Ode to Private Practice

I recently celebrated 24 years in private practice. (I am a Rolfing practitioner, some of you might know it as Structural Integration).  So I thought an apt way to kick off season three of the podcast would be to talk about what a  fantastic business model self employed solo private practice is. 

Sometimes (oftentimes!) this business model just does not get as much love as it deserves. 

First let me define what I mean by self employed solo private practice: What I mean is you work for yourself, and you are the one who delivers the service that you provide.  You don't have any employees who are delivering services, though you might have a front desk person, and you probably have some subcontractors who pinch hit for important things like an accountant, a bookkeeper, a web designer, that kind of thing. 

Maybe you even rent out other office spaces, or sublet your own office, to other practitioners. But they're not your employees, and they're not delivering services under the umbrella of your business. They see their clients, you see yours, and your businesses are separate.  

There is always a lot of excitement and chatter around other business models. For example, running a studio or a center, or creating an online course. It could even be something as big and ambitious as developing your own modality and codifying that into a teacher training or certification of some kind.

I am certainly as attracted to shiny objects as much as anyone (in fact, probably much, much more than anyone else that I know!). 

In addition to my private practice, I run this podcast, which is my third podcast. I have the online course and the umbrella courses underneath it in HAPI (short for the Healing Arts Practice Incubator), which teaches the skills of self employment healing arts providers.

In the past, I've also run an online somatic mindfulness studio, which included four teachers in addition to myself. I have created and run group coaching programs, and numerous other courses. I've even dipped one pinky toe into the waters of physical product creation.

So if you are similarly entrepreneurial, you may have also tried many things, or run other businesses, or just considered other business models for yourself. 

And if you're that person, that's great! I love being that person. I am in no way trying to make that bad or wrong. 

But if you are going to try out other businesses, just make sure that it's because you are, in fact, entrepreneurial. Meaning you really like learning about and implementing things related to business.

You like product creation, whether that's physical or digital. 

You like marketing and learning about marketing, i.e. how to be visible to the market (aka the people that your business serves). 

You like numbers.

You like tracking things, and then changing course and having to come up with new stuff based on what the data is telling you.

In essence, you like the game of entrepreneurship itself. Whether that be because you love to learn, or you love to create, or maybe you love to compete and challenge yourself. Or all of the above!  

Because there is no such thing – and I'll say this over and over and over again – there is no such thing as passive income. 

And no business model is easier than private practice. 

I'm just going to pause for effect here. 

No business model requires less marketing. No business model requires less risk, or has a more, shall we say, chill learning curve than private practice. 

In fact, there truly is no business model that I know of that is as easy to start, to maintain, and to earn a good living at– while also maintaining a really high quality of life–  in an earning model that also allows you to have a lot of flexibility in your schedule. 

All self employment is going to have a certain amount of shifting sands that you're standing on. That's just part of the process. But the sands that are under your feet in private practice, they shift a lot less than other models. 

These days, I'd even say that many people who are employed in what used to be considered rock solid jobs also find themselves living with a lot of shifting sands. The same kinds of shifting sands as we self employed folks live with, but they have much, much less autonomy built in.

Think of, for example, all the churn for employees in tech and finance and even healthcare these days.  

If you have a skill set that you trained in, which allows you to deliver a service that you provide, (and because I work with people in the healing arts, we're talking massage therapy, acupuncture, fitness, et cetera, you, you know who you are) and if what you  really care about and really love is using those skills that you have been trained in to help the people who are your clients and patients (and you really don't get excited about business development) private practice is probably the best fit for you. 

I could probably pontificate about this for a long time, but I  think one of the reasons we don't hear people singing the praises of private practice as a business model is because it's not new.

It's not flashy and exciting, right? Having a service that you know how to provide, you're trained to provide it, you have qualifications to provide it, and then providing that to a client – this is a business model as old as time, right? It's as old as selling things in the marketplace.

There are ways to perfect that and hone private practice, but it is, of course, more exciting when there's something new, right? This means that oftentimes what we are hearing about are digital business models.

Now, does private practice have its own downsides? Of course. Nothing is perfect.  

In my coaching offering, when I work with people one-on-one, I often talk with people who have been in private practice for a while who are getting in touch with me because they are considering branching out and trying a new model.

Sometimes they're considering that because they are entrepreneurial people, like I was describing.  

And they can see how the service that they provide, the skills that they have, could fit in another model. And they've gotten creative around how they want to consider delivering their work in that new model.

And in that case, we dive in, right? We dive into all the nitty gritty: How likely is it to succeed? What will it need? Where can they shore themselves up to get this new, more challenging, model off the ground? 

