What happens when therapists abandon group practices en masse? This phenomenon is sweeping across the mental health field, leaving practice owners scrambling to understand why their associates are heading for the exits. At the heart of this exodus lie several critical issues that, once recognized, can be addressed to create thriving, ethical practices where clinicians want to stay.

The financial relationship between practices and clinicians represents the most significant source of dissatisfaction. Fee splits of 50/50 or 60/40 aren't inherently problematic, but the lack of transparency about where that money goes creates resentment. When clinicians generate thousands in revenue but don't understand how their contribution supports the business infrastructure, they question the value of remaining with the practice. Similarly, practices that pass insurance clawbacks to clinicians or make them wait for payment until insurance reimburses claims create financial instability that drives talented therapists away.

Beyond compensation issues, many practices make promises they can't keep. The most damaging is guaranteeing full caseloads to new hires without having the marketing infrastructure or client base to deliver. Therapists who join a practice expecting consistent work find themselves with empty schedules and insufficient income, forcing them to seek opportunities elsewhere. Successful practice owners understand that growth should be organic—adding clinicians only when current therapists are at capacity and there's genuine client demand.

The power dynamics become even more complex when practice owners also serve as clinical supervisors. This dual role requires careful navigation to maintain boundaries and ensure associates feel supported in both their professional development and financial wellbeing. Practice owners must recognize this inherent power imbalance and take extra steps to create safe spaces where supervisees can voice concerns without fear of retaliation.

Building an ethical group practice isn't mysterious—it requires patience, strategic planning, and a commitment to fair treatment of clinicians. Seek guidance from business resources, learn from adjacent industries, and prioritize creating a workplace where therapists feel valued and fairly compensated. The return on this investment will be staff retention, positive word-of-mouth, and ultimately, a thriving practice that makes a meaningful difference in your community.

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