Therapists often tell me that they've learned nothing about the business of private practice in Grad School.

Last week I heard this again from a client who's trying to transition from insurance to private-pay. She's been racking her brain on the right way to make this transition as she mentioned her training.

My theory is that in school, your training is focused on making therapy accessible to wide swaths of population. As providers, you know that most people can benefit from therapy, so focusing on the financial side of private practice can feel almost indecent.

And in all fairness, when you are an in-network provider, you can absolutely build a practice that emphasizes accessibility. You can grow, employ others, and make therapy accessible to more people.

An insurance-based model can make demand easier to generate because you're offering something many people are already looking for: accessible care covered by their in-network benefits. But the economics tend to favor volume, efficient operations and availability.

Private pay changes the calculation. You give up some of that built-in demand and accessibility. And in exchange, you gain more control over your fees, caseload and the kind of work you want to build your practice around.

But that independence comes with a responsibility: you have to give people a compelling reason to choose you when cheaper options exist.

As I always say, neither of these business models is inherently good or bad. It depends on your vision, preferences and financial goals.

There are companies and practices built around making mental health care easier to access. There are others that provide a more specialized or premium layer of care and charge higher out-of-pocket fees.

Today, on Labor Day, I've been thinking about this as a question about work itself.

What do you want your work to do for your future? And what kind of future are you actually trying to build?

Is it one with greater independence from insurance and the freedom to build a practice on your own terms? Or do you value the security and built-in demand that insurance can offer?

Neither answer is wrong.

But I think it's worth knowing which one you're working toward.

See you next week,

Avivit