Because it will be more challenging than private practice.  

But other times, and I would even say frequently,  I have people come to me with the idea to branch out from private practice, but it's not because they're entrepreneurial.

Instead, they're saying things like, “I'm burned out and I don't think I can do this for another 10 years. So I need to figure something else out.”  

Or they're saying,  “I need to stop trading time for dollars.”  

Or they're saying, “I have, [insert a great idea her]e, and I think it's such a great idea, I'm so excited about making it, it's going to be great.”

Let's take some time to look at each one of those statements, because these are really the three most common things that I'm hearing from people when they are pondering a move away from private practice. 

So the first one, “I'm burned out. I don't think I can do this for another 10 years, or probably more. So I need to figure something else out.” 

Burnout is real. Most of us experience it in different seasons of our private practices.  And sometimes, but I would even go so far as to say rarely, when a person is experiencing burnout,  it is a clear indicator that they do need to evolve out of private practice.

To give an example of something that would be a clear indicator that it is time to consider leaving private practice: If someone is dealing with physical pain or disability and they're coping with a form of physical burnout, meaning they can no longer physically deliver their service. This would be a really good reason to start some career planning for yourself around exiting private practice. 

But most of the time, when people are experiencing burnout, what they're feeling is: 

A lack of good systems that support them in their work. When I say good systems, I don't mean super complicated stuff. This is usually really simple stuff. So, for example, instead of seeing clients whenever clients say they want to come in and just having a wide open seven day a week calendar, a very simple non techie system would be that you just define your work week for yourself.

What days and what hours do you work? What days and what hours do you not ever work? And then you don't stray from that. You make time off sacred, and you make your schedule make sense for your life. 

You're not seeing clients all spread out seven days a week. Seeing one client at 8 am. and one client at 6 pm because that is going to feel like a long day, even if you are only seeing two clients.  

The other thing that I hear frequently when people are experiencing burnout, or the other thing that's going on underneath it, is that they are at the mercy of the effects of working in a field that can easily become codependent by its nature.

This is a massive topic for another episode. But, the short version is that we helper/healer types do have stronger than average tendencies to take on other people's pain, or to soldier on when people are projecting their pain at us. 

Maybe your practice is too full of really low functioning clients who want you to save them or who are dealing with an extreme amount of negativity that they don't actually want to let go of. 

This is a deep or dive for another time, but the short version is that this is a very, very common cause of burnout for those of us in the healing arts. 

The next common idea that I'm hearing from people underneath why they might leave private practice is they say, “I need to stop trading time for dollars.” Or some version of that, like, “I need to earn more.”  

But I do often hear that exact phrase, “Stop trading time for dollars”. Because we hear a lot in this entrepreneurial era that we're living in. 

It's as if it were possible to sit in your house doing whatever you please and have dollar bills arriving! Make money while you sleep, right!?

We've heard all these things. And I'm being snarky because, first of all, you will always have to trade time for dollars. Unless you were born wealthy, or, related to that, or just due to your own efforts, you have significant investments that you earn good interest on reliably.

If that's you, you are making money in your sleep, right? You are not trading time for dollars.  But you're probably not the person listening to this episode.  

The other thing about this “stop trading time for dollars” is that it does actually hit on a couple of totally valid things that are true.

First, it is true that in private practice we are literally trading time increments for dollars. Whatever your session length and rate is, you are the one who is there delivering the session, and you get paid for that after you have spent that time with the client.  

And the earning ceiling is real. We can all only see so many clients in a week, and unless you want to brand yourself as a magical guru and prey on desperate and/or wealthy people, there's just a limit to what you can reasonably charge for your session rate.

You're not going to declare that your sessions cost $10,000 because that would be really great for you. It just won't work.  

The other thing about this notion, “stop trading time for dollars” which is true is that one way around trading time for dollars is to scale your business.

It's only logical, right? You personally can only see X number of clients for X rate. If you, for one example, add more practitioners who are also seeing X number of clients at X rate, and they are your employees, well then you increase your earning potential.  

Or if you just create a product once, for example, an online course, and then you can sell it to an infinite number of people without having to create it every single time – the way we create a session every time we deliver it –  then ta-da! Increased earning potential. 

And these things are all very true. But the question that doesn't get asked enough is: are you  up for scaling? 

Are you entrepreneurial? 

Are you up for the increased lift related to marketing, budgeting, build out, payroll, and management? 

