The Economics of Group vs Solo Private Practice

by jennbossio | Apr 7, 2026 | Jobs

What Clinicians Rarely See Behind a Successful Group Practice

Why Give Away Part of My Income to a Group Practice?

Many clinicians considering group practice ask a simple question:

Why share income with a clinic when you could keep 100% in solo practice?

On the surface, the logic seems straightforward.

If a clinician works independently, they keep their full fee. In a group practice, a portion of that fee is shared with the clinic.

The math seems like a no brainer; 100% is better than 60%!

However, this comparison assumes that clinical income exists in isolation from the infrastructure required to generate and sustain it.

In reality, running a stable, ethical, and high-quality clinical practice requires a complex system of operations, risk management, financial planning, and professional infrastructure.

Most clinicians never see this work.

In fact, when a clinic is functioning well, clinicians should not see most of it.

At the Tri Health Clinic, a significant amount of work is happening continuously in the background to ensure clinicians have:

• stable referral streams
• predictable income
• legal and financial protection
• administrative support
• high-quality office space
• ethical pricing structures
• sustainable workloads
• protection against burnout
• community of like-minded professionals

If clinicians are largely unaware of how much work is happening behind the scenes, that usually means the system is functioning as intended.

This article aims to briefly pull back the curtain on that infrastructure and explain how the economics of a well-run group practice actually work.

My Personal Experience in Solo Practice

Before founding the Tri Health Clinic, I operated in solo private practice from 2018 to 2019, and prior to that I was in a pseudo solo practice from 2016.

Running a solo practice provides a clear education in the realities of clinical business operations.

During those years I managed:

• marketing
• referrals
• client inquiries
• website development
• billing systems
• payment collection
• administrative communication
• financial tracking
• tax preparation
• legal documentation
• office infrastructure
• client scheduling
• cancellation management

Even while operating conservatively and carefully managing expenses, I was unable to reduce operating costs below approximately 30% of gross revenue.

This was a time well before the mental health field was as saturated as it is today. For example, Kingston’s Psychology Today search had about 5 pages of therapists, compared to the almost 600 therapists the same search reveals today.

My operating costs din’t even capture the time spent managing the business itself, which further reduced effective income.

Operating a clinic at scale only increases the complexity, costs, and risk associated with these systems.

Calculating Take-Home in Private Practice

I’m sure that you, like me, have run the mental calculations of running a private practice in your mind. You think “okay, take my hourly rate, multiple by the number of clients I’ll see in a week, and consider how many weeks I want to work in a year”.

Even with a generous amount of vacation, the number these mental exercises produce are usually eye-watering.

Cue excitement! Cue mental shopping lists! Cue visions of retiring in Costa Rica at the age of 41!

However, because we have degrees in human behaviour and not in economics, we forget that that figure represents gross revenue, not income.

Running a practice requires investment in several categories of infrastructure.

These include:

• office space and utilities
• administrative systems
• billing and payment processing
• legal and accounting services
• marketing and reputation management
• technology platforms and EMR systems
• client intake and communication systems
• financial compliance and reporting
• policy development and documentation

Many of these costs require considerable risk.

For example, signing a commercial lease often requires a much longer commitment and more legal nuance than the residential lease most of us are familiar with. This is a considerable liability.

Not to mention the considerable up front expenses associated with an office space.

Even if you plan to work virtually, you will need an ergonomic computer set up to protect your body long into your career (think: standing desk, costly office chair, computer monitor set up). Plus a high quality computer and reliable internet connection so you can do your job with minimal interruption.

In addition, clinicians must account for the opportunity cost of time spent managing non-clinical work.

Each hour spent on administrative work (building strong referral networks, managing inquiries in a timely manner), effectively costs the dollar amount you would be making by seeing a client. That’s just not lost income, it’s an expense.

For many therapists operating independently, the financial difference between solo practice and group practice becomes significantly smaller once these realities are accounted for.

The Administrative Infrastructure Behind a Clinic

One of the largest unseen components of a clinic’s operations is administrative coordination.

At the Tri Health Clinic, administrative work includes:

• managing inquiries in a timely manner
• coordinating intake appointments
• responding to any and all client communication
• managing scheduling systems
• processing payments
• maintaining records
• implementing policies and procedures

Administrative coordination is handled by trained staff who we all love and who specializes in this work. This allows clinicians to focus their professional time on clinical services rather than administrative logistics.

