How We Hold ~90% Clinician Retention in a Field That Loses a Third of Its Workforce
Behavioral health loses somewhere between a quarter and 40 percent of its workforce every year. At Sprout Therapy PDX we have held roughly 90 percent annual retention across a team that grew past 40 clinicians. That gap is not a personality difference or a perks budget. It comes down to four things: pay people properly, protect the caseload, supervise for real, and take the administrative load off them.
OHP and CCO Credentialing for Group Practices: How Oregon Medicaid Actually Works
Oregon Medicaid credentialing is two separate processes and almost everyone discovers the second one late. First you enroll as a provider with the Oregon Health Authority, which covers open-card fee-for-service. Then you separately contract and credential with each Coordinated Care Organization serving the area where your clients live. Finishing step one does not get you paid by a CCO.
What Hiring an Associate Actually Costs You
The fee split is not the cost of an associate. It is one line in a stack that also includes payroll burden of roughly 15 to 25 percent on top of wages, your own supervision time at its opportunity cost, two to four months of credentialing before a single claim pays, and a ramp period where the caseload is not full. Most owners I coach are surprised by the total, and it is the surprise — not the number — that causes the damage.
Can You Supervise an Associate in Oregon? (And What It Actually Requires)
To supervise a professional counselor or marriage and family therapist associate in Oregon you need three things: an active Oregon license, 30 clock hours of post-master's supervision training, and a passing score on the Board's Supervisor Law and Rules Exam. How long you have been licensed determines which path you qualify under.
Private Pay vs. Insurance (and Medicaid vs. Private): Choosing Your Payer Mix
Your payer mix — private pay, commercial insurance, Medicaid, Medicare, or a blend — is one of the biggest decisions you'll make, because it shapes both your revenue and who can access your care. In short: private pay usually pays the most per session and is simplest to run, insurance reaches far more clients but pays less and adds admin, and Medicaid reaches the people with the fewest options. Here's how to weigh them.
W-2 vs. 1099 for Group Practices: How to Classify Your Therapists
Whether a therapist is a W-2 employee or a 1099 contractor is a legal classification, not a preference — and it comes down to control. In general, if you control how, when, and where the work is done (set schedules, require your systems, supervise the work), the person is likely an employee, not a contractor. Most group practices that want an integrated team end up with W-2 employees. Here's how to think about it.
The Clinician Onboarding Checklist for Group Practices
Good clinician onboarding covers three things: operational (access and logistics), clinical (caseload and supervision), and cultural (team and values). Get all three right in the first month and your new hire ramps faster, feels supported, and is far more likely to stay. Here's the checklist I use.
When Should You Hire Your First Therapist? (Signs You're Ready)
You're ready to hire your first therapist when demand consistently exceeds your capacity, you have systems a new person can step into, and you have enough cash to pay them before they're full. If you're regularly turning clients away or sending referrals elsewhere, that's the clearest signal of all. Here are the six signs I look for — and the one financial check to run first.
How Much Should You Pay an Associate Therapist? (Fee Splits Explained)
Most group practices pay associate therapists through a fee split, and a competitive share is often 55–65% to the clinician when the practice covers admin, billing, marketing, and space. But the percentage alone doesn't tell you whether a deal is fair or sustainable — that depends on what your share actually pays for and whether the math works for both sides. Here's how to think about it clearly, so you land on a number you can stand behind.
How to Build an Ethical, Non-Exploitative Group Practice
An ethical group practice is one where clinicians are paid fairly, supported clinically, and treated as people rather than revenue units — and it can absolutely still be profitable. In fact, the two reinforce each other: when clinicians are well cared for, they stay, they do better work, and clients get better care. I've built this in real life. At Sprout Therapy PDX, we've held roughly 90% annual staff retention in a field where 50% turnover is common. Here's how to grow without exploiting the people who make it possible.
How to Hire Your First Therapist for Your Group Practice
Hiring your first therapist is the moment a private practice becomes a group practice — and the moment your job quietly shifts from clinician to leader. Before you post a job, do three things: systemize how your practice runs, get clear on what you can actually afford to pay, and define exactly who you're looking for. Rushing any of those is the most expensive mistake I see new group-practice owners make. Here's the full path, from readiness to a clinician seeing clients.
How to Start a Group Therapy Practice in Oregon: Licensing, LLC & Payer Basics
Starting a group therapy practice in Oregon comes down to four things: making sure your (and your clinicians') licenses are in order, choosing and registering a business entity, getting credentialed with the payers you want to accept, and understanding Oregon's specific rules for Medicaid and behavioral health. Oregon does a few things differently than other states — especially its coordinated-care Medicaid system and a Certificate of Approval requirement — so here's what to know before you build. I've walked this path myself building Sprout Therapy PDX from solo to 40+ clinicians, and I'll flag the Oregon-specific traps along the way.