Pros and Cons of Having Employees
Shortly after I signed the lease to my private practice location I was offered a contract in a small charter school. I was also committed to other contracts, so I was not going to have time to meet the needs of the school by myself while building a practice to make use of the space I just leased. I hired an OT assistant and had to learn how to be a boss really fast.
Fortunately, I was lucky enough to get into a free SCORE event in which attorneys were providing some free advice. I learned a lot from that! I also ended up hiring the attorney to create some of the documents I needed and to make sure that I had everything in place to be ethical and legal.
Often business owners choose to hire therapists as a contractor, or 1099 provider, but this is often not appropriate to meet the legal definition of a contractor. They often justify hiring this way because they have worked in that position. However, just because you worked a position that way does not mean that the business owner did the right thing. You can read the IRS definition of a contractor versus employee here to make sure you understand the difference.
Some benefits to having employees include:
earning more income
Of course this is the primary reason to have a therapist as an employee; they can bring in additional income.
having collaborators
As the sole practitioner in your business it can be fairly lonely when you don't have other therapists to bounce ideas off of. It can be helpful to have someone else around to discuss cases.
Some challenges of becoming an employer
You need to know and understand legal requirements in your state to be an employer
You have to file and pay payroll taxes
In some ways it can be like parenting. You may have to navigate personalities, “sibling” rivalries, difficulties when they don't follow expectations, etc.
You may be in the uncomfortable position of having to let someone go if they aren't performing according to expectations.
There are additional expenses you may not realize when you hire, such as the cost to add them to your EMR, providing them an email address, increased liability insurance, workers compensation insurance, buying supplies for them to use, etc.
You need to keep the census up and at a rate to keep them busy
There may be a gap of time between hire date and the time they can see clients while you are getting them in network with insurance.
As the sole practitioner in your business you may not have to think about having written policies and procedures, but this is a must if you have employees so they know their expectations
The list of challenges exceeds the list of benefits and not everyone wants to deal with the challenges. Not all of the challenges in that list are ongoing concerns, though, just things that need to be set up initially. There is most definitely a learning curve to being an employer, and hiring can be challenging in some markets, so you have to decide if those challenges are worth the potential additional income.