But consider the risk here, as well. What happens if our admin unexpectedly goes off on leave? As a member of a group practice, this is not your concern! Things will continue to operate as normal in the event of an administrator’s leave, because it is ultiamtely the responsibility of the clinic owner to ensure this happens.

As a clinician in a group practice, you will never need to deal with the horrors and administrative nightmare of finding a last minute administrative replacement.

The scale of administrative work, or even the management of an administrator is often underestimated until clinicians experience it firsthand in solo practice. No, thank you!

Financial Infrastructure and Compliance

Might you get a sense of dread or confusion when hearing words like “taxes”, “Canadian Revenue Agency”, “tax deductions”, or “reconciliation”?

Do you feel confident in your ability to accurately categorize and document every single business-related expense you make, forever?

Operating a clinic requires ongoing, detailed financial management.

This includes:

• bookkeeping
• accounting
• financial reporting
• tax preparation
• legal compliance
• financial decision-making
• assessing financial health of the business
• choosing how/when to invest in the business

At the Tri Health Clinic, clinicians receive clean monthly associate summaries that simplify financial reporting and tax preparation.

They also receive T4As at the end of every year, uploaded to the CRA for ease of reporting.

Clinicians receive their payment from the clinic via a protected service (no e-Transfered payments here), to ensure no accidents or losses or fraud.

These systems have been carefully chosen and they all provide protection in the event of regulatory review or tax audit.

Without structured systems, financial documentation can become one of the most stressful aspects of independent practice. And finding the right professionals to manage all of this can be extremely pricey.

As part of a group practice, you can trust that this has all been taken care of for you.

Breathe that sign of relief now.

Payment Systems and Revenue Protection

Policies around payment processing are a good example of the kind of high-level operational decision-making that happens continuously within a well-run group practice.

These are not decisions clinicians should have to spend their time making. The goal is simple: clinicians focus on providing excellent care, while the clinic ensures that the operational systems supporting that care are stable, ethical, and financially sound.

For this reason, the Tri Health Clinic requires that all clients maintain a credit card on file. This policy ensures that payments can be processed promptly after sessions and that clinicians are protected from the administrative burden and financial uncertainty associated with unpaid balances.

Credit card processing fees are substantial. Across the clinic, these fees amount to tens of thousands of dollars per year. However, the clinic deliberately absorbs this cost rather than passing it on to clinicians. We consider these fees a necessary cost of doing business in order to maintain a reliable payment system and protect clinicians’ income.

Some solo practitioners attempt to avoid credit card fees by relying on eTransfers or manual payment arrangements. While this approach may reduce transaction costs, it significantly increases the risk of unpaid sessions. When payments are missed, clinicians often have limited practical recourse and may spend considerable time attempting to recover balances.

Our approach prioritizes reliability and clinician protection. By maintaining structured payment systems and absorbing the processing costs at the clinic level, we ensure that clinicians are paid consistently and are not placed in the position of chasing payments from clients.

As a result of these systems, the clinic maintains exceptionally low bad debt rates (under 1%), which helps ensure that clinicians’ income remains stable and predictable.

Referral Stability and Income Predictability

Income stability is one of the most overlooked benefits of working within an established clinic.

Many solo practitioners experience significant fluctuations in referral volume. Look at any therapist facebook group and you will see countless messages to the effect of “is anyone else noticing fewer referrals?”, or “my Psychology Today page doesn’t seem to be working anymore…?”.

When your full time job is seeing clients and marketing is something that happens off the side of your desk (or not at all), you can expect periods of high demand that may be followed by weeks or months of reduced bookings.

Since it was established in 2018, The Tri Health Clinic has gown into one of Ontario’s recognized centres for sex and couple therapy. This was not passive growth; it was deliberate, curated, and took considerable effort, time, and financial investment. Our reputation was established before the pandemic hit and the market became saturated, and this work continues at all times.

Due to the enormous amount of ongoing effort to market the clinic, we receive a large volume of referrals and carefully distribute them among clinicians based on availability and specialization.

This provides clinicians with a more predictable and stable client flow.

This level of investment of time and finances into building a brand is nearly impossible to do while also prioritizing client-facing time. It just isn’t possible as a solo practitioner.

By joining an established, healthy group practice, clinicians benefit from income stability, and thus a significant reduction in financial stress. This peace of mind allows clinicians to focus on clinical work rather than marketing.

Client Fit, Referral Matching, and Burnout Prevention

Solo practitioners often feel pressure to accept most inquiries in order to maintain income stability.

