The Data Confirmed What We Already Knew: Therapists Were Never Trained to Run the Whole Business
A note from Brie: SimplePractice released its first ever Annual State of Private Practice Report: 2025 in Review on May 13, 2026, and honestly? We felt very seen.
Not surprised whatsoever and very, very validated.
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 damn thing.
I want to talk about why these numbers are important and what we can do to make sure you can be more than a statistic in next year’s review.
Practices are businesses. Period.
Therapy practices are businesses and client intake is a sales process. I KNOW it feels so incredibly icky. However, remember that the word “business” is not inherently good or bad. You don’t have to feel like a sleazy slumlord to run a profitable practice.
Your practice doesn’t have to feel cold, corporate, unethical, or disconnected from care. Running a business just means you have revenue, expenses, clients, policies, systems, software, risks, team members, vendors, compliance needs, and decisions that affect actual humans. You can have that while still being warm, care-centered, and human-first.
That is the start of a successful business.
Part of the way successful businesses thrive is through structure. Structure creates freedom, not restrictions.
The SimplePractice report found that independent clinicians delivered more than 113.6 million sessions in 2025. That’s not cute “side hustle” energy. That is a massive contribution to mental health access in this country. 58.8% of those sessions were insurance-based which means profit margins are even smaller.
So while everyone is out here talking about access to care (which we LOVE), we also need to talk about the back-end systems that make access sustainable for both clients AND clinicians.
Taking insurance is not just a values decision. It is an operations decision. It affects:
cash flow,
documentation,
billing workflows,
admin workload,
staffing,
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. (More on that later.) 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. (Especially with the OBBBA changes coming down the pipeline…)
The practice grew. The systems did not.
This is the part we see all the time. The practice starts growing. YAY!
🎉 More inquiries.
🎉 More clinicians.
🎉 More clients getting care.
🎉 More revenue.
🎉 More opportunities.
And then, seemingly overnight, the practice owner realizes they are no longer just a clinician with a practice. They are leading a team and running this behemoth of a thing that has grown out of control. When you’re running a small group practice, a lot of the processes you used as a solo practitioner can still work. But once you get to the point where your circle of control explodes, you have to realize what having a team looks like. A functional, sustainable, productive team needs
onboarding,
clear roles,
communication rhythms
accountability,
policies (both admin/HR and clinicial),
someone other than the owner to know where everything lives, how things work, 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.
We LOVE a good paycheck…but that’s just revenue.
Group practice owners reported average monthly business costs of $11,776.96, compared with $1,855.75 for solo practice owners. (That’s a 20% hire profit margin for solo owners.)
Growth brings more revenue potential AND 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.
We’re not trying to dissuade you from starting your group practice and we’re definitely not telling you to burn your current practice to the ground.
A group practice is not just a solo practice with more clinicians. It’s an entirely different business model. That’s a big piece of what practice experts forget to mention in the “scale your practice” webinars. You don’t just need more
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.
Practice owners are tired. We don’t have to tell you that - you’re living it. And you’re not tired because you’re lazy, disorganized, or “bad at business.”
You’re tired because you’re carrying too many roles without the structure to support them.
You’re tired because you are the chief question answerer and you’re constantly task switching.
You’re tired because the team doesn’t know where to find answers.
You’re tired because the intake process depends on someone remembering the next step (or you’re constantly following up with your team to make sure they DO the next step).
You’re tired because billing issues turn into emotional support sessions.
You’re tired because hiring feels urgent every time.
You’re tired because the practice is technically working, but only because you’re responsible for ALL the invisible labor.
You’re tired because you’re holding all the things for all the people and there’s no one holding you.
That’s not sustainable leadership - it can’t be and we don’t want that to be your life either.
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 a $40 difference per session. For the same work.
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,
clawbacks,
follow ups,
client communication,
audits,
staff training,
revenue forecasting,
and on and on and on.
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 definitely doesn’t mean “don’t take insurance.”
It means if you are going to take insurance, the practice needs to actually support that choice.
Software will not save you. Sorry.
We LOVE a good software system. 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 or anti-AI. We are very much pro- “use the tool that makes sense for YOU, set it up correctly, and maximize the crap out of it.”
But let’s be clear: software is not a strategy.
AI is not a strategy. Your EHR is not a strategy. Your Google Workspace is not a strategy. Your new intake automation that half works unless Mercury is in retrograde is definitely not a strategy.
Tools are only helpful when they sit inside a workflow that makes sense.
Someone has to own the tool, train the team, decide when it gets used and for what, check if it is solving the actual problem, make sure it is compliant, appropriate, and not creating a bigger mess with prettier buttons.
This is exactly why Boss Co exists.
Boss Co was built SPECIFICALLY for this massive gap and we want to thank SimplePractice for giving us all the stats to back up what our company is all about.
The numbers don’t lie. You don’t know what you don’t know and THAT’S OKAY. You were MADE to be a healer and care taker. You just happened to have the drive to build something different, something special. That shouldn’t stop you from creating a sustainable practice that provides you the life you want to live (and provides it to the people you employ as well.)
The gap between everything being duct taped together, kind of working, feeling stuck and a sustainable, healthy, care-focused, human-first practice can be closed and we help mental health practices do just that by building the operational structure behind the care.
We’re talking:
workflows,
role clarity
team communication,
HR and people operations,
metrics tracking,
oftware setup and cleanup,
elegation 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 absolutely 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.
The answer is not “just work harder”, it’s building better infrastructure. That is what we do.
We’ve 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’re 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.
