Private practice doesn't have to be the end goal (Solo)

[00:00:05] Bronwyn: Hey, mental workers. You're listening to The Mental Work podcast, the podcast about working in mental health for early career mental health workers. As always, I'm your host, Bronwyn Milkins, and today I am doing a solo episode where I'll share my experience of closing down my private practice after four years. Yeah, six months ago I closed my private practice.

[00:00:24] I'll talk about why I make that decision, what I've learned about job satisfaction along the way, why I'm looking forward to starting clinical work again after six months, but not in private practice, and some reflections that I hope will get you thinking about what career pathways can look like in mental health.

[00:00:39] So closing my private practice wasn't an easy decision, but it was definitely the right one. The main reason why I closed my private practice was health. So when you are self-employed, you don't get sick leave. I set my fees so that I accounted for a certain amount of sick leave every year, but I had a health condition that was gradually getting worse and I needed a workplace where I could actually have access to sick leave.

[00:01:02] But there was another factor as well, and that was simply a better opportunity was available. I was offered a research focused role that came with more pay, about $15,000 more than I had been earning for myself in private practice in the role. There was also a lot more variety, support, and a sense of being part of something bigger than myself.

[00:01:23] As well by the stage that I was considering closing my private practice, I was feeling increasingly not confident in my clinical work. I had been carrying a caseload nonstop since about 2017, and when I closed the practice, I decided to take the last six months off client work completely. This is therefore the first time in years that I've had no caseload at all.

[00:01:46] Closing the private practice itself was fairly easy from an administrative side of things. I had my own lease on my office, but it worked out quite well that I was able to transfer the lease over to somebody else. As well, I was able to sell that person most of my office furniture, and I was able to work out the process of telling clients and closing down my practice fairly easily.

[00:02:11] I think the thing that I miss the most, actually, is my clients. It surprised me how much grief and loss I felt about my clients, and I often think about them and send good vibes out into the universe and hope that they're doing okay.

[00:02:29] The other thing I really miss was my office. I had made a really beautiful space and I really loved creating that calming space for clients, and it was my space where I felt like, yeah, it was a safe place, I guess.

[00:02:46] So those are things that I miss the most. Do I miss working for myself? I guess the good thing about working for yourself is that you can go at your own pace. So yes, there are demands. It's like, I don't wanna leave a GP letter for a week. I wanna get that out within a day or two. But otherwise, you can go at your own pace, you can set your own schedule. And there's some real positives to working for yourself. You don't have to deal with office politics, for instance.

[00:03:11] But there are also some things about private practice that maybe aren't all that satisfying, and so when I looked into job satisfaction in psychology more broadly. I looked up a few research articles comparing private practice to agency settings, and those studies usually show higher job satisfaction in private practice, but they're generally based on older, more experienced clinicians. So then I zoomed out and I tried to find research that looked at what predicts job satisfaction more generally.

[00:03:40] Dr. Tim Ballard from the University of Queensland recently published some fascinating findings using data from the Hilda Survey. That's the longest running Australian study that's been tracking thousands of households for decades. He looked at over 22,000 workers between 2005 and 2023 to see what really drives job satisfaction. The strongest positive predictor of job satisfaction was variety in your work, having the perception that you're being paid fairly and having job security also mattered a lot. Autonomy, that is having a say in decisions freedom and how and where you work was also really important.

[00:04:19] What predicts job dissatisfaction, was stress and the strongest, negative predictor was fearing that work stress could make you physically ill. And I guess this translates to private practice when we think about burnout. And burnout really does make you physically ill. Like you get aches and pains, we've heard multiple stories on this podcast in itself that it does make you quite unwell. Other predictors of job dissatisfaction were job insecurity, constant time pressure, and repetitive tasks.

[00:04:50] The most surprising finding was that salary itself had no real impact. So the real salary had no impact, but what mattered more than the dollar figure itself was whether people felt they were being paid fairly. So your perception of your salary is important.

[00:05:04] When I think about my own experience, I can see these patterns of what predicts job satisfaction really clearly. Yes, private practice offered variety through different clients, but the actual rhythm of the work was pretty much the same every day. Back-to-back sessions, admin letters... yes, I was paid fairly per session, but there were also a lot of unpaid tasks. Responding to subpoenas, GP consults, extended care management, professional development, supervision reports, financial admin. The list goes on. Marketing, branding.

[00:05:37] And the negative factors rang true for me as well. I did experience stress that did make me physically unwell. I had client situations that frightened me and kept me up at night. I constantly felt like there wasn't enough time for everything, even though I'm really well organized and quite efficient.

[00:05:53] And two factors that weren't even in the research really hit me, the lack of support and the lack of career progression. So even though I built peer supervision groups, like I had created them myself, I still often felt isolated. And in terms of career growth, private practice offers two main pathways. You can either promote yourself into like CEO or senior psychologist in your practice, or you can start a group practice. We have a few contractors or employees.

[00:06:24] When you do the latter options, so you start a group practice, you definitely move from working in your business to working on your business. So you are the manager, you oversee things, you work on managing a safe workplace and managing the business side of things. And initially, I remember four years ago when I was starting my solo private practice, I actually met with a business coach and she was like, what are your goals? And I thought that at the time my goal was to start a group private practice, 'cause I just thought that that was the natural career progression and maybe that's what I should want.

[00:07:00] But when I evaluated that years later, I realized that that actually wasn't for me. It's not something that I wanted. I wasn't interested in expanding in that way, and I really did prefer doing the hands-on client work, and so I didn't wanna be taken away from that either.

