Solo to Group: Systems You’ll Want in Place Before You Grow

Scaling from a solo practice to a group practice is a beautiful kind of pressure. You’re not just taking on more clients—you’re taking on more responsibility: documentation consistency, privacy, clinician support, payroll, and the operational clarity that keeps a team steady.

Most group practices don’t struggle because the clinical work is weak. They struggle because the practice owner becomes the human glue holding everything together: policies in their head, billing rules in their inbox, supervision in a spreadsheet, and client communication scattered across tools. When the practice grows, that invisible glue becomes brittle. The "I'll just tell them" method of management stops working when you have three people to tell.

Who this is for

This guide is for solo practice owners who are on the verge of hiring their first clinician (W2 or contractor) and want to avoid the "scaling chaos" trap. If you are drowning in referrals and thinking "I need help," read this first.

What you’ll walk away with

You’ll get a comprehensive 7-point systems checklist that covers the unsexy but critical operational backbone of a group practice—from standardized documentation and transparent billing policies to security protocols that satisfy HIPAA.

1) Documentation that’s consistent (and defensible)

In solo work, your shorthand may be perfectly clear to you. You know what "client anxious re: work" means in your context. In a group practice, documentation becomes a shared language—important for continuity of care, quality oversight, and risk management. If you get audited, or if a clinician leaves abruptly, you can't rely on "I know what I meant."

You need to put in place a standard note framework. Whether it's SOAP, DAP, or GIRP, pick one and enforce it across the board. Set clear expectations for what "complete" means. Similarly, standard templates are crucial. Create uniform intake packets, treatment plans, and discharge summaries so that every client chart looks the same, regardless of which clinician they see.

A formal documentation policy is also necessary. Define timeliness, for example, stating that "All notes must be signed within 48 hours of the session." Define co-sign rules for pre-licensed clinicians and how to handle clinical exceptions, such as requiring a safety plan to be completed immediately in the chart if a client reports suicidal ideation. Finally, establish internal QA. A light quality assurance cadence, like a monthly sampling of three random charts, focuses on alignment rather than punishment, protecting both your license and your business.

2) Policies clients actually understand

Group practice reveals every unclear policy because clients compare experiences. If Clinician A waives every late fee and Clinician B enforces them strictly, you have a problem. You will get angry emails saying, "But my friend sees Dr. Smith and she never charges a late fee!"

Formalize your late cancel/no-show policy. Be specific about the window (24 vs 48 hours) and the fee. Is it the full fee or a flat fee? Be rigid with the policy so you can be generous with the exception, not the other way around. Your payment policy also needs clarity. Decide when payment is collected, such as "Cards are charged at midnight on the day of service." Determine if you require a card on file and what the rules are for sliding scales.

Communication boundaries are equally important. Define what is appropriate to send via message and the expected response time, for example, "We respond to messages within 24 business hours. Do not use messaging for emergencies." Also, establish a clear crisis policy. Your staff need to know exactly what to tell a client who calls at 10pm on a Friday, as this is critical for client safety and staff liability. Write these policies in plain language for clients in your Informed Consent and in operational language for staff in your Clinician Handbook.

3) A true “source of truth” for your team

You can't run a group practice via text message. "Hey, is the Blue Room free at 3pm?" is a text you should never have to answer. You need an operational spine.

Establish one central calendar with clear rules for scheduling, whether for room usage in-person or telehealth slots. Implement role-based access controls for records so staff see what they need to see without oversharing sensitive data. Your biller doesn't need to read the trauma narrative; they just need the CPT code. Use a secure channel like Spruce, Microsoft Teams, or a HIPAA-compliant Slack for internal collaboration on non-urgent coordination. Finally, define how tasks and handoffs work. Determine how referrals get assigned and who tracks treatment plan due dates. If you rely on sticky notes, you will lose clients.

4) Billing and money flow you can explain on one page

The most common growth pain is financial ambiguity: unclear rates, unclear responsibility, unclear processes. Money friction destroys trust faster than anything else.

You need to decide who owns billing actions. Does the clinician submit the claim or superbill, or does an admin do it? If the clinician does it, are they paid for that admin time? Clarify your compensation model. Is it a split (60/40), a flat rate, or a salary? How are adjustments handled, for instance, if insurance claws back a payment 6 months later?

Be honest about your cost structure. Many platforms charge you extra for every clinician you add. For example, TherapyNotes charges around $59 per month for the first clinician plus $30 per month for each additional one, plus transaction fees for claims. SimplePractice charges per clinician and locks features behind higher tiers. Soli uses a flat subscription model so your costs don't balloon as you add staff.

5) A repeatable onboarding path

“Here’s your login—good luck” is how group practices accidentally build inconsistency. If you don't train them, they will just do whatever they did at their last job, which might have been terrible.

Create a 2‑week checklist for new hires. Start with security basics: device encryption check, password manager setup, and MFA enablement. Move to documentation training: show them "good" and "bad" examples of notes and watch them write a mock note. Establish a supervision cadence, defining when you meet, how to prepare, and the format. Clarify scheduling norms, including availability rules and cancellation handling. Finally, walk them through the billing workflow, showing them exactly which buttons to click and when.

6) Security and access control that matches reality

More people plus more devices equals an increased risk surface. You are no longer just securing your own laptop; you are securing your employee's laptop, their phone, and their home WiFi habits.

Establish a minimum baseline for security. Use role-based permissions to give staff access only to their clients. Do not give everyone "Admin" access just because it's easier. Make Multi-Factor Authentication (MFA) mandatory on all online services like your EHR, Email, and Google Workspace. Require full-disk encryption (FileVault/BitLocker) on any device used for work; this is non-negotiable. Create an offboarding checklist to revoke access, rotate shared credentials, and confirm data deletion when someone leaves. HHS explains that the HIPAA Security Rule sets administrative, physical, and technical safeguards. Use that framework as the backbone for your practice policies.

7) A “when things go wrong” plan

Write down your playbook for the bad days. When you are in crisis, you don't want to be making policy.

Plan for clinician departure: Who tells the clients? Is it the clinician or the practice? What is the script? How are records transferred? Plan for extended leave: Who covers the caseload if a clinician gets sick or goes on maternity leave? Plan for device loss: What is the reporting protocol if a laptop is stolen? This involves immediate notification so you can trigger a remote wipe if possible. Finally, plan for sudden spikes in referrals: Do you have a waitlist procedure? You don’t need a binder. You need a page. And you need it before you need it.

Common Mistakes

One common mistake is hiring before systems are in place. Bringing on a clinician to "help with the overflow" before you have a way to manage them usually results in more work for you, not less. Another mistake is the "Cloning" Fallacy: assuming your new hire will do things exactly the way you do, just because you hired them. They won't. They need explicit training. Finally, don't ignore the "Admin Creep." Forgetting that more clinicians means more admin work like payroll, supervision, and QA, not just more revenue, can lead to burnout. You need to budget time for management.

Practical Next Steps

Start by drafting your "Clinician Handbook." Start with the policies section. Even a Google Doc is better than nothing. Next, audit your software costs. Calculate what adding 1, 2, or 5 clinicians will actually cost you on your current platform. Finally, create your "Standard Note." Build the template you want everyone to use and put it in your EHR library.

The bottom line

Growth is exciting—but “scaling chaos” is a recipe for burnout. Build your systems first, and your future team will feel supported instead of stretched.

Sources

• HHS Security Rule: Security Standards: General Rules
• HHS Security Guidance: Guidance on Risk Analysis
• TherapyNotes Pricing: Subscription Options
• SimplePractice Pricing: Subscription FAQs