Has your solo practice grown to the point where you are receiving more referrals than you can handle? That’s great! Obviously, you are doing a good job.

However, if you have a long wait list, or if you are frequently referring prospective clients to other clinicians, word will get around that your practice is full, and eventually your referral sources may look elsewhere to send people who need mental services.

In order to accommodate and maintain your referral stream you could work more hours. But this is a short-term fix at best. Working too many hours can lead to burnout, which can compromise your clinical effectiveness, and even increase the risk of complaints against you.

A more sustainable solution is to add a clinician to your practice in order to accommodate new referrals. Or alternatively, remain in solo practice and change the types of referrals and/or the focus of your work.

Adding a clinician has both pros and cons:


  • You have a colleague to take on new referrals.
  • If your new associate has a specialty that complements yours, you can serve a wider range of people, and gain a larger professional footprint in your community.
  • When you need input on a clinical or business matter, it’s convenient to consult an in-house colleague.
  • You both have built-in coverage when you go on vacation.


  • You may need to move to larger office space, thus increasing your expenses – perhaps for months before you break even financially.
  • Your administrative responsibilities will increase. In addition to more bookkeeping, there are legal and tax implications.
  • Clients who are referred specifically to you may not want to work with your associate.
  • You will need to do some extra marketing and advertising to introduce your new associate to the community, and to generate interest in his/her expertise.
  • You may not get along well with one another.

See also: Before Adding a Clinician to your Practice…


If your solo practice is overflowing and wearing you down, but you'd prefer not to take on the financial and administrative responsibilities of bringing in a new associate, consider reshaping your practice. By focusing on activities on the types of clients that you enjoy working with, you will feel less drained. Here are some examples:

Specialize. Focus on specific types of problems or on specific groups of people that you like to work with. Educate your referral sources to refer people who meet your criteria. Your rate of referrals will slow down, but this can be a good thing if your practice is close to full. Here are some examples of mental health practitioners who developed niches and specialties.

Write and speak on topics related to your specialty. Writing and speaking on a given topic help position you as an expert. People who need help with issues related to your expertise will likely seek you out, and will often be willing to pay more for your services.

Writing a book will further boost your reputation, such that you can command higher fees for speaking to various groups nationwide, not to mention ongoing royalties from book sales.

Develop cross-referral relationships with other clinicians who have complementary skill sets. For example, if you decide to specialize in working with couples, it would make sense for you to establish a referral partnership with a clinician who works with children and families. When you’re treating a couple who apparently needs help for their child, you would refer them to your referral partner. Similarly, if your referral partner is working with a child whose parents need help with their marriage, he or she will refer the couple to you.

For ethical reasons, cross-referral arrangements are goodwill relationships only. No formal contract is required, and neither side is to be paid for sending the other a referral.

Consult with organizations or businesses. Your expertise extends beyond your office. You probably have skills that can readily translate into improving people's lives on a larger scale. Working with organizations can be financially as well as professionally rewarding.

You can increase income without adding a clinician:

Sublet your office when you're not using it. Clinicians starting out in private practice often look for furnished office space that they can rent for an evening or two per week, or on weekends. If your lease allows subletting, this may be a suitable way for you to earn extra income without having to move to larger quarters. There are several factors to consider, however, so read this first.

Teach a course. Teaching a college-level course as an adjunct instructor will not make you rich, but it will force you to bring yourself up to date with current knowledge and research. In addition, your university affiliation may boost your reputation as an expert in your community.

You can also teach classes for the general public. Some court systems order people to get anger management training or parenting education. You may find that your community is receptive to educational classes in family communication, job- or college interview skills, or performance anxiety management.

Re-evaluate your contracts with managed care companies. Stay with those who refer clients you enjoy working with and who pay a reasonable fee with minimal hassle. Drop out of the other plans. You can still opt to see people who cannot afford your full fee, but this will be on your own terms, with no interference by managed care.