If You Want to Be Trusted, You Have to Be Clear
What clinicians and clients need from group practice owners and why clarity is a leadership responsibility, not a nice-to-have.
I want to tell you about a conversation I had recently with a therapist who is associated with a Canadian group practice. She was thoughtful, capable, and genuinely invested in her work. She was also frustrated…not in a way that was dramatic or unreasonable, but in the quiet, accumulating way that happens when someone has been kept waiting for answers that never quite arrived.
She had started as a practicum student with that practice. The placement details, expectations, and onboarding process were vague and kept shifting right up until she started. As she wrapped up her training, she asked about next steps. The timing of that conversation kept moving. The answers kept changing from sometimes a yes, sometimes a we’ll see, always accompanied by warm reassurances about what a great fit she was for the practice. Rates were never clearly laid out. The pathway from practicum student to intern to fully registered clinician, and what each stage would mean financially, was never mapped out until she pushed for it herself.
She eventually moved forward. But the trust had already taken a hit.
I am sharing this because I don’t think this owner is unusual. I think this is a pattern, and I think it comes from a place most of us recognize: not wanting to overpromise, not being sure what the right answer is yet, not wanting to close a door before we have had time to think. Those are understandable instincts. But they have a cost. And clinicians, practicum students, interns, and clients are the ones paying it.
Clarity is not just an operational nicety. It is a leadership responsibility. And when we are not clear, we aren’t neutral we’re creating confusion, eroding trust, and making it harder for the people around us to do their best work.
The Language We Use Matters More Than We Think
There was one more thing from that conversation that I haven’t been able to stop thinking about. When describing her compensation arrangement, the clinician talked about how the owner was "taking" 40%.
I want to name that directly, because it matters.
When a clinician says an owner is "taking" a percentage, they are describing a transaction where something is being removed from them. That framing, and the fact that it has taken hold, tells us something about how the compensation structure has been explained, or not explained.
As group practice owners, we are not taking 40%. We are paying 60%. Those are not the same sentence, and they don’t land the same way. The 60% we pay out is the clinician's compensation. The 40% we retain covers (mostly) the cost of the space, the administrative infrastructure, the scheduling systems, the billing processes, the liability coverage, the credentialing support, the referral pipeline, the supervision where applicable, and the overhead that makes it possible for a clinician to walk in and see clients without building any of that themselves. We are not extracting value. We are providing a structure within which a clinician can do their work.
That distinction won’t land automatically. It has to be explained. And it has to be explained well (not defensively or as a lecture) and as a genuine orientation to how the business works and what the arrangement actually includes. If we haven’t done that, we don’t get to be surprised when clinicians feel like something is being taken from them.
Three Areas Where Clarity Has to Be Non-Negotiable
For practicum students and interns
The pipeline from practicum placement to intern to fully registered clinician is one of the most important pathways a group practice can manage well and one of the most commonly handled poorly. If you’re offering practicum placements, the student deserves to know from the outset what the placement structure looks like, what supervision will involve, what the expectations are, and what, if anything, the pathway to a paid position looks like after graduation. Not a promise but a clear picture of how decisions get made and when.
If you’re genuinely unsure whether you will have a position available, say that. "I don’t know yet, and here is when I expect to know" is a trustworthy answer. "We’ll see" repeated over several months while someone is making career decisions is not.
For clinicians joining as associates
Before a clinician starts, they should have written clarity on the following: the fee split and exactly what it covers, how and when they will be paid, what the caseload ramp-up looks like, what administrative and referral support is provided, what the contractor relationship means for their autonomy, and what the process is if either party wants to end the arrangement. These aren’t awkward conversations. They’re the foundation of a professional relationship. Practicing them gets easier quickly.
Rate progressions tied to registration milestones- from intern to fully registered, for example -should be documented and shared before the clinician starts, not negotiated mid-stream. If the rate changes when registration changes, say so up front. It demonstrates that you have thought about their trajectory, not just your immediate caseload needs.
For clients
Clients need to know who they are working with, what the fees are, how cancellations are handled, what happens if their therapist leaves the practice, and who to contact if something goes wrong. None of this is complicated. Most of it lives in an intake form and a consent document. What makes it work is that those documents actually get reviewed with the client rather than sent as a formality to sign before the first session.
When clients feel informed, they feel safe. When they feel safe, they do the work. That is the whole point.
A Practical Checklist: What Every Group Practice Owner Should Have Documented
If you are not sure where your clarity gaps are, this is a useful starting point. These are the things that should exist in writing before a clinician starts or a client books.
For practicum students and interns
Placement overview document: dates, hours, supervision structure, and expectations
Written confirmation of whether a paid position pathway exists, and when that decision will be made
Onboarding checklist so the start date is not the first time any of this is communicated
A named person they can go to with questions
For associates/contractors
Signed contractor agreement that reflects the actual working arrangement
Written fee split breakdown with a clear explanation of what the practice provides in exchange for its share
Rate progression schedule tied to registration milestones, in writing
Payment schedule and process
Caseload ramp-up expectations
Description of administrative, referral, and supervision support
Process for ending the arrangement on either side
For clients
Intake form with fee, cancellation policy, and therapist credentials clearly stated
Informed consent document reviewed with the client, not just signed
Process for what happens if their therapist leaves or is unavailable
Clear contact for billing or administrative questions
This Is What Leadership Actually Looks Like
I want to close with something that might be uncomfortable, and I say it with genuine care for the owners reading this.
The version of leadership where we stay vague to keep our options open is not leadership. It is self-protection at the expense of the people we are responsible to. And it has a cost that shows up in clinician trust, in client experience, in the culture we are building, and ultimately in the sustainability of the practice itself.
The version of leadership that earns trust looks like knowing what you are offering before you offer it. It looks like saying "I don’t know yet, and here is when I will" when that is the honest answer. It looks like explaining your compensation structure with confidence, because you understand what you are providing and you can articulate its value. It looks like having the hard conversation early so it does not become a harder conversation later.
None of this requires perfection. It does require intention. And it’s entirely within reach for every practice owner who is willing to do the work.
Clarity is one of the most generous things you can offer the people who work with you and for you. It costs nothing except the willingness to think things through before someone asks.
Build something great,
Lisa Catallo
