As a consultant to mental health practice owners, eventually, fundamental existential questions come into the conversation: Is this worth doing? Am I suited for this job? Do I like this? Are the rewards worth the trouble?
The questions themselves tell us that owning and managing a practice is challenging. And I would say that struggle seems the norm. Clearly, there is a mix of costs and rewards in the role.
Let’s peek beneath some of these questions and see where we come out.
Table of contents
The rewards of ownership
There are many tangible rewards for those willing to plunge into ownership of a mental health practice.
Turning a dream into reality
At a recent conference, I hosted a panel of practice owners at different stages of their careers. I asked this question:
When you think about your whole time as an owner, what experiences have been the most enjoyable for you?
First for all of them was this–envisioning the practice of their dreams and then pursuing it. The conversation was very animated, and I found the energy infectious. The process of turning the dream into reality was exciting to them and our listeners. And I think in most cases, turning dreams into reality is very satisfying and motivating. That has to be one of the more powerful rewards helping us answer the question of whether it is worth it or not.
Developing a diversity of skills
There is no doubt that every owner is over their head when they start a practice. No person has all the skills they need. And getting through the early stages certainly takes on-the-job training. However, I think most owners see ownership demands as a plus. Most owners enjoy learning and overcoming the challenges that show up every day.
Never a dull day
Moreover, the constant decisions and learning make boredom impossible. There is always more to learn and projects to work on. Nearly every day, I could count on something coming up that I had not planned for on the previous day. The stimulation was usually invigorating, though, at times, it was exhausting as well. Whether exciting or exhausting, it was never dull.
The possibility of creating a saleable asset
I have written on the factors that turn a practice into a saleable asset, so I will not belabor that point now. Just note that there is great joy in superintending the growth of an organization that grows to have a significant impact on a community. For me, the greatest pleasure was in the increased effect and not the value of the asset itself. The value was a consequence of doing things well.
The costs of ownership
Most owners stumble into the role without a comprehensive understanding of the position. But over time, we learn that the job has unpleasant aspects that undermine our joy and drive us to wonder whether it is worth it. Here are a few.
Sacrificing for the sake of the whole
When I drifted into the ownership role, I naively thought, “Well, I have to do all this stuff for my solo practice, so how hard can it be to do it for others as well?” Short answer, “Much harder.”
The transition from making sacrifices for one’s own solo practice to doing for the group is frankly pretty massive. The tasks may not be that different, but making decisions for the group invites them to critique how well I do it.
That brings us to the next point.
“I never aspired to become the boss”
I had an employee who always greeted me with the honorific of “boss” as in “Yeay, boss. How are you today?” At first, I would step back and inwardly say things like, “I am not the boss of you!” But she persisted, and I got used to it.
However, I did not acquire graduate degrees with any thought about whether I wanted to be a boss or an employee. (I wrote a little about my process here: Become an owner or work for one.) The boss/employee distinctions never came up in my thinking. I had “bigger” things to fret about–specifically developing skills to succeed in the therapy room.
Nevertheless, I became the boss and the person with more authority than anyone else in the organization. Certainly, at first, the role took some getting used to.
First, I learned that others were unhappy when I dodged or delayed a decision. They wanted my guidance and direction and required me to step up. My discomfort as a decision-maker was not helpful.
However, I also learned that their desire for a decision did not make them happy with every choice. Clearly, my increasing confidence in making decisions was not the whole game. I also discovered the need to stay grounded as the challenges and complaints came at me. And in truth, objections never got easy for me though I did get better at maintaining a perspective. In short, I grew in confidence in my decision-making while developing a thicker skin, so I could hold my ground once complaints came.
Betrayal by those we sacrifice for
In addition, there were those situations that were beyond the usual and propel us to ask the question of whether it is worth it. Especially challenging were those times when an employee made choices that seemed an affront to our agreement to work together. I have written quite a bit about this area because of how challenging these situations are.
- How to overcome employee betrayal: 5 steps to love resiliently
- How to make sense of soured workplace relationships: Attachment injuries
- Addition by subtraction: Types of difficult, disastrous employees
- When we need to fire an employee
Every owner I know accumulates their own horror stories. Get a few owners together and let them talk, and the stories will flow, each one topping the next. And these painful moments leave their mark. And frequently, we carry those wounds with us for our whole careers.
Pressure & responsibility
One consequence of being the boss is the weight and responsibility for superintending the whole organization. Some non-owner managers may carry some of the load due to their position, but no one bears as much weight as the owner/manager. It comes with the job.
In some ways, being the owner is a lot like being a parent. The kids may sense that the parent is stressed, but they do not carry it the same way. A parent (or owner) lives with it 24/7/365. The owner is always on call. Even on vacation, a text or call can bring the role back as if one never left the office. And it is then we really question whether it is worth it.
