The Data Confirmed What We Already Knew: Therapists Were Never Trained to Run the Whole Business

A note from Brie: SimplePractice released its Annual State of Private Practice Report: 2025 in Review, and honestly? We felt very seen.

Not surprised.

Seen.

Because if you’ve ever talked to a Boss Co team member, you know we are constantly talking about the operational gap in mental health private practices. The gap between being clinically trained and being expected to run payroll, manage people, interpret insurance chaos, build workflows, track numbers, make hiring decisions, choose software, protect client data, and somehow still have the emotional capacity to see clients.

And now we have data that says the quiet part very loudly.

43% of providers reported receiving zero formal business training.

ZERO.

And 96% reported fewer than 60 total hours of training on running a business across their entire careers.

So, helloooo. There it is.

The thing practice owners have been feeling in their bones is now sitting right there in the data.

You were trained to be a clinician. You were not trained to be an operations director, HR manager, billing strategist, project manager, compliance lead, tech admin, financial analyst, and full-time decision machine.

And yet, here you are.

Running the whole thing.

You ready? Let’s get into it.

Therapists are running real businesses. We need to start acting like it.

Therapy practices are businesses.

Pause for the pearl clutching.

That does not mean your practice is cold, corporate, unethical, or disconnected from care. It means you have revenue, expenses, clients, policies, systems, software, risks, team members, vendors, compliance needs, and decisions that affect actual humans.

That is a business.

And real businesses need structure.

The SimplePractice report found that independent clinicians delivered more than 113.6 million sessions in 2025. That is not small. That is not cute little “side hustle in a cardigan” energy. That is a massive contribution to mental health access in this country.

And 58.8% of those sessions were insurance-based.

So while everyone is out here talking about access to care, we need to talk about the back-end systems that make access sustainable.

Because taking insurance is not just a values decision. It is an operations decision.

It affects cash flow.
It affects documentation.
It affects billing workflows.
It affects admin workload.
It affects staffing.
It affects the emotional stability of the person checking the aging report at 10:47 p.m.

You can absolutely build an insurance-based or insurance-heavy practice. Many of our clients do. But you cannot do it sustainably if the systems are duct-taped together and the owner is the only person who understands how anything works.

The business grew. The systems did not.

This is the part we see all the time.

The practice starts growing. Which is great! Love that. Truly.

More inquiries.
More clinicians.
More clients getting care.
More revenue.
More opportunities.

And then, seemingly overnight, the owner realizes they are no longer just a clinician with a practice. They are leading a team.

A team that needs onboarding.
A team that needs clear roles.
A team that needs communication rhythms.
A team that needs accountability.
A team that needs policies.
A team that needs someone other than the owner to know where the thing is, how the thing works, and what we do when the thing inevitably goes sideways.

The report found that solo practice owners reported average monthly revenue of $8,660.97, while group practice owners reported average monthly revenue of $28,116.17.

Fun! Growth! Money!

But then we get to the expenses.

Group practice owners reported average monthly business costs of $11,776.96, compared with $1,855.75 for solo practice owners.

There’s the part people forget to mention in the “scale your practice” webinars.

Growth brings more revenue potential, yes. It also brings more complexity, more risk, more decisions, more expenses, more team needs, more admin work, and more places where your systems can either hold you or completely betray you.

A group practice is not just a solo practice with more clinicians.

It is a different business model.

If you are still running your group practice like everything can live in your brain, your inbox, and seventeen Google Docs named some version of “New Onboarding Final FINAL,” we need to lovingly intervene.

Administrative burden is not a personality flaw.

The report names emotional fatigue, burnout, heavy administrative burden, and insurance difficulties as some of the biggest daily challenges clinicians are facing.

Again: not shocking.

We hear this constantly.

Practice owners are tired. And they are not tired because they are lazy, disorganized, or “bad at business.”

They are tired because they are carrying too many roles without the structure to support them.

They are tired because every question comes to them.

They are tired because the team does not know where to find answers.

