Are You Hating Your Practice?

By Allison Puryear, LCSW, CEDS on November 6, 2019

We jump into private practice with hope, joy, and a real belief that we’ll have a different kind of life. For many of us, that freedom and joy is readily available. We do our good clinical work, we collect payment or insurance reimbursements, we manage the logistics, and we enjoy our lives.

However, there are many others among us who have a different experience. We have parts of our practice that we resent, we have tasks that we hate, and there are always financial situations that make us wish someone else was handling everything for us. Some of us basically created another agency job for ourselves with our private practice, and that’s not so fun and definitely not the point! This is what I call “building the wrong practice.” But don’t worry; you can turn things around and build the kind of practice that you had always hoped for. Let's explore the signs below.

Sign #1 that you built the wrong practice: You feel like you can’t say "no."

Tell us: how hard is it to say “no” to potential clients, to ongoing clients, to insurance companies, to your office landlord, to colleagues? Maybe you keep taking on clients even though you’re full to the brim. Or perhaps you’re taking on the clients that you don’t enjoy or don’t do your best work with. Your boundaries are getting stretched in every way, and your lunches are eaten hunched over your case notes or waiting on hold with your stingiest.

What to do about it: Stop. Just pause for about 30 minutes and get really clear about what you want your practice to do for YOU, not your clients. It’s easy to put them first; we tend to be givers. But what do YOU want?

For instance, I want my practice to be a vehicle for feeling useful. I want to have moments of deep connection and revelation with my clients. I want to laugh. I want to feel both appreciative and appreciated. I want to feel moved.

If I take on clients whom I don’t work well with, I’m not going to get those things. If I railroad my own boundaries, I’m resentful. If I don’t carve out time to both stay on top of my admin tasks AND have some personal down time, I get overwhelmed.

Get in your schedule and make time. Yes, right now. I’ll wait.

Now when potential clients call, if they can’t fit into the slots you have designated for therapy, refer them to a colleague.

Sign #2 that you built the wrong practice: You have a lot of tasks that you dread.

Pre-authorizations, case notes, keeping up with paperwork, social media marketing, case coordination, following up about an unpaid claim, returning phone calls, billing, setting up appointments, playing phone tag, listening to voicemails, returning emails…ugh! Just writing this makes me want to close the computer and go for a walk instead.

What to do about it: It’s true, there’s always going to be stuff you don’t want to do in any job. As a solopreneur, you’re probably trying to do it all yourself. Yes, once your practice is full, you’re making a lot more money than in an agency, right? Fantastic!

Now, consider if all of that extra money is worth it if you aren’t happy.

Two other important things to consider are what can be automated and what can be outsourced. For instance, online scheduling cuts out half of my daily tasks that I happen to hate (please never leave me a voicemail). Some of the practice management systems make billing a one-click activity, and some are totally automated. Alternatively, you can outsource your billing entirely by connecting with a trusted medical billing service provider.

Outsourcing is awesome because you can let people who like to do tasks you hate. If you’d rather shove a fork in your eye than create a bunch of social media posts, then hire someone to do it for you! Hire someone to answer your phone, or do your billing, or build your SEO, or do your bookkeeping, or do your taxes, or even clean your office! You can read more about outsourcing in this blog post I wrote for TherapyNotes not too long ago and in another post by my friend L. Gordon Brewer, Jr., MEd, LMFT.

Sign #3 that you built the wrong practice: You’re burnt out.

Noooooooo!!! Private practice was supposed to save you from burnout! But of course, if it’s not grown with intention, it can easily turn into your worst nightmare.

What to do about it: I’m going to refer you back to sign #1. Stop and reassess. Build in time.

Handle your stuff, both personally and professionally. I don’t mean that in a harsh way—in fact, I’m totally guilty of this myself sometimes. But you know when you have unresolved issues you aren’t dealing with. Hopefully, you also know your patterns of avoidance and can recognize them in time to course-correct.

Get into therapy. Force yourself into a vacation (stop making excuses about time or money). Say “no” as much as possible in most facets of your life. Reconnect to your Why. Take some time to remember your deep, personal reasons for doing this work.  

Sign #4 that you built the wrong practice: Something is off, and you know it.

Maybe it’s your niche, and maybe it’s your schedule. Maybe it’s the financial side of your practice. But you know deep down that there’s something you need to address for this to be sustainable.

What to do about it: Did you know that it’s totally fine if you wanted to work until 7pm before and now you want to be home by 5pm? Of course, it is! Let your clients know that your schedule is changing and watch with shock at how well they adapt. Resist the urge to be mad at yourself for not doing this sooner.

Want fewer clients with complex trauma on your caseload? Refer new callers out.

On an insurance panel that pays poorly—and that is, when they actually pay—get off that panel.

You’re the one with agency here. You’re the one who gets a say in all of this. It’s your practice. If making the changes are too hard right now because of other life stuff, take some time to plan out when you’ll actually implement the changes you know you need to make. And to make them easier, put them in your calendar.

There’s a fair amount of learned helplessness that many of us take on in our early professional lives. Don’t let that seep in here.

Feeling stuck in the wrong practice? We have a course in the Abundance Party called Build the Right Practice that may be a good fit for you.

You can have whatever you want. You just have to make it happen.

* 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.


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