Starting a Private Practice: Lessons from the Past, Insights for Today
Starting a private practice today can feel overwhelming—complex insurance systems, credentialing hoops, compliance requirements, and rising business costs. But believe it or not, launching a practice has always carried challenges, just in very different forms.
In the latest episode of The Right Tack, Jim and Paul Jonas take a step back in time to explore what starting a practice used to look like, drawing from Jim’s experiences as a clinician in the 1980s, alongside Paul’s perspective as a business owner today. Their discussion offers practice owners a unique lens: how the history of mental health care shapes the realities of running a practice now.
Then vs. Now: How Starting a Practice Has Changed
Insurance in Its Infancy: In the mid-20th century, therapy bills were sometimes as simple as sending an invoice to an employer—and getting a check in return. No electronic claims. No compliance audits. Just paper and trust.
The HMO Era: By the 1980s, HMOs promised access and prevention but introduced frustrating restrictions—referrals, caps, and prior authorizations that often disrupted care. Jim recalls the burdens of calling insurers every few sessions just to continue seeing a client.
Paper Claims & Compliance: Before electronic submission, clinicians used red-box CMS-1500 forms with dot-matrix printers. If your typewriter or printer was off by a fraction of an inch, the claim was denied. Compare that to today’s compliance-heavy world of fraud training, CEU tracking, and quarterly attestations—it’s evolved, but it hasn’t gotten easier.
The Timeless Challenges of Private Practice
While the systems have changed, some struggles remain familiar:
Financial Risk: Signing a lease without knowing if clients will come has always been a leap of faith.
Documentation Demands: From hand-filled forms in the past to digital compliance requirements today, paperwork has always been a time sink.
Insurance Complexities: Whether it was HMO capitation in the 80s or today’s constant payer rule changes, providers have long had to adapt to payer-driven disruptions.
What Practice Owners Can Learn Today
Looking at history helps us see that every generation of clinicians has faced obstacles, yet private practice has always found a way to thrive. For today’s owners, the lessons are clear:
Expect the systems to shift and build flexibility into your business.
Protect your time and energy by outsourcing billing and credentialing tasks when possible.
Remember that the scariest step (getting started) is the same challenge clinicians have always faced, and overcoming it is still possible.
Jim and Paul also reflect on how licensure itself was once new, how compliance demands have grown, and why finding the right support is key to avoiding “death by a thousand paper cuts” in running a practice.
👉Tune in to Episode 7 of The Right Tack for a candid, story-filled look at the evolution of private practice—and practical takeaways for your journey today.
