allmineOwning a private practice is not for everyone. Sure, it’s nice to be your own boss, set your own hours and take days off whenever you want. Whether you have a solo practice or work as an independent contractor within a group, you are in control of where you work, when you work and how you work.

But there are trade-offs. Here’s a brief rundown for U.S. based clinicians, comparing employee vs self-employed status:

Getting established

Employee – Your first few clients will be referred through the practice, usually within days after you start work.

Self-employed – You need to generate your own referrals. This can be challenging if you are new in the community, or if there are many other mental health professionals competing for the same types of clients. Even with energetic marketing, your first referral may not come for weeks.

Administrative responsibilities

Employee – You can focus on what you do best – working with clients – and then go home. Unless you have been assigned otherwise, your only administrative duties are those related to your clients: charting, reports, and correspondence to coordinate care with other professionals.

Self-employed – On top of client care, you are also responsible for billing, bookkeeping, paying bills and managing your schedule. If you are in solo practice, you need to purchase supplies and take care of cleaning your office. When equipment breaks down, you are responsible to get it fixed or replaced. All this takes time. You can pay people to do some or all of these, but the burden of getting them done rests on your shoulders. It’s not always easy to shut the door behind you at the end of the day and forget about the office until you return the next morning.

Income predictability and consistency

Employee – You can count on being paid a certain amount on a specific schedule, from day one. Depending on your employment contract, you may also receive your usual paycheck while you’re on vacation or taking sick leave.

Self-employed – When starting out, you may have little or no income for a couple of months.  Once money does start coming in, your income will fluctuate, sometimes by thousands of dollars in any given month. While you’re on vacation, when you’re out sick, and when people cancel due to weather or because they are sick, you’ll generate no income (although payment for prior work may still come in during those times).


Employee – As a W-2 employee, your paycheck will probably reflect tax deductions, which your employer pays on your behalf to federal, state and local tax agencies. Your employer also pays half of your social security and Medicare taxes.

Self-employed – You need to file quarterly payments of your estimated income taxes for the year, and you pay the full amount of your social security and Medicare taxes. If you hire employees or use the service of independent contractors, there is additional tax paperwork for them.

Benefits and retirement

Employee – If you’re laid off, you can probably collect unemployment income. Your employment contract may offer certain benefits such as health insurance, paid vacation, continuing education training, license renewal, malpractice insurance payment, travel and other perks. Your employer might also contribute to your retirement fund.

Self-employed – When work is slow and your income drops, you are not eligible for unemployment income. Health insurance, CE training, licensing, and other practice-related expenses may be deducted from your taxes, but they still come out of your own pocket. Your retirement fund is paid entirely by you.

With all these extra burdens of being self-employed, not to mention the financial risks, why do so many clinicians choose to do it?

Because the upside is of greater value to them.

It’s not just the satisfaction of being your own boss and setting your own schedule. It’s also the potential of filling your practice with the types of clients that you like to work with, and the types of activities that you enjoy.  Long-term, this is the secret to a fulfilling career.

For tips on what it takes to succeed in private practice, see this blog post: Do You Want to be a Practice Owner or a Renter?

Image credit: Leo Reynolds via Flickr