The owner’s skills will determine if a solo practice grows. The owner must be a good therapist with a good reputation, be willing to get out into the community for a sustained marketing effort, and develop ways of efficiently and effectively doing the business parts. That means consistently doing the scheduling, billing and filing insurance claims, collecting money, paying bills, returning phone calls, etc. All these must happen at the same time over a sustained time frame. There is no letting up. Many challenges exist. Supporting oneself financially while the practice is beginning is among the most difficult.
The first step toward success is the recognition that indeed one is running a business. One cannot avoid practicing therapy in a business structure. But certainly one can avoid managing others if you are committed to doing it by yourself. That is what the solo practitioner is choosing—to build a practice alone and thereby avoid all the challenges of managing employees or colleagues. (Read more on this dilemma here: The dilemma:of success: Do it myself or delegate .”
Facing oneself honestly
A solo owner has to address many issues that really are about how one sees the owner’s skills. For example:
- Do I trust myself to do the full spectrum of tasks necessary to be a successful? And can I be an excellent therapist at the same time? And can I stay sane and have a life outside work?
- How confident am I that I can keep the referrals, scheduling, billing, collections, and paperwork flowing?
- Do I enjoy meeting referrers and building relationships with them? Can I trust myself to make doing so a priority?
- Do I want the responsibility and stress that come with the ups and downs of solo practice,? If married, how comfortable is my spouse with the uncertainty of income?
- How tolerant am I of the financial risks involved? For example, how comfortable am I with borrowing money to keep everything afloat if things get tight? What about signing a lease for not only my current needs but for those in the near future? Am I good with budgets and sacrificing until I can pay for things?
- How am I at handling the clinical and business pressures largely by myself? Am I prone to loneliness and depression? How much autonomy do I need to have?
Walk through each of the questions above. Ask honestly, “Are there examples in my past where I have done each of these tasks well? If not, am I likely to do them when working for myself?” Facing your own limitations will give you the chance to develop a plan to compensate for any deficits you may find. Some tasks you may be able to delegate. Some you will just have to grow into. Either way, you need a realistic and honest assessment of how you are going to get the essential things done.
Those that fail
Those who do not make it, fail for one of two reasons. Maybe they where not honest with themselves about what skills they possessed and lacked. Or perhaps they underestimated all that would be required to succeed and how long it would take. When it comes to starting a small business, naiveté about either oneself or the startup challenges is costly financially and emotionally. Sometimes it is fatal to the business.
If you are seriously starting, interview all those you can find who have done it themselves. Take them out to lunch. Bring your questions. Most practice owners are proud of their accomplishments. They enjoy sharing with someone who appreciates what they have done.
Freedom? Not so much
People often start up a business thinking that they will have freedom to do what they want. The truth is that that certain things must be done to keep the business afloat. Being the only employee means that you have to do all those tasks. You do get “freedom” about what time of day or night you do them, but you can never neglect the essential pieces for long without risking business failure. (For more on this see: “The boss’ boss: The unrelenting business demands in mental health practice .”
Is your family ready?
Beyond the owner’s skills, there is one foundational ingredient that allowed me to respond adequately to the needs of the business. I have an extremely supportive family. They generously gave me no flak when I thought I needed to prioritize the needs of the business over giving time and energy to them. I found it very difficult to make myself attend to the less desirable aspects of what the business demanded. I cannot imagine how I might have been successful if I had also had to argue and fight with a spouse, children, or friends. Instead they were very sympathetic for the choices I made and why.
Responding to changing needs
here were years when the business needed me to generate lots of fees. I worked at least two evenings per week and sometimes on Saturdays or another evening. When working in the evening I would not get home until ten or ten thirty pm. My family was usually asleep or wanting to be. And of course I was still wound up. It was hard for me to slow down enough to sleep, and that made it difficult for me to be much help in the mornings. Yet my wife would tell me that she got through those times by thinking about those we knew who had a spouse who traveled for big parts of each week. Those thoughts helped her to be understanding and to manage without putting excessive pressure on me.
I know my inattentiveness cost my wife, children, and friends, and am grateful that they were generous in allowing me to do what I needed to do to make the business work. Success is truly a team project.
I have also laid out all the steps from planning, implementing, and the daily activities of practice, as well as managing many aspects of the practice: