How to know whether to hire employees vs contractors for your group practice is one of the most common (and confusing) decisions therapists face when expanding from solo to group practice. When I first started expanding my solo practice into a group, I did what many new private practice owners do: I hired a contractor.
It felt like the right move—simple, flexible, and honestly less scary than hiring a full-blown employee. The thought of being responsible for payroll and taxes made me cringe!! And for a while, it worked… okay-ish. But as our caseloads grew and my vision for the practice sharpened, I realized this structure wasn’t built to support what I was trying to create.
Hiring Is a Company Culture Decision
What no one tells you early on is this: Hiring is more than just filling a seat. It’s about protecting your standard of care, building a cohesive team, and ensuring your clients get a consistent experience—no matter who they’re working with. When your team represents your brand, your values, and your clinical integrity… how they work matters.
What I Learned from Hiring a 1099 Contractor
One major turning point for me came from a situation with a well-meaning contractor. She described her approach as “intensive clinical work,” which in one case meant allowing a therapy session to stretch into five hours.
Yes, five.
I was stunned. Not only did this differ wildly from our 53–55 minute outpatient standard, but I also had no authority to stop it. Why? Because she wasn’t my employee—she was a self-employed clinician.
Which meant I couldn’t:
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Enforce clinical documentation standards
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Require her to attend staff meetings or group supervision
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Set policies on session lengths, boundaries, or treatment planning
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Maintain accountability in the way I envisioned for my practice
And deep down, I knew: this wasn’t sustainable.
W-2 Employees vs Independent Contractors
Eventually, I transitioned to hiring W-2 employees—and it changed everything. Was it more responsibility? Absolutely. Payroll, onboarding, employee handbooks… all of it came with weight.
But what I gained was far more important:
- The ability to clearly set and uphold standards
- Consistency across the board for client care
- A shared team culture rooted in excellence
- Legal protection when policies are followed properly
- The freedom to lead with clarity and confidence
And best of all? A team that’s unified, aligned, and drive the mission together.
Is It Better to Hire Contractors or Employees for your Group Practice?
Here’s the truth:
There’s no one-size-fits-all answer. But think about what you want your company to stand for? Do you see yourself creating a team who find camaraderie and support from one another? Or function more as independent practitioners who comes in, does a good job and leaves for the day? Do you want to be responsible for overseeing someone’s clinical or administrative practices? Or is management not something you have bandwidth for?
W-2s aren’t the best fit for everyone, and 1099s do have their place in some settings. But you must understand the difference. And even more importantly—you need to follow your state’s laws and the IRS guidelines to make sure you’re classifying your clinicians correctly.
Need Help Deciding Between a W-2 or 1099 for Your Therapy Practice?
If you’re stuck in this decision, spinning your wheels and unsure what’s best for your next step—I’ve got something that’ll help.
Myself and Julia Nepini (fellow group private practice owner) created the CEO Mindset Program: Growing a Group Practice, a step-by-step e-course for solo practice owners ready to grow into group practice—without all the guesswork.
Inside, we will walk you through how to make this critical decision with clarity, legal awareness, and alignment to your business goals.
You don’t have to build this alone. And you can grow a team you love—one that reflects your standards and your heart.
Click here to learn more about growing a successful group private practice.