Scale does increase your ability to earn, but it's also not a guarantee. First of all, there are no guarantees. And because scaling also increases and changes your workload and your job description and your business model. So more money is coming in, but there's also more places that the money gets distributed. If you're hiring other practitioners, for example, they are not working for free. 

Now, if you're excited by this change, as always, great! 

But if you're only doing it because you're feeling the pain of the earning ceiling and you really want to increase your income,  there's some lower hanging fruit to review first that might help you to feel more flush without having to start a whole new, more challenging business.

I often see practitioners who are seeing way too many clients on a sliding scale or significantly reduced rate. So maybe they have a completely full schedule, but they can't pay their bills and it's because 50 to 80 percent of the people they see are at their lowest rate on the sliding scale.

You can also revisit my earlier comments on codependent business models, because that's one of the traps there, right? And that's going to significantly reduce your earning potential. 

If everyone is paying you one third of what you need to earn, you're not going to reach what you need.  

I also see a lot of practitioners who simply do not know what they need to earn. It took me 15 years or something before I really got clear on this. So it's not that you're alone. This is very common. 

But if people don't really know what they need to earn, meaning this is what's going to take good care of them with the expenses that they have in their actual life, then they don't have informed rates. 

They're not paying attention to the flow of money in and out of their practice, so they just can't have clarity on how to get where they need to be in order to take good care of themselves. 

And just a side note here that making this change towards understanding what you need to earn, having informed rates, etc., it can sound overwhelming when you're not a numbers person (which, historically I have not been) but it's really often not very arduous. It's just simple systems and processes, and then tiny tweaks that make all the difference. It does not have to be grand sweeping changes.  

Another thing that I see very commonly when people are feeling a low earning ceiling are practitioners who are either undercharging, similar to the sliding scale problem, or under working.

So undercharging relates to knowing what you need to charge. And I'm not saying that we swing the pendulum to the opposite extreme and just jack your rates way up. That is not what I advocate for. Again, tiny tweaks make all the difference.

And underworking is when we work part time. For example, we say, “I only want to see ten clients a week. That's it. That's all I can do.”  And then we expect to make a full time good living that way. 

It is hard to work part time and earn a full time living. It is not impossible, but it is hard. And it doesn't translate very well to a trade time for dollars business model. 

And if you want to reduce the amount you work and increase your earning, then it requires strategy to get there. It's not just an issue of setting the hours that work for you and hoping that it works out. Because the math won't work out that way.  

In short, we do need to attend to our earning ceiling, and we need to make sure that we can earn what will work for us. We deserve to be well taken care of. 

But that doesn't mean that you need to start a whole new business.  

The last common comment regarding why I'm hearing from people that they might want to branch out from private practice is, “I have, [insert great idea here]. It's a great idea. I'm so excited about making it. It's going to be great.”

My fellow creatives and ideaphoric people, I feel you! My brain is full of ideas. And if I'm feeling a little cocky, I'd say that maybe even 20 percent of them are actually great business ideas.  Coming up with creative ways to deliver a needed service is my favorite thing in the world.

But, as they say, ideas are cheap. And I've learned this one the hard way.  Even a great idea, a once in a lifetime idea, needs strategy, needs support, it needs all the other work that goes into growing anything.  

There are no magic beans that we can sprinkle on the ground and get a beanstalk out of. And if I find a magic wand that launches and sustains good ideas, I promise I will share it with you!

But this particular thought, “I have a great idea and I'm really excited about it.  So I'm sure it will be great.” It still has to be shepherded into being by you, which means you still have to be excited about the worlds of business and marketing.  

Solo self employed private practice is the lightest lift to get off the ground. 

It has potential to be really rewarding  financially and emotionally. 

So allow me to sing its praises by telling you some of the wonderful things that private practice has given to me in the last 24 years. I haven't been in practice for 18 months, it’s 24 years! This is kind of a robust amount of time. So let me tell you how it's gone:

I have been able to raise my son as a sole earning single mom. And my full income has come from my Rolfing practice. So even though I described all these other things that I've done, just to clarify before I go on, my podcasts are creative projects, not businesses. They don't pay bills. They don't earn money. 

And I have made extra money from other places. Right now I do branding and web design within Simple Prospering, I have the HAPI course, etc. But all of those 24 years, my earning came from Rolfing. That's what paid the bills. And there was also no secret alimony. There's no secret family money. 

And my son is just about to turn 18, which is crazy to me, so I feel like I can breathe a little. It's like, “Oh, I did it!” I paid for camps and tutors and cool afterschool activities. When his arm broke on the playground in first grade and it cost six grand because we live in the United States, I paid for that. When he needed his tonsils and adenoids out, I paid for that. Raising a person isn't cheap. (And we have college coming up next, so I'm sure that'll be great hahaha). 