This can lead clinicians to take on clients outside their preferred clinical areas or outside what might be considered their professional “zone of strength.” Over time, carrying a very broad caseload can increase emotional fatigue and contribute to burnout.

Within a team-based clinic, clinicians have the ability to focus more intentionally on their areas of expertise and interest. When a clinician is not currently accepting certain presentations—for example couples therapy, trauma work, or specific sexual health concerns—those clients can be matched with another clinician within the clinic who is better suited to the work.

This structure benefits both clinicians and clients by increasing the likelihood of a strong therapeutic fit.

For solo practitioners, managing this process can be significantly more complicated.

When an inquiry arrives that falls outside a clinician’s expertise, most therapists do not simply decline the request and move on. Clinicians care deeply about the people who reach out to them. Many will spend time responding thoughtfully, conducting consultation calls, reaching out to colleagues, reviewing referral options, and attempting to identify an appropriate alternative provider.

This work is meaningful, but it also carries a real cost.

It requires time, coordination, and often emotional energy as clinicians attempt to ensure that a client who has reached out for help is not simply turned away without support.

At the Tri Health Clinic, this process is built into the clinic’s intake infrastructure. Our intake coordinator manages referral matching and works carefully to connect clients with clinicians whose expertise aligns with the presenting concern.

When the clinic identifies a gap in services—for example, a type of client we cannot currently accommodate—the responsibility does not fall on individual clinicians to solve that problem. Instead, clinic leadership works to address the gap, often by recruiting additional clinicians with the appropriate specialization.

This approach ensures that clients receive appropriate care while protecting clinicians from the logistical and emotional burden of managing complex referral coordination on their own.

It also strengthens the broader professional community by ensuring that clients are matched thoughtfully with clinicians whose training and interests align with their needs.

Pricing Strategy and Market Research

Another responsibility of clinic leadership is determining appropriate fee structures.

As Independent Contractors, clinicians at our particular clinic ultimately choose their own fees. However, the clinic provides the research, data, and infrastructure needed to select a fee that supports a sustainable and thriving practice.

In solo practice, pricing decisions are often made with limited information. Many clinicians start with a quick scan of Psychology Today to see what colleagues are charging, followed by an internal debate that might sound something like:

“I want to earn a reasonable income, but I don’t want finances to be a barrier to helping people.”

“There’s no way someone would pay that much to see me.”

“This fee seems… fine, I guess…?”

The cost of therapy is a source of real tension for many clinicians in the helping professions. I know this well because I navigated the same dilemma when I ran my own solo practice.

At the Tri Health Clinic, we intentionally remove much of this burden from clinicians. The clinic conducts detailed market research on pricing across multiple Ontario cities and across several health professions. We also monitor market saturation, referral patterns, and demand for specialized services.

This work ensures that clinic fee structures remain:

• competitive within the broader market
• ethical and appropriate for the services provided
• sustainable for both clinicians, the clinic, and the people we serve
• aligned with specialized training and expertise

The clinic also manages how fees are communicated to clients and handles structured fee adjustments when necessary.

As a result, clinicians are not left wondering whether they are charging too much, too little, or when it might be appropriate to adjust their rates. Those decisions are supported by ongoing research, careful planning, and transparent procedures.

Pricing is not guesswork; it is the result of ongoing analysis, careful planning, and a commitment to ensuring clinicians are compensated appropriately for their expertise.

Monitorying the Professional Landscape is Done For You in a Group Practice

Maintaining a healthy clinic also requires ongoing engagement with the broader professional landscape. In mental health, especially, that is changing at breakneck speed these days.

As Clinic Director, I regularly participate in and collaborate with several networks of group practice owners, which provide ongoing insight into:

• emerging industry trends
• regulatory developments
• ethical considerations in group practice
• sustainable compensation models

These communities offer a perspective that is simply not available when practicing alone. Solo practitioners may consult with colleagues, but the operational realities of running a clinic—and the decisions required to support multiple clinicians—are quite different from those of individual private practice.

Engaging with other clinic directors allows us to compare models, identify best practices, and ensure that the structure of our clinic remains both ethical and sustainable.

It also raises a practical question: who has the time to do this while running a full solo practice?

Monitoring industry developments, evaluating new technologies, and analyzing operational models is a substantial responsibility in itself. At the Tri Health Clinic, this work is intentionally part of my role.

My background in research also informs how these decisions are made. Changes are not adopted based on trends alone; they are evaluated carefully, often through a combination of available research, operational data, and consultation with other clinic leaders.

