Supporting Sliding Scale in Your Group Practice (Without Sliding Into Burnout)
Sliding scale therapy is one of the most heart-led, community-minded offerings we can make as mental health professionals. But for group practice owners, especially those working with independent contractors, the logistics can quickly get complicated.
You're navigating two core tensions: the autonomy of the contractor and the sustainability of the business. It can feel like walking a tightrope. You want to honour the therapist’s values, support access to care, and still make sure the business stays afloat.
Let’s walk through how to approach sliding scale with clarity, compassion, and structure—so both your team and your business can thrive.
Autonomy Within Structure: The Balance You’re Aiming For
Independent contractors have control over their clinical work, including (usually) what they charge clients. But as a group practice owner, you’re responsible for ensuring that business operations stay sustainable.
That’s why the best approach is freedom within structure.
You're allowed to set parameters. You're also responsible for holding the line when decisions impact the group practice as a whole—like how low a rate can go, what your client policies are, or what your marketing reflects.
You can have a sliding scale policy for your group that offers contractors choice—within a clearly defined range that works for the business.
Talk About It Early (And Often)
The best way to prevent sliding scale tension is to address it at every key milestone in your contractor relationship:
1. Job Postings and Initial Conversations
If your ideal clinician has a “bleeding heart” (and let’s be honest, many of us do!), then speak to that upfront. Include language in your job postings like:
“We support community-minded therapists through a flexible sliding scale policy. You’ll have choice within a clear structure that protects both your values and your paycheque.”
2. Core Values Alignment
If equity and access are part of your group practice’s core values, build those into team discussions and client policy decisions. That way, when sliding scale comes up, it’s not a surprise—it’s part of the ecosystem you’ve created.
3. Onboarding & Contractor Agreements
Be explicit about:
The minimum fee that can be charged
Whether sliding scale clients require approval or documentation
How billing and tracking will work
How many reduced-rate clients a contractor can take on at one time
Also, make space in your agreement for a clause like:
“Contractors may offer reduced-rate sessions at their discretion within the sliding scale range of $X–$Y. Requests outside of this range must be discussed with the Clinical Director prior to implementation.”
Use Market Rates as a Reality Check
Before deciding how low your sliding scale can go, take a look at the community landscape in your area.
Ask yourself:
What’s already available for low/no cost therapy?
What do nonprofit agencies offer? (e.g., Family Services, CMHA, Foundry)
What do specialized programs cover? (e.g., CVAP, ICBC, Workers Comp, EAPs)
What would a church or community group be able to contribute toward sessions?
Often, these programs offer therapy in the $0–$50 range. If that’s what’s available to the public, you might set your lowest sliding scale rate just above those numbers—perhaps in the $60–$100 range. That way, your contractors aren’t competing with agencies or burning out to “fill a gap” that already has support.
Make the Impact Transparent (Use Real Numbers)
Therapists often offer sliding scale sessions from a place of generosity—but sometimes without fully understanding the financial implications.
Make it tangible. For example:
Let’s say your contractor’s standard fee is $160/hour, and they keep 60% of each session fee. That’s $96/hour in take-home pay.
If they offer a session at $100, they now take home $60. That’s a $36 drop per hour. Multiply that by four clients a week and they’ve lost $576 a month in income.
And your practice? You’ve gone from $64 of revenue to $40 per session. You’re still paying Jane at the front desk, still covering Stripe fees, still holding the admin and liability—on less than $25/session of operating margin.
This isn’t to guilt anyone. It’s to make informed decisions together.
Invite Values-Based Conversations (Individually & As a Team)
Sliding scale decisions aren’t just financial—they’re philosophical.
Open up conversations with your contractors around:
How do we want to give back to our community as a team?
What’s our shared responsibility versus individual responsibility?
How do we ensure all our clinicians (not just the big-hearted ones) are protected from burnout?
You might decide:
To pool a percentage of profits to sponsor free sessions
That everyone will hold one reduced-rate spot
That contractors can volunteer outside of your practice if they’d prefer to keep their caseload full-fee
The key is alignment, not assumption. Don’t guess—ask.
You're Allowed to Say No (So Are They)
Here’s a gentle reminder: You’re allowed to set a minimum session fee, and contractors are allowed to decline sliding scale altogether.
Some therapists simply can’t afford to take on reduced-fee clients, especially if they’re working part-time or paying off debt. Others may have the capacity and desire to do so.
Respect both positions. But if sliding scale is important to your group’s identity, make sure that expectation is communicated clearly and early on.
Practical Tips for Smooth Implementation
Create a sliding scale policy: Include minimum and maximum rates, limits per caseload, and admin procedures.
Add a tracking system: Use colour-coding, notes, or a shared spreadsheet so both the contractor and admin team know who’s on a reduced rate.
Revisit regularly: Schedule check-ins where you review contractors’ caseloads and sliding scale distribution. Don’t “set it and forget it.”
Support your therapists: Offer business coaching or consultation to help them navigate money mindset, boundaries, and burnout risk.
Centre sustainability: For both your contractors and your business, make sure that your generosity doesn’t compromise your longevity.
Final Thoughts
Sliding scale doesn’t have to be a stress point in your group practice. When handled with care, clarity, and collaboration, it can become a beautiful reflection of your values—without costing your therapists (or your business) more than it should.
So have the conversations. Run the numbers. Set the boundaries. And remember: you’re allowed to build a generous practice that is also deeply sustainable.
Want more support navigating contractor dynamics in your group practice?
Come join me in the Group Practice Connection—a Canadian-specific membership community where we talk about these kinds of tricky-but-important decisions every day.
