Ep. 17 Coffee Chats: Practice owner Sara Buxton on hiring challenges in private practice
In this Coffee Chat, Sam connects with Sara Buxton, owner of Room to Breathe Psychotherapy and Yoga, to discuss hiring challenges in private practice. They touch on current shifts in the mental health workforce and the ongoing impact of the pandemic. They also cover what we aim to offer clinicians at Room to Breathe, as well as general advice for any therapists looking to become part of a group practice. The ultimate theme of this episode moves beyond the hiring process and challenges of a private practice to supporting clinicians during challenging times. When most of the world is seeking therapy, how do we meet that demand while we resource and support our therapists?
This episode might be an interesting listen for you if:
you’re a recent grad navigating the job pool
you’re a solo therapist looking to make a switch into group practice
you’re a practice owner with these same questions and challenges
Connect with Sam: Sam@RoomToBreatheChicago.Com
Connect with Sara: Sara@RoomToBreatheChicago.Com
Are you a therapist looking to join a group practice? Let’s connect! Find out more about our open positions here.
Interview transcript {edited for clarity}
Sam Allewiss (she/her): All right. Hi, Sarah, how are you?
Sara Buxton (she/her): Doing okay, how are you?
Sam: Doing well. So for folks who are listening and watching, I'm joined today by Sarah Buxton. She's the Room to Breathe practice owner. And today we're going to talk a little bit about hiring, the challenges that we face in the hiring process, what we're doing as a practice to address the issues, and we're also going to identify the profile of a clinician that would thrive in our practice and the reasons our clinicians ultimately decide to work in a community driven private practice, like Room to Breathe.
So I have an initial question for you, Sara, to jump in a little bit, and then we can go from there, if that sounds okay.
Sara: Totally.
Sam: There are a lot of conversations right now about the mental health workforce shortage. What are you seeing firsthand when it comes to hiring clinicians at Room to Breathe?
Sara: First and foremost, maybe this is just in Chicago proper, but I think everyone's hiring, um, for the not the first time, but it feels like, if I'm looking back to when I graduated grad school, there weren't private practices that were actively hiring folks out of grad school. They weren't actively taking on practicum interns. Most of us were at agencies, community mental health centers. And right now, it just feels like everyone is hiring, and there are reasons for that. In terms of like it's 2026, our bottom lines are all going up. We're expanding. People are seeking mental health services.
I think on the flip side of that, a lot of folks are leaving group practice and starting their own practice, or a lot of group practices and individual practitioners are not taking insurance, and so the need for folks taking insurance is higher, but hiring folks to take insurance is getting harder and harder, because insurance reimbursements are less than cash reimbursements. And so taking care of a clinician's livelihood with insurance reimbursements gets a little tricky, and those folks are leaving the paneling, if you will.
So it feels like there's a complicated answer to that question. Everyone is hiring because everyone is seeking mental health services, and there's a lot of people leaving group practice or leaving insurance panels.
Sam: Sure, yeah, yeah, I think that all makes a lot of sense. And I know you and I have talked about this issue a bit in terms of the changes that we've seen since I started at Room to Breathe in 2020, so just acknowledging it's been such a shift in terms of hiring trends since that time period.
Sara: Totally.
Sam: Yeah. I'm curious, what do you think has changed in the profession over the last five years, like I was alluding to, that's made hiring in general, more challenging. Anything specific to the profession.
Sara: Yes, also feels like a dyad, if you will, triad, multiple things happening, like we lost - our practice - lost a lot of clinicians in the pandemic. There were a lot of shifts happening, like 2020, pandemic, right? We all went home. We had a rent to pay, but we weren't in the office. So that wasn't something that was off. There are like, the health insurance companies were wild in terms of telehealth reimbursement versus in office reimbursements, and even grad school folks, like school folks, grad school folks, they all went online, right?