For example, consultation calls have become a common expectation across much of the therapy industry. However, the available evidence suggests that at best, they offer limited benefit beyond rewarding salesmanship rather than improving clinical outcomes, and at worst they can cause real damage by delaying client’s therapy start date. Because our clinic operates at scale, we have the ability to thoughtfully reconsider industry norms that may not serve clinicians or clients well.

Another example is the rapid emergence of AI-supported documentation tools. Before adopting any technology, the clinic evaluated multiple options, assessed clinician interest, and reviewed privacy and consent considerations. Ultimately, we selected an electronic medical record system that includes AI-assisted note-taking capabilities and developed appropriate consent procedures. Clinicians are free to choose whether or not to use these tools, but the infrastructure and due diligence have already been completed.

These kinds of evaluations take significant time and careful analysis. In a solo practice, it is often difficult to keep pace with emerging tools and trends while also managing a full clinical caseload.

At the Tri Health Clinic, part of my responsibility is to remain ahead of these developments so clinicians can benefit from thoughtful, evidence-informed decisions without needing to invest their own time in evaluating every new trend or technology.

Rethinking the Meaning of a Fee Split in Group Practice

Fee splits are often misunderstood as arbitrary numbers, or even greed on the part of a practice owner.

In reality, fee splits in group therapy practice must balance a complex set of factors, including:

• clinic health and sustainability
• clinician income
• administrative infrastructure
• physical office space
• technology systems
• clinic branding and marketing
• legal and financial compliance
• long-term operational stability

When these factors are ignored, clinics may offer unusually unbalanced fee splits in order to attract clinicians. While appealing at first glance, these models can destabilize a clinic’s finances and eventually force difficult corrections such as sudden fee increases, reductions in services, or even clinic closure.

I would ask some very serious questions about any fee split less than 35/65, or even 60/40.

At the Tri Health Clinic, fee structures are calculated deliberately and conservatively to ensure long-term stability for both clinicians and the clinic.

The purpose of this article is to illuminate what a fee split actually represents.

You are not simply “giving up a portion of your income.” You are protecting yourself from substantial financial risk, from the enormous time costs of running a business, and from the operational burdens that can quickly erode both income and professional (and personal!) wellbeing.

You are also investing in a sustainable practice environment designed to support clinicians over the long term.

Most graduate programs in the helping professions do not teach the realities of running a business. In fact, I don’t know if this is ever taught at the training level. Yet when clinicians operate as Independent Contractors, that is effectively what they are doing: running a small business.

And like most businesses, operating independently can be expensive and risky.

Consider the cost structure of many other industries: retail stores must carry large amounts of inventory, pay staff, manage supply chains, and maintain physical storefronts. Compared to many businesses, private practice is already relatively streamlined.

Group practice takes that a step further.

By sharing infrastructure, administrative systems, and operational responsibilities, clinicians are able to access the benefits of a well-run business without carrying the full burden of building and maintaining it themselves.

In many ways, it is an unusually supportive model: clinicians are able to focus primarily on the work they trained for while the clinic manages the underlying business systems that make that work possible.

At the Tri Health Clinic, this model is intentional. Our goal is to create an environment where clinicians can build sustainable careers, avoid burnout, and focus on meaningful clinical work.

Ultimately, that serves everyone involved: clinicians, the clinic, and the clients we collectively aim to support.

If this article helps illuminate the realities of practice economics for even a few clinicians, then it has served its purpose.

Offering unsustainably high splits may initially attract clinicians but can destabilize a clinic’s finances.

This can eventually force clinics to:

• raise client fees unexpectedly
• reduce services
• close entirely

Tri Health Clinic operates with a deliberate focus on long-term sustainability.

Fee splits are carefully calculated to ensure clinicians can thrive while the clinic remains financially healthy.

So… Group Practice vs Solo Practice?

If much of what you’ve read here feels unfamiliar, that is actually a good sign.

When a clinic is operating well, clinicians should not need to spend their time thinking about payment systems, pricing strategy, administrative infrastructure, legal compliance, market research, or operational risk. Those responsibilities should be handled by the clinic leadership working diligently in the background.

At the Tri Health Clinic, we take that responsibility seriously. A significant amount of work goes into building and maintaining the systems that allow clinicians to focus on what they do best: providing thoughtful, high-quality care to clients.

Our goal is simple. Clinicians should be protected from the complexity of running a clinical business, supported by strong infrastructure, and able to build sustainable, fulfilling careers. When those systems are functioning well, much of that work remains invisible.

And that is exactly how it should be.