Choose a model · 9 min read
Stay Solo or Build a Group OT Practice?
Adding clinicians changes your job. In a solo practice, you are usually the service. In a group practice, more of your week goes to building the conditions in which other people can deliver it well.
The short version
What to know before you start.
- Solo practice optimizes for control and simplicity; group practice can expand access and capacity but creates a management company.
- Hiring should solve a demonstrated constraint, not validate the founder’s ambition.
- Choose the role you want on an ordinary Wednesday, not the business that sounds more impressive.
- Use conservative collections and the full cost of employment before calling a hire profitable.
These are two different owner jobs
In a solo practice, the owner is usually the service. In a group practice, the owner builds the conditions under which other people provide the service. Each model asks for a different week and a different kind of leadership.
The decision is often framed as small versus successful. That is the wrong axis. A solo practice can be financially strong and clinically influential. A group can be fragile, overextended, and dependent on the founder. Choose based on the work and structure, not the status attached to headcount.
What solo practice makes easier
Solo ownership keeps decisions close to the client. Quality standards, schedule, communication, and service changes do not need to travel through a team. Fixed costs can be lower, especially for mobile or virtual models, and the operation is easier to observe.
The constraint is the owner’s time. Revenue, availability, and continuity depend heavily on one person. Vacation, illness, documentation, outreach, and care all compete for the same hours. A solo founder has control, but also concentration risk.
What group practice can make possible
A well-run group can offer more appointment times, complementary expertise, peer support, service continuity, and a broader referral promise. It can eventually generate value beyond the clinical hours the founder personally works.
That possibility is purchased with recruitment, onboarding, supervision, payroll, benefits, scheduling, performance conversations, documentation review, culture, and employment-law obligations. The workload may persist even as the founder’s clinical calendar shrinks.
Name the problem a hire would solve
Identify the actual constraint. Are appropriate clients waiting because your schedule is full? Are you declining a service another clinician could provide? Is administrative work consuming clinical capacity? Or do you simply feel that a real practice should have a team?
Estimate collections from conservative filled and kept visits, then subtract compensation, employer costs, billing, added systems, space, supervision, recruiting, and an allowance for ramp time. Hiring can increase revenue while decreasing profit and increasing risk.
Protect care before you add people
A safe handoff requires the service to move out of the founder’s head and into shared standards. Define selection criteria, scope boundaries, documentation expectations, escalation pathways, privacy practices, supervision, incident response, and the client experience before adding people.
Standardization should protect care without flattening clinical reasoning. Therapists can sound and think like themselves while the important boundaries and handoffs stay reliable.
Consider a middle path
You can combine solo ownership with selected outside support. A solo practice can use an external biller, bookkeeper, virtual assistant with appropriate agreements, or a carefully structured contractor relationship where lawful. A founder can also share space or build a referral collective while remaining clinically solo.
Worker classification depends on the real relationship, not the label in a contract. Get qualified employment and tax advice before treating clinicians as contractors. Convenience is not a classification test.
Choose the Wednesday you want
Imagine an ordinary midweek day three years from now. Do you want to evaluate clients, write notes, and make a few business decisions? Or do you want to coach clinicians, review metrics, recruit, resolve schedule gaps, and shape the service through other people’s work? Both can be meaningful. Only one may feel like your job.
Start with the smallest model that serves the need. Add the next layer when demand is real, the systems are documented, and you genuinely want to manage. Headcount is only useful when it solves a problem for clients or the business.
Sources
Check the rules for yourself.
- SBA: Choose a business structure
- IRS: Independent contractor or employee
- AOTA: Standards of practice for occupational therapy
These sources support the claims in this guide, but requirements can change. Confirm the current rules with your state, payer, insurer, and advisers before you act.
How we worked on this guide
Research first. Advice second.
OT Bestie checks material claims against the sources above and revises time-sensitive details as the guidance changes. Use this article to plan your questions and next steps, then bring decisions that depend on your circumstances to the right legal, tax, billing, insurance, or clinical professional.