Episode 376: Whitney on Running a Group Practice When the Field Got Harder.
You built the group practice. You wrote the culture doc. You may have even presented somewhere on how good your culture was. And then people started leaving anyway, one after another, and each notice landed like a personal verdict on you.
If that is where you are, you are not failing at something everyone else has figured out. You are running a business in a stretch of the field that has genuinely gotten harder, where clients are more fearful and more angry, where AI is quietly absorbing some of what used to be a first session, and where the venture-backed platforms flooded the market with sameness and then started tightening rates. More people are entering private practice than ever. That does not make it easier for any of them.
Whitney has been on both sides of this. She is a Licensed Professional Counselor in Georgia who founded Water's Edge Counseling in Savannah in 2014 and grew it into a private pay group practice across two locations, with a third space coming as she consolidates everyone under one roof. She also runs Wise Practice Consulting, where she works with practice owners around the country, so she sees the pattern in other people's numbers and then goes home and lives it in her own. When she was last on this show at the beginning of 2023, she had not yet bought her first commercial building. Since then: two buildings, a second location, a leadership team, and roughly fourteen clinicians out the door in about eighteen months.
That last number is the reason this episode exists. Here is what she did about it.
Lesson 1: Overhire on Purpose
Whitney's single most useful move was also the one that scared her most. She started hiring before she needed to. Not after someone gave notice, not during the notice period, but months ahead, on the assumption that a percentage of her staff would leave that year no matter how good the culture was.
The objection is obvious, and she had it herself: what if we do not have the space, what if we do not have enough clients? But the alternative is worse. When you hire reactively, there is a gap between the day someone leaves and the day their replacement is trained, and that gap gets paid for by your existing clinicians, your intake team, and your clients. When someone recently gave notice to go start her own practice, Whitney had already hired her replacement.
The mindset shift underneath it is that turnover in behavioral health is a planning assumption, not an emergency. Whitney treats a meaningful share of annual departures as expected and staffs ahead of it. Run your own numbers rather than borrowing hers, but build the assumption in somewhere.
The takeaway: Hire for the turnover you can reasonably expect, not the turnover you are currently experiencing. Reactive hiring is how a normal departure becomes a crisis.
Lesson 2: Ask the Question You Do Not Want the Answer To
After the exodus, Whitney did not guess at why. She spent a quarter doing one-on-one conversations with her staff and asking hard questions directly. One of them was: have you considered leaving, and if so, when?
People told her the truth. Someone said they had thought about it three weeks earlier. That is a brutal thing to hear from a clinician you like, and it is also the single most actionable piece of information a group practice owner can get. You cannot address a retention risk you have decided not to look at.
Most owners avoid this question because the answer might require them to change something, or because they are afraid the asking itself plants the idea. It does not. The people considering leaving are already considering it. The only variable is whether you find out in a conversation or in an email with two weeks' notice.
The takeaway: Ask your team directly whether they have thought about leaving. The discomfort of the question is much cheaper than the cost of the departure.
Lesson 3: Show People the Whole Number
One of the things Whitney heard in those conversations was frustration about pay, which tracks with an economy where everyone feels squeezed. So she built something visual: a document that shows what a clinician takes home in one bar, and what the practice invests in them stacked above it.
Because the second number is invisible. A therapist looks at their W-2, sees what they made, and compares it to a fantasy version of solo practice where they keep everything. What they are not counting is the supervision the practice paid for, the employer share of taxes, the health insurance, the retirement match, the training, the intake team that filled their caseload while they were in session. Whitney puts a real figure on that and shows it alongside the salary.
She paired it with a five-year trajectory: here is where you start on pay, schedule, and benefits, and here is how it moves, including dropping a night, increasing rate, or stepping into a leadership role, with the role actually defined. It answers the question people are silently asking, which is not "am I paid enough today" but "is there a version of my life here in three years that I want?"
The takeaway: If you have never shown a clinician the full cost of employing them alongside a concrete five-year path, they are evaluating your offer with half the information.