They are tired because the intake process depends on someone remembering the next step.

They are tired because billing issues turn into emotional support sessions.

They are tired because hiring feels urgent every time.

They are tired because the practice is technically working, but only because they are personally catching everything before it hits the floor.

That is not sustainable leadership.

That is a very expensive nervous system response.

And yes, we said what we said.

Insurance is eating everyone’s lunch.

The report found that the average self-pay rate was $139.75, while the average insurance reimbursement rate was $99.75.

That is about a $40 difference per session.

For providers accepting both private pay and insurance, private pay was, on average, $60.83 higher than insurance reimbursement.

This is why we get twitchy when people talk about insurance as if it is just a billing preference.

Insurance is an entire operational ecosystem.

Credentialing.
Eligibility.
Benefits checks.
Claims.
Denials.
Documentation requirements.
Payment posting.
Aging reports.
Payer mix.
Rate analysis.
Client communication.
Audits.
Staff training.
Revenue forecasting.

If you accept insurance and do not have clean systems around it, the cost shows up somewhere. Usually in owner stress, staff confusion, delayed revenue, or all of the above. So fun!

This does not mean “don’t take insurance.”

It means if you are going to take insurance, build the practice to actually support that choice.

Software will not save you. Sorry.

The report also looked at technology adoption.

Online appointment requests were used by 62.7% of clinicians. Automated measurement-based care was used by 55.3%. Integrated AI note-taking was used by 10.2%.

And 53% of survey respondents said they were not incorporating AI into clinical work at all.

We are not anti-tech. We are very much pro “use the tool that makes sense and set it up correctly.”

But let’s be clear: software is not the strategy.

AI is not the strategy.
Your EHR is not the strategy.
Your project management system is not the strategy.
Your Google Workspace is not the strategy.
Your new intake automation that half works unless Mercury is in retrograde is not the strategy.

Tools are only helpful when they sit inside a workflow that makes sense.

Someone has to own the tool.
Someone has to train the team.
Someone has to decide when it gets used.
Someone has to check if it is solving the actual problem.
Someone has to make sure it is compliant, appropriate, and not creating a bigger mess with prettier buttons.

Otherwise, congratulations. You have another subscription.

This is exactly why Boss Co exists.

Boss Co was built for this gap.

The gap between clinical training and business ownership.

The gap between “I have a full caseload” and “I have a sustainable practice.”

The gap between “I hired help” and “my team actually knows what to do.”

The gap between “we have tools” and “we have systems.”

The gap between “I want to grow” and “I cannot keep being the only person holding this together.”

We help mental health practices build the operational structure behind the care.

That means workflows.
Role clarity.
Team communication.
HR and people operations.
Metrics tracking.
Software setup and cleanup.
Delegation systems.
Accountability rhythms.
Leadership support.
Decision-making structure.

All the things that sound boring until they are missing and suddenly your entire practice feels like a group project where everyone is texting you for the instructions.

We are not here to make your practice more corporate.

We are here to make it more sustainable.

Because a human-first practice cannot depend on one human being crushed under the weight of every decision, task, reminder, escalation, and unanswered Slack message.

We have been closing this gap already. Now we are ready to close it for more practices.

The SimplePractice report confirms what our clients have been showing us for years.

Practice owners are not overwhelmed because they do not care enough.

They are overwhelmed because they are running businesses they were never trained to run, inside an industry that keeps getting more complicated.

More insurance complexity.
More documentation requirements.
More technology decisions.
More staffing challenges.
More client need.
More pressure to grow.
More pressure to stay accessible.
More pressure to somehow do all of this without burning out.

No thanks.

The answer is not “just work harder.”

The answer is building better infrastructure.

That is what we do.

We have already been helping mental health practices clean up the back end, strengthen their teams, build systems that actually get used, and help owners step out of the constant reaction loop.

And now?

We are ready to make a bigger impact with even more practices.

Because private practice is not the problem.

The lack of operational support is.

And that is fixable.