So in terms of our need or our perception of community and support completely shifted to: I can be at home and do this work. Do I need this practice behind me? If I know how X, Y and Z works, right? And there are some folks that thrive in that, if you will, of like, just being a one woman, one man, one person, show of running your own practice, being online, finding collectives that work, and we can get into that in terms of the collective space.
But one big thing that I think has also shifted, and I think I mentioned this before, is just, you can go to group, you can go to private practice right out of grad school, and that wasn't a thing back then. “Back then”, I feel so old saying that…
But I feel - I'm sports psych, hopefully most people know that are watching this, I'm sports psych minded, if you will, in terms of like I see things in team setting, coach setting, like a coach doesn't want to take on an athlete that hasn't gone through the hard rigor of, you know, bringing themselves up through the sport, right? You're not gonna, you're not gonna recruit a hockey player that hasn't gone through the rings of junior hockey and farm league and all of that, like really fought their way. And that sounds silly, but like that seemed to be the mindset when I graduated in 2012 of like this person hasn't gone through the difficulty of community mental health or really learned how the financials work when it comes to mental health and Medicaid and Medicare and health insurance reimbursement and marginalized folks that can't even get mental health care right? And that seemed to be kind of like the process, if you will, of getting to private practice.
And I'm not a good example of that, I went right to private practice. But hiring folks into private practice, you were typically highly hiring seasoned clinicians, folks that had a niche, folks that knew the ropes, if you will, of how to conduct private practice and counseling and individual clinical load, if you will.
And now it's different. We are hiring folks right out of grad school, which is a lovely thing, like training is happening within private practice, and we're all hiring. Like all private practices are hiring folks, and we're all looking for similar folks, like we're all looking for clinicians who are relationally focused, who have some sort of feminist theory approach, if you will, right, who can sit with complex trauma, who understand the integration, the holistic view of trauma and the body, and - know? So I really do feel like in terms of like competition, we're all hiring and looking for the same folks and trying to build solid cultures and communities, and we're all trying to be aligned in terms of accepting insurance, being able to be open to a more accessible, be more accessible, if you will, to folks by accepting all the insurances, which is all fun, but accepting all the insurances requires a lot of back end work, right? And so financially, we're all trying to figure out, how do I split the pie among these community members who all have livelihoods, who want to grow families, who want to live a good life, who want to take care of themselves, right? So I want to be able to offer benefits, 401k, I want to be able to have some sort of growth structure that people can look to and say, like, Okay, I'm not just going to be grinding on a 25 client per week caseload for the rest of my career. I have options.
And with that, that's lovely, and we all want to do that. We're all choosing different ways that seem, I don't know what the term is I'm looking for. I wanted to say elusive, but like, this practice say has - covers 75% of your health insurance. Awesome. I'm going to go over there. But what does that mean? What health insurance? What, who? Who are they contracted with? What does that cover? Right? Or, this practice has 401 K benefits within this year. Great. What's the percentage match? What does that mean long term, what, do we even speak that language? Right? Like 401K was foreign to me up until, like, five years ago.
But the reason I'm saying all this is because it's really interesting to look at all the job ads out there. There's a lot, there's a lot of private practices hiring, and I imagine it can be somewhat overwhelming to choose if like values and niche and I don’t know like supervision style, all of that isn't something that an individual really knows what they're looking for yet, right? Or, for some reason the term like financial literacy, if you will, of mental health and health insurance reimbursement, right? Because on the other side of this, you could just go to Headway and work for an app that is promising you a pretty high reimbursement, because they're directly contracted with the health insurance company, right? And I don't feel we're competing with that, but at the same time, like there's so many different options and things to sift through as a newer clinician that's trying to get into private practice that it can seem pretty overwhelming, or it could drive somebody to just practice on their own and, like, just build it on my own, which is great, and I am envious of those folks who have that sort of ability to just be entrepreneurial. And I'm - I always call myself a team player, or, like, I'm the third of four children. I don't do things alone so I hope I'm making cohesive sense, but I feel like so much has shifted. The biggest two things that have shifted are: everyone is hiring in terms of private practice, group practice, there's much more opportunity out there to join a private practice and you can cut the pie many different ways, and so on a job ad, it all looks different, but it's all very much the same, if, like, in terms of, like, our little cohort of private practices that are accepting insurances trying to do solid niche work on integrative, holistic, healing practices and pretty trauma informed focused.
