How to Lead a Group Practice: Five Things Every Practice Owner Needs to Know

Learning how to lead a group practice is one of the things no one really prepares you for. You build your caseload, hire your first associate, maybe your second, and suddenly you are not just a clinician anymore. You are a leader. And most of us step into that role without a roadmap.

I have been sitting with this a lot lately. As someone who coaches group practice owners, I know the terrain well. And I recently had the opportunity to step into a leadership cohort as a participant rather than a facilitator. Getting to be led, to be a peer among other leaders, and to learn alongside people who are asking the same hard questions has been a good reminder of how much there is still to sit with.

What came up in that space crystallised something I want to share with you. These are not abstract leadership principles. They are the real, sometimes uncomfortable, often clarifying truths about what it means to lead people well inside a group practice.

1. Know What to Surrender and What to Steward

One of the most important skills in how to lead a group practice is knowing the difference between these two actions: letting something go, and taking care of something.

Surrendering means recognising this is not the hill I want to die on. Maybe a system is not working and you stop trying to force it. Maybe an associate has been a poor fit for a long time, and continuing to make it work is costing you more than it is giving back. Surrendering is not failure. It is discernment.

Stewarding is something else entirely. It means making wise, protective decisions for your business and your people. It means staying in a hard conversation because your team deserves your presence in it. It means holding the long view when everyone else is reacting to the short one.

The nuance is that these are not always the same thing. Sometimes surrendering an associate is the act of stewarding your business. Sometimes holding on is the right stewardship call. Part of growing as a leader is developing the discernment to know which is which.

2. A Good Leader Leaves People Better Than They Found Them

This is something I believe deeply, with one important caveat: as much as you are able.

You can create a culture of care and growth. You can invest in your associates, build systems that support them, offer mentorship, and model the kind of clinician and professional you want them to become. And you should. But they have to be willing participants. You cannot do the work of growth for someone who is not ready to do it themselves.

Here is the other layer. Your therapists are, in many ways, the face of your practice. They are why clients refer friends to the business, and they also tell other therapists about their experiences under your leadership.. They are what your reputation is built on. Your investment in them is not just the kind thing to do, it is a wise business decision. When your leadership style builds people up and helps them grow as both people and clinicians, that comes back to you in the form of a practice you are proud of.

3. Leadership Is Influence, Whether You Claim It or Not

A lot of group practice owners struggle with the word "leader." We got into this work because we love clinical care. We want to be part of the group, not in front of it. We want to be liked, to be a peer, to belong.

But leadership is influence, and you are already doing it.

Every decision you make about your practice culture, your onboarding, your expectations, your tone in a team meeting - all of it shapes how your associates experience their work. The question is not whether you are influencing your team. You are. The question is whether you are doing it intentionally.

Your team wants you to lead them. They want clarity. They want someone to hold the vision. When you understand how to lead a group practice with intention, you give your team something to orient around.

4. Disappointing People Is Central to Leadership

Someone said to me recently: "I wish I had known how central disappointing people is to leadership."

Sit with that.

If you are a people pleaser (and many of us in this field are) this is the part of group practice ownership that will stretch you the most. Real leadership means making decisions that will not make everyone happy. It means saying no when the business, a client, or another team member needs you to. It also means having a hard conversation instead of letting something slide. And it may mean holding a boundary that someone is going to push back on.

Those moments of disappointment are not signs that you are doing it wrong. They are often the clearest sign that you are doing it right. And they can move you and your practice forward in ways that accommodation never could.

5. Your Inner Life Is Part of Your Leadership

Parker Palmer wrote that a leader must take special responsibility for what is going on inside themselves, lest the act of leadership create more harm than good.

This is the foundation everything else rests on.

You cannot lead from an empty tank. You cannot take care of your team if you are not taking care of yourself. The unexamined stuff inside you, the unprocessed stress, the unacknowledged fears, the parts of leadership you are avoiding. Those do not stay contained. They leak into your team, your culture, and your decisions and they need to be released in a safe space.

Investing in your own development, getting support, being willing to look honestly at your patterns as a leader isn’t optional. It is the work.

Showing Up Is a Practice

Knowing how to lead a group practice is not about being perfect. It is about being intentional. Knowing when to surrender and when to steward. Investing in your people as much as you are able. Accepting your influence and using it well. Being willing to disappoint someone in service of the bigger picture. And tending to your own inner life so that your leadership builds people up rather than wearing them down.

This is an ongoing practice, not a destination. And it is one you do not have to navigate alone.

Ready to Keep Growing as a Leader?

If this resonated with you, there are two ways to go deeper and expand your capacity as a leader.

The Group Practice Connection is a membership community built for Canadian group practice owners who want to lead well, build sustainably, and stop figuring it out alone. It is a space for ongoing learning, peer support, and real conversation about what it actually takes to run a practice.

If you are looking for something more personalized, I also work with group practice owners through individual coaching. We go into the specific challenges you are navigating — the decisions, the team dynamics, the leadership edge you are standing on — and we work through them together.

You can learn more about both at grouppracticenetwork.ca. I would love to have you in the room.