When to hire your next clinician in your group practice

Hiring can feel like a lonely or confusing decision. Thankfully, if you run a therapy group practice, you can look for clear signs (based on solid business fundamentals) to figure out when it’s a good time to add a new team member. Strategy, finances, demand, and team capacity can all inform the decision. Here’s what to look out for.

Client demand outpaces capacity

The first sign hiring might be necessary is increasing client demand, especially if you notice growing waitlists with your current clinicians or delays for clients booking their first session. Turning away clients and revenue may be a sign that you're already behind on the hiring process. 

Caseload utilization rate can also be a useful metric, as it shows how much a clinician is filling their billable hours. Brighid Gannon, co-founder of the group practice Lavender, recommends using this metric and getting ahead of the curve of client demand so your practice doesn’t find itself missing out. “Because it takes two to three months to hire a new clinician, we start the hiring process when the schedule of our most recent hire is fifty percent full,” Gannon says. Still, she acknowledges that “every practice must find its own metrics that work for them.” 

Data that can help define these unique metrics include the number of inquiries your practice receives each week, the percentage of those inquiries that convert to new clients, and how long clients are waiting to book a new session. 

If there is a mismatch between inquiries for specialties from potential clients and the specialty offerings of the practice, that can be another signpost. When multiple inquiries are walking away each week or month because your practice doesn't offer their requested treatment approaches or specialties, it may mean it’s time to hire a clinician with those skills. 

The key with these signs is to determine that demand is consistent enough to hire a clinician who won't be bored once they are onboarded. At the same time, you do not want to wait so long on the demand that too many clients end up being waitlisted or turned away. 

Revenue and utilization metrics support expansion

Financial history and reporting are other helpful hiring guideposts. Having a good sense of your finances over time will show whether or not you have predictable billing patterns and a stable financial picture. Consistency is key: If there are unpredictable patterns and inconsistencies in the finances, it may not be the best time to hire. When cash flow, revenue, and billing are all steady, that provides the foundation for the next hire. 

The book Profit First for Therapists by Julie Herres recommends having a financial system that can ensure there will be enough money to cover overhead expenses, staff compensation, your own compensation, profit distributions, and emergency funds. One essential financial metric the book highlights is consistently covering these core costs in your practice. If this isn't happening, you likely don't have the margin to grow. A stable financial base gives you the foundation for growth. Adding more people typically won't solve financial instability, because the instability is likely a sign that something isn't working quite right in the business model. 

Once a clinician is hired, they can often take several months to build a full caseload depending on client demand. One recommendation made by Kristin Meador, CPA, on “The Practice of Therapy Podcast,” is to have three months of savings set aside to cover the cost of the new clinician while they build up their caseload. Without this cushion, there may be financial strain in the initial phase.

Team capacity and burnout

Another clear sign that it’s time to hire someone new is the current state of your team. If other clinicians are showing signs of burnout or being overworked, it’s likely time to hire. You might notice more mistakes, less effective treatment, more complaints from clients or the staff, clinicians talking about leaving the practice, more time off taken, or more visible fatigue.

It's important to keep a finger on the pulse of the team. This can happen through monitoring their schedules and workload. It can also be tracked through regular individual check-ins, team meetings, or larger group retreats. These types of connection points are not only important for team building, but also to stay connected with the morale of the group. The Maslach Burnout Inventory is a proven assessment tool that can also help measure the state of your team. 

Strategic growth goals

Your team size and structure should align with your practice's mission, vision, and goals; Your vision and strategic goals should be the anchor for your hiring decisions. Specific goals may relate to expanding services to meet more client needs, adding new specialties, or entering new geographic or population markets. 

For example, you may have the goal to add more EMDR clinicians to your practice in order to serve a larger number of clients and deepen the trauma expertise of your practice. Or you might want to start working with clients in a new state or demographic. If your key goals align with growth, this gives you permission to start hiring. If you don't have clear goals or vision in place, it may be wise to think that through before hiring more clinicians.