A few weeks ago, the New York Times ran an article titled, "Nobody Has Openings: Mental Health Providers Struggle to Meet Demand."
In many areas, the demand for mental health services (especially for in-network therapists) has far exceeded supply. Clinicians report feeling bad about turning people away, but they also recognize the need for self-care in order to help prevent burnout.

If you are getting more referrals than you can handle, the New York Times article lists some additional resources that you can recommend to people who contact you, and there are additional suggestions in the comments section.

Also, find out if your state or regional professional associations maintain lists of clinicians who have openings. If not, propose that they start such a list. Especially now, with the ubiquity of telehealth, people can be matched up with therapists beyond their local community. (Many folks don't think about this when searching for a mental health professional.)


Is this a good time to expand your practice?

If you keep turning people away, your best referral sources may eventually stop recommending you to their clients and patients. Later, when you do start accepting referrals again, you will have to do some extra marketing.

Thus, to maintain the flow of referrals, you may want to consider adding one or more clinicians to your practice. There are probably mental health professionals in your area who are currently working in agencies or in college counseling centers, and who would welcome the opportunity to see a few private clients on the side.

Of course, you will want to interview candidates and do your due diligence in checking references, license, and any board complaints or litigation. There are other factors to consider as well. Here are three of them:

1. How much control do you want over an associate's work activities?

The answer to this question has implications for your taxes as well as for your preferred working arrangement.

If you want to manage all the major decisions about clients, referrals, payments and working hours, then your associate would be considered an employee. You would be responsible for paying employee taxes and issuing a W2 form (T4 form in Canada).

If you are simply looking to provide office space to a colleague who sets their own hours and fees, you could either sublet and collect rent, and/or enter into an "independent contractor" arrangement. You probably won't need to pay employment taxes, but do carefully review the IRS rules of what constitutes an independent contractor. To be certain, get a professional opinion from an accountant or tax attorney.

2. Are you willing to take on additional administrative responsibilities?

Prior to bringing an associate into your practice, you'll need to prepare a contract outlining compensation, who owns the clinical records, what happens if the associate leaves, and other details. (We highly recommend legal and professional consultation at this point.) After the associate joins your practice, you'll have extra paperwork related to tax accounting and reporting.

If you tend to procrastinate on record keeping and other administrative tasks in your solo practice, you'll need to be more diligent (or hire an assistant) when you have other clinicians who depend on you to keep current records and to be paid in a timely manner.

3. How much time are you willing to invest in your relationships with practice associates?

Having other clinicians in your practice requires more than simply providing them with clients and office space. It is also important that everyone gets along, is mutually supportive, and is committed to the mission and values of your practice.

Do you have the time and patience to make sure that channels of communication are working smoothly? Are you open to discussion and negotiation about the little things as well as the big things? You may need to cut back on your own clinical schedule in order to manage your team.

Related info:

A multi-clinician practice is not for everyone. Before deciding to add clinicians, check out the resources below. Also, if you're a TPI member, we can help you identify and navigate your options. (More info about membership here.)

Adding a Clinician to Your Practice. Audio interview with Dr. Jeff Zimmerman. (TPI members, use your  member discount code to get 100% off the price in the shopping cart.)

Comparing Solo and Group Practice. This is written from the perspective of a clinician looking to join a practice, but is also helpful in pointing out the differences for practice owners.