Abundant Practice Podcast

Episode #700: Private-Pay Group Practice Tips, feat. Kelly McCullough

Air Date: October 29, 2025
Host: Allison Puryear
Guest: Kelly McCullough, Private-Pay Group Practice Owner

Episode Overview

This episode focuses on actionable strategies and mindset shifts necessary for therapists considering opening or expanding a private-pay group practice. Allison Puryear and Kelly McCullough dive into practical marketing, networking, specialization, compensation philosophies, therapist retention, and debunk myths about “passive income” in group practice ownership. The discussion is personal, honest, and supportive, emphasizing the realities and rewards of group leadership.

Key Discussion Points and Insights

1. Group Practice Origin Story and Early Lessons

• Solo First, Group Second:
  Kelly emphasizes the importance of confidently practicing solo before starting a group:

  "...don't do a group unless you've had at least two years of being solo and feeling really good about being solo under your belt." (Kelly, 03:16)

• Transition to group began as a means to cover for maternity leave, snowballing into a stable team of four clinicians (03:26–04:00).
• Kelly continues to see a sizeable caseload, enjoying direct clinical work (04:04).

2. Marketing a Private-Pay Group Practice

• Referral Relationships & Niche Networking:
  Kelly finds the most effective referrals come from relationships with providers whose patient populations are adjacent but not overlapping (04:21–05:42).
• Hosting Low-Cost Networking Events:
  • Events are personal, welcoming, and run on a low budget (Costco pastries, free venues).

  "I kid you not, Allison, I have found a way to host 30 person networking events for under $30." (Kelly, 05:38)

  • Emphasis on making genuine connections—networking "should really feel like you're making friends" (Allison, 06:45).

3. The Role of Specialization/Niche

• Niching Works, Even for Groups:
  Both agree it’s easier to fill a private-pay group when the practice is specialized (kids, anxiety, OCD, CBT/ERP, in Kelly’s case) versus a “generalist” group (09:08–10:27).

  "I've only hired people that are really into working with kids ... that's a non-negotiable." (Kelly, 09:36)

4. Modality and Client Preferences

• In-Person vs. Telehealth for Kids:
  • In San Diego, almost all families still prefer in-person therapy for children/teens, with video as a backup option (11:08–11:46).
  • There’s a greater pull toward in-person for youth than adults (11:26–11:42).

5. Mindset Shifts in Group Practice Ownership (and Money)

• Valuing Clinical and Leadership Time:
  • Crucial to recognize not only the worth of clinical hours but also the “behind the scenes” admin/leadership hours (12:37–14:32).

  "I also deserve to draw some sort of revenue ... just for doing all the behind the scenes, the coordinating, the orchestrating, the generating referrals ..." (Kelly, 14:06)

• Let’s Talk Margins:
  • Allison points out the widespread misconception that group owners are "rolling in it":

  “As a group practice owner myself, I want you to understand, like, the group practice owners aren't rolling in it unless they have like 100 people working for them..." (Allison, 15:38–16:31)

  • Most small group practices have thin margins after taxes, compensation, and overhead (18:08–18:37).
• Passive Income Myths:
  • Kelly and Allison debunk the myth that group practice income is "passive":

  “Does [passive income] ever exist anywhere? Like, it certainly doesn’t exist in group practice.” (Kelly, 16:39) "I think passive income is as real as get rich quick schemes are." (Allison, 17:01)

6. Leadership and “Being the Boss”

• Leadership as Mission-Driven:
  Don’t open a group as a “side-hustle”—you need a genuine passion for leading people (19:06–19:16).

  "Don’t do a group practice unless you really have a passion to lead." (Kelly, citing Allison, 19:08)

• Managerial Skills:
  • Owning the “boss” role requires giving direct feedback and maintaining healthy boundaries, even when uncomfortable (20:12–21:23).

  "...that's part of being a boss, is being accountable and holding people accountable." (Allison, 21:15)

  • Group owners must maintain clarity and consistency in expectations to foster a healthy workplace (21:38–22:38).

7. Finding Community as a Group Practice Owner

• Peer Support is Vital:
  • Kelly sought out a support community of other group owners for mutual aid—a necessity, as the role can feel isolating (22:38–23:53).
  • No one else (not employees, spouse, or solo therapist friends) has quite the same perspective and understanding.

8. Personal Growth Through Business Ownership

• Kelly highlights how repeatedly putting herself in “uncomfortable” networking and leadership situations helped her naturally overcome significant social anxiety (24:22–24:57).

  "I used to be so socially anxious ... now I feel like I can just talk to anyone." (Kelly, 24:22)

9. Workforce Retention Strategies

• Intentional Smallness & Quality of Life:
  • Kelly intentionally keeps her practice small to avoid “revolving door” burnout and to focus on therapist well-being (25:43–26:28).
  • Retention centers on creating strong working conditions, community, and growth:
    • Community/social/professional events
    • Ongoing supervision and consultation (with outside child psychiatrist)
    • Tiered compensation with clear advancement pathways (28:10–28:31)

  “Therapist working conditions are client healing conditions, but also therapist retention conditions.” (Kelly, paraphrased, 25:43–26:28)

10. Memorable Quotes

• "[Networking] should really feel like you're making friends." (Allison, 06:45)
• "Does [passive income] ever exist anywhere? Like, it certainly doesn’t exist in group practice." (Kelly, 16:39)
• "Don’t do a group practice unless you really have a passion to lead." (Kelly, citing Allison, 19:08)
• "Owning the boss role is, for me, a new persona... What kind of boss do I want to be?" (Kelly, 19:20)
• "Therapist working conditions are client healing conditions, but also therapist retention conditions." (Kelly, paraphrased, 25:43)
• "I used to be so socially anxious ... now I feel like I can just talk to anyone. And I do, all day long." (Kelly, 24:22)

Segment Timestamps

• Kelly's Origin Story – 02:31–04:00
• Private Pay Group Practice Marketing – 04:21–07:42
• Importance of Niche – 09:08–10:27
• In Person vs. Telehealth – 11:08–11:46
• Mindset & Money (Leadership Value) – 12:02–14:32
• Margins & Passive Income Myths – 14:32–18:37
• Managerial Realities – 19:06–21:23
• Boss Boundaries & Leadership – 21:23–22:38
• Peer Community for Owners – 22:38–23:53
• Personal Growth through Practice – 24:22–24:57
• Therapist Retention – 25:29–28:31

Further Resources

• Kelly McCullough’s practice: La Jolla Therapy Center
• Allison’s membership and resources: Abundance Party
• Therapist support: help@abundancepracticebuilding.com

For therapists thinking about group practice:
This episode is essential listening for the honest realities, strategies, and personal shifts needed to build and lead an effective, sustainable, and joyful private-pay group practice.