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5 Ways to Restructure Your Private Practice
By L. Gordon Brewer, LMFT on January 6, 2021
There is no doubt about it: we have all experienced A LOT of change over this past year. COVID, social distancing, and masks are the norm nowadays. We are interacting with others in much different ways, and it has caused a lot of us in private practice to rethink how we deliver our services and the structure of our practices. The possibilities can seem overwhelming, so where do you start?
First, Assess Where You Are Now
Before thinking about the different ways of restructuring your practice, the starting point is to assess where you are now. In particular, do a deep dive into your systems, processes, and profitability. Figure out what is working well compared to what is not working well for you in your practice. Here are some things to consider:
Intake processes and workflow
Documentation processes and workflow
Time management: how much time is it taking you to do administrative functions?
Caseload: are you seeing the number of clients you want to see (too many or too little)?
Business expenses: are there things you are paying for that are no longer relevant or useful?
Fee structure: do you need to increase your fees? (If your practice is full, then absolutely yes!)
Website content: is it attracting your ideal clients?
Knowing what's not quite working for your practice will help you determine how to best focus your restructuring efforts.
5 Ways to Consider Restructuring Your Practice
1. Going Fully Online?
It's important to think about why you want to make changes to your practice and restructure to begin with. For example, this past year we have seen the shift to telehealth and how holding sessions online has a lot of advantages for us as practitioners, but also clients. Given this, keeping a physical office space has become less important. This would be a huge cost savings for a lot of practices. Would making the shift to a totally online practice be worth it to you? No right answers here, but something to think about.
The vast majority of us have made the switch to telehealth and holding sessions virtually. And the trend seems to be that this is now going to be much of the norm—at least for the next year or so—and so this, in and of itself, has caused a lot of us to rethink our business models.
There are a lot of pros and cons about going fully online. One of the big pros is the huge savings in overhead costs of running a practice. You no longer need to invest in brick and mortar office space to see clients. Other than employees or contractors, that is usually one of the biggest expenses of running a practice.
Seeing clients in the therapy room is the primary way to bring in income for mostly any practice. Creating other income streams for a practice is a great restructuring move that needs to be considered. Most successful practices have a diversity of income streams.
One of the major restructuring opportunities for a lot of practices is to add clinicians. This is particularly true for solo practitioners who find they have full practices and a waiting list. By adding clinicians to a practice and starting a group practice, you not only give yourself more earning potential, but create opportunities for other clinicians to be part of a private practice.
Other ideas around diversifying income would be to think of ways to go from one to one delivery of services (traditional therapy), to the one to many way of delivering services. Examples of this would be to offer therapy groups or classes—and within the online space, the opportunities for doing this are limitless.
3. Streamlining Systems and Processes
Another area of restructuring that gives a lot of opportunity for improvement is in looking at streamlining your systems and processes. Documentation, handling phone calls and emails are all necessary and needed in running a business, but they are not always income producing activities. Our time as therapists is best spent working with clients.
The key is to know how to automate and outsource those systems and processes so that your time is best spent on activities that give you the best return of your time investment. For example, if you are spending a lot of time returning phone calls and setting up appointments with potential clients, that is time that is better to outsource or automate.
A process that can usually be streamlined easily are your intake procedures. By making use of the TherapyNotes™ patient portal, you can make this process easier for yourself and your clients. Clients can pick appointment times, fill out paperwork online and also receive appointment reminders. This is a huge time saver that will free you up for sessions and time with clients.
4. Fixing The “Money Leaks”
Another place that can often be restructured are your financial systems and processes. In particular, it's important to look at your cash flows and understand the financial side of your practice. Many times there are “money leaks”—where you might be spending on things that are no longer needed or duplicated. For example spending money on subscriptions or services that do not really bring you a good return on investment (ROI). Another area similar to this is spending on advertising that you do not have a way of measuring to know if it is effective.
It's a good idea to do a deep dive into your finances to understand your profitability. Often we need to restructure our fees and what we charge. All too often therapists will undervalue what their services are worth. Regularly evaluate your fees and increase them. This can be a “low hanging fruit” for increasing profits.
Another area of finances to evaluate and possibly restructure are what you pay to the people you hire. Certainly we need to pay people a fair and living wage, but the way in which we do that might make things better for them and for you as a business owner. For example, moving from having contractors to having employees.
In my own practice I made this switch a few years ago. It not only increased my profitability but also created a better deal for the people working for me. They now have benefits such as health insurance. Again, do a deep dive into this in order to better understand your cash flows.
Always consult with financial and tax experts. Having a trusted accountant is a great ROI in terms of learning about how to structure your practice financially. If you want to learn more about the financial side of private practice, check out the e-course, Money Matters in Private Practice.
5. Updating Your Website and Marketing Efforts
Finally, is it time to restructure your website? Is it attracting your ideal client? Does it reflect who you are and your practice? Your website is truly your “storefront” and where the majority of your clients will find you. It is good practice to keep your content fresh and up to date—your website can be your number one marketing tool.
Also think about how you are connecting in your community. Reaching out to other clinicians and professionals is always a good marketing strategy. People will refer to who they know. As you restructure think about your marketing efforts and how you are developing your referral sources.
Restructuring your practice in reality is an ongoing process, and there are a lot of moving pieces. A good way to think about how you want to restructure your practice is to spend some time mapping it out for yourself and formulating small, actionable steps toward the changes you want to see. After all, if you don’t know where you are going, how will you get there?
* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.
About L. Gordon Brewer, LMFT
L. Gordon Brewer, LMFT is a therapist and owner of Kingsport Counseling Associates, PLLC located in Kingsport, TN. Gordon started his private practice in 2006 after working for a non-profit agency for several years. He is also the person behind
The Practice of Therapy Podcast and Blog that provides information and resources for private practice owners to help them in starting and growing their practices. Visit
practiceoftherapy.com for more information and resources.