[00:07:17] As I said, I don't think I regret closing my private practice, but at the time I did have some feelings along some of those lines. I actually said to my partner, I'm sorry I failed. And he reminded me that starting a business and running it for four years is no small thing. At the time, I didn't really believe him, but now I do. My books were always full. GPS gave me really positive feedback, and clients seemed to genuinely benefit from the work. That's not failure. That's something to be proud of. And so if you've been in a similar situation to me where you're considering closing your practice, but you are fearing failure, I think, yeah, being on the other side, I can really say that it's not, it's a massive success to have started and run your own business and have taken that leap.

[00:08:02] So what are the things I've noticed now? Okay, so since I've been in my research role, I have noticed that I no longer need recovery time the way I did in private practice. Back in private practice, I used to schedule a week off every seven weeks just to keep going for burnout prevention, and I couldn't manage more than 15 to 20 clients a week, while I know many workplaces expect 25 clients a week.

[00:08:27] Now that I'm working in research, I'm working full time for the first time in years, and I haven't needed to take any leave... I actually feel like I am thriving, which is something that I didn't feel like for a long time in private practice. Like I felt like things were getting easier because I had built up systems for myself and like I had templates and I had familiar ways of doing things and familiar ways of doing therapy, but I never felt the same way that I do now where I feel on top of things.

[00:08:56] So, do I regret going solo? The short answer is no as well, but I wouldn't make the same decision again, at least not so early in my career. So I started my private practice within 12 months of full registration, but I hadn't planned it that way. I actually tried to join several group private practices, but I was turned down. Around the same time I had a really harmful supervisory experience, and I was isolated from other senior psychologists and told that I wasn't allowed to seek input elsewhere.

[00:09:26] Without guidance around me, I felt really that solo practice was my only option. I kind of felt backed into a corner. I also had a caseload, and it was just a messy situation. It's a little difficult to explain, but long story short, that was how I felt that the only way I could rely on myself without getting into a negative situation was to open a private practice. Looking back, I wish I had sought therapy to help process that experience, and then found a senior psychologist to help me map out options that were available to me.

[00:10:03] The biggest challenges in starting a private practice, at least for me, they weren't the business side or even my clinical skills, but it was some of the more complex situations that I hadn't encountered earlier in my career in that first 12 months that I didn't yet have the experience to manage alone. And even though I was seeking supervision and I was quite proactive in supervisory situations, I think it's, I think it was even difficult for the supervisors to quite get insight into what I was dealing with because I didn't know how to report it.

[00:10:36] I wanted to share my experience because I think it raises some important reflections that might be takeaways for you. The first takeaway is that I think we often get told explicitly or implicitly, or maybe we learn it from watching others in the field, that solo private practice is the marker of success. It's something to aspire to. And I think we need to challenge that idea that solo private practice is really the pinnacle of a career in mental health. There are so many other fulfilling ways to work in mental health, in not-for-profits, education research, leadership advocacy, and corporate roles that focus on workplace culture. Private practice is one option, but it's not necessarily the ultimate goal or has to be your goal.

[00:11:22] The second takeaway that I think comes from my experiences is that it's okay to close your practice if something better comes along. I mean, it kind of goes to number one in not thinking that private practice is the best opportunity or the only opportunity out there. There are better opportunities than I can really see in hindsight, that the research job I'm currently in is a better opportunity, but that won't be for everyone. I think one of the reasons why the current opportunity is better for me is that I still have a lot of flexibility, a lot of autonomy. It's pretty much like I need to do my work, but how I do it and how I go about it is entirely up to me, which suits me really well. And I also feel like I have heaps of support. I don't think closing a private practice is a failure. I think it's just a different direction.

[00:12:08] The number three takeaway, is that something I've observed over the past few years is quite open feedback... I'll say feedback. Feedback from other psychologists who say that early career psychologists shouldn't open private practices early in their career. And literally, like I can quote this... early career psychologists are quote, "entitled", quote overconfident. But I think we should approach this a little differently. I think we should be asking why is it that early career psychologists are feeling like private practice, solo private practice is the option for them? Is it because we've seen, or we are seeing an increase in narratives that this is the way to success, or is it because they've been exposed to exploitative unsafe workplaces or poor supervision, and solo practice feels safer?

[00:13:04] I think it's actually an interesting case study, when I think about solo private practice, because if you're a nurse, you can't open your own private practice. But I do wonder, like if that were possible in a hypothetical world, would a lot of nurses do that if they were exposed to exploitative or unsafe workplaces? So with psychologists we can do that. Is it just because we can that we're seeing it and is this a reflection of workplace health more generally?

[00:13:30] I think, long story short, I think if we're labeling early career psychologists as entitled and overconfident, but not seeing the reasons behind their decisions and speaking with them about their current conditions, it really takes us out of what can be a really interesting conversation and insight into the field as it is currently, and how healthy that is for our next generation psychologists. What we really need overall is support, mentorship, healthy workplaces, safe workplaces.

[00:14:00] So that's my story and those are my reflections. Overall, I really think we need to broaden the conversation about what success looks like in mental health and how we can better support early career practitioners to thrive and not burn out.

[00:14:14] I'd be really keen to hear your thoughts on this episode. You can always leave a comment on Instagram, Facebook, LinkedIn, and I think Spotify does comments as well.

[00:14:23] That's it for today though. Thanks for listening to Mental Work. I hope sharing my journey of closing my own private practice gave you some food for thought, and I hope you have a good run and catch your next time. Bye!