I want to start a private practice. What do I need to know?

© Catherine L. Waltz, PhD, LCSW

October 19, 2014

I’ve been licensed and working for a while but I really want to be in private practice.  What do I need do first?  I’m a Registered Intern; can I have a private practice?

These questions and others have been posed to me over the years.  This commentary is an exploration of initial issues related to creating a private practice.  I start with issues of interest to Registered Interns.   Qualified Supervisors and other licensed mental health professionals may be interested to know this information.  That being said, it is imperative that the clinician seeking to establish an independent private practice become familiar with topics related to “formulating, developing, and maintaining business savvy in the provision of professional services” (Woody, 2013).  Some specific costs and procedures related to an independent private practice business are identified to prompt you to consider.

Let’s look at the Florida statute regarding independent private practice.  The quote is from the section of law for social work practice and we can substitute marriage and family therapy or mental health counselling as the wording is the same.

Chapter 491, our practice act states this:

491.005 Licensure by examination.—

491.005(1)(c) . . .

“The experience requirement may be met by work performed on or off the premises of the supervising clinical social worker or the equivalent, provided the off-premises work is not the independent private practice rendering of clinical social work that does not have a licensed mental health professional, as determined by the board, on the premises at the same time the intern is providing services.”

So, what does this complex statute really say?  Here is one understanding of that section’s intent.  I paraphrase the section and include bits of other relevant statutes in this way:

Registered interns are required to complete 1500 clinical hours under the supervision of a qualified supervisor.  For the sake of this commentary let’s call that process an internship.  A registered intern may do their clinical work on or off the premises of their qualified supervisor.  Off premises clinical work must only be done when a licensed mental health professional is on the premises when the registered intern is providing clinical services to clients. 

Can I count those private practice hours for licensure?

You probably can and should count those hours towards the required 1500 hours.  A more important question is “Who will supervise me for that clinical work?”  It is possible to have more than one supervisor as long as you comply with the statutes and rules associated with seeking approval of the supervisory relationship from the Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling.  Don’t forget you can collect clinical hours more quickly than you can complete the supervision.  By law, you cannot complete your 100 hours of supervision in less than two years.

What steps do you recommend for registered interns?

First, talk with your current qualified supervisor about your desire.  Ask if he or she would be willing to supervise that clinical work in addition to whatever work they for which they have agreed to supervise you.  If he or she is willing to do so, then move to the tasks and costs lists to see what else you need to consider.

What can you do if your current supervisor does not want to assume the additional risk and liability for this work?  You need to determine whether or not there are licensed individuals onsite when you will be seeing clients.  If not, you must keep looking for the right office space.  You can try to find a second qualified supervisor who is willing to provide the supervision.  Since you are required to have a licensed mental health professional on site, you could approach any of the clinicians working at your potential location to see if they would be willing to provide supervision for your private practice clients.  You should develop a written agreement with the second supervisor which outlines the expectations for both of you and include the specifics of the financial arrangement to which you both agree.

Finally, I suggest that registered interns develop a written agreement with the onsite licensed mental health professional that outlines each of your responsibilities in the event of a crisis or emergent situation.  For example, if you have a client who decompensates while in session, will the onsite person help you with assessing for the need for hospitalization, help you persuade the client to voluntarily enter the hospital or after assessing the client to prepare the paperwork for an involuntary hospitalization (aka Baker Act).

What are the costs associated with private practice?

Here are some of the costs and procedures that come immediately to mind as I started writing this article.  It is by no means a complete list of things to consider and prepare for.

Legal and accounting services – I cannot emphasize strongly enough that having the ability to consult with an attorney about all manner of legal questions as needed is a boon to the entrepreneur.  There are some questions that only an attorney should address.  An accountant may help with understanding some of the tax implications related to independent contractor (1099) status versus being an employee (W9) in a practice.

City/county licenses – City and county jurisdictions typically require a business license.  Licensed professionals (contractors, plumber, doctors, and mental health practitioners should check within their county and city offices for information about the fees associated and procedures and documentation required for the license.  Some institutions have indicated that they do NOT provide business licenses to unlicensed individuals, so Registered Interns should consult with an attorney licensed to practice in Florida

Malpractice insurance; general liability insurance – Registered interns and licensed individuals should strongly consider securing the protection offered by malpractice insurance.  If you have had your policy for a while and secured it while working for an agency or other business you should contact your provider to determine whether or not independent private practice is included in your current policy or be added to the current coverage. 

General liability insurance – if you are renting space from another practitioner or other situation it is advisable to determine if that ‘landlord’ maintains general liability insurance for the property.  If not, you may want to consider seeking office space elsewhere.  What would you do if one of your clients were injured on the property?

Developing policy and procedures including forms and documents for completing client files – This particular procedure deserves some additional attention and I will write about it in the future but policy and procedure manuals need to include many issues including but not limited to: confidentiality policies related to all means of communication (phones, email, text, social media, releases of information; your availability; how crises will be addressed; billing and fee collections procedures and more.

Once you have adequately developed the plan for your practice and ensured that you are meeting all legal requirements, you can begin to attend to some of the more creative and fun aspects of entrepreneurship.  Please feel free to send comments or questions about this topic directly to Dr. Waltz.

– Catherine L. Waltz, PhD, LCSW is an adjunct professor in the graduate program of the School of Social Work, Barry University.  She has been a continuing education provider in the state of Florida for more than 10 years.  She provides courses on professional ethics, laws and rules, supervision, mental health error prevention among other topics:  http://drwaltz.corecommerce.com/Workshops-At-A-Glance-15.html 

The educational commentaries provided by Dr. Waltz do not constitute a legal opinion.  If legal advice is needed, it is recommended that contact be made with an attorney qualified in the jurisdiction in which you practice or is applicable to your case.  We recommend that you use your knowledge of the law and your code of ethics in conjunction with this information (and any other) when deciding upon any course of action.