Lesson 4: Build the Leadership Team at the Size You Actually Are
Whitney is enthusiastic about her leadership team and equally clear that people are building them too early. She has watched owners with one or two employees bring on a COO or CFO, and she has watched owners promote people into leadership before either the person or the finances were ready. That is one of the most common expensive mistakes she sees.
Her own sequence was staged. A clinical director came first, at roughly eight therapists, part time, carrying a caseload alongside the leadership work. Then an operations director, which grew out of a real bottleneck: her intake coordinator was running offices and could no longer get to all the calls, so they hired a dedicated intake person, and that person needed a manager. Each role solved a problem that already existed.
The COO came later, over the million dollar revenue mark, and even then she was nervous about putting someone on salary. He started carrying ten to fifteen clients a week and they quickly figured out that was not sustainable; he now sees closer to six to eight. Note that the correction happened fast, out loud, and without anyone treating it as a failure.
The takeaway: Add leadership when a specific bottleneck already exists and the finances already support it. A title you cannot afford is a money leak wearing a nice hat.
Lesson 5: Hire Your Leaders From the Chair
Whitney is blunt about the companies marketing outsourced CFO and COO services to practice owners: she would not want that. Not because the expertise is not real, but because therapists want to be led by someone who has done the work.
Her COO was excellent as a clinician. He saw twenty-five to thirty clients a week, worked a second job, went through the associate years of getting paid poorly while accruing hours, then got licensed and got a raise. So when he talks to a therapist about caseload management, scheduling, burnout, or pay, he is not theorizing. He has the receipts. Whitney points out that caseload, pay, and burnout are exactly the things people cite when they struggle or leave, especially in their first six to twelve months, which means those are precisely the conversations you want handled by someone with credibility.
Kelly's addition here matters: this is also a growth path. There are people in Business School for Therapists who were accountants or had MBAs before they became clinicians, and there are people who grew into the business skill on the job. Either way, you can develop leadership internally rather than importing it, and you get someone who still has a caseload and stays in touch with what service actually feels like day to day.
The takeaway: Leadership that has lived the clinician experience gets believed. Grow it internally where you can, and keep your leaders in some clinical contact.
Lesson 6: Google Ads Is Not a Client Strategy
Whitney gets animated about this one. She sees practice owners treat Google Ads as the secret to getting clients, spend real money on it, and never track whether it works. The ad company sends a cheerful email full of clicks and impressions, and the owner reads that as clients.
So she asks for the actual phone numbers and runs them through her own system. What comes back: a wrong number. Someone trying to reach a different practice with a similar name in another state. Someone wanting anger management or a parenting class, services they do not offer. Ten calls in a month, one of which became a scheduled client. That is a very different picture than the dashboard.
Kelly adds the compliance layer most owners have not thought about. Now that practice websites are treated as containing protected health information, contact forms need to be HIPAA compliant and tracking is limited. A lot of Google Ads vendors do not know how to run campaigns for therapy practices inside those constraints. And even the good ones are working against an algorithm that changes, which is why entire ad businesses in this space have been upended and rebuilt around new strategies.
The takeaway: Ask your ad vendor for the raw call data and match it against who actually scheduled. If you cannot connect spend to booked clients, you are not marketing, you are donating.
Lesson 7: Your Intake Process Is Cheaper Than Your Ad Spend
Here is the part that stings. Before you spend another dollar on ads, look at what happens to the calls you already get. Whitney sees intake teams converting a fraction of their inquiries, and owners who have never measured it at all.
You can change your intake process and get more clients without paying anyone for traffic. You just have to train the team better. Whitney runs two full-time intake counselors, which makes people gasp, and she considers it a major driver of her success. Answering the phone live is how you help someone in the moment they finally worked up the nerve to call, and it is how they end up on the calendar. She credits nailing the script and following it consistently.
Notably, the script has not changed since she was a solo practice owner. Not when she added therapists, not when she added a second location, not through the market shift everyone keeps blaming for their empty caseloads.
The takeaway: Track your intake calls before you track anything else. Conversion is the cheapest growth lever you own, and most practices have never measured theirs.
