When Your Group Practice Needs You to Lead Differently

There’s a moment many group practice owners reach where something just doesn’t feel right anymore. You’ve built something real. You’ve brought clinicians onto your team. Clients are being seen. On paper, it looks like success.

And yet, underneath all of that, you might feel stuck, tired, or quietly resentful — even though this is the business you worked so hard to create.

I see this crossroads most often around year two or three of group practice ownership, or when a practice grows to around seven clinicians. At that point, the decisions get heavier. The financial questions feel more urgent. And the leadership role you’ve been stepping into starts asking more of you than before.

This blog post builds on my recent conversation with Jessica Cowling and then my upcoming podcast episode, where we talked openly about money, leadership, and what it really means to move from people-pleasing into a CEO role. If that episode resonated with you, consider this your next step.

When leadership starts to feel uncomfortable

Many therapists become group practice owners because they care deeply about people. That doesn’t disappear when you grow a team — if anything, it intensifies. You want your clinicians to feel supported, valued, and successful. You want your culture to feel good. You want people to stay. And there’s a part of you that feels that you would/should do anything you can to take care of them.

But if you’re honest, you might notice that some of your decisions are being driven more by avoiding discomfort than by long-term sustainability. You say yes when you want to say no. You absorb the stress so no one else has to. You put your own needs — financial, emotional, and energetic — at the bottom of the list.

Over time, that shows up as resentment. Toward your team. Toward the business. Sometimes even toward yourself.

That’s not a personal failure. It’s a leadership signal.

Why avoiding the numbers costs you confidence

One of the most common places this shows up is with finances. I hear versions of this all the time:

“I’m not a numbers person.”
“I just let my bookkeeper handle it.”
“I’ll deal with it later when things calm down.”

I’ve been there myself. In my first group practice, I thought I was managing the finances well enough — until I realized I wasn’t actually equipped to do the bookkeeping properly. I handed it off to a professional, which was the right move, but then I stepped too far away.

What I learned (the hard way) is that outsourcing doesn’t mean disengaging. When you don’t understand what your numbers are telling you, it becomes almost impossible to lead with confidence.

You hesitate when a clinician asks about a split. You feel unsure about what you can afford to offer. You second-guess decisions because you don’t have clarity.

Leadership requires information — not mastery, but awareness.

You don’t need all the numbers — just one

A mistake many practice owners make is trying to understand everything at once. Profit and loss statements. Balance sheets. Marketing metrics. Capacity. Revenue. Expenses.

And all of those numbers and information can be overwhelming, especially if numbers aren’t your comfort zone.

Instead of trying to look at everything, choose one place to start. One number that matters right now. That might be your actual owner’s pay. Not what you hope to make — what you are truly paying yourself.

It might be your therapist split and whether it realistically covers your expenses. Or your monthly subscriptions and overhead. Or how well your physical space is being used compared to the revenue it’s generating.

When you slow down and focus on one area, something important happens. You stop avoiding. You start understanding. And with understanding comes confidence.

The hidden cost of people-pleasing leadership

People-pleasing often feels like being kind or supportive — until it doesn’t.

For me, it showed up during a season where I was already stretched thin personally. I said yes to hosting a team event because it was “good for morale,” even though I didn’t have the capacity. I remember standing there, watching everyone enjoy themselves, and feeling resentful. That was my wake-up call (or one of them!).

When leadership decisions consistently come at the expense of your own capacity, burnout isn’t far behind. And burnout doesn’t stay contained to your business — it spills into your relationships, your health, and your sense of self.

People-pleasing in leadership doesn’t protect your team. It eventually harms everyone.

Shifting from clinician to CEO

One of the most important leadership shifts in group practice ownership is recognizing that your role has changed.

You are no longer just a therapist who owns a practice. You are leading a business. You are guiding a team. People have joined your practice because they want clarity, structure, and leadership — even if they don’t always say that out loud.

Some practice owners struggle with this because of the word “boss” or “CEO.” It can bring up fears of being controlling, unkind, or “too much.” But leadership doesn’t mean abandoning your values. It means embodying them with clarity.

When you truly step into the role of leader, something shifts. You listen. You collaborate. And you also make decisions.

Your confidence becomes a stabilizing force for the entire practice. It allows you to show up authentically, to lead your team, and to show them what the path forward looks like.

Your team becomes your client

As your practice grows, your primary focus has to change.

In the early stages, your clinical clients are what sustain the business. But in a group practice, your clinicians become your main point of responsibility. The energy you once poured into preparing for sessions now gets redirected into supporting systems, boundaries, and leadership.

This doesn’t mean over-functioning or sacrificing yourself. It means being intentional about where your time and energy go — and making sure that support flows in both directions. You get to take care of them and see them grow so that more clients are taken care of…and you don’t burn out.

Get support before you’re desperate

One of the hardest parts of group practice ownership is how isolating it can feel. You’re responsible for others, but you don’t always have people who truly understand the weight of that responsibility.

Please don’t wait until you’re exhausted or resentful to reach out.

Support might look like connecting with peers, joining a community, investing in coaching, or stepping away on retreat to get perspective. Leadership was never meant to be done alone.

A leadership challenge for you

Leadership is not about doing more. It’s about choosing differently.

This week, I want you to identify one leadership decision you’ve been avoiding — whether it’s related to money, boundaries, or clarity — and make that decision. Not perfectly. Just intentionally.

Small, grounded steps are what create sustainable practices.

If this post resonated with you, I’d love to hear what you’re working on. You can reach me at lisa@grouppracticenetwork.ca, or explore the resources and communities available through Group Practice Network.

You don’t have to do this alone — and you don’t have to sacrifice yourself to be a good leader.