If I Were Starting a Private Practice Tomorrow: 6 Things I’d Do Without a Doubt (Part 2)

Apr 10

When I work with private practice owners, one of the most common things I hear is some version of this: I love being a therapist. I just didn't know I was also going to have to be a business owner.

I get it. Nobody hands you a business degree when you walk out of grad school with your clinical certification. You go into private practice because you want to help people, and then suddenly you're also doing billing, managing a schedule, dealing with cancellations, trying to figure out insurance, and wondering why you're more stressed than you were in your salaried job.

This is Part 2 of my series on what I'd do if I were starting a private practice tomorrow. If you haven't read or listened to Part 1 yet, go back and start there. Part 2 builds on that foundation directly.

Thing 5: Start Thinking Like a CEO

The second you open a private practice, you become a business owner. That part doesn't wait until you feel ready, until you have a full client load, or until you've been doing this for a few years. It starts on day one.

But here's what most of us do instead: we keep showing up as clinicians and hope the business side somehow handles itself. We treat private practice like a slightly more autonomous version of the salaried jobs we left. And then we wonder why the business never quite feels stable.

A CEO is not someone who wears a suit or has a corner office. A CEO looks at the numbers. A CEO makes decisions based on what the data is saying, not based on emotion or guilt. A CEO sets policies and actually holds them. A CEO thinks months ahead, not just week to week.

That's you. That's what you're doing when you run a practice.

Why Your Numbers Matter More Than You Think

One of the most powerful things about stepping into the CEO role is that it changes your relationship with your numbers. And I know that's the part a lot of people want to skip.

I've had this conversation on countless discovery calls, coaching calls, and in years of working with therapists. So many practice owners don't know what numbers they're supposed to be watching, so they just don't watch them at all. They hope that if things feel okay, things probably are okay.

That's not a business strategy. That's a hope strategy.

When you track your revenue month over month, your cancellation rate, your new referrals, your expenses, you start to see patterns. You notice that August is slow every year. You realize that referrals pick up in April. You start to understand your business well enough to make real decisions, like whether it makes more sense to keep the clinic open during the holidays or just close it down, give everyone a break, and plan for it.

Those numbers give you permission to make decisions. And the clinician in you might be uncomfortable with that framing, but the CEO in you knows it's true.

Boundaries Are the Structure, Not the Enemy

I want to address something that comes up a lot when I talk about the CEO mindset. A lot of therapists hear "think like a CEO" and feel like it means caring less. Like stepping into the business owner role somehow means losing the heart for the work.

It doesn't. The boundaries you set in your practice, the ones around your schedule, your cancellation policy, your session rates, those aren't walls you build to keep clients out. They're the structure holding your business up.

The clinician in you wants to accommodate everyone. The CEO in you understands that the moment you start making exceptions for everyone, you're slowly dismantling the thing that allows you to keep serving anyone.

Set CEO time on your calendar. Once a month, sit down and look at your numbers, review your policies, check where your boundaries have gotten a little fuzzy. This doesn't have to be a full day. Even a couple of hours of intentional reflection will tell you more about your business than months of just pushing through.

Thing 6: Build a Second Income Stream Before You Need One

This one feels like a "later" project for almost everyone. It isn't.

If all of your income depends on you physically being in the therapy room, you are one bad season, one injury, one family emergency away from a real financial crisis. That's not me being dramatic. That's just the math of what happens when a single-source income dries up suddenly.

The best time to build a second income stream is when your practice is stable and full and you're not scrambling. When you're scrambling, you make reactive decisions. When you have breathing room, you get to be creative and intentional.

What a Second Income Stream Can Actually Look Like

I want to be specific here because I think a lot of people hear "passive income" and immediately picture a polished online course with thousands of students. That's not where you start.

Leveraged income is a great first step. This is income that still requires your time but pays more per hour than one-on-one therapy. Think running a parent workshop, a small group, a professional development training. You're still showing up, but you're serving more people at once and keeping more of what you earn.

What I love about leveraged income is that it creates a buffer. That extra profit can go into savings so that if you ever need to step back from therapy for a while, you have something to float you. It can also fund a new clinician you're bringing on while you're waiting for their credentialing to come through.

From there, passive income is the next layer. Therapy templates, evaluation report bundles, parent resource kits, digital guides, mini courses, replays of workshops you already ran. These are things you build once and sell again and again without your direct time and energy going into each transaction.

Your expertise as a clinician means you have already solved problems that other people are still dealing with. What's your most common parent question? What are the materials you pull off the shelf for every eval? What do you know about your specialty that other therapists wish someone would just explain clearly? Those are your products.

One More Thing About Starting Before You're Ready

The first time you host a workshop, maybe three people show up. The first time you put a template for sale, maybe it sits there for two weeks before anyone buys it. That doesn't mean it isn't working. It means you're in the part of the process that most people quit before it gets good.

I've said this a lot, and I'll keep saying it: if you wait until you're ready, you will be waiting forever. You build the thing. You sell it. You learn from it. You make it better. That's the whole process. It just takes time, and it takes starting.

The Practice You're Dreaming Of

The practice where you work the hours you want, take real time off, and feel financially stable on the other side of all of it? That practice doesn't get built by accident. It gets built by making decisions like a CEO, by having income coming in from more than one place, by setting up systems and structures early enough that they actually hold when life gets complicated.

You don't have to do all six of these things perfectly. You don't have to do them all at once. Pick one and go. The practice you're dreaming of is built one decision at a time, and none of those decisions require you to have everything figured out first.