Sam: Yeah, absolutely. And I think to your point, for folks coming into the field, or even, I think for myself, transitioning from years in community mental health into private practice, it can be hard to have that financial literacy, as you're looking at like how that piece of the pie or how that pie is sliced in terms of what is the best fit for you.
And so I'm curious, like, beyond even the benefits or the things that get written down on paper. If we can talk a little bit about what community looks like at Room to Breathe, I always say when I support with the hiring process like that is one of the truly unique aspects of being at Room to Breathe. So I'm curious, Sarah, as the Room to Breathe practice owner, what kind of culture have you intentionally tried to create at the practice, and how do you think this supports our clinicians with their well being as we think about the hard work that we do?
Sara: Yeah, my mind always goes to like if I feel I have built - we have built - a practice that's centered in humility and humanity, like we are so relational first, and I want most people to know they can debate and argue and bring new models, if you will of like this practice is paying this for PTO, or like this practice has this consult group, or that wasn't right, what you did in terms of handling some leadership thing, and that's what I mean by humility first of like, super growth mindset focused, diverse in the term in the term of like, supervision support, I really like to make sure that there's a fit supervision wise, for everyone. And I think we've done a pretty good job at having a different type of supervisor for each clinician in terms of both personality fit, clinical fit, niche fit, all of that. And when it comes to our culture, I think a big shift that we've recently made is bringing in joy and humor and making sure that we are, sounds silly, laughing through the work, releasing all of the massive things we're holding, especially as the world is blowing up, and we are holding that space for people to navigate that and holding that space for each other. And I want to make sure that our community is consistently growing in that, in that growth, in that ability to be together, in the hard shit that we're all experiencing differently because we're all different people, different walks of life, different financial things, different families, all of that. And I, I think without that community piece behind our work, it would be really difficult to keep moving and holding space for individuals, so I hope we are creating a culture that is somewhat therapeutic while also like - back to my coach mindset - that is both holding space and challenging clinicians so that support is both pushing and holding at the same time.
Sam: Yeah, absolutely. I mean, I think about the importance of just human psychology, the importance of having some structure, right? So we know what success can look like at a practice, so we know what our upward trajectory is, while also allowing for as much autonomy as possible. I think this is something I speak to a lot in the hiring process that we have done really well, from my perspective, is having as much flexibility as possible. So acknowledging that a lot of clients want evening or weekend hours, but that clinicians get to decide where, what that looks like for them, and they get to decide when they're available in those evenings, if they want to do weekends. And you know, like giving folks that autonomy allows them also to identify, how do they want to show up as a clinician? How can they best show up as a clinician? I am not a morning person, and so I don't have clients early in the morning, and we have clinicians that love the mornings and cannot work in the evenings. And I think if we had a set or regimented schedule, we would be - folks would be selecting out, because that isn't how their brain works. And so we're trying to be as inclusive as possible, acknowledge people are caregivers, and so they might have to have an afternoon off or a couple afternoons off to care give and that flexibility is really important, also for increasing access for clinicians.