Loneliness and isolation are the norm
I have written about the loneliness and isolation of leadership in this post: Why effective leadership is lonely and exhausting. My point is that there are aspects of leading that do not facilitate friendship. Furthermore, all leaders find that a struggle and need support.
The mixed bag of ownership
Some aspects of ownership both add and subtract to the joy of being the owner.
No boss but lots of constraints
Becoming one’s own boss is a misnomer. In truth, market, financial, and business demands are every boss’s boss. Owners cannot do as they wish. They always feel the constraints of what the market, finances, or business require. This website has a whole section on meeting the demands of the practice: How to master the unrelenting business demands of practice.
The joys and trials of mentoring employees
When I began, I had no concept that mentoring a group of employees would become such a central part of my life. My focus was on doing all the daily requirements for staying afloat. My head was down, hardly noticing my colleagues. Eventually, I awoke to the joys and trials of mentoring coworkers.
Working with colleagues became one of the most meaningful aspects of being an owner. And fortunately, I found working with employees as enjoyable as working with clients. And as a bonus, managing, mentoring, and supervising staff used different mental and emotional muscles. Yes, the schedule was full, but the tasks were more varied.
Of course, there was another side. Earlier I went over some of the disappointments and betrayals that lead us to question whether it is worth it. Yes, working with employees was the most memorable and disappointing part of my job as a leader. And now, in retirement, these are the memories I most cherish and replay in my mind. The good and the bad all stick with me.
The organization becomes what you are, for good and ill
The isomorphism between owner and practice can be good or bad. Because the founder of an organization is so central to what an organization becomes, they both tend to follow similar paths. For example, an organized person typically will build an organized practice. Furthermore, that organized leader will attract people who like order. And similarly, the spontaneous will beget spontaneity while drawing the likeminded. The strengths and weaknesses eventually are on full display in the organization.
Our investment becomes our identity
The dedication that a practice owner demonstrates also can be good or bad. While intense engagement in the practice will solve many issues, it can also create them. For instance, boundaries can get confused. Everything that occurs can feel very personal. Owners can take too much responsibility for choices others make. Furthermore, owners can experience practice events as individual events. The dedication can be exemplary, but the overidentification can be harmful to all.
So how do we sum up?
1. One has to do something with one’s life
Owners, in general, are talented enough and privileged enough to have options about a career. An owner can go back to solo practice. One could write a book and go on tour. Some do. But I would argue that giving oneself to building a practice is one good option among many. And subsequently, the positives are substantial.
2. Seek what is the best fit
Sometimes, we cannot see beyond what we are doing to develop new ways of utilizing our skills and interests. Despite our shortsightedness, we should strive to find the best fit. Uncovering that hand-in-glove feeling is good for us and those around us. The trick is figuring out if that means growing more comfortable with the ownership role, i.e., adapting. Or does that mean exiting and finding a new position?
3. Let our practice and our life be mission-driven
In answering the best-fit question, let us decide based on our mission in the world. Let our work and our life be mission-driven. The more our work fits our core values – what is important and what gives us meaning – the more manageable the job will seem.
4. You will be an owner for only part of your life
As I have said in many other places, eventually, every practice gets sold or shut down. In all cases, you will have a life apart from the practice. We need to invest in a life that is still full when we are not the owner.
And what makes it worthwhile?
So let’s weigh out the pros and cons. On the one hand, we have:
- Making a dream a reality
- Developing new skills
- The stimulation of constant challenges
- The possibility of creating an asset
And on the other hand:
- The sacrifices can be hard
- Being the boss is challenging
- The betrayals really hurt
- The pressure & responsibilities are no picnic
- Loneliness and isolation are the norm
And then there is the mixed bag:
- No boss but lots of constraints
- The joys and trial of mentoring staff
- Seeing one’s strengths and weaknesses enacted in the organization
So is it worth it?
Each owner is wired up differently so the honest answer comes down to how we weigh each aspect of ownership. For some, building the dream outweighs any negative. For others, it is the constant stimulation and joy in mentoring staff that tilts the evaluation toward an affirmative answer.
In my specific case, as evidenced by my running an organization for 35 of my 40 years in practice, I decided it was very much worth it. But I admit that by the time of my retirement, I was worn out. There was a toll and I was ready to hand it off to others. And fortunately, the organization was ready to accept the new leadership team enabled by my retirement. It was a win/win.
And yet, I recognize that others may profoundly struggle with the negatives. They need something different. Especially costly are the betrayals, and managing the pressures that seem a part of every owner’s story. Therefore some will weigh things differently than I did. That also may be the right answer. Each owner has to figure out if it is worth it.
So to summarize, how each of us finds joy and addresses the challenges is entirely personal. And so will the answer to whether you think it is worth it or not.