By: Jeann Linsley
Fall 1996, Vol. 3, No. 2
The Business of Starting a Private Practice
by Jeann Linsley, CSW
You've just completed your second year in your first post-graduate social work job. The paperwork is killing you. Supervisors are hounding you. Your salary is barely supporting you.
You begin making inquiries about private practice, starting your own business so that you can finally free yourself of the frustrating constraints of agency work.
You have to get on a managed care panel, says one colleague. But the panels often are jammed to capacity, says another. And you probably won't get on the panels, because you don't have enough experience, says another seasoned private practitioner.
You have to have lots of supervised agency work, take special courses, and be supervised for a specific number of hours by a licensed mental health professional or social worker. And fiscal cutbacks are making it harder to find quality supervision in agencies.
If you've just received your master's degree, you might be able to open a private practice legally-if you live in Minnesota or New York. But even in Minnesota, laws are getting stricter. And insurers might not reimburse you, because of your inexperience. Besides, professionals in the field discourage brand new graduates from going immediately into private practice.
Is this how Sigmund Freud started?
The reality of the 1990s is that social work graduates who are thinking of entering private practice will have to clear not only the hurdles of managed care, but will face all the usual challenges of starting their own businesses and obtaining the supervision and credentials necessary for a private practice.
Before even thinking about managed care, new clinicians need to start by finding out what credentials and training are required or recommended, say experienced practitioners.
Most states require new private clinicians to have at least two years of supervised post-master's experience, says Elise Young, of the National Association of Social Workers headquarters in Washington, DC.
Some practitioners recommend even more training.
Sheila Peck, LCSW, a private practitioner and a consultant on practice-building for clinicians, recommends that anyone starting a practice have at least five years of supervised agency practice.
"We discourage people coming right out of school," says Peck, whose private practice is on Long Island, NY.
Peck, who is public relations chair for the New York State Society for Clinical Social Work and serves on the marketing and public relations committee of the National Federation of Societies for Clinical Social Work, Inc. (NFSCSW), also emphasized the importance of credentials, even though in some states, including New York, these are not an absolute requirement for a private practitioner.
Credentialing requirements vary from state to state, and some states are making their requirements stricter, says Young.
New York does not require a specific license for private practitioners, but some professional organizations recommend the BCD, or Board Certified Diplomate, an advanced clinical credential awarded by the American Board of Examiners in Clinical Social Work. To obtain the BCD, a clinician must have six years of supervised experience and must pass a test and pay a fee, according to Peck.
In New York, the Federation also recommends that private practitioners have an "R" number, which documents that a Certified Social Worker has had six years of supervised psychotherapy experience. All insurance companies in New York State that provide mental health coverage must cover Certified Social Workers who have an "R" number.
Other states have varying requirements or recommended levels of training and credentials. In California, you can't hang out a "counselor" shingle without first having two years of post-master's degree experience under the supervision of a licensed social worker or a licensed mental health professional, passing an exam, and taking special courses in child abuse/neglect, human sexuality, and other subjects, says Young.
In Minnesota, the required credential for private clinicians is the Licensed Independent Clinical Social Worker (LICSW). To obtain that license, private practitioners must have a minimum of two years of post-graduate employment, also under the supervision of a licensed social worker, according to Chad Breckenridge, president of the NFSCSW.
Minnesota law does not allow new master's degree graduates to engage in private practice without having the two years' experience, Breckenridge says. However, insurers might be reluctant to reimburse these newcomers, and a recent case before the Minnesota licensing board questioned the ethics of allowing new graduates to practice, he says.