent on paperwork and phone calls, which are unlikely to bring in more income. Let’s say, a bi-weekly take-home pay is around $1,100. For clinics with a base salary and bonus for seeing 23 patients per week, the earnings may be better, but it depends on the specific base salary and bonus incentive structure.

Office Politics and Saddling Tensions

Another significant challenge in clinics is the culture of distrust among colleagues. It often feels like no one can be trusted; coworkers monitor each other and report any perceived missteps to higher-ups. The atmosphere is tense as people guard their words, knowing that any slip-up could lead to a corrective interview and potential termination. This constant monitoring and distrust create a highly uncomfortable environment for many therapists.

Excessive and Redundant Paperwork

The workload in clinics is not just limited to patient care. Therapists often face an overwhelming amount of paperwork, much of which is redundant and pointless. Paperwork that does not contribute to patient care but is required for compliance can be both time-consuming and demotivating, leading to burnout.

Focus on Social Justice Over Clinical Skills

While social justice is an important aspect of mental health care, the emphasis on these issues often comes at the expense of clinical skills and patient care. This imbalance can lead to a misunderstanding of the core duties of a therapist.

Unqualified Leadership and Office Dynamics

Another issue is the leadership structure, where those in charge are not necessarily qualified to lead. Instead, they are passive and often lack the critical thinking skills needed to make informed decisions. This can result in a lack of support and a toxic work environment.

Ineffective Meetings and Team-Building Drudgery

Meetings and team-building exercises often lack meaningful decision-making, and retreats can become a burden. They are overbearing and often involve people who are difficult to work with, creating a stressful and competitive atmosphere where any misstep can result in a backlash.

Life in Private Practice

Leaving the clinic environment and embarking on a private practice has transformed my life for the better. Here are the reasons why:

Increased Income and Flexibility

Private practice offers a more flexible schedule and higher income. Earnings can triple compared to clinic work, and the self-employed nature of private practice allows for better control over one's life. Private practice also offers the opportunity to lecture and try new techniques, providing a sense of fulfillment and continued growth as a therapist.

Reduced Paperwork and Increased Autonomy

With private practice, the paperwork required for state and federal guidelines is minimal. There is also much less administrative burden, allowing therapists to focus more on patient care. This reduced paperwork also contributes to a more relaxed and enjoyable work environment.

Autonomy and Professional Fulfillment

Working in private practice allows therapists to have more control over their schedules, set their own hours, and take more time for themselves and their families. This autonomy leads to higher job satisfaction and a better work-life balance. The ability to take two-hour lunches and work only the minimum required paperwork significantly improves the overall quality of life for therapists in private practice.

Is Private Practice Right for Everyone?

Private practice is not for everyone. Those who prefer working with a team or in a company may not thrive in the independent environment of private practice. It requires a certain entrepreneurial outlook, a multi-disciplinary approach, and skills in therapy, self-motivation, constant education, marketing, accounting, public relations, networking, and general business skills. Additionally, the rise of teletherapy has introduced a need for technical skills to manage online video conferencing.

Many therapists find the flexibility, income, and professional fulfillment of private practice to be worth the challenges it presents. However, it is important to evaluate one's needs and preferences carefully before making the switch.