Sara: Totally, yeah, which is a tricky thing too, right? And I think that's the tricky thing of hiring and solidifying a new clinician and supporting them of like, hey, we're not going to force you to work at night, but there are going to be clients requesting that time. And so let's work through what that might look like of like, can we do one night a week to start, and then eventually we move those clients right? And that's where I also feel, where we have that solid supervision support of like, we have very, very objective supervision, right? We have somebody who's really good at working through that clinical stuff of scheduling and treatment planning and being on the nose with diagnoses, and, like, really feeling through that in terms of being values aligned and also having to diagnose. And then we have you who's, like, reflective and growth set minded in terms of, like, hey, how are you doing? And how is this client pushing you, and what's going on here. And really like opening that piece up of the clinical side of things, right? And I, yeah, I think flexibility and autonomy is a huge piece of our culture, while also figuring out structure and boundaries. And like, we show up Tuesdays at noon, and we have very set themes for our meetings and what we are talking about and making sure we are holding ourselves accountable to and I think that's been really cool to watch us grow into in terms of, like training and exposing ourselves to different things that we might not be comfortable actually working with in a clinical sense, but it's important we are exposing ourselves to that.
Sam: Yeah, yeah, absolutely. And I think it is worth mentioning that a lot of the structures that we've put in place came out of direct feedback from staff around what was working, what wasn't. When, you know, at the height of the pandemic, there were, what eight offices and folks weren't able to use any so the model of the practice shifted considerably. And therefore the needs of clinicians really shifted. And so that also speaks to the fact that feedback isn't just something that we look for, but something that's become such a critical aspect of the practice since that's where a lot of our growth has happened.
Sara: Absolutely, yeah. Yeah, that's been huge. And I think that's, that's a piece that I like to hit home a lot of boundaries are important. Boundaries are a thing. We are going to make decisions that, yes, at the end of the day are financially, taking care of the business, and then the community, and then the individuals within that community, and feedback is literally the only way that we move and grow and shift.
Sam: Yeah, absolutely. When we think about folks joining private practice for clinicians who are considering going into a group practice, maybe after working independently, right like they start in, they start on Headway, and then they're realizing that things are feeling a little bit siloed. They want more support in their growth. What do you think they should be thinking about or considering, as they are looking at practices in Chicago?
Sara: There's a lot, I think. And I want to bring back the collective piece, which I am not very privy to that information, but I know there are collectives out there that are supporting solo group practices, and those collectives are built out in different ways, in terms of taxes and billing and all of that, and I think that's a lovely thing for people out there and so will keep you in solo practice. I think, in terms of finding and sifting through all these group practice job ads, I think it's important to really hone in on culture fit in terms of like, almost similar to finding friends in your adulthood, right? Like finding friends as adults is really hard, especially in these times where we live in this hybrid remote world and we're trying to connect with people, right? And as therapists and as clinician colleagues, I think it is really important to ask questions and push back on things that don't make sense, not necessarily argue and but more of like, tell me more about this piece of your practice. Like, how, what does autonomy mean, right? And I think the term entrepreneurial always comes up in our interviews and explaining what group practice is like, because there is this need to be entrepreneurial. And the difference between entrepreneurial on your own right, you've been practicing on your own. You've been doing all of your own marketing, if you will. A lot of it's been word of mouth, or you've been awkwardly navigating Instagram. Sorry, I inserted awkwardly. Cause that’s how I feel about it, which there are a ton of therapists out there doing well with their Instagram marketing and like, more power to them. Content creation is difficult.
The difference of entrepreneurial on your own versus entrepreneurial and group practice is that you have a full support team behind you, and you get to see what that messaging is before you enter the group. I think it's really important to go through what is that messaging, right? Like, oh, what is Room to Breathe putting on their Instagram? What are they putting on their LinkedIn, which we're really bad at. What are they offering outside of individual services? And can I join that to get a feel for what's going on there before entering the community? Right? Like, come to a Room to Breathe class. Do a workshop. Go to, like Centered. We've taken their CEUs a lot. Go to one of their CEUs, engage. There's so many opportunities to engage with a private practice before joining. And I think then the next piece of joining a group practice after being an individual practitioner is like really asking yourself, what is it that I am craving, and is that something that's offered as a group. Like, obviously the group community is there, but what aspects of it, right? So, supervision, group supervision, consults, trainings, like, where am I missing out on a need?
