Abundant Practice Podcast — Episode #696

Title: Can I Realistically Have A Private Practice If I Have A Chronic Illness
Host: Allison Puryear
Date: October 18, 2025

Episode Overview

This episode tackles an important and nuanced question: Can someone with a history of serious health issues realistically and sustainably leave an agency job, with its attendant benefits, for the world of private practice? Host Allison Puryear breaks down the practical and emotional considerations, sharing strategies for maintaining security while gaining flexibility and autonomy in private practice. The episode is aimed at therapists grappling with the push-pull of agency security versus private practice freedom—especially those managing chronic illness.

Key Discussion Points & Insights

1. Validating the Fear and Assessing Real Needs

(01:41)

• Fear of Losing Benefits Is Rational: Allison affirms that concerns about losing agency benefits are fully valid, especially in the US where many benefits are job-tied.
• First Step—Clarify Needs:
  • “Start by writing down what you currently get at your agency... look at which of those are actually non-negotiables for you, given your health history.” (02:54)
  • Actions: List existing benefits, recognize which are essential for you, and distinguish true requirements from optional perks.

2. Health Insurance Outside Agency Work

(04:06)

• Marketplace Options:
  • “There's marketplace insurance... you might find a plan that's comparable to what you've had. Yes, it can be expensive, but not as expensive as people assume, especially with subsidies. If those continue, I recommend meeting with an insurance broker...” (04:16)
• Spousal Coverage/Association Plans:
  • Options exist via a partner’s employer or professional associations.
• Compare Real Numbers:
  • Many find marketplace costs similar to agency payroll deductions when examined closely.

3. Sick Leave, FMLA, and Time Off

(05:37)

• Build Your Own Safety Net:

  • “Private practice doesn’t have built-in paid sick leave... so here’s the mindset shift: you get to build in your own safety net.” (05:40)

• Practical Steps:

  • Create a 2-3 month emergency fund for sick leave.
  • Structure session fees to account for a certain amount of unpaid time off yearly.
  • Consider short-term disability insurance to protect income.

• FMLA in Private Practice:

  • “FMLA doesn’t pay out money. It just holds your position for you... It’s your business, so you don’t have to worry about that part. No one can fire you.” (06:50)

4. Life Insurance & Retirement: You Can DIY

(07:47)

• Replace Agency Perks Yourself:
  • “You can get term life insurance independently. You can set up a SEP IRA or a solo 401k... that actually gives you more flexibility and potentially better tax advantages...” (07:50)

5. Work Less, Earn More: The Case for Premium Fees

(08:21)

• Fewer Hours, Better Health:
  • “Most find that working far less, like 15 hours a week, means they have fewer health flare ups and they have more time for appointments, their own appointments... they make way more seeing those 15 hours per week of clients than they did working full time.” (08:25)
• Session Pricing Example:
  • $250 per session x 15 clients/week = $172,500/year (accounting for six weeks off).
  • This supports maintaining health while meeting financial goals.

6. Transition Options: Hybrid & Easing In

(09:13)

• Hybrid Approach:

  • “Some people do a hybrid, keeping nonprofit work for the benefits while building their practice. That way they can kind of test the waters and see if private practice income feels stable enough to replace the benefits cushion.” (09:16)

• Save All Side Practice Income:

  • Allison strongly suggests saving all private practice income to accelerate a full transition.

• Or—All-In, with a Cushion:

  • Build at least a six-month financial buffer and secure disability insurance before leaping.

• No One-Size-Fits-All:

  • “There’s really no moral high ground on either option. The best choice is the one that keeps you physically safe and emotionally at peace.” (09:54)

7. Emotional Reality of Chronic Illness & Entrepreneurship

(10:03)

• Different from Usual “Business Fears”:
  • “Fear about health is different than fear about marketing or getting clients. This isn’t just like, What if I fail? This is, What if I get sick again and I can’t provide for myself?” (10:07)
• Find What Makes You “Safe Enough”:
  • Not perfectly safe, but secure enough emotionally and financially to make the leap when/if ready.
  • “Your nervous system deserves to be a part of this decision, not just your business brain.” (10:45)

8. Concrete Action Steps & Reassurance

(10:52)

• Recap of Steps:
  • Get clear on your must-have benefits.
  • Price out private practice alternatives.
  • Build a safety net for emergencies and downtime.
  • Try part-time practice or hybrid work if nervous about a full leap.
  • “Don't shame yourself for valuing security. It is wise. It's not weak.” (11:02)
• Freedom to Change Your Mind:
  • “If you try private practice, it's too stressful without benefits, agencies will still be there. They'll still be hiring.” (11:03)

9. Community & Resources

• Free Worksheet:
  • This episode’s worksheet addresses plans for managing chronic illness and working through fears (link in show notes, or DM “sheets” via social).

Notable Quotes & Memorable Moments

• On Taking the Leap:

  “You don't have to make this decision overnight. You are allowed to ease into private practice.” – Allison Puryear (09:11)

• On Fear and Safety:

  “Safe enough. Maybe that's a certain dollar amount saved. Maybe that's having a disability policy in place. Maybe that's testing your private practice part time before quitting your nonprofit job. Your nervous system deserves to be a part of this decision, not just your business brain.” (10:40)

• Permission to Value Security:

  “Don’t shame yourself for valuing security. It is wise. It’s not weak.” (11:02)

• On Autonomy:

  “Private practice gives you the autonomy, better income potential, and control of your time. Agency work gives you structured benefits and predictability. You get to decide which makes... your health and your life best right now.” (11:01)

Timestamps for Important Segments

| Time | Topic | |:----------:|:-------------------------------------------------------------------------| | 01:41 | Acknowledging the fear of losing benefits and why it matters | | 02:54 | How to clarify which benefits you really need | | 04:06 | Exploring health insurance alternatives outside agency work | | 05:37 | Building your own safety net for sick leave and paid time off | | 07:47 | How to replace life insurance & retirement benefits independently | | 08:21 | Why working fewer hours (at higher rates) supports chronic illness | | 09:13 | Hybrid transitions & saving side-practice income | | 10:03 | The unique emotional reality of chronic illness in entrepreneurship | | 10:52 | Summarizing concrete steps & motivational reassurance |

Final Thoughts & Resources

This episode is a compassionate, step-by-step walkthrough for any therapist with chronic illness who is considering private practice. Allison offers practical advice, genuine reassurance, and points to resources (such as a free worksheet) for continued support. She emphasizes that you can build your own safety net, transition at your own pace, and always have options—reminding listeners, “the decision is not permanent.”

For more hands-on support and resources, visit abundancepracticebuilding.com or check out the Abundance Party membership.