What Running a Group Practice Actually Takes Now (And Why It's Not What It Took Ten Years Ago)

If you started your group practice more than a few years ago, I'm willing to bet you've thought some version of this. I built the thing I set out to build. Why does it still feel this hard?

I think about this a lot, because it's true for me too. What worked when I started my first group practice isn't what works now. Not because either of us did it wrong back then. The ground underneath all of us has shifted, and a lot of the advice still floating around out there was written for a landscape that doesn't exist anymore.

So let's talk about what's actually changed, and what hasn't.

The Essentials Haven't Gone Anywhere

Before I get into what's different, I want to be clear about what's still true. Every thriving group practice is still built on the same handful of systems, and if you skip these, nothing else in this post will save you.

You need to know the client experience from inquiry through completion. That means you can actually describe, step by step, what happens between the moment someone finds you online and the moment they finish care with your practice. Who responds to the inquiry, and how fast? What does the intake process feel like from their side? What happens if a client wants to switch therapists, or if they drop off after session two?

You need to know the therapist experience just as intentionally. What does onboarding actually look like in the first 30 days? Who do they go to when something feels off? What does it feel like to be new on your team versus two years in?

You need billing systems that don't depend on you remembering things. Splits, invoicing, direct billing, collections... all of it needs to run whether or not you're the one running it that day.

And you need a team culture you're actually building on purpose, not one that happened to you. Culture is what your team says about you when you're not in the room, and if you haven't named what you want that to be, someone else is deciding it for you.

Those four things are the bones. They haven't changed. What's changed is everything happening around them.

1. The Market Isn't Small Anymore

The BCACC, the governing association for counsellors here in BC, recently announced that there are now roughly 10,000 registered therapists in this province alone. And I hear the same story from practice owners everywhere, from Victoria to St. John's. The field has grown fast, and it keeps growing.

This changes something real for us. Clients have more options than they've ever had, which means the days of "list yourself on a directory and wait" are mostly over. If you want to be the practice a client chooses, you have to give them an actual reason, not just availability.

2. There Are More Group Practices Than Ever

Some of this is the same saturation is also showing up on the group practice level. Solo practitioners are banding together, partly because the market pushes them to, and partly because there's a genuine pull toward community and connection with other therapists who get it. I understand that pull. It's a lot of why I built what I built.

But it means group practices now have to stand out from each other too, not just from solo practitioners. And it creates a hiring problem that didn't used to exist in the same way. With more therapists in the field overall, a lot of us are seeing a flood of applications from brand new grads and fewer applications from seasoned clinicians who already have a full caseload and no reason to leave it. Finding the right fit for your practice takes more intention now than it used to, because the volume of applicants doesn't mean the volume of the right applicants.

3. The Contractor Relationship Has Shifted

This is the one I hear the most tension around. Therapists looking for contractor positions have more options now, and a number of them have been burned. They've joined a practice, been told there would be referrals, and then sat with an empty calendar. They talk to each other about it. And I've heard the language shift because of it... some contractors now talk about clinic owners who "take the split" rather than "provide the split."

That framing stings if you're doing this well. But it exists because enough owners haven't been, and it means we all have to be able to answer a harder question than we used to. What are you actually providing in exchange for that split? Referrals? Marketing? Admin support? A system that means they can just show up and do clinical work? If you can't answer that clearly, a good contractor with options is going to notice.

4. AI Is Changing How Clients Find You, and What They're Looking For

This one's newer for all of us. Clients are starting to ask AI tools where to find a therapist, not just Google. That changes what your website needs to say and how it needs to be structured so it actually gets seen. It's also changing the demand for therapy itself, in ways we're still figuring out together. I don't think any of us has this fully solved yet, and I'd be lying if I told you I did. But it's not something we get to ignore anymore when we think about marketing.

5. Extended Health Benefits Have Changed What Clients Expect

More and more clients want to use their extended health benefits to afford therapy, and that means they're asking for direct billing before they'll even book. That's not a nice-to-have anymore in a lot of markets. It's table stakes. And it comes with an operational cost that's easy to underestimate, because someone on your team needs to manage those claims, the back and forth with insurers, and the questions clients have about coverage. If you haven't built that into your systems and your staffing, it's probably landing on whoever has the most time, which usually means it's landing on you.

A Story I Hear a Lot

I talked with a group practice owner recently who told me she'd posted an associate position and gotten 40 applications in a week. She was thrilled, until she realized almost none of them had more than a year of experience, and the one seasoned therapist who applied turned down her offer because a bigger clinic across town could promise a fuller caseload faster. She'd built a good practice. She just hadn't updated how she talked about what made it good, or how she showed a contractor what they'd actually be walking into.

This is a landscape she hadn't caught up to yet. Most of us haven't, fully. That's kind of the point of this post.

What would it look like to run your practice like it's actually 2026, instead of running it like it's whatever year you started?

How to Know If Your Systems Are Built for Today's Landscape

Here’s a few questions worth sitting with.

• If a prospective client asked an AI assistant to find a therapist like the ones on your team, would your website give it enough to work with?

• Can you describe, out loud and specifically, what a contractor gets from joining your practice beyond the split itself?

• Do you have an actual workflow for direct billing, or does it get figured out client by client?

• When you post a job, do you know how to spot the seasoned therapist in a stack of new grad applications, and do you have something worth staying for if you find one?

Final Thoughts

None of this means the essentials stop mattering. If anything they matter more, because a saturated market and a shifting contractor landscape punish practices that are still running on good intentions instead of good systems. But the systems that worked ten years ago were built for a different set of conditions. The bones are the same. The muscle around them has to be built for right now, not for whenever you started.

You don't have to figure all of this out alone, and you weren't meant to. If any of this is landing for you, hit reply and tell me which one hit hardest, the hiring piece, the contractor piece, the AI piece, or the direct billing piece. I read every reply, and I'd love to talk it through with you. That's also exactly the kind of conversation happening inside Group Practice Connection every week, with other Canadian owners who are living this same shift in real time. If that sounds like something you want in your corner, reach out and I'll tell you more about it.