And then I also think…I want this to come off well, but it might not. I think checking our egos as therapists is always really important. And I imagine going from running your own practice to joining a group could almost be impossible to check your ego in terms of, like, I've been running shit my own way. I do not want to do it somebody else's way, and that's valid. And I think checking our egos in terms of joining our group also means like, I get to represent myself in this group. I am not necessarily now wrapping myself in the identity of the group. I am still an individual, and I get to add something here, while also growing something in myself. And what is that thing in myself that this practice could support me in?
Sam: Yeah, yeah. I think that makes a lot of sense. You know, I think the support with the billing and administrative aspects of the practice and knowing like, what is it that you don't want to take on, and recognizing the way that group practice allows for that. I think there's going to be kind of to your point, some sort of compromise that folks have to make coming into a community. I think also assessing what are the compromises that you're willing to make, how does this align with your values and your growth, and how do you recognize that being part of a community kind of exactly to your point, means that you're not making all the decisions now, but then, as a byproduct of that, you don't have to hold everything on your own. So like holding and acknowledging the dialectic of that sounds really important.
Sara: Totally, yeah, the administrative piece completely shifts.
Sam: Yeah, yeah, absolutely.
One last question for you, Sara, if a therapist is listening and either feeling isolated or overwhelmed in their work in general, since, especially as you, you know, acknowledge that we are in trying times, what would you want them to know?
Sara: This sounds like a pitch, but group practice is here to catch you in that, right, and the structure is already there in terms of the supervision, the group supervision, the consult spaces, the colleagues that are all going through the same stuff.
I also think, I mean, Illinois is an at-will state like there's so many opportunities to join different practices. And I hate saying this, because I don't want people to leave, but you can leave and go to different practice, and there are a lot of lovely practices out there, but like, similar to my belief that you can't - like therapy is not a one size fits all. You are not going to jive with a therapist like the hard reality of going out and finding a therapist is that you're not going to find a good fit off the bat, maybe you are and that's wonderful, but finding a “good” therapist subjectively to you and your needs in that season of life and growth and healing that you're in that takes hard relational work, and that is the same thing for finding a practice, a collective, a community, that is going to support that growth in your season and asking questions and experiencing the things that each practice is putting out there and the people that are there is super important, which is why I love…one of our interview processes is actually just meeting with somebody that is not in leadership that has just rather recently joined or similar in practice, to the person we're interviewing like it's so important they connect with them so they can ask the questions that they might not want to ask somebody in leadership.
Sam: Yeah, absolutely. I know we say this in the interview process, but it really is as much about goodness of fit for a candidate as it is for us, especially when we think about being part of a community driven practice where you're getting that consultation, you're getting that support, you're having and building those relationships. So if you have to take medical leave, suddenly you're supported in that process and not trying to work that out while you're also experiencing a crisis, right? But as a result of that, it's a lot of investment, and we're looking for folks who really want to experience that growth through training, and supervision, and consultation.
Sara: Yeah.
Sam: All of the things that I think make community-driven mental health practice and private practice really unique.
Sara: Yeah, for sure.
Sam: Awesome. Any last words of wisdom? I asked Kelsey this last coffee talk.
Sara: Words of wisdom? Don't judge a book by its cover, meaning, like, don't judge a practice by its job ad. If… if you are drawn to a practice based on something, seek more answers. Right?
Sam: Beautiful.
Sara: Like, financially, we all want…We all want to be, like, just totally supported financially, and that is an important piece for every practice. I believe all practice owners want their therapists to be financially supported. And there is so much more to that that needs to be explored before just going by a job ad.
Sam: Thank you, Sarah, for taking the time to talk with us about the trials and tribulations of hiring, as well as the beautiful and unique aspects of private practice.
If folks have any questions for Sara, they can get in touch with you via email at sarah with no H, S-A-R-A at room to breathechicago.com, or you can get in touch with me, Samantha, at RoomToBreatheChicago.com. Thanks, y'all, take care.