But I pulled it off and that's because. I have earned a six figure income for most of those 24 years as a Rolfer. I'm not talking 500k a year, I'm not trying to sound fancier and flashier than I am, but my earning has consistently been between 100 and 120k a year. I want to be really honest with you all about numbers because we get so brainwashed that there's a noble poverty thing in healing arts. 

Or the opposite, right? That we need to turn into a wellness guru and be making seven figures a year.  

But there's something really beautiful about this great, solid living in a business model that works. 

That 100k to 120k year, that's gross. It's before taxes, expenses, whatever, but it's not too shabby. It has meant that I don't have to stress over grocery bills or things like that.

Life has not been free from financial stress. I'm not sleeping on a pile of money at night, but that income has allowed me to have a really good quality of life.  

Speaking of which,  I managed to buy a house on that income. My parents did not give me the down payment or co-sign the loan (because that's usually what people assume).

I saved up and, to be clear, I have a mortgage, but I bought a cute little house in Connecticut. It has a nice yard. It's in a great neighborhood. I'm surrounded by my friends. The piece of luck in this– because if you're wishing you could buy and you're in a very expensive real estate area, my advice is not just, “Pull yourself up by your bootstraps”.

The real estate market is a mess, so luck helps. And the luck for me was that I bought before the real estate market went pandemic crazy. I bought in July of 2019, before prices became bananas. That's just luck, that wasn't brilliance and it wasn't hard work. 

But planning and saving and living in a lower cost rental through my son's childhood years, it also really helped.

I have also been able to take great family vacations without having to ask a boss for time off. I've only taken one lavish vacation in those 24 years. That was last summer to Australia and New Zealand, so it was also recent.  But, we have family in Seattle, and we live in Connecticut, so we've managed to make the cross country trip at least once a year, and that's in addition to those occasional little road trips or vacation in another pretty US state. 

And while I can't pretend that I take off more time in a year than an employed person would, I do take about two to three weeks off a year. Probably less than plenty of employed people, but I do love my flexible schedule. 

I can build my client times around what works best for me, and in a rhythm that doesn't burn me out. 

Over the years, that means I've been able to be there for all those little kids' school plays and sick days or family and friend emergency days, or family and friend celebration days, like going to weddings or things like that – without feeling like I'm annoying a boss. 

All of this has come with a business that requires less and less marketing energy over time. 

If you don't like promoting yourself, if you don't like marketing, a private practice is going to be the lowest amount of marketing you can do and still be a business owner. Because if you stay in one place your word of mouth referrals are going to keep snowballing until you don't really need to do the work of getting your name out there anymore.  

Solo private practice also has low overhead.Renting a small office space to see clients in doesn't require a big budget up front. You don't have to do an expensive, or any, big build out.  

You don't have to have an office that has a crazy high rent. I love my office. It's in a great neighborhood, but it's not pricey. 

And the pace of work in solo private practice is determined by me. It feels really satisfying, and also pretty relaxed. I'm not rushing around at a breakneck pace, I'm not juggling multiple tasks all the time. I have a skill. I see clients. I provide said skill. It's nice and straightforward! 

I need extra rest because I have a chronic illness, and like I said, I'm a single mom and life is just full, right? So to me one of the biggest perks is that I am in control of my schedule. 

As I mentioned earlier, I can't decide I only want to see 10 people a week – there's a certain number of people I need to see. But, I can create a rhythm of work, rest, and free time that is perfect for me. 

So if you are an entrepreneurial type and you love the idea of getting creative around delivering your service, then go for it! That path also has  wonderful adventures and rewards. (Soeaking as somebody who has both paths here). 

But should you be in private practice and for some reason you feel like you have to, or should. be expanding beyond private practice, I would have you ask yourself, “Why?”

Just ask the why question and figure it out stream of consciousness style. Journal it out: what's coming up underneath the idea to leave private practice? 

That will hopefully surface for you some things that you could set up a little better for yourself so that you feel more satisfied by your practice and more taken care of by your practice.

And most of us do have to tinker with all those variables through the years.  But the idea that you need to just ditch private practice, it might just be because there's a lot of flashiness around being an entrepreneur these days. 

And I would also say that there's a significant bias against caregiving fields and care providers, which is pervasive. And it's another longer, deeper topic for another episode.

But for the time being, we can proudly, be solo self employed care providers and know that this is not just a viable, but an enviable business model. Even if we never wind up on the Forbes 500 list… I don't know about you, but I could care less about that.