The 5 Biggest Mistakes I See Group Practice Owners Make

I have spent more than 25 years working in mental health. During that time, I've worn a lot of hats. Therapist. Clinical supervisor. Group practice owner. Consultant. Coach. And somewhere along the way, I lost count of how many practice owners have sat across from me, convinced they were failing.

Truthfully speaking, they usually aren't failing. But convincing them that they aren’t failing when their brain and nervous system are consistently reinforcing that is challenging at best. What they are is exhausted, and those are two very different things.

One of the things I love most about consulting with group practice owners is that I get to see behind the curtain. I hear the conversations that most people never hear. I see the stress, the second-guessing, the financial pressure, the staffing issues, and the constant balancing act between taking care of clients and taking care of a business.

What fascinates me is that while every practice looks different on the outside, the mistakes are remarkably similar. And before we dive in, I want to make something really clear. None of these mistakes happens because someone is a bad leader. No matter what their brain or their employees try to tell them. 

Most of them happen because someone became an exceptional clinician before they ever became a business owner. Those are not the same skill set. Side note, this is often a catastrophic mistake that many leaders make. They see someone who is excelling at being a clinician or a therapist and automatically promote them to become a supervisor. But that could be a whole blog in and of itself! Let’s get into mistake number one.

Mistake #1: Believing You Have to Be Good at Everything

I honestly don't know where this belief comes from, but it seems to follow almost every group practice owner I meet. Somehow, we convince ourselves that because we own the practice, we should also be the experts in billing, marketing, hiring, payroll, compliance, leadership, conflict resolution, clinical work, scheduling, technology, and, apparently, plumbing whenever something breaks.

When I opened my group practice, I had heard so many of the horror stories from former employees of group practices that I absolutely VOWED to do better. To be better. I was consistently the first one in the door and the last one out the door. 7 days a week. 

Hear me out, because this is likely to make some of you uncomfortable. Owning a practice does not require you to master every role inside the practice. It requires you to build a business where those roles are covered. There is a huge difference.

Somewhere along the way, we confuse responsibility with personal ownership of every task. That's a recipe for burnout. One of the first questions I ask practice owners is simple. "What would happen if you disappeared for two weeks?"

The answers tell me everything I need to know. If the entire practice would grind to a halt because you took a vacation, that's not a sustainable business. Worse yet, if your team doesn’t respect you enough to allow you to take the time off it’s an even bigger problem. 

That's dependence. The goal is never to become indispensable. The goal is to build something bigger than yourself. This reminds me of my coaching client, Nancy. Nancy had owned her group practice for about 6 years. She initially had so much pride driven by her ability to do so much of the work herself. But, as many of us already know, that’s just not sustainable. And again, eventually you will either burn out or get sick. 

Mistake #2: Hiring Because You're Desperate

This one hurts because I've lived it. A clinician leaves. Your waitlist is growing. Clients are frustrated. Referrals keep coming. And worse yet, your profit margin just plummeted because of the loss of revenue by the clinician that leaves. All of these factors just amp up your anxiety and dysregulate your nervous system.

The pressure just keeps building! Then someone with a license and a pulse applies. They suddenly seem like the perfect fit. I have made this mistake in the past, as have my of the Group Practice Owners that I consult with. So, if you are finding yourself in this concept, please know you are not alone. 

Desperation has a funny way of lowering our standards. I've watched owners spend months trying to coach someone into becoming a clinician they never demonstrated they could be in the first place. Hiring the wrong person costs far more than waiting another month for the right one.

I'm curious how many difficult employment situations could have been avoided if we had simply slowed down enough to ask harder questions during the interview. Skills matter. Experience matters.

But character matters just as much. You can not teach a workable attitude. You can teach systems, but you can not teach integrity. You can teach documentation, diagnosis, and retention strategies. But I’m not sure if you can actually teach a clinician how to have a solid therapeutic rapport with a client, if they haven’t learned how to do it by the time they are licensed. 

Mistake #3: Avoiding Difficult Conversations

Therapists are funny people. We spend all day helping clients navigate conflict. Then we avoid conflict in our own businesses. I've done it. You've probably done it. And please know this is not coming from a place of judgement. Also, I have witnessed first hand what happens when you rush into those challenging conversations too quickly.

Accountability without relationship just causes more ruptures for you both! Therefore please don’t misunderstand what I’m suggesting here. I’m not suggesting you run into your practice and immediately start having all the challenging conversations. But I’m also encouraging you to have the conversations if you have the relationship in place that will support the conversation. 

We've all hoped someone would magically notice the issue and fix it without us having to say anything. If I had a dollar for everytime in the past I used that approach, I would easily be a trillionare. Unfortunately, that's not how leadership works.Every difficult conversation you avoid becomes a heavier conversation later.

