How to Peek Out From Behind the Mountains: A Guide to Independent Practice in the Platform Era

Private practice has a middleman problem.

Companies such as Headway and Zocdoc have built enormous platforms connecting patients with healthcare providers. From a capitalist perspective, there is nothing particularly mysterious about it. They have every right to invest heavily in technology, advertising, and search visibility and capture as much of that market as they can. Patients may genuinely appreciate having large databases of providers in one place, and for some practitioners the services these companies provide may be very tempting despite the cost and tradeoffs.

The problem is what happens to independent practitioners.

Search for a therapist in a competitive market and small practices can feel like houses sitting behind mountains. The mountains are national platforms with enormous websites, sophisticated marketing, and resources individual clinicians cannot match.

Spend time in private-practice forums and you'll encounter recurring concerns about these platforms such as Headway and Zocdoc: relationships with insurers and venture capital, referral-fee models, patient privacy, workplace culture, and the long-term loss of practitioner autonomy. It is beyond my expertise to determine how well substantiated many of these claims are, and they should be taken with a grain of salt. Some have at least partial support—for example, Glassdoor includes mixed overall feedback but also specific allegations of a "bro" or "fratty" culture and sexism, noteworthy concerns in a predominantly female field. Other concerns involve inappropriate use of PHI or patient information. While I am not aware of those allegations being substantiated by a regulatory or legal authority, they raise broader questions about the commercial use of sensitive patient information. The point isn't that every criticism is correct; it's that practitioners are raising concerns worth examining as our field becomes increasingly dependent on large intermediaries.

For a new practitioner leaving graduate school or an established group, joining one of these platforms can understandably feel like warm shelter. Credentialing, referrals, billing infrastructure, and immediate access to patients are attractive when the alternative is figuring out how to build a viable practice from scratch. Even practitioners with serious reservations may slink toward that shelter, tail tucked, feeling like they're making a deal with the devil because financial survival comes first.

But independent practice is still viable.

We just need to get better at peeking out from behind the mountains.

1. Build Some Visibility of Your Own

You don't need to outrank Headway or Zocdoc everywhere. You need the right patients to be able to find you.

A useful website, basic SEO, and targeted Google advertising can accomplish more than many practitioners realize. In my own practice, a Google Performance Max campaign through Wix (my website platform) has produced leads at approximately $53 each, compared with the $73 per lead from ZocDoc. Those numbers won't generalize to every practice, but they demonstrated something important to me: purchasing visibility directly can compete economically with purchasing leads through an intermediary. A "Search" campaign should be even more economical, and Google consistently offers "spend $500, get $500."

Note: when I was a solo private practitioner, I did not think a website was necessary. It is possible to just use Psychology Today and direct referrals, possibly a long with Google Ads with a Lead Form or pointing toward you Psychology Today profile, but they you are spending your money to send patients to psychology today essentially advertising for them, rather than investing in your own property (website).

For small to medium practices, I particularly like the logic of a Google Search campaign. You're reaching people who are currently searching for the services you provide (while performance max shows it to anyone who has shown interest in the topic).

The setup is confusing, but doable in just a few hours:

1. Create a Google Ads account and start a new campaign.

2. Choose Leads as the objective and Search as the campaign type.

3. Start with focused, high-intent searches: "ADHD testing," "couples therapy," "eating disorder therapist," etc.

4. Send people to a relevant service page rather than a generic homepage.

5. Target the geographic area you actually serve and use negative (excluded) keywords to weed out irrelevant searches.

6. Decide what you're optimizing for. You may initially focus on clicks to generate traffic, but ultimately you want conversions—prospective patients actually contacting the practice. Change this after the campaign first optimizes clicks.

7. Set up conversion tracking early. Track meaningful actions such as calls, contact forms, emails, or appointment requests.

   
   

Google's own Search campaign guidance walks through choosing Leads, selecting Search, and establishing conversion goals. Google also emphasizes conversions and cost per conversion when evaluating whether advertising is actually producing something valuable for your business.

And get help. Google provides live (HUMAN!) support during the advertising process. They will literally set up the complex part for you. Take advantage of it, particularly when setting up and verifying conversions. Google Ads has enough menus, terminology, and changing interfaces to make an intelligent person wonder whether they've accidentally wandered into the cockpit of a 747.

