Licensed Social Worker Monica Mehalshick in Philadelphia wrote in with the following dilemma . . .

I am an LSW in the state of Pennsylvania and for the last seven years, I’ve been working at an inpatient facility for substance abuse treatment.

I recently have been attempting to find some other ways to continue within the field, and was offered a position in a private practice. I was informed that upon joining the practice, the director would be able to assist with marketing and finding the clients, and they have an officer manager to continue the billing,etc, but that I would just be doing the therapy which is a great opportunity!

A few months back, I had been offered a similar position in a practice, however, the practice just consisted of a psychiatrist and after obtaining my IP, and we continued the process with insurance, I was informed that since I have my LSW, not my LCSW, that they could not bill the insurance.

I have a follow up interview with the more recent position to meet the other therapists within the practice, and at this time, I know that this is a great opportunity, however, I don’t know much about going into a private practice and my concern is that I will need to take the time to build up a clientele in order to be financially compensated (with my current job it is salaried). However, I am unsure of whether I’ll run into this issue with just being an LSW in a private practice. I’m not sure if this helps, however, the director is an LPC.

Any suggestions or information would be super helpful!

Monica”

Monica’s situation is common. As mental health professionals gain their sea legs in the field, they often get the itch to move on into other settings or into private practice.  I did that.  And, I was not prepared.

Before you decide to turn in your resignation, give up your salary, your benefits, the free supervision and professional development that often come with the lower pay of agency jobs, if your goal is private practice, you have some things to do.

Unless you have the financial backing of another income, you need to save up a pile of money to pay your expenses to live on.  It is not uncommon to spend more money – a lot more money – than you earn in the first year or two in private practice.  Plan on it.  If I’m wrong, I’m happy for you.  But if I’m right, you can drop in here and thank me!

If someone approaches you and invites you to join their practice, then I’m assuming they think that you have really strong clinical skills and will be an asset to the practice and it’s reputation.  It doesn’t really mean anything beyond that.  Don’t assume that they will keep your appointment book full – even if they have someone on payroll to market the practice.  You need to ask questions and get the answers in writing – specifically “How many clients will you guarantee / week?”  “What happens if you don’t produce them or they don’t show?”  And, by the way – how do you expect to get paid then?

Don’t assume that just because there is a billing person on payroll that their services will be free or available to you.  Nor should you assume that their billing is correct.  You -  not the billing person – are ultimately responsible for those bills.  Again . . . ask questions and get answers in writing.

None of the insurance companies that I am aware of will reimburse a mental health professional unless they hold a terminal degree and clinical license.  That degree and license vary from company to company and state to state here in the USA.  You need to do your research and find out what that means about you and your particular discipline in your particular geographic area.  Call each company that you are interested in being a provider for and ask for “Provider Relations.”  That is the department that can provide accurate information to you about their requirements for reimbursement.  Get the info in writing.

I speak from experience when I say you will not hang out your shingle and find that the masses come your way.   You will need to build in time to build up a private practice.  Thriving as an entrepreneur is not contingent solely upon your clinical skills.  Success is not so much about whether you are on managed care panels or whether you hold certain credentials as it is about the business of private practice.

As you begin to think about being in private practice . . . you need a plan – one that helps you map out how you are going to help clients find you and how you are going to keep them.  That’s really what I do – help you figure that out.

If you like to get your information on line, feel free to prowl around this website and others to learn all that you can.

If you prefer to get your information from books or in classes, go for it!  That works well, too,

If you need one on one support from a consultant or coach or mentor, you can hire me to help you map out that strategy for growing your practice.

Or, if you like working with a small group of like-minded therapists who are growing their practices together and supporting each other in the process, I can help you with that, too.

Whatever your learning mode it, know that there are lots of right ways to build a practice into a strong and resilient business.  Just know that above all else, you will do best by taking the time to create a plan that is unique to you and your circumstances, that reflects your values and desires, and is chunked into small enough do-able steps that build your courage and your confidence along the way.  What else can you guys think of that might be helpful to Monica and others who are getting ready for private practice?