Winter 2025 Issue

Starting a Group Practice
By Sue Coyle, MSW
Social Work Today
Vol. 25 No. 1 P. 24

Starting a group practice as a social worker can offer broad benefits, but there’s much to consider first.

Carol Mirones, LCSW-QS, LMFT-QS, co-owner of Seasons Psychotherapy Associates, a practice with multiple locations in Florida, did not intend to start a group practice, at least not right away. She had entered into the profession with the plan of becoming a therapist and being her own boss. “I came into this field as an older adult. I was already in my mid-40s and had business experience before getting my master’s degree,” she says. “I always knew when I went back to graduate school that I would be able to turn this into something that was profitable. I always knew there was a way to parlay my skills as a therapist and a businessperson.”

Mirones’ plan, at least while she was getting started, was to open a private practice with her as the sole provider. However, it was the timing of when Mirones was ready to do this that changed her vision. It was 2020.

“When COVID hit in 2020, I was due to get licensed in June. That was the height of the pandemic,” she says. She explains that where she was working at the time had a business model that could not be sustained through the pandemic’s restrictions. “The writing was on the wall. I resigned before I could get laid off. My husband and I took an RV trip, and I was doing a lot of soul-searching. I said, ‘All right, I’m going to take this big leap now that I’ve got my license and open a private practice.’”

“A lot of my colleagues where I had worked, they had been laid off, as well,” Mirones says. Knowing this, Mirones decided to ask her former coworkers if they would like to join her practice. “So, I was able to start the practice with four colleagues that kind of followed me into it. We started immediately as a group.”

Four years later, Mirones does not regret the shift from private to group practice. She has built Seasons Psychotherapy Associates into a business with three—soon to be four—locations and finds fulfillment in what she is able to accomplish. But making the change required Mirones to think differently about what she was planning to do.

“It really made my husband [Mirones’ co-owner] and I think about the structure of our business completely differently in that we needed to have a payroll system. We needed to have group insurance contracts,” she describes.

Opening a group practice requires social workers to think not only about the services they hope to provide and the business they hope to build but also what type of employer they plan to be. Before social workers take that step toward a group practice, whether at the start like Mirones or after time on their own, they should be aware of all it entails.

Building a Business
A group practice is, first and foremost, a business. Services cannot be rendered to those in need if there is not an organization structured around them. Thus, a social worker opening their own practice needs the tools—the space, the technology, and the support to build that business.

For many social workers, doing just that and finding the right resources to help means learning on the go. Courses on the mechanics of owning a business or working with insurance providers are not common at schools of social work.

“Most folks are trained clinically, but most folks are not trained on how to manage the day-to-day business. And so, a lot of people will say, hey, I’m not using insurance, or I’m just going to be cash only. But if you’re running a business, you want to be able to give yourself exposure to a case mix—people who will pay through insurance as well as pay cash. I think that the naivete of some of our clinicians might be [detrimental],” says Orlando Wright, LCSW-C, PhD, founder of Halcyon Clinical Services in Columbia, Maryland. “Folks ought to take the time to really understand the dynamic of the field.”

Elizabeth Olson, PsyD, LCSW, director of the Collective for Psychological Wellness in Boulder, Colorado, agrees. “I had to learn how to be a businessperson. I had to learn quickly about insurance and about employment. I needed to get an assistant. It added more to the complexity of the situation.” Finding the right resources and support while doing that was challenging but crucial. When she started her practice in 2015, Olson says that she tried to reach out to an individual with a similar organization for guidance, but he was not interested in helping. She did, however, find other professionals who offered their services and advice, including a lawyer and a website designer.

Similarly, Erin Tate, LCSW, owner of and therapist at Dragonfly Counseling in Billings, Montana, says that finding the right people and services has been a pivotal part of Dragonfly Counseling’s success. “I have an amazing office manager who takes on projects. I’m smart enough to know that there are things that I don’t know. I have a financial advisory team. I have a lawyer on retainer. I have a tax person. I have good relationships with other providers in town,” she says, adding that it has been “A little bit of trial and error. I have now transitioned away from billing companies due to poor experiences. We brought billing in-house,” for instance.

Technology is another key aspect of a successful business in today’s world, and not just if telehealth is offered. The right tool, like an electronic health record, can help automate complex processes, run reports, and more. Wright stresses that a social worker needs to “understand the technology stack”—what the tools they are choosing are capable of doing, and what the business needs them to do.

