Sustaining Clinician Independence: Why Simplicity, Not Consolidation, Is Key to Solving the Mental Health Crisis

America’s mental health crisis is often framed as a clinician shortage problem. Demand for appointments is rising faster than availability, waitlists are growing, and burnout is pushing clinicians out of the field at alarming rates. In response, much of the industry’s attention has turned toward driving scale: larger provider networks and standardized care models that promise efficiency through consolidation. The assumption is that bigger systems are inherently better equipped to solve access challenges; but, there is risk in treating consolidation as the default solution. 

In reality, most licensed mental health clinicians in the United States still work independently. These solo or small group clinicians do not need layers of administrative oversight to deliver high-quality outpatient care. When the overhead necessitated by consolidation is applied to outpatient care, costs rise, administrative work expands, and clinicians lose the autonomy that allows them to stay focused on patients.

When independent practice becomes harder to sustain, the consequences are significant. Patients lose access to local care; employers and payers absorb higher costs; and clinician burnout accelerates. Instead of adding more layers of complexity to an already strained system, there’s a more effective solution: make it simpler for independent clinicians to run a practice, participate in insurance networks directly, coordinate care, and provide treatment.

Why clinician independence still works

Independent practice remains one of the most practical and effective ways to deliver outpatient mental health care at scale as it allows clinicians to choose who they serve, how they practice, and where they build long-term relationships in their communities. Those choices are not just preferences; they shape how care is delivered in real, everyday settings. 

That autonomy directly affects quality. When clinicians engage in evidence-based practices such as measurement-based care, they do so because they believe it improves outcomes, not because they are required to comply with a system mandate. In more consolidated environments, those same practices often become checkboxes, completed without meaningful clinical engagement. 

Access is another core component of quality. Getting the right care at the right time is foundational. When patients face long waitlists, many disengage before treatment even begins. Independent practices help to close that gap by making care available sooner and by matching patients with clinicians who meet their specific needs.

For these reasons, we should be cautious about assuming that consolidation automatically improves care. Standardization can support consistency, but layers of management and overhead do not guarantee better outcomes or clinical experiences. 

The pressures pushing clinicians out

If independent practices can deliver strong care, then why is it becoming harder to sustain? The barriers are structural, not clinical. Our healthcare system increasingly rewards provider group scale over effectiveness. Many of the pressures clinicians face stem from how care is financed and managed, rather than how it is delivered. 

Insurance contracting is one major driver. Payers tend to negotiate with large groups because it is operationally simpler; and as a result, solo and small practices are left with less leverage and fewer pathways to participate. At the same time, independent clinicians are rarely reimbursed for high-value work, such as coordinating with other providers or systems, collaborating with prescribers, or doing the additional work required to make measurement-based care meaningful. These activities take time, and time is the resource independent practices have the least to spare. 

Administrative and financial burden compounds the problem. Hours spent navigating insurance rules, billing issues, documentation, and follow-ups do not improve outcomes, yet they consume energy on top of already full schedules. When combined with the emotional demands of clinical care, burnout becomes inevitable. Financial pressure further accelerates attrition, particularly for early-career clinicians. Student debt is high, reimbursement often lags behind the cost of living, and running a practice carries real risk. Many clinicians move into employment models for stability, while others leave the profession entirely.

The system does not explicitly mandate consolidation, but it consistently nudges clinicians in that direction. If independent practice is to remain viable, reimbursement incentives, policies, and technology must evolve together.

Policy and technology must support independence

If simplicity is essential to sustaining independent care, then policy and technology must work together to remove friction rather than reinforce it. 

Today’s models often do the opposite, compensating providers based on the volume of services they deliver alone and disincentivizing the very activities associated with better outcomes, including care coordination, consistent follow-through, and meaningful use of measurement. 

Network rules and reimbursement structures may create roadblocks; but, policy reform must prioritize support for solo and small group practices in their ability to credential, contract under their own practices, and participate in insurance networks without giving up control. Further, we need reform that puts mental health on the same playing field as physical health, making it more viable for independent practices to remain in-network. 

Beyond credentialing and parity, incentives should also be redesigned to actively support collaboration. Integrating physical and mental health is widely recognized as valuable; yet, reimbursement often favors large, corporate-owned models, while excluding independent clinicians from being paid for this essential, collaborative work. If collaboration improves outcomes and reduces downstream costs, payment should support it regardless of practice size. 

Finally, technology also supports independent care through various means, such as AI-assisted documentation and clinical decision support. For these digital tools to become a supportive, human-centered part of treatment though, both policy and reimbursement structures must evolve to support their use. However, real, valid barriers to adoption exist, stemming from clinicians’ rightful concerns about data security, unclear regulations, and whether AI threatens their professional role. Addressing those concerns requires clear guardrails, safe system checks, and practical education. Most clinicians are not looking for novelty; they want trustworthy tools that make their work more sustainable.

A simpler path forward

A healthier mental healthcare system will not be one dominated by large institutions or solo practices alone. There are times when larger systems make a lot of sense, especially for  early-career clinicians who can benefit from mentorship and exposure to diverse populations. But there should be a viable path to independent practice for those who choose it, without making that choice financially unsustainable. 

The capacity to meet the demand for mental health services already exists: Nearly a million licensed professionals providing mental health care in the United States are qualified to deliver care. The question is whether we will build systems that help them stay in practice, or continue to make it harder for them to do so.

Going forward, we can spend the next decade consolidating clinicians into larger organizations. Or, we can invest now in smarter policies, reimbursement models that align with the realities of outpatient care, and better systems that implement technological tools to more efficiently reduce burdens for independent clinicians. Expanding access does not require rebuilding the system from scratch. It requires removing unnecessary complexity so independent clinicians can continue delivering high-quality care at scale.

Photo: pixelliebe, Getty Images

Jonathan Seltzer is the CEO of SimplePractice, the industry-leading EHR and practice management platform built to help solo and group practitioners thrive and retain their independence. Since joining in 2019, Jonathan has held several leadership roles, including Chief Operating Officer and President, before being named CEO in 2024. Under his leadership, SimplePractice has grown to serve more than 250,000 independent practitioners. Prior to SimplePractice, Jonathan served as CFO at CLEAResult and worked in private equity at KRG Capital Partners. An advocate for clinician independence, he believes supporting solo and small practices is essential to expanding access to mental health care.

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