Lesson 8: Hire for Values, Then Teach the Rest
About a year ago, Whitney rebuilt her entire hiring process. She now hires primarily on values and culture fit rather than clinical work, which she acknowledges sounds a little crazy coming from a clinician.
The result, in her words, is that everyone is rowing in the same direction. Attitude across the practice changed. And there was a self-sorting effect: the people whose values were not aligned left on their own, without a difficult conversation or a performance plan.
This connects back to everything else. A longevity program only works on people who want the life it describes. A leadership team only functions when the leaders and the team share a definition of good. The SOPs Whitney and her COO have been writing, the ones that mean she can now go look something up instead of holding it all in her head, only get followed by people who believe in what they are for.
The takeaway: You can teach clinical skill, and you can teach systems. Alignment is much harder to install after the fact, so select for it at the door.
Ready to Build a Practice That Actually Works for Your Life?
The thing worth noticing about Whitney's three years is what she is excited about now. Not another business. Not a new revenue stream. She is excited about moving everyone into one building after years spread across two old houses and a duplex, about investing in the therapists she has, about the fact that the summer slump ended and they scheduled thirty-one clients in a week.
That is a different phase than the one most business content is written for. There is a stretch where every quarter is about the next level, the next hire, the next launch. And then, if you build it right, there is a version where the work is refinement. It is running more beautifully and you are allowed to enjoy it. Kelly named this in the episode as something she hopes listeners hear: sustaining a business well is an achievement, not a plateau.
Getting there is not luck and it is not a personality trait. Whitney was in coaching for two years when she started her group practice, and she has been in multiple rounds of coaching since, for leadership, for the second building, for the things she had never done before. She said the same thing we hear constantly: the person she consulted with that day wished she had reached out six months earlier, before she made the expensive mistakes, because she did not know what she did not know.
We built Business School for Therapists for exactly that gap. It is a blend of live coaching and self-paced curriculum, plus a community of clinicians who normalize niching, real fees, and clinical depth, so you are not making group practice decisions alone at eleven at night with a search bar. We have reached more than 100,000 clinicians over the years, and the pattern is consistent: people do not need to be smarter, they need to stop guessing at things someone could have just told them.
One more thing from this episode worth sitting with. Whitney asked Kelly whether anyone had ever come off insurance panels and told her later they regretted it. Neither of them could think of a single person. There is a freak-out period, reliably. But afterward the sentence is almost always some version of "I wish I had done this sooner."
Learn more at zynnyme.com, or keep listening at zynnyme.com/blog.
Key Takeaways for Therapists
Hire ahead of expected turnover instead of reacting to notices; a replacement hired in advance makes a departure seamless for clients.
Ask your team directly whether they have considered leaving, and when. Use the answers to build something, not to take it personally.
Show clinicians what the practice invests in them alongside what they take home, plus a defined five-year path on pay, schedule, and role.
Sequence leadership hires to real bottlenecks: clinical director around eight therapists, operations director when intake outgrows one person, COO past the million-dollar mark.
Promote leaders who have carried a caseload; therapists take direction on burnout and pay from people who have lived it.
Demand raw call data from any ad vendor and match it against booked clients. Clicks are not clients.
Measure and train your intake conversion before you buy more traffic. Live answering and a consistent script are cheaper than ads.
Hire on values and culture; misaligned people tend to leave on their own, and aligned people row together.
Getting off insurance panels involves a freak-out period and then, almost universally, the wish that it had happened sooner.
Resources
Water's Edge Counseling: https://watersedgecounseling.com/
Wise Practice Consulting: https://www.wisepracticeconsulting.com/
Whitney on Instagram: https://www.instagram.com/wise_practice_consulting/
Whitney on LinkedIn: https://www.linkedin.com/in/whitney-owens-85376a27/
EOS, the Entrepreneurial Operating System: https://www.eosworldwide.com/what-is-eos
Ken Clark, referenced on therapists returning to group practice: https://www.semiprivatepractice.com/about-ken-clark-and-spp
Whitney's first episode with us, January 2023: https://www.zynnyme.com/blog/navigating-the-challenges-of-running-a-faith-based-practice-with-whitney