For him, that once again meant learning through experience. “I just started looking around and what I found was that over time, I developed what I needed to help me to scale. I started off with QuickBooks, being able to run a report about what patients were seen,” he describes. The more he learned, the more he was able to find the technology that met his needs.

Becoming an Employer
With the foundation of the business created or in creation, a social worker can then take the next important step in creating a group practice: becoming an employer. When they do so, they need to know what type of employees they plan to hire, contract or formal. The two are sometimes described by the type of tax form they fill out—1099 for independent contractors and W-2 for formal hires.

Contract employees cover their own taxes and are generally not eligible for benefits from the company. These individuals are seen as self-employed. Formal employees are employed by the company, are subject to tax withholdings in their pay, and are eligible/entitled to certain benefits.

In a group practice, there are pluses and minuses to both types of employees. Deciding which to take on depends on a number of factors. With a W-2 employee model, the employer takes on more liabilities.

For example, when Mirones started with her colleagues, all four were independent contractors. Over time, however, Mirones has shifted to a W-2 employee model. “As we continued to scale and grow, in order to attract new clinicians, being a W-2 model was more attractive to employees. If you’re working with people that are straight out of school, they really need the W-2 model.”

She adds that she wanted to be able to have a bit more control over the practice, as well. “It wasn’t that I wanted to be more controlling as a boss. I still wanted all of my employees to have autonomy with their lives and their work-life balance and how many clients they want to take, but I did want to have a bit more say—you can’t really do that with independent contractors,” she says.

For Wright, the opposite is true. “They’re bringing on independent contractors when it should be W-2 employees because they’re directing the work. I wanted to be the practice where we can do clinical supervision, and folks can see people as they saw fit, based on whatever their needs were.” Wright opened his practice in 2018 and brought on a contract employee within the next seven months. To this day, all of the practitioners within Halcyon are 1099.

In addition to how much say a practice owner/founder may have in their employee’s workload, a W-2 model allows the social worker to offer more benefits to their employees. This was important to Tate. “I wanted W-2 employees because I wanted to take that tax burden off them. I wanted to offer an insurance plan, a capped caseload, health and wellness benefits. I wanted us to be a team that could rely on each other and not be stressed out all the time.”

Of course, a group practice can have a combination of independent contractors and W-2 employees. How that works may depend on how a company is growing, the experience of the clinicians, and the desires of the owner.

Scaling and Balancing
Once a group practice has been built, the social worker leading it has the opportunity to scale (grow) their business as they see fit. This may mean adding more providers to the team and/or, as Mirones has, adding more locations. In 2024, it can also mean working with practitioners who are out of state, either in a physical office of their own or through telehealth services only. This is, however, complicated by licensing and other regulations between states. The Social Work Licensure Compact, which has been enacted in at least seven states and would allow for a social worker to receive a multistate license, could make the process more plausible in the future.

However, scaling brings with it its own complications that a social worker should consider, as well. As administrative responsibilities increase, it can be challenging for a social worker who is both a provider and an owner, to do all that they wish. Both Mirones and Tate have reduced their caseloads as they’ve scaled their businesses. “I tried to keep a full caseload when I started this, and that hasn’t worked out,” Tate says.

Growing can also mean less time for life outside of work. Olson says that consideration is why she’s chosen to keep her practice small. “I’m a mom, and I have an 18-year-old son. I really wanted to prioritize my family. I have not prioritized the business as much. The more people you have, the more stress you have. I dialed it back a little bit, just to keep my life sane,” she says. “I wanted to have time with my son.”

Discussing Benefits
While starting, running, and potentially scaling a group practice can be challenging and complicated, there are many benefits to it as well. For one, it gives more seasoned social workers the opportunity to create a practice that offers supervision, support, and learning opportunities to clinicians new to the profession. As aforementioned, social workers may be trained clinically but they do not leave school knowing how to launch a practice. Having a company that they can start with is invaluable, even if the new social worker chooses to branch off independently after getting licensed or more experienced. All of the social workers interviewed stressed how important it was to them to be a resource for new clinicians through their work.

A group practice also offers more opportunities for collaboration and community to social workers. “It feels good to me to know the people that I’m working in collaboration with and to be able to kind of guide them,” Olson says. “If you’re working with people that are outside [your agency], you don’t always have as much communication. I like the way of being able to collaborate.”

But perhaps most importantly, opening a group practice rather than a sole-provider private practice gives social workers the opportunity to have a larger impact on their community. After all, Tate says, “If I have more providers, we can see more people.”

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.