The clinician whose documentation is consistently late. The employee whose attitude is affecting the team. The boundary violations.The gossip. The negativity. The repeated cancellations (and worse not charging the client per your policy).

None of these problems improves because we ignore them. Truthfully speaking, avoidance isn't kindness. It's delayed discomfort. Leadership requires us to care enough about people to tell them the truth. That truth should always be delivered with compassion. But it still has to be delivered.

We recently had an applicant who had done both interviews, completed the background check, and signed her offer letter. And then she just sort of ghosted us. She didn’t respond to any of our credentialing document requests, we couldn’t get a copy of her license, and still had no bio for our website.When I reached out to the applicant, I did so in keeping with our core values. I reminded her that one of our core values was transparency. And in the mentality, this level of communication where she just wasn’t responding, just wasn’t working for us. I advised her we were going to move on for now, and when her life slowed down she could reach back out. 

The way I handled this today, really made my prior (more naive) younger group practice owner self, so very proud!

Mistake #4: Building a Practice Around Yourself Instead of Around Systems

I think this may be one of the biggest mindset shifts a practice owner can make.Many owners become the system. I know that I unintentionally did this and I could only blame myself for this. At one point I couldn’t even get through a 53 minute client session without getting at least 8 pm’s from clinicians with questions. And that didn’t count the emails that were just raining in. 

Every question comes to the Group Practice owner. Every decision comes to them. Every exception comes to them. Every crisis comes to them. Eventually, they become the bottleneck they were trying so hard to avoid. Systems create freedom. Those same systems are also what help your practice (as well as yourself) to become sustainable.

People create variability.When everything depends on memory instead of process, your business becomes incredibly fragile. I remember years ago, I was working with my business coach and she told me that because I had such amazing policies, I was the problem. I would never push a clinician to check those same policies. I would just give them the answer with ligtening speed. 

One of my favorite consulting exercises is asking owners to imagine they hired a brand-new office manager tomorrow. Could that person figure out how your practice operates? Or does everything exist inside your head? If it's the second one, your business isn't scalable yet.

Documentation isn't exciting. Standard operating procedures aren't glamorous. Neither are onboarding manuals. But they protect your future self. And documenting policies and procedures will ensure that your business keeps running if you get sick, have an accident, or even worse have some other level of personal crisis. 

Even though it feels counterindicative, we need to set our businesses up for success by ensuring they can still run seamlessly even in our absence. 

Mistake #5: Measuring Success by Productivity Instead of Sustainability

If you've followed my work for any length of time, you probably knew this one was coming. We have been taught to admire the business. We celebrate hustle. We glorify exhaustion. And at what cost? For some of us the results are absolutely terminal. You may find yourself wishing your practice would burn down, hoping you can find an escape hatch, or even just fantasizing about selling your practice. 

Somewhere along the way, many practice owners began believing that if they're overwhelmed, they must be doing something right. I disagree. Completely. And that’s saying a lot. I work more than the average person partially because of my neurodiversity and the other part is because I really enjoy what I do. But I also really strive for balance. I do dog training with my service dog in training, I take weekly voice lessons, I paint, I wood burn, I write, and I spend time with my family and my loved ones.

The goal isn't to become the busiest owner in town. The goal is to build a business that still allows you to enjoy your life. Because here's what I've learned: Your practice cannot consistently outgrow your own nervous system.

If you're constantly operating in survival mode, eventually your business begins reflecting that. Decisions become reactive instead of intentional. Creativity disappears. Leadership becomes harder. Relationships suffer. The irony is that many practice owners started their own businesses hoping for more freedom.

Instead, they accidentally built themselves another full-time boss. One that's available twenty-four hours a day, 7 days a week. With absolutely no end in sight. No reprieve at all. 

If you recognized yourself in any of these mistakes, I hope you'll extend yourself some compassion. None of us received a graduate degree in running a business. Most of us received excellent clinical training. Those are not interchangeable.

Leadership is learned. Business ownership is learned. Building systems is learned. Having difficult conversations is learned. Creating a sustainable practice is learned. You don't have to get everything right. You just have to become a little more intentional than you were yesterday.

Because at the end of the day, your group practice should support your life. Your life shouldn't be sacrificed to support your group practice. And if no one has reminded you of that recently, let me be the first. You are allowed to build a practice that serves both your clients and yourself.

In my experience, those are almost always the practices that last. If this blog made you even the tiniest bit uncomfortable, please consider exploring business coaching! I’d love to offer you a free 15 minute call to see if we’d be a good fit.

For more information on business consulting with me please go here: https://www.mymentalwellnesscompany.com/clinician-business-growth-consulting