Choosing the Right Setting for Your Therapy Career: Outpatient Practice 101
Finding a good home for your therapy career can be challenging and full of decisions to make. For example, if you want to work in an outpatient setting, you might ask yourself if you’d like to join a group practice, whether to accept insurances, etc. This article will help clinicians make key decisions about outpatient practice.
Outpatient settings provide a lot of flexibility and diversity of opportunities. However, it also typically requires you to be available when average people aren’t working (evenings and weekends) if you want to be accessible to clients in your community.
On a similar note, it can be a difficult trade-off when deciding if you want to accept insurance. Working with insurance companies has the benefit of making your services accessible to a large majority of people, but has significant downsides. For example, claim denials, retroactive clawbacks, audits, extensive documentation demands, lower reimbursement rates, and long reimbursement delays can often lead clinicians to spend unpaid hours correcting billing errors, resubmitting claims, and waiting on hold with insurance representatives.
Even when everything is done correctly, claims can be denied for technicalities, requiring additional administrative time with no guarantee of payment. The non-reimbursed time spent dealing with insurance companies can be significant, and takes time away from clinicians when they can be providing therapy (and earning income). For these reasons, some clinicians decide to open private-pay-only practices. However, this limits who can afford to work with you, which not only makes it difficult to build a caseload and make a living, but also may not be aligned with your values.
Some clinicians prefer to give up paid therapy hours to be their own admin in a solo practice, while others prefer to give up some of their income to have the group practice’s administrative support and just focus on the clinical work with their clients. In either case, you’re giving up some income – the question is how do you want to be spending your time.
A popular middle-of-the-road option is to join an insurance-based group practice. Depending on the structure of the group practice, you’re often protected from having to deal with most of the downsides of working with insurance companies. Admin teams submit billing, deal with denials, and call insurance companies to wait on hold for an hour.
Once you’ve decided to join an insurance-based group practice, you still have decisions to make. Over the past decade, many independent group practices have been bought up or supplanted by large national or regional corporations. The downsides to these corporate-type organizations are productivity pressures tied to investor expectations, large caseload requirements, reduced autonomy in scheduling and clinical decision-making, standardized templates and quotas, limited influence over organizational policies, frequent leadership turnover, and a workplace culture that can feel impersonal or numbers-driven. Clinicians may feel like replaceable employees rather than valued professionals, and opportunities for mentorship, collaboration, and thoughtful clinical growth can be limited.
Another thing to consider is how much growth and support you want within your practice. Some practices provide mentorship, consultation for tricky ethical concerns or tough clinical cases, and training in niche areas of care, such as couples therapy. However, this is not guaranteed in every practice, so deciding your needs for professional growth will be paramount in your decision.
Luckily, there are still some clinician-focused independent group practices. In the Philadelphia metropolitan area, this includes Equilibria Psychological and Consultation Services.
