Sliding Scale Without Sinking Your Practice
A sliding scale works best when it's in the budget, not when it’s a case by case, on the fly decision. Decide in advance how much reduced-fee work your practice can carry, write down the criteria, and apply them the same way every time. Without those three things, a sliding scale quietly drains revenue and lands unevenly. It usually favors the clients who are most comfortable asking.
When It's Not Working: Letting a Clinician Go Without Betraying Your Values
Letting a clinician go can fit your values if three things are true: they knew the expectations and had a real chance to meet them, their clients are protected through the transition, and they leave with their dignity intact. Most of what makes a separation ethical happens months before the conversation. What usually goes wrong isn't the decision. It's the delay.
How to Choose a Business Coach for Therapists (and When You Shouldn't Hire One)
Most therapists who ask me whether they should hire a business coach are starting one question too late. The better first question is narrower: what exactly is stuck, and is a coach the right person to unstick it?
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.
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.