Managing Third-Party Contractor Relationships in Your Private Practice

Contractors and Vendors Bring Expertise, You Bring Leadership

There comes a point in almost every practice owner’s journey when you realize you can’t do everything yourself.

Maybe it’s the insurance claims piling up, or the bookkeeping you keep meaning to catch up on. Maybe it’s a website that stopped reflecting who you’ve become, or marketing that’s gone quiet enough that a referral had to point it out.

So you do what many business owners do, you hire someone.

A biller. A bookkeeper. An SEO consultant. A website designer. A social media manager.

Initially, there’s relief. Finally, someone else is going to take care of this!

But months later, things aren’t magically taken care of. You feel frustrated: the contractor doesn’t seem proactive enough, the website still isn’t generating calls, marketing feels disconnected from your practice, reports are confusing, and it doesn’t seem like any progress has been made.

The conclusion may be:“I guess I hired the wrong person.”

Sometimes that’s true. But in my experience as a consultant to psychotherapy practice owners, something else is happening much more often. The owner expected the contractor to own the problem.

This is one of the least recognized leadership pitfalls in owning a psychotherapy practice. We spend years becoming experts in clinical work, but almost no one teaches owners how to manage and direct the expertise of others. Hiring a contractor doesn’t reduce your responsibility. It changes the nature of it.

Working effectively with contractors: what you bring, and what your contractor brings

A skilled contractor brings methods, experience, and recommendations. You bring something only you can provide: a vision for the business, values, priorities, timely decisions, and accountability for results. The most successful owner/contractor relationships happen when both people contribute what they uniquely bring.

The healthiest owner/contractor relationships have a lot in common with your other personal and professional relationships. They don’t need to be complicated, but they do work best when you (the owner) stay engaged. That engagement is what drives success, both before the work begins and once it’s underway.

Before you start work with a contractor

Choosing the Right Contractor for your Private Practice

Before any work begins, you need to determine not simply who seems knowledgeable, but whose expertise matches the problem you’re actually trying to solve. A referral from a fellow owner may build your confidence in a vendor, but only you can determine whether you can work with this person and whether what they offer is right for your practice. Credentials and referrals matter, but so does asking good questions, checking references, understanding how the contractor works, their experience with your problem or need, and clarifying expectations before the engagement begins.

The relationship starts in the back and forth before the contract is signed.

Clarify the Problem & Outcome: Getting the Most From Contractors

This, I think, is where many projects begin to unravel. You need to be confident you’re solving the right problem, with a clearly defined outcome. Every contractor relationship succeeds or stalls based on how well you’ve defined the problem to be solved and the outcome desired.

If you think you need more inquiries and hire someone to improve your SEO or run Google ads, make sure that’s actually your problem, and not weak conversion of the inquiries you already get. It helps to know the scale of the problem, too: how many more requests for service do you actually need?

More is not always better. If you run a small practice with three or four therapists whose caseloads are partly full, you may not need an ad budget of $1,000 a month plus another $500 to manage it, especially if it takes three to six months before those ads start reaching the right audience.

Before you engage any contractor, ask yourself one question: How will I know if this project has been successful? Note the symptoms you’re reacting to: fewer inquiries, confusing financials, a website that isn’t working. A good contractor will help you dig into the symptoms to define the underlying problem, and that problem is what shapes a real goal, one you can get specific about, track, and measure against a starting point. Without that shared understanding, neither of you will know whether the work is succeeding.

What Only the Owner Can Do

Good contractors contribute ideas and expertise, not just labor, but they don’t know your practice the way you do. 

• Your bookkeeper cannot decide what financial information you need to manage your practice.
• Your insurance biller cannot determine your reimbursement strategy.
• Your website designer cannot decide how you want to position your practice.
• Your SEO consultant cannot determine which services you most want to grow.
• Your social media manager cannot define your brand.

Those are ownership decisions.

The purpose of hiring a contractor isn’t to avoid ownership decisions. It’s to free you from doing work someone else can do better so that you have more time and energy to do the work only you can do.

That means making decisions about your strategy, your service mix, your payer mix, your hiring plans, your compensation model, your financial priorities, and the long-term direction of your practice.

Your contractor brings expertise in a particular discipline:

• A great SEO consultant teaches.
• A great biller advises.
• A great bookkeeper points out trends.
• A great website designer challenges assumptions.

They’re thinking professionals. They’re contributing and thinking from within their discipline.

Only the owner can integrate all of those disciplines into a coherent business strategy. You remain responsible for leading the business. The most successful contractor relationships happen when each person stays in their lane while working toward the same outcome.

Why Good Contractors Don’t Fix Struggling Practices

Some contractors are simply better than others. But I’ve also watched very capable ones work inside conditions that made success almost impossible.

