Or: Why Group Practice Ownership Is a Terrible Get-Rich-Quick Scheme
This morning, I opened my computer and saw a reminder that made me laugh.
In June of 2019, I paid myself my first salary from Tri Health Clinic.
It was $2,000.
At the time, I was thrilled.
So thrilled, in fact, that I set the very reminder that went off today to remind future me of this momentous occasion.
Not because $2,000 a month was a lot of money. It wasn’t. But because it meant the idea was working.
What makes this milestone particularly funny is that I opened the clinic in October of 2018.
October. November. December. January. February. March. April. May. June.
Nine months.
Nine months before I paid myself anything.
And when I finally did, it was $2,000.
If you’re reading this as a therapist in private practice, you may already be doing some math and realizing that there were probably easier ways to make money.
You would be correct.
The Parts of Starting a Group Practice That Nobody Sees
One of the funny things about owning a group practice is that people often assume the business owner is making a fortune.
I occasionally hear comments that imply group practice owners simply collect a percentage of everyone else’s work and ride off into the sunset.
The reality is a little less glamorous.
Before there were clinicians, there was rent.
Before there were referrals, there was rent.
Before there was revenue, there was…
…you guessed it…
rent.
Commercial leases are not small commitments. When you sign one, you are taking on years of financial responsibility regardless of whether a single client walks through the door.
Then there are the offices themselves.
Six furnished therapy offices don’t magically appear.
Trust me, I know exactly how eye-watering the IKEA and Structube bills can become.
We grew carefully over time. One office became two. Two became four. Four became six.
Every expansion meant another gamble.
Another lease commitment.
Another room to furnish.
Another financial risk taken before there was any guarantee it would pay off.
And that doesn’t even include websites, marketing, software subscriptions, insurance, professional services, administrative support, training systems, or the countless other expenses required to build a clinic.
Many therapists never have to think about these things.
That’s not a criticism.
It’s actually the point.
The Strange Reality of Early Practice Ownership
There were years when clinicians working at the clinic made significantly more money than I did.
Oddly, I was proud of that.
Because it meant the system was working.
It meant clients were finding us.
It meant therapists were building successful practices.
It meant people were getting help.
It meant that something I had poured time, money, energy, and risk into was starting to become real.
The goal was never to build a clinic where I made the most money.
The goal was to build something that mattered.
Something that could help people.
Something that could outlast me.
What Therapists Often Miss About Fee Splits in Group Practice
Therapists can see the fee split.
What they don’t always see is the decade that came before it.
The years spent building referral relationships.
The years spent networking.
The years spent meeting physicians.
The years spent learning Google Ads.
The years spent writing blogs.
The years spent refining intake systems.
The years spent figuring out which marketing strategies worked and which were simply expensive mistakes.
The years spent creating training systems, supervision structures, and processes.
In other words, therapists see the percentage.
They rarely see the investment.
Today, a therapist can join our clinic and walk into a referral ecosystem that took years to build.
They don’t have to pay for Google Ads, design a website, hire an intake coordinator, build physician relationships from scratch.
They don’t have to spend nine months making nothing.
It’s because someone already spent years building it.
The Therapy Market Has Changed
When I opened Tri Health Clinic, the therapy market looked very different.
I opened my practice shortly before the COVID-19 pandemic hit. This was a time of growing acknowledgement that having a therapist was a sign of strength, not a weakness.
Online therapy was becoming all the rage.
Start up costs were lower and waitlists grew with little to no effort.
When I opened my clinic in Kingston, Ontario, the Psychology Today search results for my town produced 5 pages of results.
Today that same search produces over 100 pages.
in 2026, Ontario has more therapists than ever before.
I see private practitioners who previously had thriving caseloads worrying about where their next referrals will come from.
I see clinic owners trying to sell practices that are no longer financially viable.
I see clinicians wondering whether they can afford to stay in the profession.
The reality is that being an excellent therapist is no longer enough to guarantee a thriving practice.
Marketing matters.
Systems matter.
Referral relationships matter.
Business strategy matters.
The reason Tri Health Clinic continues to grow isn’t luck.
It’s not because we’re smarter than everyone else.
It’s because we have spent years investing in the clinic during periods when the return on that investment was uncertain.
What Success Means to Me Now
When I started the clinic, I probably thought success meant making more money (more than $2000 a month, anyways).
Today, I think success looks very different.
Success is that more than 3,000 individuals and couples have received care through our clinic.
Success is that people have better relationships because of us.
Success is that people have better sex because of us.
Success is that clinicians have built meaningful careers here. Built friendships.
Success is that our clinic is continuing to grow during a period when many practices are struggling.
Success is that what started as an idea is now something that genuinely helps people.
That was the dream all along.
And honestly, I feel like we’re just getting started.
A Note to Therapists Looking for Work
If your dream is to own a practice, wonderful.
We need more thoughtful, self-regulated, ethical practice owners.
The profession benefits from people who are willing to take risks and build something meaningful.
But I also hope you understand what you’re signing up for.
I hope you have realistic expectations.
I hope you appreciate the financial risks involved.
I hope, like I did, that you have support around you while you’re building.
Because practice ownership is not simply therapy with better pay.
It is an entirely different job.
And if your goal is simply to do excellent therapy and help people live better lives, don’t underestimate the value of joining a strong group practice.
Especially in today’s market.
There is tremendous value in walking into a referral system, a support system, a training system, and a community that somebody else spent years building.
After all, somebody has already paid the IKEA bill.
And speaking from experience, that bill is no joke.
If you’re a therapist reading this and thinking, “I’d rather skip the nine months to $2,000 part,” I don’t blame you. If you’re a high-quality therapist looking to advance your skills in sex therapy, or an exceptional couples therapist looking for a strong referral base, supervision, consultation, and a community of like-minded clinicians, take a look at the Tri Health Clinic Careers page. We’d love to hear from you.