And, yes, consult ChatGPT. It can help develop keyword groups, negative keywords, headlines and descriptions, think through geographic targeting and landing pages, and prepare questions for Google support.

You don't need to become an advertising expert.

There is also an important difference between renting visibility and building it. Money spent improving your website, search presence, reputation, referral network, and your own advertising expertise builds something your practice continues to benefit from. Visibility purchased through an intermediary remains dependent upon that intermediary's pricing, algorithms, and business priorities.

2. Stop Thinking Like a Solo Practitioner

One therapist competing with a national platform isn't much of a contest.

Five therapist cooperating with one another is different.

That doesn't necessarily require creating a traditional group practice. Like-minded independent practitioners can pool resources around a specialty—perhaps advertising collectively as "ADHD Treatment Specialists."

Or play zone defense.

One clinician focuses on ADHD. Another on couples. Another on eating disorders. Another on assessment. Each covers a different part of the field while sharing infrastructure and referring among colleagues when appropriate.

The same principle applies behind the scenes. Find a good insurance specialist to handle benefits verification, claims problems, and credentialing. Share EHR and administrative expenses where practical. Let one person learn advertising instead of five clinicians independently spending their Saturday afternoons deciphering Google Ads.

A "practice manager" doesn't necessarily need to be an employee with that title. It can be an owner, a clinician who enjoys the business side, or simply someone taking the lead among collaborating colleagues.

Specialization makes small practices more efficient, too.

3. Advocate for Independent Practice

Adapting to the marketplace shouldn't mean resigning ourselves to whatever marketplace develops.

The political and regulatory landscape of psychology and healthcare isn't my particular wheelhouse. But that doesn't mean practitioners shouldn't communicate their concerns to professional organizations, regulators where appropriate, and elected representatives.

Under its current pricing model, Zocdoc charges a "discovery booking" fee when it helps a new patient discover and book with a provider. The cost of this booking fee varies by specialty and location, and Zocdoc charges the fee when the appointment is booked, regardless of whether the patient ultimately attends. Beyond this base cost, Zocdoc has started collaborating and integrating with platforms like Headway, reducing the referrals to smaller practices unless you use "sponsored" results to bid, on top of your base referral fee, for higher search results placement.

This sounds an awful lot like selling a referral, not a marketing fee, which is prohibited by the APA Ethics Code and state regulations such as Pennsylvania. Zocdoc considers this a payment for the connection its marketplace helped create. I'm not going to pretend to adjudicate the legal boundaries of healthcare referral fees.

But we should be willing to ask the policy question:

Where should advertising end and paid patient referral begin?

And, more broadly:

Do we want a healthcare marketplace in which increasingly powerful intermediaries can place a toll between independent clinicians and patients trying to find them?

Regulatory change is slow. The answer doesn't necessarily involve banning any particular business model. These platforms provide services that some clinicians and patients genuinely value.

But practitioners should be heard.

Talk to professional associations. Communicate with representatives. Ask questions about referral-fee rules, patient privacy, relationships between platforms and insurers, and the increasing role of third parties in determining which clinicians patients find.

We can work within the system that exists today while advocating for a system that preserves meaningful choices tomorrow—including the choice to remain independent.

Here are some regulatory bodies to communicate concerns to:

ASPPB licensing board directory

APA Advocacy / contact information

For Pennsylvania readers specifically, Pennsylvania State Board of Psychology

Cooperation Isn't Giving Away Business

There is an obvious question about sharing strategies like these:

Why teach my competitors how to compete with me?

Because we may be looking at the wrong competitors.

The therapist three miles away certainly competes with me for some patients. But we also share an interest in maintaining a healthcare system in which independently owned practices remain financially viable.

If hundreds of independent practitioners conclude that marketing, credentialing, billing, and patient acquisition are simply too difficult and migrate to a handful of large intermediaries, something important changes.

We become increasingly dependent upon those companies to connect us with our own patients.

So considering mentoring new clinicians, and build a useful website. Learn enough advertising to make yourself visible. Share administrative infrastructure. Collaborate with colleagues. Refer to other independent practices. And advocate for policies that preserve the ability to do so.

The mountains aren't going away.

But we can help each other peek out from behind them.