Imagine asking an architect to redesign your dream home while you change the floor plan every week, or hiring an accountant without giving them your financial records. Many contractors face something similar: priorities shift, emails go unanswered, or no one has defined what success looks like.

Even a highly capable contractor will struggle under those conditions. The relationship doesn’t fail because the contractor lacks expertise. It fails because no one is leading the work toward a shared outcome.

Collaborating with Contractors

One assumption I hear often is that hiring a contractor means you can step away and leave the work to someone else. The opposite is usually true.

Your contractor will need information, decisions, approvals and feedback throughout the project. They’ll ask questions you hadn’t considered, introduce ideas outside your expertise and recommend approaches that involve trade-offs. Your role is to stay engaged, learn enough to make informed decisions, and keep the work aligned with your broader business goals.

Working with a contractor is less about delegation and more about informed collaboration. Both sides should keep the other informed of changes, bottlenecks, and surprises, and both should share feedback and ideas as they come up.

The most successful contractors I know don’t simply bring technical skill. They enter into a partnership with owners who know where they’re headed, remain actively involved, learn along the way and are willing to lead the relationship all the way to the desired outcome.

You remain responsible for steering the ship. Your contractor helps navigate particular stretches of water. 

Commit: Building Strong Contractor Relationships

It’s easy to treat contractors as one-off vendors brought in to complete a specific task. While that approach may get the job done, it misses a larger opportunity: building a relationship that delivers ongoing value.

As projects evolve, new challenges often surface. A contractor who understands your business can help address those secondary needs more effectively, but only if there is real in understanding and trust in place. Without investing in the relationship, you risk missing out on a reliable, knowledgeable partner.

As therapists, we recognize that strong relationships are built over time through consistent communication, shared problem-solving and deeper insights are often the product of ongoing collaboration and co-creation. Your goal is not just to complete a project, but to develop a trusted advisor who can become more instrumental and valuable as your practice grows.

Here are some tips to help build lasting partnerships with your contractor:

1. Commit to regular check-ins (weekly, biweekly or monthly as appropriate to the project or work). Develop a standard agenda for these meetings. Track open issues, next steps, bottlenecks and anticipated completion dates for key tasks.  A simple agenda for recurring meetings might include:
   • What have we accomplished since we last met?
   • What obstacles are getting in the way?
   • What decisions do you need from me?
   • What are our priorities to complete before the next meeting?
     
2. Commit to timely responses and decisions. Review the project timeline at the outset and make sure you will have time to review and provide feedback in a timely way during critical phases of review. Recognize that contractors can either guess what you want or get an answer from you. You are a part of the team and impact how fast or slow things proceed.
   
3. Commit to giving feedback and asking questions. This is a critical aspect of learning about aspects of your practice you do not understand and respecting the work of others. It is also crucial to investing in the process and building strong vendor relationships. Ignore this at your own peril. It’s a lot easier to work with someone you have an established working relationship with than finding a new vendor every time you need to address the next problem or need. 
   
4. Commit to not letting the relationship drift because you’re busy with other aspects of the practice. One of the realities of hiring contractors is that they require management. If you hire five contractors, you’ve also taken on five leadership relationships. So, commit only to the vendors and projects that you can actually take on – prioritize and sequence your projects. You probably can’t do it all at once.

Confirm: Communicating with Contractors

Rather than asking yourself what the contractor is working on, ask whether the work is producing the outcomes you agreed upon. Review the work as it progresses, not once at the end of the project. Your contractor should also keep you involved in the process and decisions needed with regular communication – not a “big reveal” at the end. Progress together is important for clarity, for your learning as well as the contractor’s learning, strengthens the partnership, and reflects your commitment.

Good contractors will appreciate accountability because it gives both parties an opportunity to adjust and incorporate new information. Progress is rarely a purely linear journey.

Long-term Value: Leading to a Shared Outcome

Learning to work effectively with non-clinical contractors is a management skill that requires moving from the mindset of a consumer of professional services to the mindset of a leader who engages professional expertise in service of a larger vision.

As your practice grows, you’ll almost certainly rely on more outside expertise, not less. Learning to lead contractors effectively is therefore not a temporary challenge, it’s an enduring leadership skill.

Slick offers and charismatic talent might make for an impressive kick-off call but, as a practice owner, you will get the greatest value from contractors when you establish clear goals, remain actively engaged, make timely decisions and continually connect each contractor’s work to the larger vision for the practice.

In the end, your contractors bring expertise. You bring the leadership.

I’m here to help you navigate the business and leadership decisions that fuel your therapy practice. Reach out to schedule a complimentary call and see if 1:1 consultation is right for you.