What Nobody Tells You About Going From Solo to Group

Someone told me early in my career that group practice was the path to passive income. I think about that a lot now — usually when I'm knee-deep in a credentialing question nobody warned me about, or reviewing an employment contract at 9pm, or realizing that one of my clinicians needs more support than I expected this week.

Passive. Income.

I have never laughed harder at two words in my life.

Here's what I actually know about making the leap from solo to group practice — the version nobody handed me, the one I wish they had.

The infrastructure will shock you

Not the hiring. Not the management. The infrastructure.

Before you bring on your first person, you are suddenly responsible for things you have never thought about once in your solo career. An NPI 2. An employment attorney who understands the nuances of your field. A real payroll system. A personnel file process. An employee manual. Background check vendors. Credentialing your new hire on the insurance panels you've been billing under your own number for years. A phone system that scales. A second, third, fourth bank account if you're running Profit First.

None of this is hard, exactly. But it is a lot. And it all needs to exist before your first hire walks in the door — not after.

The solo practice owner brain thinks: I just need to find the right person and we're off. The group practice owner brain has to think 12 steps ahead. It's a different mode entirely. It takes some getting used to.

The people you hire are not like you

This one surprised me more than anything.

The clinicians who choose to work for a group practice — good ones, talented ones — often aren't entrepreneurial. They don't want to run a business. They want to do good clinical work and go home. That's not a flaw. It's actually a feature: you want people who are excellent at the clinical work, and you handle the business.

But it means you cannot lead them the way you lead yourself.

You will need to set expectations clearly, in writing, before they start. You will need to follow up. You will need to hold people accountable and have real conversations when things aren't working. You will need to accept — genuinely accept — that no one will ever care about this practice the way you do. And that's okay. That's not their job. Their job is to serve their clients well. Your job is to build the container that makes that possible.

If you're not comfortable with that dynamic yet, get comfortable. Fast.

You might make less money. At first.

This is the part that doesn't make it into the posts about growing your practice.

I remember the moment clearly. I had added new clinicians. Their caseloads were filling up. Things looked good on paper. And then I looked at my own income — and it had gone down. Significantly. My costs had risen, I was working harder than I ever had, and I was making less than I did when it was just me.

I was terrified I had made a huge mistake.

What I didn't fully understand yet was that the structure matters everything. The split between you and your clinicians, whether you're running 1099 contractors or W2 employees, how quickly their caseloads fill, whether your overhead is actually under control — all of it determines whether the model works financially. If the structure isn't right, you can work yourself into the ground and come out behind.

This is why I tell every practice owner I work with: get your financial infrastructure right before you hire anyone. Understand your numbers. Model out what the math looks like at different caseload levels. And build a real cash buffer before you bring anyone on, because there will be a lag between when your costs start and when the revenue catches up.

The passive income people don't mention the lag.

You are responsible for people's livelihoods. Full stop.

At some point it hit me — really hit me — that the people working in my practice were counting on me. Their ability to pay rent, their student loans, their families. It all ran through my decisions. My competence as an operator. My judgment as a business owner.

That's not something to be scared of. But it is something to be serious about.

Your ignorance has consequences now. Your mistakes have consequences. Not just for you — for them. That weight will sharpen you quickly if you let it. It made me want to get better at the business side faster than anything else ever had.

The mindset shift nobody warns you about

Going from solo to group isn't just an operational change. It's an identity change.

You have to get comfortable with money in a way most clinicians were never trained for. You have to build systems and processes — real ones, documented ones, ones that don't live only in your head. You have to set expectations and hold people to them. You have to accept that as the owner, you are ultimately responsible for everything. Even the things that aren't your fault.

No one will care as much as you. Nor should they.

That sentence used to frustrate me. Now I think it's just the truth. The practice is yours. The vision is yours. The accountability is yours. The faster you make peace with that, the better owner you become.

Before you post the job listing

If I could sit across from every practice owner considering this move, here's what I'd tell them before they did anything else:

Group practice can be an extraordinary thing to build. I mean that. But it is a business — with all the weight, responsibility, and operational complexity that word carries.

The owners who thrive are the ones who stopped waiting for it to feel simple and started learning what it actually takes.

It's not passive. Not even a little.

But when you build it right, it's worth every bit of it.